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Infectious disease > Malaria > Flashcards

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
Q

Potentially severe disease criteria

A

Parasitaemia >2%
<2% with schizons
<2% w clinical complications
(WHO 5%)

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26
Q

Severe disease malaria criteria

A

Complications present, regardless of parasitaemia

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27
Q

Where is p.vivax endemic

A

Asia, south america

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28
Q

Wheere is p.ovale more common

A

West and central africa

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29
Q

Features of benigin malraal disease

A

P.vivax, p.ovale, p.malariae
<2% paraesitaemia
Dormant liver stages - hypnozoites, relapsing malaria

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30
Q

What strain can cause neprotic syndrome in malaria

A

P.malariae
V rare malaria cause
Nephrotic syndrome is rare aswell

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31
Q

Treatment for severe/complicated malaria

A

IV quinine or artesunate

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32
Q

How does quinine treat malaraia

A

Prevents production of haemozoin in RBC - malaria parasite poisons itself

33
Q

Dose of quinine treatment of malaria

A

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
Q

Side effects of quinine

A

Cardiac toxicity
Cinchonism

35
Q

What ECG monitoring in quinine can show

A

Na channel blocking - electrical conduction disturb
QT intervals prolonged, QRS braod

36
Q

What conitnuing treating malaria with after IV quinine

A

Oral doxycyclcine, clindamycin

37
Q

What is cinchonism

A

Tinnutus, vertigo, headahce, nausea, abdo pains, visual disturbance occasionally blind

38
Q

CI to treatment with quinine

A

Heart condutction problems
Cinchonism causing visual disturbance

39
Q

How is artesunate given for malaria

A

2.4mg/kg IV at 0, 12, 24 hours then daily
Minimum 24 hrs therapy

40
Q

What can be seen after artesunate treatment

A

Delayed haemolysis (membrane instability)

41
Q

Mechanism of artesunate

A

Disrupts electric transport chani - RBC membrane instability
Broad spectrum anti arasite, v rapid clearance of parasite

42
Q

Which drug has greater survival from malaria in children

A

Artesunate

43
Q

Oral therapy for malaria

A

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
Q

Why does doxycycline have to be prescribed with oral quinine/after IV quinine

A

Quineine is narrow spectrum antiparasitic - does not kill off maturing parasites
Doxycycline does

45
Q

Hypnozoite therapy

A

Preventing relapse in vivax and ovale malaria
Primaquine 2 weeks
G6PD activity levels

46
Q

Why check G6PD levels with primaquine treatment

A

Increased risk of haemolysis due to oxidative stress by metabolising drug - lower dose drug for longer period of time

47
Q

Chemoprophylaxis for malaria - causal

A

Directe at hepatic stage - prevents enter blood
Continue for 7 days following last exposure
eg atovaquone/proguanil - maralone

48
Q

Supressive chemoprophylaxis of malarai

A

Against erythrocytic stage
cont 4 weeks post exposure
Chloroquine, doxycycline, mefloquine

49
Q

Why chloroquine used less for malarai prophylaxis

A

Global drug resistancce in malaria widespread

50
Q

What pale skinned indivuals warn with doxycycline

A

hypersensitivity to sun

51
Q

doxycycline side effects

A

gi upset
take with water while upright
moderate alcohol intake

52
Q

who is mefloquine CI in

A

Major depressive disorders, psychiatric conditions, seizure s neuropsych profile

53
Q

Physical prophylaxis malaria

A

Bed nets
Repellent esp after dusk
Long sleeved clothing
Accomodation

54
Q

Lab tests for malaria

A

FBC
Quantiative buffy coats
Thick and thin films
Immunochromatographic rapid diagnositc tests
PCR
Antibody detection - immunoassays, flurorescence

55
Q

What see on FBC in malaria

A

Low platelets
Leuco/neutropenia
DNA/RNA - fluroescent pops on haemotaology analysers on flow cytometry

56
Q

What is quantitative buffy coat screen

A

Blood -> acridine orange coated capillary tubes and centrifugues
Nucleic acid fluroesces when excited with blue light under fluroscent microscope

57
Q

Gold standard malarial screening and species differentiation

A

Thic and thin filmds

58
Q

What are thin films stained with

A

Methanol fix, MGG stain pH 6.8
Giemsa stained thin films 7.2 = additional information

59
Q

What stain are thick films used malaria

A

Fields stain - unfixed - needs to stand ofr an hour before stain
Mehtyl blue + stelin B = fields stain

60
Q

Rapid malaria diagnostic tests what are they and what test for

A

Immunochromatography
HRP2/pLDH monoclonal antibodies tested for on strip

61
Q

Which species are HRP2 and pLDH specific to

A

HRP2 - P.falciparum
pLDH = P.falciparu,, vivax, malariae, ovale

62
Q

Positive RMT for malaria

A

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
Q

PCR test for malaria

A

Parasiti nucleic acids detected by polymerase chain reaction
Sensitive, limitied use in acute health care settings - reference centres only. QUERY dual infection

64
Q

What used to screen blood donations

A

mALARIAL antibody tests eg immunoassays, fluroescense

65
Q

Routine investiations for mlaaria

A

FBC
Thick and thin films
Carestart combo rapid tests- HRP2, pLdh TESTS

66
Q

Gametocytes on blood film

A

Characteristic crescent shape
Dont appear in blood for first 4 weeks

67
Q

What se on blood film falciparum

A

Fine ring trophozoites
No red cell enlargement
Chromatin dots, multiple infestation

68
Q

What stain shows mauers clefts

A

Giemsa stain
Dots inside red cells

69
Q

P.vivax blood film

A

Red cells enlarged
Schuffners dots
Mature ring - large and coarse

70
Q

P.malariae on blood film

A

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
Q

P.ovale on blood film

A

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
Q

Microfilaria worms that can infect blood

A

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
Q

Samples taken for microfilia

A

MINIMUM of one day blood taken 1pm and one night blood at midnight

74
Q

Test of choice for W.bancrofti infection

A

Antigen testing
ICT filiaris test card

75
Q

Vector of loa loa (eye worm)

A

Manog fly
Microfiliaria - eye worms

76
Q

Features of loa loa

A

west and central africa
Diurnal periodicity
Curves and kinks in body
Nuclei dense and dark stain extend to rounded tail

77
Q

Fever patterns different strains

A

Vivax and ovale - tertian 48 hs
Malariea - quartian - 72 hrs
Falciparum - irregular spikes

78
Q

What is chloroquine CI in

A

Epilepsy, pregnancy

79
Q

When consider exchange therapy

A

if parasite count > 10% then exchange transfusion should be considered

Infectious disease (37 decks)

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