Prepared by:

ALINGAN, MUAMIR A.
WHAT IS MALARIA
• A vector-borne infectious disease caused by protozoan
parasites.
• The term MALARIA originates from MEDIEVAL ITALIAN: MALA
ARIA – “BAD AIR”; and the disease was formerly called
ague or marsh fever due to its association with swamps.
• It is widespread in tropical and subtropical regions,
including parts of the Americas, Asia, and Africa.
• Historical records suggest malaria has infected humans
since the beginning of mankind.
• It has been infected humans for over 50,000 years, and
may have been a human pathogen for the entire history of
our species.
1880
 A French army doctor
working in the military
hospital of Constantine
Algeria named Charles
Louise Alphonse Laveran
observed parasites for
the first time, inside
the red blood cells of
people suffering from
malaria. He therefore
proposed that malaria was
caused by this protozoan,
the first time protozoa
were identified as
causing disease.
1884
 Ettore Marchiafava and
Angelo Celli, while
studying wet blood
smears from malarious
patients with the new
oil-immersion lens,
looked at unstained
blood and saw an active
amoeboid ring in the
red blood cells. They
then published this
finding and named it
Plasmodium.
A year later
 Carlos Finlay, a Cuban
doctor treating patients
with yellow fever in
Havana, first suggested
that mosquitoes were
transmitting disease to
and from humans.

1898
 It was Britain's Sir
Ronald Ross working in
India who finally proved
in 1898 that malaria is
transmitted by mosquitoes
NORMAL ANATOMY AND
PHYSIOLOGY
ETIOLOGY

• Malaria is caused by protozoan parasites of the

genus Plasmodium (phylum apicomplexa).
• There are several species of Plasmodium Parasites
but only four of them are significant to the cause
of malaria diseases to humans. Some of these are
in to animals. Like birds,reptiles, monkeys,
chimpanzees, and rodents.
 PATHOPHYSIOLOGY

A female Anopheles mosquito bites, injecting saliva containing sporozoites,

the infective form of malaria parasite.

The sporozoites enter the liver and multiply

In the liver, the sporozoites change into merozoites,

another form of the parasite.
 Merozoites are released from the liver and
enter the bloodstream.

Merozoites attack Red Blood Cells.

Red Blood cells burst and release the merozoites

which invade other red blood cells
and cause recurring chills and fever.
(At this point the infected person becomes a reservoir of malaria that infects
any mosquito that feeds on him.)
PLASMODIUM
FALCIPARUM

PLASMODIUM
VIVAX
• P. Vivax is the most common
cause of infection, responsible
for about 80% of all malaria
cases.
PLASMODIUM
MALARIAE • However, P. Falciparum is the
most important cause of disease,
and responsible for about 15% of
infections and 90% of deaths.

PLASMODIUM
OVALE
 The Parasite’s primary hosts and
transmission vectors are female
mosquitoes of the Anopheles genus.

 The disease is transmitted to

humans when an infected Anopheles
mosquito bites a person and injects
the malaria parasites (sporozoites)
into the blood.
 Mosquito injects the  Sporozoites enter the liver
infective plasmodial cells, and transform into
merozoites which penetrate RBC.
sporozoites.

 Once in RBC,
merozoites reproduce
rapidly, producing
many more
merozoites, which
burst out of the RBC
& penetrate new
cells.
 Some of these
merozoites form male
& female
gametocytes, which
can be picked up by
another mosquito.
 Inside the gut of
the mosquito,
gametocytes will
 The zygote then develops into an fertilize creating
 Ready for
oocyst and ruptures to release zygote.
another cycle.
thousands of sporozoites.
 Only female mosquitoes feed on
blood, thus males do not
transmit the disease. The
females of the Anopheles genus
of mosquito prefer to feed at
night. They usually start
searching for a meal at dusk,
and will continue throughout
the night until taking a meal.

