Download - Malaria391.53
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UDOM CHAITHONGPh.D. L’POOL
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OBJECTIVES :OBJECTIVES :
TO STUDY TO STUDY MORPHOLOGY MORPHOLOGY
LIFE CYCLE LIFE CYCLE GEOGRAPHICAL DISTRIBUTION GEOGRAPHICAL DISTRIBUTION
EPIDE MIOLOGYPATHOGENICITY
DIAGNOSIS PREVENTION AND CONTROL
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OBJECTIVE :
Human MalariaHuman MalariaPlasmodium malariaePlasmodium malariae (Laveran,1880) (Laveran,1880)
Plasmodium vivaxPlasmodium vivax (Grassi & (Grassi &
Feletti,1890)Feletti,1890)
Plasmodium falciparumPlasmodium falciparum (Welch,1897) (Welch,1897)
Plasmodium ovalePlasmodium ovale (Stephens,1922) (Stephens,1922)ZOONOSIS MALARIAPlasmodium knowlesi
Natural transmission of Plasmodium knowlesi to humansby Anopheles latens in Sarawak, Malaysia 2006
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Geographical DistributionGeographical Distribution
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HISTORY OF MALARIA
INDIA : AYURAVEDA AIR, FIRE , WATER
EARTH ,BREATHMASAGAH IS VECTOR
GREEK : ILIAD (HOMER) “PYRETOS” ANOPHELES (HARMFUL) IS THE VECTOR
CHINA: HUANG TI HEADACHE CHILL FEVER “ YAU MU” QINGHAUSU
THAILAND ‘KASAI” FEVER ,CHILL
EGYPT “ AATA”MOSQUITO IS VECTOR
MALARIA HISTORY
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Geographical DistributionGeographical DistributionP. malariaeP. malariae & & P. vivaxP. vivax Tropical to Temperate Zone
P. falciparumP. falciparum Tropical & Subtropical Zone
P. ovale P. ovale Tropical Africa & Eastern Asia
ThailandThailandP. falciparum > P. vivax > P. malariae > P.ovale
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MORPHOLOGYMORPHOLOGY Base on thin blood film
1. Trophozoite 1.1 Early, young, trophozoite (ring form) -Infected red cell - Enlarge -Multiple infected - Common -Trophozoite - Signet ring -Cytoplasm - Light blue -Chromatin - 1 red dot
Plasmodium vivax
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1.2. Growing Trophozoite Form - Amoeboid Cytoplasm - Light blue Chromatin - Red dot or thread Stippling - Schuffner’s dot Pink dot on cytoplasm Pigment - Fine yellow brown rodlets
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2. Schizont - Early - Chromatin 2 granules
- Growing - Chromatin 4 granules
- Mature- Chromatin12-24merozoites
- Schuffner’s dot - Pink dots
- Pigments - Fine yellow brown
rodlets eccentric mass
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3. 3. GametocytesGametocytes 3.1. Young - Cytoplasm - Light blue with no vacuole - Chromatin - Large piece of red dot - Schuffner’s dot - Pink dots - Pigment - Fine granules yellow brown rodlets
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3.2. 3.2. MicrogametocyteMicrogametocyte (Male gametocyte)Form - Spherical or ovalCytoplasm - Periphery pale blueChromatin - Abundant or diffused pale pinkPigment - Fine yellow brown rodlets
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3.3.3.3.MacrogametocyteMacrogametocyte(Female gametocyte)Form - Spherical or ovalCytoplasm - Deep blueChromatin - Compact eccentric pinkPigment - Coarse yellow brownSchuffner’s dot - Pink dots
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Ring formAmoeboid form
Mature Schizont
Female gametocyte
Male gametocyte
Growing Schizont
WBC
WBC
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Plasmodium malariaePlasmodium malariae1.1.Trophozoite Trophozoite 1.1.1.1. Young , ring formYoung , ring form Infected red cellInfected red cell - Normal - Normal CytoplasmCytoplasm - - Deep blueDeep blue Chromatin Chromatin - Large - Large red red dot dot compact ringcompact ring
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12. . Growi ngtrophozoi te 121. . - . Band form Cytoplasm - Deepblue band across the cell Chromatin - Red dot or thread
122. . - Compact form Cytoplasm - Deepblue compact ring Chromatin - Red dot Stippling Ziemann’s dot ( rare)
123. . Erregular form
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2. Schizont 2. SchizontEarly - 2 red chromatin granules
Growing - 4 red chromatin granules
Late - - 6 1 2 merozoites(mature) ( rosset form ) Pigment Central blackbrownish mass
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3. Gametocyte3. Gametocyte
3.1. Microgametocyte Cytoplasm - Pale blue Chromatin - Abundant or diffused pinkish Pigment - Scattered coarse blackbrownish granules
