MALARIA

INTRODUCTION
 Malaria is a protozoal disease caused by infection
with parasites of the genus Plasmodium(agent)
and transmitted to man by infected female
Anopheline mosquito(vector).
 In2020, there were an estimated 241 million
cases of malaria worldwide.
 The estimated number of malaria
deaths stood at 627 000 in 2020.
AGENT
 Malaria in man is caused is caused by four distinct
species-
1. P. vivax
2. P. falciparum
3. P. malariae
4. P. ovale
 Plasmodium vivax has the widest geographic
distribution throughout the world.
 In India, about 50 per cent of the infections are
reported to be due to P. falciparum and 4-8 per cent
due to mixed infection and rest due to P. vivax.
LIFE CYCLE

 The malaria parasite undergoes 2 cycles of

development
1. The human cycle (asexual cycle)
2. The mosquito cycle (sexual cycle).
 Man is the intermediate host and mosquito the
definitive host.
1.ASEXUAL CYCLE

 The asexual cycle begins when an infected

mosquito bites a person and injects
sporozoites.
 a) HEPATIC PHASE: The sporozoites disappear
within 60 minutes from the peripheral
circulation.
 Many of them are destroyed by phagocytes,
but some reach the liver cells.
 After 1-2 weeks of development , they
become hepatic schizonts, which eventually
burst releasing a shower of merozoites.
 (b) ERYTHROCYTIC PHASE: Many of the merozoites
are quickly destroyed, but a significant number
attach to specific receptor sites on the RBC.
 The merozoites then penetrate the RBC and pass
through the stages of trophozoite and schizont.
 The erythrocytic phase ends with the liberation of
merozoites, which infect fresh red blood cells.
 The cycle is repeated over and over again until it
is slowed down by the immune response of the
host.
 The duration of the erythrocytic cycle is 48 hours

 (c)GAMETOGENY: some erythrocytic forms do not

divide but becomes male and female gametocytes
SEXUAL CYCLE
 The
mosquito cycle (sporogony) begins when
gametocytes are ingested by the vector mosquito
when feeding on an infected person.
 Thefirst event to take place in the stomach of
the mosquito is exflagellation of the male
gametocyte.
 The
female gametocyte matures into female
gamete or "macrogamete“.
 Boththe male and female gametes fertilizes to
form zygote which within 18-24 hours, becomes
motile and is known as Ookinete
 which penetrates the stomach wall of the
mosquito and develops into an oocyst on the outer
surface of the stomach.
 The oocyst grows rapidly and develops within it
numerous sporozoites.
 When mature, the oocyst bursts and liberates
sporozoites into the body cavity of mosquito.
Many of the sporozoites migrate to the salivary
glands of the mosquito, and the mosquito now
becomes infective to man.
 RESERVOIR OF INFECTION-human reservoir is one
and only reservoir who harbours the sexual forms
(gametocytes) of the parasite.

 PERIOD OF COMMUNICABILITY-Malaria is
communicable as long as mature, viable
gametocytes exist in the circulating blood in
sufficient density to infect the vector mosquitoe
HOST FACTORS
 human elements that have an influence on malarial
epidemiology
1. Age - All ages are affected but neonates are
considerably resistant
2. Sex - males>females because of outdoor life they lead
3. Socioeconomic development and housing - I’ll ventilated,
I’ll lighted houses becomes ideal resting place for
mosquitoes.
4. Occupation - predominantly a rural disease related to
agricultural practices.
5. Human Habits - sleeping outdoors ,not using personal
protection like nets.
ENVIRONMENTAL FACTORS-

1. Season-in India, prevalence is max

from July- November
2. Temperature -20 deg to 30 deg
3. Humidity - high
4. Rainfall – rain increases humidity
which is necessary for breeding of
mosquitoes
MODE OF TRANSMISSION
 Vector transmission-malaria transmitted by the
bite of infected female anopheline mosquitoes.
 Direct transmission-intramuscular and intravenous
injections of plasma or blood.
 Congenital transmission-infected mother to the
newborn
INCUBATION PERIOD

 P. falciparum – 12 days(9-14 days)

 P. vivax – 14 days (8-17 days)
CLINICAL FEATURES
 Predominant symptoms
1. Fever
2. Headaches
3. Body pain
4. Nausea and vomiting
5. Diarrhea
6. Abdominal pain
 The typical attack comprises three distinct stages-
1.COLD STAGE: The onset is with lassitude,
headache,and chilly sensation followed in an hour or
so by rigors.
The temperature rises to 39-41°C.
In early part of this stage-Skin feels cold; later it
becomes hot.
Pulse :Rapid and weak.
Stage lasts for 1/4-1 hour.
2. HOT STAGE-patient feels burning hot.
skin is hot and dry to touch.
Headache is intense .
pulse is full and respiration rapid.
This stage lasts for 2 to 6 hours.

3.SWEATING STAGE-Fever comes down with profuse sweating.

 The temperature drops rapidly to normal and skin Is cool and
moist.
 The pulse rate - slower
 This stage lasts for 2-4 hours
DIAGNOSIS
 Diagnosis depends on demonstration of parasite in the
blood-
1. Microscopy-2 types of films -thin and thick films are used
both preapared on single microscopic glass slide.
Thick film more reliable for searching the parasite whereas
thin helps to identify the type of parasite.
2. Serological test-Positive test is not usually an indication
of current infection,positive results can be found even if
the person had malaria in the past.This is because malarial
fluorescent antibody test usually becomes positive two
weeks or more after primary intection,by which time the
infection may have been cured.
 3.Rapid Diagnostic test-based on the detection of
circulating parasite antigens with a simple
dipstick format.
 Some of them can only detect P. falciparum while
others can detect other parasites also.
TREATMENT
 Treatment when microscopy result is available within 24
hours-
 Positivefor P.vivax- Choloroquine 3days and Primaquine-
0.25 mg per kg body weight for 14 days
 Positive for P.Falciparum-For north east states-Age
specific ACT-AL -Artemisinin based combination therapy -
Artemether Lumefantrine -3 days Primaquine-single dose
on second dayIn other states-ACT SP-Artemisinin based
combination therapy-
artesunate,sulfadoxine,pyrimethamine for 3
daysPrimaquine-single dose on 2nd daya
microscopy result is available within
24 hours
PREVENTION