Malariaintro2010 (2)
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- 1. “The awkward fact with which US policy wrestles is that People flee the world’s Haitis for a combination of motives. All are deserving of some compassion but how much?” Newsweek, Dec. 4 1991 “Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed, to me” Inscribed at base of Statue of Liberty, by Emma Lazarus
- 2. As you know in the developing world treatable infectious diseases remain big killers Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age 0-44 (World Health Organization)
- 3. Now it’s time to look at number 3: Malaria Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age 0-44 (World Health Organization)
- 4. That’s right: 300 million new cases per year making it the most prevalent serious infectious disease! Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age 0-44 (World Health Organization)
- 5. –2.1 billion people live in MALARIOUS areas
- 6. –Like HIV and TB, malaria is –unequally distributed, even in the tropics
- 7. –In areas of Africa with high transmission –there are 2700 deaths per day = 2 per minute www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
- 8. It’s especially hard on kids
- 9. It’s especially hard on kids 75% of the deaths are among African children
- 11. What Is malaria? A mosquito-borne infectious disease caused by Protozoan parasites of the genus Plasmodium
- 12. What Is malaria? Transmitted only by Anopheles Mosquitoes (>60 species!) Seattle Biomedical Research Institute
- 13. What Is malaria? The Disease can be Acute or Chronic
- 14. Acute Symptoms Classical features include cyclic symptoms – Cold stage: chills and shaking – Hot stage: fever, headache, vomiting, seizures in children – Sweating stage: weakness – Feel well for period of time, then cycle repeats itself www.uhhg.org/mcrh/resources/video/malariappt.pdf
- 15. In fact it is several different diseases
- 17. Each disease has a distinct course
- 18. Each disease has a distinct course “Tertian Malaria” (P.falciparum, P.ovale and P.vivax) fever occurs every third day. “Quartan Malaria” (P. malariae) fever occurs every fourth day. www.uhhg.org/mcrh/resources/video/malariappt.pdf
- 19. Each disease has a distinct course P.ovale and P.vivax can cause chronic malaria, reappearing after months or years due to latent parasites in liver www.uhhg.org/mcrh/resources/video/malariappt.pdf
- 20. Each disease also has a distinct geographical distribution www.uhhg.org/mcrh/resources/video/malariappt.pdf
- 21. Each disease also has a distinct geographical distribution www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
- 22. Each disease also has a distinct geographical distribution www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
- 24. Malaria damages the body in a number of ways Red blood cell destruction -> anemia Waves of parasites bursting red blood cells Lead to classic cycles of fever and chills
- 25. Malaria damages the body in a number of ways Changes adhesive properties of infected Red blood cells -> blocking blood vessels leading to Tissue hypoxia
- 26. Malaria damages the body in a number of ways If this happens in brain it is cerebral malaria which is often fatal Blocking blood vessels can also cause kidney failure
- 27. Malaria damages the body in a number of ways In severe cases 20% of patients can die, even with the best care
- 28. DIAGNOSIS Gold standard: Multiple thick and thin smears
- 31. Malaria is not currently a serious threat in the US 1300 cases in US per year Essentially all “imported” Also transfusion related malaria www.uhhg.org/mcrh/resources/video/malariappt.pdf
- 33. Malaria is not currently a serious threat in the US
- 34. However, this was not always the case
- 35. Not that long ago…. www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
- 37. It could come back! www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
- 38. Let step back and look at the parasites that cause malaria
- 39. It was discovered more than 100 years ago A French army doctor in Algeria observed parasites inside red blood cells of malaria patients and proposed for the first time that a protozoan caused disease Charles Louis Alphonse Laveran www.uhhg.org/mcrh/resources/video/malariappt.pdf
- 40. 907 Nobel Prize for Physiology r Medicine! French army doctor in Algeria observed parasites inside red blood cells of malaria patients and proposed for the first time that a protozoan caused disease Charles Louis Alphonse Laveran www.uhhg.org/mcrh/resources/video/malariappt.pdf
- 41. So just who is this Plasmodium? www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
- 42. It’s not a bacterium or virus but a eukaryote like us www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
- 43. However, unlike us it lives a solitary life as a single cell www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
- 44. Let’s go back to the family tree
- 45. Let’s go back to the family tree http://drnelson.utmem.edu/Woods.Hole/slide5.png
- 46. Let’s go back to the family tree You and me http://drnelson.utmem.edu/Woods.Hole/slide5.png
- 47. mushrooms You and me http://drnelson.utmem.edu/Woods.Hole/slide5.png
- 48. mushrooms You and me plants http://drnelson.utmem.edu/Woods.Hole/slide5.png
- 49. We are family…. mushrooms You and me Plasmodium plants http://drnelson.utmem.edu/Woods.Hole/slide5.png
- 50. They are on the same region of the eukaryote tree as plants You and me Plasmodium plants http://drnelson.utmem.edu/Woods.Hole/slide5.png
- 51. Consistent with this, we now know Plasmodium and its relatives have a remnant of the chloroplast called the apicoplast which may help it digest heme and other things it harvests from red blood cells
- 52. Consistent with this, we now know Plasmodium and its relatives have a remnant of the chloroplast called the apicoplast which may help it digest heme and other things It harvests from red blood cells We don’t have this sort of organelle How might we use that fact??!