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3.2. Macrogametocyte
Cytoplasm - Deep blue
Chromatin - Compact or eccentric pink
Pigment - Coarse blackbrownish granules are crealy defined
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Ring form
Band form
Compact form
Mature Schizont
Female gametocyte
Male gametocyte
Female gametocyte
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Plasmodium falciparumPlasmodium falciparum1. Trophozoite Infected red cell - Normal red cell Multiple infected - Very common Cytoplasm - Medium blue Chromatin - Red dot Frequently 2 signet rings 2 chromatins in one ring
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1.2. Growing trophozoite Cytoplasm - Medium blue Chromatin - Red dot Stippling - Maurer’s dot Pigment - Fine black granules
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2. Schizont
Early - 2 red dots chromatin Growing - 4 red dots chromatin Mature - 16-24 merozoites Pigment - Central or eccentric solid fused dark
brownish mass Early ,growing and mature are rarely seen in peripheral blood
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3. GametocyteGametocyte3.1.Microgametocyte Form - Crescent, sausage or banana round end in shape Cytoplasm - Pale blue Chromatin - Central diffused pink Pigment - Dark brownish rodlets
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32. . MacrogametocyteMacrogametocyte
- Form - Form Crescent , sausage banana Crescent , sausage banana pointed end pointed end - Cytoplasm - Cytoplasm Deep blue Deep blue - Chromatin - Chromatin Compact eccentric Compact eccentric red dot red dot - Pigment - Pigment scattered coarse granules scattered coarse granules are clearly defined in dark are clearly defined in dark blackbrownish rodlets blackbrownish rodlets
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Ring form
Female gametocyte
Mature SchizontMale gametocyte
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Double chromatins
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Plasmodium ovale
1. Trophozoite Infected red cell -Enlarge oval red blood cell 1.1. Early , ring Multiple infected - Rare Cytoplasm - Deep blue Chromatin - Large red dot
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12. . Growing Trophozoite
- Cytoplasm Elongate or oval deep blue - Chromatin Red dot or thread - Pigment Fine greenish brown granule - Stippling Schuffner’s dot - Pale bluish dots
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2. Schizont
Early - 2 red dots Growing - 4 red dots Mature - - 612merozoites - Pigment Central or eccentric greenish brown mass
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3.Gametocyte 31. . Microgametocyte
- Form Oval or Tear dorp - Cytoplasm Pale blue - Chromatin Abundant diffuse pinkish - Pigment Fine greenish brown -Schuffner’s dot violet blueish dots
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3 .2 . Macrogametocyte
- Form Oval or Tear dorp - Cytoplasm Deep blue - Chromatin Compact or eccentric red dot - Pigment Greenish brown granules
- Schuffner’s dot violet blueish dots
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Ring form
Female gametocyteMature Schizont
Male gametocyte
Growing Schizont
Young gametocyte
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Plasmodium knowlesi is a primate malaria parasite commonly found in Southeast Asia. It causes malaria in long-tailed macaques (Macaca fascicularis),
and pig-tailed (M.nemestrina) macaques
but it may also infect humans, either naturally or artificially.
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Plasmodium knowlesi is the fifth major human malaria parasite. It may cause severe malaria as indicated by its asexual erythrocytic cycle of about 24 hrs
The known vectors belong to the genus Anopheles
An. latensAn. leucosphyrusAn. hackeriare believed to be the main vector of P. knowlesi
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P . knowlesi in human infection could not easily differentiate with other Plasmodium species, especially for atypical form of P . falciparum and P . malariae .Symptoms typically begin approximately 11 daysafter an infected mosquito has bitten a person andthe parasites can be seen in the blood between 10 – 12 days after infection. The parasite may multiply rapidly resulting in very high parasite densities that may be fatal.
