MINISTRY OF HEALTH OFTHE REPUBLIC OF UZBEKISTAN
CENTER OF DEVELOPMENT OF MEDICAL EDUCATION
TASHKENT MEDICAL ACADEMY
Department of Infectious and Pediatric Infectious Diseases
Subject: Infection diseases
THEME: MALARIA
Educational-methodical guideline for teachers and students of Treatment Faculty
Tashkent
MINISTRY OF HEALTH OFTHE REPUBLIC OF UZBEKISTAN
CENTER OF DEVELOPMENT OF MEDICAL EDUCATION
TASHKENT MEDICAL ACADEMY
"A F F I R M"
Pro-rector of educational work
Professor Teshaev O.R.
__________________________
«____»____________2012
Department of Infectious and Pediatric Infectious Diseases
Subject: Infectious diseases
THEME: MALARIA
Educational-methodical development
for teachers and students of medical faculty
"A F F I R M E D"
at a DNC meeting of Therapeutic Faculty
Protocol № ___from_________2012
Chairman of DNC, Professor
Karimov M.Sh.___________
Tashkent
SUBJECT: MALARIA
1.
Place of the lessons, equipping
- The auditorium;
- The emergency room;
- Diagnostic department;
- The laboratory.
- TCO: Case patients with malaria slide projector; TV-video, teaching, supervising the program,
methods of work scenarios in small groups, case studies.
2. The duration of the study subjects
Number of hours - 4
3. The purpose of classes
- To familiarize students with the main clinical symptoms of malaria;
- Diagnostic methods and principles of treatment;
- Bring a sense of interest in the problem of malaria;
- Bring a sense of responsibility for the lives of people with malaria;
- Develop scientific, logical thinking at the bedside;
- A creative approach to the diagnosis and treatment of malaria.
Objectives
The student should know:
- Statement of the clinical diagnosis of malaria;
- Therapeutic Management of malaria;
- Diagnosis of complications of malaria;
- The principles of laboratory diagnosis of malaria;
- Principles of treatment for malaria;
- Principles for the prevention of malaria.
The student should be able to:
- To collect patient complaints of malaria;
- To collect patient epidemiologic anamnesis malaria;
- Examine the patient for organs and systems;
- Identify the symptoms characteristic of malaria;
- To formulate a preliminary clinical diagnosis;
- To assess the severity of the patient;
- Draw up a plan of treatment of malaria patients.
As a result of training the student should learn practical skills:
- To take on a thick blood smear and drop;
- Preparation of a thick smear and drop;
- Immunological methods of diagnosis.
4. Motivation
The wide spread of malaria in the Central Asian region, the high rate of complications
socially active population made it necessary for doctors' knowledge of GPs clinical features,
complications and laboratory diagnosis, treatment and prevention of malaria.
5. Inter-subject and intero-subject communication
Teaching this topic is based on the knowledge bases of students of biochemistry
metabolism, microbiology, immunology, pathological anatomy, pathological physiology,
physiology of blood-forming organs. The findings of the studies of knowledge will be used
during the passage of medicine, surgery, obstetrics, gynecology, hematology and other clinical
disciplines.
6. The content of training
6.1. The theoretical part
Malaria is a mosquito-borne infectious disease of humans and other animals caused by
eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of
Plasmodium parasites within red blood cells, causing symptoms that typically include fever and
headache, in severe cases progressing to coma or death. It is widespread in tropical and
subtropical regions, including much of Sub-Saharan Africa, Asia, and the Americas.
Five species of Plasmodium can infect and be transmitted by humans. Severe disease is largely
caused by P. falciparum while the disease caused by P. vivax, P. ovale, and P. malariae is
generally a milder disease that is rarely fatal. P. knowlesi is a zoonotic species that causes
malaria in macaques but can also infect humans. Malaria transmission can be reduced by
preventing mosquito bites by distribution of mosquito nets and insect repellents, or by mosquitocontrol measures such as spraying insecticides and draining standing water (where mosquitoes
breed.
Life cycle
The parasite's secondary hosts are human and other vertebrates, female mosquitoes of the
Anopheles genus are the primary, i.e. definitive hosts and act as transmission vectors. Young
mosquitoes first ingest the malaria parasite by feeding on an infected human carrier and the
infected Anopheles mosquitoes carry Plasmodium sporozoites in their salivary glands. A
mosquito becomes infected when it takes a blood meal from an infected human. Once ingested,
the parasite gametocytes taken up in the blood will further differentiate into male or female
gametes and then fuse in the mosquito's gut. This produces an ookinete that penetrates the gut
lining and produces an oocyst in the gut wall. When the oocyst ruptures, it releases sporozoites
that migrate through the mosquito's body to the salivary glands, where they are then ready to
infect a new human host. This type of transmission is occasionally referred to as anterior station
transfer. The sporozoites are injected into the skin, alongside saliva, when the mosquito takes a
subsequent blood meal.
