Examination of Incidence of Malaria Infestation Caused by Different Species of Plasmodium in Enugu Metropolic

Examination of Incidence of Malaria Infestation Caused by Different Species of Plasmodium in Enugu Metropolic (A Case Study Of Parklane Hospital Enugu)

  • Literature Review
  • The Parasite

The micro-organisms causing malaria are commonly referred  to as malaria parasite by (Mornica Cheesbrogh 1998). This  term is usually restricted to the family plasmodiidae within the order coccidida, sub-order Haemosporididea, which comprises various parasites found in the blood of reptile, birds and animals.  The classification of Haemosporirche as a sub-order of the coccidida is complex and controversial since an alternative system has been proposed by (Cutteridge et al 1977).  However (Bernett 1979) classification of Hencocytozoidae has been maintained here. 

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The zoological family of plasmodiidae includes the parasites which undergo too types of multiplication by asexual division (schizogony) in the vertebrate host and a single multiplication (sporogony) in the mosquito host. The genus plasmodium has been defined on the liver of the vertebrate test (exoerythrocytic schrizogony), the other characteristic of the genus isa that he mosquito hosts are various species of Anopheles.

The word “malaria” was used about the year 1927 by John macculloaugh a London physician to described febrile illness associated with swampy places.  Previously the term had been used to denote the emanations form marshes and swaps, exposure to which was supposed to cause these illness. In 10880, Laveran, a French Army surgeon, first described microscopic organisms in the blood of malaria patients and associated them with the illness. Rose an English Army surgeon in 1897 proved that analogous parasites in birds were transmitted similarly.  Subsequently, the role of Anopheless mosquitoes in the epidemology of human malaria was established by Halian scientist sunder the leadership of Grassi in 1898.  Malaria has been a scourge throughout the ages and is still a very important disease in some parts of the world.  The world Health organisation (WHO) reports in 1948, over three hundred million persons in 1948, over three hundred million persons in the world were afflicted with malaria.  Today, the incidence has been reduced by half.  In the tropics and subtropics, hovere, malaria still remain a major cause of ill health.

So great is the impact of malaria on the health of man that the disease has over the years  continued to earn recognition for itself from individuals committees, governmental agencies etc.  Because of its high frequency of occurrence, the WHO has recommended that all febrile illness in malaria endemic areas should receive anti-malarials.

Malaria which was previously referred to as the while man’s killer” Thrives in certain environments where the physical conditions farvour the propagation of its vector.  It occurs in almost every part of the world where physiographic factors tend to produce and to maintain propagation, and where the agricultural economy of he region is associated with relatively low standard of living.  In those areas awhere it exisats in endemic state is usally one of the msot important diseases from a public health and economic standpoint with which local health agencies have to contend.  These conditions seem to be mainly in the tropics regions and so malaria is described as being “essentially a tropical disease that is found in the regions between latitude 62N and 40S and is most commonly found throughout Africa”  (Osuntokun 1970).

In areas of high malaria transmission, a lot of setback with respect to human health and productivity and the economy is attributable to malaria.  Dr.  Henry R. Carter, the dear of North America malariologists, hence stated, “the loss of efficiecny caused by malaria is beyond comparism greater than that caused by any other diseases combined” There is no question but that in regions of relatively mhigh malaria prevalence, this disease holds back the general development of the section affected and interferes with the normal growth of local industries.  The death rate of malaria may not see alarming, yet in amount of sickness and suffering, the loss of time, efficiency and expense, the lowered vitality of those afflicted and in the reduction of property values, malaria is without rival among the diseases affecting man.

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In general, it may be said that malaria is pre-eminently a disease, which causes prolonged morbidity in rural populations.  Aside from the acute episodes of fever, which are usually of short duration, the morbidity is caused principally by estruction of red blood cells (amemia).  This condition is characterized by weakness and inexitably finds expression in loss of efficiency for work particularly manual Labour.

2.2     PLASMODIUM SPECIES AND THEIR DISTRIBUTION

          THE P. FALCIPARUIA:  malaria caused by plasmodium Falciparum is referred to a falaparum malaria formerly known as subtertian (ST) or malignant (MT) malaria.  It is the most serious of the disease and the most widespread, most serious form of the disease and the most widespread, accounting for up to 80% of malaria cases worldwide.

DISTRIBUTION:  P. Falciparum is found mainly in the hotter and more  humid regions of the world.  T is the main species found in tropical and subtropical African, Bangladish, Pakistan,, Afghanistan, Nepal, Sri Lanka, South East Asia, Indonesia, Philippines, Hati, Solomon Islands, New Guinea, and many Islands in Melanesia.  It also occurs in part of India the middle east, eastern Mediterranean and countries of North Africa.

