MALARIA

Description ➢ Derived from Italian word Mal’ aria or bad air

➢ It is a life-threatening disease caused by parasites that are transmitted
to people through the bites of infected female Anopheles
mosquitoes.
➢ Malaria is a potentially fatal condition caused by infection of RBCs
with protozoan parasites of the genus Plasmodium.
➢ There are 5 parasite species that cause malaria in humans:
1. P. vivax - Benign Tertian Malaria
2. P. ovale - Benign Tertian Malaria (Has periodicity and relapse
similar to P. vivax but is milder and can be cured)
3. P. malariae - Quartan Malaria
4. P. falcifarum - Malignant Tertian Malaria
5. P. knowlesi - Quotidian malaria
- The fifth species of Plasmodium causing malaria in
humans.

Epidemiology ➢ In 2020, there were an estimated 241 million cases of malaria

worldwide.
➢ Estimated number of malaria deaths stood at 627 000 in 2020.
➢ The WHO African Region carries a disproportionately high share of
the global malaria burden. In 2020, the region was home to 95% of
malaria cases and 96% of malaria deaths. Children under 5
accounted for about 80% of all malaria deaths in the Region.
➢ The Philippines has significantly reduced the incidence of malaria by
87 percent – from 48,569 in 2003 to 6,120 cases in 2020 – and has
also reported a 98 percent reduction in the number of mortality due to
malaria (from 162 deaths in 2003 to 3 deaths in 2020).
➢ At the end of 2020, only 126 villages from two provinces Palawan &
Mindanao island (Sulu, Occidental Mindoro, and Sultan Kudarat) have recorded
local malaria transmission.
➢ DOH said the WHO aims to declare the Philippines malaria-free
by 2030.

Pathogenesis Individual is bitten by infected mosquitos, the clinical outcome may be:
1. No infection
2. Asymptomatic parasitemia
3. Uncomplicated malaria
4. Severe malaria
The malaria life cycle is a complex system with both sexual and asexual
aspects. The cycle of all species that infect humans is basically the same.
Exogenous sexual phase in the mosquito called sporogony during which the
parasite multiplies. There is also an endogenous asexual phase that takes
place in the vertebrate or human host called schizogeny

Sporozoites infect liver cells

and mature into schizonts
which rupture and release merozoites
(Of note, in P. vivax and P. ovale a dormant stage [hypnozoites] can
persist in the liver (if untreated) and cause relapses by invading the
bloodstream weeks, or even years later.) After this initial replication in the
liver (exo-erythrocytic schizogony ), the parasites undergo asexual
multiplication in the erythrocytes (erythrocytic schizogony ). Merozoites
infect red blood cells
The ring stage trophozoites mature into schizonts, which rupture releasing
merozoites
Some parasites differentiate into sexual erythrocytic stages (gametocytes)
Blood stage parasites are responsible for the clinical manifestations of the
disease. The gametocytes, male (microgametocytes) and female
(macrogametocytes), are ingested by an Anopheles mosquito during a blood
meal
 The parasites’ multiplication in the mosquito is known as the sporogonic
cycle . While in the mosquito’s stomach, the microgametes penetrate the
macrogametes generating zygotes
The zygotes in turn become motile and elongated (ookinetes)
which invade the midgut wall of the mosquito where they develop into
oocysts
The oocysts grow, rupture, and release sporozoites
which make their way to the mosquito’s salivary glands. Inoculation of the
sporozoites
into a new human host perpetuates the malaria life cycle.

Pathogenesis
Clinical Incubation period of Plasmodium:
manifestations 1. P. vivax - 12-18 days
2. P. ovale - 12-18 days
3. P. malariae - 18-40 days
4. P. falcifarum - 9-14 days
5. P. knowlesi - 9-12 days

Malarial paroxysm
1. Stage 1 aka COLD STAGE
a. Chills for 15m to 1 hour
b. Caused due to rupture from the host red cells
 c. Accompanied with Nausea vomiting, headache
2. Stage 2 aka HOT STAGE
a. 2-6 hour hot stage
b. Fever reaching up to 40 degree celsius that last for several
hours
c. Starts invading newer red cells
3. Stage 3 aka SWEAT STAGE
a. Patient starts sweating, concludes the episode
b. Cycles are frequent asynchronous paroxysms occur every
48-72 hours

More commonly, patient presents with a combination of the following

symptoms:
➢ Fever
➢ Chills
➢ Sweats
➢ Headaches
➢ Nausea and vomiting
➢ Body aches
➢ General malaise

P. falciparum can produce fatal complications:

1. Cerebral malaria
2. Malarial hypepyrexia
3. 3. Gastrointestinal disorders
4. Algid malaria (SHOCK)
5. Black water fever leading to death

Diagnostics 1. Thick & thin blood smear - Gold standard for malaria testing

a. Thick smear
i. Drop of blood on a glass slide.
ii. May see malaria pigment within WBCs
iii. Useful for detecting the presence of parasites
iv. Sensitive
*Sensitivity: the ability of a test to rule out a disease (For screening to reduce
false negative)

b. Thin smear
i. Drop of blood that is spread across a large area of the
slide.
ii. View after thick smear
iii. Useful for parasite identification
iv. Specific
* Specificity: the ability of a test to rule in a disease (For Confirmatory to
reduce false positive)

*The gold standard test, when compared with other options, is most
likely to correctly identify people with the disease (it is specific), and
correctly identify those who do not have the disease (it is sensitive)

2. Rapid Antigen Test

a. Test kits that detect antigens derived from malaria parasites
b. based on the detection of P. falciparum histidine-rich protein II
(HRP2) and Plasmodium vivax-specific LDH test for P. vivax
detection and the pan-malaria-specific pLDH test for the
detection of P. falciparum, P. vivax, P.ovale or P. malariae.
c. Differentiate the following:
3. Molecular-Based Test (PCR)
a. More accurate but expensive and requires a specialized
 laboratory.
b. for detection and speciation of malarial parasites and are
especially helpful in cases of:
● Mixed infections,
● Low parasitemia, and
● Infection with P. knowlesi.

Treatment