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Microbiology > Malaria/Fever in the returning traveller > Flashcards

Malaria/Fever in the returning traveller Flashcards

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Biology 101 flashcards
1
Q

List 10 causes of fever in the returning traveller

A 
Malaria (check if prophylaxis taken)
Dengue (rash)
Typhoid
Rickettsia
Bacterial diarrhoea
UTI
Pneumonia
HIV seroconversion
Brucella
Viral haemorrhagic fever (Ebola/lassa fever etc)
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2
Q

Which mosquito spreads malaria?

A

Female Anopheles

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3
Q

When and why do female mosquitoes bite?

A

At night

Need blood proteins for their eggs

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4
Q

Which 2 factors attract mosquitoes?

A

Heat and CO2

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5
Q

What type of pathogen causes malaria?

A

A protozoan parasite; Plasmodium

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6
Q

Name the 5 species of malaria-causing Plasmodium

A 
P. falciparum 
P. malariae
P. ovale 
P. vivax
P. knowlesi
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7
Q

Which species of plasmodium usually infects animals and very rarely infects humans?

A

P. knowlesi

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8
Q

Which species of plasmodium is most common, especially in Africa and Asia

A

P. falciparum

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9
Q

Which species of plasmodium causes a benign malarial infection?

A

P. malariae

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10
Q

Which species of plasmodium causes the most severe form of malaria, with a possible parasitaemia of >2% and risk of complications associated with high mortality rates?

A

P. falciparum

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11
Q

Which 2 plasmodium species have a chronic liver stage, persisting in the liver as hypnozites, and what does this mean for the patient?

A

P. vivax and P. ovale

Means that symptoms can reappear (a malarial relapse) 8-24 weeks (or in some cases even a year) after apparent recovery

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12
Q

Which 3 species of plasmodium have a tertian rhythm and what does this mean?

A

P. faciparum, vivax and ovale

Means that the classic symptom of paroxysm (a cyclical occurrence of sudden coldness followed by shivering and then fever and sweating) occurs every 48 hours

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13
Q

Which species of plasmodium has a quartan rhythm and what does this mean?

A

P. malariae

Means that the classic symptom of paroxysm (a cyclical occurrence of sudden coldness followed by shivering and then fever and sweating) occurs every 72 hours

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14
Q

Give 3 features that can be seen on blood film in a P. falciparum infection

A
  • Young trophozoites (rings)
  • Absence of mature trophozoites and schizonts
  • Crescent-shaped gametocytes
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15
Q

Give 2 features that can be seen on blood film in a P. vivax infection

A
  • Schuffner’s dots

- >20 merozites/schizonts

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16
Q

Give 1 feature that can be seen on blood film in a P. ovale infection

A

Schffner’s dots

17
Q

Which 2 species of plasmodium have a similar appearance on blood film?

A

P. ovale and P. knowlesi

18
Q

Which 2 species of plasmodium have Schuffner’s dots on blood film?

A

P vivax and P. ovale

19
Q

What is the treatment for a stable/mild P. falciparum infection?

A

Quinine for 7 days then doxycycline/clindamycin/fansidar (Sulfadoxine and pyrimethamine)
OR
Malarone (Atovoquone and proguanil hydrochloride)
OR
Riamet (artemether and lumefantrine)

20
Q

What is the treatment for a severe P. falciparum infection?

A

Artemisinin combination therapy (ACT)
OR
Quinine and doxycycline/clindamycin

21
Q

What is the treatment for both P. vivax and ovale

A

Chloroquine then primaquine

22
Q

In P. falciparum, what can be seen on FBCs and LFTs, and in what percentage of pts?

A

WCC is rarely raised
70% have thrombocytopaenia
50% have deranged LFTs
30% have anaemia

23
Q

Which specific investigations are used in malaria?

A

Thick and thin blood films

Antigen detection tests (rapid POC tests, used in settings where lab not available)

24
Q

Which blood film establishes a parasitaemia?

A

Thick

25
Q

Which blood film distinguishes malarial species?

A

Thin

26
Q

List 3 common signs of P. falciparum malaria

A

Pyrexia
Splenomegaly
No signs

27
Q

List 5 uncommon signs of P. falciparum malaria

A 
Focal neurology
Reduced GCS
Coma
Shock
Hepatomegaly
28
Q

List 6 common symptoms of P. falciparum malaria

A 
Fever/rigors
"Flu-like illness"
Headache
Back pain
Myalgia
Nausea/vomiting
29
Q

List 4 uncommon symptoms of P. falciparum malaria

A

Diarrhoea
Abdominal cramps
Cough
Dark urine

30
Q

List 9 major features of severe/complicated P. falciparum malaria in adults

A 
Impaired consciousness/seizures
Renal impairment
Acidosis (pH,7.3)
Hypoglycaemia ( less than 2.2)
Pulmonary oedema
Anaemia
Spontaneous bleeding/ DIC
Shock (BP less than 90/60)
Heamoglobinuria
Other indications for parental therapy- pregnancy, vomiting
31
Q

Other than the features of complicated disease, give 3 more indications for parental therapy in P. falciparum malaria

A

Parasitaemia >2%
Pregnancy
Vomiting

32
Q

What is “algid malaria”?

A

A form of falciparum malaria chiefly involving the gut and other abdominal viscera

 - "Gastric algid malaria" is characterized by persistent vomiting
 - "Dysenteric algid malaria" is characterized by bloody diarrheic stools in which enormous numbers of infected red blood cells are found.

Microbiology (27 decks)

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