 Malaria parasites can also be

transmitted by blood
transfusion, although this is
rare.
 SIGNS & SYMPTOMS
 The symptoms characteristic of malaria include
flu-like illness with fever, chills, muscle aches,
joint pain (athralgia), vomiting, anemia caused by
hemolysis, hemoglobinuria, convulsions, and
headache.
 The classical symptom of malaria is cyclical
occurrence of sudden coldness followed by rigor
and then fever and sweating lasting four to six
hours, occurring every two days in P. vivax and P.
ovale infections, while every three for P.
malariae. P. falciparum can have recurrent fever
every 36-48 hours or a less pronounced and almost
continuous fever.
 People with severe P.
falciparum malaria can develop
bleeding problems, shock,
liver or kidney failure,
central nervous system
problems, coma, and can die
from the infection or its
complications.

 Cerebral malaria (coma, or

altered mental status or
seizures) can occur with
severe P. falciparum
infection. It is lethal if not
treated quickly; even with
treatment, about 15%-20% die.
INCUBATION PERIOD
 The period between the mosquito bite and the onset of
the malarial illness is usually one to three weeks
(seven to 21 days). This initial time period is highly
variable as reports suggest that the range of incubation
periods may range from four days to one year.
 The usual incubation period may be increased when a
person has taken an inadequate course of malaria
prevention medications.
 Certain types of malaria (P. vivax and P. ovale)
parasites can also take much longer, as long as eight to
10 months, to cause symptoms. These parasites remain
dormant (inactive or hibernating) in the liver cells
during this time. Unfortunately, some of these dormant
parasites can remain even after a patient recovers from
malaria, so the patient can get sick again. This
situation is termed relapsing malaria.
TREATMENT
 Malaria can be a severe, potentially fatal disease
(especially when caused by P. Falciparum) and treatment
should be initiated as soon as possible.
 The Word Health Organization recommends that those in
endemic areas, treatment should be started within 24
hours after the first symptoms appear. Treatment of
patients with uncomplicated malaria can be conducted on
an ambulatory basis (without hospitalization) but
patients with severe malaria should be hospitalized if
possible.
 In areas where malaria is not endemic, all patients with
malaria (uncomplicated or severe) should be kept under
clinical observation if possible.
 Drug Treatment
 The first effective treatment for malaria
was the bark of cinchona tree, which
contains QUININE. It was first used by the
inhabitants of Peru, where these trees
mainly grow.
 Today, there are several antimalarial drugs
available for treatment:
 Chloroquine

 sulfadoxine-pyrimethamine (Fansidar®)

 mefloquine (Lariam®)

 atovaquone-proguanil (Malarone®)

 quinine

 doxycycline

 artemisin derivatives

 primaquine

 But, drug treatment of malaria is not

always easy. You have to consider some
factors in treating different conditions of
patients having malaria.
There are three main factors in determining treatment

1. The infecting species of Plasmodium parasites.

 Different species of Plasmodium parasites may vary in
treating patients.
2. The clinical situation of the patient.
 Mild malaria can be treated with oral medication.
 Severe malaria (having one or more symptoms of either
coma, severe anemia, renal failure, shock, etc.)
requires intravenous (IV) drug treatment and fluids.
 Malaria may pose a serious threat to a pregnant women
and her pregnancy. Infection may be more severe than
those women who are not pregnant.
3. The drug susceptibility of the infecting parasites.
 Determined by the geographic area where the infection
was acquired.
 Different areas of the world have malaria types that
are resistant to certain medications.
 Correct drug must be prescribed by the doctor who is
familiar with malaria treatment protocol.
PUBLIC HEALTH PREVENTION
& NURSING MANAGEMENTS
MALARIA CONTROL
 The goal of malaria control in
malaria-endemic countries is to reduce
as much as possible the health impact
of malaria on a population, using the
resources available, and taking into
account other health priorities.
 Malaria control does not aim to
eliminate malaria totally. Complete
elimination of the malaria parasite
(and thus the disease) would
constitute eradication. While
eradication is more desirable, it is
not currently a realistic goal for
most of the countries where malaria is
endemic.
 Malaria control is carried out through the following
interventions, which are often combined:

