Malaria By: Dorthea Beecroft Emetu Onuma Danielle Kiss

MalariaMalaria

By: Dorthea BeecroftEmetu Onuma

Danielle Kiss

MalariaMalaria

Malaria is a mosquito-borne infectious disease of humans caused by eukaryotic Protista of the genus Plasmodium.

It is widespread in tropical and subtropical regions, including much of Sub-Saharan Africa, Asia, and the Americas.

The disease results from the multiplication of malaria parasites within red blood cells, causing symptoms that typically include fever, chills, and headache.

Malaira (Cont.)Malaira (Cont.)

Four species of Plasmodium can infect and be transmitted by humans.

Malaria caused by Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae is a generally milder form of the disease that is rarely fatal.

Malaria caused by Plasmodium falciparum is the severest form of malaria.

History of MalariaHistory of Malaria

Malaria has infected humans for over 50,000 years, and Plasmodium may have been a human pathogen for the entire history of the species.

References to the unique periodic fevers of malaria are found throughout recorded history, beginning in 2700 BC in China.

History Of Malaria (Cont.)History Of Malaria (Cont.)

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”.

The term malaria originates from Medieval Italian: mala aria ”bad air”. The disease was formerly called ⎼ ague or marsh fever due to its association with swamps and marshland.

History Of Malaria (Cont.)History Of Malaria (Cont.)

Malaria was once common in most of Europe and North America, where it is no longer endemic, though imported cases so still occur.

Past EpidemicsPast Epidemics

Since Malaria has been around since before recorded history, the list of epidemics would be much too long to be contained here. Therefore, only a few will be mentioned starting with some of the most recent.

Some of the recent epidemics are that of the northern Iraq and southern Turkey (1993-1995)

Tajikistan (1993-1994)

Past Epidemics (Cont.)Past Epidemics (Cont.)

Azerbaijan (1993-1993) northwestern India (Rajasthan; 1995-1996) southern and east Africa (1996). Valid statistics are not available for these epidemics

because many cases went unreported because most of the epidemics took place in rural areas where medical attention was either unavailable or too expensive.

In Africa, a child dies every 45 seconds due to malaria and its complications.


Southeastern Turkey (1977-1978) caused about 270,000 cases.

Indian subcontinent (1976-1977) caused over 7 million cases.

Sri Lanka in 1968 caused 1.5 million cases.


Hurricane Flora disrupted an ongoing malaria eradication program in Haiti in 1963 and caused 75,000 new cases to erupt.

Ethiopia (1958) caused more than 3 million cases and 150,000 deaths.

What Causes MalariaWhat Causes Malaria

P. falciparum is the most common cause of infection and is responsible for about 80% of all malaria cases, and is also responsible for about 90% of the deaths from malaria.

Most uninfected people contract the disease after having been bitten by the female Anopheles mosquito that is carrying the parasite in her saliva.

In many undeveloped countries, infection can also be spread through the sharing needles with an infected person or through unscreened blood transfusions.

Incubation PeriodsIncubation Periods

The incubation period is defined as the time between initial infection and when the symptoms first appear.

After the initial infection, the incubation stage can last from as little as seven days up to four weeks depending on which Plasmodium parasite the host is infected with, the strength of the host’s immune system, and the type of antimalarial drugs that are used.

In some cases, the incubation period can last as long as several years.

Incubation Periods (Cont.)Incubation Periods (Cont.)

Plasmodium malariae produces a form of malaria that is rare and quite benign. It produces little discomfort which is a good thing because there have been reported cases of this form lasting for up to thirty years!

Plasmodium falciparum, the severest and most fatal form of malaria has been reported to develop within three months of leaving the malarial region.

Plasmodium vivax and Plasmodium ovale have been reported to appear up to 22 months after initial infection.

Incubation Periods (Cont.)Incubation Periods (Cont.)

The strength of the host’s immune system largely depends on his overall health and nutrition.

Many people that develop malaria have very poor nutrition especially in countries that are undeveloped, underdeveloped, or going through civil unrest.

Mode of TransmissionMode of Transmission

The Plasmodium parasite is mainly transferred to a human host by means of a mosquito bite.

Only the female Anopheles mosquito can contract and transmit the parasite that causes malaria because only the female feeds on blood to nourish her eggs.

There are about sixty species of this mosquito.

Mode of Transmission (Cont.)Mode of Transmission (Cont.)

