malarai

Question 1

what is malaria?

Answer 1

Malaria is a disease caused by Plasmodium protozoa which is spread by the female Anopheles mosquito

Question 2

what causes malaria?

Answer 2

Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

Question 3

what causes serve malaria?

Answer 3

Plasmodium falciparum causes nearly all episodes of severe malaria.

Question 4

which is common cause of benign malaria?

Answer 4

The other three types, of which Plasmodium vivax is the most common, cause ‘benign’ malaria.

Question 5

what traits protect against malaria?

Answer 5

The protection from malaria that sickle-cell trait offers is well documented. Other protective factors include
G6PD deficiency
HLA-B53
absence of Duffy antigens

Question 6

general features of falciparum malaria?

Answer 6

cyclical fever
anorexia, nausea, vomiting, and abdominal pain
diarrhoea, jaundice, itch
Generalised body aches and joint pains
severe headache
thrombocytopaenia
mild anaemia
AKI

Question 7

features of severe falciparum malaria?

Answer 7

schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
complications as below

Question 8

complications of falciparum malaria?

Answer 8

cerebral malaria: seizures, coma
acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown
acute respiratory distress syndrome (ARDS)
hypoglycaemia
disseminated intravascular coagulation (DIC)

Question 9

mx of falciparum malaria uncomplicated?

Answer 9

strains resistant to chloroquine are prevalent in certain areas of Asia and Africa
the 2010 WHO guidelines recommend artemisinin-based combination therapies (ACTs) as first-line therapy
examples include artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, artesunate plus sulfadoxine-pyrimethamine, dihydroartemisinin plus piperaquine

Question 10

mx of falciparum malaria complicated?

Answer 10

a parasite counts of more than 2% will usually need parenteral treatment irrespective of clinical state
intravenous artesunate is now recommended by WHO in preference to intravenous quinine
if parasite count > 10% then exchange transfusion should be considered
shock may indicate coexistent bacterial septicaemia - malaria rarely causes haemodynamic collapse

Question 11

where is plasmodium vivax found?

Answer 11

Central America and the Indian Subcontinent whilst Plasmodium ovale typically comes from Africa.

Question 12

which malaria cause four din south east Asia?

Answer 12

Plasmodium knowlesi

Question 13

features of non falciparum malaria?

Answer 13

general features of malaria: fever, headache, splenomegaly
Plasmodium vivax/ovale: cyclical fever every 48 hours. Plasmodium malariae: cyclical fever every 72 hours
Plasmodium malariae: is associated with nephrotic syndrome.

Question 14

tx of non falciparum malaria?

Answer 14

in areas which are known to be chloroquine-sensitive then WHO recommend either an artemisinin-based combination therapy (ACT) or chloroquine
in areas which are known to be chloroquine-resistant an ACT should be used
ACTs should be avoided in pregnant women
patients with ovale or vivax malaria should be given primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse