Malaria Flashcards
How many are exposed? How many cases? How many deaths? Where?
- 3.2 billion
- 214 million cases
- 0.5 million deaths
- 90% in subsaharan Africa
Which mosquito?
Anopheles
Pl. falciparum fever?
Every other day. Can be very irregular though. Infects regular sized erythrocytes.
Pl. falciparum incubation period?
7-14 days, range up to 30 days
Pl vivax and ovale incubation and fever? Illness?
Fever every other day. Incubation 14 days. Illness can occur months-years after initial infection due to hypnozoites in the liver. Only infect reticulocytes.
Pl. malariae fever, incubation period?
Every 3rd day. 14 days, Infects normal sized or smaller erythrocytes.
Which malaria commonly occurs in south-east Asia?
Pl. knowlesi
Explain the lifecycle of plasmodium.
- Sporozoites invade hepatocytes and form merozoites.
- Merozoites invade erythrocytes
- In erythrocytes they grow to trophozoites which then become schizonts.
- Schizonts rupture and release merozoites into the bloodstream —> FEVER (due to proinfl. cytokines)
- Some schizonts become gametocytes which infect new mosquitos.
Symptoms of malaria?
- fever
- myalgia
- diarrhea
- abdominal pain
- spleen enlargement
- nausea, vomiting
- chills, sweating.
VERY unspecific symptoms. So if from malaria region, consider malaria.
What characterizes severe malaria?
First 4 are more common in children.
- altered consciousness
- severe anemia
- metabolic acidosis
- hypoglycemia
- trombocytopenia
- circulatory collapse
- bleeding
- pulmonary edema
- renal failure
- jaundice
- hyperparasitaemia >10%
Clinical signs of severe malaria?
- pallor
- jaundice
- petechiae
- dark urine
- hepatosplenomegaly
- altered vital signs and consciousness
How to diagnose malaria?
- Thick smear (tjock droppe)
- Thin smear (blodutstryk)
- Rapid diagnostic tests
- PCR
Treatment of pl. falciparum and severe malaria?
- Parenteral Artesunate, followed by oral ACT (artemisinin-based combined therapies)
- Intramuscular artemether, followed by ACT
- Quinine i.v + clindamycin or doxycycline 3-7 days
Artesunate has 30% lower mortality rate than quinine.
Follow up of severe malaria treatment?
- monitor parasite density with daily blood smears.
Uncomplicated malaria falciparum treatment?
Oral ACT for 3 days. Can be different combinations of artesunate and other substances.
