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a. block e microbiology > Malaria > Flashcards

Malaria Flashcards

1
Q

Malaria is a disease caused by Plasmodium protozoa which is spread by the female Anopheles mosquito. In 2021, how many imported cases of malaria were reported in the UK?

1 - 12
2 - 101
3 - 1012
4 - 10,100

A

3 - 1012

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2
Q

Is Malaria a notifiable disease?

A
  • Yes
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3
Q

Of the following, where is malaria LEAST prominent?

1 - North Africa
2 - North and South America
3 - South East Asia
4 - South Africa

A

2 - North and South America

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4
Q

There are four different species that can cause malaria in humans, but which is the most common and most severe?

1 - Plasmodium falciparum
2 - Plasmodium vivax
3 - Plasmodium ovale
4 - Plasmodium malariae

A

1 - Plasmodium falciparum

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5
Q

Which of the following is NOT a protective factor against being infected by malaria?

1 - G6PD deficiency
2 - HLA-B53
3 - Sickle cell disease
4 - Haemophilia
5 - Absence of Duffy antigens

A

4 - Haemophilia

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6
Q

Which organ does the parasites (termed sporozoites) target once infected?

1 - lungs
2 - spleen
3 - liver
4 - kidneys

A

3 - liver

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7
Q

In the liver the parasites divide asexually over 10 days, maturing into schizonts, following which they emerge from the liver (as merozoites) and infect which cells?

1 - RBCs
2 - WBCs
3 - Platelets
4 - B cells

A

1 - RBCs

Appear as tiny rings

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8
Q

Once the parasite has infected RBCs, the infected RBCs are sequestered by various tissues (hidden away). 2 of the species are able to lay down hypnozoites in the liver, which cannot be affected by conventional antimalarial drugs and can hence reactivate after months or years. Which 2 of the following species are these?

1 - Plasmodium falciparum
2 - Plasmodium vivax
3 - Plasmodium ovale
4 - Plasmodium malariae

A

2 - Plasmodium vivax
3 - Plasmodium ovale

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9
Q

What is the typical incubation period of malaria?

1 - 24-72h
2 - 3-7 days
3 - 3-11 days
4 - 1->21 days

A

4 - 1->21 days

Can have a short or long incubation period

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10
Q

Malaria can cause prodromal symptoms once infected. Which of the following is NOT a typical symptom during the prodromal phase?

1 - malaise
2 - headache
3 - photophobia
4 - fatigue
5 - myalgias
6 - arthralgias

A

3 - photophobia

These non-specific symptoms can precede the onset of fever by several days.

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11
Q

A hallmark of malaria infection is fever, but is this fever constant?

A
  • no

Fever can present with periodic episodes

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12
Q

Which w of the following can cause a biphasic fever, meaning it rises and falls twice a day?

1 - malaria
2 - typhoid fever
3 - sepsis
4 - viral pneumonia
5 - dengue fever

A

1 - malaria
5 - dengue fever

Typhoid fever and viral pneumonia cause a constantly raised fever
Sepsis causes intermittent fevers

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13
Q

Is a virus or bacteria more likely to cause a consistently high fever?

A
  • Viral
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14
Q

Match the fever presentation with the species of parasite?

  • Plasmodium falciparum, Plasmodium vivax and Plasmodium ovale and Plasmodium malariae
  • random timings, every 48h (2 parasites do this), every 72 hours
A
  • Plasmodium falciparum = random timings
  • Plasmodium vivax and Plasmodium ovale = every 48h
    Plasmodium malariae = every 72 hours
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15
Q

Which 2 organs can become enlarged in a malaria infection due to sequestering of infected RBCs?

1 - spleen
2 - kidneys
3 - heart
4 - liver

A

1 - spleen
4 - liver
Hepatosplenomegaly

Spleen clears parasitized erythrocytes from circulation. Increased risk of splenic rupture

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16
Q

Hepatomegaly can occur in malaria infection, as can all of the following, EXCEPT which one?

1 - nausea
2 - jaundice
3 - vomiting
4 - abdominal pain
5 - diarrhoea
6 - lymphadenopathy

A

6 - lymphadenopathy

17
Q

Which of the following neurological symptoms can manifest in a malaria infection?

1 - cerebral malaria
2 - nystagmus
3 - cranial nerve palsies
4 - focal neurological deficits.
5 - all of the above

A

5 - all of the above

Cerebral malaria is very severe

18
Q

Which of the following is most likely to occur in malaria?

1 - anaemia
2 - thrombocytopenia
3 - leukcytopenia
4 - pancytopenia

A

1 - anaemia

Intravascular haemolysis due to the destruction of parasitized erythrocytes can lead to anaemia in malaria patients

DIC can occur

19
Q

Which of the following groups should avoid endemic areas of malaria?

