Malaria (Febris intermittens)

Kutmanova A.Z.

are transmitted to people through the bites of infected female Anopheles mosquitoes.

In 2015, 91 countries and areas had ongoing malaria transmission.

Malaria is preventable and curable, and increased efforts are dramatically reducing the malaria burden in many places.

risk (the rate of new cases) fell by 21% globally.

In that same period, malaria mortality rates among populations at risk fell by 29% globally among all age groups, and by 35% among children under 5.

The WHO African Region carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths.

well-being
Register
Period
2000
1997
2001
2002
Recurrance
of Malaria
2744 сases.
28сases.
12 сases
13сases.
Intensive incident for 100 000

people

Absolute data.

cells, using hemoglobin as a nutrient, eventually, the infected red

cells rupture, releasing merozoits that can invade other erythrocytes. If a large numbers of red cells rupture at roughly the same time, a paroxysm (sudden onset) of fever can result from the massive release of toxic substance.
Plasmodium falciparum is the most dangerous species.
P. malriae, P. vivax, and P. ovale cause milder form of the disease, probably because they invade either young or old red cells, but not both. This is in contrast to P. falciparum, which invades cells of all ages.
Plasmodium falciparum is characterized by persistent high fever and orthostatic hypertension. Infection can lead to capillary obstruction and death if treatment is not introduced.

for influenza or gastrointestinal infection

mistake for influenza or gastrointestinal infection
Slight fever may worsen just

prior to paroxysm
Paroxysm
Cold stage - rigors
Hot stage – Max temp can reach 40-41o C, splenomegaly easily palpable
Sweating stage
Lasts 8-12 hours, start between midnight and midday

of erythrocytic forms, no exo-erythrocytic cycle (P.f., P.m.)
Relapse
reactivation of hypnozoites

forms of parasite in liver, separate from previous infection with same species (P.v. and P.o.)
Recurrence or reinfection
exo-erythrocytic forms infect erythrocytes, separate from previous infection (all species)
Can not always differentiate recrudescence from reinfection

parasite
Geographic origin of parasite
Size of inoculum of parasite
Host factors
Age
Immune

status
General health condition and nutritional status
Chemoprophylaxis or chemotherapy use
Mode of transmission
Mosquito
Bloodborne, no hepatic phase (transplacental, needlestick, transfusion, organ donation/transplant)

- tertian
Usually persistent fever or daily paroxyms for P.f.
Days 1

and 4 for P.m. - quartian

normal and patient feels well
falciparum may not exhibit classic

paroxysms (continuous fever)

Malaria Paroxysm

tertian malaria
quartan malaria

to P.v.
Lack Duffy blood group antigens needed for RBC invasion
Mild

– severe anemia, thrombocytopenia, mild jaundice, tender hepatosplenomegaly
Splenic rupture carries high mortality
Headache, dizziness, muscle pain, malaise, anorexia, nausea, vague abdominal pain, vomiting
Fever constant or remittent

months or longer
Some strains from temperate zones show longer incubation

periods, 250-637 days
First presentation of imported cases – 1 month – over 1 year post return from endemic area
Relapses
60% untreated or inadequately treated will relapse
Time from primary infection to relapse varies by strain
Treat blood stages as well as give terminal prophylaxis for hypnozoites

Presentation of P.vivax

malaise, anorexia, nausea, vague abdominal pain, vomiting
Fever constant or remittent
Postural

hypotension, jaundice, tender hepatosplenomegaly
Can progress to severe malaria rapidly in non-immune patients
Cerebral malaria can occur
Parasites can sequester in tissues, not detected on peripheral smear

Presentation of P.falciparum

the aggregates of red blood cells, glued together with fibrin,

sealed terminal vessels
Acute renal failure - a violation of the micro-circulation, malarial hemoglobinuria, deficiency of erythrocyte glucose-6-phosphate dehydrogenase
Acute pulmonary oedema - disruption of the microcirculation of cell membranes and capillaries in combination with heart failure
Acute adrenal insufficiency (syndrome Waterhouse – Fridrichsen)

observed the birth of premature infants and cases of stillbirth

> 10,000 /l and severe anemia (haemaglobin < 5 g/l).
Prognosis

is poor if > 20% parasites are pigment containing trophozoites and schizonts (more mature forms) and/or if > 5% of neutrophils contain visible pigment.

Hänscheid T. (1999) Diagnosis of malaria: a review of alternatives to conventional microscopy. Clin Lab. Haem. 21, 235-245

Antibodies to asexual parasites appear some days after invasion of

RBCs and may persist for months
Positive test indicates past infection
Not useful for treatment decisions

for
Identifying infective donor in transfusion-transmitted malaria
Investigating congenital malaria, esp. if

mom’s smear is negative
Diagnosing, or ruling out, tropical splenomegaly syndrome
Retrospective confirmation of empirically-treated non-immunes

whole blood collected in anticoagulated tube (200 µl) or directly

onto filter paper (5 µl)
100% DNA is extracted
10% blood volume used in PCR reaction