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Malaria Flashcards

1
Q

What is the most common tropical parasitical infection

A

Malaria

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2
Q

What are the four species of the genus plasmodium

A

Ovale
Falciparum
Knowlesi
Vivax

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3
Q

Plasmodium parasite originated from which kind of monkeys

A

Macaque monkeys

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4
Q

What are the two distinct patterns of malarial transmission

A

Stable malaria transmission
Unstable malaria transmission

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5
Q

What is the incubation period of malaria

A

7 days or longer

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6
Q

Incubation period for P. falciparum

A

7-14 days

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7
Q

Incubation period for P. vivax

A

12-17 days

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8
Q

Incubation period for P. ovale

A

15-18 days

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9
Q

Incubation period for P. malariae

A

18-40 days

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10
Q

Incubation period for P. knowlesi

A

9-12 days

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11
Q

Which two species of plasmodium can remain dormant in the liver (hypnozoites) and relapse (caused by these persistent liver forms may appear months and rarely several years after exposure)

A

Vivax and ovale

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12
Q

……… is unable to infect red cells lacking the Duffy blood-group antigen as the antigen is the receptor for its merozoites.

A

P. vivax

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13
Q

What are some innate immunity mechanisms against malaria

A

Lack of Duffy antigen
G6PD deficiency
Alpha and beta thalassemia
Genotype AS

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14
Q

In malaria, if reinfection of the disease does not occur, the immunity wanes after …….. years

A

Five

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15
Q

Neonates are usually protected by maternal antibodies for how many months

A

6

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16
Q

What are some features of severe malaria

A

Severe anaemia (Hb<5g/dL)
Hypotension and shock (algid malaria) BP < 90/60 mmHg
Noncardiogenic pulmonary edema and acute respiratory distress syndrome
Hyperpyrexia (temperature 38.5°C)
Inability to take oral fluids/feeds, Repeated profuse vomiting
Prostration, i.e. generalized weakness so that the patient cannot walk or sit
Acute kidney injury due to acute tubular necrosis
Severe hemolysis with jaundice
Blackwater fever (Intravascular haemolysis and haemoglobinuria (without G6PD deficiency), increased bilirubin, acute tubular necrosis, haemoglobin casts)

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17
Q

What are some syndromes resulting from disorders from immunological responses to repeated

A

Nephrotic syndrome
Hyper-reactive malarial splenomegaly syndrome (HMS)

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18
Q

What is the pathophysiology of nephrotic syndrome, a complication of malaria normally in children

A

Antigen-antibody complex binds to the glomerular basement membrane immune complex glomerulopathy causing an intractable nephrotic syndrome which is not responsive to corticosteroids nor eradication of the malaria

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19
Q

It is a massive enlargement of the spleen due to an abnormal exaggerated immune response to repeated exposure to malaria parasites
It is characterized by massive splenomegaly (at least 10cm), hepatomegaly, polyclonal hypergammaglobulinemia, raised serum immunoglobulin M (IgM) levels and positive malaria antibody test
Hepatic sinusoidal lymphocytosis is also seen
Patient may have features of secondary hypersplenism
It responds clinically and immunologically to malaria prophylaxis with regression of splenomegaly by 40% by 6 months after start of therapy
Is a massive enlargement of the spleen due to an abnormal exaggerated immune response to repeated exposure to malaria parasites
•Is characterized by massive splenomegaly (at least 10cm), hepatomegaly, polyclonal hypergammaglobulinemia, raised serum immunoglobulin M (IgM) levels and positive malaria antibody test
Hepatic sinusoidal lymphocytosis is also seen
Patient may have features of secondary hypersplenism
It responds clinically and immunologically to malaria prophylaxis with regression of splenomegaly by 40% by 6 months after start of therapy
What syndrome is this

A

HMS

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20
Q

What is the major criteria for case definition in the Bates and Bedu-Addo diagnostic criteria for HMS

A

Gross splenomegaly 10 cm or more below the costal margin in adults for which no other cause can be found
Elevated serum IgM level 2 SDs or more above the local mean
Clinical and immunologic responses to antimalarial therapy
Regression of splenomegaly by 40% by 6 months after start of therapy
High IgG antibody levels to plasmodium species (≥1:800)

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21
Q

What is the minor criteria for case definition in the Bates and Bedu-Addo diagnostic criteria for HMS

A

Hepatic sinusoidal lymphocytosis
Normal cellular and humoral responses to antigenic challenge, including a normal phytohemagglutination response
Hypersplenism
Lymphocytic proliferation
Familial occurrence

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22
Q

The differential diagnosis of malaria include every condition that causes ……………………

A

Acute febrile illness

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23
Q

What are some differential diagnosis of malaria

A

Enteric fever, UTI, Pyelonephritis
COVID-19, Viral hemorrhagic fevers, HIV infection, Acute viral hepatitis and other viral illness
Pharyngitis, Sinusitis, Otitis media, Pneumonia, Tuberculosis
Gastroenteritis, Giardiasis, Amebiasis and amebic liver abscess
Pelvic inflammatory disease
Lymphoma
Meningitis, Encephalitis

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24
Q

What blood smear remains the mainstay of malaria

A

Giemsa stain

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25
Q

Which smear is useful for quantification discrimination of parasite species

A

Thin smear

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26
Q

Which smear is most sensitive for determining if malaria infection is present

A

Thick smears

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27
Q

A single negative blood film does not rule out falciparum malaria
True or false

A

True

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28
Q

The choice of RDT will depend on ……….

