Malaria Flashcards
Malaria is a disease caused by (obligate or facultative ?) _____cellular protozoa of the genus __________
it may be acute or chronic.
Obligate
Intra
Plasmodiuman
Plaasmodium infection is the ____________________________ with or without signs and symptoms
presence of the parasite in the blood
History
Disease probably originated in _____ and affected prehistoric humans
Was widespread in the (colder or warmer?) regions globally
______ named the disease mal aria (_______) in the 18th century
Africa; warmer
Italians; foul air
History of malaria
Reference to _________ found in early Hindu and Chinese writings
__________ , the Greek Physician, described the clinical manifestations and some of the complications of malaria in the fifth century B.C
The _____ of the Peruvian quina-quina (______) tree was successfully used for treatment of ________ in the early 17th century
periodic fevers
Hippocrates
bark; Cinchona; intermittent fever
History of malaria
However, the active ingredient in chinchona tree ( _________ ) was first extracted, isolated, purified and named by French Pharmacists Pierre Joseph Pelletier and Joseph Bienaime Caventou in 1820.
Major breakthrough in the understanding of the etiology was by Laveran, a French army Surgeon in Algeria, in 1880, who first _____________ in a fresh blood from a patient.
alkaloid quinine
described the ex-flagellated gametocytes of P. falciparum
History or malaria
Transmission remained a mystery until 1880’s, when Patrick Manson discovered that _____ was transmitted by ______ and postulated that malaria might also be _______. This was confirmed by ______ in India, in 1897.
The complex cycle of development was confirmed by Bignami, Bastianelli, and Grassi in Italy in 1898 & 1899, and by Manson et. al., in London & Rome in 1900.
filariasis; mosquitoes
vector borne; Ronald Ross
Epidemiology
Globally in 2021, there were an estimated ________ malaria cases in _____ malaria endemic countries an increase of _______ cases compared with 2020.
247 million
84; 2 million
Epidemiology
Four countries accounted for half of all malaria cases globally: ______ accounted for the highest proportion of cases globally (27%), followed by the ____________ (10%), _____ (6%) and ________ (4%).
Nigeria
Democratic Republic of the Congo
India
Mozambique
Epidemiology
Between 2019 and 2020, estimated malaria cases increased from 218 million to 232 million, and deaths from 544 000 to 599 000 in the WHO African Region
This region accounted for about 95% of cases and 96% of deaths globally; 78.9% of all deaths in this region
were among _________
children aged under 5
Epidemiology
High-risked groups are children < ___ years, ______ women, __[_ infected persons and _____________
Estimated ____% of all malaria deaths occur in Sub-Saharan Africa, while U5 years account for ___% of all deaths.
5; Pregnant; HIV
non-immune visitors
90; 78
Epidemiology
140 million Nigerians are at risk of having malaria
____% of population are likely to have an episode of malaria a year
Malaria accounts for >___% of hospital visitations
50
60
Malaria is transmitted by the _________________.
female anopheles mosquito
Factors which affect mosquito ecology, such as _______ and ________, are key determinants of malaria transmission.
temperature and rainfall
Mosquitoes breed in (cold or hot?) , ____ areas and below altitudes of ______ meters.
Development of the malaria parasite occurs optimally between ___-___oC and stops below ___oC.
Hot; humid
2000
25-30
16
Endemicity refers to the _______ of malaria in an area or community.
Malaria is said to be endemic when there is a __________ over a period of __________
amount or severity
constant incidence of cases
many successive years.
Endemic malaria may be present in various degrees. Recognised categories of endemicity include :
A. Hypoendemicity -_____ transmission and the disease has ______ effect on the population.
B. Mesoendemicity -______ intensity of transmission; typically found in the _______ communities of the sub-tropics.
C. Hyperendemicity - ______ but ______ transmission; _______ is insufficient to prevent the effects of malaria on all age groups.
little; little
varying; small, rural
intense; seasonal
immunity
Endemic malaria may be present in various degrees. Recognised categories of endemicity include :
D. Holoendemicity - ______ transmission occurs _____ the year.
As people are continuously exposed to malaria parasites, they gradually develop ______ to the disease. In these areas, severe malaria is mainly a disease of _____ from ______ to ______.