- 53. Plasmodium and its relatives also have a specialized Structure at one end of the cell Involved in invading other cells
- 55. Plasmodium’s closer relatives Include parasites causing Babesiosis, Toxoplasmosis, And Cryptosporidiosis
- 56. Plasmodium has a wildly complex life cycle 6 2 5 3 4 1 Purves et al., Life: The Science of Biology, 4th Edition
- 57. And that’s just in the mosquito! 6 2 5 3 4 1 Purves et al., Life: The Science of Biology, 4th Edition
- 58. The wildly complex life cycle continued 7 8 Purves et al., Life: The Science of Biology, 4th Edition
- 59. Had enough yet?? 9 Purves et al., Life: The Science of Biology, 4th Edition
- 60. Now we get to the troublesome stage Cycles of replication inside red blood cells Lead to cycles of fever and chills And aggregated blood cells block blood vessels 10 Purves et al., Life: The Science of Biology, 4th Edition
- 61. We also need to get back to the next mosquito to complete the cycle 11 Purves et al., Life: The Science of Biology, 4th Edition
Notes de l'éditeur
- What is Malaria? -Malaria is a serious febrile illness caused by an intracellular parasite of the genus Plasmodium . The parasite is transmitted by the Anopheles species of mosquitoes. -There are only four species of the parasite that are capable of transmitting the disease to humans: P. falciparum, vivax, ovale, and malariae. -Malaria due to any one of the Plasmodia species can make a person very sick- but P. falciparum is the most deadly as cases have died within 24 hours of onset of symptoms. References: 1,2
- What is Malaria? -Malaria is a serious febrile illness caused by an intracellular parasite of the genus Plasmodium . The parasite is transmitted by the Anopheles species of mosquitoes. -There are only four species of the parasite that are capable of transmitting the disease to humans: P. falciparum, vivax, ovale, and malariae. -Malaria due to any one of the Plasmodia species can make a person very sick- but P. falciparum is the most deadly as cases have died within 24 hours of onset of symptoms. References: 1,2
- What is Malaria? -Malaria is a serious febrile illness caused by an intracellular parasite of the genus Plasmodium . The parasite is transmitted by the Anopheles species of mosquitoes. -There are only four species of the parasite that are capable of transmitting the disease to humans: P. falciparum, vivax, ovale, and malariae. -Malaria due to any one of the Plasmodia species can make a person very sick- but P. falciparum is the most deadly as cases have died within 24 hours of onset of symptoms. References: 1,2
- -Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness. -After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic. -The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds. -The hot stage lasts 2 to 6 hours. Fever is up to 106 F with falciparum and up to 104 F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium. -The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved. -After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3 rd day. -With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern. Ref: 1.
- -Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness. -After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic. -The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds. -The hot stage lasts 2 to 6 hours. Fever is up to 106 F with falciparum and up to 104 F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium. -The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved. -After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3 rd day. -With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern. Ref: 1.
- -Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness. -After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic. -The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds. -The hot stage lasts 2 to 6 hours. Fever is up to 106 F with falciparum and up to 104 F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium. -The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved. -After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3 rd day. -With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern. Ref: 1.
- -Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness. -After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic. -The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds. -The hot stage lasts 2 to 6 hours. Fever is up to 106 F with falciparum and up to 104 F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium. -The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved. -After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3 rd day. -With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern. Ref: 1.
- -Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness. -After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic. -The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds. -The hot stage lasts 2 to 6 hours. Fever is up to 106 F with falciparum and up to 104 F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium. -The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved. -After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3 rd day. -With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern. Ref: 1.
