BLOOD PARASITESPLASMODIA/ BABESIA

WINIFREDA U. DE LEON

SPECIES

PLASMODIUM FALCIPARUM

PLASMODIUM VIVAX

PASMODIUM MALARIAE

PLASMODIUM OVALE

PLASMODIUM KNOWLESI

ARTHROPOD -BORNEANOPHELES MOSQUITOES

A. MINIMUS FLAVIROSTRIS

HABITAT IN MAN – RBCHIGH OXYGEN TENSION

COMPONENTS:NUCLEUS (CHROMATIN)CYTOPLASM

ON THE MOSQUITO VECTOR

NIGHT BITER

SLOW FLOWING CLEAN STREAMS

FOOTHILLS

EXOPHAGIC

ZOOPHILIC

FORESTED AREAS- CLEANSLOW FLOWING STREAMS

LIFE CYCLE

SCHIZOGONYASEXUAL MULTIPLICATIONEND PRODUCTS – SCHIZONTS (MEROZOITES)OCCURS IN MAN

GAMETOGONYGAMETOCYTESOCCURS IN MAN

SPOROGONYSEXUAL MULTIPLICATIONEND PRODUCTS – OOCYSTS (SPOROZOITES)OCCURS IN MOSQUITOES

ASEXUAL STAGES

TROPHOZOITESYOUNGEST - RINGFORMSDEVELOPINGMATURE

SCHIZONTSEARLYDEVELOPINGMATURE - MEROZOITES

TROPHOZOITES

SCHIZONTS

RED CELL DEFENSESCELL MEMBRANE

DUFFY Ag NULL – RESISTANCE TO P. VIVAX

HEMOGLOBIN-HEMOGLOBIN S (SICKLE TRAIT) HELPS IN THE SURVIVAL OF PATIENTS FROM P.

FALCIPARUM PRIMARY ACUTE ATTACK -B-THALLASEMIA- IMBALANCED GLOBIN CHAIN PROD’N

OXIDATION BY HEMICHROMES (REACTIVE O2)

G6PD PREVENTS OXIDATION OF THE HEME GROUPDEFICIENCY – GENERATION OF REACTIVE O2

ACCUMULATES IN THE RBCDAMAGES P. FALCIPARUM

VIRULENCE FACTORS

RUPTURE OF SCHIZONTS

RELEASE OF MEROZOITES:

MONOCYTES – TNF (PYROGENIC)

OTHER CYTOKINES

GLYCOSYLPHOSPHATIDYL INOSITOL (GPI)

KNOBS – CYTOADHESION (PfEMP)

HISTIDINE RICH PROTEIN (HRP)

MULTI-ORGAN INVOLVEMENT

GASTRO-INTESTINAL

DIARRHEA, ABD PAIN, NAUSEA, VOMITING, ANOREXIA

RESPIRATORY

DYSPNEA

NON PRODUCTIVE COUGH

FEVER PERIODICITY

COINCIDES WITH RUPTURE OF SCHIZONTS INITIAL INFECTION – ASYNCHRONOUS

AFTER 5- 7 D - SYNCHRONOUSPF – EVERY 40 HOURS

PV & PO - EVERY 48 HOURS PM - EVERY 72 HOURS

PATHO-PHYSIOLOGY

DESTRUCTION OF RED BLOOD CELL (INFECTED/ UNINFECTED)PRODUCTION OF CYTOKINES - TUMOR NECROTIC FACTOR (TNF)

