![▪ P. vivax cases
✓ Chloroquine 25 mg/kg bw – divided dosage – 3 days
✓Primaquine – 0.25 mg/kg bw daily – 14 days
✓ Primaquine is contraindicated in infants, pregnant women and
individuals with G6PD deficiency.
[When primaquine is administered to individuals with G6PD deficiency,
its metabolites lead to more severe hemolysis by inducing
oxyhemoglobin generation, GSH depletion and stimulation of the hexose
monophosphate pathway]
5/7/2020 29Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta](https://image.slidesharecdn.com/malariaepidemiologyclinicalfeaturestreatment-200507151213/75/Malaria-epidemiology-clinical-features-amp-treatment-29-2048.jpg)
Uploaded byDr. Animesh Gupta
Malaria epidemiology, clinical features & treatment
Malaria is a protozoal disease caused by Plasmodium parasites, primarily transmitted by infected Anopheles mosquitoes. In 2018, approximately 228 million malaria cases were reported globally, with significant mortality, especially among children under five. The document details the epidemiology, symptoms, transmission, and recommended treatments for malaria, highlighting the importance of understanding risk factors and the effectiveness of different therapeutic approaches.
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Dr. Animesh Gupta presents malaria's epidemiology, clinical features, and treatment.
Malaria is caused by Plasmodium species transmitted by Anopheles mosquitoes. Key historical figures contributed to its understanding.
In 2018, there were 228 million malaria cases worldwide, resulting in 405,000 deaths, with P. vivax and P. falciparum being notable species.
Over 50% of India's malaria burden is from P. vivax. It details the demographics and geographical areas most affected.
Discusses reservoirs of infection and various factors influencing malaria transmission: age, sex, environment, and housing.
Details malaria transmission types and the life span of different Plasmodium species.
Describes symptoms of uncomplicated and severe malaria, including fever, chills, and potential complications.
Outlines diagnostic techniques for malaria, including microscopy and rapid tests, along with treatment regimens for P. vivax.
Advises on malaria treatment protocols during pregnancy, emphasizing safety and restrictions.
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Malaria epidemiology, clinical features & treatment
- 1. 5/7/2020 1Malaria -Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 2. Dr Animesh Gupta MBBS,MD, FDM, FAGE Associate Professor Dept. of Community Medicine, NMCH, Jamuhar (Bihar)
- 3. ▪Malaria is aprotozoal disease caused by infection with parasites of the genus Plasmodium and transmitted by certain species of infected female Anopheles mosquito. ▪Four species of Plasmodium can infect and be spread by humans. ▪Humans occasionally become infected with Plasmodium species that normally infect animals, such as P. knowlesi 5/7/2020 3Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 4. ▪ Hippocrates wasthe first person who described feature of malaria in man – 400 BC ▪ Charaka mentioned as fever is the main symptom of malaria – 300 BC ▪ Charles Louis Alphonse Laveran discovered P. malariae parasite in the blood of soldier – 1880 ▪ Ronald Ross discovered the disease transmission by mosquito ▪ Grassi and Feletti discovered P. vivax parasite 1890 ▪ WilliamWelch discovered P. falcifarum parasite 1897 ▪ Stephenes discovered P. ovale parasite 5/7/2020 4Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 5. ▪In 2018 anestimated 228 million cases of malaria occurred worldwide and 405 000 people died. ▪Children aged under 5 years are the most vulnerable group affected by malaria. Source :WHO Malaria Report 2019 5/7/2020 5Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 6. 5/7/2020 6Malaria -Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 7. ▪Globally, 53% ofthe P. vivax burden is in the WHO South-East Asia Region, with the majority being in India (47%). 5/7/2020 7Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 8. Reported cases ofMalaria (2018) ▪ Total cases- 429928 ▪ P. falciparum cases- 204733 ▪ P. vivax – 222730 ▪ Mixed - 2465 ▪ Deaths- 96 Source :WHO Malaria Report 2019 5/7/2020 8Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 9. 5/7/2020 9Malaria -Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 10. ▪ Tribal malaria– contributes about 50% of the cases in country (AP, MP, Gujarat, Jharkhand, Bihar, Maharashtra, Odhisa). ▪ Infants, young children & pregnant women are considered as high risk group. ▪ Rural malaria – irrigated areas of Haryana, Punjab, western U.P., & parts of Rajasthan ▪ Urban malaria – 15 major cities like Delhi, Mumbai, Chennai, Kolkata, Hyderabad, Bengaluru. ▪ Malaria in project areas ▪ Border malaria ▪ Forest malaria 5/7/2020 10Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 11. Parasite Vector Host Environment 5/7/2020 11Malaria- Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 12. ▪Agent factor ▪ Malariais caused by 4 distinct species - P.falciparum, P.vivax, P.ovale, and P.malariae. ▪ P.falciparum causes about 60% of the infections in India, 4-8% is mixed infections, and rest due to P.vivax. ▪ P.malariae has a restricted distribution and contributes to 1% of the infections. 5/7/2020 12Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 13. 5/7/2020 13Malaria - Epidemiology,Clinical Features & Treatment Dr. Animesh Gupta