______ women are also highly susceptible because the natural immune defence mechanisms are impaired during pregnancy.
intense; throughout; immunity
children; the first few months of life to age 5 years
Pregnant
Endemic malaria may be present in various degrees. Recognised categories of endemicity include :
A. ____endemicity
B. ____endemicity
C. _____endemicity
D. ____endemicity
Hypo
Meso
Hyper
Holo
Etiology of malaria
Plasmodium ———-
Plasmodium _______
Plasmodium _______
Plasmodium ______
Plasmodium _______
falciparum
malariae
ovale
Vivax
knowlesi
Etiology of malaria
Plasmodium falciparum (> ____% of infections )
Plasmodium malariae (<___ %) Plasmodium ovale (<___ %)
90
10
10
Etiology
Plasmodium species that are found in man and they undergo ____ cycles of asexual division (_______ or _______ ) in ____ and _____ sexual reproductive cycle ( _______ ) in ______
Two; schizogony, or merogony
man
Single
sporogony; mosquito
most dangerous species of plasmodium
??
Falciparum
Plasmodium _______ is not found in Nigeria
Plasmodium ______ is zoonotic
vivax
knowlesi
Relationship Between the Life-cycle and the Manifestations of Malaria
Relapse:________ of parasitaemia (from ___________ phase in the _____ = _______ stage) in a sporozoite-induced infection following adequate ___________ therapy;
E.g P._______ & P. ______ infections
Re-appearance
exoerythrocytic; liver
hypnozoite
blood schizonticidal
ovale; Vivax
Relationship Between the Life-cycle and the Manifestations of Malaria
Recrudescence: _____ease in parasites that has persisted at ___ levels in the blood. E.g —————————- P. ______ & P. _______ infections
Incr
low
inadequately treated P. falciparum & P. malariae infections
Relationship Between the Life-cycle and the Manifestations of Malaria
Synchronicity: Tendency for Parasites to _________ causing _________ to occur at ____________:
grow in synchrony
fever paroxysms; regular intervals of time
Relationship Between the Life-cycle and the Manifestations of Malaria
Synchronicity:
______ in tertian malaria ( benign tertian malaria due to P. ____ & P. ______ , and Malignant tertian malaria due to P. ______)
______ in quartan malaria due to P. ____
48 hrs; vivax; ovale
falciparum
72 hrs; malariae
The periodicity of fever becomes (more or less?) regular as the malaria
infection progresses
More
Relationship Between the Life-cycle and the Manifestations of Malaria
Sequestration
This is the _______ of the parasites from ____________ and be retained or sequestered in ___________.
This is characteristic of P. _________ infection
removal of stages
peripheral bloodstream
various host tissues
falciparum
Relationship Between the Life-cycle and the Manifestations of Malaria
Sequestration
In P. falciparum, __________(_____) are present in ___________ and later developmental stages such as the ______ are sequestered within the _____ of various organs
early trophozoites (rings)
peripheral circulation
schizonts
capillaries
Sequestration is caused by the ________________________________________ by means of a specific interaction between a _______ molecule present at the surface and specific host cell receptors
adherence of infected erythrocytes to capillary endothelial cells
parasite-derived
Sequestration
The packing of cerebral capillaries with these adherent, highly metabolically active cells is responsible for ______________ (including _______ and _____ ), which may in turn lead to ______ and —————
local metabolic defects
hypoglycaemia and hypoxia
comma and cerebral malaria
e.g of red cell receptors in sequesteration are: _______,______,______,______ etc
ICAM-1,CD36, VCAM-1, Chondroitin sulphate
sequestered _____ in capillaries consume _____% more glucose than ______ in peripheral circulation
Schizonts
75
Trophozoites
Sequestration has an important consequences for the diagnosis of _______ malaria as parasites may __________________ at a time when the clinical picture is most suggestive
falciparum
not be found on a blood film
Sequestration
During pregnancy, infected erythrocytes are preferentially retained in the ______.
