MALARIA

By DR. Maeen Gamal AL-Hadhrami

❖ Defination:
➢ is an acute potentially life-threatening parasitic disease
caused by infection with Plasmodium protozoa transmitted
to people through the bites of infective female
Anopheles mosquito.
➢ About 3.2 billion people almost half of the world’s
population –are at risk of malaria.
➢ Young children, pregnant women and non-immune travelers
from malaria-free areas are particularly vulnerable to the
disease when they become infected.
❖ Etiology:
➢ It is caused by 4 human species:
1- Plasmodium falciparum: malignant malaria (periodicity every
24 hrs i.e. every day).
2- Plasmodium vivax & ovale: benign tertian malaria (periodicity
every 48 hrs i.e. every third day).
3- Plasmodium malaria: quartan malaria
(periodicity every 72 hours i.e. every
fourth day).
❖ Transmission:
➢ Malaria is transmitted by the bite of an
infective female Anopheles mosquito.
➢ Because the malaria parasite is found
in red blood cells of an infected
person, malaria can also be transmitted
through: blood transfusion, organ
transplantation and shared use of needles or syringes contaminated with
blood.
➢ Malaria may also be transmitted from a mother to her baby before or during
delivery ("congenital" malaria).

1
❖ Life cycle of malaria:

❖ Clinical picture:
1- Tertian malaria (plasmodium ovale or Vivax):
➢ Incubation period: 1-2 weeks
➢ Phases: The attacks occur every 48 hrs i.e. every third day and passes into
three phases:
1. Cold phase:
• Mechanism: The fever and rigors results from the rupture of the RBCs with
liberation of merozoite and the heme pigments.
• Duration: it lasts 20-60 minute
• Features: sudden onset of tever (39.40 C) with sense of coldness, rigors,
nausea & vomiting.
2. Hot phase:

2
 • Mechanism: The fever and rigors results from the rupture of the RBCs with
liberation of merozoites and the heme pigments
• Duration: it lasts 3-8 hrs
• Features: Fever (39-40 C) persists with sense of hotness, nausea & vomiting
3. Sweating phase:
• Mechanism: The fever disappears after the end of RBCs rupture
• Duration: It lasts 2-3 hrs
• Features: Rapid tall of temperature with excessive sweating and relief of
symptoms .

Spleen is hugely enlarged, soft & tender by the end of 2 weeks

The liver may be slightly enlarged and tender.
The attacks become gradually Infrequent denoting disappearance of the parasite
from the blood with the termination of the primary attack. Relapses may occur
when sporozoite from the liver re-invade the blood.
2- Quartan malaria (Plasmodium Malariae):
➢ incubation period: 3-6 weeks
➢ Phases: The attacks occur every 72 hours i.e. every fourth day and passes into
three phases as tertian malaria but:
• It is the mildest but the most chronic form of malaria.
• Nephritis may occur due to deposition of immune complex resulting in
haematuria (should not be confused with black water fever).
3- Plasmodium Falciparum malaria:
A) Ordinary (Uncomplicated) type:
➢ Incubation period: 1-2 weeks
➢ Phases: The attacks occur every 24 hours and passes into three phases as
tertian malaria but:
• No actual rigors but only chills
• Fever is either continuous or remittent
• Hot stage is prolonged & sweating is minimal
• Marked nausea and vomiting
• Splenomegaly occurs rapidly (within one week)
B) Pernicious (complicated) type:
1. Cerebral malaria:

3
 • Mechanism: Increased capillary permeability with leak of proteins and fluids.
• Clinical picture: Sudden onset of gradually increasing headache passing into
coma without focal neurological deficit
• Convulsions in 50 % of cases
• Death in 20% of cases due to multi-organ failure
2. Acute pulmonary Insufficiency: with picture of ARDS (acute respiratory
distress syndrome)
3. Algid malaria: Severe shock with abdominal pain and hypothermia, that
develops suddenly without apparent causes and has been proposed to occur
secondary to spontaneous gram -ve septicemia
4. Acute renal failure
5. Jaundice: is common but rarely hepatic failure
6. GIT malaria: severe vomiting, diarrhea or dysentery
C) Black Water Fever:
➢ Mechanism:
• AutoImmune hemolysis of RBCs due to treatment by quinine
• G6PD deficiency patients receiving anti malarial treatment
• Some times spontaneously
➢ Clinical picture:
• Fever and rigors followed by jaundice, hemogloblnuria, collapse and may end
in renal failure.
D) Tropical splenomegaly:
➢ Occurs In endemic areas, with huge splenomegaly and marked elevation of
serum IgM.
➢ Splenomegaly responds to anti-malarial therapy.
❖ Investigations:
1- CBC:
a. WBC: normal, eleveted or low
b. RBCs: anemia
c. Platkets: may be low
2- Liver function test.
3- Kidney function test.
4- Demonstration of the parasite:
a. Stained thick blood drop (to concentrate the parasite) by Giemsa stain

4
 b. Bone marrow or Splenic aspirate may show the paracite.
❖ Treatment:
1- Bed rest.
2- Paracetamol for fever
3- Antiemetic if there is vomiting
4- Anti-malaria:
a. Chlorquin sensetive malaria (vivax, ovale, malriae):
i. Chloroquin tab 250 mg (10 tablets) as follow:
1. 4 tablet at start
2. 2 tablets after 6 hours
3. 1 tablet twice in the next day.
ii. Primaquin 15mg tab daily for 14 day to eradicate the hpnozoites.
b. Chloroquin resistant malria (falciprum):
i. Artemethar:
1. 80mg im (2 start then one daily for 4 days)
2. 40mg capsule (2 capsule daily for 7 days)
ii. Fansidar : 3 tabs
iii. Atovaquone-proguanil (Malarone): 4 tablets daily for 3 days
iv. Artemether-lumefantrine (Coartem) 24 tablets:
1. Day1: 4 tablets intially and 4 tablets again after 8 hours
2. Day 2 & 3: 4 tablets twice ( morning and evening)