A

The species prevalent in that area. In most circumstances, the detection of P. falciparum is most important

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29
Q

Tests using ……….. are more sensitive for detecting P. falciparum than RDTs using pan-malarial antigens

A

HRP2

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30
Q

RDTs using pLDH are more suitable determining response to treatment and not HRP-2 tests. Why

A

RDTs may remain positive several days or weeks following effective treatment. HRP-2 antigen persists in the blood circulation 2–3 weeks after treatment and so is not useful for determining response to treatment; RDTs using pLDH are more suitable for this purpo

31
Q

In immune populations, highly sensitive molecular tests, such as ………, have limited value because subclinical infections, which are not routinely treated, are common

A

PCR

32
Q

What condition is the most common cause of fever in the tropics

A

Malaria

33
Q

Symptomatic malaria is caused only by the ………… stage of infection

A

Erythrocytic

34
Q

Available antimalarial drugs act against the erythrocytic stage, except for ……….., which acts principally against hepatic parasites

A

Primaquine

35
Q

What is amodiaquine used to treat

A

Treatment of P. falciparum, optimally in fixed dose combination with artesunate

36
Q

What is sulfadoxine-pyrimethamine used to treat

A

Treatment of P. falciparum, optimally in combination with artesunate, intermittent preventive therapy

37
Q

What are the artemisinins (artesunate, artemether, dihydroartemisinin) used to treat

A

Treatment of P. falciparum, in oral combination regimens for uncomplicated disease and parenterally for severe malaria

38
Q

WHO recommends 6 artemisinin-based combination therapies (ACTs) as first-line therapies for falciparum malaria in nearly all endemic countries. What are these ACTs

A

Artemether + Lumefantrine
Artesunate + Amodiaquine
Artesunate + Mefloquine
Artesunate + Pyronaridine
Artesunate + Sulfadoxine –pyrimethamine

39
Q

Severe malaria is a medical emergency
True or false

A

True

40
Q

………….. treatment is indicated for all patients with severe malaria

A

Parenteral

41
Q

The standard of care for severe malaria is ……………….

A

Intravenous artesunate

42
Q

Intravenous artesunate has been shown to be superior to ………. for the treatment of severe malaria in adults and WHO recommends that IV artesunate be used in preference to quinine for severe falciparum malaria

A

Quinine

43
Q

What is the dose of administration for IV artesunate

A

Intravenous artesunate is administered in four doses of 2.4 mg/kg over 3 days, every 12 hours on day 1, and then daily

44
Q

Parenteral therapy should be given for at least …… hours with step down to a full course of an oral ……. or oral………. plus ……… once the patient improves

A

24, ACT, quinine, doxycycline

45
Q

What is the first line drug for non-falciparum malaria from most areas

A

Chloroquine

46
Q

For P vivax or P ovale, eradication of erythrocytic parasites with chloroquine should be accompanied by treatment with ………….. or ………….. (R/O G6PD deficiency) to eradicate hypnozoites, which may lead to relapses with recurrent erythrocytic infection and malaria symptoms after weeks to months if left untreated

A

Primaquine, Tafenoquine

47
Q

What are P. malariae infections treated with

A

Chloroquine

48
Q

What are some supportive treatments for malaria

A

Oral or rectal paracetamol and tepid sponging
Rehydration with IV fluids for hypovolaemia, electrolyte disorders and acidosis
Monitoring renal function and initiating dialysis if indicated
Blood transfusion when there are strong clinical indications; e.g., when the haemoglobin concentration is < 5 g/dL or at higher levels if accompanied by hyperparasitaemia
Anticonvulsants if indicated
Monitoring of blood glucose and correction of hypoglycaemia where necessary
Treating DIC if severe enough to cause bleeding; fresh whole blood and fresh frozen plasma may be given

49
Q

What are some prognosis for malaria

A

When treated appropriately, uncomplicated malaria generally responds well, with resolution of fevers within 1–2 days
Prompt effective treatment reduces the risk of progression to severe disease
Severe malaria can progress to death, but many children respond well to therapy
With effective treatment most children with cerebral malaria will recover with a minority (5–10%) left with a neurological deficit, such as hemiparesis, cerebellar ataxia or epilepsy
Pregnant women are at particular risk during their first pregnancy
Malaria in pregnancy also increases the likelihood of poor pregnancy outcomes, with increased prematurity, low birth weight, and mortality

