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Protozoal Infections > Blood Protozoa > Flashcards

Blood Protozoa Flashcards

1
Q

What are the Blood Protozoa

A

Malaria and Babesiosis

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2
Q

What kills more children under 5 than any other organism?

A

Plasmodium Falciparum

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3
Q

What are the 5 plasmodial species that cause disease in humans?

A

Falciparum, Knowlesii, Malariae, Ovale and Vivax

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4
Q

What is the life form of malaria transmitted to humans?

A

Sporozoites. They are cleared from the blood and enter the liver and lymph nodes within 20 minutes

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5
Q

Sporozoites transform into what form after 10 to 14 days?

A

Merozoites. These enter RBCs which later become schizonts.

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6
Q

Some schizonts transform into another life form. What is it?

A

Gametocytes

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7
Q

How many stages of infection are there?

A

3

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8
Q

What are the three stages?

A
  1. cold shaking chills, 2.Hot and dry, 3.diaphoresis, fatigue and resolution of fever.
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9
Q

What are the fever patterns?

A

Tertian-vivax and ovale, Quartan-malariae, Malignant Tertian-Falciparum

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10
Q

What are the signs of malaria in adults?

A

Tachycardia,Tachypnea,Pallor,Ill appearance and Splenomegaly

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11
Q

What are the signs of malaria in children?

A

Fever, Kussmaul’s Sign, Jaundice, Dehydration sx include nausea, vomiting and diarrhea, malaise, headache

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12
Q

How many classes of Anti Malarial Drugs?

A

7

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13
Q

What are the classes?

A

4-Aminoquinolones, 8 Aminoquinolones, Antibiotics,Aryl Alcohols, Respiratory Chain Inhibitors, Antifolates and Artemisinins

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14
Q

What are the 4 Aminoquniolones?

A

Amodiaquine, Piperaquine, Chloroquine,Pyronaridine. They work on asexual forms causing toxic waste to build up in the organism by binding to Chloroquine Resistance Transporter (CRT). Not active against Gametocytes

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15
Q

What are the 8 Aminoquinolones?

A

Primaquine and Tafedoquine. Primaquine acts on Gametocytes and Hypnozoites, not schizonts.. Tafedoquine acts on asexual forms and hypnozoites.

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16
Q

Side effects of 4 aminoquinolones?

A

Itch especially in Africans, GI and Psych sx.

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17
Q

Side effects of 8 Aminoquinolones?

A

Lysis and Methemoglobinemia with G6PD patients.

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18
Q

What are the Aryl Alcohols?

A

Quinine, Quinidine, Mefloquine, Halofantrine and Lumenfantrine. Unknown mechanism of action. USed in combination with abx or artemesinins.

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19
Q

What are the side effects of Aryl Alcohols?

A

Neuropsych problems, Hypoglycemia due to release of insulin, Hypotension, Avoid in 1st Trimester.

20
Q

What Abx are used to treat Malaria?

A

Azithromycin, Clindamycin and Doxycycline, They inhibit protein synthesis. Active against heaptic and blood forms except hypnozoites. Used synergistically with artemisenins,and quinine.

21
Q

What are the side effects of the Abx?

A

GI, Photosensitivity.Do not use in Pregnancy

22
Q

What are the respiratory chain inhibitors?

A

Atovaquone. It acts on the parasite respiratory chain.It is used with Proguanil.

23
Q

What is the combination of Atovaquone and Proguanil?

A

Malarone.Resistance develops rapidly to the Atovaquone. SIde effects are minimal.

24
Q

What are the antifolate drugs?

A

Sulfadoxine(S), Pyrimethamine(P), Proguanil(P),Dapsone(D). They act on cofactors needed for nucleic acid synthesis.

25
Q

How are the antifolates used? ? side effects?

A

As IP therapy 3 times during preganacy as Fansidar (Pyrimethamine and Sulfadoxine) DHPS (D and S)
, DHFR(P and P)

26
Q

What are the Artemisenins?

