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MALARIA
ETIOLOGY
LIFE CYCLE
PATHOGENESIS
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1.
2.
Cerebral malaria
Severe anemia (hematocrit <15%)
results from accelerated RBC removal by the
spleen, obligatory RBC destruction, and
ineffective erythropoiesis
Renal failure (no urine output <400mL in 24 h,
or 12mL/kg/24 h after rehydration, or serum
creatinine > 3 mg%)
related to RBC sequestration interfering with
renal microcirculatory flow and metabolism
acute tubular necrosis
Pulmonary edema or adult respiratory distress
syndrome
Hypoglycemia (blood sugar <40 mg%)
results from a failure of heptic gluconeogenesis
and increase in consumption of glucose by the
host and the parasite
Shock (systolic BP<70 mmHg in adults or <50
mmHg in children age 1-5 y)
3.
4.
5.
6.
Most
falciparum
Malignant Tertian malaria for P. falciparum
This qualification of malaria is no longer
applicable nowadays.
characteristic pathologic feature/s:
Anemia (P. falciparum produces greatest
degree of anemia) that is microcytic
hypochromic type due to direct loss (impaired
hematopoiesis) or destruction (by parasite) of
RBCs.
Pigmentation of organs (phagocytosis of
hemozoin or malarial pigment after the rupture
of host cells, macrophages of spleen & bone
marrow; Kupffer cells of liver, at termination of
asexual cycle) that increases as infection
lengthens. Evident grossly in chronic malaria
Liver enlargement due to congestion in
acute malaria and increases in size during
chronic malaria.
Splenomegaly is evident, first as a result of
congestion following cavernous dilatation of
sinusoids and then results from increase in
macrophage elements in Billroths cords.
Repeated attacks results to progressively
greater enlargement. Palpation of the spleen is
characteristic of malaria.
7.
8.
9.
10.
11.
12.
13.
Spontaneous
bleeding
and
disseminated
intravascular coagulation
Repeated convulsions
Acidosis (arterial pH<7.25 or plasma HCO3<15)
Macroscopic hemoglobinuria
Hyperparasitemia
(>5%
parasitemia
in
nonimmunes)
Hepatic dysfunction
common manifestation is jaundice
Hyperpyrexia (T>40 OC)
Plasmodium falciparum:
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Plasmodium vivax:
Plasmodium malariae
Late
trophozoite-more
solid
looking
than
corresponding stage of P. vivax. Assumes a
characteristic band from across the diameter of the
RBC. Band can be wide or narrow but well-defined
and is diagnostic for this sp. Pigment is coarser and
with golden-yellow and black pigment (Ziemanns
dots). Infected RBC is of normal size.
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Plasmodium ovale:
Late
trophozoites-solid-looking
non-ameboid
parasites. Pigment is scanty and James dots are
seen.
Differential Diagnosis:
Babesiosis
Hepatitis
Influenza
Liver abscess
Tuberculosis
For schizonts
Primaquin
For Exo-erythrocytic cycles
Chlorguanide,
pyrimethamine
(Folic
Acid
Metab)
Primaquin
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Not severe
Severe
Chloroquine (Aralen)PO1
Chloroquine IV3
Not severe
Sulfadoxine/pyrimethamine
PO3
Severe
Not severe
Severe
Not severe
Severe
P. vivax
P. ovale
P. malariae
quinine PO5
quinine IV6
Not
severe
Severe
quinine
PO5
tetracycline
quinine IV6
artesunate IV10
artemether IM11
Chloroquine PO,
primaquine 12
Chloroquine PO1
or
quinine PO5
quinine IM7
D. Multidrug-resistant
Mixed Infections
Species
Unknown
Sulfadoxine/pyrimethamine (Fansidar)
PO2
Chloroquine IV4
plus
followed
by
PO
Mefloquine PO followed by
primaquine PO12
Mefloquine PO8
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