MalariaMalariaPlaguePlague

Disease characterized by Disease characterized by certain febrile disturbances certain febrile disturbances caused by protozoa caused by protozoa parasites class SPOROZOA parasites class SPOROZOA family PLASMODIAE). family PLASMODIAE). Clinically malaria is Clinically malaria is characterized by periodic characterized by periodic attacks of fever, associated attacks of fever, associated with anemia and with anemia and enlargement of liver and enlargement of liver and spleenspleen

EtiologyEtiology

Causative agentsCausative agents – – elementary elementary microorganismmicroorganism ( (1-1,5 – 40-60 1-1,5 – 40-60 mcmmcm))

Plasmodium vivax – Plasmodium vivax – 3-days malaria3-days malaria (P. vivax vivax - “(P. vivax vivax - “southsouth” ” stam stam, ,

P. P. vivax hibernans – “vivax hibernans – “northnorth”” stam stam)) P. malariae – P. malariae – 4-days4-days P. ovale – P. ovale – oval-malariaoval-malaria P. falciparum – P. falciparum – tropictropic

Cycles of developmentCycles of development

sexualsexual ( (sporogonysporogony) – ) – in in mosquito organismmosquito organism

asexualasexual ( (schizogonyschizogony) - ) - in human in human or animal spinal organismsor animal spinal organisms::

tissuetissue ( (incubation periodincubation period))

erythrocyteerythrocyte (P. malariae - 72 (P. malariae - 72 hourshours, , for othersfor others – 48) – 48)

EpidemiologyEpidemiology

SourceSource – – sicksick personperson, , carriercarrier

MechanismMechanism – – transmissibletransmissible

After the bites of female mosquitoAfter the bites of female mosquito Anopheles Anopheles

SeasonalSeasonal – –-- summer-autumn, in tropics – whole summer-autumn, in tropics – whole

yearyear

Susceptibility - Susceptibility - highhigh

ImmunityImmunity – – non persistent non persistent, , homologoushomologous

PathogenesisPathogenesis Tissue schizogony (incubation period)Tissue schizogony (incubation period) Erythrocyte schizogony – incorrect Erythrocyte schizogony – incorrect

temperature typetemperature type Typical attack – Typical attack – massive destruction of massive destruction of

erythrocytes, massive appearance of erythrocytes, massive appearance of parasites and products of their metabolismparasites and products of their metabolism

Disturbance of thermoregulation centre, Disturbance of thermoregulation centre, increasing of vessels penetrationincreasing of vessels penetration

Disturbance of microcirculation, water-Disturbance of microcirculation, water-electrolytes balance, vegetative neurotic electrolytes balance, vegetative neurotic systemsystem

Development of hemolytic anemia Development of hemolytic anemia Hepatosplenomegaly Hepatosplenomegaly Development of comaDevelopment of coma

Malaria classificationMalaria classification OnOn paraziteparazite:: three days three days (P. vivax), (P. vivax), four four

daysdays (P. malariae), (P. malariae), malaria ovale malaria ovale (P. (P. ovale), ovale), tropicaltropical (P. falciparum) (P. falciparum)

According to originAccording to origin:: hereditary hereditary , , primaryprimary, , inaculated inaculated ((shizontshizont), ), reinfectionreinfection

Stage of severityStage of severity:: mild, moderate, mild, moderate, severesevere

DurationDuration:: acute, prolonged, with early acute, prolonged, with early and late recidives, without recidives.and late recidives, without recidives.

ComplicationsComplications:: comacoma, , hemoglobinuria hemoglobinuria feverfever, , interruption of spleeninterruption of spleen, , infectiousinfectious--toxic shock,toxic shock, intravascular DSintravascular DS

Clinic symptoms of Clinic symptoms of malariamalaria

Incubation periodIncubation period: : 3-days malaria3-days malaria – 10-14 – 10-14 days days ((south tapesouth tape) ) or or 8-14 8-14 monthsmonths. (. (northnorth),),

4- days4- days– 20-25 – 20-25 daysdays, , tropicaltropical – 8-10 – 8-10 daysdays Attack of feverAttack of fever ( (chill chill – – hothot – – sweatsweat)) with periodswith periods ( (forfor P. malariae - 72 P. malariae - 72 hourshours , ,

for othersfor others – 48 – 48 hourshours) ) HepatosplenomegalyHepatosplenomegaly Hemolytic anemiaHemolytic anemia (icterus)(icterus)Tachycardia,Tachycardia, hypotonia, cyanosis, hypotonia, cyanosis, herpes, herpes,

diarrhea, vomitingdiarrhea, vomiting, , pain in abdomenpain in abdomen, , back. aickback. aick

DiagnosticDiagnostic

Finding of parasite in bloodFinding of parasite in blood

((parasitoskopyparasitoskopy) – ) – ““fatfat” ” dropdrop ( (plasmodies in plasmodies in different stages of developmentdifferent stages of development – – ringring, , shizontshizont morulamorula, , gametsgamets), ), blood blood smear smear ((identification of plasmodiesidentification of plasmodies))

