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Malaria Flashcards

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Biology 101 flashcards
1
Q

Malaria is a disease caused by (obligate or facultative ?) _____cellular protozoa of the genus __________

it may be acute or chronic.

A

Obligate

Intra

Plasmodiuman

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2
Q

Plaasmodium infection is the ____________________________ with or without signs and symptoms

A

presence of the parasite in the blood

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3
Q

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

A

Africa; warmer

Italians; foul air

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4
Q

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

A

periodic fevers

Hippocrates

bark; Cinchona; intermittent fever

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5
Q

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.

A

alkaloid quinine

described the ex-flagellated gametocytes of P. falciparum

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6
Q

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.

A

filariasis; mosquitoes

vector borne; Ronald Ross

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7
Q

Epidemiology
Globally in 2021, there were an estimated ________ malaria cases in _____ malaria endemic countries an increase of _______ cases compared with 2020.

A

247 million

84; 2 million

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8
Q

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%).

A

Nigeria

Democratic Republic of the Congo

India

Mozambique

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9
Q

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 _________

A

children aged under 5

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10
Q

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.

A

5; Pregnant; HIV

non-immune visitors

90; 78

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11
Q

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

A

50

60

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12
Q

Malaria is transmitted by the _________________.

A

female anopheles mosquito

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13
Q

Factors which affect mosquito ecology, such as _______ and ________, are key determinants of malaria transmission.

A

temperature and rainfall

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14
Q

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.

A

Hot; humid

2000

25-30

16

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15
Q

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 __________

A

amount or severity

constant incidence of cases

many successive years.

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16
Q

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.

A

little; little

varying; small, rural

intense; seasonal

immunity

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17
Q

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.

A

intense; throughout; immunity

children; the first few months of life to age 5 years

Pregnant

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18
Q

Endemic malaria may be present in various degrees. Recognised categories of endemicity include :
A. ____endemicity
B. ____endemicity
C. _____endemicity
D. ____endemicity

A

Hypo
Meso
Hyper
Holo

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19
Q

Etiology of malaria

Plasmodium ———-
Plasmodium _______
Plasmodium _______
Plasmodium ______
Plasmodium _______

A

falciparum

malariae

ovale

Vivax

knowlesi

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20
Q

Etiology of malaria

Plasmodium falciparum (> ____% of infections )

Plasmodium malariae (<___ %) Plasmodium ovale (<___ %)

A

90

10

10

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21
Q

Etiology

Plasmodium species that are found in man and they undergo ____ cycles of asexual division (_______ or _______ ) in ____ and _____ sexual reproductive cycle ( _______ ) in ______

A

Two; schizogony, or merogony

man

Single

sporogony; mosquito

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22
Q

most dangerous species of plasmodium

??

A

Falciparum

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23
Q

Plasmodium _______ is not found in Nigeria

Plasmodium ______ is zoonotic

A

vivax

knowlesi

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24
Q

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

A

Re-appearance

exoerythrocytic; liver

hypnozoite

blood schizonticidal

ovale; Vivax

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25
Q

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

A

Incr

low

inadequately treated P. falciparum & P. malariae infections

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26
Q

Relationship Between the Life-cycle and the Manifestations of Malaria

Synchronicity: Tendency for Parasites to _________ causing _________ to occur at ____________:

A

grow in synchrony

fever paroxysms; regular intervals of time

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27
Q

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. ____

A

48 hrs; vivax; ovale

falciparum

72 hrs; malariae

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28
Q

The periodicity of fever becomes (more or less?) regular as the malaria
infection progresses

A

More

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29
Q

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

A

removal of stages

peripheral bloodstream

various host tissues

falciparum

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30
Q

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

A

early trophozoites (rings)

peripheral circulation

schizonts

capillaries

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31
Q

Sequestration is caused by the ________________________________________ by means of a specific interaction between a _______ molecule present at the surface and specific host cell receptors

A

adherence of infected erythrocytes to capillary endothelial cells

parasite-derived

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32
Q

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 —————

A

local metabolic defects

hypoglycaemia and hypoxia

comma and cerebral malaria

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33
Q

e.g of red cell receptors in sequesteration are: _______,______,______,______ etc

A

ICAM-1,CD36, VCAM-1, Chondroitin sulphate

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34
Q

sequestered _____ in capillaries consume _____% more glucose than ______ in peripheral circulation

A

Schizonts

75

Trophozoites

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35
Q

Sequestration has an important consequences for the diagnosis of _______ malaria as parasites may __________________ at a time when the clinical picture is most suggestive

A

falciparum

not be found on a blood film

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36
Q

Sequestration

During pregnancy, infected erythrocytes are preferentially retained in the ______.

