Lecture originally from
University of Warwick Medical
Student website
adapted by Siobhan Quenby
Professor of Obstetrics
Yeasts
vs
• Single cell
• Reproduce by budding
• Identify using
biochemical tests
Moulds
• tubular structures
called hyphae
• grow by branching and
longitudinal extension.
…and dimorphic fungi
Yeasts: Candida sp.
Mucocutaneous candidiasis
Protozoa
• Unicellular,
• simple eukaryote
• Broad range of diseases
• Plasmodium sp.
– Malaria
• Giardia sp.
– Diarrhoea
• Leishmaniasis
– Cutaneous and systemic infections
• Amoebiasis
– Dysentery, liver abscess
• Trypanomonisasis
– Sleeping sickness, Chagas disease
Leishmaniasis
Malaria
Malaria and pregnancy
WHO malaria in pregnancy
Malaria in
pregnancy
sulfadoxine-pyrimethamine (SP)
Insecticide treated nets
Arnold Mkandawire
120
100
80
60
PERCENTAGE
40
20
0
Syphilis
test
IPTp
HIV TEST
ITN
ART
Felix Simbeye
Lenard
Gama
Malaria – Life Cycle
Life Cycle of Plasmodium vivax
Malaria – Pathology : Sepsis
Sepsis due to Malaria
Malaria – Pathology : Haemolysis
Jaundice due to Malaria
Malaria – Pathology : Sequestration
Erythrocyte Sequestration due to Falciparum Malaria
Malaria – Symptoms & Signs
Benign + Falciparum Malaria :
hot + cold sweats
arthralgia + myalgia
hepatosplenomegaly
headache
diarrhoea + vomiting
anaemia
Falciparum Malaria only :
hypoglycaemia
haemorrhage
renal failure
coagulopathy
septic + hypovolaemic shock
respiratory failure
cerebral malaria = various CNS features that lead on to
 consciousness / fits / coma / death
Malaria – Investigations (Blood Films)
Thick & Thin Blood Films
Malaria – Investigations (Blood Films)
Thick & Thin Blood Films
Malaria – Investigations (Blood Films)
Malaria Parasites at Various Stages
Malaria – Investigations (Malaria Antigen Tests)
Malaria – Investigations (Malaria Antigen Tests)
Malaria – Investigations (Malaria Antigen Tests)
Negative
Non-Falciparum
Falciparum or Mixed
Malaria – Treatment
Supportive treatment & management of sepsis …
Benign Malaria
chloroquine 600 mg then 300 mg after 8 hours
then chloroquine 300 mg daily for another 2 days
followed by primaquine 15 mg for 14 days to eradicate
Falciparum Malaria
quinine 600 mg (or 10 mg/kg if IV) every 8 hours for 7 days
followed by doxycycline 200 mg daily for 7 days to eradicate
alternatives are : malarone (4 tablets daily for 3 days)
riamet (4 tablets at 0, 8, 24, 36, 48 & 60 hours)
Malaria – Supportive Management
Complicated falciparum malaria should be treated in an ITU / HDU
Monitor : Glasgow Coma Scale / AVPU score
temperature
heart rate
blood pressure
(invasive CVP monitoring)
respiratory rate
(urine output / fluid balance)
blood glucose
FBC (Hb + platelets)
clotting tests
renal function
chest radiograph
Malaria – Supportive Management
May also include :
nasogastric tube
ventilation if GCS < 8
treat seizures + continue anti-convulsants
reduce temperature with tepid sponging + paracetamol
optimise fluid balance (CVP +5 to +10) + maintain urine output
treat pulmonary oedema → sit upright / high % oxygen / IV diuretic
consider haemofiltration / venesection
treat hypoglycaemia + continue 10% glucose infusion
transfuse if Hb < 7 g/dl or haematocrit < 20% (with frusemide cover)
transfuse if platelets < 20 x 109 / litre + signs of bleeding
consider clotting factors (FFP) if DIC develops
consider haemodialysis if ARF develops
Treatments
• Malaria
– Quinine, artesunate, chloroquine
• Giardiasis
– Metronidazole
• Leishmaniasis
– Amphotericin B
Helminths
Helminths
• Most prevalent human infection
• Multicellular
• Usually life cycle involving more than one
host with an egg, larval and adult stage
Helminths
• Round worms
– Nematodes
• Tape worms
– Cestodes
• Schistosomiasis
– Trematodes
Roundworms : hookworm
• 10% worlds population
• Can cause iron deficiency anaemia
Roundworms: Enterobius
Tapeworms – Taenia sp.
Tapeworms: Taenia sp.
Neurocysticercosis
Schistomomiasis
Katayama fever
Schistosomiasis
Schistosomiasis
Cutaneous larva migrans
Treatments
• Hookworms
– Mebendazole
– Albendazaole
• Schistosomiasis/ tapeworms
– Priziquantel
Parasite resources
• http://dpd.cdc.gov/dpdx/html/Para_Health.h
tm