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*===Human liver stage===#schizontsprozoite→schizont
*===Human blood stage===
*===Mosquito stage===
==検査==
→Vaccine
{{TM menu}} ==歴史History of malaria==
*2700BCのNei Ching（內經＝黃帝內經）に記述あり
*ヒポクラテスも記述
*1948年 P.C.C. Graham が初めてヒト肝細胞への感染を発見
==病原体=Malaria in Yaeyama, Okinawa, Japan===*[https://storymaps.arcgis.com/collections/b8f0dcc7c52746e8837e9aecb1833db0 Malaria History in Yaeyama War Malaria & Malaria Elimination (in 4 languages)]*[https://www.amazon.co.jp/gp/product/4901427261/ マラリア撲滅への挑戦者たち (やいま文庫13) 南風原 英育] ==Pathogen and life cycle==
*[https://www.youtube.com/watch?v=1v55yg0RfoY YouTube: Malaria Lifecycle Part 1]
*[https://www.youtube.com/watch?v=MxiWp8vkRFI YouTube: Malaria Lifecycle Part 2]
===etymology===
*''sporo-''
**
*''mero-''
**[Gr] part
*''tropho-''
**
*''hypno-''
**
*''-zoite'', ''-zont''
**
*''gameto-''
**
*''oo-''
**
*''-kinate''
**
*''-cyst''
**
*sporozoite
*merozoite
*trophozoite
*schizont
*hypnozoite
*gametocyte
*ookinate
*oocyst
##hypnozoite only by ''P. vivax'' and ''P. ovale''
#merozoite
#trophozoite
##gametocyte
###male/female
#gametocyte
#macrogametocyte
**Genetically sub-Saharan people highly lack Duffy antigen, which consists the reason why ''P. vivax'' is not endemic in sub-Sahara
==疫学Epidemiology==
in 2017
*219mil. per year ←500mil. in 2005
**琵琶湖南岸の水田と湖へ注ぐ小川でハマダラカが繁殖
*最後の患者は1961年沖縄
===China is certified as malaria-free by WHO in 2021===
*[https://www.who.int/news/item/30-06-2021-from-30-million-cases-to-zero-china-is-certified-malaria-free-by-who From 30 million cases to zero: China is certified malaria-free by WHO]
==Vector==
*treatment
*economical development
==Prophylaxis==
*ABCD of malaria prophylaxis
**Awareness
**Bite protection
**Chemoprophylaxis
**Diagnosis and treatment
*atovaquone/proguanil
**effective for both of liver stage and blood stage
**needs 1 week continuation after leaving endemic area
*mefloquine, doxycycline
**effective only in blood stage
**needs 4 weeks continuation after leaving endemic area
==Malaria immunology==
===Reasons why immunity against ''Plasmodium'' needs repetitive infections===
*Genetic heterogeneity of ''Plasmodium''
*Modulation of host immune responses by ''Plasmodium''
===Candidate antigens for malaria vaccine===
*Radiation-attenuated sporozoite (RAS)
*Genetically-attenuated sporozoite (GAS)
**Sap 1: early arresting
**Fabb/f: late arresting
*Circumsporozoite protein (CSP)
[https://www.niid.go.jp/niid/ja/typhi-m/iasr-reference/2566-related-articles/related-articles-508/11207-508r08.html IASR 2022年6月]
===Proteins on RBC knobs===
*Surface proteins on trophozoite-infected RBC
**PfEMP-1
***binds adhesion molecules on brain endotherial cells = sequestration
****ICAM-1, VCAM-1, CD36
***only in ring form in blood
**RIFINs
**STAVOR
==Vaccine==
*BK-SE36
*Rh5
*PfRipr
*MSP1-withdrawn
*AMA1-withdrawn
**not enough antibody induction or serious side effects at phase 1
==症状='''W'''heat '''G'''erm '''C'''ell-'''F'''ree Protein Synthesis '''S'''ystem (WGCFS)===*to extract ribosome, tRNA, TFs from germ （胚芽） of wheat**WGCFS is optimal recombinant protein synthesis system for ''Plasmodium'' proteins, much better than utilization of ''E. coli''*Immunoscreening against ''Plasmodium'' and recombinant target protein as antigen ===Potential of transmission-blocking vaccine===*被接種者個人の感染は予防されないため，TBV単独でのphase 3は原理的に困難．やるとしたら複数の村をincorporateしての大規模なcluster-randomizationを行い，村間に蚊が飛んでいかない程度の境界域も設けて，数年～10年単位で疫学的に観察する必要があり，およそ現実的ではない．*よってTBVはphase 2までが現実的で，その後は他の直接的な感染防止策が確立された時点でcombine methodとして地域単位で接種してtransmissionの減少を観察するという phase 4 が必要． ==Clinical feature=====severe malaria===*cerebral malaria*AKI, acute renal failure**"black water fever", mechanism unknown***treatment with quinine is associated with black water fever*jaundice*acidosis*ARDS*DIC, less common*purpura fulminans, due to coagulation abnormality; rare condition
*mortality due to falciparum increases according to age ==Diagnosis==*increase likelihood in imported cases**fever>39℃**splenomegaly**low platelet count***decrease likelihood in imported cases** ===suspected cerebral malaria===*first check blood glucose**''Plasmodium'' consume blood glucose and quinine induce insulin secretion*there is no definitive diagnosis for cerebral malaria, only clinical diagnosis*pathogenesis of cerebral malaria is still unknown ===microscopy===*[https://www.mcdinternational.org/trainings/malaria/english/DPDx5/HTML/Frames/M-R/Malaria/body_Malariadiagfind2 Comparison of Plasmodium Species Which Cause Malaria in Humans] ==治療Treatment==*Quinine [ku-'''wai'''-na-in キニーネ] ===arteminisin-based combination therapy===*to reduce parasites by rapid-acting arteminisin*to prevent recrudescence and drug resistance by lumefantrine or others *arteminisin resistant around Thailand-Myanmar border and Thailand-Cambodia border *IV forumulations for severe malarial patients who have difficulty in PO administration**IV artesunate is more effective than IV quinine***IV artesunate is unavailable in Japan ===clinical classification of malaria==={|class="wikitable"|-!rowspan="3"|malaria|colspan="2"|severe|-|rowspan="2"|uncomplicated|falciparum|-|non-falciparum|} *no specific additional treatment for cerebral malaria other than usual malaria treatment, nothing proved effective
==予後Prognosis==