This is more common among the _______ than women who __________
placenta
primigravida
have had more than one pregnancy
Pathophysiology of Malaria
Pathophysiologic changes involve many different organ systems and stem from several different parasite derived stimuli
______-stage parasites are the main source of stimuli
__________ stages, ________, and _______ do not induce pathophysiologic changes
Blood
exoerythrocytic
gametocytes; sporozoites
Pathophysiology of Malaria
______ enter the blood and within minutes attach to and invade the ___ cells by binding to ______ and _____
The Multiply rapidly and as many as ———- _______ are released when each infected _____ ruptures
Sporozoites
liver; thrombospondin and properdin
30,000 merozoites
hepatocyte
P. _____ and P._____ form hypnozoites
vivax; ovale
Pathophysiology of malaria
_______ bind by parasite _____-like molecule to ______ on the ____ molecules on the surface of RBCs
Merozoites
lectin
sialic residue; glycophorin
Pathophysiology of malaria
Within the RBC , parasite grow in ________ bound ________ to become ________, hydrolyses _____, polymerises ____ to form _________
Divide to form —————- or _________
Infected RBC _____ to release _____
membrane
digestive vacuole
mature trophozoites ; haemoglobin
haem; hemozoin pigment.
schizont –merozoites or gametocyte
lyses; merozoites
P.falciparum infects rbcs of ___ age
any
Pathophysiology of malaria
P. vivax and P. ovale preferentially invade ______ and therefore only very rarely cause parasitemias greater than ____%.
reticulocytes; 2
Pathophysiology of malaria
P. malariae preferentially infects (younger or older?) erythrocytes and may cause (acute or chronic?), (symptomatic or asymptomatic?) parasitemia lasting for many years
Older
Chronic ; asymptomatic
Pathophysiology of malaria
Pf infected cells clump together (______)s\ and sticks to _______ of (small or large?) blood vessels ( ________ ) and thereby __________
rosetting; endothelial lining
Small
sequestration
blocks blood flow
Pathophysiology of malaria
Several proteins including __________________ (PfEMP1) form ______ on the surface of rbcs.
PfEMP1 binds to ligands on endothelial cells including _____,_______,______,________
P. falciparum erythrocyte membrane protein 1
knobs
CD36,thrombospondin,VCAM1,ICAM1 and E-selection
Pathophysiology of malaria
______ due to poor perfusion –_________–main cause of death in ________.
Ischaemia
cerebral malaria
children
Pathophysiology of malaria
Pf induces high levels of ______ production including _____,______, and _____ by releasing of parasite proteins like _______________ (MSP)
cytokine
TNF, IFN-γ and IL-1
merozoite surface protein
Pathophysiology of malaria
Cytokines ________ the production of RBCs, _____ease fever, induce _______ production –tissue damage and induce expression of ___________ for ________ , thereby increasing __________
suppress
incr; nitric oxide
endothelial receptors for PfEMP1
squestration
Pathogenesis of malaria
Most of the pathologic findings of malaria result from ___________
the destruction of red blood cells.
Red cells are destroyed both by the ____________ and by the action of ______________________
release of the merozoites
the spleen to first sequester the infected red cells and then to lyse them.
The enlarged spleen characteristic of malaria is due to ___________, coupled with __________ of __________ and __________
congestion of sinusoids with erythrocytes
hyperplasia of lymphocytes and macrophages
Malaria caused by P. __________ is more severe than that caused by other plasmodia.
falciparum
Plasmodium falciparum
It infects far more red cells than the other malarial species
T/F
T
Plasmodium falciparum
occlusion of the capillaries with aggregates of parasitized red cells leads to life-threatening _______ and _______, particularly in the ________
hemorrhage and necrosis
brain
Plasmodium falciparum
extensive hemolysis and kidney damage occur, with resulting _________.
The ——- colored urine gave rise to the term “ __________ .”
hemoglobinuria
dark
blackwater fever
Plasmodium falciparum
The hemoglobinuria can lead to _________
acute renal failure.
Host resistance to malaria
Inherited genetic alteration in RBCs
–________________________________
Absence of protein to which parasite bind
– Absence of ________________– P. _______
Immune response due to ______________________________
Heterozygous sickle cell trait (HbAS, HbAC)
Duffy blood group antigen ; Vivax
repeated or prolonged exposure to Plasmodium spp
Clinical features of uncomplicated malaria
– Acute febrile _____ characterized by ___,_____, and ________ stages.
