Prepared by: Narcisa Cupahan

An acute and chronic parasitic infectious disease

transmitted by the bite of infected mosquito and is confined mainly to tropical and subtropical areas. Causes more disability and a havier economic burden than in any parasitic disease.
Other name: ague,marsh fever, periodic fever,paludism, black water fever

 Each year Malaria causes 200-300 million cases

It kills over 1 million people every year

It is causes by a parasite called plasmodium (4 types) It is spread by the anopheles mosquito (72 types)

Protozoa of genus plasmodia 1. The disease is caused by four species of protozoa: a. Plasmodium falciparum (malignant tertian) This is considered as the most serious malarial infection because of the development of high parasitic densities in blood (RBC) with tendency to agglutinate and form into microemboli. This is most common in the Philippines.

This is nonlife threatening except for the very young and the old. It is manifested by chills every 48 hours on the 3rd day onward especially if untreated.

It is less frequently seen. This specie is nonlife threatening. Fever and chills usually occur every 72 hours usually on the 4th day after onset.

This is rarely seen in the Philippines.

a. It breeds in clear, flowing, and shaded streams usually in the mountains. b. It is bigger in size than the ordinary mosquito. c. It is brown in color. d. It is a night-biting mosquito. e. It usually does not bite a person in motion. f. It assumes a 36 position when it alights on walls, trees, curtains, and the like.

 12 days for P. Falciparum

14 days for P. vivax and ovale

30 days for P. malariae

 Untreated or insufficiently treated patient may be the

source of mosquito infection for more than three years in P. malariae, one to two years in P. vivax, and not more than one year on P. falciparum.

 The disease is transmitted mechanically through the

bite of an infected female anopheles mosquito It can be transmitted parenterally through blood transfusion. On rare occasions, it is transmitted from shared contaminated needles. However, transplacental transmission of congenital malaria is a rare case.

 Paroxysms with shaking chills (Pathognomonic

sign) Rapidly rising fever with severe headache Profuse sweating Myalgia, with feeling of well-being in between Splenomegally, hepatomegally Orthostatic hypotension Paroxysms may last for 12 hours, then, maybe repeated daily or after a day or two.

 In children:
Fever maybe continuous
Convulsions and gastrointestinal symptoms are

prominent Splenomegally
In cerebral malaria
Changes in sensorium, severe headache, and vomiting Jacksonian or grand mal seizure may occur

 Nephritis (due to P. Malaria)

Albuminuria
Hematuria Black fever (P. falciparum)

 Increased serum indirect bilirubin and other evidence

of hemolysis. Identification of organism is made in thin or thick smears of peripheral blood or bone marrow. Indirect flourescent antibody test (for IgG) shows high sensitivity (99%)

 Anemia

Bone marrow shows erythroid hyperplasmae

decraesed WBC Presence of protien and leukocytes in urine sediments Increased monocytes in peripheral blood Serum globulin increased ESR increased

 Blackwater fever (massive intravascular hemolysis)

Reduced # of platelets (20,000-50,000/mm3)

Prolonged partial thromboplastin time (60-100 sec) Decreased plasma fibrinogen

Prolonged prothrombin time(18-20 sec.)

 Liver

-Vary from congestion of fatty changes to malarial hepatitis -Increased in SGOT, SGPT and alkaline phosphates Gallbladder -Pigment stones Cerebral anemia

 Eliminate Anopheline mosquito vectors

Eliminate/drain areas of impounded water that serves

as anopheline breeding habitats Spray screened living and sleeping quarters with liquid or aerosol preparations Screen rooms and use bed nets.

 Use insect repellant lotions

Most effective available repellant is di-ethyl tolumide.

Screen blood donors for a history of malaria or

possible exposure to disease. Prompt and effective treatment of the disease.

Give anti-malarial drugs:

Chloroquine (all species except for P. Malariae) Quinacrine

Chloroguanide
Sulfadoxine for resistant P. Falciparum Primaquine for relapses of P. Vivax and ovale

Erythrocyte exchange transfusion for rapid reduction

of high levels of parasites in the blood.

 Close monitoring of patient.

Strict monitoring of input and output (to prevent

pulmonary edema and evaluate renal failure) Daily monitoring of patients serum quinine, bilirubin, BUN concentrations, parasite count and packed RBC. If the patient exhibits respiratory or renal symptoms, determine arterial blood gas and plasma electrolytes.

 If case is severe falciparum malaria consider it as a

medical emergency.
Administer oxygen if needed because of tissue anoxia. Watch for abnormal bleeding such as: o Passage of flesh blood in the stool o Oozing of blood from venipuncture site o Nose bleeding

 During the febrile stage, tepid sponges, alcohol rubs, and

ice cap on the head will help bring the temperature down. Application of external heat and offering hot drinks during chilling stage is helpful. Provide comfort and psychological support. Encourage the patient to take plenty of fluids. As the temperature falls and sweating begins, warm sponge bath maybe given. The bed and clothing should be kept dry.

 Administer IV guinine as ordered.

Watch for neurologic toxicity from quinine infusion

such as:
o Twitching o Delirium o Confusion o Convulsion

o Coma.

 Evaluate the degree of anemia.

Watch for any signs especially abnormal bleeding.

Consider severe malaria as medical emergency that

requires close monitoring of vital signs.

Malarial smear In this procedure, a film of blood is placed on a slide, stained, and examined microscopically. 2. Rapid diagnostic test (RDT) This is a blood test for malaria that can be conducted outside the laboratory and in the field. It gives a result within 10 to 15 minutes. This is done to detect malarial parasite antigen in the blood.
1.

Anti-Malarial Drugs Artemether-lumefantrine (Therapy only, commercial names Coartem and Riamet) Artesunate-amodiaquine (Therapy only) Artesunate-mefloquine (Therapy only) Artesunate-Sulfadoxine/pyrimethamine (Therapy only) Atovaquone-proguanil, trade name Malarone (Therapy and prophylaxis) Quinine (Therapy only)

 Chloroquine (Therapy and prophylaxis; usefulness

now reduced due to resistance) Cotrifazid (Therapy and prophylaxis) Doxycycline (Therapy and prophylaxis) Mefloquine, trade name Lariam (Therapy and prophylaxis) Primaquine (Therapy in P. vivax and P. ovale only; not for prophylaxis) Proguanil (Prophylaxis only) Sulfadoxine-pyrimethamine (Therapy; prophylaxis for semi-immune pregnant women in endemic countries as Intermittent Preventive Treatment IPT) Hydroxychloroquine, trade name Plaquenil (Therapy and prophylaxis)

 Malaria cases should be reported.

A thorough screening of all infected persons from

mosquitoes is important. Mosquito breeding places must be destroyed. Homes should be sprayed with effective insecticides which have residual actions on the walls.

 Mosquito nets should be used especially when in

infected areas. Insect repellents must be applied to the exposed portion of the body. People living in malaria-infested areas should not donate blood for at least three years. Blood donors should be properly screened.

THANK YOU AND GOD BLESS!!!