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1.Double chromatine in red cell ( PF)2.Mature shizonts have 8-16 merozoites (PM)3.Band form (PM)
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LIFE CYCLELIFE CYCLE1. EXOGENOUS PHASEEXOGENOUS PHASE OR MOSQUITO PHASE SEXUAL CYCLE OR SPOROGONY ANOPHELES MOSQUITOESANOPHELES MOSQUITOES2. ENDOGENOUS PHASEENDOGENOUS PHASE OR HUMAN PHASE ASEXUAL PHASE OR SCHIZOGONY -A. EXO-ERYTHROCYTIC SCHIZOGONY
-B. ERYTHROCYTIC SCHIZOGONY
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ENDOGENOUS PHASEENDOGENOUS PHASEA. EXOERYTHROCYTIC A. EXOERYTHROCYTIC SCHIZOGONYSCHIZOGONY SPOROZOITES
BLOOD CERCULATION
PARENCHYMAL CELL
EXOERTHROCYTIC SCHIZOGONY HYPNOZOITES OR DORMOZOITES(TISSUE SCHIZOGONY)
EXOERYTHROCYTIC MEROZOITES
BLOOD CERCULATION
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B. ERYTHROCYTIC SCHIZOGONYB. ERYTHROCYTIC SCHIZOGONYEXOERYTHROCYTIC MEROZOITES
RED BLOOD CELL
TROPHPZOITES
TROPHOZOITE
SCHIZONT
ERYTHROCYTICMEROZOITES
ASEXUAL CYCLE
YOUNG GAMETOCYTE
GAMETOCYTE
MICROGAMETOCYTEMACROGAMETOCYTE
SEXUAL CYCLE
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EXOGENOUSEXOGENOUS PHASEPHASEMACROGAMETOCYTE MICROGAMETOCYTE
MACROGAMETE MICROGAMETE
ZYGOTE( EXFLAGELATION )
OOKINETEPENETRATE TO MIDGUT WALL
OOCYST
SPOROZOITES
SPOROZOITES IN SALIVARY GLANDS
HUMAN
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Exogenous phase
Endogenous phase
Mosquito phase
Human phase
2 อาทิ�ตย์ ทิ� 25o C ต��า กว่�า 16o C จะไม่�เก�ด
Sporogony ในม่าลาเรีย์ ทิ�กชน�ด
Incubation period
PV 13 ( 12-17 )PO 17 ( 16-18 )PF 12 ( 9-14 )PM 28 ( 18-40 )
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CLINICAL FEATURES AND PATHOLOGYTHE CHARACTERISTIC FEATURE
OF MALARIA IS FEVERIT USUALLY OCCURS IN THREE STAGE
AS FOLLOWS:1. COLD STAGE ; 15 - 60 Min.2. HOT STAGE ; 2 - 6 Hrs.3. SWEATING STAGE
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1. Cold stage : characterized by
- Rigor and headache
- Patients feel cold and shiver even
though their temperature are rising
- The skin pale and cyanotic
- Take 15 -60 Min.
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2. Hot stage.
The temperature rise to its maximum.
Severe frontal headache
Often vomiting and diarrhea
The skin becomes flushed
Take 2 - 6 Hrs.
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3. Sweating stage
The patient starts to sweat profusely and
usually begins to fell better.
Weak and exhausted and tend to asleep
The temperature is normal, headache and
other pains are relive until the next rigor
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Plasmodium vivax
P. ovale
Benign tertian malaria
Ovale tertian malaria
PERIODICITYPERIODICITYP. vivax 48 Hrs.P. falciparum 36-48 Hrs.P. ovale 48 Hrs.P. malariae 72 Hrs.
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Plasmodium malrariaeQuartian
malarai
..P. vivax 48 Hrs.P. falciparum 36-48 Hrs. P. ovale 48 Hrs.P. malariae 72 Hrs..
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Plasmodium falciparumMalignant tertian malaria
P. vivax 4 8 Hrs.
P. falciparum- 3648 Hrs.
P. ovale 48 Hrs.
P. malariae 7 2 Hrs.
P.knowlesi 24 Hrs.
