this i think one of the best presentation about malaria.

1. Malaria
Lajina ghimire
BSC nurse/researcher

2. Introduction
• Malaria is a mosquito borne-disease caused by
plasmodium, which is transmitted by the bite of
infected female anopheles mosquito.
• The term malaria originates from Italian word: mala
aria — "bad air"
• The disease is widespread
in tropical and subtropical regions that are present in a
broad band around the equator.[2] This includes much
of Sub-Saharan Africa, Asia, and Latin America.
The World Health Organization estimates that in 2012,
there were 207 million cases of malaria.

3. History:
• Malaria or the associated disease have been
noted 4000 years ago.
• References to the unique periodic fevers of
malaria are found throughout recorded
history, beginning in 2700 BC in China.
• Malaria may have contributed to the decline
of the Roman Empire, and was so pervasive in
Rome that it was known as the "Roman fever".

4. History:
• Scientific studies on malaria made their first significant
advance in 1880, when Charles Louis Alphonse
Laveran—a French army doctor working in the military
hospital of Constantine in Algeria—observed parasites
inside the red blood cells of infected people for the
first time. For this and later discoveries, he was
awarded the 1907 Nobel Prize for Physiology or
Medicine.
• Scottish physician Sir Ronald Ross who proved that the
mosquito was the vector for malaria for this he was
awarded the Nobel prize in 1902.

5. History
• The first effective treatment for malaria came
from the bark of cinchona tree, which
contains quinine.

6. Malaria patient in Nepal

7. Epidemiology
• The WHO estimates that in 2010 there were 219
million cases of malaria resulting in 660,000 deaths.
• Others have estimated the number of cases at
between 350 and 550 million for falciparum
malaria and deaths in 2010 at 1.24 million up from 1.0
million deaths in 1990.
• The majority of cases (65%) occur in children under 15
years old.
• About 125 million pregnant women are at risk of
infection each year; in Sub-Saharan Africa, maternal
malaria is associated with up to 200,000 estimated
infant deaths yearly.

8. Epidemiology
• P. vivax is the most common cause of malaria
and is found in subtropical and temperate
areas of the world.
• P. vivax and P. ovale causes relapsing malaria.
• P. falciparum is found in the tropical region
and causes the most severe and fatal disease.
• P. ovale is the least common malarial species
and is endemic in Africa.

10. Malaria prevalence in Nepal

11. Aetiology
• Malaria parasites belong to the
genus Plasmodium (phylum Apicomplexa).
• In humans, malaria is caused
by P. falciparum, P. malariae, P. ovale, P. vivax and P. knowle
si.
• Among those infected, P. falciparum is the most common
species identified (~75%) followed by P. vivax (~20%).
• Although P. falciparum traditionally accounts for the
majority of deaths, recent evidence suggests
that P. vivax malaria is associated with potentially life-threatening
conditions about as often as with a diagnosis
of P. falciparum infection.
• P. vivax proportionally is more common outside of Africa

12. Life cycle of malarial parasite

14. Lifecycle
• The lifecycle of malaria parasite consists of following
phases:
 sexual cycle: in female anopheles mosquito, definitive
host.
Asexual cycle: in human, as intermediate host.
• Sporozoites are the sexual form of the parasite.
• When the infected female anopheles mosquito bites
the human then the sporozoites enter the human
along with the saliva of the mosquito.
• Within 30 min they enter the parenchymal cells of the
liver, where, during next 10-14 days, they undergo pre-erythrocytic
stage of development and multipication.

15. Lifecycle:
• Following mitotic replication of its nucleus, the parasite is
termed as schizont.
• At last the parasite rupture the liver cell and merozoites are
released.
• The merozoites from the liver cell then bind to or enter the
red blood cells and further develops into trophozoites.
• The multipication here results to Erythrocytic schizont.
• Some merozoites of erythrocytic schizony develop into
male and female gametocytes known as microgamates and
macrogamates res.
• They are sexual form and are found in peripheral blood.

16. Lifecycle:
• Some of the sporozoites also, on entering into the
liver cells, do not undergo asexual multiplication
but enter into a resting phase called hypnozoite.
• The sexual cycle of malarial parasite actually
starts in the human host by the formation of
gametocytes which are then transferred to
mosquito for further development.
• In the midgut of the mosquito, one
microgametocyte develops into 4 to 8 thread like
filamentous structures named microgamates.

17. Lifecycle:
• From one macrogamate only one microgamate is formed.
• The fertilization occurs, and the gamate is known as zygote.
• The zygotes matures into an ookinete and it further
develops into an oocyst.
• An oocyst mature and it increases in size and a large
number of sporozoites develop inside it.
• The oocyst rupture and releases sporozoites in the body
cavity of mosquito.
• The sporozoites are distributed to different organs of the
mosquito and they have a special predilection for salivary
glands.
• The mosquito is now capable of transmitting the infection
to man.

18. Symptoms of malaria:
Physical findings may
include:
oElevated temperature
oPerspiration
oWeakness
oEnlarged spleen
oMild jaundice
oEnlargement of liver
oIncreased respiration
rate.

19. Symptoms of malaria:
• Other symptoms of malaria are:
• Dry (nonproductive) cough.
• Muscle or back pain or both.
• Enlarged spleen.
• In rare cases, malaria can lead to impaired function of the brain or
spinal cord, seizures, or loss of consciousness.
• Infection with the P. falciparum parasite is usually more serious and
may become life-threatening.
• Symptoms may appear in cycles. The time between episodes of
fever and other symptoms varies with the specific parasite.
Episodes of symptoms may occur:
 Every 48 hours if you are infected with P. vivax or P. ovale.
 Every 72 hours if you are infected with P. malariae. Other common
symptoms of malaria include:

20. Pathogenesis:
• Incubation period: 10-14 days in P. vivax, P.
falciparum and P. ovale but it is 28-30 days in
P. malariae.
• The typical clinical features consists of febrile
paroxysm, anaemia and spleenomegaly.

21. Stages of disease:
• Cold stage
• Hot stage
• Sweating stage

22. Cold stage:

23. Hot stage:

24. Sweating stage:

25. Diagnosis:
• Laboratory - thin, thick smears, antigen capture
EIA, PCR etc.
• Clinical - platelets, regularly intermittent fever
• Other tests:
– CBC:
- Lukopenia, Thrombocytobenia, Esinophilia,
monocytosis, Quntitative buffy coat techniqe,
Urinalysis,Increase ESR

26. .
.
Medical intervention:
Examine blood under microscope
(geimsa stain)
chest x-ray: helpful if respiratory symptoms are
present
CT scan: to evaluate evidence of cerebral edema or
hemorrhage

27. .
Polymerase chain reaction (PCR)
.
-determine the species of plasmodium
Dipstick test
- not as effective when parasite levels
are below 100 parasites/mL of blood
Blood examination:
Thick and thin blood film

28. Thick and thin smear:

29. Treatment:

30. Malaria control protocal:

31. Prevention:

32. .
Insecticides
coil and
spray
Screened
windows &
doors
Insecticides
impregnate
d sites
Protective
clothing
Fishes

33. Malaria project in Nepal:
• The initiation of Malaria control project was
first started in Nepal in 1954 with an objective
to study malaria in Terai belt of central Nepal.
• Currently malaria control activities are carried
out in 65 districts at risk of malaria.