Malaria

DR Vidit Goyal

Associate Professor
Dept of Microbiology
Welcome to parasitology
Some
Some characteristics
characteristics of
of parasitic
parasitic diseases
diseases

Prevalence
Prevalence in
in developing
developing countries;
countries; in
in
lower
lower socioeconomic
socioeconomic population
population
Low
Low mortality
mortality and
and morbidity
morbidity
Limited
Limited drug-development
drug-development
No
No vaccines
vaccines
 Scope
• Introduction
• Pathogenesis
• Morphology
• Clinical features
 Introduction
• Most important parasitic disease
• Protozoan disease
• Bite of Anopheles mosquito
• High morbidity and mortality
• Drug resistance of parasites
• Insecticide resistance of vectors
• The World Health Organisation estimates that
each year 300-500 million cases of malaria
occur worldwide and more than two million
people die of malaria.
 Etiology and Pathogenesis
• Plasmodium falciparum
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium malariae
• Plasmodium knowlesi
• Most deaths by falciparum malaria
FEMALE ANOPHELES MOSQUITO
 Human Cycle
• Sporozoites. Bloodstream. Liver.
• Pre-erythrocytic schizogony
• 10,000-30,000 merozoites released
• Exo-erythrocytic schizogony
• Relapse : vivax, ovale (hypnozoites)
• dormant for 3 weeks to 1 year
 Erythrocytic schizogony
• Multiplication in RBCs
• 6-20 fold every 48 to 72 hrs
• Symptoms occur when parasite density is
50/uL
• Merozoites to trophozoites
• Duffy blood group antigen in P.vivax
offers immunity
 Erythrocytic schizogony
• Ring forms : early stage
• Schizont : end of 48 hrs
– Occupies entire RBC
– 6-30 merozoites
– Rupture
– Cycle repeats
• gametocytes
 Erythrocyte changes in malaria
• Degradation of hemoglobin
• Heme to hemozoin (malarial pigment)
• In P. falciparum after 24 hrs
– Cytoadherence
– RBCs stick to the wall of small blood vessels
– Rosettes, agglutination
– Sequestration of mature forms in vital organs
Ring stage of pl. vivax
 Predilection
• Young RBCs
– P.vivax,P.ovale,P malariae
– Parasitemia seldom>2%
• P. falciparum
– RBCs of all ages
– High level of parasitemia
Gametocyte of pl.falciparium
 Mosquito Cycle
• Gametocytes form zygote in midgut
• Ookinete penetrates gut wall
• Motile sporozoites migrate to salivary glands
• Inoculation
 Clinical Features
• Very common cause of fever in tropics
• Symptoms : early nonspecific
– Headache, fever, myalgia
• Classic paroxysm
– Fever spikes,cills,rigors at regular intervals
• Fever, malaise, mild anaemia, palpable spleen
• Generalised seizures in falciparum malaria
 LAB.DIAGNOSIS
• 1. Peripheral smear study
• 2. Quantitative Buffy Coat (QBC) test
• Rapid Diagnostic Tests (RDTs)
• Para Sight F test
• OptiMal Assay
• The immuno chromatographic test (ICT
Malaria P. f. test)
• immuno assay
• Polymerase Chain Reaction
• Detection of antibodies by Radio immuno
assay, immunofluorescence or enzyme
immuno assay
• The simplest and surest test is the time-
honoured peripheral smear study for malarial
parasites. None of the other newer tests have
surpassed the 'gold standard' peripheral
smear study.
Preparation of thick & thin smears
Ring form of pl.vivax
The QBC Test
 Quantitative Buffy Coat (QBC) Test

developed by Becton and Dickenson Inc.

new method for identifying the malarial parasite
in the peripheral blood. Quantitative Buffy Coat (QBC) Test
It involves staining of the centrifuged
and compressed red cell layer with acridine orange and its
examination under UV light source. It is fast, easy and
more sensitive than the traditional thick smear examination.
The QBC Tube

« Platelets
« Lymphocytes/
monocytes
« Granulocytes
« Red Blood Cells
QBC
Optimal
 Optimal
• Rapid
• Sensitive
• Speciates vivax from falciparum
• Monitors Therapy
• Involves various measures to reduce the load of infection
in the community and reduce the transmission by
controlling the mosquitoes.
• 1. Early Diagnosis and Prompt Treatment
• 2. Personal Protection
– a. Repellants
• b. Bed nets
• c. Chemoprophylaxis
• 3. Mosquito Control Measures
– a. Source Reduction
• b. Larvicides - chemical, biological
• c. Adult insecticides
 • 1. Early Diagnosis and Prompt
Treatment
• 2. Personal Protection
– a. Repellants
• b. Bed nets
• c. Chemoprophylaxis
• 3. Mosquito Control Measures
– a. Source Reduction
• b. Larvicides - chemical, biological
• c. Adult insecticides
 Intestinal
Intestinal and
and uro-genital
uro-genital
protozoa
protozoa of
of man
man

