BLOOD PARASITES PLASMODIA/ BABESIA WINIFREDA U. DE LEON
Mar 26, 2015
BLOOD PARASITESPLASMODIA/ BABESIA
WINIFREDA U. DE LEON
SPECIES
PLASMODIUM FALCIPARUM
PLASMODIUM VIVAX
PASMODIUM MALARIAE
PLASMODIUM OVALE
PLASMODIUM KNOWLESI
ARTHROPOD -BORNEANOPHELES MOSQUITOES
A. MINIMUS FLAVIROSTRIS
HABITAT IN MAN – RBCHIGH OXYGEN TENSION
COMPONENTS:NUCLEUS (CHROMATIN)CYTOPLASM
ON THE MOSQUITO VECTOR
NIGHT BITER
SLOW FLOWING CLEAN STREAMS
FOOTHILLS
EXOPHAGIC
ZOOPHILIC
FORESTED AREAS- CLEANSLOW FLOWING STREAMS
LIFE CYCLE
SCHIZOGONYASEXUAL MULTIPLICATIONEND PRODUCTS – SCHIZONTS (MEROZOITES)OCCURS IN MAN
GAMETOGONYGAMETOCYTESOCCURS IN MAN
SPOROGONYSEXUAL MULTIPLICATIONEND PRODUCTS – OOCYSTS (SPOROZOITES)OCCURS IN MOSQUITOES
ASEXUAL STAGES
TROPHOZOITESYOUNGEST - RINGFORMSDEVELOPINGMATURE
SCHIZONTSEARLYDEVELOPINGMATURE - MEROZOITES
TROPHOZOITES
SCHIZONTS
RED CELL DEFENSESCELL MEMBRANE
DUFFY Ag NULL – RESISTANCE TO P. VIVAX
HEMOGLOBIN-HEMOGLOBIN S (SICKLE TRAIT) HELPS IN THE SURVIVAL OF PATIENTS FROM P.
FALCIPARUM PRIMARY ACUTE ATTACK -B-THALLASEMIA- IMBALANCED GLOBIN CHAIN PROD’N
OXIDATION BY HEMICHROMES (REACTIVE O2)
G6PD PREVENTS OXIDATION OF THE HEME GROUPDEFICIENCY – GENERATION OF REACTIVE O2
ACCUMULATES IN THE RBCDAMAGES P. FALCIPARUM
VIRULENCE FACTORS
RUPTURE OF SCHIZONTS
RELEASE OF MEROZOITES:
MONOCYTES – TNF (PYROGENIC)
OTHER CYTOKINES
GLYCOSYLPHOSPHATIDYL INOSITOL (GPI)
KNOBS – CYTOADHESION (PfEMP)
HISTIDINE RICH PROTEIN (HRP)
MULTI-ORGAN INVOLVEMENT
GASTRO-INTESTINAL
DIARRHEA, ABD PAIN, NAUSEA, VOMITING, ANOREXIA
RESPIRATORY
DYSPNEA
NON PRODUCTIVE COUGH
FEVER PERIODICITY
COINCIDES WITH RUPTURE OF SCHIZONTS INITIAL INFECTION – ASYNCHRONOUS
AFTER 5- 7 D - SYNCHRONOUSPF – EVERY 40 HOURS
PV & PO - EVERY 48 HOURS PM - EVERY 72 HOURS
PATHO-PHYSIOLOGY
DESTRUCTION OF RED BLOOD CELL (INFECTED/ UNINFECTED)PRODUCTION OF CYTOKINES - TUMOR NECROTIC FACTOR (TNF)
FEVER, HYPOGLYCEMIA, ARDS SEQUESTRATION IN DEEP VASCULATURE OF
INTERNAL ORGANS (RBC RECEPTORS) - INTRACELLULAR ADHESION - VASCULAR ADHESION
HEMATOLOGIC CHANGES
ANEMIA
LEUKOPENIA
THROMBOCYTOPENIA
