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Malaria Flashcards

1
Q

Where is malaria endemic

A

The whole tropical belt
Especially subsaharan africa

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2
Q

Who is malaria most common in

A

Childhood, neonates and pregnant women

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3
Q

Vector for malaria

A

Female anopheline mosquitos
esp anophelese gambiae

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4
Q

Five plasmodial species of malaria - plasmodium:

A

Falciparum
Vivax
Ovale
Malariae
Knowlesii - infrequent, zoonotic

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5
Q

What strain of malaria is most fatal

A

Falciparum

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6
Q

What two species can cause a dormant liver stage and therefore relapses

A

Vivax and ovale

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7
Q

PLasmodium malariae features

A

Chronic low level infection years to decades fluctuating

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8
Q

Cases of malaria and UK

A

1500-2000 cases per year

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9
Q

Where do most cases of malaria in UK come from

A

West africa - nigeria
Often holidaymakers, people who have family there

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10
Q

What is the life cycle of mlaaria

A

Female anopheline mosquito injects sporozoites into blood stream -> liver -> enter hepatic cell -> hepatic schizont (binary fission)
After 7 dyas rupture -> merozoites -> infect RBCs
Each RBC -> trophpzoites, plasmodium replicates -> schizont (haemozoin made in metabolism)
60s
-> cycles of red cell rupture every 48 hrs ->
gametocytes - sexual infection.

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11
Q

What immune protection naturally get in endemic areas

A

Immune cells in skin - goes after 6 months outside of malaria endemic areas

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12
Q

Why get spikes in fever on 48 hour basis

A

RBC schizonts (infected RBCs) rupture and release sporozoites into bloodstream every 48 hours

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13
Q

What allows plasmodium vivax to remain dormant

A

Vivax -> hypnozoites in liver - remain dormant and only rupture far down line

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14
Q

Pathology of malaria

A

RBC schizont rupture -> haemolytic anaemia
Glucose decreased (used)
Decreased liver function - hepatitis and splenomegaly
Exposure to damaged tissue - complement cascades and platelet aggregation - DIC

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15
Q

Sequestrian of infected RBC malaria

A

Altered rheology - less flexible
Electrical charge positive
Intra-cellular adhesion
More difficult to pass through microcirculation - omre likely to adhere to each other, other cells and internal cell wall

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16
Q

What organs are particuarly sensitivie to RBC infected

A

Brain
Kidneys
bell mesentery
Extremities
Pulmonary bed

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17
Q

What are severe features of malaria

A

Cerebral malaria w reduced GCS/seizures
Renal failure + anuria
ARDS
Tissue acidosis - microinfarct
Coagulopathy - exacerbated by tissue damage

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18
Q

Symptoms of malaria

A

FEVER
Rigors
Headache +/- confusion
Myalgia, arthralgia,
Nausea, vommitting, diarrhoea, dark urine

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19
Q

When do blood film for mlalaria

A

Anyone with fever returingin from endemic area

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20
Q

Signs of malaria

A

May be present, may be absent
Doesnt rule out
Fever
Jaundice
Pallor
Splenomegaly, hepatomegaly
Altered consciousness
Focal neurological signs
Coma

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21
Q

Indications for IV treatmnet in malaria (sev)

A

Cerebral involvement - reduced GCS/sezirues
Anaemia - Hb<8
Lactic acidosis <7.3
Renal failure Cr>265, <0.4ml/kg/hr urine - dark
Pulmonary oedema/ARDS
hypoglycaemia - BM <2.2 mmol/L
Shock - BP <90/60 (refractory to fluid resus)
Bleeding/DIC
Haemoglobinuria

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22
Q

How is severity of malrai graded

A

Proportion of infected RBCs on microsocpe of thin films

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23
Q

How will severity increase soon if see schizon on blood film

A

10 fold extremely soon - schizon about to rupture and infect 10x more RBC

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24
Q

Uncomplicated malaraia criteria

A

Parasitaemia <2%
No schizonts
No clinical complications
Oral treamtnet
(WHO recommends 5% - globally not UK)

