Agent factor

Plasmodium Vivax - benign Tertian Malaria Plasmodium Malariae - quartan Malaria Plasmodium Falcifarum malignant Tertian Cause the mildestform

Plasmodium Ovale - ovale Malaria

Plasmodium knowlesi

Cause the severest and most deadly form

Causes malaria in macaques but can also infect humans

EPIDEMIOLOGY

EPIDEMIOLOGY
World wide 100 countries are considered malarious half of which are in Sub-Saharan Africa. Incidence of malaria is 300-500 million cases every year 90 % of these are in Africa & mostly caused by P. falciparum. Malaria epidemics kill more than 1.1-2.7 million people each year & of whom 1 million are children under 5 years of age. An estimated 2700 deaths per day, or 2 deaths per minute.

Reasons for global spread

Female Anopheles mosquito spreads the parasite to people very fast and discreetly. Drugs currently used to combat the disease are becoming ineffective. Mosquitoes developing resistance to pesticides. Mass migration - social and political oppression means that infected people spread Malaria easily to many new people

MODE OF TRANSMISSION
VECTOR TRANSMISSION

DIRECT TRANSMISSION

by bite of an infected female anopheles mosquito accidental hypodermic intramuscular & intravenous injections of blood or plasma Infection of newborn from an infected mother

CONGENITAL MALARIA

Female mosquitoes have hypodermic mouthparts which enable them to pierce the skin and suck the blood of mammals, birds, reptiles, and other arthropods.

Life Cycle of the Malaria Parasite

(A) Mosquito infected with the malaria parasite bites human, passing cells called Sporozoites into the humans bloodstream.

(MORE EXPLANATIONS)

(F) Another mosquito, bites the infected human, ingesting the gametocytes.

(B) Sporozoites travel to the liver. Each sporozoite undergoes asexual reproduction, in which its nucleus splits to form two new cells, called Merozoites.

(E) Some merozoites develop into sex cells known as male and female gametocytes.

(C) Merozoites enter the bloodstream and infect red blood cells.

(D) In red blood cells, merozoites grow and divide to produce more merozoites, eventually causing the red blood cells to rupture. Some of the newly released merozoites go on to infect other red blood cells.

(G) In the mosquitos stomach, the gametocytes mature. Male and female gametocytes undergo sexual reproduction, uniting to form a Zygote. The zygote multiplies to form Sporozoites, which travel to the mosquitos salivary glands.

(H) If this mosquito bites another human, the cycle begins again.

P. vivax and P. ovale hypnozoites remain dormant for months They develop and undergoe preerythrocytic sporogeny The schizonts rupture, releasing merozoites and produce clinical relapse

 Recrudescence

Relapse

exacerbation of persistent undetectable parasitemia, due to survival of erythrocytic forms, no exoerythrocytic cycle (P.f., P.m.) reactivation of hypnozoites forms of parasite in liver, separate from previous infection with same species (P.v. and P.o.) exo-erythrocytic forms infect erythrocytes, separate from previous infection (all species)

Recurrence or reinfection

Can not always differentiate recrudescence from reinfection

A microscopic image shows parasites of the genus Plasmodium

HOST FACTORS
AGE : all ages susceptible. GENDER: males more at risk RACE: Europeans more susceptible to benign tertian malaria than Africans. SOCIO-ECONOMIC DEVELOPMENT: malaria has disappeared from most developed countries. HOUSING: ill-ventilated & ill-lighted houses ideal resting places for mosquitoes

Red cell polymorphisms associated with some protection

Red cell membrane changes

Hemoglobin S sickle cell trait or disease Hemoglobin C and hemoglobin E Thalessemia and Glucose 6 phosphate dehydrogenase deficiency (G6PD) Absence of certain Duffy coat antigens improves resistance to P.v.