FEVER, HYPOGLYCEMIA, ARDS SEQUESTRATION IN DEEP VASCULATURE OF

INTERNAL ORGANS (RBC RECEPTORS) - INTRACELLULAR ADHESION - VASCULAR ADHESION

HEMATOLOGIC CHANGES

ANEMIA

LEUKOPENIA

THROMBOCYTOPENIA

SUPPRESSED HEMATOPOIESIS

RETICULOCYTES

REDUCED SERUM IRON

DEFECTIVE BLOOD CELL MATURATION

PATHO-PHYSIOLOGYSEVERE MALARIA

HYPOGLYCEMIA LOW SERUM SODIUM

MALABSORPTION (FATS, XYLOSE, VIT B 12 PULMONARY EDEMA CNS DYSFUNCTION ( COMA) ELEVATED BUN, CREATININE,

PROTEINURIA

MALARIA

OCCURS IN TROPICAL/ SUBTROPICAL COUNTRIES

300-500 M CASES ANNUALLY

1.5.-2.7 M DEATHS

10 LEADING CAUSES OF MORTALITY

MALARIA

FIRST FEW DAYS:STEADY LOW GRADE FEVERHEADACHEPHOTOPHOBIAMYALGIAANOREXIANAUSEA/ VOMITING

REGULAR CYCLE

CLASSIC:

CHILLS

FEVER

SWEATING

SPLENOMEGALY

ANEMIA

JAUNDICE

CAUSES OF ANEMIA

HEMOLYSIS

SPENIC REMOVAL OF RBC FROM CIRCULATION

AUTO-IMMUNE LYSIS

DECRASED INCORPORATION OF IRON INTO HEME

BONE MARROW DEPRESSION

MALARIA - PHILIPPINES

65-70% P. FALCIPARUM – MALIGNANT

30% P. VIVAX – BENIGN TERTIAN

1% P. MALARIAE - QUARTAN

FALCIPARUM MALARIA

INVADES ALL AGES OF RBCSEQUESTRATION IN INTERNALORGANS

ISCHEMIALIVER – ABDOMINAL PAINS

JAUNDICELUNGS – PULMONARY EDEMAKIDNEYS - BLACKWATER FEVER-

HEMOGLOBINURIACEREBRAL INVOLVEMENT

COMPLICATED

COMACONVULSIONSHYPOGLYCEMIAACIDOSISRESPIRATORY DISTRESSALGID (CIRCULATORY COLLAPSE,

SHOCK & SEPTICEMIA)HYPER-PARASITEMIA

CEREBRAL MALARIA

VIVAX MALARIA

LESS SEVERE RELAPSES OCCUR AFTER WEEKS OR MONTHS

INVADES ONLY RETICULOCYTES

LOW ALBUMIN/ ELEVATED GLOBULIN

INCREASED SERUM POTASSIUM

MALARIAE MALARIA

INVADES OLDER RBC

LONGER INCUBATION PERIOD

NEPHROTIC SYNDROME – DEPOSITION OF IMMUNE COMPLEXES

LATENT INFECTION FOR MANY YEARS

WHO ARE AT RISK?THOSE IN ENDEMIC PLACES

CHILDRENPREGNANT WOMEN

SPONTANEOUS ABORTION CONGENITAL INFECTIONSLOW BIRTH WEIGHTPRE-TERM DELIVERYPERI-NATAL DEATH

TRAVELERS

BLOOD RECIPIENTS- TRANSFUSION

PHILIPPINES

14.8% AT RISKSOLDIERSFARMERSINDIGENOUS CULTURAL GROUPSMINERSFOREST WORKERS

65/ 79 PROVINCES8TH LEADING CAUSE OF MORBIDITY

SOLDIERS/ FORESTERS

SCOUT RANGERS

LOGGERS

MALARIA FREE

AKLAN GUIMARAS

BILIRAN ILOILO

BOHOL LEYTE

CAMIGUIN LEYTE DEL SUR

CAPIZ N/ SAMAR

CATANDUANES SIQUIJOR

CEBU

HIGHLY ENDEMIC PLACES

PALAWAN

KALINGA-APAYAO

IFUGAO

AGUSAN DEL SUR

DIAGNOSIS

CLINICAL – MIMIC DISEASEGASTROENTERITISPNEUMONIAMENINGITISHEPATITISENCEPHALITISDENGUETYPHOID

TRAVEL Hx

LABORATORY Dx BLOOD SMEARS

THICK/ THINSTAIN WITH WRIGHT’S OR GIEMSA

FLOURESCENT STAINING (QBC)

