Malaria

[PATHOGENESIS &
PREVALENCE]

Prarthana
11201158
INTRODUCTION

● Malaria is a protozoan disease transmitted by bite of

Anopheles mosquitos
● 5 species of genus Plasmodium infect humans- P.
falciparum, P.vivax, P.ovale, P.malariae, P.knowlesi
PREVALENCE
Malaria affects about a quarter of a billion people and leads to almost
900,000 deaths annually (World Health Organization, 2009).

• P. falciparum and P. vivax cause most of the malarial infections

worldwide.

• P. falciparum accounts for the majority of the burden of malaria in sub-

Saharan Africa and is associated with the most severe disease

India contributes 77% of the total malaria in Southeast Asia.

 PREVALENCE IN INDIA

• About 95% population in the country resides in malaria endemic areas and
80% of malaria reported in the country is residing in tribal, hilly, difficult and
inaccessible areas.

• Annual Parasite Incidence (API) rate has come down from 2.12 per thousand in
2001 to 0.25 per thousand in 2019 but confirmed deaths due to malaria have been
continuously down

• Slide Positivity Rate (SPR) and Slide falciparum Rate (SfR) have reduced over
the years 2001-2019.
PATHOGENESIS
HEPATIC PHASE

Sporozoites attach and invade liver cells by binding to receptor –

Thrombospondin and properdin

Malaria multiply rapidly and releases

about 30,000 merozoites(asexual
forms)
P. falciparum infection, rupture usually occurs within 8 to 12 weeks.
P. vivax and P. ovale form latent hypnozoites in hepatocytes, which
cause relapses of weeks to months.
ERYTHROCYTIC PHASE
Plasmodium merozoites use a lectin-like molecule to bind to sialic acid
residues on glycophorin molecules on the surface of RBCs and invade
by active membrane penetration

Schizogony in RBCs

Release of merozoites by lysis of

RBCs
ERYTHROCYTIC PHASE

Release of toxic waste products-RBC membrane products,

hemozoin pigment

Activate macrophages and endothelium

Release tumour necrosis factor alpha(TNF alpha) & other cytokines

(IL-1, IL-6, IL-8, etc.).

Fever, Chills and Rigors characteristic of malaria

PATHOGENESIS OF SEVERE MALARIA

P. Falciparum infects all ages of RBCs

P. falciparum erythrocyte membrane protein1 (PfEMP1), associate

and form knobs on the surface of infected red cells

PfEMP1 binds to ligands on endothelial

cells including CD36,
thrombospondin, VCAM-1,
ICAM-1, and E-selectin
Infected RBCs to clump together
(ROSETTE)

Stick to endothelial cell lining of small

blood vessels (SEQUESTRATION)

Blood flow blocks which decreases

tissue perfusion and leads to Ischemia
[Manifestation of cerebral malaria]