Only female mosquitoes feed on blood while male mosquitoes feed on plant nectar, thus males
do not transmit the disease. The females of the Anopheles genus of mosquito prefer to feed at
night. They usually start searching for a meal at dusk, and will continue throughout the night
until taking a meal. Malaria parasites can also be transmitted by blood transfusions, although this
is rare
Symptoms of malaria include fever, shivering, arthralgia (joint pain), vomiting, anemia (caused
by hemolysis), jaundice, hemoglobinuria, retinal damage, and convulsions. The classic symptom
of malaria is cyclical occurrence of sudden coldness followed by rigor and then fever and
sweating lasting about two hours or more, occurring every two days in P. vivax and P. ovale
infections, and every three days for P. malariae. P. falciparum infection can cause recurrent fever
every 36–48 hours or a less pronounced and almost continuous fever. For reasons that are poorly
understood, but that may be related to high intracranial pressure, children with malaria frequently
exhibit abnormal posturing, a sign indicating severe brain damage. Malaria has been found to
cause cognitive impairments, especially in children. It causes widespread anemia during a period
of rapid brain development and also direct brain damage. This neurologic damage results from
cerebral malaria to which children are more vulnerable. Cerebral malaria is associated with
retinal whitening, which may be a useful clinical sign in distinguishing malaria from other causes
of fever.
Severe malaria is almost exclusively caused by Plasmodium falciparum, and usuall y
arises 6–14 days after infection. Consequences of severe malaria include coma and death if
untreated—young children and pregnant women are especially vulnerable. Splenomegaly
(enlarged spleen), severe headache, cerebral ischemia, hepatomegaly (enlarged liver),
hypoglycemia, and hemoglobinuria with renal failure may occur. Renal failure is a feature of
blackwater fever, where hemoglobin from lysed red blood cells leaks into the urine. Severe
malaria can progress extremely rapidly and cause death within hours or days. In the most severe
cases of the disease, fatality rates can exceed 20%, even with intensive care and treatment.[12] In
endemic areas, treatment is often less satisfactory and the overall fatality rate for all cases of
malaria can be as high as 10%. Over the longer term, developmental impairments have been
documented in children who have suffered episodes of severe malaria.
Pathogenesis
Malaria develops via two phases: an exoerythrocytic and an erythrocytic phase. The
exoerythrocytic phase involves infection of the hepatic system, or liver, whereas the erythrocytic
phase involves infection of the erythrocytes, or red blood cells. When an infected mosquito
pierces a person's skin to take a blood meal, sporozoites in the mosquito's saliva enter the
bloodstream and migrate to the liver. Within minutes of being introduced into the human host,
the sporozoites move to the liver and infect hepatocytes, multiplying asexually and
asymptomatically for a period of 8–30 days. After a potential dormant period in the liver, these
organisms differentiate to yield thousands of merozoites, which, following rupture of their host
cells, escape into the blood and infect red blood cells, thus beginning the erythrocytic stage of
the life cycle. The parasite escapes from the liver undetected by wrapping itself in the cell
membrane of the infected host liver cell.
Within the red blood cells, the parasites multiply further, again asexually, periodically
breaking out of their hosts to invade fresh red blood cells. Several such amplification cycles
occur. Thus, classical descriptions of waves of fever arise from simultaneous waves of
merozoites escaping and infecting red blood cells.
Some P. vivax sporozoites do not immediately develop into exoerythrocytic-phase
merozoites, but instead produce hypnozoites that remain dormant for periods ranging from
several months (6–12 months is typical) to as long as three years. After a period of dormancy,
they reactivate and produce merozoites. Hypnozoites are responsible for long incubation and late
relapses in P. vivax infections, although their existence in P. ovale is uncertain.
