Malaria

MR MARIELA HUERTA ROSARIO

INEN

INTRODUCCION.
La malaria o paludismo es una enfermedad
infecciosa producida por protozoarios del
gnero Plasmodium
Es transmitida por la picadura de mosquitos
del gnero Anopheles
Se caracteriza por paroxismos
anemia y esplenomegalia

febriles,

Adems de su reemergencia, existe

resistencia a las drogas antimalricas.
2

la

VECTOR.
Anopheles
pseudopunctipennis.
Anopheles darlingi
Anopheles albitarsis.
Anopheles albimanus

MALARIA.

PRIMAQUI
NA
PIRIMETAM
INA

CLOROQUI
NA
ARTEMETE
R

TO
DO
S

CARACTERISTICAS DE LAS
INFECCIONES MALARICAS

CARACTERISITICAS
CLINICAS
Infeccin por
P. falciparum

Infeccin por
P. Vivax

Infeccin por
P. ovale

Infeccin por
P. malarie

Hemoglobinuria y
fallo renal
Anemia severa ictericia
y esplenomegalia

No secuestro
perifrico

No secuestro
perifrico

No secuestro
perifrico

Enf. microvascular
difusa con GR
parasitados que
obstruyen el flujo

No
complicaciones
microvasculares

Dao por hipoxia e

hipoglicemia(nios).
Efectos txicos FNTa,IL1,FNTb, protena
EMP1(agrupacmiento
de eritrocitos
infectados y no)

Parasitemia
limitada a
reticulocitos

No
No complicaciones
complicaciones
microvasculares
microvasculares
Recaidas
Produce una
glomerulonefritis por
inmunocomplejos

Parasitemia
limitada a
reticulocitos
8

CUADRO CLINICO.
SINTOMAS

SIGNOS

Fiebre

(90.6%)

Escalofros

(90.6%)

Cefalea

(90.6%)

Sudoracin

(50%)

Mialgias
(37.5%)
Artralgias

(34.3%)

Nuseas y vmitos
(21.8%).

Hepatomegalia
(50%)
Palidez
(43.7%)
Esplenomegalia
(31.2%)
Ictericia
(31.2%)
Adenopata
(18.7%)

Asintomtico: 1-2 semanas (replicacin heptica).

Fiebre peridica (liberacin de merozoitos
9
pirognicos).

DIAGNOSTICO.
Dx. INMUNOLOGICO
DIRECTO

INDIRECTO

Deteccin del
Parsito antgeno

Deteccin de
anticuerpos

Gota gruesa, gota fina

Elisa Directo
Pruebas rpidas

Elisa indirecto,
IFI,
Inmunoblot
etc.
10

 Analisi microscpico continua siendo el gold estndar

Tincion 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 of P. ovale in a thin blood smear. Note

the fimbriation and Schffner's dots.

Rings of P. falciparum in a thick blood smear.

Rings of P. falciparum in 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 of P. falciparum in a thin blood smear.

Also seen in this image are ring-form trophozoites
and an RBC exhibiting basophilic stippling (upper
left).

: Gametocytes of P. falciparum in a thick blood

smear. Note also the presence of many ring-form
trophozoites.

Gametocyte of P. falciparum in a thin

blood smear. Also seen in this image are
ring-form trophozoites exhibiting
Maurer's clefts

Comparison ofPlasmodiumSpecies W hich Cause Malaria in Humans

Plasmodiumspe Stages found

cies
in blood

Appearance of Erythrocyte (RBC)

Appearance of Parasite

normal; multiple infection of RBC more common than in delicate cytoplasm; 1 to 2 small
Ring
other species; Maurer's clefts (under certain staining
chromatin dots; occasional appliqu
conditions)
(accol) forms
normal; rarely, Maurer's clefts (under certain staining
seldom seen in peripheral blood;
Trophozoite
conditions)
compact cytoplasm; dark pigment
seldom seen in peripheral blood; mature
P. falciparum
normal; rarely, Maurer's clefts (under certain staining
Schizont
= 8 to 24 small merozoites; dark
conditions)
pigment, clumped in one mass
crescent or sausage shape; chromatin in
a single mass (macrogametocyte) or
Gametocyte distorted by parasite
diffuse (microgametocyte); dark pigment
mass
normal to 1.25x, round; occasionally fine Schffner's
large cytoplasm with occasional
Ring
dots; multiple infection of RBC not uncommon
pseudopods; large chromatin dot
enlarged 1.5 to 2x; may be distorted; fine Schffner's
large amoeboid cytoplasm; large
Trophozoite
dots
chromatin; fine, yellowish-brown pigment
large, may almost fill RBC; mature = 12
enlarged 1.5 to
Schizont
to 24 merozoites; yellowish-brown,
P. vivax
2x; may be distorted; fine Schffner's dots
coalesced pigment
round to oval; compact; may almost fill
RBC; chromatin compact, eccentric
enlarged 1.5 to 2x; may be distorted; fine Schffner's
Gametocyte
(macrogametocyte) or diffuse
dots
(microgametocyte); scattered brown
pigment
normal to 1.25x, round to oval; occasionally Schffner's
Ring
dots; occasionally fimbriated; multiple infection of RBC sturdy cytoplasm; large chromatin
not uncommon
normal to 1.25x; round to oval; some fimbriated;
compact with large chromatin; darkTrophozoite
Schffner's dots
brown pigment
mature = 6 to 14 merozoites with large

 The 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