Microbiology Seminar

MALARIA AND ORAL COMPLICATIONS

GROUP 5
Ooi Jia Min
Patrina Bte Saidin
Por Yen Tsen
Shermaine Ho Kah Yan
Tan Zhe Ken
Tan Louise
Tey Su Jeanne
Tey Su Lynne
Wan Nur Hazimah binti Wan Rozuhan
Wang Kai Wen

SCM-031946
SCM-031817
SCM-031924
SCM-030917
SCM-031942
SCM-031945
SCM-030210
SCM-030203
SCM-031829
SUKD-1503863

INTRODUCTION
Malaria is a life-threatening disease
Typically transmitted through the bite
of an infected Anopheles mosquito.
Infected mosquitoes carry the Plasmodium parasite.
Types of protozoan in the genus Plasmodium that causes human malaria :
- P. vivax
- P.malariae
- P. ovale
- P. falciparum
also known as cerebral malaria
is the most lethal
estimated to cause 200 million clinical cases
and 1-3 million deaths (including many children) every year
world-wide.
Malaria is usually found in tropical and subtropical climates

CAUSES OF MALARIA

Bitten by mosquito infected with the

Plasmodium parasite
By blood :

An infected mother can also pass the disease

to her baby at birth. (congenital malaria)

SYMPTOMS OF MALARIA
Typically develop within 10 days to four weeks following the infection.
In some people, symptoms may not develop for several months.

Other symptoms : Anemia , bloody stools, addominal cramps, loss of appetite, diarrhea,

 Severe cases: Acute spread of the disease to the brain which

causes cerebral malaria.
- lead to chipped or broken teeth, impaired
consciousness, seizures, coma, and death.
Maternal malaria increases the risk of spontaneous abortion,
stillbirth, premature delivery, and low birth weight.

premature baby

coma

TRANSMISSION
1.
2.
3.

4.

5.

During the bite, the mosquito takes a blood meal and injects parasites into
the new host's bloodstream
These parasites receive chemical cues that allow them to rapidly enter cells
of the host's liver.
Without causing any pathology to the liver, the Plasmodium parasite
multiplies and develops into a blood stage once again.
- Depending on the species, it will remain in the liver for 6
days to 1 year before reentering the bloodstream.
Through recognition of cell surface receptors, the parasites invade the
nutrient-rich red blood cells.
- In this stage, the parasites grow and multiply
rapidly, invading new red blood cells every 48 hours to 72
hours until the host literally contains billions of parasites.
Consequently, the swollen red blood cells burst and the parasites and their
toxic metabolic byproducts are released into the host's bloodstream,
inducing many of the symptoms of clinical malaria.

TRANSMISSION
Has two stages : in Human and in Mosquito
A. In human :
They are intermediate host. Reproduce by asexual method
(schizogony)
In liver (tissue phage, 8-10 days): preerythrocytic
schzogony- no clinical symptom. Hypnozoite stage: in P.
vivax & P. ovale causes relapse. Liberated merozoite called
cryptozoite.
In R.B.C. (erythrocytic phage): erythrocytic schizogonycauses of malarial paroxysm. Merozoite is detected in
thick smear. Gametogony: infect mosquito.

B. In mosquito:
Female anopheles mosquito. Ingest the sexual
(gametocyte) and asexual form during blood meal.
Fusion of micro- and macrogametes --zygote
ookinete (~24 hr) ookinete transverses gut
epitheliumoocyst--- in stomach wall rupture sporozoites releasedspecial predilection toward
salivary glandtransfer the sporozoite during blood
meal

 Once in the human bloodstream, the sporozoites arrive in the

liver and penetrate hepatocytes, where they remain for 9-16
days, multiplying within the cells.
Next they return to the blood and penetrate red blood cells, in
which they produce either merozoites, which reinfect the liver,
or micro- and macrogametocytes, which have no further
activity within the human host.
Another mosquito arriving to feed on the blood may suck up
these gametocytes into its gut, where exflagellation of
microgametocytes occurs, and the macrogametocytes are
fertilized.
The resulting ookinete penetrates the wall of a cell in the
midgut, where it develops into an oocyst.
Sporogeny within the oocyst produce many sporozoites and,
when the oocyst ruptures, the sporozoites migrate to the
salivary gland, for injection into another host.

Oral Complications of

Malaria infection can cause severe anemia,

which manifest as pallor of the tongue and
buccal mucosa in the oral cavity

Oral Conditions found in Patients who have

malaria - induced anemia
Mucosal
Pallor

Angular
Cheilitis

Erythema of
oral mucosa

Loss of
filiform and
fungiform
papillae on
dorsum of
tongue

MUCOSAL PALLOR
Pale color seen on mucosal caused by anemia, result
of a reduced amount of oxyhaemogobin

ANGULAR CHEILLITIS
Inflammation of lips. Including the skin arounf the
mouth, vermilion border and the labial mucosa.

