Human Malaria

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Human Malaria
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• Human Malaria
• Suborder Haemosporina
• ????????????????? Heteroxenous ??? ?? Asexual
  cycle ??? Sexual cycle ???????????
• Asexual cycle ????????? RBC ??? Vertebrate
• Sexual cycle ?????? Invertebrate
• ?????????????????????????????? ??????
  ????????????? ????????

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Family Plasmodiidae Genus Plasmodium
( Human , Animal Malaria) Mal
aria Bad air
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Human Malaria - ?? 4 species ??? Plasmodium
falciparum (Welch,1897)Plasmodium vivax (Grassi
and Felett, 1890) Plasmodium malariae (Laveran,
1881) Plasmodium ovale (Stephens, 1922)
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• Genus Plasmodium ??????????? 9 subgenera
• ????? 2 subgenera ???????????????? Malaria
  ???????????? ??????
• 1. Subgenus Plasmodium
• 2. Subgenus Laverania

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• Subgenus Plasmodium
• ???? Exoerythrocytic schizonts ????? generation
  (?????? Parenchyma liver cells)
• Gametocytes ????????????
• Host insect ??? ??? Genus Anopheles
• ?????? Plasmodium vivax
• Plasmodium ovale
• Plasmodium malariae

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• Subgenus Laverania
• ???? Exoerythrocytic schizonts ???????????????
• Gametocytes ????????? crescent
• Host insect ??? ??? Genus Anopheles
• ?????? Plasmodium falciparum

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??????????????????????????? ?.?. 2390
(1847) Meckel ?? Pigment ??????? ?.?. 2392
(1849) ?????????????????? Virchow ?.?. 2398
(1855) ?????????????????? Chacot ?.?. 2423
Laveran ?????????????????????? ?.?.
2428 Marchiafava and Celli ???????????
??? Laveran??????????? Genus
Plasmodium
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?.?. 2434 Romanosky ???????????????????????? ?.?.
2441 Ross ????? Life cycle ??????????? ?.?.
2442 Bignami ?????? ?????????????
?????????????????? ???????????
???????????
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• ????????????? (Distribution)
• ??????????? (Tropical Zone)
• ????? Plasmodium malariae ????????????
• Subtropical zone
• Temperate Zone ?? Plasmodium vivax
• Plasmodium ovale ????????????? East
• Africa , West Africa , Nigeria ??? Philippines

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????????? (Mode of Infection) 1.
??????????? ?????????????? (Anopheles spp.)
?????????????? ?????? Sporozoites 2.
??????????????????????? ??????????????
Trophozoites ?????????????? 3. ???????????????????
???????? ?????????????????????????????????
???? ?????? Trophozoites ??????
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• ??????? (Life cycle)
• 1. Sporogony cycle (Exogenous sexual phase)
• ???????????????????? ?????????????????
• ???? cycle ????????????? Invertebrate Host
  (Mosquito cycle)

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2. Schizogony cycle (Endogenous sexual phase) -
??????????????????????? ???????? - ???? cycle
????????????? Vertebrate Host (Human cycle) -
?????????????? 3 ???
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1. Exo-erythrocytic schizogony (Tissue stage) -
???????????????????????????? 2. Erythrocytic
schizogony (Blood stage) - ????????????????????
?????????????? 3. Gametogony -
??????????????????????
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• Sporogony cycle (Mosquito cycle)
• ??????????????????????????????? ???????? ???
  ??? Gametocyte ???????????????
• Mature Gametocytes ?????????????????????????????
  ?

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Gametocyte Microgamete Macro
gamete Zygote Ookinete (Fusiform
body) Oocyst Sporozoites
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• Oocyst ?????????? Hemocelomic cavity ??????
• Mature Oocyst ???????? Sporozoite ???????
  Hemocele Hemolymph Salivary
  gland

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• Schizogony cycle (Human cycle)
• Sporozoites ???? Infective stage
• ?????????????????? ????? sporozoites
• ??????????????