This is more common among the _______ than women who __________

A

placenta

primigravida

have had more than one pregnancy

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37
Q

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

A

Blood

exoerythrocytic

gametocytes; sporozoites

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38
Q

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

A

Sporozoites

liver; thrombospondin and properdin

30,000 merozoites

hepatocyte

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39
Q

P. _____ and P._____ form hypnozoites

A

vivax; ovale

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40
Q

Pathophysiology of malaria

_______ bind by parasite _____-like molecule to ______ on the ____ molecules on the surface of RBCs

A

Merozoites

lectin

sialic residue; glycophorin

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41
Q

Pathophysiology of malaria

Within the RBC , parasite grow in ________ bound ________ to become ________, hydrolyses _____, polymerises ____ to form _________

Divide to form —————- or _________

Infected RBC _____ to release _____

A

membrane

digestive vacuole

mature trophozoites ; haemoglobin

haem; hemozoin pigment.

schizont –merozoites or gametocyte

lyses; merozoites

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42
Q

P.falciparum infects rbcs of ___ age

A

any

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43
Q

Pathophysiology of malaria

P. vivax and P. ovale preferentially invade ______ and therefore only very rarely cause parasitemias greater than ____%.

A

reticulocytes; 2

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44
Q

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

A

Older

Chronic ; asymptomatic

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45
Q

Pathophysiology of malaria

Pf infected cells clump together (______)s\ and sticks to _______ of (small or large?) blood vessels ( ________ ) and thereby __________

A

rosetting; endothelial lining

Small

sequestration

blocks blood flow

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46
Q

Pathophysiology of malaria

Several proteins including __________________ (PfEMP1) form ______ on the surface of rbcs.

PfEMP1 binds to ligands on endothelial cells including _____,_______,______,________

A

P. falciparum erythrocyte membrane protein 1

knobs

CD36,thrombospondin,VCAM1,ICAM1 and E-selection

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47
Q

Pathophysiology of malaria

______ due to poor perfusion –_________–main cause of death in ________.

A

Ischaemia

cerebral malaria

children

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48
Q

Pathophysiology of malaria

Pf induces high levels of ______ production including _____,______, and _____ by releasing of parasite proteins like _______________ (MSP)

A

cytokine

TNF, IFN-γ and IL-1

merozoite surface protein

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49
Q

Pathophysiology of malaria

Cytokines ________ the production of RBCs, _____ease fever, induce _______ production –tissue damage and induce expression of ___________ for ________ , thereby increasing __________

A

suppress

incr; nitric oxide

endothelial receptors for PfEMP1

squestration

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50
Q

Pathogenesis of malaria

Most of the pathologic findings of malaria result from ___________

A

the destruction of red blood cells.

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51
Q

Red cells are destroyed both by the ____________ and by the action of ______________________

A

release of the merozoites

the spleen to first sequester the infected red cells and then to lyse them.

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52
Q

The enlarged spleen characteristic of malaria is due to ___________, coupled with __________ of __________ and __________

A

congestion of sinusoids with erythrocytes

hyperplasia of lymphocytes and macrophages

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53
Q

Malaria caused by P. __________ is more severe than that caused by other plasmodia.

A

falciparum

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54
Q

Plasmodium falciparum

It infects far more red cells than the other malarial species

T/F

A

T

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55
Q

Plasmodium falciparum

occlusion of the capillaries with aggregates of parasitized red cells leads to life-threatening _______ and _______, particularly in the ________

A

hemorrhage and necrosis

brain

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56
Q

Plasmodium falciparum

extensive hemolysis and kidney damage occur, with resulting _________.

The ——- colored urine gave rise to the term “ __________ .”

A

hemoglobinuria

dark

blackwater fever

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57
Q

Plasmodium falciparum

The hemoglobinuria can lead to _________

A

acute renal failure.

