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Senior - ID 3 > 17 - Malaria > Flashcards

17 - Malaria Flashcards

1
Q

Definition of malaria?

A

Infectious disease characterized by:

  • chills
  • Fever
  • sweating

Caused by protozoa of the genus plasmodium in the RBC
Transmitted by female anopheles mosquito

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2
Q

Malaria is found?

A

90% is africa

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3
Q

Most malaria deaths are caused by?

A

P. Falciparum - sub saharan africa

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4
Q

Who dies the most from P. Falciparum?

A

Kids under 5

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5
Q

Types of malaria?

A 
Plasmodium falciparum
- tropics/subtropics
Plasmodium vivax
- widespread
Plasmodium ovale
- W. Africa
Plasmodium malariae
- tropics/subtropics
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6
Q

Phases of malaria?

A 
Infection
Liver phase
- Sporozites migrate to hepatocytes 
Erythrocyte phase
- infects the erythrocytes
- erythrocytes rupture and spread disease
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7
Q

A small % of the malaria parasite:

A

Turn into gametocytes

  • sexual reproduction
  • get picked up by mosquito

“Its the circle, the circle of life”

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8
Q

Malaria relapse?

A

P. Vivax and P. Ovale have relapses
- they have a hypnozite stage that can stay in the liver and come back

P. Malariae doesnt have a hypnozite stage
- can still live in the RBC for years

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9
Q

Malaria incubation phase?

A

Vary by species

P. Falciparum: 12 days
P. Vivax: 14 days
P. Ovale: 17 days
P. Malariae: 28 days

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10
Q

Periodicity or paroxysm of fever?

A

48hrs:

  • p. Falciparum
  • p. Vivax
  • p. Ovale

72hrs
- p. Malariae

Fever is not a reliable clue to diagnosis

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11
Q

Febrile stages of malaria pics?

A

Slide 15

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12
Q

S/s of malaria?

A

Nonspecific

  • flulike illness
  • HA
  • fatigue
  • diarrhea
  • fever
  • malaise
  • muscle aches

PT is very ill

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13
Q

Asymptomatic malaria?

A

If pts are immune or partially immune (non-sterile) they will be asymptomatic or only have mild anemia

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14
Q

Most severe malaria?

A

P. Falciparum

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15
Q

What makes p. Falciparum so bad?

A

It is a microvascular sequestration/disease

It targets all RBCs
- others only target the reticulocytes

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16
Q

P. Falciparum causes?

A

Severe anemia

  • rapid development in the non-immune population
  • HCT decreases by 8-10% in 48hrs
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17
Q

Sever manifestations of malaria of malaria?

A

Cerebral malaria
- coma

Sever anemia
- P. Falciparum infection

Renal failure

Pulmonary edema

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18
Q

Why does malaria cause renal failure?

A

RBCs adhere to the renal microvasculature

Oliguric renal failure

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19
Q

Which malaria causes nephrotic syndrome?

A

Chronic P. Malariae

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20
Q

Pregnancy and malaria?

A

Like oil and water…

Increased risk of morbidity and mortality

  • low birth rate
  • fetal loss
  • prematurity
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21
Q

Vivax and ovale can cause this late complication after 2-3 months?

A

Spleinic rupture

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22
Q

Ddx for malaria?

A

Anemia
Babesiosis
Dengue fever

23
Q

Non-diagnostic malaria labs?

A 
Hemolysis 
- Anemia
- Increased lactic acid
- Decreased haptoglobin
- Thrombocytopenia 
NO eosinophilia
Acute renal failure
- proteinuria
- elevated serum Cr
- hemoglobinuria 
Bilirubinemia
- hemolysis 
Hypoglycemia
24
Q

Warning signs of a poor prognosis?

A

Biochemical

  • Renal imparment (Cr>3)
  • Acidosis (bicarb <15)
  • Jaundice (bili >2.5)
  • Hyperlactemia (lactate >5)
  • Hypoglycemia (<40)
  • aminotranserase (>3x normal)

Hematologic
- parasitemia - >5% neutrophils contain malaria pigment

25
Q

Diagnostic labs for malaria?

A

Thick and thin smears
- 3 smears 12-24hrs apart

  • Thick smears 20x more sensitive
  • Thin smears - specification is easier

Parasitemia = number of parasites/1000RBC

26
Q

What is the best time (highest yield) time to get the thick and thin smears?

