الفهرس 
Approval Sheet
Clinical features and severe malariaOnly 14 pages are availabe for public view
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Abstract
n Yemen, malaria disease is still representing a major health problem, especially in children. Malaria control and elimination interventions have been intensified, and despite these interventions the prevalence remains high among the people and hence this study was carried out to show the prevalence of falciparum malaria infection in the study area Additionally, the clinical symptoms, some studies with light and electron microscopy, haematological patterns, liver and kidney function, oxidative stress and antioxidants, others such as some important biochemical parameters like (uric acid, blood glucose and nitric oxide) and their possible predictive values of malaria in the study area are identified and try to determine the relationships between some these biochemical parameters.
Descriptive cross – sectional study was carried out to show the prevalence of malaria infection in Abs district of (Tehama - Hajjah) northewest Yemen during the period from Septemper 2013 to February 2015 using the light microscope. This study was focused to determine the prevalence of P. falciparum malarial disease among patients in Abs Hajjah northwest Yemen from September 2013 to May 2014. A random sampling was carried out, and structured questionnaire for data collection. Further more some studies with light and electron microscopy plus some biochemical parameters was carried out.
This thesis is divided into five main parts. The first part of this project aimed to determine the prevalence of Plasmodium falciparum in the Abs northwest Hajjah, Yemen and some studies with light and electron microscopy. The results showed that overall rate of infection was (18.1%) by P. falciparum. The infection rate was highest in males (18.17%) %) as compared to with females (18.04%). The highest prevalence of falciparum malaria was seen in both age groups (<5 and 5-14) years is (67.27%). The differences between age group was statistically significant (p>0.0001). Also the infection percentage was highest in Abs Center)
20.8%) followed by Badah-Bani Hassan then Labadah 17.7 compared with other regions. The low positive percentage of infection (10%) was recorded in villages Algar10%. The percentage of infections varied with season. The infection was highest in winter (68.5%) and the peak in February. Statistically there is significant difference between months (P<0.002). Predominant cases were moderate to severe parasite density infection.
Fever was predominant in patient infected with P. falciparum, followed by other signs, headache, chills, vomiting ...etc. More casualties from malaria were belonging to primary education follwed by illiterate.
Scanning electron micrograph shows excrescences on external surface of the erythrocyte infected with mature asexual stages of P. falciparum, these excrescences called knobs. Positive relationship was evident: Knob numbers increase as density parasites increased. Also data revealed distinct variations and of knob distribution the average knob density and size changed dramatically during parasite maturation, Knob size varied throughout parasite development.
Microscopic ultrastructural data, shows the ring stage and trophozoite which shows changes in red blood cell due to infection with falciparum malaria such as cytoplasmic, maurer‟s clefts. Also changes in parasite organelle structure such as nucleus, endoplasmic reticulum, food vacuole, rhoptry mitochondrial, membrane of the parasite and the parasitophorous vacuole were investigated. n this study we noticed the Knobs in the membrane of a P falciparum–infected erythrocyte have an underlying electron-dense layer
TEM shows the early schizont with two nuclear divisions and other schizont contains multiple nuclei. Also in the present study we were able to see a merozoite of P. falciparum fixed during invasion of red blood cell, which was contact with its membrane.
Part two of this study focused on the parameters hematological changes among patients with falciparum malaria.
The results show that significant decreases were found in hemoglobin (Hb), packed cell volume (PCV), lymphocyte , total RBC, total WBC count and platelets during acute falciparum malaria, while significant elevations was found in neutrophils
Part three of this study aimed to determine the liver function (activity of enzymes), and kidney functions.
The results showed that significant increases in activities of serum aspartate aminotransferase AST, alanine aminotransferases ALT, alkaline phosphatase ALP and lactate dehydrogenase LDH during acute malaria infection. Significant increases were found in serum total and direct bilirubin. Also significant elevation was found in both serum urea and creatinine levels. Part four of this study focused on investigate the hypothesis that oxidative stress has been accompanied with Plasmodium falciparum malaria infection with respect to the intensity of parasitaemia with estimation of oxidative stress and antioxidant.
The results show that of lipid peroxidation LPO (both erythrocytic and serum) and ceruloplasmin CP were significantly elevated in patients compared to healthy counterparts. On the other hand, the antioxidant catalase CAT activity, glutathione GSH, superoxide dismutase SOD and vitamin C were found to be lower (P < 0.0001) during infection when compared to their activities in normal, healthy individuals.
The results showed negative correlation of eLPO with catalase eCAT activity, glutathione eGSH and serum vitamin C. Catalase show high significant negative correlation (r2=0.45) with LPO, while eGSH showed less negative correlation with eLPO (r2=0.29). Also vitamin C show significant negative correlation (r2=0.34) with LPO.
Part five of this study was done to investigate the effects of the infection with falciparum malaria on nitric oxide, uric acid and blood glucose among patients.
The results show that significant increase was found in both serum nitric oxide and uric acid, while decline was observed in blood glucose among falciparum malaria patients. Nitric oxide shows significant positive correlation with LPO (r2=0.24).
The results revealed a clear relationship between the differnts biochemical parameters in this study and density of parasites.