58
Q

Host resistance to malaria

Inherited genetic alteration in RBCs
–________________________________

Absence of protein to which parasite bind
– Absence of ________________– P. _______

Immune response due to ______________________________

A

Heterozygous sickle cell trait (HbAS, HbAC)

Duffy blood group antigen ; Vivax

repeated or prolonged exposure to Plasmodium spp

59
Q

Clinical features of uncomplicated malaria

– Acute febrile _____ characterized by ___,_____, and ________ stages.

– The symptoms include _____,________,________,__________ , nausea, GIT complaints etc.

A

paroxysms; cold, hot, and sweating

fever, body and joint aches, headache, loss of appetite

60
Q

Clinical features of uncomplicated malaria

Signs-

_____eased temperature
_____cardia
________________
____________ skin e.t.c

A

Incr

Tachy

hepatosplenomegally

warm flushed

61
Q

Clinical features of Severe or complicated malaria

_______ consciousness but _____

______ malaria (____________).

_______tion, extreme ______
shock
______ failure
Respiratory _____
Multiple ________
Circulatory collapse/shock (______ malaria)
Pulmonary ______

A

Impaired; rousable

Cerebral; unarousable coma

Prostra; weakness

Renal; distress; convulsions

Algid ; oedema

62
Q

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)

A

bleeding

Macro; haemoglobinuria

5; 15

Hypo; acidosis ; Hyper; 40.5; 106

5; 500000

63
Q

MALARIA DIAGNOSIS

CLINICAL DIAGNOSIS- This is _______, based on clinical signs and symptoms of _____,________,________etc.

A

presumptive; fever, anorexia, malaise

64
Q

MALARIA DIAGNOSIS

LABORATORY DIAGNOSIS This is _____ and (more or less?) reliable.

WHO current policy is that there must be _____________ before antimalarial administration

A

definitive

More

parasitological diagnosis

65
Q

LABORATORY DIAGNOSIS of malaria

laboratory techniques to confirm and diagnose malaria :

the traditional ______ techniques, _____________ tests (RDTs) and
molecular techniques such as the ___________

A

microscopy

rapid malaria diagnostic

polymerase chain reaction (PCR).

66
Q

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.

A

enhanced management

NMEP; antimalarial drug requirements

67
Q

Laboratory diagnosis of malaria

__________ is the gold standard

A

Microscopy

68
Q

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.

A

thin and thick; Giemsa

Wright’s or Field’s

Simple; low

High

69
Q

Thick Blood Film is used for :
– Parasite _______
– Parasite ________

Thin film
–parasite _______

A

identification; density

Speciation

70
Q

Quantitative Buffy Coat Test

– Blood is mixed with ______
–_______ in a capillary tube
– Read directly with a ___________

A

acridine orange

Centrifuge

fluorescent microscope.

71
Q

Rapid Diagnostic Tests (RDTs)

RDTs are based on the detection of _________________.

A

circulating parasites antigens

72
Q

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

A

Histidine Rich Protein 11

Plasmodium Lactate Dehydrogenase

Aldolase

73
Q

E.g. of RDTs
___________ test- Malaria antigen or enzyme test- (PfHRP-II).
__________________- (PfHRP-II).
 ‘_________ Test’-Detection of Parasite Lactate Dehydrogenase (pLDH).

A

ParaSight FTM

Immuno-chromatographic card (ICT)

OptiMAL

74
Q

E.g. of RDTs
 ParaSight FTM test- Malaria antigen or enzyme test- (_________).
 Immuno-chromatographic card (ICT)- (________).
 ‘OptiMAL Test’-Detection of _________

A

PfHRP-II

PfHRP-II

pLDH

75
Q

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. ________.

A

monoclonal antibody

P. falciparum histidine rich protein-2

Rapid

falciparum

76
Q

The Immunochromato-graphic test (ICT):
OptiMAL

• Dip stick coated with ________ against _____________

•Allows for _______ between the pLDH isoforms.

A

monoclonal antibodies; parasite lactate dehydrogenase (pLDH).

speciation

77
Q

pLDH is produced only by ________

Hence ICT-optimal test has the ability to differentiate _____ from ________

A

live parasites

live from dead organisms

78
Q

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.

A

laboratory equipment ; anti- malaria antibodies .

training

power; Portable

79
Q

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.

