Lecture originally from University of Warwick Medical Student

Lecture originally from University of Warwick Medical Student website adapted by Siobhan Quenby Professor of Obstetrics

Yeasts Moulds • Single cell • Reproduce by budding • Identify using biochemical tests vs • tubular structures called hyphae • grow by branching and longitudinal extension. …and dimorphic fungi

Yeasts: Candida sp.

Mucocutaneous candidiasis

Protozoa

• Unicellular, • simple eukaryote • Broad range of diseases

• Plasmodium sp. – Malaria • Giardia sp. – Diarrhoea • Leishmaniasis – Cutaneous and systemic infections • Amoebiasis – Dysentery, liver abscess • Trypanomonisasis – Sleeping sickness, Chagas disease

Leishmaniasis

Malaria

Malaria and pregnancy

WHO malaria in pregnancy

Malaria in pregnancy sulfadoxine-pyrimethamine (SP)

Insecticide treated nets

Arnold Mkandawire 120 100 80 60 PERCENTAGE 40 20 0 Syphilis test IPTp HIV TEST ITN ART

Felix Simbeye

Lenard Gama

Malaria – Life Cycle of Plasmodium vivax

Malaria – Pathology : Sepsis due to Malaria

Malaria – Pathology : Haemolysis Jaundice due to Malaria

Malaria – Pathology : Sequestration Erythrocyte Sequestration due to Falciparum Malaria

Malaria – Symptoms & Signs Benign + Falciparum Malaria : hot + cold sweats arthralgia + myalgia hepatosplenomegaly headache diarrhoea + vomiting anaemia Falciparum Malaria only : hypoglycaemia haemorrhage renal failure coagulopathy septic + hypovolaemic shock respiratory failure cerebral malaria = various CNS features that lead on to consciousness / fits / coma / death

Malaria – Investigations (Blood Films) Thick & Thin Blood Films

Malaria – Investigations (Blood Films) Thick & Thin Blood Films

Malaria – Investigations (Blood Films) Malaria Parasites at Various Stages

Malaria – Investigations (Malaria Antigen Tests)

Malaria – Investigations (Malaria Antigen Tests)

Malaria – Investigations (Malaria Antigen Tests) Negative Mixed Non-Falciparum or

Malaria – Treatment Supportive treatment & management of sepsis … Benign Malaria chloroquine 600 mg then 300 mg after 8 hours then chloroquine 300 mg daily for another 2 days followed by primaquine 15 mg for 14 days to eradicate Falciparum Malaria quinine 600 mg (or 10 mg/kg if IV) every 8 hours for 7 days followed by doxycycline 200 mg daily for 7 days to eradicate alternatives are : malarone (4 tablets daily for 3 days) riamet (4 tablets at 0, 8, 24, 36, 48 & 60 hours)

Malaria – Supportive Management Complicated falciparum malaria should be treated in an ITU / HDU Monitor : Glasgow Coma Scale / AVPU score temperature heart rate blood pressure (invasive CVP monitoring) respiratory rate (urine output / fluid balance) blood glucose FBC (Hb + platelets) clotting tests renal function chest radiograph

Malaria – Supportive Management May also include : nasogastric tube ventilation if GCS < 8 treat seizures + continue anti-convulsants reduce temperature with tepid sponging + paracetamol optimise fluid balance (CVP +5 to +10) + maintain urine output treat pulmonary oedema → sit upright / high % oxygen / IV diuretic consider haemofiltration / venesection treat hypoglycaemia + continue 10% glucose infusion transfuse if Hb < 7 g/dl or haematocrit < 20% (with frusemide cover) transfuse if platelets < 20 x 109 / litre + signs of bleeding consider clotting factors (FFP) if DIC develops consider haemodialysis if ARF develops

Treatments • Malaria – Quinine, artesunate, chloroquine • Giardiasis – Metronidazole • Leishmaniasis – Amphotericin B

Helminths

Helminths • Most prevalent human infection • Multicellular • Usually life cycle involving more than one host with an egg, larval and adult stage

Helminths • Round worms – Nematodes • Tape worms – Cestodes • Schistosomiasis – Trematodes

Roundworms : hookworm • 10% worlds population • Can cause iron deficiency anaemia

Roundworms: Enterobius

Tapeworms – Taenia sp.

Tapeworms: Taenia sp.

Neurocysticercosis

Schistomomiasis

Katayama fever

Schistosomiasis

Schistosomiasis

Cutaneous larva migrans

Treatments • Hookworms – Mebendazole – Albendazaole • Schistosomiasis/ tapeworms – Priziquantel

Parasite resources • http: //dpd. cdc. gov/dpdx/html/Para_Healt h. htm