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is a vector-borne infectious disease caused by protozoan parasites. Malaria has infected humans for over 50,000 years, and may have been a human pathogen for the entire history of our species. It causes about 400±900 million cases of fever and approximately one to three million deaths annually. This represents at least one death every 30 seconds. If the prevalence of malaria stays on its present upwards course, the death rate could double in the next twenty years. 

Malaria

e.. Central and South America. Hispaniola. and Oceania). 2003 . Source: WHO. the Middle East. parts of Africa. and the disease was formerly called ague or marsh fever due to its association with swamps over 40% of the population lives in areas where malaria transmission occurs (i.The term malaria originates from Medieval Italian: mala aria ² ³ bad air". Asia.

The primary vector species are A. culicifacies and A. In most parts of the country. stephensi. between July and November 1998 2001 2003 2002 1999 2000 Sindh Roll Back Malaria Monitoring and Evaluation Generated:4/27/2005 2003 2002 2003 2002 NWFP Baluchistan 2003 2002 2003 2002 FATA Punjab 2003 2002 . the transmission occurs post-monsoon.

PATHOGENESIS .

Plasmodium species which infect humans Plasmodium vivax (tertian) Plasmodium ovale (tertian) Plasmodium falciparum (tertian) Plasmodium malariae (quartan) .

ovale) Gametocytes Merozoites Erythrocytic Cycle Schizont preerythrocytic sporogony Schizont Schizogony Merozoites Trophozoites .Malaria Life Cycle Sporogony Oocyst Sporozoites Mosquito Salivary Gland Zygote Hypnozoites Exoerythrocytic (hepatic) cycle (for P. vivax and P.

v. 28 (18-40) or longer 72 Mild P. 17 (16-18) or longer 50 Mild P. Incubation period (days) Erythrocytic cycle (hours) Primary attack Febrile paroxysms (hours) Relapses P.m. 12 (9-14) 48 Severe in nonimmunes 16-36 or longer - 15 (12-17) or up to 612 months 48 (about) Mildsevere 8-12 ++ 8-12 ++ 8-10 - .f.Some characteristics of infection with four species of human Plasmodia P.o.

periods of fever or febrile paroxsyms assume a more definite 3 (tertian). (tertian) ± 72 hours in P.o. (quartan) ‡ Initially may not see characteristic fever pattern if schizogeny not synchronous ‡ With synchrony..day pattern ..m. and P. P.v.or 4 (quartan).Schizogenic periodicity and fever patterns ‡ Schizogenic periodicity is length of asexual erythrocytic phase ± 48 hours in P.f.

Malaria Diagnosis ‡ ‡ ‡ ‡ ‡ ‡ Clinical Diagnosis Malaria Blood Smear Fluorescent microscopy Antigen Detection Serology Polymerase Chain Reaction .

Malaria Clinical Diagnosis ‡ Early symptoms ± Headache ± Malaise ± Fatigue ± Nausea ± Muscular pains ± Slight diarrhea ± Slight fever. usually not intermittent ‡ Could mistake for influenza or gastrointestinal infection .

Malaria Clinical Diagnosis ‡ Signs ± Anemia ± Thrombocytopenia ± Jaundice ± Hepatosplenomegaly ± respiratory distress syndrome ± renal dysfunction ± Hypoglycemia ± Mental status changes .

splenomegaly easily palpable ± Sweating stage ± Lasts 8-12 hours.Malarial Clinical Diagnosis.rigors ± Hot stage ± Max temp can reach 40-41o C. start between midnight and midday . Paroxysm ± Slight fever may worsen just prior to paroxysm ‡ Paroxysm ± Cold stage .

Malaria Lab Diagnosis Blood Smear ‡ Remains the gold standard for diagnosis ‡ Giemsa stain ‡ distinguishes between species and life cycle stages ‡ parasitemia is quantifiable ‡ Threshold of detection ‡ thin film: 100 parasites/ l ‡ thick film: 5 -20 parasites/ l Schizont Ring form Gametocytes Trophozoite .

falciparum histidine-rich protein 2 (PfHRP-2) -parasite LDH (pLDH) ‡ Cannot detect mixed infections ‡ Cross reactivity with rheumatoid factor reportedly corrected .Malaria Antigen Detection ‡ Immunologic assays to detect specific antigens ‡ Commercial kits now available as immunochromatographic rapid diagnostic tests (RDTs). used with blood -P.

RBM Partnership Secretariat. Malaria Medicines & Supplies Services Copenhagen ± 31 January 2006 .