In many undeveloped countries, infection can also be spread through the sharing needles with an infected person or through unscreened blood transfusions.

Only the asexual parasite is transferred by this method and there is no development in the liver. The incubation period is shorter and relapses do not occur.

The Life Cycle of The Life Cycle of PlasmodiumPlasmodium

The malaria parasite has three to four different stages that occur in two different phases and locations in a cycle that moves it from the mosquito to the human and then from the human back to the mosquito. Since this is the case, we will begin with the stage in which the parasite enters the human body.

The Life Cycle of The Life Cycle of Plasmodium Plasmodium (cont.)(cont.)

Phase one, stage one: is the asexual stage that begins when an infected mosquito

bites a human and the sporozoites enter the body through the saliva of the mosquito.

Within 30 minutes, the sporozoites that survive the body’s immune system move through the blood to the liver where they enter the liver cells and undergo development to form schizonts and multiply.

Over the next five to fifteen days, the schizonts mature, rupture the liver cells and invade the blood as merozoites.


Phase one, stage two: Merozoites bond to red blood cells, penetrate them and

then develop as ring forms and grow into trophozoites. During this stage, the trophozoites divide further and

create red blood cell merozoites, which form mature schizonts.

The red blood cells then rupture, releasing the merozoites into the blood stream to attack more red blood cells.


Phase one, stage three: Not all of the red blood cells rupture to release merozoites. The merozoites that are not released into the blood

develop into male and female gametocytes and are transferred back to the next mosquito that takes a blood meal.


Phase two, stage four: this is considered the sexual cycle. The male and female gametocytes travel to the gut of the

mosquito in the blood that it has ingested and there they fuse together to form an oöcyst.

The oöcyst then bursts; releasing sporozoites that migrate to the salivary glands, ready to be injected back into a human host.

Vectors and Reservoir Hosts of Vectors and Reservoir Hosts of MalariaMalaria

Humans who are partially immune to malaria appear to be the reservoir host.

The more than sixty species of Anopheles mosquito is the vector for human malaria and their distribution varies from country to country.

They are both vectors as well as intermediate hosts for the Plasmodium parasite.

Malaria DistributionMalaria Distribution

During the 1980’s and 1990’s, the incidence of malaria increased in Africa.

The reasons for this increase were resistance to commonly used antimalarial drugs, the deterioration of primary health services in many areas and the emerging resistance of mosquitoes to insecticides used for vector control.

Malaria Distribution (Cont.)Malaria Distribution (Cont.)

During the past decade, malaria also increased in intensity in Southeast Asia after interruption of eradication efforts and re-emerged in several Central Asian and Transcaucasian countries

90% of malaria cases appear in South Africa and south of the Sahara. 6.7% of malaria cases appear in Brazil, Columbia, India, Solomon

Islands, Sri Lanka, and Vietnam. 3% of malaria cases appear in other countries.

Morbidity and MortalityMorbidity and Mortality

The World Health Organization estimates that there are some 300 to 500 million clinical cases annually, resulting in approximately 1.5 to 2.7 million deaths annually.

90% of the deaths that occur from malaria are in children under five years of age living in sub-Saharan Africa.

Morbidity and Mortality Morbidity and Mortality (Cont.)(Cont.)

Other high-risk groups include pregnant women, internally displaced people, refugees, and international travelers.

Malaria in pregnancy can have devastating effects, especially when caused by P. falciparum. In non-immune pregnant women, malaria infections can lead to increased risk of maternal and fetal death. Among semi-immune pregnant women, low birth weight due to placental parasitemia represents the greatest risk factor for neonatal death.

Morbidity and Mortality Morbidity and Mortality (Cont.)(Cont.)

People with the sickle cell trait are usually resistant to malaria, although the exact mechanism of how sickle cell anemia safeguards against malaria is unknown.

It is interesting to note that the high incidence of sickle cell anemia can be found mainly in the regions where Malaria is most prevalent.

Sickle cell anemia in African-Americans is less of a health factor than it once was because they seldom come in contact with malaria and their genetics are changing to exclude the genes for sickle cell anemia.

People that survived their first bouts with malaria as children, often grow to have a much stronger resistance than those adults that contracted the disease as adults.

Clinical Disease and Diagnosis and Clinical Disease and Diagnosis and Symptoms of MalariaSymptoms of Malaria

The clinical presentation of malaria is very nonspecific. The degree of natural and acquired immunity of the patient can influence the clinical course dramatically.