50
Q

Which part of Asia is considered as the birthplace of antimalarial resistance

A

South-East Asia and in particular, the Thai-Cambodian border area

This refers to the observation that parasite drug resistance to CQ, SP and mefloquine was first observed in this area, before spreading to other parts of Asia and onto Africa

51
Q

Which four countries has been documented to show decreased sensitivity of P. falciparum to artemisinins

A

Cambodia
Myanmar
Thailand
Vietnam

52
Q

There is also evidence of a decline in the efficacy of Quinine in parts of …………

A

South-East Asia

53
Q

What is recrudescence in malaria

A

Recrudescence means that the infection has recurred from persistent blood stages of the malaria parasite. Symptoms return after a symptom-free period, and it is caused by parasites surviving in the blood as a result of inadequate or ineffective treatment

54
Q

What is relapse in malaria

A

Relapse is when symptoms reappear after the parasites have been eliminated from blood but persist as dormant hypnozoites in liver cells

55
Q

Episodes of illness may recur after the primary infection due to recrudescence of small numbers of blood stage parasites. Which species of plasmodium are responsible for this

A

P. falciparum
P. malariae

56
Q

Recurrent fever may occur due to relapse from liver hypnozoites. What plasmodium species are responsible for these

A

P. vivax and P. ovale

57
Q

Relapses occur despite drug treatment to eliminate the red cell parasite stages in primary infection and can only be prevented by specific therapy to achieve a ‘radical’ cure with the eradication of the hypnozoites
True or false

A

True

58
Q

Chemoprophylactic regimen are fully protective
True or false

A

False. No chemoprophylactic regimen is fully protective

59
Q

List some vulnerable groups chemoprophylactic measures are recommended for

A

Pregnant women
Non-immune travelers

60
Q

Mention some chemoprophylaxis for malaria

A

Atovaquone-proguanil (Malarone)
Doxycycline
Mefloquine
Chloroquine-sensitive parasites, Primaquine
Tafenoquine
Sulfadoxine-pyrimethamine (SP)

61
Q

What is the dose range for artemether and lumefantrine

A

Artemether - 1.4-4 mg/kg
Lumefantrine - 10-16mg/kg

62
Q

There is a fixed-dose formulation with dispersible or standard tablets of artemether and lumefantrine. What is the mass (in mg) of artemether and lumefantrine in the drug

A

20g of artemether and 120g of lumefantrine and 80mg of artemether and 480mg of lumefantrine

63
Q

What is the dosing regimen time for artemether-lumefantrine

A

0, 8hours, then 12hourly for a total of 3 days

64
Q

What is the dose of artesunate-amodiaquine

A

A dose of 4 mg/kg/day artesunate and 10 mg/kg/day amodiaquine is given once or twice a day for 3 days

65
Q

What is the dosing for dihydroartemisinin-piperaquine

A

A dose of 4 mg/kg/day dihydroartemisinin and 18 mg/kg/day piperaquine once a day for 3 days

66
Q

In order of preference, what are the available options for anti-malarial medication for severe malaria

A

IV/IM Artesunate
IM Artemether
IV/IM Quinine

67
Q

In what form should quinine be given

A

Quinine should be given either by IV in dextrose infusion or IM until patient can swallow, then treatment shall be continued with oral quinine

Blood glucose should be monitored every 4–6 hours, and 5–10% dextrose may be co-administered to decrease the likelihood of hypoglycemia

68
Q

Quinine should always be given by slow rate-controlled infusion, never by bolus intravenous injection
True or false

A

True

69
Q

Quinine causes QTc prolongation and ideally patients receiving intravenous quinine should receive continuous cardiac monitoring; if QTc prolongation exceeds 25% of baseline, the infusion rate should be reduced
True or false

A

True

70
Q

What is the dosing of IM quinine

A

IM Quinine: 10 mg/Kg body weight given 8 hourly by deep IM injection, to a maximum dose of 600 mg

71
Q

What is the dosing for IV Quinine

A

IV Quinine: 10mg per kg body weight of Quinine Hydrochloride salt

72
Q

What is the dosing of IV/IM artesunate

A

IV / IM Artesunate: 2.4 mg/kg body weight given IV/IM on admission (time =0 hour), then at 12 hours and 24 hours then every 24 hours daily till the patient can tolerate oral therapy or up a maximum of seven days

73
Q

What is the dosing of IM artemether

A

IM Artemether: 3.2mg per kg body weight as a loading dose, then 1.6mg/kg body weight daily till the patient can tolerate oral therapy or up to a maximum

74
Q

Give an example of a molecular diagnostic test that is highly sensitive but not available for routine diagnosis of the malaria parasite

A

Loop-mediated isothermal amplification (LAMP)

Medicine (38 decks)

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