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Sporozoites Parenchymal cell ???
??? Schizogony Merozoite RBC
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Pre-erythrocytic schizogony - ???????
?????????????????????????????? Schizogony
?????????????????? ?????????????? Merozoite
????????????????? (Erythrocytic cycle) - ???????
Pre-erythrocytic schizogony ??? 1 generation
??????????????????????????????????????????? ???
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Piasmodium vivax ??????? 8 ??? Piasmodium
falciparum ??????? 6 ??? Plasmodium ovale
??????? 9 ??? Plasmodium malariae ??????? 15
???
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Post-erythrocytic schizogony - Merozoites
???????????????? Infect cell ?????? ????
schizogony ???????????? Exoerythrocytic -
????? Merozoites ???????????? Hypnozoites -
??????? Post-erythrocytic ??????????????
??????????????????? ( Relapsing Fever)
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Erythrocytic schizogony - ??????? Blood phase -
??????????????? Merozoites ?????
???????????? (RBC) - ?? 2 ??? ??? 1. Asexual
cycle ???? Schizogonic cycle 2. Gametogonic
cycle ???? Gametocytogenesis
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Asexual cycle (Schizogonic cycle) - ????????
Merozoite ????????? ????????????????????? -
???????????????? (???? Erythrocytes ???
Reticulocytes ) - ?????????????????????????????
????????????????????? ??????????????
Plasmodium vivax ??? Plasmodium ovale
??????? Reticulocytes Plasmodium malariae
??????? Old Erythrocytes Plasmodium
falciparum ????????????????? RBC
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• ???????? RBC ????????????????????????????
  Merozoites
• ??????? - merozoite ?????????? (Oval)
• - ????? vacuole ?? cytoplasm
• - ????? pigment (????? Malarial
  pigment)
• - ??? cytoplasm ??????????????????????
  ??
• - ??????????????????????? ?????????????
• (Ring form)

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????????cytoplasm??? RBC ?????????
????????????????????????????? ?????????????
Hematin ???????? Haemogobin , Hematin
??????????????? ???? Malarial Pigment
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???? Ring Form - ??????????????? cytoplasm
???????????????????????????????? ????????????
Amoeboid Form - Malarial pigment ?????????
(pigment ????????????????????????????????????)
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???? Amoeboid Form - ??????????????? Mitosis -
Activity ???? - Malarial pigment ??????? -
?????????????? nucleus ????? Immature Schizont
( Early Schizont) - ????????????????????????????
?????????????? ??????? activity ????? Mature
Schizont (Late Schizont)
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???? Mature Schizont - cytoplasm
???????????????????? nucleus - ???????? pigment
?????? cell - ????? cell ???????? Malarial
pigment ??? vacuole ??? Merozoite
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???? Merozoite - ?? infect RBC ?????
??????????????????????????????? - ????
Schizogony ????? - ???????????? Relapsing
Malaria ????? Merozoite ??????????????????
??????? Post erythrocytic cycle
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• Gametocytes ????????????? ??? ?? 1 nucleus
  ???????????????????????????????? gametocyte ?????
  ????????????????????
• Gametocyte ?????????????????????
  ????????????????
• ????????? gametocyte ???????????????????????????
  ? ??????????????? ?????? ???????????????????
  (crescents shape)

