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Z Year3 Infectious Diseases > Malaria > Flashcards

Malaria Flashcards

1
Q

What is Malaria?

A

infection with Protozoan Plasmodium

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2
Q

Where is Malaria endemic?

A

in tropics – affects 250 million people worldwide yearly

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3
Q

What is the incubation period of malaria like?

A

usually 1-2 weeks but up to a year

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4
Q

How is Malaria transmitted?

A

Female Anopheles mosquito

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5
Q

What are the different plasmodium species?

A
  1. P.Falciparum (80% cases worldwide, highest mortalirt)
  2. P.vivax
  3. P.ovale
  4. P.malariae
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6
Q

When should you suspect Malaria?

A

Fever+recent travel + normocytic anaemia

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7
Q

What is the general patho of Malaria?

A
  1. Plasmodium spp. are transmitted by the bite of the female Anopheles mosquito
  2. protozoa infect red blood cells (RBCs) and grow intracellularly
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8
Q

What is injected into the bloodstream?

A

injection of sporozoites into the bloodstream by the bite of the female Anopheles
mosquito

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9
Q

What can other specieis of plasmodium do?

A
  1. invasion and replication in hepatocytes (exoerythrocytic schizogeny)
  2. P. vivax and P. ovale
  3. may develop into dormant hypnozoites and cause relapse within months or even years.
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10
Q

What happens to the parasites when they reinvade the blood?

A

called merozites

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11
Q

What happens inside the RBC?

A

parasites develop from ring forms (trophozoites) to multinucleated schizonts (erythrocytic
schizogeny)

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12
Q

What happens to the RBC?

A

RBCs rupture and release merozoites, which may reinfect new RBCs. Some differentiate
into male and female gametocytes

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13
Q

What happens to the gameocytes?

A

taken up by the Anopheles mosquitoes, develop into sporozoites in their
gut and migrate to the salivary gland of the mosquito to be transmitted in their bite.

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14
Q

Which populations have inate immunity to malaria?

A
  1. sickle cell trait
  2. G6PD deficiency
  3. pyruvate kinase deficiency
  4. thalassaemias
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15
Q

Why are trophozites important?

A

can be identified under a microscope to aid diagnosis of malaria

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16
Q

Why can there be jaundice in malaria?

A
  1. intravascular hemolysis
  2. disseminated intravascular coagulation
  3. rarely, ‘malarial hepatitis’. (I.e. jaundice not rly due to liver involvement, more to do with RBC destruction etc.)
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17
Q

What are the symptoms of malaria?

A
  1. Headache
  2. Weakness
  3. Myalgia/ Arthralgia
  4. Anorexia
  5. Cyclical fevers
18
Q

What are cyclical fevers?

A

characteristic paroxysms of severe cold / rigors followed by severing sweating

19
Q

What are the signs of malaria?

A
  1. Pyrexia
  2. Splenomegaly
  3. (Haemolytic) Anaemia
  4. Dark urine “Black water fever”
  5. DIC
20
Q

Why is there haemolytic anaemia in malaria?

A

due to destruction of parasitized RBC, uptake by spleen and marrow suppression

21
Q

What sort of disease is malaria?

A

notifiable disease and all cases of malaria should be notified to public health

22
Q

When do you suspect malaria?

A

patients with fever who have recently travelled to endemic regions, malaria must always be considered

23
Q

Why is there haemoglobinuria in Malaria?

A

P. falciparum can cause severe haemolysis with dark red urine (‘blackwater fever’)

24
Q

When is sever malaria more likely?

A
  1. children
  2. pregnant women
  3. older people
  4. immunocompromised people (for example those with splenectomy or HIV/AIDS)
25
What are features of severe or complicated malaria in adults?
1. Cerebral malaria — impaired conscious level (GCS < less than 11) or seizures. 2. Renal impairment (may present with oliguria). 3. Acidosis (may present with acidotic breathing). 4. Hypoglycaemia (< 2.2 mmol/L) — common in pregnant women. 5. Respiratory distress which may be due to pulmonary oedema or acute respiratory distress syndrome (ARDS) — common in pregnant women. 6. Severe anaemia (may present with pallor). 7. Spontaneous bleeding/disseminated intravascular coagulation. 8. Shock (BP < 90/60 mmHg). 9. Sepsis — more common in pregnant women. 10. Haemoglobinuria — P. falciparum can cause severe haemolysis with dark red urine (‘blackwater fever’). 11. Parasitaemia > 10%.
26
What Ix is done for Malaria?
Giemsa-stained thick and thin blood smears
27
What is the thick stain?
detects parasites present ((higher sensitivity) - to find out if have malaria
28
What is thin stain?
identifies species (higher specificity)
29
What else can you look for in Ix?
1. Look for trophozoites and % RBC infected | 2. High % (>30%) has high mortality
30
Which smear is done first?
thick
31
What does the Mx of Malaria depend on?
* species of Plasmodium parasite * Severity of infection * Tolerability of specific drugs * Patterns of drug resistance
32
How do you treat complicated/severe malaria?
1. Artesunate | 2. Quinine (2nd line)
33
How do you treat uncomplicated malaria?
1. Artemisinin combination therapy (ACT) | 2. Atovaquone-proguanil (2nd line)
34
What other drugs can be used in Malaria?
1. chloroquine | 2. Primaquine
35
When is chrloriquine used?
treat uncomplicated P. malariae, P. ovale, P. knowlesi, and most cases of P. vivax malaria but use depends upon patterns of resistance and tolerance
36
When is primaquine used?
the only currently effective drug for the eradication of hypnozoites (dormant parasites which persist in the liver after treatment of P. vivax and P. ovale)
37
What do you need to screen for before starting Primaquine?
G6PD deficiency is essential before treatment with primaquine is started as it can cause haemolysis in G6PD deficient individuals, which can be fatal
38
What is primaquine contraindicated in?
1. Pregnancy | 2. Breastfeeding
39
What does sick cell trait protect against?
Sickle cell trait (HbS) is relatively protected against P. falciparum malaria (àbiologic advantage)
40
What is resistant to infection by P.vivax?
duffy blood group negative red blood cells are resistant to infection by P. vivax

Z Year3 Infectious Diseases (5 decks)

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