Malaria

Question 1

How is malaria controlled in Malawi (2)

Answer 1

1. malaria vector control
   -ITNs
   -Indoor residual spraying
2. case management
   - diagnostic testing
   -prescribing anti malarial drugs

Question 2

Why is malaria a big deal (3)

Answer 2

• its a predominant disease burden in children under 5 and pregnant women
• its responsible for half a million deaths annually
• it can cause repeated admissions, chronic malaria, economic burden

Question 3

What are the types of malaria (5)

Answer 3

• plasmodium falciparum
• plasmodium knowlesi
• plasmodium vivax and ovale
• plasmodium malariae

Question 4

What is the most dominant type of malaria in malawi and what does it cause

Answer 4

-plasmodium falciparum
- it causes the most severe disease

Question 5

What test do you do in a suspected uncomplicated malaria

Answer 5

MRDT

Question 6

who do you suspect uncomplicated malaria in (2)

Answer 6

• a child with reported fever
• an adult with recorded fever and a correlated symptom

Question 7

what test do you do in suspected complicated malaria

Answer 7

blood film

Question 8

what rx should you start in someone with suspected complicated malaria

Answer 8

artesunate iv

Question 9

what are symptoms for uncomplicated malaria (6)

Answer 9

• headache
  -fever
  -diaphoresis
  -nausea and vomiting
  -hepatosplenomegaly
  -jaundice

Question 10

what are signs of severe malaria (8)

Answer 10

-impaired consciousness
- respiratory distress (acidosis)
-> 1 convulsion
-shock
-pulmonary edema (ARDS) on CXR
- abnormal bleeding (DIC)
-jaundice
-hemoglobinuria (black water fever)
-AKI

Question 11

what labs should you be assessing in severe malaria (6)

Answer 11

• severe anemia
  -hypoglycemia
  -renal impairment
  -hyperparasitemia >10%
  -high lactate
  -acidosis

Question 12

what severe presentation do you see in adults (5)

Answer 12

• AKI- acute tubular necrosis
  -jaundice (due to hemolysis, cholestasis)
  -ARDS
  -secondary p vivax infection
  -blackwater fever due to hemoglobinuria

Question 13

what severe presentation do you see in children (5)

Answer 13

• cerebral malaria
  -anemia
  -acidosis
  -hypoglycemia due to liver dysfunction, quinine
  -blackwater fever

Question 14

what does malaria do in pregnancy

Answer 14

produces an immunological response which renders your previous acquired immunity useless

Question 15

what problems can malaria cause in pregnancy (6)

Answer 15

• maternal anemia
• fetal anemia
• LBW
• still birth
• spontaneous miscarriage/ abortion
• premature labor

Question 16

whats the relationship between malaria and HIV (4)

Answer 16

-malaria worsens HIV by increasing the viral load
- HIV worsens malaria
-HIV patients are at increased risk for clinical malaria
- the risk of malaria is higher in advanced HIV

Question 17

How can you prevent malaria in HIV (3)

Answer 17

• CPT (cotrimoxazole) reduces the risk of malaria
• ARV
  -ITN

Question 18

how to do manage a malaria patient

Answer 18

ABCDE

Question 19

what key investigation do you do in malaria (3)

Answer 19

-RBS
-MRDT/ BF
-FBC

Question 20

how do you treat uncomplicated malaria

Answer 20

lumefantrine artemether (LA)

Question 21

how do you treat severe malaria

Answer 21

Artesunate IV

Question 22

what is the best supportive management you can give (4)

Answer 22

-blood transfusion (Hb<6/ Hb<7 with acidosis or heart failure)
-fluids
-anti epileptic drugs like diazepam/ phenobarbitone
- concomitant bacterial infection (raised WCC)

Question 23

Ho can you reduce mosquitoes

Answer 23

with indoor residual spraying (IRS) (its expensive)

Question 24

how can you prevent mosquito bites

Answer 24

Insecticide treated nets (ITN)

Question 25

what chemoprophylaxis can you use for prevention (3)

Answer 25

Pregnant- sulfadoxine-Pyrimethamine (SP)
HIV- CPT
Travelers- doxycycline, atovaquone-proguanil (malarone), mefloquine

Question 26

malaria in pregnancy affects who

Answer 26

the fetus mostly

Question 27

how do you treat malaria

Answer 27

with artemether based drugs