1 - pregnant women
2 - sickle cell disease patients
3 - T2DM
4 - G6PD deficient patient

A

1 - pregnant women

If cannot avoid, give them chloroquine

Native individual from infectious area develop immunity, but quickly lose it when they leave area

20
Q

Which of the following is NOT a characteristics of a blood sample in an infected patient with malaria?

1 - thrombocythaemia is characteristic
2 - normochromic normocytic anaemia
3 - normal white cell count
4 - reticulocytosis
5 - normochromic microcytic anaemia

A

5 - normochromic microcytic anaemia

No problem with iron so would be normal size

Reticulocytes are increased as RBCs are being broken down due to infected RBCs with parasites

21
Q

What test remains the gold standard for diagnosing malaria?

1 - CRP
2 - PCR
3 - blood film
4 - rapid diagnostic tests (detecting plasmodial histidine-rich protein

A

3 - blood film

Thick and thin smears, with thin best for identifying the parasite

22
Q

Which 2 of the following are tests used to diagnose malaria?

1 - thin blood film smear
2 - rapid diagnostic test
3 - thick blood film smear
4 - all of the above

A

4 - all of the above

23
Q

What stain is used in thick and thin blood smears when trying to diagnose malaria?

1 - giemsa stain
2 - acid fast stain
3 - gram stain
4 - ziehl–neelsen stain

A

1 - giemsa stain

24
Q

The thin and thick blood film tests and rapid diagnostic test (RDT)
can be used to diagnose malaria. Which are preferred?

A
  • thick and think blood smears
  • RDT done in addition
25
Q

If a thick of thin blood film smear is negative, does that automatically mean the patient doesn’t have malaria?

A
  • no
  • blood smear should be repeated between 12-24h and then again at 24h
  • if all are negative then patient is unlikely to have malaria
26
Q

Which of the following is the 1st line treatment option for a patient with uncomplicated falciparum malaria?

1 - Atovaquone–proguanil
2 - IV ARTESUNATE
3 - Artemether with lumefantrine
4 - Quinine plus doxycycline

A

3 - Artemether with lumefantrine
- Artemisinin is combined with other drugs due to drug resistance

27
Q

Which of the following is the 1st line treatment option for a patient with severe (comolicated) falciparum malaria?

1 - Atovaquone–proguanil
2 - IV ARTESUNATE
3 - Artemisinin combination therapy (ACT)
4 - Quinine plus doxycycline

A

2 - IV ARTESUNATE
able to act at the ring stage called the tropnozite
- reduces infection and complications of infection

Page should be managed on a high dependancy unit though

28
Q

Which of the following medications should be used in non-Plasmodium falciparum infections?

1 - Atovaquone–proguanil
2 - IV ARTESUNATE
3 - Artemisinin combination therapy (ACT)
4 - Quinine plus doxycycline
5 - Primaquine

A

5 - Primaquine

29
Q

Which of the following is safe in pregnant women who have been diagnosed with malaria?

1 - Chloroquine and proguanil
2 - Doxycycline
3 - Atovaquone/proguanil
4 - any of the above

A

1 - Chloroquine and proguanil

Others are either contraindicated or no evidence supporting their use

30
Q

If a patient is returning from the tropics with a fever, what is the diagnosis, until proven otherwise?

1 - enteric fever
2 - malaria
3 - dengue
4 - rickettsia

A

2 - malaria

31
Q

Does mlaria typically cause a high or low neutrophilia?

A
  • low

Intracellular = low neutrophils
Pathogens MUST enter cells to replicate

Extracellular = high neutrophils
Pathogens do NOT need to enter cells to replicate

If pathogen is inside the cell the neutrophils cannot target it, and therefore neutrophils are low

32
Q

If a patients platelets are normal, which 2 of the following would you rule out?

1 - malaria
2 - dengue
3 - enteric fever
4 - lyme disease

A

1 - malaria
2 - dengue

Almost always LOW platelets

33
Q

Is CRP typically higher in viral or bacterial infections?

A
  • bacterial

Viral = lower CRP
Bacterial = higher CRP

34
Q

A 22yr old male GAP yr student spends 3 months in The Gambia and returned 1 week ago. Fever for 3 out of 7 days with rigors and headache.

O/E Temp 380C P110 BP 125/70
No localising features

Hb 11.2 WBC 3.8 Plt 72 CRP 76
U&E normal Bil 35 Transaminases normal

Which of these results would make you rule out enteric fever?

A
  • CRP = typically higher in bacteria
    Here is is close to 70, which suggests a viral cause
35
Q

A 22yr old male GAP yr student spends 3 months in The Gambia and returned 1 week ago. Fever for 3 out of 7 days with rigors and headache.

O/E Temp 380C P110 BP 125/70
No localising features

Hb 11.2 WBC 3.8 Plt 72 CRP 76
U&E normal Bil 35 Transaminases normal

Which of these results would make you think of malaria as a potential cause?

A
  • lower CRP (close to 70)
  • low platelets
  • travelled to Gambia in Africa where Malaria is common

a. block e microbiology (38 decks)

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