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Year 3 > Malaria (I) > Flashcards

Malaria (I) Flashcards

1
Q

Define malaria.

A

Parasitic infection caused by protozoa of the genus Plasmodium

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2
Q

What is the most life-threatening species causing malaria?

A

Plasmodium falciparum

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3
Q

What type of disease is malaria?

A

Notifiable

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4
Q

Where in the world is malaria prevalent?

A

Through topical and subtropical regions - travellers account for majority of disease in Western countries

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5
Q

How is malaria transmitted? (3)

A
  • via a bite by an infected female Anopheles mosquito
  • potentially blood transfusion
  • potentially organ transplant
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6
Q

What are some protective features for malaria? (2)

A
  • sickle cell anaemia
  • G6PD deficiency
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7
Q

Where does the protozoa (Plasmodium) grow in malaria?

A

Red blood cells

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8
Q

What are the clinical features of malaria? (9)

A
  • headache
  • weakness
  • myalgia
  • arthralgia
  • anorexia
  • diarrhoea
  • splenomegaly
  • haemolytic anaemia - jaundice, dark urine
  • cyclical (alternating days) fevers with chills and rigors (shivering)
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9
Q

What is important to check in suspected malaria?

A

Travel Hx (incubation period can be up to a year)

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10
Q

What might you find on examination in malaria? (5)

A
  • pyrexia
  • haemolytic anaemia
  • jaundice
  • hepatosplenomegaly
  • hypotension
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11
Q

What are some risk factors for malaria? (9)

A
  • travel to endemic area
  • inadequate/absent chemoprophylaxis
  • insecticide-treated bed net not used in endemic area
  • low host immunity
  • pregnancy
  • age<5
  • immunocompromised
  • older age
  • malnutrition
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12
Q

What are the first-line investigations for malaria?

A
  • Giemsa-stained thick and thin blood smears
  • rapid diagnostic tests (RDTs)#
  • FBC
  • clotting profile
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13
Q

What is the main first-line investigation for malaria?

A

Giemsa-stained thick and thin blood smears:

  • detection of asexual or sexual forms of parasites inside erythrocytes
  • thick detects parasites
  • thin detects species
  • 2% is a sign of severe disease
  • thick films more sensitive, headphone-like sign
  • smears should be repeated daily on three occasions
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14
Q

Why do we do rapid diagnostic tests (RDTs) in malaria?

A

Rapid detection of parasite antigens or enzymes

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15
Q

Why do we do FBC in malaria?

A

To look for anaemia

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16
Q

What are some differential diagnoses for malaria?

A
  • dengue fever (abrupt onset of Sx, headache, retrobulbar pain that worsens with eye movements, leukopenia, thrombocytopenia, PCR)
  • Zika virus - unprotected sexual contact with infected individual
  • chikungunya virus
  • yellow fever
  • South American haemorrhagic fevers
  • pneumonia
  • influenza
  • enteric fever (typhoid infection)
  • pyogenic infection
  • leptospirosis
  • infectious mononucleosis
  • HIV seroconversion
  • amoebic liver abscess
  • African trypanosomiasis
  • Rickettsia infection
  • Legionnaire’s disease
  • pulmonary TB
  • COVID-19
17
Q

What drugs do we give for malaria?

A
  • chloroquine (okay during pregnancy) or hydroxychloroquine
  • once Sx resolved to prevent relapse: primaquine
18
Q

What do we do in malaria if complicated and parasitaemia >2%, evidence of organ dysfunction, pregnancy, child or >65 years?

A

Admission

19
Q

What do you do in malaria before starting medication?

A

Confirm which type of malaria before starting medication unless concurrent bacterial infection with life-threatening sepsis

20
Q

What do we give for complicated case of malaria? (3)

A
  • IV artesunate
  • strict fluid balance
  • early ITU
21
Q

What do we give for Plasmodium falciparum (uncomplicated) malaria?

A

Artemether, lumefantrine OR artenimol, piperaquine phosphate

22
Q

What do we give for Plasmodium ovale or vivax malaria?

A
  • artemether-lumefantrine
  • in areas which are known to be chloroquine-sensitive then WHO recommend either artemisinin-based combination therapy (ACT) or chloroquine
  • in areas which are known to be chloroquine-resistant an ACT should be used
  • ACTs should be avoided in pregnant women
  • patients should be given primaquine (following acute Rx with chloroquine to destroy liver hypnozoites and prevent relapse)
23
Q

How do we monitor malaria? (3)

A
  • blood films daily
  • follow-up of complications or HIV (2-4 weeks after starting Rx to check for haemolysis)
  • primaquine - 14 days
24
Q

What do we give for malaria prevention? (2)

A
  • avoid exposure (nets/repellent/protective clothing)
  • prophylaxis
25
Q

What are some complications of malaria? (9)

A
  • AKI (due to dehydration and hypovolaemia)
  • hypoglycaemia (quinine medications and severe disease, check BGC every 4h)
  • metabolic acidosis
  • severe anaemia
  • septicaemia
  • seizures/CNS complications
  • ARDS
  • DIC
  • blackwater fever
26
Q

Describe the prognosis of malaria.

A

Groups at risk of severe disease include low host immunity, pregnancy, age<5, immunocompromised, older adults

Year 3 (101 decks)

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