Transcript P malariae

MALARIA
Is a parasitic disease, infections with four human
malarias can present sufficiently similar
symptoms to make species differentiation
generally impossible without laboratory studies.
The early clinical manifestations of malaria ( in the
first few days of illness ) are non-specific and it
resembles in early stages of many other febrile
illnesses due to bacterial, viral or parasitic
causes.
Infectious agents:
Plasmodium falciparum,P. vivax, P.ovale and
P.malariae. Protozone parasites with asexual
and sexual phases that occur in humans and in
mosquito. Most species infections are not
infrequent in endemic areas.
Transmission of Plasmodium from
Mosquito to Human…to Mosquito
P. falciparum
P. vivax
P. ovale
P. malariae
P. knowlsei
Malaria
•It is a disease transmitted by
mosquitoes
•The disease is passed by female
Anopheles mosquitoes that bite at NIGHT
The female Anopheles mosquito bites at night
•The mosquito injects parasites into
the blood which take less than 30
minutes to reach the liver
•Once in the liver parasites develop
until ready to leave and enter the
blood stream where they attack red
blood cells
Malaria interrupts children's social development
depleting Africa’s future human recourses
one bite is enough to give malaria:
one parasite upon entering the liver can
produce around 50,000 daughter cells after 6
days. When the liver cells rupture and release
the daughter cells into the blood they enter red
blood cells, where, after 48 hours a single
daughter cell can produce 8-24 daughter cells
which are in turn released into the blood stream
when the red blood cell ruptures.
.
 Over 80% of the malaria related fatalities in
the world each year are in Africa. The highest
mortality rate is amongst young people.
Malaria is also a disease of the under
nourished, with a poor diet you are less able
to withstand an attack of malaria. With such
high numbers of young deaths many African
countries are losing a significant portion of
their potential workforce
 It affects over 40% of the worlds population
infecting between 300 – 500 million people per
year resulting in over a million deaths worldwide
(>80% in Africa)
 From the time one gets bitten to the time the
symptoms start to appear can take between 7
and 60 days
 There is no vaccination
 TREATMENT IS URGENT! THIS IS AN
EMERGENCY
The incubation period for malaria is approximately 9-14
days for P. Falciparum, 12-18 days for P. vivax and P.
ovale and 18-40 days for P. Malariae.
Some strains of P.vivax, mostly from temporate areas
may have an incubation period 6-12 months, with
infection through blood transfusion, I.P. depend on
the number of parasites infused and are usually short,
but may range up to 2 months.
 There is no liver stage with transfusion transmitted
malaria vivax or ovale ,relapses can not occur.
 There is a brief prodromal period with symptoms of
fever, headache, and myalgia. Symptoms begin
with a cold stage (a shaking chill), following by a
fever stage (40–41°C) that lasts about 24 hours, and
finally a wet stage.
The wet stage occurs several hours after the fever,
when the body temperature drops quickly to normal
and profuse sweating begins. The patient is
exhausted but well until the next cycle of fever
begins.
Other symptoms include
1. myalgias
2. Arthralgias
3. Headache
4. diarrhea,vomiting splenomegaly
5. anemia, thrombocytopenia often develop after a
few days.
Sever malaria if no treatment or delay treatment:
Acute encephalopathy
Sever anemia
Icterus
Renal failure
Hypoglycemia
Res. Distress lactic acidosis
More rarely :coagulation defect and shock
Period of communicability:
Human may infect mosquito as long as infective
gametocytes are present in the blood this varies
with parasite species and with response to therapy.
Untreated or insufficiently treated patient may be a
source of mosquito infection for several years in
malariae, up to 5 years in vivax, and generally not
more than one year in falciparum.
Transfusional transmission as long as asexual form
remain in circulating blood( with p. malariae, up to
40 years or longer)
Three basic types of malaria
1. Benign tertian (P vivax and P ovale) with a fever
every 2nd day (e.g., Monday; fever, Tuesday; no
fever, Wednesday; fever).
2. Benign quartan (P malariae) with a fever every 3rd
day (e.g., Monday; fever, Tuesday; no fever,
Wednesday; no fever, Thursday; fever).
 3. Malignant tertian (P falciparum), in which the
cold stage is less pronounced and the fever stage is
more prolonged and intensified (if the fever is
recurring it occurs every 2nd day).
 However, the fever is usually continuous or only
briefly remittent. There is no wet stage. This type of
malaria is more dangerous because of the
complications caused by capillary blockage (i.e.,
convulsion, coma, acute pulmonary insufficiency,
and cardiac failure).
Large numbers of erythrocytes are parasitized and
destroyed, which may result in dark-colored urine
(blackwater fever; intravascular hemolysis,
hemoglobinuria, and kidney failure.).
