Approach to Parasitic Infections

• Parasitic infections are responsible for

substantial morbidity and mortality
worldwide.
• Many parasitic infections are spread
through fecal contamination of food or
water. They are most frequent in
impoverished areas where sanitation
and hygiene are poor.
Malaria
 Malaria is a vector-borne infectious
disease caused by protozoan parasites.
It is widespread in tropical and
subtropical regions. The disease is
caused by protozoan parasites of the
genus Plasmodium.
Plasmodium is four types
 Plasmodium vivax
 Plasmodium ovale
 Plasmodium falciparum
 Plasmodium malariae
Prudêncio et al. Nature Reviews Microbiology 4, 849–856 (November 2006) | doi:10.1038/nrmicro1529
Symptoms

 Symptoms of malaria include fever,

shivering, arthralgia (joint pain),
vomiting, anemia (caused by
hemolysis), hemoglobinuria, retinal
damage , and convulsions.
Treatment

 Drugs are classified according to:

Drugs that eliminate tissue schizonticides
Drugs that eliminate blood schizonticides
Drugs that eliminated gamitocides
Drugs that are used as a prophylaxis
No drug can cause radical cure
 QUININE
 Treatment of malaria
 Resistance is not common
 It is derived from cinchona tree
 Very effective when administered parentally.
 Not used for prevention.
Pharmacokinetics
 Given orally
 Rapidly absorbed
 Loading dose will help in reaching it in less time
 Widely distributed all over the body
 High protein bound
 In ill patient the drug is highly concentrated in
plasma and less toxic (the opposite occur in
healthy individuals)
 Metabolized by the liver excreted in urine
Action
 Highly effective against blood
schizontisides
 Gametocidal against P. Vivax P. ovali
but not P. falcipram
 Not active agaist liver stage paracite
Clinical uses
 Treatment of sever resistant falcipram
malaria (parentrally)
 Oral treatment of falcipram malaria
 Not used in chemoprophylaxis
 Babesiosis: used in combination with
clindamycin
 Mefloquine
Again one of the 4-aminoquinolines.
Developed to treat cholroquine resistant
malaria.
Highly effective against the blood stage of
malaria.
The mechanism of the drug’s action is
unknown.
 It is excreted in feces
 Drug remain detected in blood after
months from stopping the treatment
 USES
1. Anti-malarial drug: for only the blood
stage not the hepatic or the gametocyte
2. Prophylaxis
 Primiquine
 Is a synthetic amino quinolone
1. active against hepatic stage of all four types
of plasmodium
2. Also gametocidal against all four types
3. Less active against the erythrocytic stage
 Prophylaxis: for P. vivax and P. ovali
Artemisinin and its derivatives
 It is a lactone endoperoxide and the active
compund of a herbal medicine that has been
used as an antipyretic in china
 Artemether is insoluble, can not be taken orally
 Artesunate Rapidly absorbed T1/2 life = 1-3hrs
 It has two derivatives:
1. Artesunate: water soluble (orally, IV, IM,)
2. Artemether: lipid soluble (IM)
 They are metabolized to an active
metabolite (di-hydroartemisinin)
 It also stay for days after stopping
treatment
 Action:
 They act on all four type of malaria in
the blood stage
 No effect against the hepatic stage
Giardiasis

 Giardiasis is a disease caused by the

flagellate protozoan Giardia lamblia .The
giardia organism inhabits the digestive
tract.
 Transmission
Giardiasis is passed via the fecal-oral
route. Primary routes are personal contact
and contaminated water and food.
• Symptoms
Symptoms include loss of appetite, fever,
explosive diarrhea, loose or watery
stool, stomach cramps, upset stomach.
Treatment

• Metronidazole, albendazole and

quinacrine.
Schistosomiasis

 it is a parasitic disease caused by

several species of fluke of the genus
Schistosoma. he three main species
infecting humans are Schistosoma
haematobium, S. japonicum, and S.
mansoni. 
Treatment:
 The drug of choice is praziquantel for
infections caused by all Schistosoma
species. 
Praziquantel
 Praziquantel is an anthelmintic effective
against flatworms. Praziquantel increases
the permeability of the membranes of
parasite cells (certain schistosomes) for
calcium ions. The drug thereby induces
contraction of the parasites resulting in
paralysis in the contracted state.
Ascariasis
 Ascariasis is a human disease caused
by the parasitic roundworm Ascaris
lumbricoides. Infection occurs through
ingestion of food contaminated with
feces containing Ascaris eggs.
 Diagnosis

Stool samples for ova and parasites will

demonstrate Ascaris eggs.
Treatment

 Mebendazole: Causes slow immobilization

and death of the worms by selectively and
irreversibly blocking uptake of glucose and
other nutrients in susceptible adult intestine
where helminths dwell.
 Piperazine: A flaccid paralyzing agent that
causes a blocking response of ascaris muscle
to acetylcholine. The narcotizing effect
immobilizes the worm, which prevents
migration when treatment is accomplished with
weak drugs such as thiabendazole.
References

 www.wikipeda.org
 www.ask.com

DR. Awatif Osama lecture of

pharmcology