Management of Childhood Malaria Flashcards
Malaria is a clinical entity following the __________ of ______________ by species of ______________.
invasion of red blood cells
Plasmodia.
P. falciparum (——-% of infection, approx. ______% of mortality)
P. _________
P. _________
P. _________
P. _________ (South East Asia)
It is transmitted by the _________ ___________ mosquito.
95% ; 100%
P. malariae
P. ovale
P. vivax
P. knowlesi (South East Asia)
female Anopheles mosquito.
Majority of the cases (88%), deaths (90%) and reduction in malaria-deaths occur in _____________
It is a common cause of morbidity and mortality in children in _______
sub-Saharan Africa
Africa
Endemicity
Amount of malaria in a community or region
1.Based on use of _________ and __________ rates children 2-9years
2. Based on ___________ rates
spleen and parasite
transmission
spleen
Hypoendemicity :parasite and splenic rate _______%
Mesoendemicity :parasite and splenic rate _______%
Hyperendemicity :parasite and splenic rate persistently >_____%
adult spleen rate >_____ %
Holoendemicity :parasite and splenic rate persistently >_____%
adult spleen rate >_____% with low adult spleen rate
0- 10
11- 50
50
25
50; 75
Transmission rates
High transmission stable >___ case per 1000 population
all year round, seasonal variation
Partial immunity in older children/adult likely to have severe malaria
Low transmission <___ case /1000 population, intermittent transmission
annual biannual or variable . Immunity is _____
1
1
low
Severe disease and death occur in children less than _______
Parasitemia and symptomatic in _______ age
Decreasing parasite density prevalence and acquisition of immunity in older groups
5 years
School
Cell mediated immunity and humoral immunity
Presence of Hb ———- , ———- deficiency
Hb ———- ,Hb ———-, ———- genotype
All reduce ability of parasite to to penetrate red cell reduce severity of acute and chronic malaria
Hb S , G6PD deficiency
HbF ,HbE thalassemia , Duffy -negative genotype
Pathogenesis of malaria
Infected red cells exhibit ________ on their surfaces that allow them to ____________________ and also to the ________ of small vessels such as arterioles, venules and capillaries
Also infected red cells are less ________
Both features promote ________ of infection red cells in deep vessels and subsequent _______________
__________________ and impaired ________ are the hallmarks of severe malaria. Little ________ is known to occur
Infected red cells rupture releasing both ________ and ________ which activates monocytes and macrophages causing the release of pro-inflammatory cytokines
knobs ;adhere to one another
endothelial wall ;deformable
sequestration ;vascular occlusion
Microvascular obstruction ; perfusion
inflammation ;parasite
host cells metabolites
Economics of malaria
It has been estimated that the direct and indirect costs of malaria is more than ___________ per year.
Malaria-afflicted families are able to harvest only _____% of their crops compared to healthy families.
Malaria slows economic growth in African countries by about _____% every year.
Clearly malaria is closely linked to poverty.
$2 billion
40; 1.3
Malaria and Children
Malaria affects children in the following ways:
■Causes __________ and ______________ among babies born to women living in endemic regions.
■Congenital Malaria (____% in Lagos and ____% Ife)
■Anaemia leading to _____________ function (poor school performance).
■____________ (from recurrent illnesses).
prematurity and low birth weight
15;47
poor cognitive
Poor growth
Risk factors for malaria in Nigeria (High Transmission area)
Young children
▪ ___________ visitors
▪ Children with ________
__________ or __________
Non-immune
HIV/AIDS
Asplenia or hyposplenism
Two forms of clinical Presentation
_____________________ malaria
_______________________ malaria
Acute uncomplicated
Severe (complicated)
Uncomplicated malaria
Symptoms
Fever (often ________ grade and __________ )
__________
Malaise
__________
Anorexia
________ or ________
________ pain
Diarrhoea
high; intermittent
Vomiting; Headaches
Myalgia or Arthralgia
Abdominal
In most cases the physical examination reveals no significant finding.
