MALARIA

PRESENTATION
 Definition of malaria
• Malaria is a protozoa infection of the
blood (red blood cells) but with general
effect on the body caused by a genus
plasmodium species that is transmitted
by an infected female anopheles
mosquito, characterized by regular
cycles of chills and fever (Marcia and
Jeanette, 2004).
 Definition of malaria cont
• Malaria is a protozoa infection of the
genus plasmodium, transmitted
through the bite of an infected female
mosquito belonging to the genus
anopheles
Berkow et al (1997)
 Definition of other related
terms
• Merozoite: is the product of division by schizogony.
• Schizont: the stage undergoing division by
multiple fusion or segmentation. These may be
found in the liver cells (pre-erythrocytic schizonts) or
in the erythrocytes (erythrocytic schizons).
• Sporozoite: this is the infective stage passed in
the saliva of the mosquito and formed inside an
occyst by the process of sporogony.
• .
 Definition of other related terms cont

• Trophozoite: is the stage of the

sexual form with an individual nucleus
seen in erythrocytes.
• Sporogony: is the sexual phase in the
life cycle taking place in the mosquito.
• Paroxysms: these are bouts of fever
due to the liberation of merozoites
during the erythrocytic schizogony
 Types of malaria causing Plasmodium

• There are four types of plasmodium

that are capable of causing infection in
human. These are:
Plasmodium falciparum,
 Plasmodium vivax,
Plasmodium ovale
 Plasmodium malariae.
 Types of malaria cont
All these plasmodia infect and destroy
human erythrocytes, produce chills,
fever, anaemia and spleenomegally.
Plasmodium falciparum causes more
severe disease than the other
plasmodium species and accounts for
highest number malaria deaths (Rubin
and Farber1999).
 Life Cycle Of Malaria
Parasite
• The life cycle of the plasmodium parasite has two
phases;
 A sexual cycle known as sporogony which takes
place within the intestinal tract of a mosquito; and
an
 Asexual cycle known as schizogony (the infective
form for human)
 Which is found in the saliva of an infected mosquito.
 Life Cycle Of Malaria
Parasite cont
• Saliva containing infective sporozoites
is injected into the blood stream of
humans through the mosquito
proboscis.
• After circulating in the peripheral blood
for about 20-30 minutes, the
sporozoites enter the parenchyma
cells of the liver, where they begin to
multiply.
• This stage is also called
exoerythrocytic stage.
 Life Cycle Of Malaria
Parasite cont
• In about 6-14 days, merozoites are released from,
the liver cells and are released into the Blood
circulation
• where they seek out and penetrate erythrocytes.
• This stage is also known as erythrocytic stage)
• Within the erythrocyte the parasite goes through a
series of developmental stages.
 Life Cycle Of Malaria
Parasite cont
• These organisms develop into a “ring
form” known as the trophozoites,
• which depending on the species,
enlarge and divide into a segmented
state known as the schizont.
• The individual segments of the
schizonts rapture the erythrocytes and
merozoites are released in the
circulation
 Life Cycle Of Malaria
Parasite cont
• These merozoites then seek out
uninfected erythrocytes and the cycle
continues.
• Producing several chill and fever
including the typical signs of malaria
• After several erythrocytic cycles have
taken place, some of the merozoites
transform into sexual form called
macrogametocyte (female) and
microgametocyte (male).
 Life Cycle Of Malaria
Parasite cont
• When a plasmodium free anopheles
female mosquito bites a human
infected with plasmodia parasites,
• These gametocytes are ingested along
with the trophozoite infected
erythrocytes as part of the blood meal.
• In the stomach of the mosquito the
microgametocyte develop six to eight
flagella.
 Life Cycle Of Malaria
Parasite cont
• This microgametocyte breaks free to penetrate the
female macrogametocyte and produce fertilized
zygotes.
• These zygotes then enter the stomach wall of the
mosquito forming the oocyst
• The oocyst later breaks releasing the sporozoite
• The sporozoite migrate to the salivary glands of the
mosquito.
 Life Cycle Of Malaria
Parasite cont
• When the mosquito bites a new host,
• sporozoite are squeezed from the
salivary glands and injected through
the proboscis into the human host.
• Plasmodium falciparum schizonts
rarely seen in peripheral blood
(Koneman et al 1997).
 Pathophysiology of malaria
• In all forms of malaria, the spleen and
liver enlarges as erythrocytes are
sequestered by the fixed mononuclear
phagocyte system.
• The organs of this system (liver,
spleen, and lymph nodes) are
darkened by macrophages filled with
haemociderin and malarial pigments,
the end product of parasitic digestion
of haemoglobin
 Pathophysiology of malaria
cont
• The adherence of infected red blood
cells to microvascular endothelium in
falciparum malaria has two
consequences.
• First parasitized erythrocytes attached
to endothelial cells do not circulate, so
patients with severe falciparum malaria
have few circulating parasites.
 Pathophysiology of malaria
cont
• Secondly, capillaries of deep organs
especially the brain, become
obstructed leading to ischemia of the
brain, kidney, and lungs.
• The brains of a person who die of
cerebral malaria show congestion and
thrombosis of small blood vessels in
the white matter, which rimed with
edema and hemorrhage (ring
hemorrhage).
 Pathophysiology of malaria
cont
• Obstruction of blood flow in the kidney
produces acute renal failure
• While intravascular haemolysis leads
to haemoglobinuric nephrosis (black
water fever).
• In the lungs, damage to alveolar
capillaries produces pulmonary
oedema and acute alveolar damage
(Rubin and Farber 1999)
 Signs and symptoms of
malaria
• For easy recognition the signs and
symptoms have been categorized into
symptoms of:
 uncomplicated malaria,
 moderately severe malaria,
 severe and complicated malaria
 General signs and symptoms in
children
Signs and symptoms of uncomplicated
malaria
• Fever due to parasitaemia
• Headache due to toxins and cerebral
hypoxia
• Joint pains due to ischaemia
• Sweating due to fever
• chills due to interference with the
temperature control centre
• Body pains due to tissue hypoxia.
• Acute gastroenteritis due to parasitaemia
 Signs and symptoms of Moderately
severe malaria.

