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7/26/2019 K24-Malaria Blok Tropmed
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Malaria
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Exo-erythrocytic(hepatic) cycle
Sporozoites
Mosquito SalivaryGland
Malaria LifeCycleLife Cycle
Gametocytes
ocyst
ErythrocyticErythrocyticCycleCycle
!y"ote
Schizogony
Sporogony
#ypnozoites(for P. vivaxand P. ovale)
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Plasmodium spp.1.Plasmodium vivax : Benign Tertian,Tertian Malaria
2.Plasmodium ovale : Ovale tertianMalaria
3.Plasmodium malariae : Quartan malaria
4.Plasmodium faliparum : MalignantTertian malaria.
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Afnity o Parasite toErythrocytes
P.vivax P.malariae Inectes only young
or P.ovale Old Erythocytes
P.alciparum Inects all agegroups
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AAlteration olteration o HHostost CCellsells
! variet" of strutural #anges, $#i# alterits funtion, appearane or antigeniit".
T#ese alterations are a onse%uene ofparasite gro$t#
!dvantage to t#e parasite &e.g. inreasedmem'rane permea'ilit", inreased seletiveinta(e of nutrients, or esape from immunit"
'" se%uestration). T#e nature of t#e alterations indued are
varia'le from one speies to anot#er.
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1.! visi'le #ange of s#apeand redued deforma'ilit"
2.T#e presene of eletron*dense protrusions or
+(no's3.T#e presene of small
depressions, or-aveolae-, at t#e surfae
of t#e red ell, onneted'" a net$or( of smallvesiles and lefts in P.vivaxand P. ovale
he alterations identi!edhe alterations identi!ed
include "include "
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4.4. TT#e "toad#erene to#e "toad#erene to
endot#elial ellsendot#elial ells
.. TT#e ad#erene to normal#e ad#erene to normal
er"t#ro"tes &-rosetting-) or toer"t#ro"tes &-rosetting-) or toot#er infetedot#er infeteder"t#ro"teser"t#ro"tes&-auto*agglutination/&-auto*agglutination/oror
lumpinglumping))
0.0. TT#e presene of ne$ meta'oli#e presene of ne$ meta'oli#annels evidene of ne$#annels evidene of ne$
parasite*spei antigensparasite*spei antigens
assoiated $it# t#e red ellassoiated $it# t#e red ell
mem'ranemem'rane
he alterations identi!edhe alterations identi!ed
include "include "
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Pathogenesis
elated to er"t#ro"ti infetion '" t#e asexual
stages, ameto"tes not involve inpat#ogenesis
Pat#olog" is assoiated $it#:Haemolysis
* 5iret invasion 6 rupture of B7 during er"t#ro"ti "le
* 8nreased osmoti fragilit" of B7
Increased adhesiveness o inected #$C* 8nreases $it# t#e maturit" of t#e parasite &s#i9ont trop#o9oite)
* ;no' t#eor"#elease o pyrogens% toxin and cyto&ines
Immunological responses
Capillary permea'ility
issue hypoxia
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Rosetting
Sludging
Sequestration
PathoPathogenesisgenesis
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Pathogenesis
7"to(ines an indue &mimi) man" of s"mptoms7"to(ines an indue &mimi) man" of s"mptomsand signs of malaria &s#ivering, #eada#e, #ills,and signs of malaria &s#ivering, #eada#e, #ills,spi(ing fever,s$eating, vasodilation,spi(ing fever,s$eating, vasodilation,#"pogl"emia)#"pogl"emia)
!d#erene and in
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Immunity
8n
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Immunity
8nnate ed ell pol"morp#isms assoiated $it#
some protetion =emoglo'in @ si(le ell trait or disease
=emoglo'in 7 and #emoglo'in A
T#alessemia C and D
luose 0 p#osp#ate de#"drogenasedeien" &0P5)
ed ell mem'rane #anges
!'sene of ertain 5uE" oat antigensimproves resistane to P.v.
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Immunity
!%uired
Transferred from mot#er to #ild 3*0 mont#s protetion
T#en #ildren #ave inreased susepti'ilit"
8nreased susepti'ilit" during earl" #ild#ood
="per* and #oloendemi areasB" age atta(s usuall" F fre%uent and severe
7an #ave parasite densities $it# fe$er s"mptoms
Meso* or #"poendemi areas ?ess transmission and repeated atta(s
Ma" a%uire partial immunit" and 'e at #ig#er ris( fors"mptomati disease as adults
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Immunity
!%uired Go omplete immunit"
7an 'e parasitemi $it#out linial disease
Geed long period of exposure for indution
Ma" need ontinued exposure formaintenane
8mmunit" an 'e unsta'le 7an $ane as one spends time outside endemi
area 7an #ange $it# movement to area $it#
diEerent endemiit"
5ereases during pregnan", ris( improves$it# inreasing gravidit"
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Immune Mechanisms
@tage spei :
!nti sporo9oite anti'odies in adults inendemi areas* 'lo(s liver invasion
!nti sporo9oiteHmero9oite anti'odies *
'lo( r' invasion 7"to(ines : TGI 'lo(s mero9oite
development 8?1 8?1J
Ar"t#ro"te learane * liver and spleen
Blo( "to*ad#erene An#ane learane t#roug# opsonisation
!577 li(el"
G; ativit" 15
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T#an( Kou