The parasite is relatively protected from attack by the body's immune system because for
most of its human life cycle it resides within the liver and blood cells and is relatively invisible
to immune surveillance. However, circulating infected blood cells are destroyed in the spleen. To
avoid this fate, the P. falciparum parasite displays adhesive proteins on the surface of the
infected blood cells, causing the blood cells to stick to the walls of small blood vessels, thereby
sequestering the parasite from passage through the general circulation and the spleen. This
"stickiness" is the main factor giving rise to hemorrhagic complications of malaria. High
endothelial venules (the smallest branches of the circulatory system) can be blocked by the
attachment of masses of these infected red blood cells. The blockage of these vessels causes
symptoms such as in placental and cerebral malaria. In cerebral malaria the sequestrated red
blood cells can breach the blood-brain barrier possibly leading to coma.
Diagnosis
The mainstay of malaria diagnosis has been the microscopic examination of blood using
blood films. Although blood is the sample most frequently used to make a diagnosis, both saliva
and urine have been investigated as alternative, less invasive specimens.More recently, modern
techniques using antigen tests or polymerase chain reaction have been discovered, though these
are not widely implemented in malaria-endemic regions.[39] Areas that cannot afford laboratory
diagnostic tests often use only a history of subjective fever as the indication to treat for malaria.
Treatment
When properly treated, a patient with malaria can expect a complete recovery. The
treatment of malaria depends on the severity of the disease; whether patients can take oral drugs
or must be admitted depends on the assessment and the experience of the clinician.
Uncomplicated malaria is treated with oral drugs. The most effective strategy for P. falciparum
infection recommended by WHO is the use of artemisinins in combination with other
antimalarials artemisinin-combination therapy (ACT) to avoid the development of drug
resistance against artemisinin-based therapies. Recent reports from Southeast Asia suggest
evidence of emerging resistance to artemisins.
Severe malaria requires the parenteral administration of antimalarial drugs. Until the mid2000s the most used treatment for severe malaria was quinine, but artesunate has been shown to
be superior to quinine in both children and adults. Treatment of severe malaria also involves
supportive measures. Infection with P. vivax, P. ovale or P. malariae is usually treated on an
outpatient basis. Treatment of P. vivax requires both treatment of blood stages (with chloroquine
or ACT) as well as clearance of liver forms with primaquine.
Prevention
Methods used to prevent the spread of disease, or to protect individuals in areas where
malaria is endemic, include prophylactic drugs, mosquito eradication and the prevention of
mosquito bites. The continued existence of malaria in an area requires a combination of high
human population density, high mosquito population density and high rates of transmission from
humans to mosquitoes and from mosquitoes to humans. If any of these is lowered sufficiently,
the parasite will sooner or later disappear from that area, as happened in North America, Europe
and much of the Middle East. However, unless the parasite is eliminated from the whole world, it
could become re-established if conditions revert to a combination that favours the parasite's
reproduction. Many countries are seeing an increasing number of imported malaria cases owing
to extensive travel and migration.
Many researchers argue that prevention of malaria may be more cost-effective than
treatment of the disease in the long run, but the capital costs required are out of reach of many of
the world's poorest people
Used in this lesson, new educational technology, "Brainstorming."
USING "brainstorming"
The purpose of training - in a short period to get the most from a group of numbers
answers, in order to determine the initial level by the students' knowledge.
Direct students to view a more in-depth study of the topic, creating favorable conditions
for full reflection and exchange of views.
To teach students to use the most correct and optimal solutions in the process of studying
this problem.
Objectives of this method:
- To develop and enhance the ability of clinical thinking in students and the ability to use the
knowledge gained in the course of solving problems in everyday practice.
- Be able to challenge his position during an active analysis of the proposed answers and make
the right decision.
SCENARIO.
Duration of lesson 30 minutes.
Subject studies "Malaria".
The teacher invites students to give answers on this subject.
Students begin to list the variants.
1. Malaria anthroponotic protozoal disease, manifested by febrile seizures, anemia,
hepatosplenomegaly.
2. The causative agents of disease - malaria plasmodium. Under natural conditions cause malaria
in humans are 4 types: Rl.vivax - exciter three-day malaria Rl.malariae - agent 4-day malaria
Rl.ovale - pathogen ovale-malaria Rl.falcirarum - the causative agent of tropical malaria.
3. The source of infection is a sick man, parasite including gametonositely
4. The main mechanism of infection - transmissible through the bite of female mosquitoes
invaded the genus Anopheles, which ended in the body sporogony.
Transmission of malaria is possible parenteral route - with blood transfusion from a donor parasite, during treatment and diagnostic tools for manipulating not treated as well as vertical
transmission.
5. Distinguish between periods in the pathogenesis of tissue and erythrocyte schizogony.
6. As a result of erythrocyte schizogony parasitemia reaches 'pyrogenic level' that determines the
occurrence of fever and other symptoms of the primary manifestation of malaria.