• Nausea due to GIT involvement

• vomiting due to GIT involvement
• Dehydration due to fever
• Diarrhea due to GIT involvement
• extreme weakness due to tissue
hypoxia.
 Signs and symptoms of Severe and
complicated malaria
• Severe anaemia due to haemolysis
• Jaundice due to severe haemolysis
• Drowsiness or lethargy due to cerebral
hypoxia
• Prostration (in ability to seat or stand
without support) due to severity of the
disease
• Respiratory distress due to pulmonary
oedema
 Signs and symptoms of Severe and
complicated malaria cont
• Unconsciousness due to interruption of
blood supply to the brain by occlusion
• Change in behavior e.g. confusion due
to cerebral malaria
• Hepatosplenomegally due to
excessive destruction of RBCs and
sequestration of blood in the spleen
 Rigors in malaria
• Rigor is a common manifestation of
malaria and the following are some of
the stages involved in a rigor
 Cold stage:
It is characterized by shivering,
intense feeling of cold, lips and fingers
are cyanotic, dry and pale. In children
there may be seizures. This stage
takes about 15 minutes to 60 minutes.
 Rigors cont
• Hot stage:
This stage last about 2-6 hours and it
is caused by temperature which could
be above 41c. It is characterized by full
bound pulse, dry burning skin, intense
headache, and nausea and vomiting.
 Rigors cont
• Sweating stage
This stage lasts about 2-4 hours and it
is characterized by profuse sweating,
temperature falls rapidly below normal,
patient falls into a deep sleep and on
waking up the patient feels weak, but
normal (Koneman 1997).
 Diagnosis
• History of sudden onset of fever
• Clinical picture such as fever, nausea vomiting and
general body weakness
• Blood slide for malaria parasite which will be
positive
• FBC count will show low Hb, leukocytosis
and high ESR
• LP to r/o meningitis
• Blood Glucose estimation for patients with altered
consciousness
 Treatment
 First line treatment of
uncomplicated Malaria:Artemether
20mg – Lumefantrine 120mg
(coartem) is the first line treatment
choice for uncomplicated malaria.
However, children with weight less
than 10kg body weight and
pregnant
 Treatment
• First line treatment of uncomplicated cont:
women are not recommended for this drug,
• therefore it means that they have to be started
on the second line drug of choice which is
fansida
• Fansida is not recommended in the first
trimester of pregnancy.
• Therefore, pregnant women in the first trimester
with malaria should be treated with quinine as
the first line treatment of uncomplicated
malaria.
The second line of treatment

