Malaria

Rennie Puspa N, M.Farm.Klin.,Apt

What Is malaria?
A mosquito-borne infectious disease caused by

Protozoan parasites of the genus Plasmodium Transmitted only by Anopheles Mosquitoes (>60 species!)

What is Malaria?
Malaria is a parasite that enters the blood. This parasite is a protozoan called plasmodium.

3 to 700 million people get malaria each year, but

only kills 1 to 2 million 40% of the worlds population lives in malaria zones Malaria zones are: Africa, India, Middle East, Southeast Asia, Central and South America, Eastern Europe, and the South Pacific

Symptoms and Transmission

Female Anopheles mosquito carries parasite

and transmits it to humans. Affects red blood cells Not highly contagious, however, as it affects blood cells it is possible to receive the parasite through unclean needles. Can pass through a placenta to a fetus. Symptoms: chills, fever, headache, anemia, muscle pain, nausea, sweating and vomiting.

Acute Symptoms
Classical features include cyclic symptoms
Cold stage: chills and shaking Hot stage:

fever, headache, vomiting, seizures in

children
Sweating stage: weakness Feel well for period of time, then cycle repeats itself

Types of Malaria
Falciparum: Almost 80% of cases and 90% of

malaria deaths. Primarily found in South America and Africa. Ovale: Rarest form. Found in West Africa. Can be up to four years before and symptoms occur. Malariae: Can infect other mammals. Found in Africa and SE Asia. Vivax: 20% of infections. Widest geographic distribution.

Each disease has a distinct course

Tertian Malaria (P.falciparum, P.ovale and P.vivax) fever occurs every third day. Quartan Malaria (P. malariae) fever occurs every fourth day.
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Each disease has a distinct course

P.ovale and P.vivax can cause chronic malaria, reappearing after months or years due to latent parasites in liver

How Malaria Affects You

When malaria enters the blood, the parasites

go to the liver, where they reproduce. After they infect the liver, they transform, and go for red blood cells. The more the parasite breaks out of blood cells, the sicker a person gets. This is when symptoms occur. The period when malaria is in the liver is called the dormant phase. Falciparum malaria is the most dangerous type of malaria, because it makes red blood cells stick to veins, clogging them.

Diagram of Malaria Infection

Infection is by mosquito bite

Infects liver, then blood cells

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Malaria damages the body in a number of ways

Red blood cell destruction -> anemia
Waves of parasites bursting red blood cells

Lead to classic cycles of fever and chills Changes adhesive properties of infected Red blood cells -> blocking blood vessels leading to Tissue hypoxia

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Malaria damages the body in a number of ways

If this happens in brain it is cerebral malaria

which is often fatal.

Blocking blood vessels can also cause kidney failure
In severe cases 20% of patients can die,

even with the best care

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Treatment and Prevention

Different medicine is needed for different types of

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malaria. Important to know where the malarial zones Important to know where malaria was picked up: malaria from Africa might be resistant to medicine that malaria from South America is not. Primaquine is the standard medicine for malaria in the liver Chloroquine is medicine for malaria in blood. Some types of malaria are chloroquine resistant, so quinine is used. Use bug spray and mosquito nets to avoid being bitten. Prophylaxis (prevention) and Malarone are used to

Malaria adalah penyakit protozoa yang paling serius. Malaria disebabkan oleh empat spesies protozoa, yaitu: Plasmodium falciparum Plasmodium vivax Plasmodium malariae Plasmodium ovale (jarang) Tetapi pada P.falciparum yang resisten obat merupakan masalah yang semakin mendekat di banyak bagian dunia.
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Nyamuk menyebarkan parasit ke manusia di daerah tropis dan subtropis. Orang yang berpergian ke daerah endemik malaria mempunyai resiko terinfeksi. Resiko dapat sangat dikurangi dengan menggunakan obat-obat antimalaria,yaitu: Schizontisid Darah (obat yang bekerja pada parasit darah) a. Kerja Lambat : Proguanil Primetamin b. Kerja Cepat : Cholroquine Mefloquine Atovaquon Quinine Schizontisid Jaringan (mengeliminasi bentuk yang sedang berkembang dan juga dormant dalam sel hati) Primaquine
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Mefloquine Kerja : Schizontosidal Kegunaan klinis : P.falciparum yang resisten Chloroquinine Resistensi : Aktif melawan strain yang resisten multiobat dengan dosis tunggal Efek yang Tidak Diinginkan : Ditoleransi baik, bradikardi sinus ringan, neuropsikiatrik Farmakokinetik : Per oral. Diabsorpsi dan dieliminasi lambat. Waktu paruh = 4 hari 16

Chloroquine Kerja : Plasmosidal Kegunaan klinis : Profilaksis atau serangan akut. Bentuk eritrosit dari P.falciparum dan P. vivax Resistensi : Resistensi luas dengan melanisme yang tak diketahui Efek yang tidak diinginkan : Pusing, sakit kepala, akomodasi, retina mata sapi, hemolisis pada pasien defisiensi G6PD Farmakokinetik : Per oral, Intramuskular. Dosis muatan 2x dosis rumatan. Waktu paruh = 4 hari
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Primaquine Mekanisme : Mekanisme tidak jelas. Mungkin melibatkan ikatan silang glutation Kegunaan klinis : Malaria vivax resisten Chloroquine. Lebih aktif melawan stadium hati dibandingkan bentuk eritrosit malaria Resistensi : Resistensi sedikit terhadap obat oleh P.vivax Efek yang Tidak Diinginkan : Mual, muntah, depresi sum-sum tulang dan anemia hemolitik (hemolisis pada pasien defisiensi G6PD)
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History and Future Research

One of the oldest known diseases. King Tut died of malaria. Malaria has been infecting humans for over 50,000 years. References to malaria have been recorded for nearly 6000

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years, starting in China. Used to be common in Europe and North America. First advances in malaria were made in 1880 by a French army doctor named Charles Laveran. He looked into infected red blood cells and discovered the parasite was a protist. This was the first time a protist was discovered to cause a disease. Carlos Finlay discovered that mosquitoes transmitted diseases. Ronald Ross discovered that mosquitoes transmitted malaria in 1898. First effective medicine was discovered by Pierre Pelletier and Joseph Caventou. This medicine is called quinine, which comes from the bark of cinchona trees in Peru. No effective vaccine: only immunity is a result of multiple

Age
No age limit

Pregnant women and children are most likely to

get it. People from non-malaria zones are at much higher risk than natives when they are in malaria zones.

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Chart: Malaria Cases per 100,000 people.

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Source: United Nations Development Program

Diagram: Malaria Zones

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Source: United Nations Development Program