Anaemia - Malaria (Normocytic)

Question 1

Definition

Answer 1

Notifiable protozoal infection

Question 2

Epidemiology

Answer 2

Africa
V.young/old
Pregnant ladies

Question 3

Four types of malarial infections/ Aetiology

Answer 3

All female anopheles’ mosquito
Plasmodium falciparum = MOST COMMON
P. ovale
P. vivax
P. malariae = LEAST COMMON
Depends on WATER SOURCES - found in contaminated stagnated pools

Question 4

Risk factors

Answer 4

Travel to endemic areas
Not taking prophylaxis
Pregnant women - esp p.vivax
Immunocompromised

Question 5

Pathophsiology

Answer 5

Parasitic infection caused by plasmodium genus
- Infected blood is sucked up by feeding mosquitos.
- The malaria in the blood reproduces in the gut of the mosquito producing thousands of sporozoites (malaria spores)
- When that mosquito bites another human = sporozoites injected by the mosquito.
- These sporozoites travel to the liver of the newly infected person. They can lie dormant as hypnozoites for several years in P.vivax and P. Ovale.
- They mature in the liver into merozoites which enter the blood and infect red blood cells.
- In blood cells the merozoites reproduce over 48 hours, after which the RBC rupture releasing loads more merozoites into the blood and causing a haemolytic anaemia.
This is why people infected with malaria have high fever spikes every 48 hours.

Question 6

Signs and symptoms

Answer 6

Symptoms occur 6 days post infection
Non-specific symptoms:
- BLACK WATER FEVER (malarial haemoglobinuria)
- Huge hepatosplenomegaly
- Jaundice
- Pallor
Symptoms
- Headache
- Cough
- Myalgia
- Nausea + Vomiting
- Diarrhoea
Severe disease in P. falciparum
- SOB
- Fits + hypovolaemia
- AKI + Nephrotic syndrome

Question 7

Diagnosis

Answer 7

Consider malaria as diagnosed if feverish Px with recent travel history
Rapid diagnostic tests (RDT’s)
GOLD STANDARD = Thick (malaria) + thin (species) blood film
-identification of trophozoites and quantification of parasitaemia
3 separate readings -ve before declared -ve

Question 8

Treatment

Answer 8

Uncomplicated Plasmodium falciparum infection (chloroquine-sensitive region): FIRST LINE TREATMENT =
- Oral chloroquine or hydroxychloroquine
- Chloroquine resistant = oral artemether

Severe Plasmodium falciparum infection:
FIRST LINE = IV ARTUSENATE (severe)
- Take high fat food to increase absorption
- rapid clearance of parasites
+ oral primaquine in low transmission areas

Non-falciparum species infection:
FIRST LINE = oral chloroquine or hydroxychloroquine
Adjunct: oral primaquine (Plasmodium vivax or Plasmodium ovale)

Question 9

Prevention

Answer 9

Travel to P. falciparum chloroquine-sensitive areas:
- CHLOROQUINE = Weekly tablet to begin 1 week prior to travel + finish 4 weeks post travel
- Side effects: may exacerbate psoriasis
Travel to P. falciparum chloroquine- resistant areas
- ATOVAQUINE
- DOXYXYCLINE
- MEFLOQUINE = CI in epilepsy