A

Soon after the fever spike

27
Q

How are thick and thin smears collected?

A

Some lab guy just smears your bloody finger on a slide and then looks at it

  • one heavy drop
  • one smeared spot
28
Q

Alternate diagnostic tests?

A

Rapid dipstick test

  • detects bi-product (LDH) of parasite
  • specific to P. Falciparum

DNA, PCR, etc
(W p. Falciparum they may be dead before it comes back)

29
Q

Rapid malaria test?

A

BinaxNOW

  • p. Falciparum 95% sens 94% specific
  • P. Vivax: 69% sens 100% specific

Confirm w thick/thin smears

30
Q

BinaxNOW cannot be used for?

A

Monitoring therapy response, it cant detect non-viable organisms

31
Q

Malaria prevention?

A

Dont go to africa

Barring that:

  • wear your ppe
  • mosquito repellant (30-35% deet)
  • permethrin impregnated
  • pants
32
Q

Malaria vaccine?

A

Some in the works but nothing yet

33
Q

Malaria prevention drugs?

A 
Chloroquine - q wk
- CNS side effects
Mefloquine - q wk $
- CNS side effects
Doxycycline - qd
Atovaquone/proguanil - qd \$\$
Primaquine - qd
34
Q

Starting and stopping malaria drugs?

A

1-2 wk before and 4 wk after
- Chloroquine, mefloquine, doxy

1-2 wk before 7 after
- atovaquone/proguanil

14 days after (shorter run up too i think)
- primaquine

35
Q

Why doesnt malaria prophylaxis work?

A

People dont take it, only
- 60% of service members surveyed were compliant

her: “My head still hurts”
Him: “did you take the tylenol i gave you?”
Her: “NO”
Him: “Hmm”

36
Q

How can you eradicate persisten hypnozoites?

A

During the liver stage of P. Vivax or P. Ovale you can take

- primaquine phosphate

37
Q

With primaquine phosphate you need to monitor?

A

G-6-PD status

38
Q

PART?

A

Presumptive anti-relapse tx
- primaquine to prevent relaps from hypnozites w P. Vivax

Again noncompliance was an issue (only 1 in 5 did it)

39
Q

Indications for malaria tx?

A 
Determine species 
- must treat falciparum
Magnitude of parasitemia
Impaired consciousness
Renal failure
Pulmonary edema
Antimalarial resistance
40
Q

Malaria pts must be protected from?

A

Further bites in malaria endemic environment

41
Q

Tx for uncomplicated malaria?

A

Prophylaxis drug - different dose than prophylaxis

42
Q

Chloroquine sensitive malaria?

A

Give them chloroquine (aralen) PO

43
Q

Chloroquine resistant malaria?

A

PO:
- coratem (artethemer and lumefantrine)
- malarone (atovaquone+proguanil)
Quinine sulfate + doxy

44
Q

How is P. Falciparum treated?

A

Quinidine gluconate IV
+
Doxy or clinda

45
Q

Where do you get the meds for p. Falciparum?

A

Eli lilly stoped making quinidine gluconate IV

Artesunate is available through the CDC

46
Q

Treatment monitoring?

A

Thick and thin blood smears q 6-12 hrs until parasitemia falls below 1%

If its not falling its not working

If it doesnt fall by 75% in 48hrs or not gone by 7 days your tx isnt working, change it up

47
Q

___ makes malaria worse?

A

Steroids

48
Q

Things to monitor/manage during malaria tx?

A

Control glucose

Monitor

  • acidosis
  • pulmonary
  • renal failure
  • seizures
  • edema
49
Q

CDC no longer recommends?

A

Exchange transfusions

50
Q

Reoccurrence

A

Relapse - hypnozoite (p. Vivax and p. Ovale)

Recrudescence
- incomplete tx

Reinfection
- Most commonly p. Falciparum

Low level infection
- p. Malariae - below detectable levels

51
Q

Sickle cell and malaria?

A

SCD is not a protective factor

- malaria is one of the top precipitating factors of a sickle cell crisis

52
Q

Malaria is not a US problem right?

A

Nope:
2000 cases in 2011

A lot of it was brought back by service members (not the coast guard) (slide 52)

53
Q

Malaria meme?

A

Really not any good ones

- sorry i tried

Senior - ID 3 (11 decks)

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