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Module 2 > Malaria > Flashcards

Malaria Flashcards

1
Q

Who are the majority of deaths due to malaria in?

A

<5

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2
Q

What is hte main plasmodium species involved in malaria?

A

plasmodium falciparum

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3
Q

What are the other malaria plasmodium species?

A

plasmodium malariae; vivax and ovale

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4
Q

What form of the parasite is injected into the human when the mosquito injects anticoagulant?

A

sporozoite

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5
Q

Where do the sporozoites initially travel to?

A

liver

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6
Q

What type of repoduction do the parasites undergo in the liver?

A

asexual reproduction

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7
Q

What form are the parasites when tehy burst out of the liver and infect RBCs?

A

merozoites

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8
Q

Why do you get waves of symptoms in malaria?

A

parasites tend to burst out of cells at the same time

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9
Q

What life form of the parasite is capable of infecting a mosquito?

A

gametocyte

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10
Q

What type of replication do the parasites undergo in the blood?

A

asexual;, however a sub-population of intraerythocytic parasites switches to sexual development producng gametocytes

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11
Q

When do malarial symptoms appear in non-immune individuals?

A

after 7-15 days

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12
Q

What are the first symptoms of malaria?

A

fever; HA; chills and vomiting

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13
Q

What happens if not treated within 24 hours

A

sever anaemia; respiratory distress in relation to metabolic acidossi or cerebral malaria

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14
Q

What happens if you have been infected multiple times?

A

develop partial immunity

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15
Q

What happens to clinical immunity as endemicity decreases?

A

acquired slower

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16
Q

What genus of mosquito transmits plasmodium?

A

anopheles

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17
Q

How many species of anopheles mosquito can transfer plasmodium?

A

70

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18
Q

Where does sexual reproduction of the palsmodium take placei n the mosquito?

A

in the stomach

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19
Q

How does temperature affect the replication of plasmodium?

A

takes place much quicker at higher temperatures- e.g in colder temps, mosquito wont become infectious before it dies as takes too long for parasite to replicate

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20
Q

What is endophagy?

A

propensity to bite indoors

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21
Q

What is endophily

A

propensity to rest in the house after feeding

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22
Q

What is the huamn biting index?

A

propensity to bite humans

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23
Q

Where do mosquitoes lay their eggs?

A

in water

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24
Q

What are the 2 arms of current malarial interventions?

A

vector targets and human targets

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25
Q

What are hte vector targets of malarial interventions?

A

long-lasting insecticide-treated nets; indoor residual spraying; spatial repellents and larval control

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26
Q

What class of insecticde are used on bednets?

A

pyrethroids

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27
Q

What is the problem with all nets using pyrethroids?

A

lots of resistance

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28
Q

What are the current vaccine targets?

A

targeting of incoming parasites; blood-stage asexual development; transmsision stages

29
Q

What is the first pre-erythrocyte vaccine?

A

mosquirix

30
Q

What insecticides are thought to be between than pyrethroids?

A

PBO- however more expensive

31
Q

What is another emerging rpoblem with bednets?

A

mosquitoes are increasingly starting to bite outside of night-time avoiding bed net coverage

32
Q

Where does the majority of falciparum malaria occur?

A

sub-saharan africa

33
Q

How long does the pre-erythrocytic liver stage of hte disease typically last before onset of hte blood stage?

A

1-2 weeks

34
Q

What happens once male and female gamtes fuse in the mosquito midgut?

A

form a mobile ookinete which passes through the gut wall and becomes an oocyst

35
Q

What happens to the oocyst?

A

releases sporozoites which migrate to the mosquito salivary glands completing the lifecycle

36
Q

What can result in malarial relapses months or years after the intial infection?

A

a proportion of sporozoites become dormant hypnozoites

37
Q

What is hte MOA of quinine?

A

kills sequestered parasites but not circulating rings which continue to develop after treatment

38
Q

What is the MOA of artesunate?

