Pumerantz Flashcards
Malaria DDx
Influenza Enteric fever Bacteremia/sepsis Dengue fever Schistosomiasis Leptospirosis African tick fever Trypanosomiasis Yellow fever
Thick smear
Can see trophozoites
Dengue fever
Flavi virus from mesquito Can be self limiting or hemorrhagic fever with shock syndrome GI, rash, myalgia, and eye pain Symptoms appear before 14 days Leukopenia with elevated AST
P. falciparum key features
Schizont normally in microvasculature and can only see if they are really sick
Pre-erythrocitic cycle- about 2 weeks
In RBCs, knobs (histidine rich proteins) help with ET attachment
Yellow fever
Flavi virus from mesquito
Hemorrhagic with hepatic, renal, shock, and coagulopathy.
South America and sub-Saharan Africa
Premunition
Infected but no symptoms
Must live in effected area
Mechanism of quinine
Inhibit ETC
Blood schizonticide
Hepatic drugs for malaria
Atovaquone-proquanil (also does blood) and only needed for 1 week post travel for prophylaxis.
Primaquine (can also kill hypnozoites and can cause hemolytic anemia) can be used for prophylaxis.
RBC drugs for malaria
Atovaquone-proquanil (more for prophylaxis)
Doxycycline
Chloroquine (resistant species near equator can be used for prophylaxis)
Mefloquine (use if chloroquine resistant areas for prophylaxis at least 14 days after return to prevent malaria due to hepatic cycle)
Artesunate- For complicated malaria
Severe malaria tx
Quinidine
Doxycycline
Artesunate
I. scapularis
North part of America
Babesia, Borellia, Anaplasma
A. americanum
Middle to South part of America
Babesia Tx
Mild- Azithromycin, atovaquone
Severe- Quinine with clindamycin
Consider RBC exchange transfusion
Will see howell-jolly bodies if asplenic
Radical cure
primaquine requires the presence of quinine or chloroquine in order to work
Causal Prophylaxis for malaria
Atovaquone-proquani
Chloroquine
Target both liver and blood stages
