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Lecture originally from University of Warwick Medical Student website adapted by Siobhan Quenby Professor of Obstetrics

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Yeasts vs Moulds Single cell Reproduce by budding Identify using biochemical tests tubular structures called hyphae grow by branching and longitudinal extension. and dimorphic fungi

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Yeasts: Candida sp.

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Mucocutaneous candidiasis

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Protozoa

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Unicellular, simple eukaryote Broad range of diseases

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Plasmodium sp. Malaria Giardia sp. Diarrhoea Leishmaniasis Cutaneous and systemic infections Amoebiasis Dysentery, liver abscess Trypanomonisasis Sleeping sickness, Chagas disease

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Leishmaniasis

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Malaria

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Malaria and pregnancy

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WHO malaria in pregnancy

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Malaria in pregnancy sulfadoxine-pyrimethamine (SP)

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Insecticide treated nets

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Arnold Mkandawire

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Felix Simbeye

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Lenard Gama

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Malaria Life Cycle Life Cycle of Plasmodium vivax

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Malaria Pathology : Sepsis Sepsis due to Malaria

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Malaria Pathology : Haemolysis Jaundice due to Malaria

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Malaria Pathology : Sequestration Erythrocyte Sequestration due to Falciparum Malaria

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Malaria Symptoms & Signs Benign + Falciparum Malaria : hot + cold sweatsheadache arthralgia + myalgiadiarrhoea + vomiting hepatosplenomegalyanaemia Falciparum Malaria only : hypoglycaemiacoagulopathy haemorrhageseptic + hypovolaemic shock renal failurerespiratory failure cerebral malaria = various CNS features that lead on to consciousness / fits / coma / death

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Malaria Investigations (Blood Films) Thick & Thin Blood Films

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Malaria Investigations (Blood Films) Thick & Thin Blood Films

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Malaria Investigations (Blood Films) Malaria Parasites at Various Stages

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Malaria Investigations (Malaria Antigen Tests)

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Negative Non-Falciparum Falciparum or Mixed

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Malaria Treatment Supportive treatment & management of sepsis Benign Malaria chloroquine 600 mg then 300 mg after 8 hours then chloroquine 300 mg daily for another 2 days followed by primaquine 15 mg for 14 days to eradicate Falciparum Malaria quinine 600 mg (or 10 mg/kg if IV) every 8 hours for 7 days followed by doxycycline 200 mg daily for 7 days to eradicate alternatives are :malarone (4 tablets daily for 3 days) riamet (4 tablets at 0, 8, 24, 36, 48 & 60 hours)

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Malaria Supportive Management Complicated falciparum malaria should be treated in an ITU / HDU Monitor :Glasgow Coma Scale / AVPU score temperature heart rate blood pressure (invasive CVP monitoring) respiratory rate (urine output / fluid balance) blood glucose FBC (Hb + platelets) clotting tests renal function chest radiograph

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Malaria Supportive Management May also include : nasogastric tube ventilation if GCS < 8 treat seizures + continue anti-convulsants reduce temperature with tepid sponging + paracetamol optimise fluid balance (CVP +5 to +10) + maintain urine output treat pulmonary oedema sit upright / high % oxygen / IV diuretic consider haemofiltration / venesection treat hypoglycaemia + continue 10% glucose infusion transfuse if Hb < 7 g/dl or haematocrit < 20% (with frusemide cover) transfuse if platelets < 20 x 10 9 / litre + signs of bleeding consider clotting factors (FFP) if DIC develops consider haemodialysis if ARF develops

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Treatments Malaria Quinine, artesunate, chloroquine Giardiasis Metronidazole Leishmaniasis Amphotericin B

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Helminths

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Most prevalent human infection Multicellular Usually life cycle involving more than one host with an egg, larval and adult stage

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Helminths Round worms Nematodes Tape worms Cestodes Schistosomiasis Trematodes

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Roundworms : hookworm 10% worlds population Can cause iron deficiency anaemia

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Roundworms: Enterobius

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Tapeworms Taenia sp.

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Tapeworms: Taenia sp.

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Neurocysticercosis

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Schistomomiasis

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Katayama fever

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Schistosomiasis

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Cutaneous larva migrans

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Treatments Hookworms Mebendazole Albendazaole Schistosomiasis/ tapeworms Priziquantel

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Parasite resources http://dpd.cdc.gov/dpdx/html/Para_Health.h tmhttp://dpd.cdc.gov/dpdx/html/Para_Health.h tm