• Quinine can be administered orally,

intramuscularly and intravenously.
• Orally 10mg/kg body weight every 8
hours for 5-10 days.
• Intramuscularly 10mg/kg body weight,
diluted with equal volume of water-for-
injection ( no need for a loading dose )
The second line of treatment
• Intravenously 20mg/kg body weight in
1 litre of 5% dextrose loading dose
(infused over 4 hours),
• followed by a maintenance dose
10mg/kg body weight in 500mls of 5%
dextrose 8 hour for 5/7
 Supportive treatment
• Analgesics like panadol 1g tds for 3/7
• Folic acid 5mg od for 14/7
• Oxygen 2-5litres/ minute
 Complications of malaria
• Cerebral malaria
• Anaemia
• Black water fever
• Convulsion in children
• Dehydration
• Hepatospleenomegally
 Prevention
• USE OF INSECTICIDE TREATED
MOSQUITO NETS
Consistent and correct use of ITN can
help prevent malaria
 Prevention
• ENVIRONMENTAL MODIFICATION
MEASURES :
This may involve burying any potholes
that hold water to prevent mosquitoes
from breeding in them. This can help to
reduce the mosquitoes the by reduce
the incidence of malaria.
 Prevention cont
• INTERMITTENT PRESUMPTIVE
TREATMENT (IPT):
This will help to prevent malaria in
pregnancy by given pregnant
women Fansida. This is started in
the second trimester.
 Prevention cont
• Use of insecticide and mosquito
repellant:
This will prevent mosquito bite thereby
prevent malaria
 Prevention cont
• Wearing long clothes:
This will prevent mosquito bites and
prevent the chance of acquiring
malaria.
 Prevention cont
• Closing window early: This prevent
mosquitoes from entering the houses
there by reducing the chances of being
bitten by mosquitoes thereby prevent
malaria
 Prevention cont
• CHEMICAL CONTROL
PROGRAMMES (RESIDUAL
SPRAYING AND LARVICIDING)
This keeps killing the mosquitoes
over a period of time thereby
preventing malaria
 Specific Nursing Care
• Aims:
 To promote quick recovery
 Prevent complications
 Educate the patient about his condition
 Cold stage of the rigor
• I will switch on the heater to promote
comfort
• I will add extra linen to keep patient
warm and promote comfort
• I will give oxygen therapy if the patient
is cyanotic
 Hot stage of the rigor
• I will remove extra linen to promote hit loss
• I will switch of the heater in order to cool the patient
• I will switch on the fan to promote heat loss thereby
reduce temperature
• I will do oral care to moisten the mouth and promote
appetite and prevent halitosis
• If my patient fits I will give the care of a fitting
patient
 Sweating stage of the rigor
• I will change the wet linen to promote
comfort
• I will bath the patient to remove
perspiration and promote comfort
• I will offer copious oral fluids to prevent
dehydration
• I will observe the IV line to promote
recovery
General Nursing care applies
• Every patient admitted will benefit from
general nursing.
• Refer to the general nursing care
THE END

THANK
YOU!
TWALUMBA….