Malaria

Question 1

What is malaria?

Answer 1

Systemic protozoal infection

Question 2

What causes malaria in humans?

Answer 2

• P. falciparum
• P. vivax
• P. ovale
• P. malariae

P = plasmodium

Question 3

Describe the transmission of malaria?

Answer 3

• Transmitted through mosquito bite
• Present in the tropics and subtropics
• Mostly P. Falciparum

Question 4

Describe the pathology of malaria?

Answer 4

• RBCs infected with malaria are prone to haemolysis
• Formation of knob proteins
• Rosettes and rouleaux of uninfected RBCs

Question 5

Clinical features of malaria?

Answer 5

• Malaise, headache, vomiting
• Anaemia, jaundice
• Hepatosplenomegaly

Question 6

Effects of malaria in pregnancy?

Answer 6

• Immunity is impaired
• Maternal side of placenta is infected causing:
  
  • Abortion
  • Growth retardation

Question 7

Name some severe complications of falciparum malaria?

Answer 7

• Coma (cerebral malaria)
• Hyperpyrexia
• Convulsions

Question 8

Describe the management of cerebral malaria as a complication of falciparum malaria?

Answer 8

• Maintain airway
• Avoid glucocorticoids, heparin and adrenaline
• Intubate if necessary

Question 9

Describe Vivax and Ovale malaria?

Answer 9

1. Prodrome fever, rigors
2. Flushes
3. Hepatosplenomegaly
4. Anaemia develops

Question 10

Describe Malariae and Knowlesi malaria?

Answer 10

• Mild symptoms and intermittent fever
• Parasitaemia persists for years
• Chronic P. Malariae => glomerulonephritis

Question 11

Which malaria sub-species causes sever disease or death?

Answer 11

Falciparum

Question 12

Read the case history presentation for malaria

Answer 12

Question 13

Name some risk factors for malaria infection?

Answer 13

• Pregnancy
• Travel to endemic areas
• Inadequate chemoprophylaxis
• Settled migrants returning to endemic area of origin

Question 14

Describe the diagnostic tests to perform for someone with suspected malaria infection?

Answer 14

• Giemsa-stained thick and thin blood smears
• Rapid diagnostic tests
• FBC, clotting, U&Es, LFTs

Question 15

Differential diagnoses for malaria infection?

Answer 15

• Dengue fever
  
  • Headache and retrobulbar pain that worsens with eye movements
  • PCR may detect dengue virus early in infection
• Zika virus infection
  
  • Maculopapular, pruritic rash
  • Serology positive for Zika virus

Question 16

What is different about the treatment for P. falciparum malaria?

Answer 16

• It has developed resistance to:
  
  • Chloroquine
  • Sulfadoxine-pyrimethamine

Question 17

Treatment for mild falciparum malaria?

Answer 17

• Co-artemether
  
  • (should be avoided in early pregnancy)
• OR Quinine

Question 18

Treatment for severe falciparum malaria?

Answer 18

Artesunate

Question 19

Treatment for non-falciparum malaria?

Answer 19

Chloroquine + Primaquine

Question 20

Name 2 conditions which protect patients from malaria?

Answer 20

• Sickle cell disease
• G6PD deficiency

Question 21

What is a characteristic feature of plasmodium ovale malariae?

Answer 21

Cyclical fever every 48 hours

Question 22

what is the most common non-falciparum cause of malaria?

Answer 22

Plasmodium vivax