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Senoir paeds > Management of Childhood Malaria > Flashcards

Management of Childhood Malaria Flashcards

1
Q

Malaria is a clinical entity following the __________ of ______________ by species of ______________.

A

invasion of red blood cells

Plasmodia.

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2
Q

P. falciparum (——-% of infection, approx. ______% of mortality)

P. _________
P. _________
P. _________
P. _________ (South East Asia)

It is transmitted by the _________ ___________ mosquito.

A

95% ; 100%
P. malariae
P. ovale
P. vivax
P. knowlesi (South East Asia)
female Anopheles mosquito.

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3
Q

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 _______

A

sub-Saharan Africa

Africa

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4
Q

Endemicity
Amount of malaria in a community or region
1.Based on use of _________ and __________ rates children 2-9years
2. Based on ___________ rates

A

spleen and parasite

transmission

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5
Q

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

A

0- 10

11- 50

50

25

50; 75

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6
Q

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 _____

A

1

1

low

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7
Q

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

A

5 years

School

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8
Q

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

A

Hb S , G6PD deficiency

HbF ,HbE thalassemia , Duffy -negative genotype

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9
Q

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

A

knobs ;adhere to one another

endothelial wall ;deformable

sequestration ;vascular occlusion

Microvascular obstruction ; perfusion

inflammation ;parasite

host cells metabolites

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10
Q

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.

A

$2 billion

40; 1.3

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11
Q

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).

A

prematurity and low birth weight

15;47

poor cognitive

Poor growth

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12
Q

Risk factors for malaria in Nigeria (High Transmission area)
Young children
▪ ___________ visitors
▪ Children with ________
__________ or __________

A

Non-immune

HIV/AIDS

Asplenia or hyposplenism

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13
Q

Two forms of clinical Presentation

_____________________ malaria

_______________________ malaria

A

Acute uncomplicated

Severe (complicated)

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14
Q

Uncomplicated malaria

Symptoms

Fever (often ________ grade and __________ )
__________
Malaise
__________
Anorexia
________ or ________
________ pain
Diarrhoea

A

high; intermittent

Vomiting; Headaches

Myalgia or Arthralgia

Abdominal

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15
Q

In most cases the physical examination reveals no significant finding.
Fever
_______
_____________ megaly
No localising signs
Lymphadenopathy is ____________

A

pallor

Hepato or Spleno

NOT a feature

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16
Q

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

A

Life threatening

asexual

falciparum or vivax

vital organ dysfunction

17
Q

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 __________

A

Cerebral
Prostration
Pulmonary oedema
Respiratory Distress Syndrome
Convulsions ; 2
anaemia

18
Q

Forms of Severe Malaria

Shock (systolic BP<______mmHG)
______________ injury
Abnormal ______________
Hyper ______________
______________ nuria
Hyper ______________

A

50mmHG
Acute kidney
bleeding
Hyperbilirubinaemia
Haemoglobinuria
Hyperpyrexia

19
Q

Forms of Severe Malaria

_______glycaemia (serum glucose <____mmol/L)
Metabolic _________ (serum HCO3- <15mmol/L )
Hyper__________ (serum lactate >5mmol/L) Hyper___________

A

Hypoglycaemia (serum glucose <2.2mmol/L)
Metabolic acidosis (serum HCO3- <15mmol/L )
Hyperlactaemia (serum lactate >5mmol/L)
Hyperparasitaemia

20
Q

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

A

30 minutes

No CSF abnormality
encephalopathy

21
Q

Pathogenesis of cerebral malaria

__________ of __________ in the brain by _____________ and ____________

Cerebral oedema is (common or rare?) in children

A

Occlusion

small vessels

parasitized and non-parasitized red cells

Common

22
Q

Blantyre coma scale

Eye:

_______
_________

A

Directed
Not directed

23
Q

Blantyre coma scale

Verbal:

________
________
__________

A

Appropriate cry
Moan or inappropriate cry
None

24
Q

Blantyre coma scale

Motor :

A

Localizes painful stimuli
Withdrawal from pain
Nonspecific or absent response

25
Q

Severe Malaria: Severe Anaemia

Fever
Pallor (PCV <_____%) with or without evidence of decompensation
No evidence of other causes

A

15

26
Q

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

A

Acute splenic removal

Rupture; Ineffective

Mild bleeding

27
Q

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

A

blood microscopy

asexual parasitaemia

Histidine rich protein ; falciparum

Lactate dehydrogenase ; falciparum and vivax

Aldolase

28
Q

Other Investigations
________ with _______
__________
Electrolytes ,Urea & creatinine
Blood PH and gases
Blood glucose
Lumbar Puncture (where necessary)

A

Full Blood Count with ESR

Hb genotype

29
Q

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 _______________.

A

Artemisinin-combination therapy (ACT)

2; an artemisinin derivatives

30
Q

For Nigeria examples of ACT include:
• ____________ -____________
• ____________-____________
• ____________-____________
• Dihydroartemisinin-Piperaquine

A

For Nigeria examples of ACT include:
• Artemisinin-Lumefantrine
• Artesunate-amodiaquine
• Artesunate-mefloquine
• Dihydroartemisinin-Piperaquine

31
Q

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

A

airway

semi-prone; antimalarial

mono; ACT

hypoglycaemia

32
Q

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

A

blood

8 hours

39; Lumbar puncture

33
Q

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)

A

death

ARTESUNATE, ARTHEMETHER & QUININE

IV or IM;3

IM; absorption

IV

34
Q

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

A

Insecticide-treated

insecticides; bushes

water puddles

35
Q

A vaccine with ~____% efficacy was licensed for use in children in 2015!

A

30

36
Q

____________ and ___________ resistance is widespread rendering these medications ineffective

____________ is the most effective antimalarial for severe malaria

A

Chloroquine and sulphadoxine-pyrimethamine

Artesunate

Senoir paeds (25 decks)

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