Organism Disease Epidemiology

dysentery, liver & 500x106 cases: 50%
Entamoeba coli brain abscess worldwide,

200x106 cases world-

Giardia lamblia diarrhea
wide

farm associated: world-

Balantidium coli dysentery wide
 Intestinal
Intestinal and
and uro-genital
uro-genital
protozoa
protozoa of
of man
man

Organism Disease Epidemiology

Cryptosporidium parvum diarrhea sporadic epidemics: world-
wide

Isospora belli diarrhea rare, opportunistic

frequent, common among

Trichomonas vaginalis prostitutes: world-wide
Sexual
What
What you
you need
need to
to know
know

Morphology
Morphology
Geographic
Geographicdistribution
distribution
Life
Lifecycle
cycle
Symptoms
Symptoms
Pathogenesis
Pathogenesisand
andimmunity
immunity
Diagnosis
Diagnosis
Treatment
Treatmentand
andprevention
prevention
 Amebiasis
Amebiasis

Etiologic
Etiologic agent:
agent:
Entamoeba
Entamoebahistolytica
histolytica

Disease:
Disease:
Amoebic
Amoebicdysentery
dysentery
liver,
liver,lung,
lung,brain
brainand
andother
other
abscesses
abscesses
 Amebiasis
Amebiasis
AA37
37year
yearold
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businessmancomplains
complainsofofcentral
central
abdominal
abdominalpain,
pain,diarrhea
diarrheaand
andflatulence
flatulenceof
of10-days
10-days
duration
durationwhich
whichstarted
started22days
daysafter
afterreturning
returningfrom
fromaatrip
trip
to
toCentral-South
Central-SouthAmerica.
America. His
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who
did
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travelwith
withhim
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haveno
noGI
GIcomplaints.
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Hehas
has
no
nofever
feverand
andthe
thephysical
physicalexamination
examinationisisotherwise
otherwise
normal.
normal. The
Thestool
stoolcontains
containsmucus
mucusand
andblood.
blood.
E.
E. histolytica:
histolytica: morphology
morphology

10:
E.
E. histolytica:life
histolytica:life cycle
cycle
 Symptoms
Symptoms of
of acute
acute amebiasis
amebiasis

Organ involved Symptoms

Small and large Abdominal pain; frequent

intestine bloody dysentery with necrotic
mucosa
 Symptoms
Symptoms of
of chronic
chronic amebiasis
amebiasis

Organ involved Symptoms

Recurrent bloody and mucoid
Small and dysentery with intervening
large constipation; appendicitis;
intestine pseudopolyps; perforation

Liver Abscess; hepatitis

Lun Abscess; pneumonia
g Brain Abscess; encephalitis
 E.
E. Histolytica
Histolytica
pathology
pathology and
and Immunology
Immunology

Pathology
Pathology Immunology
Immunology

Invasiveness Antibodies
Antibodies are
are
Invasiveness and
and
abscess detectable
detectable inin
abscess formation
formation chronic
are chronic infections
infections
are due
due to
to but
but they
they are
are of
of
amoebic
amoebic questionable
questionable
proteolytic
proteolytic protective
protective value
value
enzymes
enzymes
 Amebiasis
Amebiasis
Differential
Differential diagnosis
diagnosis

Amebiasis
Amebiasis isis different
different from
from giardiasis
giardiasis
and
and bacterial
bacterial dysentery
dysentery
Mucus and blood in stool
No granulocytosis
No high fever
 E.
E. Histolytica
Histolytica::
the
the diagnostic
diagnostic features
features
 E.
E. Histolytica
Histolytica
and
and some
some nonpathogenic
nonpathogenic amoebae
amoebae

Distinguished on the basis of size and the location and number of kryosomes
 E.
E. Histolytica
Histolytica
prevention
prevention and
and treatment
treatment

Prevention
Prevention
Better
Betterhygiene
hygiene
Efficient
Efficientsewage
sewagetreatment
treatment
and
anddisposal
disposal

Treatment
Treatment

Iodoquinol
Iodoquinol

metronidazole
metronidazole