- -Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness. -After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic. -The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds. -The hot stage lasts 2 to 6 hours. Fever is up to 106 F with falciparum and up to 104 F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium. -The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved. -After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3 rd day. -With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern. Ref: 1.
- -Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness. -After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic. -The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds. -The hot stage lasts 2 to 6 hours. Fever is up to 106 F with falciparum and up to 104 F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium. -The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved. -After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3 rd day. -With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern. Ref: 1.
- -Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness. -After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic. -The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds. -The hot stage lasts 2 to 6 hours. Fever is up to 106 F with falciparum and up to 104 F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium. -The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved. -After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3 rd day. -With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern. Ref: 1.
- -The massive RBC destruction and the sudden release of cell breakdown products results in the onset of fever. -Recall that there are no symptoms during the liver stages. So many RBCs can become infected, that huge numbers of them are destroyed. As this destruction occurs, severe anemia can result . -In addition, infected RBCs that aren’t yet destroyed develop sticky "knobs" on their surfaces. These knobs cause RBC clumping and sludging. RBCs adhere to capillary walls, and interfere with blood flow in vital organs such as brain, liver, lung, and kidney. Tissues become hypoxic, and tissue damage interferes with vital organ functions. -Immune complexes and mediators are released contributing to tissue hypoxia and capillary permeability. Ref: 1, 5.
- -The massive RBC destruction and the sudden release of cell breakdown products results in the onset of fever. -Recall that there are no symptoms during the liver stages. So many RBCs can become infected, that huge numbers of them are destroyed. As this destruction occurs, severe anemia can result . -In addition, infected RBCs that aren’t yet destroyed develop sticky "knobs" on their surfaces. These knobs cause RBC clumping and sludging. RBCs adhere to capillary walls, and interfere with blood flow in vital organs such as brain, liver, lung, and kidney. Tissues become hypoxic, and tissue damage interferes with vital organ functions. -Immune complexes and mediators are released contributing to tissue hypoxia and capillary permeability. Ref: 1, 5.
- -The massive RBC destruction and the sudden release of cell breakdown products results in the onset of fever. -Recall that there are no symptoms during the liver stages. So many RBCs can become infected, that huge numbers of them are destroyed. As this destruction occurs, severe anemia can result . -In addition, infected RBCs that aren’t yet destroyed develop sticky "knobs" on their surfaces. These knobs cause RBC clumping and sludging. RBCs adhere to capillary walls, and interfere with blood flow in vital organs such as brain, liver, lung, and kidney. Tissues become hypoxic, and tissue damage interferes with vital organ functions. -Immune complexes and mediators are released contributing to tissue hypoxia and capillary permeability. Ref: 1, 5.
- -The massive RBC destruction and the sudden release of cell breakdown products results in the onset of fever. -Recall that there are no symptoms during the liver stages. So many RBCs can become infected, that huge numbers of them are destroyed. As this destruction occurs, severe anemia can result . -In addition, infected RBCs that aren’t yet destroyed develop sticky "knobs" on their surfaces. These knobs cause RBC clumping and sludging. RBCs adhere to capillary walls, and interfere with blood flow in vital organs such as brain, liver, lung, and kidney. Tissues become hypoxic, and tissue damage interferes with vital organ functions. -Immune complexes and mediators are released contributing to tissue hypoxia and capillary permeability. Ref: 1, 5.
- - You should suspect malaria in any febrile patient with a history of possible exposure to infected mosquitoes, whether they’ve been on chemoprophylaxis or not. One of the most important concepts to understand is: when to do a malaria blood smear on a patient?—and the answer is…WHENEVER malaria is suspected or possible. -The Geimsa-stained blood smear is considered the “gold standard” for lab diagnosis of malaria. -The thick smears are used for screening to detect the presence of malaria parasites -The thin smears are used for identifying which species is/are present -Multiple thick smears and thin smears should be prepared— a) Use venous or capillary blood for the blood smears– b) If the sample is negative, it should be repeated as often as every 6-8 hours for 24 –36 hours for two reasons—1) because symptoms can precede detectable parasitemia by 24-36 hours; and 2) if the parasites are synchronous, they may be present in the peripheral circulation for only half of the cycle (cycle is 48 h for falcip, vivax, and ovale). If the sample is positive, then slides should be repeated periodically to determine whether the parasitemia is decreasing in response to treatment –very important, especially with falciparum. Para-sight F is like a rapid “dipstick” for Plasmodium falciparum only- it doesn’t identify the presence of other species. It is a very promising technique, but isn’t yet available in the U.S. -The most common lab findings that can be seen on a CBC are: (1) anemia, thrombocytopenia, leukopenia (or leukocytosis), without eosinophilia -Other lab findings include: (2) elevated liver enzymes (3) elevated urinary albumin, urobilinogen, and bilirubin -The most specific finding , of course, is the presence of parasites on peripheral blood smears. Ref: 1.