7. The development of immune reactions (synthesis of opsonins, agglutinins, the cellular
immune response) limits the intensity of para sitemia, which is manifested by gradual fading of
malaria attacks and the restoration of disturbed functions.
8. However, due to imperfections in the initial immune response within the next 1-2 months.
parasitemia reaches a new level piorgenosis , which leads to the development of the early phase
of erythrocyte relapse.
9. Further during the invasion varies depending on the type of pathogen. In the case of tropical
malaria, the phase of convalescence. In a four-malaria parasitaemia can be saved on the
subpirogennom level, which provides the appearance of erythrocytic late relapses.
In falciparum malaria cases in the completion of schizogony paraerythrocytes develops late
relapses.
10. Under the influence of pyrogenic substances develops an allergic reaction, which is
accompanied by stimulation of the thermoregulatory centers, increasing the activity of biogenic
amines, kallikrin-kinin system with increased vascular permeability, disturbance of blood
circulation, fluid and electrolyte disorders.
The presence in the blood of immune complexes containing complement to exacerbate vascular
damage.
11. As a result of the destruction and phagocytosis of erythrocytes infested, fixation of
complement-containing immune complexes on the membrane of red blood cells, causing the
lowering of their resistance and hyperfunction of spleen, bone marrow hemopoiesis oppressor
developed progressive anemia, leukopenia and thrombocytopenia.
12. If malaria is formed unstable species specific non-sterile immunity.
13. The development of malaria invasive process is accompanied by a marked impairment of
various systems and organs. In the brain revealed the phenomenon of swelling, extravasation,
damage to the capillaries and the formation of granulomas around the vessels of specific Durk
often reveals severe degenerative changes in the myocardium, epicardium, and bleeding under
the endocardium, degenerative and necrobiotic changes in the kidneys, hemorrhages in the
capsule or renal pelvis.
14. The main symptoms of malaria are high fever, with the phases of "chills", "hot" and "sweat",
anemia, and hepatosplenomegaly.
15. There are three-day malaria, ovale-malaria, dengue and malaria, a four-day that can occur as
a manifestation of primary and recurrent - and exo-erythrocytic erythrocytic. The disease may be
mild, moderate and severe forms.
16. The disease onset is usually acute in some cases is possible in a short Prodromus malaise,
chilliness, dryness in the mouth.
17. In the course of the malarial paroxysm develop a general toxic manifestations - fever,
headache, myalgia possible, urticaria, bronchospasm, vomiting, ending the attack is accompanied
by sweating.
18. Examination of the patient at the height of the malarial paroxysm identify facial flushing, dry
skin and hot body, and often cold extremities, tachycardia, hypotension, splenomegaly.
19. Against the background of impaired immunobiological status of the tropical form of malaria
can acquire malignant course with development of coma, acute renal failure, hemorrhagic
syndrome, fever, etc. hemoglobinuric
20. Comatose form of tropical malaria develops in the form of severe headache, dizziness,
vomiting, anxiety multiple patients. The next period - the period of somnolence is characterized
by mental and physical sluggishness patients who are reluctant to come into contact, answers in
monosyllables, is quickly exhausted, even falling asleep during the conversation. A few hours
later develops sopor period during which consciousness is lost, possibly psychomotor agitation,
epileptiform convulsions, and rarely focal meningeal symptoms, revealed abnormal reflexes,
marked pupillary constriction, and the extinction of pupillary reflex. The period of deep coma
shows a complete areflexia, deep breathing and noisy breathing or Cheyne-Stokes type,
progressive hypotension and diffuse cyanosis. In the absence of adequate treatment of patients
die.
21. OPN appears progressive oliguria, azotemia, hyperkalemia and acidosis.
22. Hemoglobinuria begins suddenly and is accompanied by a terrific fever, a rapid rise in
temperature, intense pain in the lumbosacral region, repeated vomiting, bile pley-chrome,
myalgia, jaundice, oliguria, the urine becomes dark brown or black. observed in the subsequent
acute renal failure, azotemia, anemia, which determine death. Urine detects oxyhemoglobin,
methemoglobin, hematin, clumps of hemoglobin, protein, red blood cells, hyaline and granular
cylinders.
23. Haemorrhagic form of falciparum malaria is accompanied by phenomena of heavy ITSH,
DIC with bleeding into the skin, internal organs and vital centers of the brain and adrenal glands.
