MALARIA Dr Aslesh OP MBBS MD Assistant professor

MALARIA Dr Aslesh OP MBBS, MD Assistant professor, community medicine Pariyaram Medical College

Content � � � � History Burden Agent vector Epidemiology Clinical features control

Malaria- Mal air

Malaria in History � Ancient references � China, Assyria, India � 500 BC Hippocrates gives first clinical description

Malaria in History � � Ancient references � China, Assyria, India � 500 BC Hippocrates gives first clinical description Historical Impacts � 413 BC Fall of Greek empire � 323 BC Alexander the Great died of malaria � The Roman Empire: Malaria is generally considered to have played a role in the decline of Rome, a city located in marshland, where malaria is transmitted � In world war 2, more people died due to malaria than in war

Burden of malaria � Globally 150 to 300 million cases annually � 81% in African region � 13% South east Asian region � 5% eastern Mediterranean

Burden in India � � In India 27% of the population live in malaria high transmission area 58% in low transmission area

Burden in kerala

Agent � Plasmodium – 4 species �P falciparum � P vivax � P ovale � P malaria

Vector –Anopheles mosquito

Breeding place of anopheles

Reservoir of infection � Only human reservoir

Host factors favoring malaria infection � � � � Age Sex Genetic- sickle cell anemia, duffy negative blood type Low socio economic status Poor housing standards Migration Occupation- agriculture

Environmental factors � � Season-Rainy season Temperature – 16 -30 degree High humidity- above 60% Altitude- less than 2500 metes

Incubation period � Length of time between infective mosquito bite and first appearance of fever �P Falciparum malaria- 12 days � P Vivax -14 days � P malaria- 28 days � P ovale -17 days

Clinical features � � Typical fever- 3 stages Cold stage � Chills and rigor � Last for 1/4 th to 1 hour � Hot stage � Hot and dry � Last for 2 -6 hour � Sweating stage � Fever comes down with profuse sweating

Complication � � � Cerebral malaria Renal failure Liver damage Dehydration Anemia

Diagnosis � � � Microscopy-Blood smear examination for parasite Serological test- fluorescent antibody test Rapid diagnostic test

Treatment � For falciparum � Artisunate � combination therapy For vivax � Chloroquine along with primaquine

Epidemiological Models Habitat Behavior Infected People contact Mosquitoes contact Source of Plasmodium Uninfected People Source of New Hosts Climate Habitat Food

Breaking the Chain Habitat Behavior Infected People contact Mosquitoes contact Source of Plasmodium Uninfected People Source of New Hosts Climate Habitat Food

Eliminating Mosquitoes � � � Destroy habitat Insecticides Biological control

Indoor residual spraying

Pesticide Resistance � � Rapid Reproduction Natural selection

Anti larval method-Source reduction

Biological method- larvicidal fish

Getting rid of the source of Plasmodium

Getting rid of the source of Plasmodium � � Drug treatment Transgenic mosquitoes

Getting rid of the source of Plasmodium � � � Drug treatment Transgenic mosquitoes Why don’t these work?

Getting rid of the source of Plasmodium � � � Drug treatment Transgenic mosquitoes Why don’t these work? � Availability of drugs Money Medical staff � Recrudescense � Drug resistance � Reservoir hosts? � Transgenic mosquitoes not a reality � Expensive

How can we protect the uninfected population? � � Vaccines Prophylactic drugs

How can we protect the uninfected population? � � � Vaccines Prophylactic drugs Why don’t these work?

How can we protect the uninfected population? ? � � � Vaccines Prophylactic drugs Why don’t these work? � Vaccines unsuccessful � Prophylactic drugs expensive � Prophylactic drugs unpleasant

How can we prevent contact between people and mosquitoes? � � � Insecticides Mosquito nets Long clothing Behavior Avoid mosquito habitat Screens on houses

How can we prevent contact between people and mosquitoes? � � � Insecticides Mosquito nets Long clothing Behavior Avoid mosquito habitat Screens on houses � Why don’t these work?

How can we prevent contact between people and mosquitoes? ? � � � Insecticides Mosquito nets Long clothing Behavior Avoid mosquito habitat Screens on houses � Why don’t these work? � Money � Availability of materials � Human behavior difficult to change

Other diseases caused by mosquito � � Dengue Chikenguniya Filariasis Japanese encephalitis

Aedes Dengue fever Chikunguniya Yellow fever in African countries

Filariasis Culex mosquito Filarial scrotum Filarial leg 120 millions in 73 countries SEAR countries 31 millions clinical cases, 60 millions mf carriers India 45 prevalence millions , incidence 6 millions per year

What you can do to prevent � Observe dry day once a week

Thank you