SEROLOGY: ANTIBODY DETECTION: IFAT

ELISAANTIGEN DETECTION : RAPID DIAGNOSTIC

TESTS (RDT’S)HRP IILDH

PCR

BLOOD SMEARSTHICK/ THIN

TREATMENTNON FALCAPARUM:

CHLOROQUINE ORALUNCOMPLICATED FALCIPARUM

CHLOROQUINE ORALQUININE ORALFANSIDAR (SULFADOXINE PYREMETHAMINE)

PRIMAQUINE – HYPNOZOITES/ GAMETOCYTESCHECK FOR G6PD DEFICIENCY

ARTEMISININ (QINGHAOSU) CO-ARTEM

COMPLICATED MALARIA – HOSPITALIZE (IV MEDICATION)

PROPHYLAXIS – CHLOROQUINEPROGUANIL

P. FALCIPARUM P.VIVAX P.MALARIAE

ASEXUAL 36-40 HRS 48 HRS 72 HRS

DISEASE

INCUBATION

MALIGNANT

8 -11 DAYS

BENIGN

10-17 DAYS

QUARTAN

18-40 DAYS

INFECTED RBC

NORMAL & ENLARGED SIZE

ENLARGED NORMAL SIZE

PIGMENTS MAURER’S

CLEFTS

SCHUFFNER’S

DOTSZIEMANN’S DOTS

P. FALCIPARUM P. VIVAX P.MALARIAE

RINGS 1/5 1/3 1/3

TROPHOZOITES NOT IN THE CIRCULATION

AMEBOID CYTOPLASM

BAND/BASKET

OR BIB FORMS

SCHIZONTS (NO. OF MEROZOITES)

12- 36

AVE-24

NOT IN THE CIRCULATION

12-24

AVE 16

6-12

AVE -8

GAMETOCYTES BANANA

SAUSAGE CRESCENT

SPHERICAL SPHERICAL

PLASMODIUM FALCIPARUMRINGS

PLASMODIUM FALCIPARUM GAMETOCYTES

PLASMODIUM VIVAX

PLASMODIUM VIVAX RINGS

PLASMODIUM VIVAX DEVELOPING TROPHOZOITES

PLASMODIUM VIVAX SCHIZONTS

PLASMODIUM MALARIAE

PLASMODIUM MALARIAE BANDFORM

PLASMODIUM MALARIAE SCHIZONTS

PREVENTION

• Mosquito nets

• Clean clothing

CONTROL

BABESIA- PIROPLASMA

BLOOD PARASITES THAT CAUSESHEMOLYSIS

B. MICROTI - USAB. DIVERGENS - EUROPE

TICK-BORNE – IXODES spp LYME DISEASE

BLOOD TRANSFUSION

BABESIOSIS -PIROPLASMOSIS

MANIFESTATIONSIRREGULAR FEVERS

CHILLSSWEATING

PAIN/ MALAISELETHARGY

SEVERE CASESHEMOLYTIC ANEMIAJAUNDICESHORTNESS OF BREATHHEMOGLOBINURIA

HIGH RISK

IMMUNO-SUPPRESSEDELDERLYCO-INFECTION WITH LYME DISEASE

COMPLICATIONSACUTE RESPIRATORY FAILURECONGESTIVE HEART FAILUREPULMONARY EDEMARENAL FAILURE

DIAGNOSIS

BLOOD SMEAR EXAMINATION

IFAT

ANIMAL INOCULATION - GERBILS

TREATMENT

CLINDAMYCIN ORAL/ IV

WITH QUININE

ATOVAQUONE - ORAL

AZITHROMYCIN - ORAL