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Y3R5: Medicine I 🩺 > L6: Malaria > Flashcards

L6: Malaria Flashcards

1
Q

Def of Malaria

A
  • An acute & chronic potentially life-threatening tropical disease caused by obligate intracellular protozoa of the genus plasmodium
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2
Q

History of Malaria

A
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3
Q

…. is the most common specific cause of fever in returned travellers overall

A

Malaria

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4
Q

……. cases of travel-associated
malaria are reported every year

A

10,000

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4
Q

3 billion people at risk from infection in 106 countries endemic for malaria

A

..

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5
Q

Falciparum malaria accounts for ……
of all cases.

A

50%

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6
Q

…… acquired in Sub-Saharan Africa

A

85%

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7
Q

In Egypt.
- ……. is the commonest type
- ……….. is the commonest vector

A
  • P. vivax
  • Female anopheles (pharoensis)
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8
Q

Number of Species of Plasmodium

A

> 120 species in the genus plasmodium

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9
Q

What is Plasmodium knowlesi?

A

Considered 5th plasmodium species to cause human disease

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9
Q

Compare between Types of Plasmodium in terms of

  • Time
  • Number of merozoites during Hepatic stage
  • IP
  • Longest IP
A
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10
Q

Morphology of Plasmodium knowlesi

A

Morphologically similar to Plasmodium malariae

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11
Q

Geography of Plasmodium knowlesi

A

Found in Southeast Asia

  • Has now been described as causing illness in Malaysia
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12
Q

Infection in Plasmodium knowlesi

A

Once believed to only infect macaques (monkeys)
- BUT recent findings suggest it may be transmitted to humans via the Anopheles mosquito.

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13
Q

MOT of Plasmodium

A
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14
Q

High Risk Groups of Plasmodium

A
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15
Q

Life Cycle of Plasmodium

A
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16
Q

Pathogenisis of Malaria

A
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17
Q

CP of Malaria

A

The consequences of infection with P. falciparum malaria can be classified into 3 syndromes

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18
Q

Asymptomatic Malaria

A
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19
Q

Incidence of Asymptomatic Malaria

A
  • Occur in older children & adults who grow up in areas of high malaria transmission where immunity is built up during early childhood.
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20
Q

Cause of Asymptomatic Malaria

A
  • This immune tolerance is due to the development of malaria-specific partial immunity as a result of repeated falciparum
    infections
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21
Q

CP of Uncomplicated Malaria

A
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22
Q

Uncomplicated Malaria

  • Non-specific symptoms (influenza-like)
A

Headache - Muscular pain - Lethargy - Lassitude

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23
Q

Uncomplicated Malaria

  • Fever (Paroxysm)
A
  • Ruptured schizont –> Release pyrogens –> Cytokines
    secretion by leucocytes - Fever
  • Classic paroxysm (Cold stage - Hot stage - Sweating stage)
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24
Q

Uncomplicated Malaria

  • Hemolytic anemia
A

Most marked in P. falciparum

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25
Q

Uncomplicated Malaria

  • Splenomegaly
A
  • The spleen enlarged in all forms of acute M.
  • 2ry hypersplenism (in repeated attacks)
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25
Q

Uncomplicated Malaria

  • Hemolytic, hepatocellular & cholestatic Jaundice
A

Deep jaundice occurs in P. falciparum

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26
Q

Uncomplicated Malaria

  • Malarial dysentery
A
  • Occur in P. falciparum
  • Due to intestinal infarction 2ry to intestinal sequestration
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27
Q

CP in Severe malaria

A
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28
Q

What is Severe malaria?

A

Development of organ or tissue complications

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29
Q

MR in Severe malaria

A

Mortality rate of 15 - 50%

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30
Q

CP of Severe malaria

A
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31
Q

Why malaria in pregnancy is dangerous?

A
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32
Q

Why falciparum infections are dangerous?

33
Q

Complications of Malaria

A
  • Acute & Chronic
34
Q

Acute Complications of Malaria

35
Q

Black water fever

A

 P. falciparum infection
 Fever – Hemoglobinuria – Bilirubinuria - Oliguria or anuria

36
Q

Chronic Complications of Malaria

A
  1. Malarial nephrosis (Quartan nephropathy)
  2. Hyper-reactive malarial splenomegaly
  3. Immunosuppressive effects
37
Q

Def of Malarial nephrosis (Quartan nephropathy)

A
  • An intractable nephrotic syndrome with P.Malariae infection
  • Antigen-antibody complex is bound firmly to glomerular basement membrane
38
Q

CP of Malarial nephrosis (Quartan nephropathy)

39
Q

TTT of Malarial nephrosis (Quartan nephropathy)

A

 Anti-malarial do not prevent progression
 Corticosteroids are ineffective

40
Q

Pathophysioology of Hyper-reactive malarial splenomegaly (Tropical splenomegaly syndrome)

41
Q

Pathology in Hyper-reactive malarial splenomegaly (Tropical splenomegaly syndrome)

42
Q

Approach to prevent Malaria

A

The ‘ABCD’ approach to malaria prevention
 Assessment and awareness of risk
 Bite avoidance
 Chemoprophylaxis
 Diagnosis and treatment

43
Q

Prevention of malaria

  • Awareness of Risks
44
Q

drugs for Casual Prophylaxis

A

 Primaquine
 Atovaquone-proguanil
 Tafenoquine

45
Q

MOA of Casual Prophylaxis

A

 Directed against liver stage

 Kill parasite in early stages of infection → Preventing blood- stage formation

 Taken for a short period of time after leaving a malarious area

46
Q

Drugs in Suppressive
prophylaxis

A

 Chloroquine
 Proguanil
 Mefloquine
 Doxycycline
 Atovaquone-proguanil
 Tafenoquine

