Malaria (and Toxo) Flashcards
The one exception to the “No vaccines” claim that was given in class
RTSS vaccine for malaria
(50% reduction in cases)
Malaria is caused by the genus ______
Plasmodium
Most severe Plasmodium?
Common in ____
falciparum
common in tropics
Less common plasmodium species?
Why is it less common?
Where is it found?
Vivax
Infection is limited to reticulocytes
Common in subtropics and temerate regions
Third and fourth common plasmodiums?
What are the types of infections they cause?
Ovale = Relapsing malaria
knowlesi = 24 hour life cycle, zoonotic infections
Where is plasmodium ovale found?
West africa
What is the fastest-replicating plasmodium species?
Knowlesi
It has a 24 hour lifecycle, which means it can increase the population very quickly
Plasmodium Life cycle:
- Infected mosquito injects____
- They go to the liver and become _____
- They are released and invade ___ cells
- Once in the cell, these become ______
- This multiplies, giving more ______
- These are released and become _____
- Female mosquito picks them up and _____ are formed
- Sporozoites
- Merozoites
- Red blood cells
- Trophozoites
- New merozoites
- gametocytes
- sporozoites
Which plasmodium forms hypnozoites?
How/where does this form live?
How do you treat for this?
Vivax
Lies dormant in the liver
It only responds to Primaquine
How does plasmodium bind to the placenta?
It binds to chondroitin sulfate A
Three conditions covered in malaria pathogenesis
Cerebral malaria
Severe anemia
Metabolic acidosis
Cerebral malaria pathogenesis
Blood brain barrier disruption (from ROS) = Edema and hemorrhage
Tissue hypoxia (from Microvascular obstruction) = Parenchymal and axonal damage
What causes severe anemia in malaria pathogenesis
Hemolysis of immature RBCs
(Rosetting)
What causes the metabolic acidosis in malaria?
Tissue hypoxia causes lactic acid from anaerobic glycolysis
Three stages of classic, uncomplicated malaria
Cold stage
hot stage
sweating stage
The symptoms of uncomplicated malaria are generally _______
Flu-like
(Chills, headache, myalgias and malaise)
also ANEMIA and JAUNDICE
5 major symptoms of severe malaria
Organ failures (renal)
Cerebral malaria
Anemia
Hemoglobinuria
Acute respiratory distress syndrome
What is malaria during pregnancy called?
Features?
Placental Malaria
Especially during first pregnancy, causes low birth weight and miscarriage
Antimalarials, three categories and what they target:
Tissue schizonticides = kill liver stage
Blood schizonticides = kill erythrocytic forms
Gametocytocides = kill sexual stages and block transmission
All antimalarial compounds are effective against ______
Asexual blood stages
Antimalarials that target Liver stage
Artemisinins
Primaquine
Pyrimethamine
Atovaquone
Antimalarials that target the hypnozoites
Primaquine
Antimalarials that target gametocytes
Artemisinins
Mefloquine
Amodiaquine
Primaquine
Pyrimethamine
Four methods of malaria prevention
Insect repellent
Insecticides
Bed nets
Chemoprophylaxis
5 drugs for prevention of clinical disease
Malarone (atovaquone + proguanil)
Doxycycline
Chloroquine
Mefloquine
Primaquine
Malarone area and preventive course
All areas
start 1-2 days before, continue one week after
Doxy area and preventive course of treatment
All areas
start 1-2 days before, continue 4 weeks after
Chloroquine areas and preventive course
Chloroquine sensitive areas
start 1-2 weeks before and continue 4 weeks after
Mefloquine area and Pretreatment course
Mef-sensitive areas
start more than two weeks before, continue more than four weeks after
Primaquine area and course of pretreatment
If >90 P. vivax in the area
Start 1-2 days before, continue one week after
Uncomplicated malaria (or unidentified species) can be treated with _____ agents
Examples? (area-based)
Oral
Chloroquine sensitive areas:
- chloroquine and hydroxychloroquine sulfate
Chloroquine resistant areas:
- Malarone
- Coartem (artemether + Lumefantrine)
- Quinine Sulfate PLUS Doxy/Tetra//Clinda
- Mefloquine
Treatment for uncomplicated malaria?
P. vivax/ovale (hypnozoites in liver)
**Basically add primaquine to any of the treatments of uncomplicated malaria
P. malariae or Knowlesi
Chloroquine or Hydroxychloroquine
Tx for severe/complicated malaria
Quinidine gluconate (I.V.) PLUS Doxy/Tetracycline/Clinda
Cardio consult!
Alternative Tx for Severe/complicated malaria
Artesunate (= IV only alternative if QG not available or tolerated)
Followed by one of:
- Malarone
- Doxy (Clinda in pregnant women)
- Mefloquone
Artemisinin type
Sesquiterpene lactone endoperoxide
(endoperoxide is the active group)
Artemisinin has low ___ but high ____
Low toxicity
High counterfeit rate
Artemisinin resistance has been observed in _____
SE Asia