1 發冷發熱的張小姐 Host and Defence (#B03) 林雅玲 May, 2008.
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Transcript of 1 發冷發熱的張小姐 Host and Defence (#B03) 林雅玲 May, 2008.
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發冷發熱的張小姐
Host and Defence (#B03)林雅玲
May, 2008
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瘧原蟲種類
• Plasmodium vivax 間日瘧• Plasmodium falciparum 惡性瘧• Plasmodium malariae 三日瘧• Plasmodium ovale 卵圓瘧
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Epidemiology
• 全球約五億人口感染瘧疾• 每年約一百萬人死於瘧疾• 每年超過 500,000 非洲兒童得到腦性瘧疾• 在非洲每天大約有 3000 名的兒童因瘧疾而死亡• 每 30 秒左右就有一名兒童喪生
http://www.who.int/malaria/
http://www.rbm.who.int/worldmalariaday/background.html
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Transmission of malaria
• Mosquito bite- Anopheles• Blood transfusion• Contaminated syringe• Congenital infection
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Life cycle in Anopheles minimus ( 微小瘧蚊 )
當雌瘧蚊叮咬人時
合子 (zygote) 卵動體 (ookinete) 卵囊體 (oocyst) 孢子小體 (sporozoite)
配子體 (gametocyte)
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Life cycle in human
Sporozoite (Pre-erthrocytic stage)
schizont
merozoite
ring form
(Erthrocytic stage)
gametocyte
hypnozoite(Exo-erthrocytic stage)
RBC
liver schizont
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Clinical features and pathology I
1. General symptoms Headache, Lassitude2. Fever
Cold stage 1~2 hrs Chillness, temperature mounts rapidlyHot stage 8~12 hrs 39-41oC, rapid pulse, flushSweating stage 2~4 hrsSweating, temperature falls rapidly
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Clinical features and pathology II
3. Parasitemia4. Hemolyic anemia 5. Jaundice6. Tropical splenomegaly syndrome 7. Recrudescence
Anemia can be more severe with chronic malaria.
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Severe Plasmodium falciparum infection Circulation failure
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Severe Plasmodium falciparum infection I
1. Cerebral malaria 2. Convulsion3. Circulation failure4. Renal failure5. Abnormal liver function6. Pulmonary edema
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Severe Plasmodium falciparum infection II
7. Hyperparasitemia 8. Severe anemia9. High fever10. Tropical splenomegaly syndrom
e12. Hemorrhage in many organs13. Hemolysis (Blackwater fever)14. Electrolyte imbalance 15. Hypogylcemia
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臨床診斷1. History taking
2. Blood smear
Thin film
Thick film
3.Immunodiagnosis
4. Molecular diagnosis
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抗瘧藥物1. Quinine
2. Chloroquine
3. Mefloquine
4. Doxycycline
5. Pyrimethamine
6. Primaquine
7. Proguanil
8. Artemisinin
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預防
• 避免蚊蟲叮咬• 避免因輸血而感染• 出國前詢問相關資訊
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其他議題
• 非洲醫療團• 面對病人死亡• 老年喪女