- -There are several diagnostic features that we look for when examining the thin blood smears under the microscope that help identify the species. In general they include: a) which developmental erythrocytic stages are present; b) the size of the parasitized RBCs- whether they’re enlarged, normal (or smaller ) c) the morphology of the RBCs and the parasites In this slide we see many RBCs with ring forms in them: -Ring forms are small and delicate (about 1/5 the size of the RBC), and its quite common to see multiple forms in single RBCs; Ref: 1,5.
- -This is the banana or crescent-shaped gametocyte- it has a single nucleus. If you see this, you know the patient has P. falciparum . Ref: 5.
- Malaria has had a huge impact on civilization throughout history, and continues to do so now. It is the most prevalent disease in the world. About 2 billion people live in malarious areas throughout the world and there are 100 to 300 million new cases each year. About 1 to 3 million people die from Malaria each year. Malaria kills more people each year than any other communicable disease except Tuberculosis. And few diseases have the potential for more impact on military readiness. Today, malaria continues to be a very real threat to military personnel because of frequent deployments to areas of the world where malaria is endemic. These include humanitarian missions, military exercises, and special operations. Ref: 1,
- Malaria has had a huge impact on civilization throughout history, and continues to do so now. It is the most prevalent disease in the world. About 2 billion people live in malarious areas throughout the world and there are 100 to 300 million new cases each year. About 1 to 3 million people die from Malaria each year. Malaria kills more people each year than any other communicable disease except Tuberculosis. And few diseases have the potential for more impact on military readiness. Today, malaria continues to be a very real threat to military personnel because of frequent deployments to areas of the world where malaria is endemic. These include humanitarian missions, military exercises, and special operations. Ref: 1,
- Malaria has had a huge impact on civilization throughout history, and continues to do so now. It is the most prevalent disease in the world. About 2 billion people live in malarious areas throughout the world and there are 100 to 300 million new cases each year. About 1 to 3 million people die from Malaria each year. Malaria kills more people each year than any other communicable disease except Tuberculosis. And few diseases have the potential for more impact on military readiness. Today, malaria continues to be a very real threat to military personnel because of frequent deployments to areas of the world where malaria is endemic. These include humanitarian missions, military exercises, and special operations. Ref: 1,
- Malaria has had a huge impact on civilization throughout history, and continues to do so now. It is the most prevalent disease in the world. About 2 billion people live in malarious areas throughout the world and there are 100 to 300 million new cases each year. About 1 to 3 million people die from Malaria each year. Malaria kills more people each year than any other communicable disease except Tuberculosis. And few diseases have the potential for more impact on military readiness. Today, malaria continues to be a very real threat to military personnel because of frequent deployments to areas of the world where malaria is endemic. These include humanitarian missions, military exercises, and special operations. Ref: 1,
- Malaria has had a huge impact on civilization throughout history, and continues to do so now. It is the most prevalent disease in the world. About 2 billion people live in malarious areas throughout the world and there are 100 to 300 million new cases each year. About 1 to 3 million people die from Malaria each year. Malaria kills more people each year than any other communicable disease except Tuberculosis. And few diseases have the potential for more impact on military readiness. Today, malaria continues to be a very real threat to military personnel because of frequent deployments to areas of the world where malaria is endemic. These include humanitarian missions, military exercises, and special operations. Ref: 1,
- -Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness. -After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic. -The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds. -The hot stage lasts 2 to 6 hours. Fever is up to 106 F with falciparum and up to 104 F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium. -The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved. -After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3 rd day. -With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern. Ref: 1.
- -Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness. -After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic. -The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds. -The hot stage lasts 2 to 6 hours. Fever is up to 106 F with falciparum and up to 104 F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium. -The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved. -After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3 rd day. -With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern. Ref: 1.