Parasitic and Fungal infections

Question 1

Malaria distribution in RSA

Answer 1

Northern Kwa-Zulu natal
Kruger
Limpopo

Question 2

incubation period malaria

Answer 2

7-21 days
longer: failed PEP/ other antibiotics
MAX - P falciparum 6-18 months

Question 3

Symptoms and signs of Malaria

Answer 3

fever, chills, perspiration, rigors 
headache 
muscle/joint aches 
malaise 
lethargy, lassitude, fatigue 
loss appetite 
nausea, vomiting, diarrhoea 
cough 
splenomegaly

Question 4

Diagnosis of Malaria

Answer 4

Rapid diagnostic test

• detect parasite antigens
• not for monitoring

Blood swears

• EDTA blood
• species and parasite count

Question 5

Indications for hospital admission in malaria include

Answer 5

any feature of severe malaria
danger signs
high risk groups
suspected treatment failure

Question 6

Danger signs of malaria

Answer 6

unable to drink/breastfeed
repeated vomiting 
recent history of convulsions 
lethargy 
unable to sit or stand

Question 7

Clinical features of severe malaria

Answer 7

impaired consciousness 
prostration 
multiple convulsions 
acidotic breathing + respiratory distress 
acute pulmonary oedema and ARDS 
circulatory collapse or shock 
anuria 
jaundice 
abnormal bleeding 

laboratory and other findings 
hypoglycaemia - < 2.2 mmol/l 
metabolic acidosis <15mmol/l 
hyperparasitaemia 
haemoglobinuria 
hyperlactataemia 
renal impairment - serum creatinine > 265 umol/l 
pulmonary oedema

Question 8

Laboratory findings in severe malaria

Answer 8

hypoglycaemia <2.2mmol/l 
metabolic acidosis - plasma bicarb <15mmo/l 
severe normocytic anaemia 
hyperparasitaemia - >4% or 3+/100 000 RBC 
haemoglobinuria 
hyperlactataemia 
renal impairment 
pulmonary oedema

Question 9

Treatment

Answer 9

complicated/severe = IVI 
- Artesunate
or  
- Quinine 
\+ Clinda/Doxy po 

Uncomplicated/ non-severe malaria = Oral 
- Co-artem 
or 
- Quinine 
\+ Clinda/Doxy

Question 10

10 steps of managing severe malaria

Answer 10

1. ABC don’t forget GLUCOSE (1ml/kg 50% DW)
2. Hydration: access and manage correctly
3. Regular observations needed - BP, Temp, RR, decreased LOC
4. Manage Fever: Paracetamol
5. Resp failure - O2, ventilation +/- Lasix
6. Decreased LOC - exclude hypoglycaemia and hypoxia
   - treat for convulsions
7. Parasite count: repeat daily
8. Transfuse if Hb <6/7g/dL or symptomatic
9. UKE consider/discuss early dialysis
10. Cover with broad spectrum antibiotics

Question 11

Prevention of malaria

Answer 11

Awareness of malaria risk
Bite prevention
Chemoprophylaxis
Diagnosis and treatment - prompt

Question 12

Chemoprophylaxis

Answer 12

Mefloquine
Malanil
Doxycycline (only one for HIV pt’s)

Question 13

Amoebiasis - treatment

Answer 13

Pus aspiration

Metronidazole

Question 14

Giardiasis

Answer 14

fatty foul smelling diarrhoea that floats

Metronidazole

Question 15

Schistosomiasis = Bilharzia

Answer 15

swimmer's itch 
urogenital bilharzia - haematuria 
bilharzia nephrosis 
GIT bilharzia 
Liver/hepatosplenic 
pulmonary 
CNS 
marked eosinophilia 
treatment: Praziquantel - Biltracide 
Diagnosis 
- urine/stool/ biopsy eggs 
- eosinophilia 
- liver biopsy 
- ELISA/ serology

Question 16

Significant whipworm infestation lead to what clinical sign? how would you treat a pt?

Answer 16

Tenesmus/ prolapse
Fe-def anaemia
treatment: Mebendazole or Albendazole

Question 17

Three clinical presentations of Candida albicans infection

Answer 17

endopthalmitis 
endocarditis 
catheter-related 
abscess 
CNS 
hepato-splenic 
Treatment: Amphotericin B 
azoles 
caspofungin