CBL - Malaria Flashcards
What are the important features of history and examination of a patient presenting with a fever who has just came back from Kenya? [5]
- Dates of travel and illness onset
- Pre-travel vaccinations and malaria prophylaxis
- Activities while abroad
- Viral Haemorrhagic Fever risk assessment
- The patient’s immune status.
- HIV infected travellers are at increased risk of certain travel related infections including malaria and gastrointestinal infections.
What conditions are included in the viral haemorrhagic fever risk assessment, why is it done and what patients are eligible for this risk assessment? [6]
- Viruses including:
- Lassa fever,
- Crimean-Congo haemorrhagic fever,
- Marburg
- Ebola
- It poses a potential risk to healthcare workers because they can be transmitted person-to-person in body fluids.
- It should be done on travellers who present unwell within 21 days of leaving countries where these infections are found
List the infections that could cause fever associated with the activities below:
- Work in hospitals or refugee camps [4]
- Sexual Exposure [5]
- Visit to African Game Park [1]
- Fresh Water Exposure [2]
- Caving [2]
- Contaminated food and water/raw meat or fish [8]
- Ingestion of unpasteurised milk [3]
- Animal Contact [2]
- Air-conditioning systems, showers [1]
- Tuberculosis, HIV, VHF, Typhus
- HIV, Hepatitis B and C, Syphilis, Gonorrhoea
- Tick Typhus
- Schistosomiasis, Leptospirosis
- Histoplasmosis, Rabies
- Enteric fever, Shigella, Salmonella, Campylobacter, Amoebiasis, Helminth infections, Hepatitis A and E
- Brucella, Listeria, Salmonella
- Brucella, Q Fever
- Legionella
What are the most important infections that cause fever in travellers? [5]
- malaria
- dengue fever
- enteric fever (typhoid/paratyphoid)
- rickettsial infection
- HIV seroconversion
What are the initial investigations that should be carried out on a febrile traveller? [8]
- Initial Investigation
- FBC, LFTs, U&Es
- At least 3 malaria blood films or rapid diagnostic tests (RDTs) over 2 days
- Blood cultures
- for enteric fever & other bacteraemic illnesses
- HIV Test
- Urine and stool culture and microscopy
- Serology +/- PCR
- for dengue, other arbovirus infections, rickettsiae and others pathogens
- CXR and ultrasound of liver and spleen
What is the standard treatment options for falciparum malaria? [3]
- 1 week of quinine + doxycycline
- artemisinin drugs more effective for severe malaria - but not commonly found in UK
Describe the 4 species of Plasmodia responsible for human malaria under the following categories:
- geographical distribution
- clinical features (effect on liver?/relapse?)
- drug resistance?
-
P. falciparum
- worldwide distribution,
- no dormant liver infection
- drug resistance +++
-
P. vivax
- worldwide but most commonly Asian subcontinent
- persistent liver infection
- can result in relapse months after initial infection,
- some Chloroquine resistance in SE Asia
-
P. ovale
- usually West Africa,
- persistent liver infection,
- can relapse
- no drug resistance
-
P. malariae
- worldwide
- 10% occur > 1 year after infection
- no dormant liver infection
- no drug resistance
How is non-falciparum malaria treated? [1]
Patients with confirmed non-falciparum malaria may be treated as outpatients with Chloroquine.
What additional drug is given for vivax and ovale infection and why? [2]
Vivax and ovale infection require additional treatment with Primaquine to eradicate the liver stage infection to prevent relapse
What are the clinical symptoms of uncomplicated malaria? [7]
- non-specific symptoms such as:
- fever,
- malaise,
- headache,
- myalgia,
- splenomegaly,
- anaemia
- minor GI symptoms
What are the clinical features suggestive of severe malaria infection in adults? [10]
- Impaired consciousness or seizures
- Hypoglycaemia (<2.2 mmol/l)
- Haemoglobin <8 g/dl
- Spontaneous bleeding or disseminated intravascular coagulation
- Haemoglobinuria
- Renal impairment
- Acidosis
- Pulmonary oedema/Acute Respiratory Distress Syndrome
- Shock
- Death