 Case Management (diagnosis and treatment) of

patients suffering from malaria.
 Persons who are sick should be treated promptly
and correctly. It eliminates an essential
component of the cycle (the parasite) and thus
interrupts the transmission cycle.
 WHO recommends that anyone suspected of having
malaria should receive diagnosis and treatment
with an effective drug within 24 hours of the
onset of symptoms.
 Prevention of Infection through vector control.
 Infection is prevented when malaria-carrying
Anopheles mosquitoes are prevented from biting
humans.
 Vector control aims to reduce contacts between
mosquitoes and humans.
 Some vector control measures like (destruction
of larval breeding sites, insecticide spraying
inside houses) may require organized teams and
resources that are not always available.
 Insecticide-treated bed nets could also be an
alternative in vector control and personal
protection. It could be conducted by the
community themselves and become a major
intervention in malaria control.
 Prevention of Disease by administration of
antimalarial drugs to particularly vulnerable
population groups such as pregnant women and
infants.
 Administration of antimalarial drugs to
vulnerable population groups does not prevent
infection, which happens through mosquito
bites. But drugs can prevent disease by
eliminating the parasites that are in the
blood, which are the forms that cause
disease.
 Pregnant women are the vulnerable group most
frequently targeted. They may receive, for
example, "intermittent preventive treatment"
(IPT) with antimalarial drugs given most
often at antenatal consultations during the
second and third trimesters of pregnancy.
MALARIA IN THE PHILIPPINES
PHILIPPINE SCENARIO

The Philippines is one of the Southeast Asian countries

plagued with malaria. Although the country does not
contribute significantly to the global mortality
attributed to malaria, the disease remains to be a major
cause of “healthy days of life lost” (HDLL) in the
endemic areas of the country. Malaria affects the
socioeconomic well-being of the affected population, and
the different socioeconomic activities affect
transmission, prevention, and control of the disease.
Thus, this situation not only generates an enormous
economic, social and health burden to these people per
se, but also poses a huge and persistent challenge to
the health deliverers of the Malaria Control Program.
MALARIA AS A HEALTH PROBLEM
 It is the eighth leading cause of morbidity in the
Philippines. (HIS 2000)
 According to DOH Secretary Reynaldo Duque, “an
average of three Filipinos die daily due to malaria
despite the government’s intensified efforts to
control the occurrence of the ailment”.
 Malaria has become a health threat.
 Although malaria endemicity is now generally moderate
to low, the disease continues to be a major
impediment to human and economic development in areas
where it persists
 This disease is still endemic in 65 of the 79
provinces in the country, and around 10 million
people who live in these areas are at risk of getting
the disease.
 Morbidity trend suggest that there might be a cause
and effect relationship between the activities which
aim to eradicate malaria and its incidence
 There is a decreasing number of deaths caused by
malaria
 Chloroquine, the cheapest medicine against malaria is
losing its effectiveness
Malaria as a Health Services Problem
 It poses challenges of access to health care for prompt
and effective treatment
 There are shortages of antimalarial drug supplies,
especially in peripheral health centers
 The disease still costs the Philippine economy to spend
over Php 100 million in order to sustain control efforts
 Failures in treatment still occur despite the
preventability of malaria.
 Causes of Malaria Treatment Failure in the Philippines
 Drug resistance
 Non-compliance of patients in the treatment regimen
 Deficient drug absorption
 Self-medication
 Resorting to herbal remedies
 Seeking help when the disease is severe (Malaria is
fatal only when it is seen in its later stages.)

