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HAEMATOLOGY > MALARIA > Flashcards

MALARIA Flashcards

1
Q

What are the four species that cause malaria?

A

Plasmodium falciparum
Plasmodium ovale
Plasmodium vivax
Plasmodium malariae

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2
Q

What is the name of the vector that is responsible for transmitting malaria?

A

The female Anopheles mosquito

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3
Q

What do we call the stage of the plasmodium life cycle where human are infected via the bite of the mosquito?

A

Sporozoites

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4
Q

Where do the sporozoites of plasmodium travel to when a human is bitten by the mosquito?

A

The liver

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5
Q

What stage of the plasmodium life cycle occurs in the human liver?

A

Asexual reproduction

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6
Q

What do we call the stage of the plasmodium life cycle which gets released into the blood from the liver in malaria?

A

Merozoites

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7
Q

At what stage of the life cycle of plasmodium does the patient start feeling fever?

A

When the merozoites are released into the blood stream from the hepatocytes

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8
Q

What happens to the merozoites of plasmodium in the blood stream during a malaria infection?

A

They infect red blood cells to further reproduce asexually. Each release of new merozoites causes a spike in fever, which gives malaria the characteristic cyclical spikes in fever.

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9
Q

Which species of plasmodium parasite can lay dormant in the liver leading to relapse of malaria?

A

P. vivax

P. ovale

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10
Q

Which species of plasmodium parasite can lay dormant in the blood stream leading to relapse of malaria?

A

P. malariae

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11
Q

What is the incubation period for P. falciparum parasite?

A

7-14 days

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12
Q

What is the incubation period for P. ovale parasite?

A

10-18 days

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13
Q

What is the incubation period for P. vivax parasite?

A

10-17 days

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14
Q

What is the incubation period for P. malariae parasite?

A

18-42 days

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15
Q

What is the time between each fever cycle (typical of malaria) of P. falciparum?

A

36-48 hours

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16
Q

What is the time between each fever cycle (typical of malaria) of P. ovale?

A

36-48 hours

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17
Q

What is the time between each fever cycle (typical of malaria) of P. vivax?

A

36-48 hours

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18
Q

What is the time between each fever cycle (typical of malaria) of P. malariae?

A

72 hours

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19
Q

Which red blood cells does P. falciparum tend to infect?

A

All of them especially the younger ones

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20
Q

Which red blood cells does P. ovale tend to infect?

A

Reticulocytes

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21
Q

Which red blood cells does P. vivax tend to infect?

A

Reticulocytes

22
Q

Which red blood cells does P. malariae tend to infect?

A

Older cells

23
Q

What is the mortality rate for someone infected with P. falciparum?

A

20%

24
Q

What are P. ovale, P. vivax and P. malariae collectively called?

A

Benign malarias

25
Q

How might someone with malaria present?

A 
Travel history
Periodic chills
Rigors
Periodic high fevers
Drenching sweats
Vomiting
Prodrome:
Headache
Malaise
Myalgia
Anorexia
26
Q

What species of malaria is now considered resistant to chloroquine in many parts of the world?

A

P. falciparum

27
Q

Can people from endemic areas build immunity to malaria?

A

Yes

28
Q

Does the immunity to malaria built up in those from endemic areas last forever?

A

No, if they live somewhere else for a few years they will lose their immunity, but may travel without knowing this.

29
Q

What might you notice on examination of someone with malaria?

A 
Fevers up to 41 degrees
Conjunctival pallor - anaemia
Jaundice - haemolysis
Hepatomegaly
Splenomegaly
30
Q

Which species of plasmodium is most likely to cause splenomegaly? Why?

A

P. malariae - chronicity of disease

31
Q

Which species of plasmodium causes cerebral malaria?

A

P. falciparum

32
Q

What are the features of cerebral malaria?

A

Unrousable coma
Rapid decline from reduced consciousness to coma and then death
Many suffer fits
On examination may elicit upper motor neuron pattern and nystagmus.

33
Q

What investigations should be ordered for someone with suspected malaria?

A 
Blood film
FBC
U&E's
Lactate dehydrogenase
Bilirubin
Glucose levels
Urine dipstick
ECG
LP
34
Q

What might the blood tests of someone with malaria show?

A 
Anaemia
Thrombocytopenia
Renal impairment
Raised bilirubin - haemolysis
Raised lactate dehydrogenase - haemolysis
35
Q

What might be seen on a blood film of someone with malaria?

A

Schizont - cell with replicating parasites

Parasites themselves

36
Q

From a blood film, how might you determine the severity of malaria?

A

Presence of a schizont indicates severe malaria

Parasitaemia of more than 2% indicates severe malaria

37
Q

How many blood films would you need to take from a patient to confirm that a patient does not have or no longer has malaria?

A

Three films on consecutive days

38
Q

Why is it important to check glucose level in a malaria patient?

A

Hypoglycaemia will complicate P. falciparum

Hypoglycaemia is a possible side effect of quinine

39
Q

What might the urine dipstick of someone with malaria reveal?

A

Haemoglobinuria

40
Q

Why is an ECG important in someone with malaria?

A

Quinine can induce arrythmias and conduction defects

41
Q

Why would you perform an LP in someone with suspected cerebral malaria?

A

To rule out bacterial meningitis

42
Q

What is the gold standard treatment for malaria caused by P. falciparum or by unknown cause?

A

Artemisinin combination therapy (ACT):

Artemether-lumefantrine
Artesunate-amodiaquine
Dihydroartemisinin-napthoquine
Atovaquone-proguanil (Malarone)

These are now accepted to be better than quinine, doxycycline or clindamycin

43
Q

What drug can be used to treat malaria known to be caused by non-falciparum malaria?

A

Chloroquine + Primaquine

Always use different drug to prophylaxis though

44
Q

What prophylactic drugs can be given to travellers to protect them against malaria?

A 
Chloroquine - not useful in a lot of areas of resistance
Quinine
Doxycycline
Mefloquine
Malarone
45
Q

What are the side effects of mefloquine?

A

Neuropsychiatric side effects

46
Q

Other than anti-malarial agents, what other treatment do malaria patients need?

A

Supportive care - fluids
Paracetamol for fever
Blood transfusions - platelets and red cell
ITU - especially if cerebral malaria

47
Q

What are the complications of falciparum malaria?

A 
Cerebral malaria
Septic shock
ARDS (adult respiratory distress syndrome)
AKI
DIC
Severe anaemia and thrombocytopenia
Hypoglycaemic
Hyperpyrexia
48
Q

What are the side effects of doxycycline?

A

Sun sensitivity

49
Q

What are the side effects of chloroquine?

A

Headache
Psychosis
Retinopathy

50
Q

What are the side effects of quinine?

A 
Retinopathy
Optic atrophy
Lichnoid planus (skin reaction)
Thrombocytopenia
Tinnitus
51
Q

What are the side effects of primaquine?

A

Haemolysis in those with G6PD deficiency.

52
Q

Why do we give primaquine to patients with non-falciparum malaria (ovale and vivax, not malariae)?

A

Destroys the liver hypnozoites to prevent relapse

HAEMATOLOGY (17 decks)

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