  1. Vivax: Malaria caused by plasmodium vivax referred as vivax malaria, formerly know as benign tertian (BT) malaria. It is a relapsing species and the main cause of malaria in temperate and subtropical areas.  The species of P.vivax contain many strains which shows differences in  incubation time, relapsing, pattern, morphology, number of parasites in red cella, and response in anti-malaries.

Distribution Ketchim, D.A. (1984) stated that P. Vivax is capable of developing in mosquitoes at lower temp. than P. talciparum and therefore has wider distribution in temperate and subtropical areas.  It is also found in some parts of the tropics.  P. Vivax is the main P. species in south America (Occurring as far south as northern Argentina), mexico, the middle East, northern Africa, India, Pakistan, Siri Lanka, Papua New Guinea and the solomon Islands. It is also found in parts of south east asia,  Indonesia, philipnes, madagacar,, tropical  subtropical African Korea, China and the USSR.  P.Vivax is rarely found in West Africa or other places where the red cells of the population lack the Duffy blood group antigens Fya and fyb.

PLASMODIUM MALARIAE:- Malaria caused by Plasmodium malariae is required as malariae, formerly known as quartan malaria.  P. Malariae has much lower prevalence than P.falciparum or P. Vivax and is able to persists to humans for many years.

DISTRIBUTION:- According to (Duguide et al 1978), P. Malariae is found in tropical and subtropical areas.  In tropical Africa, it accounts for up to 25% of plasmodium infection.  It is also presents in many other countries, whre malaria occurs particularly in Guyana, India, Srilanka and Malaysia.  In these countries  it usually accounts for less than 10% of plasmodium infections.

PLASMODIUM OVALE: Malaria caused by plasmodium Ovale is known as Ovale malaria, formerly known  as Ovale tertian malaria.  It is a relapsing species and has a restricted distribution and low prevalence.

DISTRIBUTION: P. Ovale is found mainly in West.  Africa which accounts for up to 10% of malaria infection.  It has also been reported from other parts of Africa and from the Philippines, china and parts of the East, south Asia and South America.

2.3     CLINICAL FEATURES AND PATHOLOGY OF THE SPECIES

          The clinical course of malaria consists of fever acompanied by other symptoms and alternating with periods of freedom from any feeling of illness (Brown 1982).  The incubation period in malaria covers the time between the infection and the first appearance of clinical signs, of which fever is the most common.  The length of the incubation period is usually between mine (9) and thirty (30) days and varies with the species of the parasite.

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For  plasmodium vivax, The incubation period varies according to the strain.  Parasite density for vivax malaria rarely exceeds 50000/ML or 2% of red cells infected.  The infection is not usually severe, the diath from this specie is less common than from falcipaarum malaria.  (Menendez 1995).

Erythrocytic schizogony becomes synchronised and therefore after a few days, a regular 48h pattern of fever develops with cold, hot and sweating stages, often accompanied by mansea and vomiting.  The temperature may rise to 40.6c (105f) or higher.  All forms of the parasite (trophozoites, schizorits and gametocytes) can be found in blood films.  The spleen enlarges and anamia may develop, especially in children.

Relapses are one of the clinical features of P.Vivax Berneth (1979).  They may occur 8-10 weeks after a previous attack (short term relapses) or about 30-40 weeks later (long term relapses). A they form and frequency of relapses depend on the infecting strian and ocar due to the activation of hypnozoites in liver cells.  The parasites are difficutl to locate in blood films during relapses.

Resisitance to vivax malaria is naturally found in person whose red cells lack the red cell duffing antigens fya and fyh. The glycophorin receptors which P.Vivax needs to attach to and invade red cells are mixing on Duffy negative (fya)  red  cells.  The protection is absolute and afforded only to homozygous.

For Plasmodium malariae,  the incubation time varies according to the strain. A the average is 18-40 days but longer time are associated with some strains.  Severe P. malaria are rarely seen.  Only up to 1% of red cells become parasitized (less than 10,000 parasites /N/blood).  The  cycle of development in the red cells become well synchronized  with a malarial attack occurring regularly about every 72 hours.  The spleen becomes enlarged in the early stages of the infection (Diliello 1979).

