IPAP 16-3 Malaria and other Sporozoa

Liver cell,

1st target after infection of plasmodium

Three distinct stages - lasts 4-8 hrs Cold Stage Feeling of intense cold, despite a fever Vigorous shivering Lasts 15-60 minutes Hot Stage Intense heat Dry burning skin Throbbing headache Lasts 2-6 hours Sweating Stage Profuse sweating Declining temperature Exhausted and weak → sleep Lasts 2-4 hours

3 stages of infection

A Rapid Diagnostic Test (RDT) is an alternate way of establishing the diagnosis of malaria infection. These are lateral flow assays which require a small amount of patient blood. These assays are specific for P.vivax and P.falciparum.

Alt. method of Malaria Dx

Malignant *tertian* malaria Continuous fevers, irregular spikes, some hyperparasitemia w/ microvascular dmg & comromise leading to *CNS dmg, renal & pulmonary failure,* and death

Clinical Manifestations P, falciparum Malignant ___ malaria

Simple *quartan* malaria Cyclic episodes of chills, defervescence, diaphoresis every * 72 hours, * glomerulonephritis

Clinical Manifestations P, malariea Simple ___ malaria

Simple *tertian* malaria cyclic episodes of chills, followed by fever, defervesscence, diaphoresis ever *48 hours* Relaps b/c *hypnoxoite forms can stay longer dormant in the liver.* therefor requiring *longer treatment

Clinical Manifestations P, vivax / P ovale Simple ___ malaria

Chlorination

Cryptosporidia are primarily resistant to?

Sporulated oocysts excreted through feces and other routes such as respiratory secretions (usually in the case of immunocompromise) (1). Transmission of C. parvum(parasite of other animals) and C. hominis (parasite of man) occurs through contact with contam water Many outbreaks in the United States have occurred in waterparks, community swimming pools, and day care centers. Following ingestion (and possibly inhalation), excystation of sporozoites are released and parasitize epithelial cells and undergo asexual multiplication (schizogony or merogony: the sexual multiplication (gametogony) producing microgamonts (male) and macrogamonts (female). Upon fertilization of the macrogamonts by the microgametes oocysts develop that sporulate in the infected host. Two different types of oocysts are produced, the thick-walled, which is commonly excreted from the host (J), and the thin-walled oocyst (K), which is primarily involved in autoinfection. Oocysts are infective upon excretion, thus permitting direct and immediate fecal-oral transmission.

Cryptosporidium

Infection with Cryptosporidium sp. incubation period of *7 days (can range from 2 to 30 days).* The most frequent symptoms is *watery diarrhea*, and can be associated with *dehydration, nausea, vomiting, weight loss, abdominal pain, and fever.* In imost, symptoms resolve (1 to 2 weeks), however symptoms may be chronic and more severe in* immunocompromised patients* especially those with low CD4 counts. For greatest sensitivity and specificity, *immunofluorescence microscopy* is the preferred method (enzyme immunoassays can also be utilized). *Acid fast staining* works like a boss.

Cryptosporidum Clinical Dx

Both are the Thick-walled oocyst

Cryptosporidum Dx and Inf form

These are usually tropical and subtropical areas and in areas of ltitude, and is endemic in areas such as South America, *sub-Saharan Africa*, and SE Asia.

Geographic Distribution

Liver (are sporozoites that stay in the liver

Hypnozoites stay in the

Sporozoites

Infectious form of Malaria

Diagnostic Differential should include the following: Typhoid fever Dengue fever Avian influenza SARS HIV Hepatitis Meningitis Encephalitis VHF

Malaria Diagnostic Differential should include the following

Merozoites infect RBC's and produce more Merozoites

Merozoites infect ___ and produce ___

Other clinical features include splenomegaly, anemia, thrombocytopenia, hypoglycemia, pulmonary or renal dysfunction, and neurologic changes. The clinical presentation can vary substantially depending on the infecting species, the level of parasitemia, and the immune status of the patient. Infections caused by P. falciparum are the most likely to progress to severe, potentially fatal forms with central nervous system involvement (cerebral malaria), acute renal failure, severe anemia, or acute respiratory distress syndrome.

P. falciparum Malaria Clinical Diagnosis

continual fevers, irregular spikes, often misdiagnosed *Cerebral malaria* - CNS changes, respiratory distress, bleeding, circulatory collapse fatigue, malaise *Hepatic malaria* - hyperbilirubinemia, jaundice blackwater fever - ruptering of RBC *high mortality with low parasitemia* fatality, microvascular obstruction, hemolysis, multiorgan system failure

P. falciparum Malaria Clinical Manifestations

southeast Asia zoonotic

P. knowlesi is found in ___ ___(still considered a malaria____).

the species of malarial parasite

PCR is most useful for confirming ____...___ after the diagnosis has been established by either smear microscopy or RDT.

Microscopy Parasites may be visualized on both thick and thin blood smears stained with Giemsa (prefered), Wright, or Wright-Giemsa stains.

Preferred method for Malaria Dx

Falciparum (malignant tertian malaria) (kill w/ lowest paracytemia) vivax (most freq. cause of benign tertian m.) ovale(less freq cause of benign tertian m.) malarie (benign quartan m.) knowlesi (severe quotidian malaria in S.E.Asia since 1965)

Species of Plasmodium that infect humans

Malaria

Sporozoa is a morphology of parasite that includes

Brain, eye, heart, developing fetus

TORCH bugs invade :

Liver schizont / schizogony

The Sporozyte gets into the liver cell and turns into ___ via ___

The most frequent symptoms include fever and chills, which can be accompanied by headache, myalgias, arthralgias, weakness, vomiting, and diarrhea.

The most frequent symptoms of Malaria

Observation of parasites in patient specimens, such as *bronchoalveolar lavage material from immunocompromised patients, CSF, or lymph node biopsy (bradyzoites). * Isolation of parasites from blood or other body fluids, by intraperitoneal inoculation into mice or tissue culture or determined by serology. The IFA and ELISA tests for IgG and IgM antibodies are the tests most commonly used today.

Toxoplasma gondii Dx

1. Cat eats animal w/ muscle cyst then 2. poops out oocysts (Infect. form: *Sporolated oocysts*) Then either: 3. Poop is eat by animals (pigs, sheep), and humans eat. muscle or 3. Oocyts are injested after handling litter box 4 develop into tachyzoites and migrate around the body 5., then develop cysts (bradyzoites) and multiplies

Toxoplasmosis life cycle

Female Anopheles mosquito

Vector that carries malaria

Anopheles mosquito

Which insect is responsible for the transmission of malaria?

Sporulated oocyst

Which is the infective stage for transmitting toxoplasmosis?

Merozoites

schizogony produces