– The symptoms include _____,________,________,__________ , nausea, GIT complaints etc.
paroxysms; cold, hot, and sweating
fever, body and joint aches, headache, loss of appetite
Clinical features of uncomplicated malaria
Signs-
_____eased temperature
_____cardia
________________
____________ skin e.t.c
Incr
Tachy
hepatosplenomegally
warm flushed
Clinical features of Severe or complicated malaria
_______ consciousness but _____
______ malaria (____________).
_______tion, extreme ______
shock
______ failure
Respiratory _____
Multiple ________
Circulatory collapse/shock (______ malaria)
Pulmonary ______
Impaired; rousable
Cerebral; unarousable coma
Prostra; weakness
Renal; distress; convulsions
Algid ; oedema
Clinical features of complicated malaria
Abnormal _______
Jaundice
____scopic ________
Severe anaemia (hb <__g/dl or PCV <___%).
_____glycaemia (<40mg/dl or 2.2 mmol/L)
Metabolic (acidosis or alkalosis?)
_____pyrexia (T ≥____°C) or ____°F Hyperparasitaemia (——% or ________/μl)
bleeding
Macro; haemoglobinuria
5; 15
Hypo; acidosis ; Hyper; 40.5; 106
5; 500000
MALARIA DIAGNOSIS
CLINICAL DIAGNOSIS- This is _______, based on clinical signs and symptoms of _____,________,________etc.
presumptive; fever, anorexia, malaise
MALARIA DIAGNOSIS
LABORATORY DIAGNOSIS This is _____ and (more or less?) reliable.
WHO current policy is that there must be _____________ before antimalarial administration
definitive
More
parasitological diagnosis
LABORATORY DIAGNOSIS of malaria
laboratory techniques to confirm and diagnose malaria :
the traditional ______ techniques, _____________ tests (RDTs) and
molecular techniques such as the ___________
microscopy
rapid malaria diagnostic
polymerase chain reaction (PCR).
WHO 2010 Policy on Malaria
the policy allows:
•_____________________ of non-malarial febrile illness
•greater certainty on the incidence of malaria enabling the _____ to predict accurately the ________ and target programme resources to areas with greatest malaria burden
•the NMEP to assess the impact of changes in malaria control interventions such as ITN and IRS.
enhanced management
NMEP; antimalarial drug requirements
Laboratory diagnosis of malaria
__________ is the gold standard
Microscopy
Laboratory diagnosis of malaria
____________ film made from peripheral blood and stained with _______.
________ or ________ stains may also be used
It is (simple or complex?) , (low or high?) cost with (low or high?) specificity and ability to assess parasite density.
thin and thick; Giemsa
Wright’s or Field’s
Simple; low
High
Thick Blood Film is used for :
– Parasite _______
– Parasite ________
Thin film
–parasite _______
identification; density
Speciation
Quantitative Buffy Coat Test
– Blood is mixed with ______
–_______ in a capillary tube
– Read directly with a ___________
acridine orange
Centrifuge
fluorescent microscope.
Rapid Diagnostic Tests (RDTs)
RDTs are based on the detection of _________________.
circulating parasites antigens
Rapid Diagnostic Tests (RDTs)
RDTs are based on the detection of circulating parasites antigens.
Which include:
–____________ (HRP2) (recommended for the diagnosis of malaria in all age groups.)
–____________(PLDH)
– _________ .
Immunological based technique
Histidine Rich Protein 11
Plasmodium Lactate Dehydrogenase
Aldolase
E.g. of RDTs
___________ test- Malaria antigen or enzyme test- (PfHRP-II).
__________________- (PfHRP-II).
‘_________ Test’-Detection of Parasite Lactate Dehydrogenase (pLDH).
ParaSight FTM
Immuno-chromatographic card (ICT)
OptiMAL
E.g. of RDTs
ParaSight FTM test- Malaria antigen or enzyme test- (_________).
Immuno-chromatographic card (ICT)- (________).
‘OptiMAL Test’-Detection of _________
PfHRP-II
PfHRP-II
pLDH
Rapid diagnostic tests -
1 Para Sight F Test
– A dip stick antigen capture assay
– Using a ________ against ___________ (PfHRP-2)
– It is a (slow or rapid?) , sensitive and specific for P. ________.
monoclonal antibody
P. falciparum histidine rich protein-2
Rapid
falciparum
The Immunochromato-graphic test (ICT):
OptiMAL
• Dip stick coated with ________ against _____________
•Allows for _______ between the pLDH isoforms.
monoclonal antibodies; parasite lactate dehydrogenase (pLDH).