24. The unfavorable course of the disease is often observed in pregnant women who have
delayed development observed reactions, multiple visceral manifestations, high lethality,
intrauterine fetal invasion with subsequent antenatal death.
25. The diagnosis is confirmed by the detection of malaria parasites in blood - and a drop of
thick blood smears.
26. Differential diagnosis of malaria flu, meningococcal disease, hemorrhagic fevers, viral
hepatitis, sepsis, and rickettsiosis.
27. Patients subject to compulsory hospitalization of malaria infection in the hospital. Relief of
malaria attack is achieved by the appointment of agents hemo-toxic (delagil, hingamin, quinine,
fansidar, mefloquine, etc.), and the radical cure of patients is achieved by using
gistoshizotropnyh drugs.
28. In order to prevent personal use gematoshizotrop funds. In order to prevent transfusion
malaria requires careful selection of donors.
6.2. The analytical part of
Case studies:
Objective number one. The patient temperature for 10 days in order to clarify the
diagnosis was to take blood for analysis.
Results of the analysis below are as follows:
1. RAC with Rickettsia burneti antigen - negative.
2. RAC to the antigen of R. prowazeki - negative.
3. Widal reaction - negative
4. Reaction Wright - negative.
5. Blood cultures on blood cultures - negative.
6. Blood cultures on sugar broth - negative.
7. Blood on the gemoparazity - Rl.vivax detected.
1. Tell the diagnosis
2. List the clinical phase of the disease?
3. What clinical data can be identified by examination of the patient at the height of the disease?
4. What is necessary to differentiate similar diseases?
5. How is causal-cropped and radical therapy?
6. Tell chemoprophylaxis of this disease?
7. The tactics of GPs?
№ answer
1. A three-day malaria.
2. The development of the malarial attack include a number of phases - "chill," "Heat,"
"sweat."
3. At the height of the malarial attack detected: flushing of the face, hot dry skin, body,
tachycardia, hypotension, hepatosplenomegaly.
4. Differential diagnosis of malaria - the flu, meningococcal disease, hemorrhagic fevers,
viral hepatitis, rickettsiosis, brucellosis, TPZ, and sepsis.
5. Relief of malaria attack is achieved by the appointment of the gematoshizotropnogo
drugs (chloroquine, delagil, quinine, mefloquine, fansidar), and the radical cure of
patients is achieved by using gistoshizotropnyh drugs (primaquine).
6. In order to malaria chemoprophylaxis used delagil.
7. Provide direction for clinical treatment.
Task number 2. Patient P., aged 38, arrived on the 7th day of illness with a fever hectic
everyday type. An increase in temperature was accompanied by chilliness, sweating moderately
expressed.
On examination, the patient's condition serious, consciousness is preserved. Adynamic.
Complains of general weakness, muscle pain in the joints, headache, dizziness, vomiting. The
skin with a slight icteric tinge. The liver is increased by 2 cm, the spleen is not enlarged. On the
eve of the disease came from Mali.
In the large drop of blood found young trofozoidy gamontnye options and the malaria parasite.
1. Substantiate the diagnosis.
2. To assess the results of studies of colon drops.
3. To assess the severity of the patient.
4. The tactics of the SPM.
№ answer
1. Malaria is a tropical form.
2. In the large drop of blood found Rlasmodium falcirarum.
3. His condition was grave.
4. Give direction to the infectious hospital.
Task number 3. Patient M., aged 28, a sailor, was admitted to the hospital on the 18th day
of the illness with complaints of high fever, headache, general weakness. The disease began with
a stunning chill, which lasted about an hour, then was to raise the temperature to 39,8 º C. In the
next 5-6 days chills recur daily, appeared in the middle of the day, after which the temperature
was set at 8-10 hours at 40-41 º C. The temperature dropped rapidly, accompanied by a decrease
in sweating. Then there were febrile seizures a day. On admission the temperature of 39,9 º C.
Face hyperemic, herpes on the lips. Injection of sclera. Tongue coated with white bloom. In the
lungs vesicular breathing. Cardiac sounds are muffled, rhythmic. Pulse 140 beats. per minute,
regular, weak. BP 100/60 mm Hg. of Art. The abdomen is soft, not distended. The liver is
palpable at the costal arch, palpable spleen, dense, serving at 3-4 cm
1. A preliminary diagnosis.
2. Plan examination of the patient.
3. Draw a leaf temperature, indicating clinical symptoms.
answer
Malaria is a tropical form.
