Malaria

Malaria
Dr. Saima Mahmood Malhi

Associate Professor,
Department of Pharmacology,
Dow College of Pharmacy,
Malaria
• Malaria is a life-threatening blood disease caused by para-
sites
and is transmitted to humans by the Anopheles mosquito.
• Once bitten, parasites multiply in the host's liver before in-
fecting and destroying red blood cells.
• Malaria is preventable and curable, and increased efforts are
dramatically reducing the malaria burden in many places.
• Between 2000 and 2015, malaria incidence (the rate of new
cases) is reduced by 37% globally.
2
Who is at risk
• Young Children
• Pregnant women
• People with HIV
• International travelers from non endemic areas
• Immigrants from endemic areas and their children
3
Facts about malaria
• Malaria was first discovered to be a parasite disease in 1880.

• The name of the disease comes from the Italian word mal'aria,
meaning "bad air."
• Malaria is transmitted by infected mosquitoes, which then in-
fect humans with a parasite via bites.
• The most common time for these mosquitoes to be active is
between dusk and dawn.
• There were an estimated 198 million cases of malaria in 2013
and 584,000 deaths.
4
Types of Malaria Parasites
• There are more than 100 types of Plasmodium parasites,
Scientists have identified five types that specifically infect
humans:
• P. falciparum (worldwide in tropical and suburban areas,
but
predominantly in Africa.) clinical emergencies, cerebral
malaria, blackwater fever occur when more than 1% RBC
are infected)
• P. vivax – (Latin America, Africa, Asia; dormant in liver and
relapse may occur when infects blood cells)
• P. ovale ( West Africa, similar to vivax in morphology)
• P. Malariae (located worldwide), 3 day Cycle) 5
Symptoms of Malaria
Malaria symptoms can be classified in two categories:
• Uncomplicated malaria
• and severe malaria.
• Uncomplicated malaria is diagnosed when symptoms are