speciation
pLDH is produced only by ________
Hence ICT-optimal test has the ability to differentiate _____ from ________
live parasites
live from dead organisms
Advantages of RDT
Unlike the various microscopy techniques, RDTs do not require _________ and are all based on the same principle and detect malaria antigen in blood flowing along a membrane containing specific ——————
Minimal ________ is needed
Not dependent on ______
_______ and can be used in PHCs
Several studies have reported the performance of RDTs to be excellent.
laboratory equipment ; anti- malaria antibodies .
training
power; Portable
RDT limitations
RDT limitations currently reported and experienced include _________, inability to be used as ‘__________’ diagnostic test, lack of community and Health worker ———- in them
failure to detect mixed malaria infections.
variation in sensitivity
stand alone
confidence
RDT limitation
Most of the available RDTs are P. _________ specific (either _____________ or ___________ ) while some RDTs detect P. falciparum and other Plasmodium proteins such as aldolase or pan-malaria pLDH.
falciparum protein
histidine rich protein II -HRP-II or lactase dehydrogenase-LDH
OTHER INVESTIGATIONS for malaria
Full Blood Count (FBC) - PCV, ____ (total & differential), _____ count & Coagulation tests
Blood ______ level
Blood Chemistry
Urinalysis- haemoglobinuria, protein etc Screening for ______ deficiency
WBC
Platelet
Glucose
G6PD
MALARIA TREATMENT
General – ________ measures
Specific measures – ____________
supportive
antimalarial drugs
MALARIA TREATMENT
General – supportive measures
– ______ agents
–_______ – oral or IV
– Blood _______
– Anti- ______ and feeding
– Treatment of associated conditions
Antipyretic
Rehydration
transfusion
emetics
MALARIA CHEMOTHERAPY
The choice of an antimalarial depends on a variety of factors classified into PARASITE FACTORS –
Parasite ____________
Level of ____________
strain or species
drug resistance
MALARIA CHEMOTHERAPY
The choice of an antimalarial depends on a variety of factors classified into PATIENTS FACTORS
Patient’s general health and medical history – age and
genetic origin of the patient (G6PD deficiency),
immune status-
Yes
Malaria must be treated urgently and intensively in order to prevent complications or death.
T/F
T
AVAILABLE ANTIMALARIAL DRUG’S
CLASS
List 6
Biguanides
Antifolates
Phenantrine methanol
4-Aminoquinolines
8- Aminoquinolines
Cinchona Alkaloids
AVAILABLE ANTIMALARIAL DRUG’S
CLASS
4-Aminoquinolines
•_________,________
8- Aminoquinolines
•_________
Antifolates
•______ ,_________
Biguanides
•_______,________
Cinchona Alkaloids
•________,_______
Phenantrine methanol
•_________,________,________
Chloroquine, amodiaquine
primaquine
Sulphones, sulphonamides
proguanil, pyrimethamine
Quinine, quinidine
Halofanthrine, desbutylhalofantrine, lumephantrine
AVAILABLE ANTIMALARIAL DRUG’S
CLASS
PANSQ
Pyronaridine
Antibiotics
Naphthoquinones
Sesquiterpene lactones
Quinoline Methanols
AVAILABLE ANTIMALARIAL DRUG’S
CLASS
Sesquiterpene lactones
•________
–
Quinoline Methanols
•__________
–
Naphthoquinones
•__________
–
Pyronaridine
•______________,
Artemisinin derivatives
mefloquine
Atovaquinone
a benzonaphthyridine
Treatment solely on the basis of clinical suspicion should only be considered when a ____________________
parasitological diagnosis is not accessible.
________________ are the recommended treatments for uncomplicated P. falciparum malaria.
Artemisinin-based combination therapies (ACTs)
The following ACTs are recommended for use in Nigeria
____________ and __________
Artemether-lumefantrine, Artesunate-amodiaquine,
Artemisinin and its derivatives should be used as monotherapy in the treatment of uncomplicated malaria
T/F
F
Should not
________ is the recommended medicine for the treatment of uncomplicated malaria in the first trimester and in children less than 5kg, however, ACTs can be used under supervision by the health care provider
Oral Quinine
_________ is the recommended treatment of uncomplicated malaria in the second and third trimesters of pregnancy.
ACTs
Severe malaria is a medical emergency. After rapid clinical assessment and confirmation of diagnosis where feasible, commence immediate treatment with parenteral medication.
