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Slide 1 This Lecture Is the Third Part of the Parasitic Protozoa. It Represents the Second Part of the Apicomplexan Parasites and We Will Cover Malaria and Babesia

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Slide 1 This Lecture Is the Third Part of the Parasitic Protozoa. It Represents the Second Part of the Apicomplexan Parasites and We Will Cover Malaria and Babesia Slide 1 This lecture is the third part of the parasitic protozoa. It represents the second part of the apicomplexan parasites and we will cover malaria and babesia. As you will see Lecture 9: Emerging Parasitic this lecture is quite long and heavy on malaria. And that Protozoa pt. 2 (Apicomplexans-2: Malaria, Babesia) is because malaria is such a huge global health problem. Presented by Sharad Malavade, MD, MPH HSC4933 1 Emerging Infectious Diseases Slide 2 These are the readings for the lecture. The tables are Readings-Lecture 9 significant and should be studied well. • Ch.8 (p. 183 [table 8.3], pp. 187- 194, special attention to tables) • Ch. 11 (pp. 310-15) • Ch. 14 (pp. 412, 422, 425) HSC4933. Emerging Infectious Diseases 2 Slide 3 These are some web links for you to get some Monsters Inside Me background information • Malaria (Plasmodium spp., Apicomplexan): Background: http://www.cdc.gov/malaria/about/index.html Video: http://www.animalplanet.com/tv-shows/monsters- inside-me/videos/malaria-parasite.htm Babesiosis (Babesia spp., Apicomplexan): Background: http://www.cdc.gov/parasites/babesiosis/ Video: http://animal.discovery.com/videos/monsters-inside-me- babesiosis.html HSC4933. Emerging Infectious Diseases 3 Slide 4 These are the learning objectives of the lecture. Most of Learning Objectives the lecture covers malaria. Malaria is a global health • Understand the enormous impact malaria has on global health • Know the various species of Plasmodium that can infect man, and differences between them. problem of great proportions. Upon completion of the • Identify populations that are especially at risk for malaria and babesiosis • Understand the various facets of malaria that make it difficult to eradicate • Know the general life cycles of malaria and Babesiosis-sources of infection, lecture you will know the plasmodium species that infect infective/diagnostic stages, hosts. How are these cycles different from other parasitic protozoa? For malaria, know key diagnostic differences between P. falciparum and P. vivax an to cause malaria, identify the populations at risk of • Be familiar with antimalarial drug resistance and where it is a major problem. What drugs are failing in the world and what are viable alternatives? • Know aspects of malaria and babesia that make them emerging diseases • Describe why vaccines for malaria are elusive malaria and babesia. You will understand the facets of malaria that make it difficult to eradicate. HSC4933. Emerging Infectious Diseases 4 You will know the general life cycle of malaria and babesia including sources of infection, infective and diagnostic stages, hosts. How they are different from other parasitic protozoa. For malaria you will know the key diagnostic differences between P.falicparum and P.vivax. You will become familiar with the antimalarial drug resistance and where in the world it is a major problem. Also, what are the alternative drugs available in the arsenal against malaria. You will know aspects of malaria and babesia that make them emerging diseases and learn why vaccines for malaria are so elusive. Slide 5 This lecture will be the second part of Phylum Lecture 9: On the Menu Apicomplexa. It will cover malaria and babesiosis. The • Phylum Apicomplexa pt. 2 slide shows the taxonomy of these parasites. – Class Aconoidasida, Order Haemosporida . Plasmodium spp. – Class Aconoidasida, Order Piroplasmida . Babesia spp. HSC4933. Emerging Infectious Diseases 5 Slide 6 Lets talk of malaria first. It kills more humans per year Malaria than any other parasite. The slides shows graphic that cover the entire spectrum of malaria from clinical cases to diagnostics, treatment and preventive measures. One cannot over-estimate the seriousness of the disease as one child dies per minute due to malaria according to the WHO. HSC4933. Emerging Infectious Diseases 6 Slide 7 Malaria Intro Video • http://video.nationalgeographic.com/video /player/science/health-human-body- sci/health/malaria-sci.html 7 Slide 8 Malaria is a disease known to man since antiquity. Malaria: Background Approximately 156 species that infect vertebrates. There • Malaria is the most important parasitic disease affecting man are four major species that infect humans and there is • Disease of antiquity – First described in Chinese writings in one more that is now an emerging problem in Malaysia 2700 B.C. • Approximately 156 species of that we will talk about later. Plasmodium which infect various species of vertebrates. – Four species are considered true parasites of humans (int. host) • Transmitted by Anopheles mosquitoes Malaria is transmitted by the mosquitoes of the genus (def. host) Anopheles. The top picture is an enhanced image showing the erythrocytes. A couple are infected and you can see the tiny parasites in them. One of the infected cells is lysed and is releasing the tiny parasite forms