SGD CASE PRESENTATION

Protozoan Infections
SGD GROUP 4
Leader: Karen C. Del Rosario
Members:
Rajit Debbarma
Airon Debuton
Sharmaine Q. De Celis
Bedsy Dhasan
Osaivbie Edith Irorere
CASE
A 4-year-old boy returned from a summer vacation
in Tanzania with his parents with symptoms of fever
and chills. He was evaluated at a clinic in St. Louis,
Missouri where blood smears were ordered, stained
with Giemsa and examined at 1000x magnification
with oil. Images captured from the stained thin smear
were sent to the DPDx Team for identification. Figures
A – F show what was observed in some of the images
submitted. What is your diagnosis? Based on what
criteria?
HISTORY OF PRESENT ILLNESS
4 year old male with symptoms of fever and chills
PAST MEDICAL HISTORY
Had returned from a summer vacation in Tanzania
LABORATORY FINDINGS
Giemsa stained thin blood smears
INITIAL DIAGNOSIS

VIRAL INFECTION
CLINICAL MANIFESTATIONS
Fever
Chills
DIFFERENTIAL DIAGNOSIS

•YELLOW FEVER
•TUBERCULOSIS
•PNEUMONIA
 FINAL DIAGNOSIS

•MALARIA

-caused by the species Plasmodium malariae

Malaria (Plasmodium)
Malaria is an acute illness characterized by paroxysms
of fever, chills, sweats, fatigue, anemia, and
splenomegaly.
malaria remains one of the leading causes of morbidity
and mortality worldwide, with an estimated 1.5 billion
malaria cases and 7.6 million malaria death in 2000-
2019
EPIDEMIOLOGY
Malaria is the world’s most important tropical disease
the principal areas of transmission are Africa, Asia,
and South America
 P. falciparum and P. malariae are found in most
malarious areas.
Countries with indigenous cases in 2000 and their status by 2019 |
SOURCES : WHO
ETIOLOGY
Malaria is caused by intracellular Plasmodium
protozoa transmitted to humans by female Anopheles
mosquitoes.
through blood transfusion, use of contaminated
needles and transplacental transmission
5 SPECIES: P. falciparum, P. malariae, P. ovale, P.
vivax and P. knowlesi
PATHOGENESIS
CLINICAL MANIFESTATIONS
Regular paroxysms of fever with associated
asymptomatic intervals
Prodromal symptoms: feeling of weakness and
exhaustion, desire to stretch and yawn, aching bones,
limbs, and back, loss of appetite, nausea and vomiting,
and a sense of chilling
Onset of symptoms: malaise, backache, diarrhea, and
epigastric discomfort
3 stages of classical malaria paroxysms:
Cold stage
-rigors (last 15-60 mins)
Hot stage or flush phase
-temp may reach 41֯ C (peak) or more
-lasts from 2-6 hrs
Sweating stage
-defervescence and diaphoresis
-temp lowers over next 2-4 hrs and symptoms diminish
-total duration of typical attack is 8-12 hrs
LABORATORY DIAGNOSIS
Giemsa-stained smears of peripheral blood
-thin smear
-thick smear
Rapid immunochromatographic assay (RDT)
TREATMENT
COMPLICATIONS
Acute renal failure
Acute pulmonary edema (ARDS)
Hypoglycemia
Other complications: spontaneous bleeding,
convulsions, aspiration pneumonia, gram-negative
septicemia, nontyphoidal Salmonella infections
PREVENTION
Reducing exposure to infected mosquitoes and
chemoprophylaxis
Personal protection against malaria
-insect repellants (contains 10-35% DEET)
-suitable clothings and ITNs
-bed nets treated with residual pyrethroids
Chemoprophylaxis:
1. mefloquine 1x a week (pregnant women)
-longer trips but no pediatric formulations
-is started 2 weeks before travel
2. atovaquone-proguanil taken daily (adults and
children)
-shorter trips up to 2 weeks
-is started 1-2 days before travel
PROGNOSIS
Uncomplicated malaria exhibit marked improvement
within 48 hrs after initiation of treatment and are fever
free after 96 hrs
P. falciparum infection has poor prognosis with high
mortality rate if untreated
Thank you!