MALARIA
PRITI THAKUR LEENA PESTONJI
Click to edit Master subtitle style
3/28/12
INTRODUCTION
Malaria is one of the major public health problems of the country. It is caused by a parasite called Plasmodium, which is transmitted via the bites of infected female Anopheles mosquitoes. Around 1.5 million confirmed cases are reported annually by the National Vector Borne Disease Control Programme (NVBDCP),of which about 50% are due to Plasmodium falciparum. Malaria is curable if effective treatment is started early. Delay in treatment may lead to serious consequences including death. Prompt and effective treatment is also important 3/28/12 for controlling the transmission of malaria.
There are five identified species of this parasite causing human malaria, namely,Plasmodium vivax, P. falciparum, P. ovale,P. malariaeandP. knowlesi. Malaria is the fifth cause of death from infectious diseases worldwide (after respiratory infections, HIV/AIDS, diarrhoeal diseases, and tuberculosis) and the second in Africa, after HIV/AIDS. The World Malaria Report estimates that the number of cases of malaria rose from 233 million in 2000 to 244 million in 2005 but decreased to 225 million in 2009. Also according to this report, the number of deaths due to malaria decreased from 9,85,000 in 2000 to 7,81,000 in 2009. More than 30,000 cases of malaria are reported annually among travellers from developed world 3/28/12
Malaria situation in the World Malaria is one of the most widespread disease in
the world. P. vivax has the widest geographic distribution throughout the world. 90 %of the malaria cases occur inAfrica and South of Sahara. 6.7 %in 6 countries viz.,Brazil, Columbia, India, Soloman Islands, Sri Lanka and Vietnam.
3/28/12
Indian Scenario
Majority of the infections falciparamandP. vivax.
are
due
toP.
After launching National Malaria Control Programme(NMCP) in 1953, there was a dramatic fall in the incidence of malaria cases. Implementation of National Anti Malaria Programme(NAMP) in 1958 brought down the number of deaths to0.1 million casesannuallywithout any deaths by 1965.
Oriss a
Source: National vector borne disease control programme
3/28/12
CLINICAL FEATURES
3/28/12
Malaria is typically described as an illness
Malaria may cause anaemia and jaundice (yellow colouring of the skin and eyes) because of the loss of red blood cells. Symptoms usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become lifethreatening by disrupting the blood supply to vital organs. Infection with one type of malaria,Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death. Symptoms due to malaria depend upon the age, immune status, intensity of transmission and prevalent species of malarial parasite.
3/28/12
3/28/12
Source: PubMed
HOW IS IT CAUSED ?
3/28/12
Mode of transmission
1)
Vector transmission
Malaria is transmitted by the bite of certain species of infected, female, anopheline mosquitoes. A single infected vector, during her life time, may infect several persons.
)
Vector of Malaria
3/28/12
DIAGNOSIS
Early diagnosis of malaria and its effective and timely treatment reduces morbidity and prevents death from malaria.
All clinically suspected malaria cases should be investigated immediately by microscopy and/or Rapid Diagnostic Test (RDT). Microscopy of stained thick and thin blood smears remains the gold standard for confirmation of diagnosis of malaria. The advantages of microscopy are: The sensitivity is high. It is possible to detect malaria parasites at low densities. It also helps to 3/28/12 quantify the parasite load.
Microscopy
3/28/12
3/28/12
3/28/12
3/28/12
3/28/12
Rapid Diagnostic Test
Rapid Diagnostic Tests are based on the detection of circulating parasite antigens. Several types of RDTs are available. Some of them can only detect P. falciparum, while others can detect other parasite species also. The latter kits are expensive and temperature sensitive. Presently, NVBDCP supplies RDT kits for detection of P. falciparum at locations where microscopy results are not obtainable within 24 hours of sample collection.
3/28/12
TREATMENT
Treatment of malaria depends on the following factors:
Type of infection. Severity of infection. Status of the host. Associated conditions/ diseases.
3/28/12
Modes Of Treatment Two important concepts in the treatment of malaria are suppressive and radical treatments.