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???????????????????????? - ?????????????????
Plasmodium ?????????????????????????????
??????????????????????????????????????????????????
??????????????????? - ??????????????????????????
???????????? ?????????????????????????????????????
??????????? ?????????????????????????????????????
?????????????? ???????????????????????????????????
? ????????????????????? ????????????????????????
???????? dot ?????
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??????????????????????????????????? ??????????????
???????????????????????????? 1.Plasmodium
falciparum RBC - ???????? -
???? Maurers dot (???? dot ????????
??????????????????????? ????????????????
??????????????????? ??????????????????
????????????????? parasitophorous
vacuole) - ?? Multiple infection
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2. Plasmodium vivax RBC -
???????????????? - ????
Schuffners dot (???????????? ?????
???????? ????????????????? ???????????
???????????????????????? ??????????
???????? caveola-vesicular
complex) - ????????? Mutiple
infection - Pigment ????????????????????
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3. Plasmodium malariae RBC - ????????
???????????????? - ???? Ziemanns dots
(??????????????????) - ????? Mutiple
infection - Pigment ????????? ???????????
?????
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4. Plasmodium ovale RBC - ??????
???????????? ???????????
??????????? - ???? Schuffners dot
?????? P. vivax -
Pigment ????????
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???????????? Plasmodium ???????????? Human
Malaria Plasmodium falciparum ????????
Malignant tertian Subtertian
Estivo autumnal Falciparum
malaria ?????????????????????????????????????????
????? ?????? ????????????????????? ????
????????????????
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Plasmodium vivax ????????
Benign tertian Simple
tertian Vivax
malaria ????????????????????????????????
????? ??????????????????????????????????
???? ?
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Plasmodium malariae ????????
Quartan malaria
Malariae malaria ??????????????
??????????????????????????
(??????? ???? ?????????? ???????? ??????????
????????) ?????????????????????????????????
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Plasmodium ovale ???????? Ovale
malaria ????????????????????????????? ??????
????????????? ??????????? ?????????????????????
????????
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??????????????????? ?? 4 ???? 1.
?????????????????? ( Pre-patent Period )
- ??????? sporozoites ???????????? ?????
?????? Asexual stage
???????????? - ?????????????????
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2. ?????????????????? ( Incubation Period )
- sporozoites ????????????????? ??????????
??????????? - ??????????
(???????????????????? ?????????) -
P.f. ?????? 12 ??? - P.o. ??? P.v.
?????? 13-17 ??? - P.m. ?????? 28-30 ???
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3. ???????????? ( Premonitory Period ) -
???????????????? ?????????????????
????????????????? ??????????????????? -
?????????? ???????????? ????????
???????????? ?????? ??????????
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4. ??????????????? ( Malaria Paroxysm ) -
????????????????? ??????????? 3 ???? ???
4.1 ???????? ( Cold stage ) ????????????
??????? ???????????????
???????????????? 15-60 ???? 4.2 ???????? ( Hot
stage ) ??????????????? ??????????????
1-3 ??????? (?????? 6 ???????)
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4.3 ????????????? ( Sweating stage )
?????? 2-4 ??????? ??????????????
?????????? ??????????? (apyrexia)
????????????????????? ?????????
??????????
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• Vivax malaria ??? Ovale malaria
• ??????????????
• ?? Hypnozoite ??????????????
• Pre-patent period 11-13 ???
• Incubation period 13-17 ???
• ??????? ??????? ???????? ?????????? ????????
  ??????? (????? ????)

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• ???????? ?????? 3 ????
• ?????? ?????? (????????????? ?????)
• ??????????????????????? 6-12 ???????
• ???????????? ????????? ???????(Relapse)
• ????? 2-3 ??

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• Malariae malaria
• Pre-patent period 15-16 ???
• Incubation period 28-30 ???
• ??????? ??????????????? ???? ????????????????
• ????????? 3 ???
• ????????????? Nephrotic syndrome (??????
• ??? ?????????)
• ???????????? Recrudescence ?????????? 20 ??