Border ofBorder of identificationidentification – 5 – 5 inin 1 1 mlml, , in case of comain case of coma – – tilltill 500. 500.000000 (20-25-50 % (20-25-50 % of lesion erythrocytesof lesion erythrocytes))

Definition of antibodiesDefinition of antibodies in in indirect indirect immunofluorescent immunofluorescent reactireactionon 1:20-1:40 1:20-1:40 ((retrospectiveretrospective))

а) Pl. vivaxb) Pl. malariaec) Pl. falciparum

а

b

c

Differential diagnosisDifferential diagnosis InfluenzaInfluenza Epidemic typhysEpidemic typhys Typhoid feverTyphoid fever SepsisSepsis Viral hepatitisViral hepatitis PyelonephritisPyelonephritis LeptospirosisLeptospirosis BrucellosisBrucellosis LeishmaniosisLeishmaniosis Meningococcal meningitisMeningococcal meningitis

TreatmentTreatment

Liquidation of acute attacksLiquidation of acute attacks ((hematoshizotropic agentshematoshizotropic agents))

Warning of possible relapsesWarning of possible relapses

((histoschizotropichistoschizotropic))

Decontamination Decontamination of sick personof sick person as as source of thesource of the infection infection

((gamontotropicgamontotropic))

ProphilaxisProphilaxis Sanitarian patrolling of the state from Sanitarian patrolling of the state from

delivery (quarantine infection delivery (quarantine infection contamination)contamination)

Mandatory registrationMandatory registration Sterilization of toolkitSterilization of toolkit At detection At detection of sickof sick or carrier – or carrier –

parasitoscopy parasitoscopy examination of examination of all family all family membersmembers

Ant mosquito Ant mosquito measuremeasuress (melioration, (melioration, usage usage of insecticides, repellents)of insecticides, repellents)

Drug prophilaxisDrug prophilaxis

Drug prophylaxisDrug prophylaxis

One week prior to departing, all One week prior to departing, all residence time in ill-behaved terrain residence time in ill-behaved terrain + 6-8 weeks after homing+ 6-8 weeks after homing

After homing - preventive and After homing - preventive and ant ant recidive recidive courses of Primachinum courses of Primachinum 0,027 0,027 gmgm//dayday 14 14 days days

PlaguePlaguePESTIS (A 20)PESTIS (A 20)

PlaguePlague ( (PestisPestis)) – –

especially dangerous infectious especially dangerous infectious disease, that is caused by a plague stick. disease, that is caused by a plague stick. Expressed by fever, severe intoxication, Expressed by fever, severe intoxication, severe hemorrhagic inflammation of severe hemorrhagic inflammation of lymphatic nodes, lungs and other organs lymphatic nodes, lungs and other organs through sepsisthrough sepsis

Yersinia Yersinia pestispestis in the in the

blood of patient blood of patient with plaguewith plague

Possible ways of Possible ways of transmission:transmission:

TranmissiveTranmissive ; ; ContactContact;;

AlimentaryAlimentary;; DropletDroplet;;

FleaFlea ««Plague fleaPlague flea»»

Classification:Classification:

Clinical forms: skin (A 20.1), bubonic (A Clinical forms: skin (A 20.1), bubonic (A 20.0), skin-bubonic; 20.0), skin-bubonic;

primary-pulmonary (A 20.2), second-primary-pulmonary (A 20.2), second-pulmonary, intestinal, primary-septic pulmonary, intestinal, primary-septic

(A 20.7), second-septic, other forms (A (A 20.7), second-septic, other forms (A 20.8).20.8).

Degree of weight: mild, moderate, severe.Degree of weight: mild, moderate, severe.

Complication: infectious-toxic shock, Complication: infectious-toxic shock, meningitis (And 20.3), adeno-meningitis (And 20.3), adeno-phlegmone and etcphlegmone and etc

Example formulation of Example formulation of diagnosisdiagnosis

Plague, skin-bubonic form: defect of Plague, skin-bubonic form: defect of upper third of right shoulder, upper third of right shoulder, inguinal bubo, severe duration.inguinal bubo, severe duration.

Plague, second-septic form. right Plague, second-septic form. right side inguinal bubo. infectious-toxic side inguinal bubo. infectious-toxic shock of the ІІ degree is a shock of the ІІ degree is a Disseminated intravascular Disseminated intravascular coaggulopathy-syndromecoaggulopathy-syndrome . .

Plague bubo, that rupturedPlague bubo, that ruptured

Laboratory diagnostics:Laboratory diagnostics:

bacteriological (basic). bacteriological (basic). bacterioscopic (reference). bacterioscopic (reference). serological. serological. biological. biological.

Anti-epidemic measures:Anti-epidemic measures:

1)1) prevention the import of prevention the import of infection from abroad;infection from abroad;

2)2) making of natural cells of making of natural cells of plague healthy;plague healthy;

3)3) urgent prophylaxis in the case urgent prophylaxis in the case of exposure of patient with a of exposure of patient with a plague.plague.

immunization of people :immunization of people :

vaccinations of population of certain vaccinations of population of certain territories;territories;

urgent 6-daily prophylaxis by urgent 6-daily prophylaxis by streptomycine tetracycline on suspicion streptomycine tetracycline on suspicion of possible infection.of possible infection.