Suppressive treatment:The symptoms of malaria can be alleviated by suppressing the erythrocytic stage of the parasitic development. Suppressive therapy involves administration of appropriate blood schizonticidal drugs. In all cases ofP. vivaxmalaria and in most cases ofP. falciparummalaria, it involves administration of chloroquine. Radical treatment:Radical treatment 3/28/12 administration of primaquine is to
All cases ofP. vivaxmalaria and uncomplicated cases ofP. falciparummalaria are treated with oral drugs. Chloroquine is the ONLY drug used forP. vivaxmalaria, because resistance to chloroquine inP. vivaxmalaria is almost unknown (only sporadic reports). In areas whereP. falciparumis sensitive to chloroquine, it can be treated with chloroquine; however, in areas with known resistance to chloroquine, artemisinin combination therapies (ACT) are now recommended. Primaquine should be used inP. vivax andP. ovalemalaria for eradicating the 3/28/12
3/28/12
Treatment of complicated/ chloroquine resistantP. falciparummalaria
All cases of severeP. falciparummalaria and chloroquine resistantP. falciparummalaria isnow treated with artemisinin combination therapy. It is better to use two drugs, one rapid acting and one slower acting. Severe malaria should always be treated with parenteral antimalarials to ensure adequate treatment.
Severe malaria is characterized by one or more of the following features:
Impaired consciousness/coma
3/28/12
Repeated generalized convulsions
Severe anaemia (Hb <5 g/dl) Pulmonary syndrome oedema/acute respiratory distress
Hypoglycaemia (Plasma Glucose <40 mg/dl) Metabolic acidosis Circulatory collapse/shock (Systolic BP <80 mm Hg, <50 mm Hg in children) Abnormal bleeding and Disseminated intravascular coagulation (DIC) Haemoglobinuria Hyperpyrexia (Temperature >106o F or >42o C) Hyperparasitaemia (>5% parasitized RBCs ) Foetal 3/28/12 and maternal complications are more
Specific antimalarial treatment of severe malaria Severe malaria is an emergency and treatment should be given promptly. Parenteral artemisinin derivatives or quinine should be used irrespective of chloroquine sensitivity.
Artesunate: 2.4 mg/kg body weight i.v. or i.m. given on admission, then at 12 hours and 24 hours, then once a day. Quinine: 20 mg quinine salt/kg body weight on admission (i.v. infusion in 5% dextrose/dextrose saline over a period of 4 hours) followed by maintenance dose of 10 mg/kg body weight 8 hourly; infusion rate should not exceed 5 mg/kg body weight per hour. NEVER GIVE BOLUS INJECTION OF QUININE. If parenteral quinine therapy needs to be continued beyond 48 hours, dose 3/28/12 should be reduced to 7 mg/kg body weight 8
Chemoprophylaxis Chemoprophylaxis is recommended for travellers, migrant labourers and military personnel exposed to malaria in highly endemic areas. Use of personal protection measures like insecticide-treated bed nets should be encouraged for 3/28/12 pregnant women and other vulnerable populations.
Some prophylactic drugs
Drugs like proguanil (paludrine) 200 mg-2 tablets once a day. Doxycycline 100 mg, 1 tablet once a day. Holofantrine 500 mg, 2 tablets one dose. 500 mg after 6 hours total 6 tablets in 12 hours.
3/28/12
PREVENTION
Protective measures adopted by individuals and families not only help in protecting the individuals against mosquito bites and hence malaria, but also help in reducing the mosquito population by denying the blood meal essential for nourishment of the mosquito eggs in the female anopheles mosquito. Use of mosquito repellents, protective clothing and mosquito nets are important measures of personal protection against malaria. These are easy to use, safe and not very expensive. However, these should be used regularly without fail and therefore, demand such commitment form 3/28/12 the users.
Mosquito Coil
Repellent Sticks
Mosquito Repellent Mats
Liquid Vaporizer
Mosquito repellent cream
3/28/12
Mosquito net
Electronic mosquito swatters
3/28/12
Government programs against malaria
The government launched the National Malaria Eradication Program (NMEP) in 1958. Under this program, the extensive use of local implementation. government makes bodies for fuller
Realizing the difficulties in eradicating malaria, the NMEP has been renamed as National Anti-Malaria Programme. Malaria is also covered under the National Vector Borne Disease Control Programme. Under the programme, the main aim is the reduction of the disease to a tolerable level in which human population can be protected from malaria transmission with the available means. 3/28/12
World Malaria Day25th April
World Malaria Day - which was instituted by the World Health Assembly at its 60th session in May 2007 is a day for recognizing the global effort to provide effective control of malaria. It is an opportunity:
for countries in the affected regions to learn from each other's experiences and support each other's efforts; for new donors to join a global partnership against malaria; for research and academic institutions to flag 3/28/12 their scientific advances to both experts and
3/28/12