called merozoites. The lower image is of a female anopheles mosquito taking a blood meal. Slide 9 As I said malaria is the most important parasitic disease Public Health Impact of man. These are some of the numbers for malaria from • World Health Organization estimates – About 3.4 billion people are at risk of malaria the WHO. These vary from year to year. The numbers – 270 million new infections per year in 2012 – 627000 malaria deaths in 2012 wont be asked in the quizzes. About 3.4 billion people are – 90% of deaths occur in Africa (south of Sahara) • Occurs in tropical and temperate regions worldwide at risk of malaria. In 2012 there were about 207 million • Most cases in Africa, followed by Asia and South America cases of malaria and about 627,000 deaths. About 90% of • Dependent upon vector and host, other factors • Global “contraction” from 1900-1950 and accelerated during 1950-1965 cases occur in Africa(south of the Sahara). Malaria is found in tropical and temperate regions of the world. After Africa, the highest number of malaria cases occur in Asia and South America. There was a global contraction of the number of cases of malaria following the malaria control efforts from 1900-1950, but the number of cases accelerated from 1950-1965 due to resistance to insecticides amongst other factors. Slide Lets look at some of the facts of the Plasmodium species. Plasmodium spp. Facts 10 • P. vivax • P. malariae Plasmodium vivax is the most common species of – Most common, except in Africa – Global, but patchy 72h cycle – Temperate and tropical • P. ovale – 48h cycle, relapse, hypnozoites, Plasmodium that causes malaria except in Africa where P. – Mainly in tropical Africa and drug resistance Oceania • P. falciparum – 48h cycle, relapse falciparum is more common. It occurs in temperate and – Tropical • P. knowlesi – Holoendemic in much of Africa – New emerging species in tropical regions and has a 48 hour cycle. It can relapse – 48h cycle, mortality, Tropical regions, humans drug resistance – Malaysia, 24 h. cycle and is due to hypnozoites which we will discuss in a short – Most lethal while. Drug resistance is a serious problem with P. vivax. The next species is P. falciparum which is endemic in much of Africa. This also has a 48 hour cycle and high mortality. It also has concerns of drug resistance. It is the most lethal form of Malaria. P. malariae is global but a patchy 72 hour cycle. P.ovale is found mainly in tropical Africa and Oceania. It has a 48 hour cycle and causes relapses. P.knowlesi is recently emerging in Malaysia where it has been suspected to have been transmitted from monkeys to humans. It has a 24 hour cycle. Slide The malaria parasite life cycle involves two hosts. During Malaria: Life cycle a blood meal, a malaria-infected 11 Mosquito is female Anopheles mosquito inoculates sporozoites into definitive host Man is the human host . Sporozoites infect liver cells and intermediate host mature into schizonts , which rupture and release merozoites . (Of note, in P. vivax and P. ovale a dormant stage [hypnozoites] can persist in the liver and cause See animated life cycle link in BB relapses by invading the bloodstream weeks, or even HSC4933. Emerging Infectious Diseases 11 years later.) After this initial replication in the liver (exo- erythrocytic schizogony ), the parasites undergo asexual multiplication in the erythrocytes (erythrocytic schizogony ). Merozoites infect red blood cells . The ring stage trophozoites mature into schizonts, which rupture releasing merozoites . Some parasites differentiate into sexual erythrocytic stages (gametocytes) . Blood stage parasites are responsible for the clinical manifestations of the disease. The gametocytes, male (microgametocytes) and female (macrogametocytes), are ingested by an Anopheles mosquito during a blood meal . The parasites' multiplication in the mosquito is known as the sporogonic cycle . While in the mosquito's stomach, the microgametes penetrate the macrogametes generating zygotes . The zygotes in turn become motile and elongated (ookinetes) which invade the midgut wall of the mosquito where they develop into oocysts . The oocysts grow, rupture, and release sporozoites , which make their way to the mosquito's salivary glands. Inoculation of the sporozoites into a new human host perpetuates the malaria life cycle . Slide Worldwide distribution of malaria This map shows the distribution of malaria in the world. As seen the most critical areas for malaria are South Asia, 12 Southeast Asia and Africa. From Public health challenges and prospects for malaria control and elimination Pedro L Alonso & Marcel Tanner Nature Medicine 19, 150–155 (2013) doi:10.1038/nm.3077 12 Slide Malaria affects infants and small children more severely Who does malaria affect? than adults. Especially under-five children. Non-immune 13 • Infants & young children (under 5 yrs. old) • Non-immune pregnant women pregnant women can undergo miscarriage. Pregnant – High rates of miscarriage and cause over 10% of maternal deaths (soaring to a 50% death rate in cases women with partial immunity have anemia when they of severe disease) annually. • Semi-immune pregnant women risk severe anemia and impaired fetal growth even if they show no get malaria.
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