Epidemiology of malaria is complex, due to

 Variety of ecological conditions observed in different
island groups
 Occurrence of more than one vector species
Malaria Control Program of the Department of Health

For 2007, The Department of Health has developed a malaria

control program as a measure to help eradicate the spread
of the disease. Some of the program strategies are:

1. Early diagnosis of the disease and prompt treatment.

This was achieved through:

 diagnostic centers which serve as cites of microscopy

 manning by a RDT (Rapid Diagnostic Test) trained
personnel
 promotion of the existence of diagnostic
centers                           
2. Controlling the spread of mosquitoes
This was achieved through:

 giving out insecticide-treated mosquito nets

 indoor spraying which targets houses and not only
communities 

3. Implementation of community-based malaria control

This was achieved through:

 social mobilization
 education sessions
JOURNALS Mosquito Nose Transplants Help Fight Malari
Main Category: Tropical Diseases
Also Included In: Biology / Biochemistry;  Aid / Disasters
Article Date: 16 Feb 2010 - 9:00 PDTIn .

a new approach to combating malaria, a disease that affects half a billion people worlwide, US scientists
successfully transplanted most of the "nose" of the disease-spreading Anopheles mosquito into frogs'
eggs and fruit flies so they could analyse the insect's odorant receptors and find out how to lure it into
traps and even prevent it being able to detect and thereby target humans.
You can read about the two studies by researchers from Yale University in New Haven, Connecticut,
and Vanderbilt University in Nashville, Tennessee, in a report in the 3rd February online issue of the
journal Nature and there is also a complementary article in the Proceedings of the National Academy
of Sciences, PNAS.
The mosquito Anopheles gambiae is the major route through which humans in sub-Saharan Africa
become infected with malaria. While we know that the insect uses its sense of smell to find human
hosts, we know little about the underlying molecular process.
A mosquito's "nose" is in its antennae which carry nerve cells covered with odorant receptors that
react to different chemical compounds in the insect's environment. These receptors are similar to
those that give us our senses of smell and taste in our nose and on our taste buds.
Co-author Dr Laurence Zwiebel, professor of biological sciences at Vanderbilt, told the press
that:"We've successfully expressed about 80 percent of the Anopheles mosquito's odorant receptors
in frog's eggs and in the fruit fly antennae."
 Zwiebel's lab at Vanderbilt is where they successfully transplanted the
receptors into frogs' eggs. The transplant into fruit-fly (Drosophila melanogaster) eggs
was done at the laboratory of John Carlson, Eugene Higgins Professor of Molecular,
Cellular and Developmental Biology at Yale and is written up as a complementary
study in PNAS.
Scientists have previously used frogs' eggs to study olfactory receptors in moths,
bees and fruit flies. For this study, the researchers injected DNA that codes for the
mosquito's olfactory receptors into a frog egg and waited for it to produce proteins.
Eventually the surface of the egg became covered with mosquito odorant receptors.
They then tested the engineered egg's reaction to being exposed to various odorant
chemicals. They floated the egg in a buffer solution in a voltage clamp (so they could
measure changes in the egg's electrical properties) and dissolved the chemicals one
by one in the solution. They detected a measurable electrical response in the egg.
Guirong Wang, lead author of the PNAS study, and a senior researcher in Zwiebel's
lab, said:"The frog egg system is relatively rapid, highly sensitive and allows us to do
very precise measurements of odorant response."
Wang, who personally conducted several thousand measurements of egg responses
to changes in odorant, described this method as a "medium throughput system",
because although they could set it up quite quickly, they had to make the odorant
solutions by hand, which took much longer.
Antioxidants May Help Prevent Malaria Complications That Damage Brain