47
Q

MOA of Suppressive
prophylaxis

A

 Directed against RBCs stages

 Continued for 4 weeks after leaving a malarious area

48
Q

Drugs used in Terminal prophylaxis (Anti-relapse therapy)

A

 Primaquine
 Tafenoquine

49
Q

MOA of Terminal prophylaxis (Anti-relapse therapy)

A

 Directed against Hypnozoite after returning from a malarious area to prevent post-travel relapses

50
Q

Prophylaxis of Malaria

  • Dose of Mefloquine (One tablet 250 mg)
51
Q

Prophylaxis of Malaria

  • Dose of Doxycycline (cap 100 mg)
A

 1 - 2 days before travel
 4 weeks after return home

52
Q

Prophylaxis of Malaria

  • Dose of Atovaquone-proguanil (250 mg atovaquone
    /100 mg proguanil )
A

 2 days before travel
 Continued during travel
 7 days after return home

53
Q

The best tolerated of currently recommended chemoprophylaxis is …..

A

Atovaquone-proguanil

54
Q

Efficacy of Chloroquine

A

The efficacy of chloroquine as a chemoprophylactic drug
is severely diminished

55
Q

indications of Chloroquine

A

It is only rarely indicated, exceptions being destinations
in Central America and Caribbean & Middle Eastern
countries

56
Q

Why is Chloroquine not effective anymore?

A

There is now widespread resistance to chloroquine in
most falciparum-endemic countries

57
Q

International guidelines from WHO regarding TTT of malaria

A

Recommend a choice of 3 priority regimens for adults travelling to areas with significant levels of resistance
 Mefloquine
 Doxycycline
 Atovaquone-proguanil (Malarone)

58
Q

What is The DOC for Prophylaxis in pregnancy?

A

Mefloquine

59
Q

Prophylaxis in pregnancy

  • Mefloquine
A

Drug of choice for pregnant woman at risk of falciparum malaria during the 2nd or 3rd trimester.

60
Q

Prophylaxis in pregnancy

  • Doxycycline
A

Contraindicated during pregnancy, in breast feeding
mothers & in children <8 years of age.

61
Q

Prophylaxis in pregnancy

  • Atovaquone-proguanil
A

Its safety has not been established during pregnancy.

62
Q

Prophylaxis in pregnancy

  • Primaquine & Tafenoquine
A

Contraindicated during pregnancy
- Because of the risk of the fetus having G6PD deficiency with an associated risk of hemolytic anemia

63
Q

What are malaria Vaccines?

A
  • RTS,S/ASo1
  • R21/Matrix-M
64
Q

RTS,S/ASo1

65
Q

R21/Matrix-M

A

The most effective malaria vaccine discovered with 77%
efficacy shown in initial trials.

66
Q

What is the key to preventing death and severe disease from Malaria?

A

Early diagnosis and treatment is the key to preventing death and severe disease

67
Q

Dx of Malaria

A

1) Clinical diagnosis
2) Direct method
3) Rapid Diagnostic Tests (RDT)
4) Polymerase chain reaction (PCR)

68
Q

Direct method in Dx of Malaria

A

Thin and thick film stained with Gemsa stain

69
Q

RDT in Dx of Malaria

A
  • Detect one or more of…
  • Parasite antigens
  • Histidinerich protein 2 (HRP2)
  • Lactate dehydrogenase
  • Not as sensitive or specific as Blood films, but are used in parallel
70
Q

PCR in Dx of Malaria

A

Nothing pathognomonic about the clinical illness of malaria.

  • Malaria is a great mimic; it may resemble influenza, gastroenteritis, pneumonia, hepatitis, leptospirosis, yellow fever or meningitis.
71
Q

Any fever occurring while away or after return from a malarious area, irrespective of prophylaxis taken, may be due to malaria.

72
Q

WHO recommends …… to treat uncomplicated falciparum malaria

A

artemisinin combination therapies (ACTs)

73
Q

…… were 1st line treatment choice in P. falciparum - endemic countries worldwide

74
Q

TTT of F. Malaria in Returned Travelers if uncomplicated

75
Q

TTT of F. Malaria in Returned Travelers

  • Dose of Artemether-lumefantrine (CoArtem)
A

Orally for 3 days

76
Q

TTT of F. Malaria in Returned Travelers

  • Dose of Atovaquone-proguanil (Malarone)
A

Orally for 3 days

77
Q

TTT of F. Malaria in Returned Travelers

  • Dose of Quinine (plus doxycycline, tetracycline or clindamycin)
A

“Orally for 7 days

78
Q

TTT of F. Malaria in Returned Travelers

  • Dose of Mefloquine
A

Orally 2 doses separated by 6-12h

79
Q

TTT of F. Malaria in Returned Travelers

  • Dose of Chloroquine
A

Orally for 3 days

80
Q

TTT of F. Malaria in Returned Travelers if severe

81
Q

TTT of F. Malaria in Returned Travelers

  • Dose of IV quinine (plus doxycycline, tetracycline or clindamycin)
A

for 7 days
- Step down to oral therapy once tolerated.

82
Q

TTT of P.Vivax & P.Ovale in Chloroquine
sensitive areas

83
Q

TTT of P.Vivax & P.Ovale in Chloroquine
resistant areas

84
Q

Doneee

Y3R5: Medicine I 🩺 (47 decks)

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