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25
Potentially severe disease criteria
Parasitaemia >2% <2% with schizons <2% w clinical complications (WHO 5%)
26
Severe disease malaria criteria
Complications present, regardless of parasitaemia
27
Where is p.vivax endemic
Asia, south america
28
Wheere is p.ovale more common
West and central africa
29
Features of benigin malraal disease
P.vivax, p.ovale, p.malariae <2% paraesitaemia Dormant liver stages - hypnozoites, relapsing malaria
30
What strain can cause neprotic syndrome in malaria
P.malariae V rare malaria cause Nephrotic syndrome is rare aswell
31
Treatment for severe/complicated malaria
IV quinine or artesunate
32
How does quinine treat malaraia
Prevents production of haemozoin in RBC - malaria parasite poisons itself
33
Dose of quinine treatment of malaria
Loading dose 20mg/kg in 5% dextrose or dextrose saline >4 hours Then 10mg/kg/8 hours for first 48 hrs Then reduced to 12 hrly quinine if ocntinued
34
Side effects of quinine
Cardiac toxicity Cinchonism
35
What ECG monitoring in quinine can show
Na channel blocking - electrical conduction disturb QT intervals prolonged, QRS braod
36
What conitnuing treating malaria with after IV quinine
Oral doxycyclcine, clindamycin
37
What is cinchonism
Tinnutus, vertigo, headahce, nausea, abdo pains, visual disturbance occasionally blind
38
CI to treatment with quinine
Heart condutction problems Cinchonism causing visual disturbance
39
How is artesunate given for malaria
2.4mg/kg IV at 0, 12, 24 hours then daily Minimum 24 hrs therapy
40
What can be seen after artesunate treatment
Delayed haemolysis (membrane instability)
41
Mechanism of artesunate
Disrupts electric transport chani - RBC membrane instability Broad spectrum anti arasite, v rapid clearance of parasite
42
Which drug has greater survival from malaria in children
Artesunate
43
Oral therapy for malaria
Artemether-lumefantrine (riomet/aloo) 4 tablets immediate, 8, 24, 36, 48 and 60 hrs Atovaquone/proguanil (malarone) - 4 tablets daily for 3 days Oral quinine sulphate 500mg 8hrly quinine for 5-7 days + doxycycline -200mg daily for 7 days or clindamycin (450mg 8hrly)
44
Why does doxycycline have to be prescribed with oral quinine/after IV quinine
Quineine is narrow spectrum antiparasitic - does not kill off maturing parasites Doxycycline does
45
Hypnozoite therapy
Preventing relapse in vivax and ovale malaria Primaquine 2 weeks G6PD activity levels
46
Why check G6PD levels with primaquine treatment
Increased risk of haemolysis due to oxidative stress by metabolising drug - lower dose drug for longer period of time
47
Chemoprophylaxis for malaria - causal
Directe at hepatic stage - prevents enter blood Continue for 7 days following last exposure eg atovaquone/proguanil - maralone
48
Supressive chemoprophylaxis of malarai
Against erythrocytic stage cont 4 weeks post exposure Chloroquine, doxycycline, mefloquine
49
Why chloroquine used less for malarai prophylaxis
Global drug resistancce in malaria widespread
50
What pale skinned indivuals warn with doxycycline
hypersensitivity to sun
51
doxycycline side effects
gi upset take with water while upright moderate alcohol intake
52
who is mefloquine CI in
Major depressive disorders, psychiatric conditions, seizure s neuropsych profile
53
Physical prophylaxis malaria
Bed nets Repellent esp after dusk Long sleeved clothing Accomodation
54
Lab tests for malaria
FBC Quantiative buffy coats Thick and thin films Immunochromatographic rapid diagnositc tests PCR Antibody detection - immunoassays, flurorescence
55
What see on FBC in malaria
Low platelets Leuco/neutropenia DNA/RNA - fluroescent pops on haemotaology analysers on flow cytometry
56
What is quantitative buffy coat screen
Blood -> acridine orange coated capillary tubes and centrifugues Nucleic acid fluroesces when excited with blue light under fluroscent microscope
57
Gold standard malarial screening and species differentiation
Thic and thin filmds
58
What are thin films stained with
Methanol fix, MGG stain pH 6.8 Giemsa stained thin films 7.2 = additional information
59
What stain are thick films used malaria
Fields stain - unfixed - needs to stand ofr an hour before stain Mehtyl blue + stelin B = fields stain
60
Rapid malaria diagnostic tests what are they and what test for
Immunochromatography HRP2/pLDH monoclonal antibodies tested for on strip
61
Which species are HRP2 and pLDH specific to
HRP2 - P.falciparum pLDH = P.falciparu,, vivax, malariae, ovale
62
Positive RMT for malaria
P.falciparum = control and line 1 P.vivax, malariae, ovale - control and line 2 All 3 lines = p.falciparum +/- mixed infection Can get false positives
63
PCR test for malaria
Parasiti nucleic acids detected by polymerase chain reaction Sensitive, limitied use in acute health care settings - reference centres only. QUERY dual infection
64
What used to screen blood donations
mALARIAL antibody tests eg immunoassays, fluroescense
65
Routine investiations for mlaaria
FBC Thick and thin films Carestart combo rapid tests- HRP2, pLdh TESTS
66
Gametocytes on blood film
Characteristic crescent shape Dont appear in blood for first 4 weeks
67
What se on blood film falciparum
Fine ring trophozoites No red cell enlargement Chromatin dots, multiple infestation
68
What stain shows mauers clefts
Giemsa stain Dots inside red cells
69
P.vivax blood film
Red cells enlarged Schuffners dots Mature ring - large and coarse
70
P.malariae on blood film
Ring forms squarish appearance bAND FORMS mATURE SCHIZONTS - DAISY head appearance, up to 10 merozoites No RBC enlarged Chromatin dot on inner surg=face ring Abundant haemozoin
71
P.ovale on blood film
Enlarged RBC Large and coarse rings Comet forms common, fimbriated - jagged edge Mature schizonts large and coarse,6-1 merozoites similar to p.malariae James dots - coarse
72
Microfilaria worms that can infect blood
Below in lymph and vessles Most - Wuchereria bancrofti Brugia malayi Brugia timori Loa loa - SC and subconjunctival tissue Mansonella perstans - cavities Mansonella ozzardi - mesenteric tissue
73
Samples taken for microfilia
MINIMUM of one day blood taken 1pm and one night blood at midnight
74
Test of choice for W.bancrofti infection
Antigen testing ICT filiaris test card
75
Vector of loa loa (eye worm)
Manog fly Microfiliaria - eye worms
76
Features of loa loa
west and central africa Diurnal periodicity Curves and kinks in body Nuclei dense and dark stain extend to rounded tail
77
Fever patterns different strains
Vivax and ovale - tertian 48 hs Malariea - quartian - 72 hrs Falciparum - irregular spikes
78
What is chloroquine CI in
Epilepsy, pregnancy
79
When consider exchange therapy
if parasite count > 10% then exchange transfusion should be considered

Infectious disease (37 decks)

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