ERYTHEMA OF MUCOSAL
A common oral inflammatory condition
commonly affecting the tongue.
May occur in children and adults and exhibits
a female predilection.
Caused by atrophy of filiform papillae and
surrounded b elevated white borders
Burning sensation

Oral Complications Seen in Patients

with Acute Malaria with persistent:
Anorexia

Fever

Acidosis

Malnutrition

1) ORAL MALADOUR (HALITOSIS)

An Element of unpleasant oral odour, resulting in poor
oral hygiene and resulting gingivitis and periodontitis
2) COATED/WHITE TONGUE
Temporary change in appearance of tongue when the surface is colonized by
bateria/fungi and dead cells become trapped between the small nodules on the
tongue. Causing tongue pain.
3) DRY MOUTH
Reduced in salivary flow rate causing dryness, difficulty with mastication,
swallowing and increase risk of caries

Oral Complications Seen in Patients

with Cerebral Malaria
Patients, commonly children with cerebral malaria
experience episodes febrile convulsions (seizures)
Causes trauma to teeth and its surrounding
structures

Other Oral Manifestations

1) ORAL CANDIDIASIS/ THRUSH
Infection of yeast fungus found in immuno-compromised
patients.
Symptoms: White, cream , yellow spots in mouth
2) CANCRUM OSIS/NOMA
A Gangrenous infection of the mouth affecting malnourished
children commonly from 1-4 years old.
Causes difficulty in opening mouth due to swelling and pain.
Primary teeth loss or damage to permanent tooth buds, ankylosis
of TMJ may occur

CLINICAL DIAGNOSIS,
TREATMENTS &
PREVENTIONS

CLINICAL DIAGNOSIS
A.

Febrile paroxysm:
generally in early afternoon
cold stage (20-60 min)
hot stage (1-4 hours)
sweating stage (2-3 hours).
Fever recurs in every third day
(tertian fever) or fourth day
(quartan fever).

B. Falciperum malaria:
there may be no paroxysm
fever may continous.

TYPES OF DIAGNOSIS
1.

Microscopic Diagnosis
examining under the microscope a drop
of the patient's blood
the specimen is stained (most often
with the Giemsa stain) to give the
parasites a distinctive appearance.

2.

Antigen Detection

3.

Molecular Diagnosis
Parasite nucleic acids are detected
using polymerase chain reaction
(PCR).
slightly more sensitive than smear
microscopy
PCR results are often not available
quickly enough to be of value in
establishing the diagnosis of malaria
infection.

Blood smear stained with Giemsa, showing

a white blood cell (on left side) and several
red blood cells, two of which are infected
withPlasmodium falciparum(on right side).

Antigen Detection

4. Serology
detects antibodies against malaria
parasites
using indirect immunofluorescence (IFA)
or enzyme-linked immunosorbent assay
(ELISA).
does not detect current infection but rather
measures past exposure.
5. Drug Resistance Tests
In vitro tests:
The parasites are grown in culture in the presence of increasing
concentrations of drugs; the drug concentration that inhibits parasite
growth is used as endpoint.
Molecular characterization:
Molecular markers assessed by PCR or gene sequencing also allow the
prediction, to some degree, of resistance to some drugs. CDC
recommends that all cases of malaria diagnosed in the United States
should be evaluated for evidence of drug resistance.

TREATMENT OF MALARIA
No vaccine against malaria
Taking care of oral hygiene to prevent serious oral manifestations
Can only practice preventive behaviour and take recommended
drugs
- to aid in preventing and/or managing malaria infection.

A. Take recommended drug :

Depends on several factors.
1. The type (species) of the infecting parasite.
- severe P. falciparum malaria or who cannot take oral medications
should be given the treatment by continuous intravenous infusion.
2. The area where the infection was acquired and its drug-resistance status.
3. The clinical status of the patient.
4. Any accompanying illness or condition|
- G6PD patient cannot take Primaquine
5. Pregnancy
- cannot take Primaquine
6. Drug allergies, or other medications taken by the patient

 Most drugs used in treatment are active against the parasite forms in the blood (the
form that causes disease) and include:

Chloroquine

quinine

mefloquine (Lariam)

artemether-lumefantrine (Coartem)

B. Avoidance behaviors include

using indoor/outdoor residual sprays
eliminating water breeding grounds
using personal protection
using insecticide treated bed nets
avoiding mosquito biting prime times
- particularly dusk and dawn.

REFERENCES
http://www.dimensionsofdentalhygiene.com/2009/12_December/Features
/
Malaria_and_the_Dental_Hygienist.aspx
https://www.researchgate.net/publication/
5657703_Malaria_and_oral_health
http://www.healthline.com/health/malaria#Causes2
http://www.cdc.gov/malaria/diagnosis_treatment/diagnosis.html
http://www.cdc.gov/malaria/diagnosis_treatment/treatment.html
http://www.healthline.com/health/malaria#Outlook7
http://www.dimensionsofdentalhygiene.com/2009/12_December/Features/