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หญิ�งอาย์� 36 ปี ม่อชพหาของปี#า ม่อาการีไข$ว่%นเว่$น สองว่%นหนาว่ส%�นตาม่ด$ว่ย์ รี$อน และเหง(�อออก ตรีว่จเล(อดพบ เช(*อม่าลาเรีย์ อาการีทิ�ผู้,$ปี#ว่ย์เก�ดอาการีหนาว่ส%�นเก�ดจาก
A. เช(*อรีะย์ะ TrophozoitesB. เช(*อรีะย์ะ gametesC. เช(*อรีะย์ะ schizontsD. เช(*อรีะย์ะ merozoitesE. เช(*อรีะย์ะ sporozoites
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ชาย์ 18 ปี อาชพน%กเรีย์น ม่อาการีปีว่ดห%ว่ ม่ไข$ ช%ก หนาว่ส%�น คล(�นไส$อาเจย์น ทิ$องรี�ว่งถ่�าย์เปี/นน�*าสน�*าตาล ปีฏิ�เสธการีเข$าปี#าสว่น น�*าตก แรีกว่�น�จฉั%ย์ Gastroenteritis e sepsis ตรีว่จเล(อดพบเช(*อม่าลาเรีย์ชน�ด falciparum การีรี%กษาเบ(*องต$นใดทิ�เหม่าะสม่1 ให$ก�นย์า antimalarial ทิ%นทิ2 .ให$ก�นย์า antimalarial ชน�ดใหม่�พรี$อม่ tetracycline3.ให$ก�นย์า antimalarial และให$กล%บบ$านได$4 .ให$ blood glucose พรี$อม่ให$ antimalarial ทิาง IV5.ให$ก�นย์า antimalarial และเฝ้5าด,อาการีอก - 5 7 ว่%น
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ชาย์อาย์� 35 ปี อาชพทิหารี ได$ไปีลาดตรีะเว่นในปี#าทิ�กาญิจนบ�รี หล$งออกจากภารีก�จ พบว่�า ม่ไข$หนาว่ส%�น 3 ว่%น ต%บโตเล8กน$อย์ ตรีว่จ Peripheral blood smear พบว่�าม่ ring form ทิม่ double chromatin, multiple infection ผู้,$ปี#ว่ย์ได$รี%บเช(*อชน�ดใด
A. Plasmodium falciparumB. Plasmodium ovaleC. Plasmodium vivaxD. Plasmodium malariaeE. Plasmodium vivax และ P malariae
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ชาย์ 36 ปี ม่อาการีไข$หนาว่ส%�นทิ�กว่%น ตรีว่จเล(อดพบเช(*อม่าลาเรีย์ ซึ่:�งน�าโดย์ย์�งพบว่�าในปีรีะเทิศไทิย์เปี/นชน�ด1 .Aedes2.Mansonia3.Anopheles4.Culex5.Amigeris
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ชาย์อาย์� 38 ปี ม่าตรีว่จทิ�รีพ.เน(�องจากม่ไข$หนาว่ส%�นทิ�กว่%น ปีว่ดห%ว่ เหง(�อออกและอ�อนเพลย์ ม่า 4 ว่%นบ$านของผู้,$ปี#ว่ย์อย์,�ชานเม่(องกรี�งเทิพฯ 2 เด(อนก�อนผู้,$ปี#ว่ย์ได$ไปีจ%บล�งในปี#าทิ�จ.จ%นทิบ�รีและได$พ%กอย์,�ทิ�น%�นอย์,�นาน 2 ส%ปีดาห เพ��งกล%บบ$านเม่(�อ ว่%น10ก�อนม่ไข$ T 38.5°C, pulse rate 90 / min . Lab: Hemoglobin s 14.0 g/dL, hematocrit 40%, WBC count 5,500 cells/μL,platelet count 90,000/μL. เจาะเล(อดย์$อม่สพบ
ว่�น�จฉั%ย์ผู้,$ปี#ว่ย์เปี/นม่าลาเรีย์ชน�ดใด 1.Plasmodium malariae2.Plasmodium falciparum3.Plasmodium knowlesi4.Plasmodium ovale5.Plasmodium vivax