17 Malaria (2014).ppt - MALARIA TRAVEL MEDICINE DR AWADH...

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DR. AWADH AL-ANAZI 1435-2014 MALARIA & TRAVEL MEDICINE
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EDUCATIONAL OBJECTIVES EDUCATIONAL OBJECTIVES At the end of this lecture students are expected to know: Epidemiology Clinical presentation Risk to travelers Malaria and pregnancy Diagnostic work up Treatment
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ETIOLOGY ETIOLOGY 4 plasmodia: P. Falciparum P. Vivax P. Ovale P. Malariae
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EPIDEMIOLOGY EPIDEMIOLOGY Endemic disease Usually does not occur at altitudes – 1500 m World wide ease of travel Most important parasitic disease of humans Transmitted in over 100 countries Affecting more than 3 billion people world wide Causing 1-2 billion deaths per year
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PATHOGENESIS PATHOGENESIS P.F. invades RBC at all ages - 10 6 2500/mcl · P. Mal: only old RBC – 10,000/mcl P. ovale and P. vivax invade young RBC’s. · Microvascular patholody: secondary Ischemia Adherence of non-deformable parasitezed RBC to endothelium · Renal failure: hemalysis, Ischemia secondary microvascular pathology · Deep Coma: hypoglycemia, microvascular adherent parasitized RBC · Pulmonary edema; 2 o: Capillary leak Synd (without C.C.F.) · Immune complex Neph. Syndrome 2 o P. Malariae
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C L I N I C A L FEATURES CF vary with: Geography Epidemiology Age High risk includes Children Pregnant women Non-immune travelers to malarious areas
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INCUBATION PERIOD Sporozoites reach the liver within 1-2 hours following female Anopheles mosquito bite. Pt. asymptomatic for 12-35 days until RBCs stage of parasite life cycle.
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Life Cycle
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C L I N I C A L F E A T U R E S 1) 1) Major Major · Recurring fevers · Chills (Assoc. RBC lysis mature zchisonts ) 2) 2) Periodicity S/O Periodicity S/O · 48 hours: P. Vivax & Ovale · 72 hours: P. Malaria · Non-regular/hectic in P.F. especially in non- immune Patients ( who are at highest risk of complications and death)
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C L I N I C A L F E A T U R E S C L I N I C A L F E A T U R E S 1) 1) Severe P.F. ( Severe P.F. ( > > 10 parasite/ mcl): AC 10 parasite/ mcl): AC Complications Complications · Renal failure · Coma 2 o: hypoglc; TNF, or microvascular pathology · Pul. Edema · Thombrocytopenia · G. Enteritis – especially diarrhea · Ch. P. Falcuparum infection Splenomegaly typically resolves after treatment with anti-malarial meds. 6-12 mon. · P. Malariae assoc. Immune compl. N. Synd. · P. Vivax – late splenic rupture with trauma 1-3 mon. after initial infection
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MALARIA FEVER PAROXYSMS MALARIA FEVER PAROXYSMS Rigors, headache Rigors, headache associated with pale cold associated with pale cold skin skin (1-2 hours) Delirium, Delirium, Tachypnoea, Tachypnoea, Hot Skin Hot Skin (Several hours) (Several hours) Fever Fever Marked sweating and Marked sweating and fatigue fatigue Patient often symptoms free between paroxysms
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DIAGNOSIS DIAGNOSIS Detailed targeted history including travel hx and clinical examination together with: High Index of Suspicion (HIS)
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DX: Blood film stained with DX: Blood film stained with · Giemsa stain or wright · Giemsa stain or wright s stain s stain
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