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Bloc G - Infection > Apr27 M2-Malaria > Flashcards

Apr27 M2-Malaria Flashcards

1
Q

returned traveller with fever: first thing on ddx

A

malaria

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2
Q

malaria is what type of pathogen

A

systemic protozoa (parasite)

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3
Q

organisms that cause malaria

A

the plasmodium species

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4
Q

vector of malaria

A

anopheles (genus) mosquito

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5
Q

malaria zoonosis

A

none for 4 of the 5 species. (knowlesi has monkey reservoir)

for 4 of 5 species, human reservoir only and no zoonosis

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6
Q

5 species of malaria

A
  • falciparum (high parasitemia and mortality)
  • vivax
  • ovale
  • malariae (benign)
  • knowlesi (high parasitemia and mortality + only with zoonosis)
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7
Q

1st step of malaria life cycle

A

anopheles bites you and sporozoides enter you. sporozoides in your blood seen in your liver

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8
Q

2nd step of malaria life cycle (after sporozoides reach liver)

A

development phase of sporozoides in the liver. takes a couple weeks. then shizonts escape from the liver

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9
Q

3rd step of malaria life cycle (after escape from liver)

A

erythrocytic phase (shizonts infect RBCs). erythrocytic cycle repeats: malaria goes in RBC, multiplies, RBC bursts, goes out to infect other RBCs and amplify

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10
Q

4th step of malaria life cycle (after erythrocytic phase)

A

small % transforms in gametocytes. next mosquito that bites you eats a male and female gametocyte from your blood

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11
Q

5th step of malaria life cycle (after mosquito eats gametocytes from your blood)

A

malaria becomes infectious in the mosquito after a short time

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12
Q

how malaria is diagnosed

A

thick smear microscopy (know that it can look like many things, shizonts, young trophozoites = ring cells, etc.): see it in blood smear inside RBCs
(thin smear is to speciate)

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13
Q

worst malaria species and why

A

plasmodium falciparum. worst symptoms. multiplies in high degree and causes lot of damage to RBCs.

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14
Q

malaria symptoms and signs

A
  • chills, rigors, FEVER, perspiration, fatigue (constitutional symptoms), headache, delirium, confusion, coma, sob, jaundice
  • anemia, splenomegaly
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15
Q

how fever helps for malaria dx

A
  • most malaria synchronizes its RBC bursting
  • tertian fever (1 day on 1 day off) = vivax or ovale, sometimes with falciparum
  • quartan fever (1 day on 2 days off) = malariae
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16
Q

time interval between the mosquito bite and the fever in malaria

A

2 weeks

17
Q

malaria clinical presentation that is not to be missed

A

fever mixed with something else making you think of another system (+cough or +abd pain or +diarrhea or +headache or +vomiting). can still be malaria

18
Q

avg interval between fever and death in malaria infection

A

7-8 days

19
Q

causes of death in malaria

A
  • cerebral malaria
  • ARDS
  • renail failure
  • hematological
  • shock
  • sepsis
  • ruptured spleen
20
Q

black water fever (syndrome seen in malaria) charact

A
  • massive hemolysis

- bilirubin in urine so BLACK urine

21
Q

celebral malaria in WHAT SPECIES, symptoms of cerebral malaria and its patho cause

A
  • cause = endothelial damage and cytokin dysregulation. ischemia less important
  • coma
  • in falciparum*
22
Q

ARDS in malaria cause and symptoms

A
  • endothelial dysfunction and fluid leak in airspace

- sob

23
Q

what can protect you from malaria

A
  • being in an area of moderate or high transmission gives you moderate or high PARTIAL immunity
  • polymorphisms (Hb, RBCs, etc.)
24
Q

microscopy modality to diagnose malaria and modality to speciate the malaria

A

thick smear to diagnose***

thin smear to speciate

25
Q

malaria treatment+prophylaxis in malaria sensitive vs malaria resistant areas

A
  • CHLOROQUINE for tx and prophylaxis in malaria sensitive areas
  • QUININE for tx and mefloquine for prophylaxis in malaria resistant areas
26
Q

3 ways drugs of malaria prophylaxis work

A
  • kill parasites in the liver = CAUSAL PROPHYLAXIS
  • kill asexual parasites in RBCs = SUPPRESSIVE PROPHYLAXIS
  • kill sexual parasites (gametocytes) in RBCs = GAMETOCYTOCIDAL PROPHYLAXIS
27
Q

goal of gametocytocidal prophylaxis

A

avoid transmission

28
Q

causal prophylaxis how long you have to take it

A

1 week after your return

29
Q

suppressive prophylaxis how long you have to take it

A

4 weeks after you return (because may take up to four weeks for the organism to get out of your liver)

30
Q

what is defined as severe malaria

A

10% + parasitemia OR 5% + parasitemia with big problems (dehydration, renal failure, pulmonary edema, shock, etc.)

31
Q

one controversial tx of malaria

A

exchange transfusion: take out one unit of blood, put it in phoresis machine, take out infected RBCs and put new ones in

32
Q

how do you prevent malaria in chloroquine sensitive regions (central America)

A
  1. chloroquine 250mg x2 weekly

2. daraprim (pyrimethamine) 25 mg weekly

33
Q

how do you prevent malaria in chloroquine resistant regions

A
  1. medications (mefloquine, atovoquone, chloroquine, doxycycline)
  2. PERMETHRIN treated bednet (bc anopheles = night biters)
34
Q

how to avoid mosquitos (and prevent malaria)

A
  • evening and night behaviors
  • mosquito nets
  • air conditioning
  • screens
  • mosquito repellants (+ put on wall bc land there after they eat)
  • pyrethrum coils
35
Q

how to kill anopheles

A
  • destroy breeding site
  • fog spraying
  • residual spraying
36
Q

how to kill plasmodium

A

chemoprophylaxis (chloroquine)

Bloc G - Infection (39 decks)

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