- 14. ▪ Reservoir OfInfection ▪ With the possible exception of chimpanzees in tropical Africa, which may carry P.Malariae. ▪ Human reservoir - one who harbours sexual forms of the parasite ▪ Conditions to serve as a reservoir : ▪ Must harbor both sexes of gametocyte in blood ▪ Gametocytes must be mature ▪ Gametocytes must be viable ▪ Gametocytes must be present in sufficient density to infect mosquitoes. 145/7/2020Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 15. ▪ Period OfCommunicability ▪ Malaria is communicable as long as mature, viable gametocytes exist in the circulating blood in sufficient densities to infect vector mosquitoes. ▪ Gametocytes appear in the blood 4-5 days after asexual forms appear in P.vivax,and they do not appear until 10-12 days after asexual forms in P.falciparum. 155/7/2020Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 16. 1. Age- Affectsall ages 2. Sex- Males are affected more frequently than females 3. Race- People with AS hemoglobin (sickle cell trait) have a milder illness with falciparum infection. People whose RBC’s are “Duffy negative” are resistant to P.vivax infection 4. Pregnancy- malaria during pregnancy have severe manifestation 5. Housing- ill-ventilated, ill- lighted houses provide ideal indoor resting place for mosquitoes. 165/7/2020Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 17. 6. Occupation –predominantly a rural disease and is closely related to agricultural practices. 7. Human habits – such as sleeping outdoors, not using personal protection measures (example: bed nets) 8. Immunity – immunity is acquired only after repeated exposure after several years. In endemic areas a state of collective immunity becomes established slowly and the people develop a considerable degree of resistance. 5/7/2020 17Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 18. 1. Season –maximum prevalence is from July to November (post monsoon) 2. Temperature – 20 to 30 degree Celsius 3. Humidity – relative humidity of 60% ensures long life span. If humidity is high they are more active and feed more. 4. Rainfall – provides opportunities for breeding of mosquitoes and may give rise to epidemics. 5. Altitude – Anophelines are not found at altitudes above 2000 meters 6. Man-Made Malaria – burrow pits, garden pools, canals, irrigation channels and engineering projects like construction of hydroelectric dams, roads, bridges 185/7/2020Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 19. ▪ An.culicifacies- Rural,periurban ▪ An.fluviatilis- Forest, Hilly areas ▪ An.stephensi- Urban, Industrial ▪ An.minimus,An.philippinensis,An.sundaicus – Foothills ▪ An. dirus : forest in NE states ▪ An. epiroticus – Andaman & Nicobar Island 195/7/2020Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 20. ▪Life Span –10-12 days ▪Resting Habits – Endophily, Exophily, Endophagic, Exophagic ▪Breeding Habits – moving water, wells, cisterns, fountains, overhead tanks, garden pools ▪Time Of Biting – Nocturnal feeding between dusk to dawn 5/7/2020 20Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 21. ▪Vector transmission ▪Direct transmission ▪CongenitalMalaria 215/7/2020Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 22. ▪ P.falciparum :12 days (9-14 days) ▪ P.vivax : 14 days (8-17 days) ▪ P.malariae : 28 days (18-40 days) ▪ P.ovale : 17 days (16-18 days) 225/7/2020Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 23. ❑ Uncomplicated Malaria ▪The classical malaria attack lasts 6-10 hours. It consists of ▪ Cold stage (sensation of cold, shivering) – 1 hr ▪ Hot stage (fever, headaches, vomiting; seizures in young children & Skin is hot and dry to touch) – 2 to 6 hrs ▪ Sweating stage (sweats, return to normal temperature, tiredness) – 2 to 4 hrs. ▪ Symptoms appear 7 days or more (usually 10–15 days) after the infective mosquito bite. 5/7/2020 23Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 24. ▪ Fever ▪ Chills ▪Sweats ▪ Headaches ▪ Nausea and vomiting ▪ Body aches ▪ General malaise 5/7/2020 24Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 25. The manifestations ofsevere malaria include ▪ Cerebral malaria ▪ Severe anemia due to hemolysis ▪ Hemoglobinuria due to hemolysis ▪ Acute respiratory distress syndrome (ARDS), ▪ Abnormalities in blood coagulation ▪ Low BP ▪ Hyperparasitemia, where > 5% of the RBCs are infected by malaria parasites ▪ Metabolic acidosis often in association with hypoglycemia. 5/7/2020 25Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 26. ▪ Microscopy- Thickfilm and Thin film. Thick film – detection of parasite Thin slide – identifying or confirmation of species ▪ Serological Tests- Malarial Fluorescent Antibody test usually becomes positive two weeks or more after primary infection ▪ RDT- Rapid Diagnostic Tests- based on detection of circulating parasite antigens by a simple dipstick. 265/7/2020Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 27. 5/7/2020 27Malaria -Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 28. 5/7/2020 28Malaria -Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 29. ▪ P. vivaxcases ✓ Chloroquine 25 mg/kg bw – divided dosage – 3 days ✓Primaquine – 0.25 mg/kg bw daily – 14 days ✓ Primaquine is contraindicated in infants, pregnant women and individuals with G6PD deficiency. [When primaquine is administered to individuals with G6PD deficiency, its metabolites lead to more severe hemolysis by inducing oxyhemoglobin generation, GSH depletion and stimulation of the hexose monophosphate pathway] 5/7/2020 29Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 30. Age in yearsChloroquine (10 mg/kg bw or 150 mg) Primaquine (2.5 mg) Day 1 Day 2 Day 3 For 14 days < 1 ½ ½ ¼ Nil 1-4 1 1 ½ 1 5-8 2 2 1 2 9-14 3 3 1½ 4 15 & above 4 4 2 6 5/7/2020 30 Chloroquine – 600 mg on day 1 & Day 2 ; 300 mg on day 3 Primaquine – 12.5 mg for 14 days Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 31. ▪ ACT isnot to be given in 1st trimester of pregnancy. ▪ Quinine can be given in 1st trimester 5/7/2020 31Malaria - Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 32. 5/7/2020 32Malaria -Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta
- 33. 5/7/2020 33Malaria -Epidemiology, Clinical Features & Treatment Dr. Animesh Gupta