SUPPRESSED HEMATOPOIESIS
RETICULOCYTES
REDUCED SERUM IRON
DEFECTIVE BLOOD CELL MATURATION
PATHO-PHYSIOLOGYSEVERE MALARIA
HYPOGLYCEMIA LOW SERUM SODIUM
MALABSORPTION (FATS, XYLOSE, VIT B 12 PULMONARY EDEMA CNS DYSFUNCTION ( COMA) ELEVATED BUN, CREATININE,
PROTEINURIA
MALARIA
OCCURS IN TROPICAL/ SUBTROPICAL COUNTRIES
300-500 M CASES ANNUALLY
1.5.-2.7 M DEATHS
10 LEADING CAUSES OF MORTALITY
MALARIA
FIRST FEW DAYS:STEADY LOW GRADE FEVERHEADACHEPHOTOPHOBIAMYALGIAANOREXIANAUSEA/ VOMITING
REGULAR CYCLE
CLASSIC:
CHILLS
FEVER
SWEATING
SPLENOMEGALY
ANEMIA
JAUNDICE
CAUSES OF ANEMIA
HEMOLYSIS
SPENIC REMOVAL OF RBC FROM CIRCULATION
AUTO-IMMUNE LYSIS
DECRASED INCORPORATION OF IRON INTO HEME
BONE MARROW DEPRESSION
MALARIA - PHILIPPINES
65-70% P. FALCIPARUM – MALIGNANT
30% P. VIVAX – BENIGN TERTIAN
1% P. MALARIAE - QUARTAN
FALCIPARUM MALARIA
INVADES ALL AGES OF RBCSEQUESTRATION IN INTERNALORGANS
ISCHEMIALIVER – ABDOMINAL PAINS
JAUNDICELUNGS – PULMONARY EDEMAKIDNEYS - BLACKWATER FEVER-
HEMOGLOBINURIACEREBRAL INVOLVEMENT
COMPLICATED
COMACONVULSIONSHYPOGLYCEMIAACIDOSISRESPIRATORY DISTRESSALGID (CIRCULATORY COLLAPSE,
SHOCK & SEPTICEMIA)HYPER-PARASITEMIA
CEREBRAL MALARIA
VIVAX MALARIA
LESS SEVERE RELAPSES OCCUR AFTER WEEKS OR MONTHS
INVADES ONLY RETICULOCYTES
LOW ALBUMIN/ ELEVATED GLOBULIN
INCREASED SERUM POTASSIUM
MALARIAE MALARIA
INVADES OLDER RBC
LONGER INCUBATION PERIOD
NEPHROTIC SYNDROME – DEPOSITION OF IMMUNE COMPLEXES
LATENT INFECTION FOR MANY YEARS
WHO ARE AT RISK?THOSE IN ENDEMIC PLACES
CHILDRENPREGNANT WOMEN
SPONTANEOUS ABORTION CONGENITAL INFECTIONSLOW BIRTH WEIGHTPRE-TERM DELIVERYPERI-NATAL DEATH
TRAVELERS
BLOOD RECIPIENTS- TRANSFUSION
PHILIPPINES
14.8% AT RISKSOLDIERSFARMERSINDIGENOUS CULTURAL GROUPSMINERSFOREST WORKERS
65/ 79 PROVINCES8TH LEADING CAUSE OF MORBIDITY
SOLDIERS/ FORESTERS
SCOUT RANGERS
LOGGERS
MALARIA FREE
AKLAN GUIMARAS
BILIRAN ILOILO
BOHOL LEYTE
CAMIGUIN LEYTE DEL SUR
CAPIZ N/ SAMAR
CATANDUANES SIQUIJOR
CEBU
HIGHLY ENDEMIC PLACES
PALAWAN
KALINGA-APAYAO
IFUGAO
AGUSAN DEL SUR
DIAGNOSIS