_________ ———— is preferred for the treatment of severe P.falciparum malaria
Intravenous artesunate
Severe malaria
_________ Or ________ is an acceptable alternative if artesunate is not available.
Parenteral quinine or artemether
Parenteral antimalarial medicines in the treatment of severe malaria should be administered for a minimum of ______ once started (irrespective of _________________) and thereafter, complete treatment with a complete course of ________
24 hours
the patient’s ability to tolerate oral medication earlier
an ACT
In settings where complete treatment of severe malaria is not possible, patients should be given ______ treatment and _____ immediately to an appropriate facility for further treatment.
pre-referral
referred
The recommended pre-referral treatment options include any of these; ___________ or ______ , and ________.
artesunate IM or rectal
quinine IM
The recommended chemoprophylaxis for non immune visitors will be as available in the visitor’s country of origin or as recommended in Nigeria.
T/F
T
______________ is the recommended medicine for Intermittent Preventive Treatment in Pregnancy
Sulphadoxine-Pyrimethamine
PROPHYLACTIC DRUGS
________ (LariamR).
________ (VibramycinR)
__________________ (Proguanil)
Others: ________ (Atovaquone + proguanil) ,_______ and _______
Mefloquine
Doxycycline
Chloroquine plus Paludrine
Malarone; Pyrimethamine and Chloroquine
PROPHYLACTIC DRUGS
Mefloquine (_______). It gives >____% protection and if combined with _____ against mosquito bites, about ___%.
Doxycycline (__________)
Chloroquine plus Paludrine (_____) is useful in some parts of ____ but not recommended in _____
LariamR; 90; personal protection; 99
VibramycinR
Proguanil; Asia; Africa
Doxycycline is not an effective alternative to mefloquine in Africa
T/F
F
It is
Malaria prophylaxis is generally not necessary in persons living in a malaria endemic area
T/F
With reason
T
because it may slow down the ability of the individual to develop partial immunity which protects from developing the severe form of the disease.
Intermittent Preventive Therapy (IPT) with ____________ is recommended for pregnant women
Non-Immune Visitors / Residents
- __________ or _________
Sulfadoxine-Pyrimethamine
Mefloquine or Atovaquone-Proguanil
Control of malaria in pregnancy
•Intermittent preventive treatment(IPTp)
-Requires a functional and effective health care system
-____________(ITN)
-Use currently low in the country
Distribution and utilization being promoted by various bodies e.g. RBM
Prompt diagnosis & treatment of cases with effective drug
Insecticide treated bed nets
Chemoprophylaxis versus IPT
Chemoprophylaxis aims at sustaining blood levels ___________________________ for a prolonged period.
IPT on the other hand is the use of
___________ given in treatment
doses at predefined intervals e.g after the 1st trimester (Adopted in 37 countries)
above minimum inhibitory concentration (MIC)
antimalarial drugs
IPT is Better for residents of endemic countries
T/F
T
Mechanism of resistance
resistance appears to occur through _________ that confer reduced sensitivity to a given drug or class of drugs
spontaneous mutations
For some drugs, only a single point mutation is required to confer resistance, while for other drugs, multiple mutations appear to be required.
T/F
T
Mechanism of resistance
drug pressure will __________ while _____________
remove susceptible parasites while resistant parasites survive.
Mechanism of resistance
Single malaria isolates have been found to be made up of _____geneous populations of parasites that can have widely varying drug response characteristics, from ______ to _____
Over time, ——— becomes established in the population and can be very stable, persisting long after specific drug pressure is removed.
hetero
highly resistant to completely sensitive
resistance
Chloroquine resistance
Chloroquine resistance in P. falciparum appears to have a _______,_______ basis
multifactorial, multigenic
Chloroquine resistance
The Chloroquine resistant P. falciparum are able to _________ to the extent that ___________ is prevented
expel the drug from the food vacuole
inhibition of heme polymerisation
mutations in the pfcrt gene found on the parasite’s chromosome ____ and pfmdr1 gene, on chromosome ____ of P. falciparum have been linked with Chloroquine resistance
7
5
Resistance to ACTs
The first evidence of resistance to artemisinins on the ___________ border emerged from routine efficacy testing in 2006.
