hemolytic anemia, malaria, G6PD, and pharm - Stillwell/Lee Flashcards
1
Q
malaria
A
- single cell protozoa
- deaths usually due to P. falciparum –> stick to endothelial cells obstructing microcirculation (ex. cerebral malaria)**
- anopheles mosquito
- P. vivax in US
2
Q
malaria life cycle
A
- sporozoite (mosquito saliva) –> exoerythrocytic form in liver (schizonts –> merozoites) –> erythrocytic phase (merozoites –> trophozoites –> schizonts –> merozoites)
- vivax and oval can live dormant in liver (hypnozoite)** –> high risk of reinfection
- merozoites can infect gametocytes (taken up by mosquitos)
3
Q
which forms banana gametocytes?
A
P. falciparum
-all of them have ring forms
4
Q
malaria signs/symptoms
A
- paroxysms = cyclic fevers, chills, sweats (from schizont rupture and cytokine response)
- vivax and ovale –> tertian fever (2 days)**; can also lie dormant for months
- malariae –> quartan fever (3 days)**
- falciparum –> irregular fevers; no dormancy
- sever infection –> hemolytic anemia (from parasite) and blackwater fever (bilirubin, Hb, and renal failure)**
- blackwater only from P. falciparum*
- other sever symptoms with P. falciparum –> pulmonary edema, cerebral malaria, stillbirth, miscarriage
5
Q
malaria protection
A
- sickle cell disease trait (HbS trait)**
- Hb C, E trait
- G6PD deficiency
- thalassemia
6
Q
malaria diagnosis
A
- thick/thin blood smears on Wright/Giemsa stain**
- thick more sensitive (identify parasites), thin for speciation
- smears every 12-24 hr 3x**
- only do PCRs 1x
- serology antibodies take a long time to turn +
- ringforms on thin smear**
7
Q
P. falciparum on smears
A
- banana gametocyte and high parasitemia (lot of RBCs infected)
- may have >60% parasitemia
- transfusions with >10% parasitemia
8
Q
malaria treatment and prophylaxis
A
-slide 22,23
9
Q
malaria treatment
A
- artemisinins and combined coartem –> for very sick people; obtained through CDC
- malarone –> for mild-moderate malaria in US (GI side effects)**
- mefloquine –> CNS side effects**
- chloroquine –> for malaria in Central America, haiti, Dominican, and Middle East (everywhere else is resistant)**
- quinine –> toxicity called cinchoism (tinnitus, nausea, headaches, dizziness, hemolytic anemia)
10
Q
terminal therapy for malaria**
A
- used to eliminate dormant hypnozoites of ovale/vivax in liver to prevent relapse**
- give primaquine (daily for 2 weeks) or tafenoquine (1x)**
- these drugs can cause hemolytic anemia with G6PDH deficiency**
11
Q
babesia
A
- can mimic malaria; parasite
- cause hemolytic anemia
- ring forms - Maltese cross**
- spread by ticks
12
Q
bartonella bacilliformis
A
- cause hemolytic anemia; bacteria
- spread by sandflies** –> Oroya fever/Carrion’s disease**
- look like spikes
- hemolytic phase –> skin lesion phase (verruga peruana)**
13
Q
toxoplasma gondii
A
- cause hemolytic anemia; parasite
- undercooked meat and cat feces**
14
Q
liver stage drugs
A
- atovaquone-proguanil (malarone)
2. primaquine
15
Q
blood stage drugs
A
- artemether + Lumefantrine (Coartem) - an artemisinin
- antifolates
- quinolones (chloroquine, quinine, mefloquine)