CLINICAL – MIMIC DISEASEGASTROENTERITISPNEUMONIAMENINGITISHEPATITISENCEPHALITISDENGUETYPHOID
TRAVEL Hx
LABORATORY Dx BLOOD SMEARS
THICK/ THINSTAIN WITH WRIGHT’S OR GIEMSA
FLOURESCENT STAINING (QBC)
SEROLOGY: ANTIBODY DETECTION: IFAT
ELISAANTIGEN DETECTION : RAPID DIAGNOSTIC
TESTS (RDT’S)HRP IILDH
PCR
BLOOD SMEARSTHICK/ THIN
TREATMENTNON FALCAPARUM:
CHLOROQUINE ORALUNCOMPLICATED FALCIPARUM
CHLOROQUINE ORALQUININE ORALFANSIDAR (SULFADOXINE PYREMETHAMINE)
PRIMAQUINE – HYPNOZOITES/ GAMETOCYTESCHECK FOR G6PD DEFICIENCY
ARTEMISININ (QINGHAOSU) CO-ARTEM
COMPLICATED MALARIA – HOSPITALIZE (IV MEDICATION)
PROPHYLAXIS – CHLOROQUINEPROGUANIL
P. FALCIPARUM P.VIVAX P.MALARIAE
ASEXUAL 36-40 HRS 48 HRS 72 HRS
DISEASE
INCUBATION
MALIGNANT
8 -11 DAYS
BENIGN
10-17 DAYS
QUARTAN
18-40 DAYS
INFECTED RBC
NORMAL & ENLARGED SIZE
ENLARGED NORMAL SIZE
PIGMENTS MAURER’S
CLEFTS
SCHUFFNER’S
DOTSZIEMANN’S DOTS
P. FALCIPARUM P. VIVAX P.MALARIAE
RINGS 1/5 1/3 1/3
TROPHOZOITES NOT IN THE CIRCULATION
AMEBOID CYTOPLASM
BAND/BASKET
OR BIB FORMS
SCHIZONTS (NO. OF MEROZOITES)
12- 36
AVE-24
NOT IN THE CIRCULATION
12-24
AVE 16
6-12
AVE -8
GAMETOCYTES BANANA
SAUSAGE CRESCENT
SPHERICAL SPHERICAL
PLASMODIUM FALCIPARUMRINGS
PLASMODIUM FALCIPARUM GAMETOCYTES
PLASMODIUM VIVAX
PLASMODIUM VIVAX RINGS
PLASMODIUM VIVAX DEVELOPING TROPHOZOITES
PLASMODIUM VIVAX SCHIZONTS
PLASMODIUM MALARIAE
PLASMODIUM MALARIAE BANDFORM
PLASMODIUM MALARIAE SCHIZONTS
PREVENTION
• Mosquito nets
• Clean clothing
CONTROL
BABESIA- PIROPLASMA
BLOOD PARASITES THAT CAUSESHEMOLYSIS
B. MICROTI - USAB. DIVERGENS - EUROPE
TICK-BORNE – IXODES spp LYME DISEASE
BLOOD TRANSFUSION
BABESIOSIS -PIROPLASMOSIS
MANIFESTATIONSIRREGULAR FEVERS
CHILLSSWEATING
PAIN/ MALAISELETHARGY
SEVERE CASESHEMOLYTIC ANEMIAJAUNDICESHORTNESS OF BREATHHEMOGLOBINURIA
HIGH RISK
IMMUNO-SUPPRESSEDELDERLYCO-INFECTION WITH LYME DISEASE
COMPLICATIONSACUTE RESPIRATORY FAILURECONGESTIVE HEART FAILUREPULMONARY EDEMARENAL FAILURE
DIAGNOSIS
BLOOD SMEAR EXAMINATION
IFAT
ANIMAL INOCULATION - GERBILS
TREATMENT
CLINDAMYCIN ORAL/ IV
WITH QUININE
ATOVAQUONE - ORAL
AZITHROMYCIN - ORAL