Transcript Malaria - Department of Community Medicine ACME Pariyaram

Dr Aslesh OP
MBBS, MD
Assistant professor, community medicine
Pariyaram Medical College
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History
Burden
Agent
vector
Epidemiology
Clinical features
control
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Ancient references
China, Assyria, India
 500 BC Hippocrates gives first clinical description
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Ancient references
 China, Assyria, India
 500 BC Hippocrates gives first clinical description
Historical Impacts
413 BC Fall of Greek empire
 323 BC Alexander the Great died of malaria
 The Roman Empire: Malaria is generally
considered to have played a role in the decline of
Rome, a city located in marshland, where malaria is
transmitted
 In world war 2, more people died due to malaria
than in war
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Globally 150 to 300 million cases annually
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81% in African region
13% South east Asian region
5% eastern Mediterranean
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In India 27% of
the population
live in malaria
high
transmission
area
58% in low
transmission
area
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Plasmodium –4 species
P falciparum
 P vivax
 P ovale
 P malaria
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Only human reservoir
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Age
Sex
Genetic- sickle cell anemia, duffy negative
blood type
Low socio economic status
Poor housing standards
Migration
Occupation- agriculture
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Season-Rainy season
Temperature – 16-30 degree
High humidity- above 60%
Altitude- less than 2500 metes
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Length of time between infective mosquito bite
and first appearance of fever
P Falciparum malaria- 12 days
 P Vivax -14 days
 P malaria- 28 days
 P ovale -17 days
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Typical fever- 3 stages
Cold stage
Chills and rigor
 Last for 1/4th to 1 hour
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Hot stage
Hot and dry
 Last for 2-6 hour
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Sweating stage
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Fever comes down with
profuse sweating
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Cerebral malaria
Renal failure
Liver damage
Dehydration
Anemia
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Microscopy-Blood smear examination for
parasite
Serological test- fluorescent antibody test
Rapid diagnostic test
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For falciparum
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Artisunate combination therapy
For vivax
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Chloroquine along with primaquine
Habitat
Behavior
Infected
People
contact
Mosquitoes
contact
Source of
Plasmodium
Uninfected
People
Source of
New Hosts
Climate
Habitat
Food
Habitat
Behavior
Infected
People
contact
Mosquitoes
contact
Source of
Plasmodium
Uninfected
People
Source of
New Hosts
Climate
Habitat
Food
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Destroy habitat
Insecticides
Biological control
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Rapid Reproduction
Natural selection
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Drug treatment
Transgenic mosquitoes
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Drug treatment
Transgenic mosquitoes
Why don’t these work?
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Drug treatment
Transgenic mosquitoes
Why don’t these work?
 Availability of drugs
 Money
 Medical staff
Recrudescense
 Drug resistance
 Reservoir hosts?
 Transgenic mosquitoes not a reality
 Expensive
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Vaccines
Prophylactic drugs
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Vaccines
Prophylactic drugs
Why don’t these work?
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Vaccines
Prophylactic drugs
Why don’t these work?
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Vaccines unsuccessful
Prophylactic drugs expensive
Prophylactic drugs unpleasant
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Insecticides
Mosquito nets
Long clothing
Behavior
Avoid mosquito
habitat
Screens on houses
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Insecticides
Mosquito nets
Long clothing
Behavior
Avoid mosquito
habitat
Screens on houses
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Why don’t these
work?
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Insecticides
Mosquito nets
Long clothing
Behavior
Avoid mosquito
habitat
Screens on houses
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Why don’t these
work?
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Money
Availability of
materials
Human behavior
difficult to change
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Dengue
Chikenguniya
Filariasis
Japanese encephalitis
Dengue fever
Chikunguniya
Yellow fever in
African countries
Culex mosquito
Filarial scrotum
Filarial leg
120 millions in 73 countries
SEAR countries 31 millions clinical cases, 60 millions mf carriers
India 45 prevalence millions , incidence 6 millions per year
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Observe dry day once a week