A serious complication of infection with P.Malariae is nephritic syndrome which may progress to renal failure.  It occurs more frequently in children and is caused by damage to the kidneys following the depositing of antigen – anatibody complexes on the glomerular basement membrane of the kidney.  It produces oedema, marked proteinuria, and a low serum albumin level.  Recrudescenses can occur over many years due to small numbers of erythrocytic forms of the parasite remaining viable in the host immune responses.  Attacks up to 20-30 years after an original one have been reported.

In Plasmodium ovale,  the incubation period is 16-18 days but can be longer.  Beadle (1991) reported that less than 2% of red cells usually become infected.

Clinically, oval malaria resembles vivax malaria with attacks reoccurring every 48-50 hours. There are, however, fever relapses with P.Ovale.  mixed infection is common paritculaarly in West African with P.Ovale  often being found with P. falciparum.

P.falciparum is the most pathogenic of the human malaria species with untreated infections causing severe disease and death, particularly in young children, pregnant women and non-immune adults.  Mornica Cheessbrough (1998), she also state that pathogenically of P.falcipanum is mainly due to:

*        The cystoadherence of falciparum parasitized red cells, causing the cells to adhere to one another and to the walls of capillaries in the brain, heart, spleen, intestines, hings and placenta.  Sequestrate of parasitized cells in the microcirculation causes congestion, hypoxia, blockage and rupturing of small blood vessels.

*        High levels of parasitaemia-resulting in the activation of cytokines and the destruction of many red cells.  Falciparum malaria parasitaemia can exceed more than 25,000 parasites / ul of  blood up to 30-40% of red cells may become parasitized severe falciparum malaria is associated with cerebral malaria, black-water fever, severe anaemia, hypoglycemia, and complications in pregnancy.

2.4     THE TRANSMISSION DYNAMIC/LIFE CYCLE

          In the salivary gland of the infections mosquitoes, plasmodia occurs in a spindle 0 shaped from known an as a sposrozoistes.  When a mosquito parasitized by these organisms, feeds on a human host, sit infects the sporozoites these migrate to the host liver where in the parenchyma cells they multiply asexually.  This part of the cyce is known as exoerythrocytic schisogony: “exo-erythrocytic thus indicates that it takes outside the red blood cells, and so being the erythrocytic schizogony phase (Berneth 1994)

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In the red cell, the malaria parasite grows in size, using the globin in haemoglobin as its amino acid source.  Haematin, the residual products, collects as a pigment.  The protozoan at this point is in the form of a trohozoites.  Sthe protozoan nucleus then divides.  The multinucleate organism inside a red cell is called a schozoat or segmentor.  Each nucleus eventually surrouned by its own cytoplasm is called a merozoites.  The numer of nuclear divisions and hence the number of merozoites, varies from species to species and is useful in identification.  Red blood cells containing mature merozoites distintegrate and the merozoites thus.  Released invades other red blood cells, become trophozoites and cosntinue the cycle.

At the same time, the erythrocytic cycle is going on, a para-erythrocytic cycle is taking place in paronchymal cells of the liver.  An important exception should be P.falciparum apparently has no para-erythrocytic cycle with the use of drugs agaisnt the organism in erythrocytic cycle, P.falciparum is relatively earsier to control than other malaria organisms.  Most, but not all parasitized red blood cells give rise to merozoites.  The plasmodia in some red cells develop differntly and ultimately beocme either of two sexual form:
Macrogametocycle (female) or the microgametocycle (male).  The gametocytes develop no further in man, and will die in a few anopheles mosquito parenthetically, all three kinds of malaria parasite can be transmitted from man to man either by blood transfussion sor congenitally

Gametocystes insited by a mosquito undergo further development from each microgametocyte a half dozen or so mobile, flagella.  Like microgamatos are found.  In the mosquito stomach, there occurs the sexual union of macrogamates and microgamate resulting in a zygote, which then proceeds to develop into an Oocyst.  Within the Oocyst repeated nuclear division take place.  The mature Oocyst, often containing thousands of sporozoites body carity.  Sporozoites then migrates to the mosquitis salivary glad, where they are in position sto be injected isnto a human host.  The cycle in the mosquito takes one to three weeks.  In man the fine from mosquito bite to first symptoms and thus presumably the fine for the pre-erythrocytic and erythrocytic cycles to occur, varies considerably.

Typical incubation period in vivax malaria, falciparum malaria are on the order of 14.,28, and 11 days respectively, this period occasionally may be much longer in vivax 16 to 12 months and malariae (years) disease.

 Examination of Incidence of Malaria Infestation Caused by Different Species of Plasmodium in Enugu Metropolic (A Case Study Of Parklane Hospital Enugu)

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