A

Artesunate and Artemether. They produce toxic O2 radicals. Inactive against Hypnozoites. Short half life. Massive cleansing of parasites.Side effects are minimal, GI, fever, dizziness

27
Q

How do you diagnose Malaria?

A

Thick Films, Thins Films and PCR

28
Q

What is the treatment for uncomplicated Falciparum Malaria?

A

Coartem, Artesunate plus Amodiaquine, Artesunate plus Mefloquine, Artesunate plus SP, Dihydroartemesin plus Piperaquine (DHP), Malarone, Coartem (Artemether/Lumenfantrine), Quinine or Chloroquine

29
Q

What is the treatment for Severe Falciparum Malaria?

A

IV quinine or IV quinidine plus Doxycycline or Clindamycin. In SE ASia Artesunate plus Doxy/Clinda,Mefloquine or Malarone. Exchage transfusion when parasitemia exceeds 15%.Start iron when patient is no longer malnourished.

30
Q

What is the treatment for uncomplicated Vivax ?

A

Chloroquine plus Primaquine or if resistant to Chloroquine, Quinine plus Primaquine plus Doxycycline

31
Q

What is the treatment for type unknown Malaria?

A

Same as for Severe falciparum.

32
Q

What are the microscopic findings with P. Falciparum?

A

Lots of parasites with thin ring form trophozoities, applique forms, banana gametocytes and chromatin dots. Look for Maurer’s clefts.

33
Q

What are the microscopic findings with P. Ovale/Vivax?

A

Look for infected large or oval shaped, ameboid RBC’s with 12 to 24 Merozoite Schizonts. Shuffner’s dots, ovoid gametocyte with brown pigmented granules.

34
Q

What are the microscopic findings with P. Malariae?

A

Look for normal or small rbc’s with thick ring trophozoites, 10 merozites per schizont, birds eyes, baskets and Daisy Head forms

35
Q

What medications are used for Malaria prophylaxis?

A

Chloroquine, Mefloquine, Primaquine, Malarone and Doxycycline.

36
Q

What medications are used in Pregnancy?

A

SP(Fansidar),Mefloquine and Maloprim.

37
Q

What is the WHO approach to prevention of Malaria?

A

Immunization (RTSS-Central Repeat Amino Acid Pattern, with T Cell Ag, Unfused HBV S Ag and AsO2 as an adjuvant. The imrmunization acts on the sporozoites CSP, Circumsporozoite Surface Protein, ITNs, IRS and ACT

38
Q

What is the effect of Malaria in Pregnancy?

A

IUGR, LBWT, Stillbirth, Preterm Labor.Apregnant woman has twice the risk of being bitten by a mosquito. The altered ratio of Th1 to Th2 lymphocytes and altered interferon levels increase susceptibility.

39
Q

How does a newborn present with Malaria?

A

Like a septic infant with jaundice, fever, anemia and hepatosplenomegaly

40
Q

What are the standby regimens for Malaria?

A

Malarone250/100 4tabs in first 24 hrs then1x per day for 2 days; Coartem 20/1204 tabs x 6 doses; Mefloquine250 mg 3 tabs then 2 tabs 6 to 12 hours later.

41
Q

How is Babesiosis transmitted?

A

Tick Bites from Lone Star or Ambyloma tick, transfusions and transplants.

42
Q

What are the sx of Babesiosis?

A

Fever, HA, Myalgias, Fatigue and reduced appetite.

43
Q

What are the lab findings associated with Babesiosis?

A

Maltese Crosses found in side and outside RBC’s, anemia and low platelets.

44
Q

What are the complications of Babesiosis?

A

Cardiorespiratory and Renal Failure. Expect co-infection. Closely watch those who are asplenic and those who are immunocompromised.

45
Q

What is the treatment of Babesiosis?

A

Clindamycin plus Quinine or Atovaquone plus Azithromycin

Protozoal Infections (1 decks)

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