Classic symptoms among non-immune persons include: fever chills Sweats body aches Headache decreased appetite Nausea Vomiting diarrhea.

Clinical Disease and Diagnosis and Clinical Disease and Diagnosis and Symptoms of Malaria (Cont.)Symptoms of Malaria (Cont.)

Malaria is also cyclical in nature and begins with a sudden coldness followed by rigor and then fever and sweating lasting four to six hours, and recurring every two days in P. vivax and P. ovale infections, and every three days in P. falciparum infections.

Signs of malaria infection may include an enlarged liver and spleen, anemia, jaundice, low blood pressure, fast heart rate, and decreases in the number of white blood cells and platelets.


Children may also show fretfulness, unusual crying, and sleep disturbances.

Malaria can lead to a number of physical consequences as well as coma and death. These consequences are especially prevalent in pregnant women and/or children.

For reasons that are poorly understood, but that may be related to high intracranial pressure, children with malaria frequently exhibit abnormal posturing, a sign indicating severe brain damage.


Malaria has been found to cause cognitive impairments, especially in children. It causes widespread anemia during a period of rapid brain development and also direct brain damage. This neurologic damage results from cerebral malaria to which children are more vulnerable.

Cerebral malaria is associated with retinal whitening, which may be a useful clinical sign in distinguishing malaria from other causes of fever.

Over the longer term, developmental impairments have been documented in children who have suffered episodes of severe malaria.


Some of the other consequences of malaria include: Splenomegaly- enlargement of the spleen. Hepatomegaly- enlargement of the liver. Hemoglobinuria with renal failure- a.k.a. blackwater fever

attributed to malaria, it occurs when hemoglobin from lysed red blood cells leaks into the urine.


Cerebral ischemia- temporary deficiency of blood flow to the brain.

Hypoglycemia- low blood sugar. Severe headache. Life-threatening disease generally occurs only with P.

falciparum infections and can progress from uncomplicated malaria within hours.


Neurologic manifestations are the most common presentation of severe disease, often appearing as altered mental status, drowsiness, coma, or convulsions.

Other important severe clinical conditions include renal failure, pulmonary distress, severe anemia, low blood sugar, and shock.

Due the nonspecific nature of malaria symptoms, the diagnosis cannot be made based on clinical signs and symptoms alone. Laboratory diagnostic tests must be performed on any patient suspected of having a malaria infection.


The standard for diagnosing malaria is the microscopic visualization of parasites in red blood cells on Giemsa-stained thick and thin smears.

Advantages of microscopy include high sensitivity and specificity among properly trained and supervised technicians.

Microscopy also offers the ability to identify the infecting species and quantify the level of parasitemia.

TreatmentTreatment

To decrease morbidity and mortality from malaria infections, early diagnosis and prompt treatment with an efficacious drug are important.

Unfortunately, due to the increasing spread and intensification of drug resistance, there are a limited number of drugs available to prevent and treat malaria.

Treatment (Cont.)Treatment (Cont.)

Chloroquine has long been the mainstay first-line therapy for uncomplicated P. falciparum infection used by malaria control programs; however, resistance to it now exists in most parts of the world.

Chloroquine is also the main drug used for infections with P. vivax, P. ovale, and P. malariae; however, there are reports of Chloroquine-resistant P. vivax in parts of Oceania.

Treatment (Cont.)Treatment (Cont.)

Primaquine is used to eliminate the hypnozoites in P. vivax and P. ovale infections.

Sulfadozine-pyrimethamine (SP) has replaced Chloroquine in many countries however; resistance to SP has developed in Southeast Asia, parts of South America, and now in certain sites in sub-Saharan Africa.

Other drugs commonly used for falciparum infections include quinine, quinidine, amodiaquine, mefloquine, halofantrine, artemisinin compounds, atovaquone, tetracycline, and clindamycin.

Control MeasuresControl Measures

Four basic elements of an effective malaria control program include case management, selective and sustainable preventive measures, early detection of epidemics, and the strengthening of local capacity.

Appropriate case management is imperative to malaria control programs and it consists of early, accurate diagnosis followed by rapid, effective treatment. The detection of malaria in children and pregnant women is especially important.

Control Measures (Cont.)Control Measures (Cont.)