Cambodia-Thailand
Resistance to ACTs
The use of _____________ threatens the therapeutic life of ACTs by fostering the spread of resistance to artemisinin.
oral artemisinin-based monotherapies
Resistance to ACTs
WHO recommends the withdrawal of _____________________ from the market and the use of ______ instead, as endorsed by the World Health Assembly in 2007. It also calls upon manufacturers to cease production and marketing of oral artemisinin- based monotherapies.
oral artemisinin- based monotherapies
ACTs
Malarial control
STRATEGIES:
(i) disease management through early ________ and complete _______
(ii)_________________ (IVM) to reduce the risk of ______________________
(iii) supportive interventions which include communicating behaviour change, capacity building and monitoring and evaluation of programmes.
case detection; treatment
integrated vector management
vector-borne transmission
VECTOR CONTROL TECHNIQUES
Measures directed against the vector:
Destroying __________- The use of indoor residual insecticides especially in cases where the vector enters houses and feeds predominantly on man.
adult mosquitoes
VECTOR CONTROL TECHNIQUES
Measures directed against the vector:
Destroying adult mosquitoes-
The insecticides in common use are;
_________ e.g. DDT (____________, indoor residual spray’ (IRS) with synthetic _______
Chlorinated hydrocarbons
dichlorodiphenyl
pyrethroids
Antilarval Measures
Mechanical: Prevent the breeding of mosquitoes by _________ e.g. the ___________ , flooding or flushing of breeding places and also ___________ in ponds, pot-holes, drainages, ditches etc.
altering the habitat
drainage of swamps
filling
ANTI-LARVAL measures
Chemical: the _________, such as _________ derivatives, ______ and _____ , and Paris Green,on pools and collection of water found to be breeding sites.
spraying of larvicides
petroleum oil
dieldrin and aldrin
Anti-larval measure
Biological: includes introduction of ________ e.g._______ and _____ ; & use of Biocides from bacterium ___________
larvivorous fish
gambusia & guppy
Bacillus thuringiensis .
VECTOR CONTROL OPTIONS- 2
Measures designed to reduce man’s contact with anophiline mosquitoes include:
_______ of houses
Mosquito _____ – particularly ____________
Siting
bed nets
pyrethroid-treated bed nets (ITN)
VECTOR CONTROL OPTIONS
Clothing- wearing protective clothing such as long trousers, long skirts, sarongs, and garments with long sleeves.
Mosquito (insect) repellents- e.g. _______ and __________
diethyl toluamide and dimethyl phthalate.
Malaria elimination
This refers to the ________________________________________ as a result of delibrate efforts.
reduction of the incidence of infection to zero in a defined geographical area
Malaria eradication is the (temporary or permanent?) reduction to ____ of the worldwide incidence of infection caused by a particular malaria parasite species. Intervention measures will no longer be needed once this has been achieved.
Permanent
zero
PREVENTIVE OPTIONS FOR MALARIA-
Malaria vaccine(_______ ; brand name: ____) for children
Avoiding mosquito bites- so reducing the risk of infection.
Chemoprophylaxis- using drugs to prevent ________ before or after transmission has occurred.
RTS,S; mosquirix
symptomatic infection
PREVENTIVE OPTIONS FOR MALARIA-
IPTp=________________ in _______ (__ or more doses) 37 countries adopted
IPTi= in __________ and _________ (6 of 16 Countries recommended by WHO adopted it not yet implemented
Intermittent preventive therapy in pregnancy; 3
infants and children U5 years
Malaria Chemoprevention
IPTp – Administration of _____________ during 2nd & 3rd trimester of pregnancy
sulfadoxine-pyrimethamine (SP)
Malaria chemo prevention
Seasonal malarial chemoprevention (SMC) with ________ plus ______ (AQ+SP) for children aged 3- 59months (works by maintaining therapeutic antimalarial drug conc in the blood during periods of greatest malaria risk.
amodiaquine plus SP
Malaria chemo prevention
IPTi with ____ delivered at routine childhood immunization clinics (protect in the ______ year)
SP
first 1
Other Control Strategies
____________ mosquitoes
____prophylaxis and _______-treated livestock
_______ administration to humans
_____-baited mosquito trapping systems
genetically modified
Zoo; insecticide
Ivermectin
Odor
We should pay a lot of attention to P.falciparum
T/F
T
P.falciparum
Affects ___ ages of rbcs
Affects ____ age groups
Affects ____ organs
all
All
Most
Most prevalent plasmodium specie in Nigeria ??
Falciparum