Two species of Plasmodium, P vivax and P ovale, can
remain in the liver, if not treated properly. The
organisms leave the liver and re-infect erythrocytes,
causing the symptoms described above. Relapsing
malaria occurs when there are relapses many years
after the initial episode of malarial disease.
 GLOBAL AND REGIONAL RISK
Approximately, 40% of the world’s population, mostly
those living in the world’s poorest countries, are at
risk of malaria. Every year, more than 500 million
people become severely ill with malaria. Most cases
and deaths are in sub-Saharan Africa. However,
Asia, Latin America, the Middle East and parts of
Europe are also affected
Malaria’s Impact
In areas with high transmission, the most vulnerable
groups are young children, who have not developed
immunity to malaria yet, and pregnant women,
whose immunity has been decreased by
pregnancy. The costs of malaria – to individuals,
families, communities, nations – are enormous.
Where malaria exacts the largest burden, Africa, it has
been extremely difficult to control.
Many reasons account for this:
1. an efficient mosquito that transmits the infection.
2. a high prevalence of the most deadly species of the
parasite.
3. favorable climate.
4.weak infrastructure to address the disease.
5. high intervention costs that are difficult to bear in
poor countries.
 Reservoir:
Humans are the only important reservoir of human
malaria , except as regards P.malariae , which is
common to man , African apes and probably
some South American monkeys
Malaria – Symptoms
There are no specific symptoms for malaria. The main
symptoms of malaria are often mistaken for those of
flu (the common cold). They can include any of the
following:
• fever
• chills
• headache
• fatigue
• weakness
aches and pains
abdominal pain
diarrhoea
vomiting
If any of these symptoms and live in a malaria
country or have visited a malaria country within
the last 8 weeks:
•
• seek medical advice
• Do not lose time
Until prove otherwise, assume any of these
symptoms are symptoms of malaria
 How is malaria diagnosed?
1- Clinical symptoms, when associated with travel to
countries that have identified malarial risk, suggest
malaria as a diagnosis , live in malaria-endemic
area, receive blood products tissues or organs.
2-antigen detection test
3- The classic and most used test is the blood smear on
a microscope slide that is stained (Giemsa stain) to
show the parasites inside red blood cells
4- RDT's (rapid diagnostic tests) approved for use in
the U.S. in 2007 and the polymerase chain reaction
(PCR) tests. These are not yet widely available and
are more expensive
Preventive measures:
1. Local community measures in endemic areas:
*insecticide-treated mosquito nets.
*Indoor residual spraying with insecticides
*Control of larval stages by elimination of
mosquito breeding sites: by filling and draining
or by increasing the speed of water flow in a
natural or artificial channels
Malaria Prevention is based on……
If you are a visitor to or an employee in a high risk
country, your safety is based on two lines of defense…
1. Insect Bite Prevention
2. Preventative Anti-Malarial Medication
OFS-QHSE-MALARIA-Level 2-2
Rev. Date: 10 Jul 2006
Malaria - Mosquito control: 6 Building
Blocks
STAGE 1
Personal Protection
Source Reduction
Deny the blood meal
Deny breeding grounds
Female mosquitoes
develop eggs, fed by
human blood
Actions
1
STAGE 2
2
Actions
Close windows and doors to prevent
entry; Protect humans against
mosquito bites by using bednets
(insecticide treated) and repellants
Prevent water logging,
destroy unwanted water
collections, keep
water containers closed
Bite Prevention
Prevent Entry
Adult female
mosquitoes bite
human beings at
night, maximum at
10pm-4am
Actions
STAGE 6
Mosquitoes
bite
humans
6
Personal protection by covering
the body with clothes; use of
mosquito nets and repellents
STAGE 5
Adult
mosquitoes
enter human
dwellings
between 5-10
pm and early
morning,
hide
Actions
in dark corners
Close the doors and windows at
that time; clear hiding places if
possible
5
STAGE 3
Chemical/Biological
Eggs hatch and
develop into larvae
and pupae in a
week
Eggs laid on
standing water
Actions
Larvicides
3
Kill the larvae with
larvicidal agents
Insecticides
STAGE 4
Adult
mosquitoes
can live up
to 4-10
weeks or
Actions
more
Kill the adults with space sprays
(for instant kill) and residual
sprays (for lasting effect)
4
Malaria – Insect bite prevention: 6 Top Tips
1. Bed Nets
2. Chemical Diffusers
Ensure chemically treated
nets are fitted above each bed
and that the nets are used and
retreated every 6 - 12 months
Use electro-chemical diffusers in
your house/rooms. Tabs give 10
hours of bite protection, while
liquid insecticide bottles give 21
days
3. Insect repellent
4. Air Conditioners
Make sure you carry in your
hand luggage and apply
before arrival in Geomarket.
Carry in your pocket when
going out for the night
Mosquitoes avoid cold places.
