Malaria and other Sporozoa Flashcards
Life cycle of Malaris
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Life cycle of mosquito and human
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Asexual reproduction in humans:
once inside the liver cells, 1 sporozoite yeilds:
P. falciparum 5-7 days, 40,000 merozoites
P. vivax 6-8 days, 10,000
P. ovale 9 days, 15,000
P. malariae 12-16 days, 2000
___ ___ is the deadliest species of malaria. Found worldwide, but heaviest in West sub-Saharan Africa
Plasmodium falciparum
___ ___ predominating in Sub-Saharan Africa
P. ovale
P. vivax in South America, India, SE Asia.
P. vivax
___ ___ has wide global distribution, being found in South America, Asia, and Africa, but it is less frequent than P. falciparum in terms of cases of infection.
P. malariae
___ ___ is found in southeast Asia (still considered a zoonotic malaria).
P. knowlesi
___ ___ is the most common species and also has a wide distribution
P. vivax
Most frequent symptoms of malaria include:
most frequent symptoms include fever and chills, which can be accompanied by headache, myalgias, arthralgias, weakness, vomiting, and diarrhea.
CNS changes, respiratory distress, bleeding, circulatory collapse
fatigue, malaise
Cerebral malaria
hyperbilirubinemia, jaundice
Hepatic malaria
Complicated malaria = one or more of:
Impaired consciousness or seizures, check blood gluclose
general management of malaria:
antimalarials
Severe malaria:
intensive care
Infections caused by ___ ____ are the most likely to progress to severe, potentially fatal forms with central nervous system involvement (cerebral malaria), acute renal failure, severe anemia, or acute respiratory distress syndrome.
P. falciparum
Complications of ___ ___ malaria include splenomegaly (with, rarely, splenic rupture), and those of __ ___ include nephrotic syndrome.
P. vivax
P. malariae
Typhoid fever Dengue fever Avian influenza SARS HIV Hepatitis Meningitis Encephalitis VHF
Differential diagnosis for malaria
Malaria: Diagnostic Differential should include the following:
Typhoid fever Dengue fever Avian influenza SARS HIV Hepatitis Meningitis Encephalitis VHF
Three stages of malaria: lasts 4-8 hrs
Cold stage
Hot stage
Sweating stage
Feeling of intense cold, despite a fever
Vigorous shivering
Lasts 15-60 minutes
cold stage
Intense heat
Dry burning skin
Throbbing headache
Lasts 2-6 hours
Hot stage
Profuse sweating
Declining temperature
Exhausted and weak → sleep
Lasts 2-4 hours
Sweating stage
Clinical manifestations:
red letters!
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preferred method for malaria diagnosis:
preferred stain:
Microscopy (morphologic analysis) continues to be the preferred method for malaria diagnosis.
Parasites may be visualized on both thick and thin blood smears stained with Giemsa, Wright, or Wright-Giemsa stains.
Giemsa is the preferred STAIN detection of certain morphologic features (e.g. Schüffner’s granules, Maurer’s clefts, etc.) that may not be seen with the other two
alternate way of establishing the diagnosis of malaria infection:
Rapid diagnostic test (RDT)
These are lateral flow assays which require a small amount of patient blood.
___ ___ is the only brand of malaria RDT approved for use in the United States
Binax NOW
How to treat a patient with malaria depends on:
Slide 40..
Malaria can be a severe, potentially fatal disease (especially when caused by ___ ___) and treatment should be initiated as soon as possible.
Plasmodium falciparum
Patients who have severe __ ___ malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.
P. falciparum
Malaria treatment:
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Primaquine is active against the dormant hepatic parasite forms (_____). (P. vivax and ovale )(up to 4 years)
Hypnozoites
_____ is active against the dormant hepatic parasite forms (hypnozoites). (P. vivax and ovale )(up to 4 years)
Primaquine
Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase).
not for preggo
low level persistence of parasites in the blood for 1-2 years (P. falciparum) up to 30 years or more (P. malariae).
Recrudescense
Prophylaxis for travelers:
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Toxoplasma life sycle
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Oocysts take 2 days to sporulate
Oocysts can be present in garden soil, food, water, survive for years
Transplacental
Definitive Host: Cats
Intermediate host: mice, pigs, sheep, mammals
Transmission of Toxoplasma
Infection during pregnancy (Toxoplasma)
1st Trimester – Abortion
2nd Trimester – Retardation
3rd Trimester – Hydrocephaly
In HIV affected patients, the loss of Interferon gamma dependent inhibition of parasite multiplication can cause tissue invasion in the heart, lung,eye, liver, and gastrointestinal tract.
Reactivation in immunocomrpomised
Serologic prevalence data indicate that _____ is one of the most common of human infections throughout the world.
toxoplasmosis
Observation of parasites in patient specimens, such as ___ ____ material from immunocompromised patients, CSF, or lymph node biopsy.
bronchoalveolar lavage
Serologic testing for both __ and ___ is the routine method of diagnosis. for Toxoplasmosis
IgM
IgG
Cryptosporidium
intestinal and urogenital protozoa
Cryptosporidium can be zoonotic in nature as well as highly resistant to ____
chlorination
___ __ ___ is most frequently used in clinical diagnostic laboratories. Usually multiple stools are assayed.
Acid-fast staining
Which is the infective stage for transmitting toxoplasmosis?
A. Unsporulated oocyst
B. Sporulated oocyst
C. tachyzoites
D. bradyzoites
B. Sporulated oocyst
Which insect is responsible for the transmission of malaria?
A. Anopheles mosquito
B. CIxodes tick
C. Dermacentor tick
D. Aedes mosquito
A. Anopheles mosquito
Cryptosporidia are primarily resistant to?
A. Oxidation
B. Hydrogen peroxide
C. Chlorination
D .Dessication
C. Chlorination
What types of clinical specimens for Malaria?
How about enteric parasite panels… which parasites mainly?
Which one of those that you do parasite panels for can you ALSO look at FECES and/or an ENTEROTEST CAPSULE?
Plasmodium we do blood smears (thick and thin)
Enteric Parasite Panels: Giardia, Cryptosporidium and Entamoeba
Giardia: look at feces, can do an ENTEROTEST Capsule, and then finish with a parasite panel if you need!
2 most common fecal preservatives?
10% formalin and PVA Polyvinyl alcohol
