MALARIA Flashcards
Types of malaria
Symptomatic malaria
Complicated
Uncomplicated
Asymptomatic malaria
Three stages in the plasmodium life cycle
Mosquito stages (Sporogonic cycle)
Human Liver stages(Exo-eryhtrocytic cycle)
Human blood stages (Erythrocytic cycle)
Name for the dormant liver stage of the plasmodium parasite
Hypnozoite
Which plasmodium species have a dormant stage
P. vivax
P. ovale
Exo-erythrocytic cycle
Sporozoites from mosquito infect liver cells
Schizonts
Merozoites
What population of the world is at risk of malaria
4 billion ( almost half)
Erythrocytic stage
Merozoites from liver infects RBCs
Ring stage trophozoite
Trophozoite OR Gametocytes
Schizont
Merozoites
Sporogonic cycle
Micro and macrogamete ingested by mosquito
Ookinete
Oocyst
Sporozoites
pfEMP1
Plasmodium falciparum erythrocyte membrane protein 1
Location of pfEMP1
Present on plasmodium infected RBCs
Function of pfEMP1
Rosetting
Clumping
Microvascular adhesion
Rosetting
Replication and sticking of infected RBC to non-infected RBC
Clumping
interactions with platelets that can lead to clumping of infected RBCs invitro
Microvascular adhesion
Cytoadherence of infected RBCs to endothelial cells
Symptoms of severe malaria include
Respiratory distress
Convulsions
Posturing
Prostration
Hypoglycemia
Jaundice
Neurological sequelae
Metablic acidosis
Pulmonary edema
Renal failure
Bleeding/Clotting disturbances
CSF opening pressure
Symptoms of uncomplicated malaria
Fever
Vomiting
Diarrhoea
Abdominal discomfort
Difficulty breathing
Cough
Symptom of severe malaria very common in children
Convulsions
Pregnant women susceptible to severe malaria
1st & 2nd Pregnancies
2nd & 3rd trimesters
Comorbid conditions that increase risk for severe malaria
HIV/AIDS infection
Splenectomy
Risk groups for severe malaria
Children < five years
Pregnant women
Persons with Low/No immunity
Person with comorbid condition
Prevalence of sicke cell disease
15% of population
Prognostic indictators of life-threatening malaria in african children
Impaired consciousness
Respiratory distress
Hypoglycemia
Jaundice
Persons with low/ no immunity to malaria hence are at risk of severe malaria
Visitors from areas with little or no malaria
Returnees who pass more than 6 months in a non-endemic area and return to Ghana
Signs of jaundice in malaria
Serum bilirubin >50mcmol/l
MPS: >100000mc/L
MARF
Malaria Associated Renal Failure
Diagnosis of MARF
Serum creatinine>265umol/L
Blood urea.20MMOL/L
Serum creatinine increased>1.5fold or rising >26.5umol/l within 48hours
Prevalence of homozygous SSD
2.0% of the population
Respiratory distress in severe malaria
Intercostal and subcostal recession
Increased respiratory rate
Grunting
Flaring Alae Nasi
Pathogenesis of SSD
Splenic and hepatic sequestrations
Hypersplenism
Intravascular and extravascular hemolysis
Flaring of the Alae nasi
Nasal flaring occurs when the nostrils widen while breathing
Differential diagnosis of respiratory distress in malaria
Pneumonia
Acidosis
Fluid overload
Aspiration
ARDS
Pathogenesis of heart failure in malaria
Anaemia
Lactic acidosis
Electrolyte imbalance
Electrolyte imbalances in malaria
Sodium
Potassium
Chlorides
Bicarbonates
Cerebral malaria
- Malaria parasetemia
- Unconsciousness BCS<3 /5 or GCS ,11/15
- No other cause of encephalopathy
Clinical signs of cerebral malaria
Convulsions
Coma
Posturing
Bruxism
Increased tone
Increase refelxes
Cranial nerve palsy
Differentials of cerebral malaria
Meningitis
Hepatic failure
Renal failure
Septicemia with metabolic imbalance
Endocrine causes
Bruxism
excessive grinding of the teeth or clenching of the jaw
Long term complications of severe malaria
Hearing loss
Visual impairment
Development regression
Independent prognostic Indicators of death or poor prognostic indicators in severe malaria
pCRT
Coma
Acidosis
Respiratory distress
Differentials for complicated malaria
Meningitis with encephalitis
Tonsillitis
Pharyngitis
Otitis media
Viral respiratory infection
Pneumonia
Typhoid fever
Measles
Parasitological diagnosis of malaria
Microscopy
Rapid Diagnostic test (RDT)
RDT can be positive up to ……… post parasite clearance.
4 weeks
Sensitivity of thick and thin blood films
Thick»Thin films for detecting low-density
Role of pCRT in malaria prognosis
prolonged Capillary Refill Time (>2sec) is an independent indicator of death in severe malaria
Antimalarials for severe malaria
IV/IM Artesunate
IM Artemethre
IM Quinine
Recommended medicine for severe malaria
IV/IM Artesunate
Dose of IV Artesunate
Children 20kg: 3mg/kg/dose
Children and adults>20kg: 2.4mg/kg/dose
0,12 and 24hrs
When is oral ACT started
4 hours after the last dose of IV Artesunate
Maximum duration of parenteral artesunate
7 days
Injection rate of IV artesunate
3-4 ml/minute
Solutions for reconstituting artesunate
Normal saline
5%Dextrose
Reconstituting of artesunate powder 60mg
- 5% NaHCO3 - 1ml
- N/S or D5W
5ml for IV
2ml for IM
Concentration of artesunate for IV and IM
IV- 10mg/ml
Im-20mg/ml
Dose for IM Artemether
3.2mg/kg loading dose
1.6mg/kg daily for 5 days
Side effects of quinine
Cinchonism
Hearing loss
Nausea
Uneasiness/restlessness
Tremors
Blurring of vision.
Hypoglycaemia
Cinchonism
ringing sounds in the ears -‐ tinnitus
How long should parenteral antimalarials be given
Minimum of 24 hours before switching to orals
Oral antimalarials
Artemether lumefantrine
Artesunate amodiaquine
Dihydroartemisinin piperaquine
Quinine clindamycin (pregnancy)
Oral dose of quinine
10mg/kg every 8 hours for 7 days. max;600mg/dose
Oral ACT avoided in pregnancy
Dihydroartemisinin piperaquine