A

acts against circulating rings and sequestered parasites; killing results in pyknotic parasite forms which the spleen removes by pitting–late haemolysis

39
Q

When do symptoms of malaria devleop?

A

once the erythrocytic cycle produces a parasitamia above a certain threshold eg 100parasites per uL

40
Q

What do the periodic fever spikes in malaria correspond to?

A

erythrocytic cycle length of the infecting species resulting from synchronisation of the devlopmental stages

41
Q

What happens to erythrocytes containing P falciparum?

A

sequester inside small and medium sized vessels avoiding parasite clearance in the spleen but causing host endothelail cell injury and microvascualr obstruction

42
Q

How does P falciparum mediate cytoadherence?

A

PfEMP1 which is set of protein exported to the infected RBC surface and encaded by the var gene family

43
Q

What are the most common manifestations of severe malaria?

A

cerebral malaria; acute lung injury- can progress to ARDS; acute kidney injury and acidosis

44
Q

What are the symtposm of uncomplicated malaria?

A

fever; chills; body-aches; HA; cough and diarrhoea

45
Q

What is the main acid implicated in malarial acidosis?

A

lactic acid

46
Q

What is the gold standard for malaria diagnosis?

A

light microscopy of stained blood films; thick films providing sensitivity and thin films allowing speciation and quntification

47
Q

What now predominate as the first line investigation for malaria?

A

rapid diagnostic tests b

48
Q

Waht is the p falciparum RDT based upon?

A

detection of PfHRP2 antigen

49
Q

What should all patients diagnosed with severe malaria receive as treatment?

A

parenteral artseunate

50
Q

Waht is the recommended treatment for falciparum malria or falciparum mixed with other species?

A

artemisinin-based combination treatments

51
Q

What do ACTs consist of?

A

artemisinin derivative that rapidly reduces parasitaemia and a partner drug taht removes residual prasites over a longer period

52
Q

What are the probelsm with quinine?

A

although efficacious, it needs a long course; is poorly tolerated and needs combination with a second agent

53
Q

What are the causes of treatment failure?

A

drug resistance; high parasite densities; poor drug bioavailability; non-adherence; falsified/substandard antimalarials

54
Q

What does repeated exposure over a long period to malaria result in?

A

premunition

55
Q

What is premunition?

A

protection from disease but ongoing blood stage infection

56
Q

What does premunition manifest as with P falciparum?

A

antibodies to PfEMP1 subtypes

57
Q

Which species of plasmodium have the dormant stage in the liver?

A

P.vivax and P.ovale

58
Q

What do sporozoites mature into in liver cells?

A

schizonts

59
Q

What is the PfSPZ vaccine?

A

IV injection of irradiated-attenuated sporozoites –difficult to get durable protection agsint all relevant strains?

60
Q

What do schizonts rupture to release?

A

merozoites

61
Q

What is the name for the parasite in its ring stage in RBCs?

A

trophozoites

62
Q

What do the ring stage trophozoites mature into?

A

schizonts

63
Q

What is the parasites multiplication in the mosquito known as ?

A

sporogonic cycle

64
Q

What is the function of targeting spoprozoite stages via one of the surface proteins with vaccination?

A

aims to reduce frequency of infection as the surface proteins mediate homing to thel iver and host cell invvasion

65
Q

What is the target of the RTS S/AS01 vaccine?

A

targets circumsporozoite protein which is invovled in sporozoite hepatocyte binding

66
Q

What have been the reuslts of the RTS S/AS01 vaccine?

A

efficacy was better in older children than younger; but didnt provide efficacy across all strains and longer term followup showed a higher incidence of malaria in vaccinated children, but long term mortality has not been released

67
Q

What is the purpose of merozoite-stage proteins as vaccine targets?

A

reduce asexual replication rate and protect against disease rather than produce steril immunity

68
Q

What is the theory behind transmission blocking vaccines?

A

generate antibodies against sexual-stage antigens which are ingested in the mosquito blood meal potentially providing immunity at ap opulation level

Module 2 (38 decks)

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