Malaria Flashcards
Malaria is caused by what organism type
Protozoan parasites of the genus Plasmodium
Subtypes of malaria organism
P. falciparum, P. vivax, P. ovale, or P. malariae.
Predisposing factors for malaria
- Mosquito exposure
- operating in endemic areas
- lack of PPE
- lack of chemoprophylaxis
- lack of bed nets
How is malaria transmitted
Female anopheles mosquito
Incubation period of Malaria
7 to 30 days, depending on the species of malaria
infection
Malaria lifecycle phases
- Sporogony Phase
- Exoerythrocytic Phase
- Erythrocytic Phase
Which phase of the malaria life cycle is the Sexual cycle in Female Anopheles Mosquito
Sporogony Phase
Which phase of the malaria life cycle is the Asexual cycle in human liver (Patient is asymptomatic in this stage)
Exoerythrocytic Phase
Which phase of the malaria life cycle is the Asexual reproduction in RBCs (Patient is symptomatic in this stage)
Erythrocytic Phase
When can sx of malaria develop
early as 7 days after mosquito bite and as late as several months or more after exposure.
2 broad categories of malaria
Uncomplicated Malaria & Severe Malaria.
Presentation:
- Paroxysmal (cyclical) fever
- Influenza-like symptoms including chills, headache, myalgias, and malaise.
- Jaundice & mild anemia secondary to hemolysis
Uncomplicated Malaria
Presentation:
- Small blood vessels infarction, capillary leakage and organ dysfunction
- Altered consciousness
- Hepatic failure & renal failure
- Acute respiratory distress syndrome
- Severe anemia
Severe malaria
What is a clinical hall mark malaria
Paroxysmal fevers
Stages of paroxysmal fevers
- Cold stage – lasts approximately 1 hour
- Febrile stage – lasts 2-6 hours
- Diaphoretic stage where fever drops – lasts 2-4 hours
- Patient then returns to normal
- Cycle repeats itself in 48 – 72 hours depending on species of infection
Dx of malaria based on
- Clinical findings consistent with Malaria infection
- Rapid diagnostic testing or laboratory confirmation via blood smear.
Treatment of malaria is dependent on
- Species of malaria
- Severity of infection
- Likelihood of drug resistance (where infection was acquired)
- Patient’s age & Pregnancy status
Two reliable-supply malaria treatment regimens available in the U.S
- Atovaquone-proguanil (Malarone)
- Artemether-lumefantrine (Coartem)
Reliable Supply definition
- Complete course of approved treatment regimen obtained in the U.S.
- Is not counterfeit or substandard
- No adverse interactions with the patient’s other medicines, including prophylaxis
- Will not deplete local resources in the destination country
Should you use the same or related drug to treat malaria that was used for chemoprophylaxis
No
Treatment of Uncomplicated Malaria
- Chloroquine phosphate 1g (600mg base) PO
- THEN 0.5g in 6 hours
- THEN 0.5g daily for 2 days
Treatment of malaria in areas with chloroquine resistance
Malarone (Atovaquone 250mg/Proguanil 100mg) 4 tabs PO QD for 3 days
Treatment of Severe Malaria
- Artesunate 2.4mg/kg IV at 0, 12, 24, 48 hours
- Followed by Doxycycline 100mg BID x 7 days after parenteral therapy
Treatment of P.ovale
- ADD primaquine 52.6mg (30mg base = 2 tablets) PO QD x 14 days
- Added to regiment for hypnozoites
Prevention of Malaria
- The most important protective measures are proper clothing and awareness.
- Long sleeve shirts, long pants, insect repellant, and head nets, will
keep mosquitoes from biting. - Addition precautions include closed sleeping quarters, insecticides, and prophylaxis.
Where would you find most up to date information for malaria resistance
ww.CDC.gov, or the cognizant EPMU prior to travel to an endemic area.
Prophylactic for malaria
- Chloroquine, & Mefloquine: 1-2 weeks prior to the expected embarkation to an endemic area and continued for 4 weeks after leaving the endemic area
- For Malarone, Primaquine, & Doxycycline: start
2 days prior to entry & continue till 7 days after departing; Doxycycline to be continued till 1 month after departing
Malaria Disposition
MEDEVAC
Malaria Complications
- neurologic abnormalities
- acute renal failure
- anemia
- metabolic acidosis
- hypovolemia
- Acute Respiratory Distress Syndrome