Using an experimental mouse model for malaria, an international group of scientists has discovered that adding
antioxidant therapy to traditional antimalarial treatment may prevent long-lasting cognitive impairment in cerebral
malaria. Their findings were published online June 24, 2010, in the journal PLoS Pathogens.
Malaria, an infection caused by parasites that invade liver and red blood cells, is transmitted to humans by the
female Anopheles mosquito. Malaria is one of the leading infectious diseases worldwide, affecting more than 400
million people and causing more than 2 million deaths each year, mainly among African children. Recently, the
U.S. Centers for Disease Control and Prevention (CDC) issued a report on 11 laboratory-confirmed cases of
malaria among U.S. emergency responders and those traveling in the United States from Haiti.
Cerebral malaria is a severe, potentially fatal neurologic complication of infection by the most-feared malarial
parasite, Plasmodium falciparum. Recent studies of children with cerebral malaria indicate that cognitive deficits,
which may impair memory, learning, language, and mathematical abilities, persist in many survivors even after
the infection itself is cured.
"Cerebral malaria and its molecular mechanisms are under intense study, but the cognitive dysfunction that can
persist in survivors in the aftermath of successful treatment has gone unrecognized until recently," says Guy A.
Zimmerman M.D., professor and associate chair for research in the University of Utah School of Medicine's
Department of Internal Medicine and a contributor to the study. "This complication may impose an enormous
social and economic burden because of the number of people at risk for severe malaria worldwide. Our findings
demonstrate that, by using experimental models of cerebral malaria in mice, we can explore mechanisms of
cognitive damage and also examine potential treatments for reducing or preventing neurologic and cognitive
impairment."
Zimmerman and colleagues in Brazil studied the persistence of cognitive damage in mice with documented
cerebral malaria after cure of the acute parasitic disease with chloroquine, an antimalarial therapy. By
administering a battery of behavioral tests to these mice, post-doctoral fellow Patricia Reis, Ph.D., determined
that impairment in memory skills was still present 30 days after the initial malaria infection. Cognitive deficits that
persist for years after the episode of cerebral malaria have also been reported in 11 percent to 28 percent of
children who survive the infection.
"Although we believe that long-term cognitive dysfunction after cerebral malaria is initiated by injury to the brain
during the initial period of untreated infection, it is possible that the mechanisms for persistent cognitive deficits
are independent of those that cause neurological injury and death during acute cerebral malaria," says
Zimmerman. "Future research is aimed at clarifying this point. However, we have been able to demonstrate that
oxidative stress is present in the brains of mice infected with cerebral malaria."
 Malaria And Algae Linked To Common Ancestor By 'Little Brown Balls'

Unconspicuous "little brown balls" in the ocean have helped settle a long-standing debate
about the origin of malaria and the algae responsible for toxic red tides, according to a new study
by University of British Columbia researchers.
In an article published this week in the Proceedings of the National Academy of Sciences Early
Edition, UBC Botany Prof. Patrick Keeling describes the genome of Chromera and its role in
definitively linking the evolutionary histories of malaria and dinoflalgellate algae.
"Under the microscope, Chromera looks like boring little brown balls," says Keeling. "In fact, the
ocean is full of little brown and green balls and they're often overlooked in favour of more
glamorous organisms, but this one has proved to be more interesting than its flashier cousins."
First described in the journal Nature in 2008, Chromera is found as a symbiont inside corals.
Although it has a compartment - called a plastid - that carries out photosynthesis like other algae
and plants, Chromera is closely related to apicomplexan parasites - including malaria. This
discovery raised the possibility that Chromera may be a "missing link" between the two.
Now Keeling, along with PhD candidate Jan Janouskovec, postdoctoral fellow Ales Horak and
collaborators from the Czech Republic, has sequenced the plastid genome of Chromera and
found features that were passed down to both apicomplexan and dinoflagellate plastids, linking
the two lineages.
"These tiny organisms have a huge impact on humanity in very different ways," says Keeling.
"The tool used by dinoflagellates and Chromera to do good - symbiosis with corals - at some
point became an infection mechanism for apicomplexans like malaria to infect healthy cells.
"Resolving their evolutionary origins not only settles a long-standing scientific debate but could
ultimately provide crucial information for tackling diseases and environmental concerns."
~ end of presentation ~