Malaria Flashcards
What is the main geographic area affected by malaria?
Sub-Saharan Africa and Southeast Asia
Malaria contributes disproportionately to the global burden of infectious diseases, especially in these regions.
In 2015, how many countries had ongoing malaria transmission according to the World Health Organization?
97 countries
Almost half the world’s population lived in areas with some risk of malaria transmission.
What percentage of malaria cases in 2015 occurred in Africa?
88% (188 million)
Africa is the area of the world with the highest HIV prevalence.
How many deaths were attributable to malaria in 2015?
Approximately 438,000 deaths
~90% of these deaths occurred in Africa.
What are the five species of Plasmodium that can cause malaria in humans?
- Plasmodium falciparum
- Plasmodium vivax
- Plasmodium ovale
- Plasmodium malariae
- Plasmodium knowlesi
P. knowlesi is a zoonotic species that also infects macaques.
Which Plasmodium species represents the most serious public health problem?
Plasmodium falciparum
It has a tendency toward severe or fatal infections.
True or False: P. vivax infections are more common than P. falciparum infections.
True
P. vivax infections occur in a wider geographic distribution.
What is the primary mode of malaria transmission?
Bite of an infected female Anopheles sp. mosquito
Other routes like vertical transmission and blood transfusion are uncommon in non-endemic areas.
What is the significance of malaria and HIV co-infection?
Both cause substantial morbidity and mortality, particularly in sub-Saharan Africa
They influence each other’s natural history and severity.
What is the incubation period for P. falciparum malaria?
From a week to several months, most often less than 60 days
Patients can present much later, especially with other species like P. vivax.
What are typical symptoms of malaria in non-immune patients?
- Fever
- Chills
- Myalgias
- Arthralgias
- Headache
- Diarrhea
- Vomiting
- Splenomegaly
- Anemia
- Thrombocytopenia
- Neurologic findings
These symptoms can vary based on the infecting species and host immunity.
What is cerebral malaria?
Unarousable coma not attributable to any other cause in patients infected with P. falciparum
Case fatality rates with cerebral malaria approach 40% in Africa.
What is the effect of HIV on malaria parasitemia?
HIV infection impairs acquired immunity to malaria
Increased frequency of parasitemia and clinical malaria is observed in HIV-infected adults.
What is the risk of severe malaria in HIV-infected non-immune patients?
Increased risk associated with low CD4 cell count
Non-immune HIV-infected patients are more likely to have severe clinical malaria.
What is the standard method for diagnosing malaria?
Direct microscopic examination of stained blood films
This allows for species identification and parasite density measurement.
What should be considered in febrile patients who have traveled to endemic areas?
A malaria diagnosis
This includes patients who have received blood products from individuals who have been to such areas.
What is the role of pre-travel evaluation by a travel medicine specialist?
Provides education about risk of exposure and preventive measures
Includes information on insecticide-impregnated bed nets and repellants.
What is the recommended approach for treating confirmed or suspected P. falciparum infections in HIV-infected patients?
Admit to the hospital for evaluation and treatment initiation
Treatment should not be delayed if malaria is strongly suspected.
What are potential drug interactions between antimalarial and HIV medications?
Several interactions can occur, affecting drug levels and efficacy
Providers should check for interactions using resources like the University of Liverpool’s website.
What is the importance of monitoring patients with P. falciparum malaria?
Necessary for measuring parasitemia, hemoglobin, and assessing organ function
Monitoring frequency depends on disease severity and patient immune status.
Fill in the blank: Malaria incidence has been markedly reduced in African adults with HIV who receive _______.
cotrimoxazole
This prophylaxis significantly reduces malaria burden.
What is the recommendation for HIV-infected travelers regarding malaria prophylaxis?
Use effective chemoprophylaxis and personal protective measures
Recommendations are the same as for non-HIV-infected travelers.
What is the effect of placental malaria on mother-to-child HIV transmission?
Increased expression of CCR5 receptors and potentially increased viral load
This raises the possibility of increased mother-to-child transmission of HIV.
What is the effect of ritonavir on quinine levels?
Ritonavir may increase quinine levels.
Which antiretroviral drugs can reduce plasma quinine levels?
Nevirapine and efavirenz.
What is the efficacy of artemether-lumefantrine in treating uncomplicated P. falciparum malaria in HIV-infected adults on nevirapine-based ART?
97.6% efficacy.
What was the efficacy of artemether-lumefantrine in HIV-infected adults on efavirenz-based ART?
82.5% efficacy with a 19-fold increased risk of recurrent parasitemia.
What is the recommended treatment for recurrent malaria caused by P. vivax or P. ovale?
Treatment with primaquine in addition to standard treatment.
What is the drug of choice for prophylaxis and treatment of sensitive strains of malaria in pregnancy?
Chloroquine.
What treatment is recommended for pregnant women with uncomplicated chloroquine-resistant P. falciparum malaria?
Mefloquine or quinine and clindamycin.
True or False: Quinine at high doses is considered safe during pregnancy.
False. It has been associated with an increased risk of birth defects.
What is the potential risk associated with mefloquine used in addition to daily cotrimoxazole for malaria prophylaxis in pregnant women living with HIV?
Increased risk of transmission of HIV to the infant.
What is the recommendation for pregnant women with normal G6PD screening tests after delivery?
They can be treated with primaquine.
What should be done when malaria is strongly suspected in HIV-infected patients?
Admit to the hospital for evaluation and treatment initiation.
What should clinicians refer to for the most up-to-date malaria treatment recommendations?
The CDC malaria website.
Fill in the blank: TMP-SMX has been shown to reduce malaria in HIV-infected adults in Africa, but it is not as effective as _______.
[antimalarial prophylactic regimens].
What is the risk of malaria treatment failure in HIV-infected individuals?
Increased risk compared to HIV-uninfected patients.
What is the recommended treatment for pregnant women diagnosed with chloroquine-sensitive P. malariae?
Prompt treatment with chloroquine.
What does IRIS stand for in the context of malaria?
Immune Reconstitution Inflammatory Syndrome.
What is a key consideration for managing treatment failure in HIV-infected patients?
Consider drug-resistant malaria and possible concomitant infections.
What is the recommendation for atovaquone-proguanil during pregnancy?
Not recommended unless other treatments are unavailable or not tolerated.
What is the clinical significance of interactions between ritonavir or cobicistat and chloroquine?
Unclear; no dose adjustments are recommended.