The P. falciparum parasite
cannot develop inside
mosquitoes if the temperature is
below 20°C
5. Mosquito coils
Use if socialising outside,
burn coils where people are
gathering
6. Insect spray
Make sure you spray your
accommodation regularly
Malaria – Insect bite prevention
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INDOORS – CHECKLIST
Windows and doors are kept closed
Doors and windows are fitted with screens and regularly checked for holes
Where available air conditioning is working and on cold (preferably ≤ 20ºC)
At night electric diffusers are plugged in and working, particularly in bedrooms
On verandas coils are burned
Accommodation is regularly sprayed with insecticide
Chemically treated bed net is provided and regularly checked for holes and
used correctly (tucked under the mattress all around the bed)
OUTDOORS - CHECKLIST
Long sleeve shirts are worn
Long trousers are worn at all times
Always wear socks outside at night
Before going outdoors apply repellent to uncovered parts of the body
Stay indoors at night whenever possible
OFS-QHSE-MALARIA-Level 2-2
Rev. Date: 10 Jul 2006
Malaria – Preventative medication
In company designated high malaria risk countries,
use of preventative medication is highly recommended
especially for visitors who are particularly susceptible.
Preventative medicine works by preventing the malaria
parasite from growing in the liver.
Take as preventative medication one of the
following medicines:
• 1 tablet/day of Malarone®
• 1 tablet/WEEK of Lariam® (Mefloquine) 250 mg
• 1 tablet/day of Doxycycline 100mg
• 1 tablet/day of Savarine®
 All medication needs to be taken
REGULARLY during the entire stay in a
malaria country and for 4 weeks after leaving
a malaria country except for Malarone which
needs to be taken for only 7 days after
leaving a malaria country.
 The risk of side effects exists with all
medications but is small and reversible
when medication is stopped. The risk of side
effects is always smaller than the risk of
malaria which is….. DEATH !
 4- Pregnant women are at high risk of malaria. *Nonimmune pregnant women risk both acute and severe
clinical disease, resulting in up to 60% fetal loss and
over 10% maternal deaths, including 50% mortality for
severe disease.
 *Semi-immune pregnant women with malaria
infection risk severe anaemia and impaired fetal
growth, even if they show no signs of acute clinical
disease.
 An estimated 10 000 of these women and 200 000 of
their infants die annually as a result of malaria infection
during pregnancy.
 Intermittent preventive treatment with a full
curative dose of an effective antimalarial at
predefined intervals durig the 2nd and 3rd
trimester of pregnancy is highly effective in
reducing malaria burden in pregnant women in
areas of stable, moderate to intense P.
falciparum transmission. ( promoted in Africa),
but is of limited value in other parts of the world
where transmission often unstable or of low
intensity.
 WHO recommends that all endemic countries
provide a package of interventions for prevention
and management of malaria in pregnancy,
consisting of (1) diagnosis and treatment for all
episodes of clinical disease and anaemia and (2)
insecticide-treated nets for night-time prevention of
mosquito bites and infection. In highly endemic
falciparum malaria areas, this should be
complemented by (3) intermittent preventive
treatment with sulfadoxine–pyrimethamine to clear
the placenta periodically of parasites.
5. in epidemic prone areas ,malaria surveillance
should be based on weekly reporting
 How do we keep from getting malaria?
CDC recommendations suggest individuals begin
taking antimalarial drugs about one to two weeks
before traveling to a malaria infested area and for
four weeks after leaving the area. Currently, there is
no vaccine available for malaria, but researchers are
trying to develop one
Malaria – Conclusion
•The risk is highest after leaving a high risk country
or when working in a remote location/rig
•THIS IS AN EMERGENCY!
•Falciparum Malaria is fatal if not treated
rapidly!!!
•Take preventive medication regularly
•If you suspect malaria – take Coartem ® /
Riamet ® for 3 days and use your Curative
Kit to perform a malaria test for
confirmation of the diagnosis. Even if the 3
tests remains negative continue the
Coartem ® or Riamet ® treatment for 3
days (4 tablets morning and evening)
•Malaria can be prevented and treated
 Previously, Iraq was considered as one of the
important foci of malarial disease, the available
reports denoted to that the number of infections
were reached 1 million per year in the early 1950.
But, after approving plan of eradication of disease
at beginning of 1957, then plan of control, Iraq has
achieved a dramatic reduction in the number of
malaria cases to less than 4000 cases per year by
the 1990.
Then, the plan of control of disease changes from
control to final elimination of local transmission of
malaria at the end of 2010.
The most malarial species that caused infection in Iraq
is the Plasmodium vivax.
Malaria is a nationally notifiable disease; clinicians and
health-care facilities are mandated by legislation or
state and local regulations to report cases to their
state health department State and local health
departments and CDC investigate malaria cases