Knowledge of mosquito behavior and relevant environmental, social, and economic features is extremely important for malaria prevention programs.

These programs often consist of personal protection (e.g., repellents, insecticide-impregnated bed-nets), chemoprophylaxis (chemical agent to prevent malaria) for travelers or other high-risk persons, and selective mosquito control (e.g., insecticides, larvicides, environmental management).


Malaria epidemics can occur when a community with little or no immunity moves into an area of intense malaria transmission.

Epidemics often take place in times of socio-political instability (e.g., complex humanitarian emergencies). These may result in high numbers of deaths.

To be able to control transmission, malaria-endemic countries need to integrate control efforts into the national health plan, strengthen in-country scientific capacity to perform malaria research, and mobilize community support for intervention programs.


There is hope on the horizon for a vaccine that is being studied in young children. As of February 2010, at least one vaccine that was tested in Mali showed some promise by boosting the immune system in young children to the immune levels found in adults that had built up immunity to malaria through a lifetime of infections.

There are several other vaccines that are in different phases of testing in Africa and other countries where malaria is endemic.

ReferencesReferences

. www.aarogya.com/index.php?...mode...transmission...malaria... www.ajtmh.org/cgi/content/full/71/2_suppl/55 - Similar www.dosomething.org/tipsandtools/11-facts-about-malaria www.epicdisasters.com/.../the_worst_outbreaks_of_disease kidshealth.org › Parents › Infections www.rbm.who.int/wmr2005/html/exsummary_en.htm www.rollbackmalaria.org/docs/najera_epidemics/naj1.htm malaria.wellcome.ac.uk › Resources › Malaria at a glance - Cached - Similar www.maha-arogya.gov.in/diseasesinfo/malaria/agent.htm www.nature.com › Journal home › Archive › Rev www.ncbi.nlm.nih.gov/books/NBK3766/ www.netdoctor.co.uk/travel/diseases/malaria_disease.htm Listen Pub Med Health. Malaria. May 30, 2009. http://www.ncbi.nlm.nih.gov/pubmedhealth/pmh0001646/ Wikipedia. Malaria. March 13, 2011 http://en.wikipedia.org/wiki/malaria Science Daily. New Malaria Vaccine Is Safe and Protective in Children, Scientists Find. February 6, 2010

http://www.sciencedaily.com/releases/2010/02/100203201425.htm Malaria and the Red Cell. January 26, 2011 http://sickle.bwh.harvard.edu/malaria_sickle.html Dartmouth Undergraduate Journal of Science. Shelter from the Swarm: The Malaria-Sickle Cell Connection.

January 26, 2011 http://djus.dartmouth.edu/fall_2004/shelter-from-the-swarm-the-malaria-sickle-cell-connection

Centers for Disease Control and Prevention. http://www.cdc.gov/malaria/about/index.html

Photo ReferencesPhoto References

D76PD00Z.jpg, 400 × 300 - Buy Close-up of Anopheles Mosquito Larvae and Pupae in Several Stages of ...art.wildlife-pictures-online.com

Malaria red.jpg, 589 × 598 – Malaria, biology.ccsu.edu mosquito‑797295.jpg, 1200 × 951 - Infection: Malaria, nursewriter.com malaria‑plasmodium‑falciparum.jpg,346 × 431 - Plasmodium falciparum...www2.cedarcrest.edu malaria%2520plasmodium.jpg, 208 × 180 - PLASMODIUM MALARIAE joomla.flyingbaer.de 2422374280_118e0a2d87.jpg, 500 × 372 - Creepy Green Swamp. Natureland Park, Walworth County, Wisconsin, flickr.com places affected by malaria.gif, 730 × 451 - Where is Malaria found? smeds.org turkey.gif, 525 × 423 - Turkey Malaria Map. Back to Turkey. Turkey Malaria Map. back to top. fitfortravel.scot.nhs.uk Africa Malaria.gif, 347 × 391 - Map of Malaria Areas in Africa. thesafaricompany.co.za getresource.axd, 525 × 652 - Sri Lanka. surgerydoor.co.uk track.gif, 640 × 512 - Hurricane Flora being the standout with 7000+ dead in Tobago, Haiti, ...wunderground.com malaria_special‑150x123.jpg, 150 × 123 - The National Malaria Control Programme (NMCP), has insisted that chloroquine ... kmca-

