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Malaria > Malaria > Flashcards

Malaria Flashcards

1
Q

2022 Malaria cases/deaths, most prevalent continent

A

247 million cases worldwide (2022)
619,000 estimated deaths
Africa accounts for 95% of cases and 96% of deaths
children <5 estimated 80% of all deaths in Africa

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2
Q

what are the 5 different plasmodium spp

A

falciparum - Africa, Asia, south America
vivax - Asia, SE Asia, South America
ovale - W Africa
malariae - worldwide
knowlesi - SE Asia

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3
Q

Malaria life cycle - two stages

A

Liver stage - mos injects parasite - sporozoites to the liver, marazoites go to the blood stage. then to trophozite, make changes to RBC membranes - sexual stage- gametozytes - then ingested by mosquito during feeding and continues

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4
Q

erythrocytic schizogony

A

RBC(mature schizont) ruptures>8-24 merozoites and debris enter bloodstream
debris - parasites +malaria toxin = inflammatory cytokine release > fever

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5
Q

schizogony timing by species

A

q 24h - P.knowlesi >Quotidian fever
q 48h - P.falcip, vivax, ovale > Tertian fever
q 72h - P.malariae > Quartan fever
*Due to synchronized release of parasites from the RBCs

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6
Q

falciparum clinical

A

can be severe, fatality rate up to 20%
rings and gametocytes in perph circ., normal RBC size.
prepatent 9-11 days
incubation 9-14 days

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7
Q

vivax clinica

A

parasitemia < 2%
dormant hypnozoites in liver > weeks to mos after infection
relapse timing is geographically variable and strain dependent
immature RBCs requires Duffy agn to bind
prepatent period: 11-13 d
incubation period 12-12 d and up to 6-12 mos

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8
Q

travel related malaria infection annually

A

~30,000

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9
Q

transmission risk

A

depends on temp, humidity, rainfall
temp 20-33 C
doesn’t occur in all parts of endemic countries
No transmission above 2500 m, during cold seasons, in deserts and in areas where transm is interrupted through control/elimination
generally - closer to equator, more likely to be year-round

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10
Q

determine risk for malaria

A

where
when
style and duration of travel
who (increased risk, pregnant, VFR, child, etc)
nighttime exposure and resistance patterns

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11
Q

% travelers who got malaria

A

57% did not have a travel visit
68% of VFRs did not have a visit
80% of children wer VFRs

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12
Q

pregnant or plan to become pregnant with malaria risk area for travel

A

1 - advise to avoid travel if possible
2 - chemoproph very important - mefloquine or chloroquine

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13
Q

how long does it take for malaria “immunity to wain?

A

6 months

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14
Q

mosquito repellents

A

DEET 30-35%
Picardin 20%

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15
Q

mosquito insecticide

A

Permethrin - treat clothing, tents, nets, etc

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16
Q

mosquito spatial repellents

A

aerosol spray, vaporizer device or smoldering coil-pyrethroid (eg metofluthrin or allethrin)

17
Q

mosquito product not for <3 years old

A

oil of lemon eucalyptus

18
Q

main goal of malaria prophylaxis

A

prevent death from P falciparum

19
Q

P falciparum chloroquine resistance is everywhere except…

A

Caribbean, Central America(west of Panama Canal) and some countries in the Middle East

20
Q

P falciparum mefloquine resistance areas

A

border Thailand with Burma and Cambodia
Western provinces of Cambodia
Eastern states of Burma and Burma-China border
Borders of Laos and Burma and adjacent Thai-Cambodian border and Southern Vietnam

21
Q

P vivax chloroquine resistance

A

Papua New Guinea and Indonesia

22
Q

malarone

A

> 98% efficacy
SE: abd pain, N,V, HA, mouth sores, rash
not for pregnant or kids < 5kg (11lb), or severe renal dz with creatinine < 30mL/min
warfarin dosing may need adjustment d/t proguanil

23
Q

chloroquine and hydrochloroquine

A

weekly, at least a week prior and 4 weeks after
okay for pregnancy- all trimesters
SE: GI, HA, dizzy, blurred vision, pruritis
take with food

24
Q

doxy

A

SE: GI - take with food, sit upright
esophageal ulceration, sun sens, candida vag.
not for pregnancy or children under 8yo

25
Q

Mefloquine

A

efficacy PF, PV >90%
discontinuation rates 1-5%
okay for pregnancy
SE: GI, insomnia, abnormal dreams, depression, anxiety
severe neuropsych disorders leading to motor neuropathies- agitation, restless, mood changes, panic attacks
occasionally psych sxs continue for long time after d/c

26
Q

mefloquine contraindications

A

active or recent hx depression, GAD, psychosis, schizophrenia or other major psyc disorders or seizures
also do not use with cardiac conduction abnromalities
moderate 1/200, severe 1/10,000

27
Q

malaria med mode of action

A

malarone and primaquine are hepatic schizontacides
primaquine works on the hepatic hypnozoites
malarone, doxy, mefloquine act blood stage schizontacides

28
Q

primaquine

A

Must check G6PD deficiency
no pregnancy
P vivax primary prophy or antirelapse tx (terminal prophy)
primary - 1-2 days before, daily and 7 d after
PART - for 14 days after leaving the area

29
Q

tafenoquine

A

adults >16
primary prev- 3 days before leaving malaria area, then weekly until 1 wk after leaving the area
PART - presumptive antirelapse - 1 300 mg dose after leaving the malaria area
not for G6PD, pregnancy, nursing, keratopathy, not for psychotic disorder

30
Q

stand by malaria treatment

A

reliable - consider for longer trips in case they are diagnosed with malaria
preferred are malarone or artemether-lumefantrine
hold chemoproph during SBET, resume after

31
Q

malaria sxs

A

fever 6-10 hrs, HA, nausea, vomiting, abdominal pain, myalgia, tachycardia,

32
Q

severe malaria mortality rate

A

20% even with good treatment
clinical: impaired consciousness
resp distress, circulatory collapse, convulsions,
pulm edema, abn bleeding, jaundice, hemoglobinuria
Lab: severe anemia, hypoglyc, acidosis, renal imp, hypercactemia, hyperprasitemia

33
Q

severe malaria - early dx imperative

A

fever in returning travel is malaria until proven otherwise
thick and thin smears and a rapid test
repeat within 24 hours if negative
dx - falciparum vs non falciparum
get percent parasitemia
sever/complicated? then parental therapy and ICU

34
Q

malaria treatments

A

oral: malarone, quinine +doxy and artemether/lumefantrine
parenteral: IV artesunate, IV quinine
no benefit to steroids

35
Q
A

Malaria (1 decks)

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