Malaria Flashcards
Name the different parasites responsible for malaria
Plasmodium falciparum Plasmodium ovale Plasmodium vivax Plasmodium malariae Plasmodium knowlesi
What is the vector responsible for spreading malaria
Female Anopheles mosquito
What are the stages in the life cycle of Plasmodium in humans?
Sporozoite
Merozoite
Trophozoite
Gametozoite
What factors give people immunity against malaria
Sickle cell Beta thalassaemia Duffy negative G6PD deficiency Acquired after long exposure Maternal antibodies for first 6 months
What are the symptoms of malaria?
Fever with paroxysm Tertian, malariae is quartan SOB Jaundice Flu like Diarrhoea
What are the complications if malaria?
Falciparum - anaemia - hyperreactive malarial splenomegaly syndrome Vivax -splenic rupture -relapse (+ovale) Malariae -nephrotic syndrome
What are the clinical features of severe malaria
GCS<11 Multiple convulsions Generalised weakness SBP<80 CRT>3s Pulmonary oedema ARDS Jaundice Abnormal bleeding
What are the laboratory features of severe malaria
Hb < or equal 5 Acidosis: pH<7.3, Lac>5, BE>8, HCO3 <15 BGL <2.2 Creatinine >265 Urea>20 Parasitaemia >10%
How do you diagnose malaria?
Clinical diagnosis VERY inaccurate
Three blood films or RDTs
Thick and think films
RDTs detect HRP2 of P.falciparum and pLDH of the others
Presence of malaria parasite in endemic areas does not mean it is the cause of the symptoms
What are the consequence of chronic malaria?
Anaemia Hyperreactive malarial splenomegaly -anaemia,2ndry bacterial infections, fever, pancytopenia -responds to prolonged antimalarials Burkitts lymphoma Quartan malarial nephropathy
What are the consequences of malaria in pregnancy?
Increased risk of malaria if pregnant Low birth weight Anaemia Hypoglycaemia Pulmonary oedema Premature birth Foetal death in severe malaria Congenital malaria
What is the general management of malaria?
All require antimalarials Analgesia Treat hypoglycaemia Consider broad spec antibiotics LP if low GCS Transfuse if needed Dialysis if needed
How do you treat uncomplicated falciparum malaria?
Artemisinin-based combination therapy for 3 days
Fixed dose combos
List some ACTs and their features
Artemether and lumefantrine -take with milk Artesunate amd amodiaquine -mainly West Africa Artesunate and mefloquine -suitable for areas of multi drug resistance but expensive Dihydroartemesinin and piperaquine Artesunate and sulfadoxine-pyrimethanine -only useful in some parts of Africa Artesunate and doxy/tetra/clinda -only to be used in hospital setting and fit rare Tx failures
What would you add for falciparum infection in a low transmission area?
Single dose primaquine
How would you treat uncomplicated malaria infection in a pregnant women in her first trimester?
7 days quinine and chloroquine or clindamycin
How would you treat uncomplicated ovale and vivax infection?
ACT
Plus 14 day course primaquine to prevent relapse
What are the side effects of quinine?
Hyperinsulinaemic hypoglycaemia
AKI
Liver failure
How to treat complicated malaria?
IV or IM artesunate or artemether for at least 24hrs then 3 days ACT
What are the features of cerebral malaria?
Seizures (doesn't mean CM in children) Focal Neuro Retinal haemorrhages Not meningism Neuro sequelae in 5%
What is the benefit of using artemisinin based therapy for malaria?
Rapid reduction in parasitaemia
Gametocytocidal so reduces transmission
How do we prevent malaria?
Chemoprophylaxis
-travellers, pregnant women in Africa, seasonally to <5s in Sahel region
Vector control
-DEET or picaridin repellents
-pyrethroid only long lasting treated bednets
-IRS
Vaccination
-RTS,S/AS01 for children in moderate falciparum transmission
What s the recommended IPT in pregnancy for malaria?
In Africa provide sulfadoxine-pyrimethamine to all women in first or second pregnancy
At least three doses at least 1 month apart from T2
What is the IPT of malaria in infants?
In mod to high transmission in Africa give sulfadoxine-pyrimethamine to under 1yr olds at the time of 2nd and 3rd DTP vaccines
What is the seasonal malaria chemoprophylaxis recommendation?
In Sahel region give monthly amodiaquine and sulfadoxine-pyrimethamine to all children under 6during each season
When should you start and stop taking malaria chemoprophylaxis?
1week before and 4wks after
What drugs are used for malaria chemoprophylaxis and what are their SEs?
Atovaquone-proguanil -well tolerated Mefloquine -nausea, dreams, acute psychiatric reaction -can be used in pregnancy Doxycycline -GI, photosensitivity Primaquine Proguanil and chloroquine -pregnant women but for low risk areas only -falciparum resistance
What are the pillars of the Global Technical Strategy for malaria?
Universal access to malaria prevention, diagnosis and treatment
Accelerate towards elimination and malaria free status
Transform malaria surveillance into a core intervention
What are the causes of respiratory distress in malaria Pts?
Profound metabolic acidosis
ARDS
2ndry bacterial infection
Air hunger due to severe anaemia
What causes black water fever?
Massive haemoglobinuria
Quinine
G6PD deficiency
….with malaria
What is the relationship between HIV and malaria?
Malaria increases HIV VL
HIV increases the incidence of malaria and severe malaria complications
