Malaria

Question 1

What is the infectious form of malaria?

Answer 1

Sporozoites. Injected from mosquito

Question 2

Where does malaria travel within host?

Answer 2

First, liver, then RBCs.

Question 3

What’s unique about vivax?

Answer 3

It’s got a “resting stage” in the liver. Can stay dormant for months

Question 4

How does malaria cause disease?

Answer 4

Infects RBCs, which lyse and release new infectious forms. Causes fevers and eventually gametocytes

Question 5

What is the incubation period for malaria?

Answer 5

10-40 days

Question 6

What are the sx of malaria?

Answer 6

Fever spikes, headache, arthralgia, chills, sweats

Question 7

Why is falciprum an emergency?

Answer 7

Can progress rapidly–well to death in 6 hrs. In a feverish ill traveler, falciprum should be at the TOP of your differential

Question 8

What is a serious complication of malaria?

Answer 8

Cerebral malaria, where cells clog the venules causing coma.

Question 9

How do you diagnose malaria?

Answer 9

blood films
dipstick
PCR

Question 10

Why is it hard to develop immunity to malaria?

Answer 10

The surface antigen is always changing and a vaccine is not available

Question 11

What would protect you from malaria? What would increase your risk?

Answer 11

sickle cell protective
G6PD deficiency protective

Duffy blood antigen increases your risk

Question 12

How do you treat malaria?

Answer 12

Chloroquine and primaquine.

Question 13

How do you get babesia?

Answer 13

From ticks

Question 14

What do you see on blood film of babesia?

Answer 14

Both INTRA and EXTRAcellular ring forms that look like malaria. MALTESE CROSS is classic

Question 15

How do you treat babesia?

Answer 15

If asymptomatic, do not treat.

• -Atovaquone and azith
• -Clindamycin and quinine.

–Consider a transfusion is serious

Question 16

How does babesia present?

Answer 16

With nonspecific symptoms and fever

Question 17

What would u see on smear of falciprum?

Answer 17

banana form. Aside from that, they should ALL be rings. Vivax has many different forms.

Question 18

What is the technical name for the pin worm?

Answer 18

Enterobius vermicularis

Question 19

What is the dx stage for pinform?

Answer 19

The perianal egg

Question 20

WHat is the diagnostic stage of ascaris?

Answer 20

egg in the feces. These are destroyed by sunlight or dehydration.

Question 21

What is the clinical presentation of ascaris?

Answer 21

light infection=malabsorption
heavy infection=intestinal obstruction or hemorrhagic pneumonitis w/ N/V/abdominal pain

Most are ASYMPTOMATIC!

Question 22

Where does strongyloides mature in the human host?

Answer 22

Within the alveoli of the lungs. Once they are coughed up and swallowed, they mature again in the intestines.

Question 23

What is the hyperinfection cycle of stronyloides?

Answer 23

Newly laid eggs hatch and stay in the intestine rather than being excreted in the feces

Question 24

How do you get strongyloides?

Answer 24

From walking barefoot

Question 25

How do you diagnose visceral larva migrans?

Answer 25

antibodies to worm antigens and liver biopsy. You will NOT see eggs in the stool!

Question 26

What causes cuteanea larva migrans?

Answer 26

the dog/cat hookworm

Question 27

Which type of schisto likes the bladder in particular?

Answer 27

S. hematobium

Question 28

How do you tell apart the three different types of schistos?

Answer 28

mansoni has one spine poking out to the side hematobium has a pointy hat japonicum is round

Question 29

How long does schisto live in your system?

Answer 29

DECADES. THey use human antigens to avoid the immune system

Question 30

How long is the incubation period with schisto?

Answer 30

6 weeks

Question 31

What is the one "key word" with schisto?

Answer 31

PIPESTEM fibrosis of the liver

Question 32

What key constellations of sx would make you suspect schisto?

Answer 32

eosinophilia hepatosplenomegaly bloody vomit hematuria FRESH WATER CONTACT

Question 33

What is the name for the pork tape worm? Who is the definitive host?

Answer 33

taenia solium. Human are the definitive host. They live in our guts. In pigs, they stay in the muscle. You can get it from eating undercooked pork. --cysticercosis is life threatening

Question 34

What's the diagnostic stage of giardia?

Answer 34

cyst in stool OR trophozoite in diarrhea

Question 35

How do you diagnose toxo?

Answer 35

sabin-feldman dye test Elisa PCR

Question 36

Symptoms of toxo?

Answer 36

myalgia, headache, fever -encephalitis, myocarditis, hepatitis If perinatal infection, blindness and mental retardation

Question 37

What do you give to a pregnant mom who is asymptomatic but positive for toxo?

Answer 37

Chemo (spiramycin) during pregnancy | Sulfadiazine after birth

Question 38

Can you have a latent crypto infection like with toxoplasma?

Answer 38

NO--must be a new infection. Cannot be reactivated

Question 39

What are the most serious sequelae of falciprum?

Answer 39

1. cerebral malaria (headache/coma/paralysis) 2. GI hemorrhage 3. Tubular necrosis in the kidneys - ->All of these stem from micro infarcts

Question 40

What is unique about the blood smear in plasmodium vivax?

Answer 40

1. Large, infected reticulocytes 2. All forms seen 3. ROUND not banana gametocytes 4. Schuffner's dots

Question 41

What do you use for malaria prophylaxis?

Answer 41

Mefloquine

Question 42

What drug is effective for P vivax in particular?

Answer 42

Primaquine

Question 43

HOw do you treat babesia?

Answer 43

atovaquone + azithro or clindamycin

Question 44

Where does vivax sleep?

Answer 44

In the liver

Question 45

What would you see in the blood tests of someone with falciprum (no smear)

Answer 45

``` Decreased hgb (hemolytic anemia) Decreased platelets (thrombocytopenia) Increased creatinine (acute renal failure) ```

Question 46

In a patient with influenza, what common OTC is absolutely contraindicated?

Answer 46

Aspirin--Can cause Reyes syndrome!

Question 47

How do you treat strep throat?

Answer 47

Penicillin. If allergic, use erythromycin

Question 48

What are pneumonia red flags?

Answer 48

hilar adenopathy heart failure diffuse infiltrate (viral/atypical) Upper lobe infiltrate with granulomas