My Malaria Presentation

7/31/2019 My Malaria Presentation

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Prepared by: Narcisa Cupahan



An acute and chronic parasitic infectious diseasetransmitted by the bite of infected mosquito and isconfined mainly to tropical and subtropical areas.

Causes more disability and a havier economic burdenthan in any parasitic disease.

Other name: ague,marsh fever, periodic fever,paludism,

black water fever



Each year Malaria causes 200-300 million cases

It kills over 1 million people every year

It is causes by a parasite called plasmodium (4 types)

It is spread by the anopheles mosquito (72 types)



Protozoa of genus plasmodia

1. The disease is caused by four species of protozoa:

a. Plasmodium falciparum (malignant tertian)This is considered as the most serious malarialinfection because of the development of high parasiticdensities in blood (RBC) with tendency to agglutinate

and form into microemboli.This is most common in the Philippines.



This is nonlife threatening except for the very youngand the old.

It is manifested by chills every 48 hours on the 3rd day

onward especially if untreated.



It is less frequently seen.

This specie is nonlife threatening.

Fever and chills usually occur every 72 hours usually

on the 4th

day after onset.



This is rarely seen in the Philippines.



a. It breeds in clear, f lowing, and shaded streams usually in the mountains.

b. It is bigger in size than the ordinary mosquito.c. It is brown in color.

d. It is a night-biting mosquito.

e. It usually does not bite a person in motion.

f. It assumes a 36º position when it alights on walls, trees,curtains, and the like.



12 days for P. Falciparum

14 days for P. vivax and ovale

30 days for P. malariae



Untreated or insufficiently treated patient may be thesource of mosquito infection for more than three yearsin P. malariae, one to two years in P. vivax, and notmore than one year on P. falciparum.



The disease is transmitted mechanically through thebite of an infected female anopheles mosquito

It can be transmitted parenterally through bloodtransfusion.

On rare occasions, it is transmitted from sharedcontaminated needles.

However, transplacental transmission of congenital

malaria is a rare case.



http://cdn.nursingcrib.com/wp-content/uploads/malaria-transmission.jpg?9d7bd4



Paroxysms with shaking chills (Pathognomonic

sign)

Rapidly rising fever with severe headache

Profuse sweating

Myalgia, with feeling of well-being in between

Splenomegally, hepatomegally

Orthostatic hypotension Paroxysms may last for 12 hours, then, maybe repeated

daily or after a day or two.



In children: Fever maybe continuous

Convulsions and gastrointestinal symptoms areprominent

Splenomegally

In cerebral malaria Changes in sensorium, severe headache, and vomiting

Jacksonian or grand mal seizure may occur



Nephritis (due to P. Malaria)

Albuminuria

Hematuria

Black fever (P. falciparum)



Increased serum indirect bilirubin and other evidenceof hemolysis.

Identification of organism is made in thin or thicksmears of peripheral blood or bone marrow.

Indirect flourescent antibody test (for IgG) showshigh sensitivity (99%)



Anemia

Bone marrow shows erythroid hyperplasmaedecraesed WBC

Presence of protien and leukocytes in urine sediments Increased monocytes in peripheral blood

Serum globulin increased

ESR increased



Blackwater fever (massive intravascular hemolysis)

Reduced # of platelets (20,000-50,000/mm3)

Prolonged partial thromboplastin time (60-100 sec)

Decreased plasma fibrinogen Prolonged prothrombin time(18-20 sec.)



Liver

-Vary from congestion of fatty changes to malarialhepatitis

-Increased in SGOT, SGPT and alkalinephosphates

Gallbladder

-Pigment stones Cerebral anemia



Eliminate Anopheline mosquito vectors

Eliminate/drain areas of impounded water that servesas anopheline breeding habitats

Spray screened living and sleeping quarters with liquidor aerosol preparations

Screen rooms and use bed nets.



Use insect repellant lotions

Most effective available repellant is di-ethyl tolumide.

Screen blood donors for a history of malaria or

possible exposure to disease. Prompt and effective treatment of the disease.



Give anti-malarial drugs:

Chloroquine (all species except for P. Malariae)

Quinacrine Chloroguanide

Sulfadoxine for resistant P. Falciparum

Primaquine for relapses of P. Vivax and ovale

Erythrocyte exchange transfusion for rapid reductionof high levels of parasites in the blood.



Close monitoring of patient.

Strict monitoring of input and output (to preventpulmonary edema and evaluate renal failure)

Daily monitoring of patient’s serum quinine, bilirubin,BUN concentrations, parasite count and packed RBC.

If the patient exhibits respiratory or renal symptoms,determine arterial blood gas and plasma electrolytes.



If case is severe falciparum malaria consider it as amedical emergency.

Administer oxygen if needed because of tissue anoxia. Watch for abnormal bleeding such as:

o Passage of flesh blood in the stool

o Oozing of blood from venipuncture site

o Nose bleeding



During the febrile stage, tepid sponges, alcohol rubs, andice cap on the head will help bring the temperature

down. Application of external heat and offering hot drinks

during chilling stage is helpful.

Provide comfort and psychological support.

Encourage the patient to take plenty of fluids. As the temperature falls and sweating begins, warm

sponge bath maybe given.

The bed and clothing should be kept dry.



Administer IV guinine as ordered.

Watch for neurologic toxicity from quinine infusion

such as:o Twitching

o Delirium

o Confusion

o Convulsiono Coma.



Evaluate the degree of anemia. Watch for any signs especially abnormal bleeding.

Consider severe malaria as medical emergency thatrequires close monitoring of vital signs.



1. Malarial smear–

In this procedure, a film of bloodis placed on a slide, stained, and examinedmicroscopically.

2. Rapid diagnostic test (RDT) – This is a blood testfor malaria that can be conducted outside thelaboratory and in the field. It gives a result within 10to 15 minutes. This is done to detect malarial parasiteantigen in the blood.



Anti-Malarial Drugs

Artemether-lumefantrine (Therapy only, commercialnames Coartem and Riamet)

Artesunate-amodiaquine (Therapy only) Artesunate-mefloquine (Therapy only)

Artesunate-Sulfadoxine/pyrimethamine (Therapy only)

Atovaquone-proguanil, trade name Malarone(Therapy and prophylaxis)

Quinine (Therapy only)



Chloroquine (Therapy and prophylaxis; usefulnessnow reduced due to resistance)

Cotrifazid (Therapy and prophylaxis)

Doxycycline (Therapy and prophylaxis)

Mefloquine, trade name Lariam (Therapy andprophylaxis)

Primaquine (Therapy in P. vivax and P. ovale only; notfor prophylaxis)

Proguanil (Prophylaxis only)

Sulfadoxine-pyrimethamine (Therapy; prophylaxis forsemi-immune pregnant women in endemic countriesas “Intermittent Preventive Treatment” – IPT)

Hydroxychloroquine, trade name Plaquenil (Therapy and prophylaxis)



Malaria cases should be reported.

A thorough screening of all infected persons frommosquitoes is important.

Mosquito breeding places must be destroyed. Homes should be sprayed with effective insecticides

which have residual actions on the walls.



Mosquito nets should be used especially when ininfected areas.

Insect repellents must be applied to the exposedportion of the body.

People living in malaria-infested areas should notdonate blood for at least three years.

Blood donors should be properly screened.



THANK YOU AND

GOD BLESS!!!

My Malaria Presentation

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