Malaria distribution and reported case of resistance or treatment failure .

from areas of high children under 5 years of ‡I n children of 5 years of age and above. as immunity is acquired. malaria clinical progressively less likely as a cause of becomesdiagnosis ± fever.5 oC) or a history of fever to children ± and no other obvious cause. transmission where treatment is based on confirmation is not immediately possible . where parasitological suspected severe malaria ‡ In older children and in adults. malaria diagnosis should be based on a parasitological confirmation. age.Malaria diagnosis ‡ 90% of Malaria Deaths Occur Among or RDT) Parasitological confirmation (microscopyChildren Under Five Years before treatment of Age ‡ Antimalarial treatment should therefore be given Exceptions: with fever (>37.

Changing antimalarial treatment policy ‡ Treatment failure of >10% (as assessed through monitoring of therapeutic efficacy at 28 days) ‡ New treatment ± an average cure rate of > 95% as assessed in clinical trials .

Treatment of uncomplicated falciparum malaria Artemisinin-based combination therapies (ACT) are the treatments recommended for all cases of uncomplicated falciparum malaria including: ± in infants. ± in people living with HIV/AIDS ± for home-based management of malaria ± pregnant women in the 2nd and 3rd trimesters Exception: ‡ 1st trimester of pregnancy .

Treatment of uncomplicated falciparum malaria First-line treatment: ‡ The following ACTs are presently recommended: ± artemether-lumefantrine ± artesunate + amodiaquine ± artesunate + mefloquine ± artesunate + sulfadoxine-pyrimethamine ‡ Efficacy of ACTs depend on the efficacy of the partnermedicine The artemisinin derivatives (oral formulations) and partner medicines of ACTs are not recommended as monotherapy .

. 3-8 recommended treatment is a 6-dose The total Yrs Tab. Artem DS plus 1+0+1 (for 3 regimen of artemether-lumefantrinedays) a day for 3 twice days.Artemether-lumefantrine Currently available as co-formulated tablets > 14 Yrs containingTab. Artem DSof artemether days) 120 mg of 20 mg plus 2+0+2 (for 3 and lumefantrine.

5 mg/kg OD) Artesunate (2 mg/kg OD)+ clindamycin (10 mg/kg BD).Treatment of uncomplicated falciparum malaria Second-line treatment: ± alternative ACT ± quinine + tetracycline or doxycycline or clindamycin Artesunate (2 mg/kg OD)+ tetracycline (4 mg/kg 6 hourly) Artesunate (2 mg/kg OD)+ doxycycline (3. Quinine (10 mg salt/kg three times a day) + tetracycline Quinine (10 mg salt/kg three times a day) + doxycycline Quinine (10 mg salt/kg three times a day) + clindamycin. Any of these combinations to be given for 7 days .

m. injection).m ± artemether i. or i.m. infusion or i. Artem 80 mg I/M 2 stat then the following antimalarial medicines are recommended Inj. Full course of ACT or quinine + clindamycin or doxycycline when patient can tolerate oral treatment .Treatment of severe falciparum malaria Any of Inj.v. ± quinine (i. Artem 80 mg I/M x OD for 4 days ± Artesunate i.v.

then 1+0+1 for next two days (total Chloroquine phosphate30mg 1xOD 10 tab. Nivaquine 4 stat then 2 after 6 hrs. ______________________________________ base 24 & 48 hours + Primaquine 30 mg >14 Yrs daily for 14 days. Primaquine for 14 days mg at 6. vivax malaria in days) + Tab. Artem DS plus 1+0+1 (for 3combination with P. followed by 500 + Tab. Artem DS plus 2+0+2 (for 3 days) + Tab. Primaquine 30mg 1xOD for 14 days Where ACT has been adopted as the first-line treatment for P. ( provided G6PD normal) Tab. . falciparum Yrs 3-8 malaria. Primaquine 30mg 1xOD for 14 days primaquine for radical cure.) 1 Gm stat. it may also be used for Tab.Treatment of Plasmodium Vivax & Ovale Infection Tab.

Approaches That Should Be Avoided ‡ Partial treatments should not be given even when patients are considered to be semi-immune or the diagnosis is uncertain. . ‡ The artemisinins and partner medicines of ACTs should not be available as monotherapies. ‡ A full course of effective treatment should always be given once a decision to give antimalarial treatment has been reached.

(Allan Shapira of Roll Back Malaria) We believe a malaria vaccine. could make a huge impact.Malaria Vaccine An effective vaccine against malaria has been developed and could be licensed by 2010. (Lead researcher Professor Pedro Alonso) . (BBC NEWS 15 October 2004) The research is very high quality and the findings are very encouraging. even of moderate efficacy.

com doctoralauddin@yahoo.in .co.CONTACT: alauddinsarwar@gmail.