A

variation in sensitivity

stand alone

confidence

80
Q

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.

A

falciparum protein

histidine rich protein II -HRP-II or lactase dehydrogenase-LDH

81
Q

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

A

WBC

Platelet

Glucose

G6PD

82
Q

MALARIA TREATMENT

General – ________ measures

Specific measures – ____________

A

supportive

antimalarial drugs

83
Q

MALARIA TREATMENT

General – supportive measures

– ______ agents
–_______ – oral or IV
– Blood _______
– Anti- ______ and feeding
– Treatment of associated conditions

A

Antipyretic

Rehydration

transfusion

emetics

84
Q

MALARIA CHEMOTHERAPY
The choice of an antimalarial depends on a variety of factors classified into PARASITE FACTORS –
 Parasite ____________
 Level of ____________

A

strain or species

drug resistance

85
Q

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-

A

Yes

86
Q

Malaria must be treated urgently and intensively in order to prevent complications or death.

T/F

A

T

87
Q

AVAILABLE ANTIMALARIAL DRUG’S
CLASS

List 6

A

Biguanides
Antifolates
Phenantrine methanol
4-Aminoquinolines
8- Aminoquinolines
Cinchona Alkaloids

88
Q

AVAILABLE ANTIMALARIAL DRUG’S
CLASS
4-Aminoquinolines
•_________,________

8- Aminoquinolines
•_________

Antifolates
•______ ,_________

Biguanides
•_______,________

Cinchona Alkaloids
•________,_______

Phenantrine methanol
•_________,________,________

A

Chloroquine, amodiaquine

primaquine

Sulphones, sulphonamides

proguanil, pyrimethamine

Quinine, quinidine

Halofanthrine, desbutylhalofantrine, lumephantrine

89
Q

AVAILABLE ANTIMALARIAL DRUG’S
CLASS

PANSQ

A

Pyronaridine

Antibiotics

Naphthoquinones

Sesquiterpene lactones

Quinoline Methanols

90
Q

AVAILABLE ANTIMALARIAL DRUG’S
CLASS

Sesquiterpene lactones
•________
–
Quinoline Methanols
•__________
–
Naphthoquinones
•__________
–
Pyronaridine
•______________,

A

Artemisinin derivatives

mefloquine

Atovaquinone

a benzonaphthyridine

91
Q

Treatment solely on the basis of clinical suspicion should only be considered when a ____________________

A

parasitological diagnosis is not accessible.

92
Q

________________ are the recommended treatments for uncomplicated P. falciparum malaria.

A

Artemisinin-based combination therapies (ACTs)

93
Q

The following ACTs are recommended for use in Nigeria

____________ and __________

A

Artemether-lumefantrine, Artesunate-amodiaquine,

94
Q

Artemisinin and its derivatives should be used as monotherapy in the treatment of uncomplicated malaria

T/F

A

F

Should not

95
Q

________ 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

A

Oral Quinine

96
Q

_________ is the recommended treatment of uncomplicated malaria in the second and third trimesters of pregnancy.

A

ACTs

97
Q

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

A

Intravenous artesunate

98
Q

Severe malaria

_________ Or ________ is an acceptable alternative if artesunate is not available.

A

Parenteral quinine or artemether

99
Q

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 ________

A

24 hours

the patient’s ability to tolerate oral medication earlier

an ACT

100
Q

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.

A

pre-referral

referred

101
Q

The recommended pre-referral treatment options include any of these; ___________ or ______ , and ________.

A

artesunate IM or rectal

quinine IM

102
Q

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

A

T

103
Q

______________ is the recommended medicine for Intermittent Preventive Treatment in Pregnancy

A

Sulphadoxine-Pyrimethamine

104
Q

PROPHYLACTIC DRUGS

________ (LariamR).
________ (VibramycinR)
__________________ (Proguanil)

Others: ________ (Atovaquone + proguanil) ,_______ and _______

A

Mefloquine

Doxycycline

Chloroquine plus Paludrine

Malarone; Pyrimethamine and Chloroquine

105
Q

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 _____

A

LariamR; 90; personal protection; 99

VibramycinR

Proguanil; Asia; Africa

106
Q

Doxycycline is not an effective alternative to mefloquine in Africa

T/F

A

F

It is

107
Q

Malaria prophylaxis is generally not necessary in persons living in a malaria endemic area

T/F

With reason

A

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.

