Malaria - Dr. Karwa Flashcards
Chloroquine-resistant P.
___ is widespread
falciparum
Transmission, distribution, and incidence of vector-born infections are impacted by:
- Extreme weather events
- Increasing temperatures
Changing climate has the potential to increase the distribution of malaria
Plasmodium species that cause infections in humans:
(5)
- P. falciparum
- P. malariae
- P. knowlesi
- P. vivax
- P. ovale
MALARIA VACCINE
Indication: ___ living in regions with moderate to high Plasmodium ___ transmission
Malaria vaccines available:
* RTS,S/AS01
* R21/Matrix-M
- 4 doses starting at ~5 months of age
- can consider 5th
- Children
- falciparum
Selection of chemoprophylaxis depends on region
traveling to:
All malaria-endemic regions (3)
- Atovaquone/proguanil
- Doxycycline
- Tafenoquine
Selection of chemoprophylaxis depends on region
traveling to:
Regions primarily with P. vivax (1)
Primaquine
Selection of chemoprophylaxis depends on region
Regions with chloroquine-sensitive malaria (2)
- chloroquine
- hydroxychloroquine
Selection of chemoprophylaxis depends on region
Regions with mefloquine- sensitive malaria (1)
- Mefloquine
CHEMOPROPHYLAXIS
Atovaquone/Proguanil (Malarone)
Duration
- Begin __ - __ days before departure and continue for __ days after leaving endemic area
take with food/milk
avoid if:
- CrCl < 30
- pregnant/breastfeeding
- 1-2, 7
CHEMOPROPHYLAXIS
Chloroquine & Hydroxychloroquine
Duration
- begin __ - __ weeks before departure and continue for __ weeks after leaving
SE
- blurred vision
- dizziness
- GI disturbance
- headache
- insomnia
- pruritus
avoid if leaving in less than 1 weel
- 1-2 weeks
- 4 weeks
CHEMOPROPHYLAXIS
Doxycycline
Duration
- begin __ - __ days before departure and continue ___ weeks after leaving
Counseling
- wear sunscreen
- 2 hrs apart from antacids
Reasons to Avoid Use
- pregnant
- kid < 8 yo
- allergy
- prone to getting yeast infections
- 1-2 days
- 4 weeks
CHEMOPROPHYLAXIS
Mefloquine
Duration
- Begin ≥ __ weeks before departure and continue for __ weeks after leaving
Counseling Points
- Has been associated with rare but serious reactions (e.g. psychosis, seizures)*
- Side effects: abnormal dreams, anxiety, depression, dizziness, GI disturbance, headache, insomnia, visual disturbances
Reasons to Avoid Use
- Active/recent ___
- Recent history of psychiatric disorders or seizures
- Cardiac conduction abnormalities
- 2 weeks
- 4 weeks
- depression
CHEMOPROPHYLAXIS
Primaquine
Duration
- Begin __ - __ days before departure and continue for __ days after leaving
Counseling Points
- take with food to minimize stomach upset
- only use for places with > 90% P. ___
Reasons to Avoid Use
- ___ deficiency or not tested yet
- pregnant/breastfeeding (unless bb tested)
- 1-2 days
- 7 days
- vivax
- G6PD
CHEMOPROPHYLAXIS
Tafenoquine
Duration
- Begin __ days before departure and continue for __ week after leaving
Counseling Points
- Take with food to minimize GI upset
Reasons to avoid use
- ___ deficiency or if not tested
- pregnant/ breastfeeding
- ___ disorders
- children
- 3 days, 1 week
- G6PD
- psychotic
- doxycycline
WHEN TO CONSIDER MALARIA
Onset of malaria symptoms:
* Typically, __ - __ weeks after mosquito bite
* Can occur up to 3 years after exposure to P. ___ or P. ___
- Fever AND has traveled to a malaria endemic region before fever onset
- 2-4 weeks
- vivax, ovale
SIGNS & SYMPTOMS OF MALARIA
Clinical Symptoms
- Fever
- Headache
- Weakness
- Rigors
- Night sweats
- Insomnia
- Arthralgias/myalgias
- GI distress (N/V/D)
- Neurologic complications
(dizziness, confusion, coma,
disorientation)
Laboratory
Findings - Anemia
- Thrombocytopenia
- Hyponatremia
- Acidemia
- Increased creatinine
- Hypoglycemia
SIGNS & SYMPTOMS OF MALARIA
Laboratory Findings
- Anemia
- Thrombocytopenia
- Hyponatremia
- Acidemia
- Increased creatinine
- Hypoglycemia
DIAGNOSIS
Giemsa-stained blood smear
- Standard for malaria diagnosis!
Thick & thin smear
- Thick smear: RBCs are lysed so visualize parasite outside of cells - Use to estimate ___ density
- Thin smear: used to determine the ___ species
Rapid diagnostic tests
- parasite
- Plasmodium
DETERMINATION OF PLASMODIUM SPP.
Why consideration of Plasmodium spp. is important:
Infection severity:
- P. ___ and P. ___ are more likely to progress to severe disease/death
Treatment
- P. ___ and P. __ also require treatment of hypnozoites (dormant liver stage
Antimalarial resistance:
- P. ___ and P. ___ have different drug resistance patterns in various regions
- falciparum, knowlesi
- vivax, ovale
- falciparum, vivax
SEVERE MALARIA
Patients have severe malaria if they have ≥1 of the following:
- Impaired consciousness/coma
* Hemoglobin < __ g/dL
- ___
* Acute respiratory distress syndrome (ARDS)
* Circulatory collapse/shock
* Acidosis
* Disseminated intravascular coagulation
* Parasite density of ≥ __ %
Typically caused by P. ___
- 7
- AKI
- 5%
- falciparum
TREATMENT OPTIONS FOR UNCOMPLICATED MALARIA
Presence of chloroquine resistance or unknown resistance
- ___ - ___ (Coartem)*
- Atovaquone-proguanil ( ___ )
- ___ sulfate PLUS doxycycline, tetracycline, or clindamycin
- Artemether–lumefantrine
- Malarone
- Quinine
TREATMENT OPTIONS FOR UNCOMPLICATED
MALARIA
Presence of chloroquine resistance, no mefloquine resistance, or unknown resistance (1)
Mefloquine
TREATMENT OPTIONS FOR UNCOMPLICATED
MALARIA
Chloroquine sensitive (2)
- Chloroquine
- Hydroxychloroquine
(Plaquenil)