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Falciparum malaria - Pre-patent period 9-10
??? - Incubation period 12-17 ??? -
??????????? ?????????????????? - ???????
????? vivax ????????????? - ?????????????????????
? ????????? ??????? ??????????????????
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- ??????????? 2-3 ??? ???????????????? ??? 36
??????? - ?????????????? 3 ???? - ??????????????
Recrudescence - ????????????? ???????????????
???? - ?????????????????? ????? ????????????
(???????????) - ?????????????? ??????
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?????????? ??????????????????????????????????
???????????????????????????????
?????????????????????????????? 1.
????????????????????? 1.1 ???????????? ???
???????????????? (????????) ???
??? Hemolysis (????????) ???
Macrophage ????? ?????????
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1.2 ???????????? Monocyte ???????????
(?????? 15) 1.3 ??????????????????????
?????????? Plasmodium falciparum
?????????????????? ?????? ???????????
(??????????????????????????)
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2. ??????????????????? - ?????
?????????????? ?? ???????? ???????
- ??????????????????????????? 3.
?????????????????? - ??????????????????????
??????????? ???? (Merozoite, Pigment,
????????????)
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4. ???????????????? - ????????????????
???? ??????????? ??? ???????? 3-4
?????????????????? 5. ??????????????? -
????????????????????????? Plasmodium vivax
??? Plasmodium malariae ??????
Plasmodium falciparum ???????? ???
(????????)
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6. ???????????????? - ?????????
Plasmodium falciparum ???
????????????????????????????????? 7.
??????????????????????? - ?????????????
??????? ??????????? ????? ?????????
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????????????? ???????????????? Plasmodium
falciparum 1. ???????????????? (Cerebral
malaria) ???????????????????????????
???? RBC ????? ????????????????????
??? ?????????????? ???????????
??????????? ???? ??? ??? ?????????
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2. ???????????? (Black water fever) ????????? RBC
??????????????? ?????????? Hemoglobin ?????????
????? ?????? ???????? ?????????? ????????????
????????? 3. ????????????????? (Pulmonary
edema) ???????????????????????????????????????
Permeability ??????????????????????????????
????? ?????????? ???
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4. ????????????????????? (Gastrointestinal
malaria) ?????????????????????????????????????
?????? O2 ????? ???????????????????????????
??????? ???????? ???????????? 5. ??????????
(Renal failure) ??????????????? ???????????????
??????????? ???????????????????????????? ????????
???? ?????????????????????????
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??????????????? 1. ??????????????
- ???????????????????????????? ????????????
????????????? -
???????????????????????????????????
- ??????????????????????
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2. ????? ????????????????????????????????????
(???????? P. falciparum) ??????????????????
??????????? ?????????
???????????????????
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3. ?????????????? ????????????????????????
??????????????????????? ????????? ?????????
????????? ??????????? ?????????????? ????
????????? ?????????
4. ???????????? ?????????????????????????????????
??? Thin film ??? Thick film
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???????? (Treatment) ??????????????????
(Antimalarial drug) ?????????????????????????????
??????????????????????????????????????????????????
? 1. Tissue schizontocides (????????????????????)
P. falciparum Pyrimethamin ,
Proquanil P. vivax , P. ovale , P. malariae
Primaquine ,
Pamaquine
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2. Blood schizontocides (???????????? Asexual ??
RBC) 2.1 Quinoline derivative (????????
?????????????) - Quinine -
Chloroquine - Mefloquine 2.2 PABA
antagonists (????????????????????????????)
- Sulfonamide
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2.3 Dihydrofolate reductase inhibitors -
Pyrimethamin - Proguanil 2.4 Antibiotic
(????????? ???????????? ???????)
- Tetracycline
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4. Sporontocides (??????????????????
Gametocyte ????????????) ?????? -
Pyrimethamin - Proguanil - Primaquine
- Pamaquine
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Tissue schizontocides Sporozoites
Exo-erythrocytic schizogony Sporonto
cides Gametocytocides Blood
schizontocides Gametocytes Gametogony
Erythrocytic schizogony
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?????????????? 1. ????????????? (Redical
treatment) - ????????????????????????????????
??????? - ??????????????????????????????
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- P. falciparum ????? MSP (Fansimef)
Primaquine M Mefloquine S
Sulfadoxine P Pyrimethamine
???????????????????? ?????????????????
?????????? sulfa ?????????????????? 6 ?????
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- P. vivax ??? P. malariae ?????
Chloroquin Primaquine ??? Asexual
???????????? Gametocytes
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2. ?????????????? (Presumptive treatment) -
???????????? ??????????????????? -
???????????????????????????? -
?????????????????????????????????
???????? ???????? - Fansidar (SP)
Primaguine S Sulfadoxin P
Pyrimethamine
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??????????????????? (Prevention and Control) 1.
??????????????????????????????? (Individual
Protection) - Bed nets - Screening -
Repellents - Antimosquito fumigants -
Pyrethrum house spray - Protective clothing
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2. ???????????????? (Vectors Control) -
Residual insecticide spraying (D.D.T. ) -
Insecticide space spraying (Malathion) -
Biological control (Larvivorous fish ,
Bacillus thuringiensis ) - Chemical larvicide
(Abate) - Environmental modification (Clearing
of vegestation , Drainage)
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3. ?????????????????????????? (Eliminate
parasite in human host) - Case detection
Active case detection Passive case
detection - Treatment Presumtive
treatment Radical treatment -
Vaccination againts malaria
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????? Individual Protection
Eliminate parasite in Human host
?? ???
vector control
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