Malaria and other Sporozoa

Question 1

Life cycle of Malaris

Answer 1

slide 7

Question 2

Life cycle of mosquito and human

Answer 2

slide 8

Question 3

Asexual reproduction in humans:

once inside the liver cells, 1 sporozoite yeilds:

Answer 3

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

Question 4

___ ___ is the deadliest species of malaria. Found worldwide, but heaviest in West sub-Saharan Africa

Answer 4

Plasmodium falciparum

Question 5

___ ___ predominating in Sub-Saharan Africa

Answer 5

P. ovale

Question 6

P. vivax in South America, India, SE Asia.

Answer 6

P. vivax

Question 7

___ ___ 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.

Answer 7

P. malariae

Question 8

___ ___ is found in southeast Asia (still considered a zoonotic malaria).

Answer 8

P. knowlesi

Question 9

___ ___ is the most common species and also has a wide distribution

Answer 9

P. vivax

Question 10

Most frequent symptoms of malaria include:

Answer 10

most frequent symptoms include fever and chills, which can be accompanied by headache, myalgias, arthralgias, weakness, vomiting, and diarrhea.

Question 11

CNS changes, respiratory distress, bleeding, circulatory collapse
fatigue, malaise

Answer 11

Cerebral malaria

Question 12

hyperbilirubinemia, jaundice

Answer 12

Hepatic malaria

Question 13

Complicated malaria = one or more of:

Answer 13

Impaired consciousness or seizures, check blood gluclose

Question 14

general management of malaria:

Answer 14

antimalarials

Severe malaria:
intensive care

Question 15

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.

Answer 15

P. falciparum

Question 16

Complications of ___ ___ malaria include splenomegaly (with, rarely, splenic rupture), and those of __ ___ include nephrotic syndrome.

Answer 16

P. vivax

P. malariae

Question 17

Typhoid fever
Dengue fever
Avian influenza
SARS
HIV
Hepatitis
Meningitis
Encephalitis
VHF

Answer 17

Differential diagnosis for malaria

Question 18

Malaria: Diagnostic Differential should include the following:

Answer 18

Typhoid fever
Dengue fever
Avian influenza
SARS
HIV
Hepatitis
Meningitis
Encephalitis
VHF

Question 19

Three stages of malaria: lasts 4-8 hrs

Answer 19

Cold stage
Hot stage
Sweating stage

Question 20

Feeling of intense cold, despite a fever
Vigorous shivering
Lasts 15-60 minutes

Answer 20

cold stage

Question 21

Intense heat
Dry burning skin
Throbbing headache
Lasts 2-6 hours

Answer 21

Hot stage

Question 22

Profuse sweating
Declining temperature
Exhausted and weak → sleep
Lasts 2-4 hours

Answer 22

Sweating stage

Question 23

Clinical manifestations:

red letters!

Answer 23

slide 24

Question 24

preferred method for malaria diagnosis:

preferred stain:

Answer 24

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

Question 25

alternate way of establishing the diagnosis of malaria infection:

Answer 25

Rapid diagnostic test (RDT)

These are lateral flow assays which require a small amount of patient blood.

Question 26

___ ___ is the only brand of malaria RDT approved for use in the United States

Answer 26

Binax NOW

Question 27

How to treat a patient with malaria depends on:

Answer 27

Slide 40..

Question 28

Malaria can be a severe, potentially fatal disease (especially when caused by ___ ___) and treatment should be initiated as soon as possible.

Answer 28

Plasmodium falciparum

Question 29

Patients who have severe __ ___ malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.

Answer 29

P. falciparum

Question 30

Malaria treatment:

Answer 30

slide 43

Question 31

Primaquine is active against the dormant hepatic parasite forms (_____). (P. vivax and ovale )(up to 4 years)

Answer 31

Hypnozoites

Question 32

_____ is active against the dormant hepatic parasite forms (hypnozoites). (P. vivax and ovale )(up to 4 years)

Answer 32

Primaquine

Question 33

Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase).

Answer 33

not for preggo

Question 34

low level persistence of parasites in the blood for 1-2 years (P. falciparum) up to 30 years or more (P. malariae).

Answer 34

Recrudescense

Question 35

Prophylaxis for travelers:

Answer 35

Slide 45

Question 36

Toxoplasma life sycle

Answer 36

slide 49/50

Question 37

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

Answer 37

Transmission of Toxoplasma

Question 38

Infection during pregnancy (Toxoplasma)

Answer 38

1st Trimester – Abortion
2nd Trimester – Retardation
3rd Trimester – Hydrocephaly

Question 39

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.

Answer 39

Reactivation in immunocomrpomised

Question 40

Serologic prevalence data indicate that _____ is one of the most common of human infections throughout the world.

Answer 40

toxoplasmosis

Question 41

Observation of parasites in patient specimens, such as ___ ____ material from immunocompromised patients, CSF, or lymph node biopsy.

Answer 41

bronchoalveolar lavage

Question 42

Serologic testing for both __ and ___ is the routine method of diagnosis. for Toxoplasmosis

Answer 42

IgM

IgG

Question 43

Cryptosporidium

Answer 43

intestinal and urogenital protozoa

Question 44

Cryptosporidium can be zoonotic in nature as well as highly resistant to ____

Answer 44

chlorination

Question 45

___ __ ___ is most frequently used in clinical diagnostic laboratories. Usually multiple stools are assayed.

Answer 45

Acid-fast staining

Question 46

Which is the infective stage for transmitting toxoplasmosis?

A. Unsporulated oocyst
B. Sporulated oocyst
C. tachyzoites
D. bradyzoites

Answer 46

B. Sporulated oocyst

Question 47

Which insect is responsible for the transmission of malaria?

A. Anopheles mosquito
B. CIxodes tick
C. Dermacentor tick
D. Aedes mosquito

Answer 47

A. Anopheles mosquito

Question 48

Cryptosporidia are primarily resistant to?

A. Oxidation
B. Hydrogen peroxide
C. Chlorination
D .Dessication

Answer 48

C. Chlorination

Question 49

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?

Answer 49

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!

Question 50

2 most common fecal preservatives?

Answer 50

10% formalin and PVA Polyvinyl alcohol