Blood samples for gemoparazity, complete blood count.
Clinical symptoms include chills, fever, headache, sweating, tachycardia, hypotension,
splenomegaly.
6.3. The practical part
Terms of blood sampling on a thick drop gemoparazita to identify with malaria.
Purpose: Diagnosis of malaria.
Indications: High fever over 3 days in patients with a diagnosis is not clarified.
Required equipment: sterile gloves, scarifier, cotton swabs, alcohol (70-96 º), a glass slide,
glass rod, wax pencil, a blank-direction.
Running steps (steps):
№ Action
Not
Fully
complete
complete
(0 point)
(10 points)
1. Wear sterile gloves
0
10
2. Process the ring finger with alcohol
0
10
3. Lancet puncture the ring finger of the hand, blood is taken
aseptically
0
10
4. The first speaker was a drop of blood wiped with a dry
cotton
0
10
5. Finger puncture turned down and a second drop of blood
with a diameter of about 5 mm is applied to the surface of
the slide
0
10
6. Smudge sticks drop a glass or angle of the slide in the disc
with a diameter of 10-15 mm
0
10
7. Dried at room temperature for at least 2-3 hours and stained
for 40-45 min with azure-eosin
0
10
8. On the reverse side of glass wax pencil indicates patient
name or registration number of the corresponding
0
10
9. The paint is washed under a tap with running water and
dried vertically at room temperature for at least 2-3 hours
0
10
10. Sent to the laboratory
0
10
Total
0
100
Terms of blood sampling on the smear to detect malaria at hemo- parasite.
Purpose: Diagnosis of malaria.
Indications: Liharadka over 3 days in patients with a diagnosis is not clarified.
Required equipment: sterile gloves, scarifier, cotton swabs, alcohol (70-96 º), a slide, a wax
pencil, the form-direction
Running steps (steps):
№ Action
Not
Fully
completed
completed (10
(0 point)
points)
1.
Wear sterile gloves
0
10
2.
Process the ring finger with alcohol
0
10
3.
Lancet puncture the ring finger of the hand, blood is
taken aseptically
0
10
4.
The first speaker was a drop of blood wiped with a dry
cotton
0
10
5.
Finger puncture turned down and the second drop
touching the slide
0
10
6.
Put on a slide a drop of blood with a diameter of about
5 mm and a second edge of the slide abruptly preparing
a smear
0
10
7.
Smear is fixed with alcohol for 2-3 min and stained for
40-45 min with azure-eosin
0
10
8.
On the reverse side of glass wax pencil indicates patient
name or registration number of the corresponding
0
10
9.
The paint is washed under a tap with running water and
dried vertically at room temperature for at least 2-3
hours
0
10
10. Sent to the laboratory
0
10
Total
0
100
7. Test questions
1. Determination of malaria.
2. The etiology of malaria.
3. The epidemiology of malaria.
4. Pathogenesis of malaria.
5. Classification of malaria.
6. The symptoms of prodromal period falciparum malaria.
7. The classic symptoms of malaria.
8. These objective examination of the patient at the height of the malarial paroxysm.
9. Complication of tropical forms of malaria.
10. Clinical symptoms comatose form of tropical malaria.
11. Manifestations of acute renal failure.
12. Clinical symptoms hemoglobinuric fever.
13. Clinical symptoms of hemorrhagic forms of tropical malaria.
14. The course of falciparum malaria in pregnant women.
15. Differential diagnosis of malaria.
16. Laboratory diagnosis of malaria.
17. Treatment of malaria.
18. Prevention of malaria.
8. The recommended literature
The basic
1. Majidov V.M. Infectional diseases. Т., 1992.
2. Maxmudov O.S. Children inflectional diseases, Т., 1995.
3. Uchaykin V.R. Manual by children inflectional diseases, М.,1999.
4. Shuvalova E.P. Infectional diseases, М.,1999.
The additional
5. Musabaev I.K. «the Management on intestinal infections», Т, 1982.
7. Pokrovsk Century И, Pak Of this year, etc. «Infectious diseases and
М, 2003
epidemiology». -
8. Jushchuk N.D., Vengerov J.J. «Lectures on infectious diseases». - М, 1999.
9. Uchajkin V. F «the Management on infectious diseases at children», - М, 1998.
10. Internet resources (www <http://www.medlinks.ru/> medlinks
<http://www.medlinks.ru/><http://www.medlinks.ru/>ru <http://www.medlinks.ru/>,
www.cdc.gov <http://www.cdc.gov/>).