Fever
_______
_____________ megaly
No localising signs
Lymphadenopathy is ____________
pallor
Hepato or Spleno
NOT a feature
Severe (Complicated) Malaria
•_____________ manifestation (clinical or laboratory)
• Presence of ________ form of P. _________ or ________
• Exclusion of other causes
• Evidence of _____________________ is the hallmark of severe malaria
Life threatening
asexual
falciparum or vivax
vital organ dysfunction
Forms of Severe Malaria
__________ Malaria
__________ (generalized weakness so that the child is unable to sit, stand or walk unaided)
Pulmonary __________ & __________
Multiple __________ (> _____ episodes within 24hr)
Severe __________
Cerebral
Prostration
Pulmonary oedema
Respiratory Distress Syndrome
Convulsions ; 2
anaemia
Forms of Severe Malaria
Shock (systolic BP<______mmHG)
______________ injury
Abnormal ______________
Hyper ______________
______________ nuria
Hyper ______________
50mmHG
Acute kidney
bleeding
Hyperbilirubinaemia
Haemoglobinuria
Hyperpyrexia
Forms of Severe Malaria
_______glycaemia (serum glucose <____mmol/L)
Metabolic _________ (serum HCO3- <15mmol/L )
Hyper__________ (serum lactate >5mmol/L) Hyper___________
Hypoglycaemia (serum glucose <2.2mmol/L)
Metabolic acidosis (serum HCO3- <15mmol/L )
Hyperlactaemia (serum lactate >5mmol/L)
Hyperparasitaemia
Severe Malaria: Cerebral Malaria Fever
Loss of consciousness > ____________ or altered sensorium
_____ CSF abnormality
No other cause of ______________
Commonest cause of malaria deaths
Other features of severe malaria such as severe anaemia and metabolic acidosis are commonly co- existing in the same child
30 minutes
No CSF abnormality
encephalopathy
Pathogenesis of cerebral malaria
__________ of __________ in the brain by _____________ and ____________
Cerebral oedema is (common or rare?) in children
Occlusion
small vessels
parasitized and non-parasitized red cells
Common
Blantyre coma scale
Eye:
_______
_________
Directed
Not directed
Blantyre coma scale
Verbal:
________
________
__________
Appropriate cry
Moan or inappropriate cry
None
Blantyre coma scale
Motor :
Localizes painful stimuli
Withdrawal from pain
Nonspecific or absent response
Severe Malaria: Severe Anaemia
Fever
Pallor (PCV <_____%) with or without evidence of decompensation
No evidence of other causes
15
Pathogenesis of severe Anaemia
_______________________ of parasitized and non-parasitized red cells
________ of parasitized red cells during schizogony
___________ erythropoiesis
___________. partly as a result of thrombocytopaenia and coagulation defects
NB: the diagnosis of malaria should be queried in the absence of thrombocytopaenia
Acute splenic removal
Rupture; Ineffective
Mild bleeding
Diagnosis
Diagnosis can be difficult.
“Gold standard” is ____________ and finding ____________ in thick and thin blood film
Rapid Diagnostic Tests: based on detection of
•_________________ (specific for _________): as good as microscopy
•_______________: for _________ and __________ •__________: less sensitive
Non rapid non-microscopic based tests: counter- immunoelectrophoresis, polymerase chain reaction
blood microscopy
asexual parasitaemia
Histidine rich protein ; falciparum
Lactate dehydrogenase ; falciparum and vivax
Aldolase
Other Investigations
________ with _______
__________
Electrolytes ,Urea & creatinine
Blood PH and gases
Blood glucose
Lumbar Puncture (where necessary)
Full Blood Count with ESR
Hb genotype
Treatment of Uncomplicated malaria
Goals: cure, prevention of severe forms and drug resistance
________________________ is the recommended treatment
It is the simultaneous use of at least _____ drugs with different modes of action; which are still effective as monotherapy; and one of which must be _______________.
Artemisinin-combination therapy (ACT)
2; an artemisinin derivatives
For Nigeria examples of ACT include:
• ____________ -____________
• ____________-____________
• ____________-____________
• Dihydroartemisinin-Piperaquine
For Nigeria examples of ACT include:
• Artemisinin-Lumefantrine
• Artesunate-amodiaquine
• Artesunate-mefloquine
• Dihydroartemisinin-Piperaquine
Initial management of severe malaria (cerebral malaria)
Clear and maintain _______
Position _________ or on the side
Weigh patient and calculate dosage
Make rapid clinical assessment
Start ______ chemotherapy: start with parenteral _______therapy and once child is able to take, complete a course of _______
Exclude or treat _________________
Assess state of hydration
Measure and monitor urine output
airway
semi-prone; antimalarial
mono; ACT
hypoglycaemia
Initial management of severe malaria 2
Take _______ for diagnostic smear (serially), monitor blood sugar, PCV and other laboratory tests
Plan first ________ of fluids (diluents of drugs, glucose and Blood transfusions)
Antipyretics if core temperature exceeds _____oC
_____________ to exclude meningitis.
Consider other infections.
Anticonvulsants and other drugs as indicated
blood
8 hours
39; Lumbar puncture
Treatment of Severe Malaria
(The goal is prevention of _______)
The 3 recommended options are ___________,_____________, and ______________ (in decreasing order of preference)
artesunate 2.4 mg/kg ___ or ____ given on admission (time = 0), then at 12 h and 24 h, then once a day; (In children weighing less <20 kg, —— mg/kg should be used instead)
artemether 3.2 mg/kg ____\ given on admission then 1.6 mg/kg. It should only be used if none of the alternatives are available as its _________ may be erratic.
quinine 20 mg salt/kg in on admission (———infusion) then 10 mg/kg every 8 h(The quinine should be added to 10ml/kg of isotonic solution and run over 2-4 hours)
death
ARTESUNATE, ARTHEMETHER & QUININE
IV or IM;3
IM; absorption
IV
Malaria and Children: Control
• _____________ net
• Regular indoor spraying of ————
• Clearing of _______ in the neighbourhood
• Removal of __________ in the neighbourhoods
• Intermittent preventative treatment of young children
Insecticide-treated
insecticides; bushes
water puddles
A vaccine with ~____% efficacy was licensed for use in children in 2015!
30
____________ and ___________ resistance is widespread rendering these medications ineffective
____________ is the most effective antimalarial for severe malaria
Chloroquine and sulphadoxine-pyrimethamine
Artesunate