108
Q

Intermittent Preventive Therapy (IPT) with ____________ is recommended for pregnant women

Non-Immune Visitors / Residents

  • __________ or _________
A

Sulfadoxine-Pyrimethamine

Mefloquine or Atovaquone-Proguanil

109
Q

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

A

Insecticide treated bed nets

110
Q

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)

A

above minimum inhibitory concentration (MIC)

antimalarial drugs

111
Q

IPT is Better for residents of endemic countries

T/F

A

T

112
Q

Mechanism of resistance

resistance appears to occur through _________ that confer reduced sensitivity to a given drug or class of drugs

A

spontaneous mutations

113
Q

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

A

T

114
Q

Mechanism of resistance

drug pressure will __________ while _____________

A

remove susceptible parasites while resistant parasites survive.

115
Q

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.

A

hetero

highly resistant to completely sensitive

resistance

116
Q

Chloroquine resistance

Chloroquine resistance in P. falciparum appears to have a _______,_______ basis

A

multifactorial, multigenic

117
Q

Chloroquine resistance

The Chloroquine resistant P. falciparum are able to _________ to the extent that ___________ is prevented

A

expel the drug from the food vacuole

inhibition of heme polymerisation

118
Q

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

A

7

5

119
Q

Resistance to ACTs

The first evidence of resistance to artemisinins on the ___________ border emerged from routine efficacy testing in 2006.

A

Cambodia-Thailand

120
Q

Resistance to ACTs

The use of _____________ threatens the therapeutic life of ACTs by fostering the spread of resistance to artemisinin.

A

oral artemisinin-based monotherapies

121
Q

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.

A

oral artemisinin- based monotherapies

ACTs

122
Q

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.

A

case detection; treatment

integrated vector management

vector-borne transmission

123
Q

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.

A

adult mosquitoes

124
Q

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 _______

A

Chlorinated hydrocarbons

dichlorodiphenyl

pyrethroids

125
Q

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.

A

altering the habitat

drainage of swamps

filling

126
Q

ANTI-LARVAL measures

Chemical: the _________, such as _________ derivatives, ______ and _____ , and Paris Green,on pools and collection of water found to be breeding sites.

A

spraying of larvicides

petroleum oil

dieldrin and aldrin

127
Q

Anti-larval measure

Biological: includes introduction of ________ e.g._______ and _____ ; & use of Biocides from bacterium ___________

A

larvivorous fish

gambusia & guppy

Bacillus thuringiensis .

128
Q

VECTOR CONTROL OPTIONS- 2
Measures designed to reduce man’s contact with anophiline mosquitoes include:

_______ of houses

Mosquito _____ – particularly ____________

A

Siting

bed nets

pyrethroid-treated bed nets (ITN)

129
Q

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 __________

A

diethyl toluamide and dimethyl phthalate.

130
Q

Malaria elimination

This refers to the ________________________________________ as a result of delibrate efforts.

A

reduction of the incidence of infection to zero in a defined geographical area

131
Q

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.

A

Permanent

zero

132
Q

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.

A

RTS,S; mosquirix

symptomatic infection

133
Q

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

A

Intermittent preventive therapy in pregnancy; 3

infants and children U5 years

134
Q

Malaria Chemoprevention

IPTp – Administration of _____________ during 2nd & 3rd trimester of pregnancy

A

sulfadoxine-pyrimethamine (SP)

135
Q

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.

A

amodiaquine plus SP

136
Q

Malaria chemo prevention

IPTi with ____ delivered at routine childhood immunization clinics (protect in the ______ year)

A

SP

first 1

137
Q

Other Control Strategies

____________ mosquitoes

____prophylaxis and _______-treated livestock

_______ administration to humans

_____-baited mosquito trapping systems

A

genetically modified

Zoo; insecticide

Ivermectin

Odor

138
Q

We should pay a lot of attention to P.falciparum

T/F

A

T

139
Q

P.falciparum

Affects ___ ages of rbcs
Affects ____ age groups
Affects ____ organs

A

all
All
Most

140
Q

Most prevalent plasmodium specie in Nigeria ??

A

Falciparum

House Microbiology (93 decks)

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