present, but there are no clinical or laboratory signs to indi-
cate the severity or vital organ dysfunction.
• Individuals suffering from this form, can eventually develop
severe malaria if the disease is left untreated, or if they suf-
fer from poor
to no immunity against the disease.
6
Severe or complicated malaria
• Severe malaria is defined by clinical or laboratory evidence of
vital organ dysfunction. This form has the capacity to be fatal
if left untreated. A general overview of the symptoms are:
• Fever and chills
• Impaired consciousness
• Prostration
• Multiple convulsions
• Deep breathing and respiratory distress
• Abnormal bleeding, such as anemia
• Clinical jaundice and evidence of vital organ dysfunction.
7
Diagnosis
• Early diagnosis of malaria is critical for a patient's recovery,
any individual showing signs of malaria should be tested
immediately.
• The WHO strongly advise parasitological confirmation by
microscopy or a rapid diagnostic test (RDT).
• Other investigation include full blood count , serum urea
and electrolyte (UCE), liver biochemistry and blood glucose
8
ANTI-MALARIAL AGENTS
• 1) CHLOROQUINE: rapidly absorbed, widely distributed, interaction
with
antacids i.e. decreased absorption. Excreted unchanged in urine.
• M.O.Action.: accumulates in food vacuoles of plasmodia and pre-
vents
polymerization of hemoglobin breakdown product heme into hemo-
zoin.
Intracellular accumulation of heme is toxic to parasite.
• M. O. Resistance: a) decreased accumulation via increased activ-
ity of
membrane ‘pumps’. (b)decreased accumulation via a transporter
encoded
by “pfcrt “gene.
• Clinical indication: drug of choice for acute attacks of non-resis-
tant strains and for prophylaxis also. [also used in 9autoimmune dis-
2) QUININE
• Rapidly absorbed orally, metabolized, excreted renaly. IV administra-
tion is
possible in severe cases.
• M.O.A.: it complexes with double stranded DNA to prevent strand
separation resulting in DNA replication blockade and inhibition of tran-
scription
to RNA. It solely attacks blood schizonts.
• Clinical Indication: Effective in chloroquine resistant cases. To de-
crease
durtation of therapy and to reduce toxicity, often is usee alongwith
Doxycycline or clindamycin. Should not be used routinely for prophy-
laxis to
delay resistance emergence.
• Toxicity: CINCHONISM (GI distress,headache,vertigo, 10 blurred vision,
3)MEFLOQUINE
• Can only be given orally. Variable absorption. Mechanism is
unknown.
• Use: First –line drug for prophylaxis in chloroquine resis-
tant areas and alternative to quinine. Resistance has de-
veloped
in SouthEast asia region.
• Toxicity: GI distress, skin rash, headache and dizziness. At
high dose cause cardiac conduction problems, neurological
symptoms, seizures. Use is now limited due to increased
cases of psychiatric disorders.
11
4) PRIMAQUINE
• Oral absorption is complete followed by extensive metabolism.
• M.O.A.: It forms quinoline-quinone metabolites (electron
transfering redox compounds that act as cellular oxidants.
Tissue schizonticide can act as gametocide hence, transmission is
also inhibited.
• Use: Eradicates liver stages and used in combination with blood
schizonticides. Conventionally 14 day course was recommended
after
chloroquine treatment.
• Toxicity: GI distress, pruritis,headache, and methhemoglobinemia.
• HEMOLYSIS in glucose-6-phosphate dehydrogenase (G6PD)-
deficient patients. BLACK WATER FEVER intravascular hemolysis.
Contraindicated in PREGNANCY. 12
5) ANTI-FOLATE anti-malarial drugs
• Pyrimethamine, Proguanil, sulphadoxine, dapsone. Orally ab-
sorbed,
renaly excreted. Proguanil is of shorter half life i.e. 12-16 hrs than
others. i.e. more than 100 hrs.
• Folic acid synthesis inhibitor , through dihydrofolate reductase
inhibition.
• Pyrimethamine-sulfadoxine combination (FANSIDAR) in chloro-
quine
resistant strains.
• Proguanil-atovaquone combination( MALARONE) in mefloquine
resistant cases and choice for chemoprophylaxis.
• TOXICITY: pyrimethamine may cause folic acid 13 deficiency in high
OTHER ANTI-MALARIAL AGENTS
• Doxycycline
• Amodiaquine
• Atovaquone
• Halofantrine
• Artesunate & artemether
14
Treatment
• (Artemether –lumefantrine)Artemisinin-based combi-
nation
therapy (ACT) is recommended by the WHO to treat
uncomplicated malaria. Artemisinin is derived from the
plant
Artemisia annua, better known as sweet wormwood, and
is
known for its ability to reduce quickly the number of
Plasmodium parasites in the bloodstream.
• ACT is artemisinin combined with a partner drug. The role
of
artemisinin is to reduce the number of parasites
15 within
Treatment cont.
Treatment of acute uncomplicated attack of malaria
1) P.valvex , P.ovale & P.malarae: Chloroquine 600mg fol-

lowed by
300mg 6hr & later 300mg for two days
2) P.Falciparum: Quinine 600mg three times daily for 7days
followed by 3 tablets of Fansidar as single dose (
Sulphonamide / pyrimethamine )
3) for fansidar allergic or resistant cases; Doxycycline 200mg
for 7 days
4) Eradication For P.valvex & P.ovale :Primaquin 15mg daily for
16
14
Prophylaxis
The ABCD of malaria prophylaxis:
• Awareness of the risk of malaria.

• Bites - reducing likelihood of bites from anophelise mos-
quitoes.
• Chemoprophylaxis (Chloroquine, doxycycline, Malarone,
Primaquine)
• Diagnosis and prompt treatment to prevent complications
17

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Malaria

Dr. Saima Mahmood Malhi

• Malaria was first discovered to be a parasite disease in 1880.

• Uncomplicated malaria is diagnosed when symptoms are

1) P.valvex , P.ovale & P.malarae: Chloroquine 600mg fol-

• Awareness of the risk of malaria.

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