m a l a r i a
TRANSCRIPT
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Dr. Oscar Pablo Toro V.Medicina Interna
MALARIA
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MALARIA.
SITUACIÓN EPIDEMIOLÓGICA DE
MALARIABolivia - 2007
Se observa que el mayor riesgo a la malaria esta en 6 municipios de la Amazonía Boliviana.
Ministerio de Salud y Deportes
Unidad Nacional de Epidemiología9
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MALARIA.
Ministerio de Salud y Deportes
Unidad Nacional de Epidemiología
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MALARIA.
Especies Período de incuba-
ción (días)
Hematíes parasita-
dos
Etapa exoeritro-
cítica
Máxima duración
P. vivax
9 - 15 Hematíes jóvenes
Persistente 3 años
P. falciparum
8 - 17 Cualquier hematíe
Limitada 9 meses a 1 año
P. malariae 30 - 40 Hematíes maduros
Persisten- te
> de 20 años
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MALARIA.
ESPOROZOITO
MEROZOITO
HIGADO
GR
INVASION DEL MEROZOITOMEROZOITO
INFECCION
CICLO ASEXUAL
ENDOTELIO
ADHESION AL
ENDOTELIO
GRINFECTADO
ADHESION PLACENTA
GAMETOCITOS
GR INFECTAD
O
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MALARIA.
Gutiérrez, J. Et al. VI Congreso SPEIT, 1999
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MALARIA.
Quino, H.. Rev. Per. Enf. Inf. Y Trop., 2001
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MALARIA.
Infección por P. falciparum
Infección por P. Vivax
Infección por P. ovale
Infección por P. malarie
Falla multiorgánic
a
No secuestro periférico
No secuestro periférico
No secuestro periférico
Enf. microvascular difusa con GR parasitados
que obstruyen el flujo
No complicacion
es microvascular
es
No complicacion
es microvascula
res
No complicacion
es microvascula
res
Daño por hipoxia e
hipoglicemia. Efectos
tóxicos FNT-a,IL1,FNTb
Parasitemia limitada a
reticulocitos
Parasitemia limitada a
reticulocitos
Inf 20-30 añosProduce una
glomerulonefritis por
inmunocomplejos
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MALARIA.
Quino, H.. Rev. Per. Enf. Inf. Y Trop., 2001
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MALARIA.
Quino, H.. Rev. Per. Enf. Inf. Y Trop., 2001
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MALARIA.
Quino, H.. Rev. Per. Enf. Inf. Y Trop., 2001
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MALARIA.Diagnóstico de MalariaDiagnóstico de Malaria
Dx. ClínicoDx. Clínico
LABORATORIOLABORATORIO
ParasitológicoParasitológico MolecularMolecular
•Gota Gruesa
•Microconcentración
•Naranja de Acridina
•Gota Gruesa
•Microconcentración
•Naranja de Acridina
•Inmunocromato
grafia (P.R)
•IFI, Elisa
•Inmunocromato
grafia (P.R)
•IFI, Elisa
InmunológicoInmunológico
PCRPCR
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MALARIA.
Dx. INMUNOLOGICO
DIRECTO INDIRECTO
Detección delParásito ó antígeno
Detección de anticuerpos
Elisa DirectoPruebas rápidas
Elisa indirecto,IFI,
Inmunoblot etc.
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MALARIA.
E Anti Ac.
SEnzima
S= Sustrato
Ac = Anticuerpo
Ag = Antígeno
Revelado, mediante el uso de conjugadoEnzimático anti-inmunoglobulina específico.
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MALARIA. Tratamiento de la malaria
Principales antimaláricos
Grupo I(acción rápida yresistenciaprolongada y difícil deaparecer)
Grupo II(acción lenta yresistenciarápida y fácil deaparecer)
Quinina, qinghaosu
4-Amino-quinoleínas•cloroquina•amodiaquinaAmino alcohol•mefloquina•halofantrine
Antifólicos•sulfonas •sulfamidasAntifolínicos•diguamidas•diaminopirimidinas
8-amino-quinoleínasPrimaquina.
Antimaláricosnaturales
Antimaláricossintéticos
Esq
uiz
on
ticid
as
Ga
me
toci
ticid
a47
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MALARIA.
TODOS
PRIMAQUINA
PIRIMETAMINA
CLOROQUINA
ARTEMETER
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MALARIA.Modo de acción
4 amino-quinoleína
Hematíe
Núcleo delparásito
Citoplasmaanulardel parásito
Inhibición de proteasas que separan la hemoglobina
Vacuola
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MALARIA.
Ácido para-aminobenzoico(PABA) +
dihidropteridine
Acido dihydrofólico(ácido fólico)
Acido tetradihydrofólico(ácido folínico)
Purinas – PirimidinaNucleoproteinas
Núcleo del parásito
Sintetasa del
ácido dihidrofólico
Reductasa del
ácido dihidrofólico
Inhi
bici
ón
Inhi
bici
ón
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MALARIA.
MEDICAMENTO
NoDias
DIAS
1o 2o 3o 4o 5o 6o 7o 8o 9o 10o 11o 12o 13o 14o
CLOROQUINA
Tab x 250 mg
(150 mg base)
PRIMAQUINA
Tab x 15 mg
Ó 7.5 mg
3
14
4 4 2
Tab Tab Tab
1 1 1 1 1 1 1 1 1 1 1 1 1 1
Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab
2 2 2 2 2 2 2 2 2 2 2 2 2 2
Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab
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MALARIA.
MEDICAMENTO
CLOROQUINA
Tab x 250 mg
(150 mg base)
PRIMAQUINA
Tab x 15 mg
No
DIAS
3
1
1o 2o 3o
4 Tab 4 Tab 4 Tab
3 Tab
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MALARIA.
0
20
40
60
80
100
120
1975 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994
Años
% Eficacia
Quinina
Mefloquina
Chloroquina
SP
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MALARIA.
BRAZILQU; CQ; SP; MQ
BOLIVIA
CQ; SP
FR. GUAYANA
CQ; SP
GUYANA
CQ; SP
ECUADOR
CQPERU
CQ; SP
COLOMBIA
CQ; SP
VENEZUELA
CQ,SP
SURINAME
CQ
QU = QuinineCQ = ChloroquineSP = Sulfadoxine + PyrimetamineMQ = Mefloquine
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MALARIA.
PCR/RFLP DEL GEN pfmdr1 que detecta la mutaciòn delPCR/RFLP DEL GEN pfmdr1 que detecta la mutaciòn delaminoàcido Aspaminoàcido Asp12461246 a Tyr a Tyr1246.1246.
500bp500bp250bp250bp
RESISTENCIA A CLOROQUINA de P.falciparum por PCRRESISTENCIA A CLOROQUINA de P.falciparum por PCR
SENSI
BLE
SENSIBLE
SENSIBLE
SENSIBLE
RREESSII
SSTTEENNTTEE
RREESSII
SSTTEENNTTEE
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MALARIA.
ZONAS SIN RESISTENCIA A PLASMODIUM FALCIPARUM
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MALARIA.RESISTENCIA A CLOROQUINA POR P.
FALCIPARUM.
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MALARIA.
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FinMUCHAS GRACIAS
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