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Malaria MR MARIELA HUERTA ROSARIOINENINTRODUCCION.2

VECTOR.5

MALARIA.

TODOSPRIMAQUINA PIRIMETAMINACLOROQUINAARTEMETER6CARACTERISTICAS DE LAS INFECCIONES MALARICAS

7CARACTERISITICAS CLINICAS Infeccin por P. falciparumInfeccin por P. VivaxInfeccin por P. ovaleInfeccin por P. malarieHemoglobinuria y fallo renalAnemia severa ictericia y esplenomegaliaNo secuestro perifricoNo secuestro perifricoNo secuestro perifricoEnf. microvascular difusa con GR parasitados que obstruyen el flujoNo complicaciones microvascularesNo complicaciones microvascularesNo complicaciones microvascularesDao por hipoxia e hipoglicemia(nios). Efectos txicos FNT-a,IL1,FNTb, protena EMP1(agrupacmiento de eritrocitos infectados y no)Parasitemia limitada a reticulocitosParasitemia limitada a reticulocitosRecaidasProduce una glomerulonefritis por inmunocomplejos8CUADRO CLINICO.9

Asintomtico: 1-2 semanas (replicacin heptica).Fiebre peridica (liberacin de merozoitos pirognicos).DIAGNOSTICO.Dx. INMUNOLOGICODIRECTOINDIRECTODeteccin delParsito antgeno Deteccin de anticuerposGota gruesa, gota finaElisa DirectoPruebas rpidas Elisa indirecto,IFI,Inmunoblot etc.10Analisi microscpico continua siendo el gold estndarTincion con giesa resalta Schffners dots, Maurers clefts,Gota gruesa: 30 veces mas q la gota delgada aunque esta ultima permite mejor visualizacin.Se pueden tomar muestras c 8-6h /2 das si permiste la sospecha clnica.

ophozoite ofP. ovalein a thin blood smear. Note the fimbriation and Schffner's dots.

Rings ofP. falciparumin a thick blood smear.

Rings ofP. falciparumin a thin blood smear.

. Like Schffner's dots, Maurer's clefts appear to play a role in the metabolic pathways of the infected RBCs.

Gametocyte ofP. falciparumin a thin blood smear. Also seen in this image are ring-form trophozoites and an RBC exhibiting basophilic stippling (upper left).

:Gametocytes ofP. falciparumin a thick blood smear. Note also the presence of many ring-form trophozoites.

Gametocyte ofP. falciparumin a thin blood smear. Also seen in this image are ring-form trophozoites exhibiting Maurer's cleftsComparison ofPlasmodiumSpecies Which Cause Malaria in HumansPlasmodiumspeciesStages found in bloodAppearance of Erythrocyte (RBC)Appearance of ParasiteP. falciparumRingnormal; multiple infection of RBC more common than in other species; Maurer's clefts (under certain staining conditions)delicate cytoplasm; 1 to 2 small chromatin dots; occasional appliqu (accol) formsTrophozoitenormal; rarely, Maurer's clefts (under certain staining conditions)seldom seen in peripheral blood; compact cytoplasm; dark pigmentSchizontnormal; rarely, Maurer's clefts (under certain staining conditions)seldom seen in peripheral blood; mature = 8 to 24 small merozoites; dark pigment, clumped in one massGametocytedistorted by parasitecrescent or sausage shape; chromatin in a single mass (macrogametocyte) or diffuse (microgametocyte); dark pigment massP. vivaxRingnormal to 1.25x, round; occasionally fine Schffner's dots; multiple infection of RBC not uncommonlarge cytoplasm with occasional pseudopods; large chromatin dotTrophozoiteenlarged 1.5 to 2x; may be distorted; fine Schffner's dotslarge amoeboid cytoplasm; large chromatin; fine, yellowish-brown pigmentSchizontenlarged 1.5 to2x; may be distorted; fine Schffner's dotslarge, may almost fill RBC; mature = 12 to 24 merozoites; yellowish-brown, coalesced pigmentGametocyteenlarged 1.5 to 2x; may be distorted; fine Schffner's dotsround to oval; compact; may almost fill RBC; chromatin compact, eccentric (macrogametocyte) or diffuse (microgametocyte); scattered brown pigmentP. ovaleRingnormal to 1.25x, round to oval; occasionally Schffner's dots; occasionally fimbriated; multiple infection of RBC not uncommonsturdy cytoplasm; large chromatinTrophozoitenormal to 1.25x; round to oval; some fimbriated; Schffner's dotscompact with large chromatin; dark-brown pigmentSchizontnormal to 1.25x, round to oval, some fimbriated, Schffner's dotsmature = 6 to 14 merozoites with large nuclei, clustered around mass of dark-brown pigmentGametocytenormal to 1.25x; round to oval, some fimbriated; Schffner's dotsround to oval; compact; may almost fill RBC; chromatin compact, eccentric (macrogametocyte) or more diffuse (microgametocyte); scattered brown pigmentP. malariaeRingnormal to 0.75xsturdy cytoplasm; large chromatinTrophozoitenormal to 0.75x; rarely, Ziemann's stippling (under certain staining conditions)compact cytoplasm; large chromatin; occasional band forms; coarse, dark-brown pigmentSchizontnormal to 0.75x; rarely, Ziemann's stippling (under certain staining conditions)mature = 6 to 12 merozoites with large nuclei, clustered around mass of coarse, dark-brown pigment; occasional rosettesGametocytenormal to 0.75x; rarely, Ziemann's stippling (under certain staining conditions)round to oval; compact; may almost fill RBC; chromatin compact, eccentric (macrogametocyte) or more diffuse (microgametocyte); scattered brown pigmentThe histologic hallmarks of malarial hepatitis are varying degrees of hepatocyte injury and deposition of malarial pigment or hemozoin ( Fig. 10-42). Inflammation is generally mild. Sinusoidal congestion and centrilobular necrosis may be caused by adherence of red blood cells in sinusoids, resulting in ischemia

EspeciesPerodo de incuba-

cin (das)Hemates parasita-

dosMxima duracin

P.

vivax 9 - 15Hemates jvenes3 aos

P. falciparum 8 - 17Cualquier hemate9 meses a 1 ao

P. malariae 30 - 40Hemates maduros> de 20 aos