Malaria/Babesia Flashcards by Kristian Melby

malaria parasite

phylum: apicomplexa
genus: plasmodium
protozoa
single celled eukaryotic parasite

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4 species infecting humans

plasmodium. ..
- falciparum
- vivax
- ovale
- malariae

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plasmodium knowlesi

monkey malaria
emerging infections
malayaia, SE asia

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malaria deaths

627,000
90% in africa
mostly < 5 yo
20% of child mortality in africa

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clinical cases of malaria

150-300 million/yr

> 90% is tropical africa

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^malaria risk

pregnancy

children

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main cause of severe malaria

& malaria death

plasmodium falciparum

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malaria transmission

mosquito (anopheles)

rare: mother to child, blood transfusion

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malria vector

anopheles mosquito

female only
definitive host (sexual stage)

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cause of uncomplicated

malaria

all species of plasmodium

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complicated/severe malaria

plasmodium falciparum

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uncomplicated malaria sxs

fever, chills, sweats
NVD
headache
sxs coincides w rupture of RBCs

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tertian malaria

fever every 2 days

P. vivax/ovale

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quartan malaria

fever every 3 days

P. malariae

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irregular fever

P. falciparum

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malaria sxs prevalence

fever 96%
fever > 39C 30%
splenomegaly 26%
elevated LDH 78%
thrombocytopenia 58%

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complicated malaria

P. falciparum

cerebral malaria (seizure, coma, posturing)
severe anemia
hypoglycemia
resp distress, pulm edema
hyperparasitemia
renal failure ("blackwater fever")
acidemia/acidosis
circulatory failure/shock

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complicated malaria

P. vivax

severe disease in 4%
splenic rupture
possibly fatal

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complicated malaria

P. knowlesi

< 10% of cases

respiratory distress

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malarial pulmonary edema

P. falciparum
non cardiogenic
more common in adults
cause unclear (possibly cytokine release)
poor prognotic sign

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acquired resistance

incomplete (infection w/o sxs)
occurs slowly w age
depends on level of exposure
can be lost w/o continued exposure

duffy antigen

RBC antigen required for P. vivax
invasion
absent in west africans

sickle cell trait

protective against P. falciparum

pregnancy risk

resistance lost during 1st pregnancy
and regained in subsequent pregnancies
(except if HIV+)

malaria in pregnancy

``` higher mortality anemia (mom&baby) low birth weight infant mortality drug therapy 2/more times during pregnancy recommended ```

Imported Malaria (US)

1500 per year acquire malaria visting family internationally 50% P. falciparum

malaria dx

microscopy (blood smear) PCR serology not useful in acute infection

light microscopy

thick or thin film finger stick (capillary blood best) identifies ssp and infection level

BinaxNOW

rapid dx test (blood drop) detects all 4 ssp only validated for Pf & Pv

liver hypnozoites

normal infection w P. ovale/vivax | not killed by chloroquine

choroquine

^ resistance: P. falciparum | rare resistance: P. vivax, ovale, malariae

malaria drugs

artemesinin-based combo therapies (ACT) mefloquine atovaquone-pyrimethamine amodiaquine

severe malaria tx

IV/IM quinine or artemesinin rectal artesunate in children < 5 fluids, +/- blood transfusion

P. ovale/vivax tx

tx hypnozoite stage primaquine x 14 days screen for G6PD first (drug will cause hemolytic crisis)

artemesinins

derived from qinghoa plant | degrade heme to produce C free radicals

fixed dose combos (ACT)

Artemether-lumefantrine (Coartem®) Dihydroartemisinin-piperaquine (Artekin®) Artesunate & chlorproguanil-dapsone(Lapdap®)

parenteral artesunate

available from CDC

IV quinidine

requires cardiac and glucose | monitoring

malaria prevention for travelers

insect repellent insectiside treated bednets chemoprophylaxis before, during, after

barriers to malaria | elimination

``` drug resistance socio-political change environmental change HIV/AIDS insecticide resistance ```

malaria vaccine | asexual blood stage

protects mosquitos not humans prevents furthur spread from infected individual

babesia

apicomplexan parasite intraerythrocytic protozoa 4 human infective ssp most US illness B. microti

babesia vector

tick-bourne (ixodes scapularis) same tick as lyme requires >24hrs attachment

babesia reservoir

white footed mouse

babesia endemic

coastal southern new england, wisconsin, minnesota occurs in summer can by transmitted via blood transfusion

assymptomatic babesiosis

>25% of cases | >50% in children

babesiosis clinical | presentation

``` incuvation 1-6 wks flu-like sxs (wks-months): fever, chills, fatigue, headache complications: ARDS, massive hemolysis, CHF, renal failure, death ```

Babesiosis High Risk

elderly | asplenic (parasitemia uncontrolled)

babesiosis dx

``` microscopy of blood: giemsa stain, tetrads, maltese cross serology (IFA) PCR xenodiagnosis in hamster (not rountine) ```

baesiosis tx

mostly self limiting severe/symptomatic tx: - atovaquone+azithromycin - clindamycin+quinine

babesiosis + HIV

long term supressive tx req

borrelia burgdorferi | co infection

must be ruled out when babesiosis | is present

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Malaria/Babesia Flashcards

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