ngo.org rosette2.jpg, 246 × 201 - Scanning electron micrograph of a P. falciparum rosette (courtesy, biology.ed.ac.uk plasmodium_1.jpg, 196 × 250 – plasmodium. tulane.edu 081008151314‑large.jpg, 500 × 354 - Blood infected with Plasmodium vivax.sciencedaily.com ts, 619 × 417 - Plasmodium vivax, ask.com indian‑poverty.jpg, 425 × 340 - indian-poverty.jpg. moonbattery.com Transfusion+Comic.jpg, 297 × 300 - During our discussion, a number of topics related to anemia, hemorrhage and transfusions

came up. We talked briefly about the TRICC trial published in the .. morningreporttgh.blogspot.com Malaria_LifeCycle.gif, 543 × 435 - Life cyle of Plasmodium ...dpd.cdc.gov Plasmodium_sporozoites.jpg, 320 × 240 - Plasmodium vivax, sporozoite in culture; 900x. ww2.sjc.edu

Photo References (Cont.)Photo References (Cont.)

MalariaLifeCycle02.gif, 435 × 363 - ... CBU MIRT Program, at [email protected] , or Dr. Janet McCord, ... cbu.edu Merozoites.jpg, 300 × 364 - Into male and sporozoites of achieves the formation of eimeria Second merozoite into male and erythrocytes by plasmodium Sporozoites of

merozoite is an ...lyrics.musicdoze.com med‑9780199204854‑graphic070802007.jpeg, 1280 × 770 - Dissected Plasmodium falciparum oocysts on gut wall of mosquito. otm.oxfordmedicine.com Mosquito_bw.GIF, 485 × 283 - The mosquito is a common flying insect that is found around the world. enchantedlearning.com Malaria_Endemic_Areas_WHO.jpg, 500 × 368 - Malaria Endemic Areas WHO April 2010. > handbook.muh.ie Malaria‑world 2010‑11 b.jpg, 4770 × 3182 - ... for malaria drug prophylaxis by area, based on the data of the World ... itg.be malaria2.gif, 314 × 266 - Malaria death rates have begun climbing again. mosquito-netting.com red‑blood‑cells‑sickle‑cells.jpg,306 × 226 - health.allrefer.com Symptoms‑signs‑Malaria.png, 565 × 599 - Symptoms Of Malaria: ... howshealth.com tumblr_lak8n50gnk1qa7k1c.jpg,160 × 174 - ... enlarged liver and spleen, anemia, painful osteoprosis and bone lesions, ... white-coat.tumblr.com malpregbox.gif, 391 × 280 - ... component of malaria Malaria in Pregnancy control during pregnancy. maqweb.org malariabrain.jpg, 500 × 338 - Photo 6: A brain affected by cerebral malaria. davidson.edu Blood_cells_normal_and_damaged_.jpg, 691 × 324 - materialsviews.com Cerebral Infarction.jpg, 1000 × 750 - cerebral ischemia. faculty.virginia.edu afp20071001p987‑f2.jpg, 270 × 326 - Chest radiograph of an infant with respiratory distress syndrome of the ... aafp.org 5905_lores.jpg, 370 × 243 - This Giemsa stained slide. idshowcase.lshtm.ac.uk pills.jpg, 350 × 233 - Malaria Drugs: Several Choices. toolkit.bootsnall.com chloroquine‑7130.jpg, 200 × 258 - Metabolic Syndrome Could Be Treated With Chloroquine, health-news-blog.com sulfadoxine_pyrimethamine_fansidar_500_25.jpg, 400 × 500 - Generic for Fansidar (Sulfadoxine–Pyrimethamine) is an antimalarial ... internationaldrugmart.com bild_primaquine.jpg, 321 × 200 - ... bild primaquine. The cancer disease is a chronic infectious disease in ... horse-doc.com Mosquito & Insect control pic.400.JPG, 400 × 250 - The insect and mosquito controls. pondandgardenwholesalers.com Mosquito‑Bed‑Nets1.jpg, 400 × 263. vtarmynavy.com Storiesfromthefieldjpg.jpg, 720 × 480 - ... disasters or complex humanitarian emergencies. bostonredcross.org 1382429_370.jpg, 254 × 300 - New Malaria Vaccine Is Safe and Protective in Children, Scientists Find care2.com

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Malaria By: Dorthea Beecroft Emetu Onuma Danielle Kiss