Schoenwald - Malaria and Tick Borne Illnesses Flashcards
1
Q
malaria symptoms are characterized as
A
cyclical
2
Q
3 sx of malaria
A
f/c
ha
myalgia
3
Q
most cases of malaria in US can be attributed to
A
returning travelers
4
Q
85% of all malaria cases are from (2)
A
Africa
India
5
Q
93% of malaria cases are from
A
sub Saharan Africa
6
Q
severe malaria migrates to the
A
brain
7
Q
sx of severe malaria
A
sx
confusion
renal failure
ARDS
coma → death
8
Q
5 forms of malaria
A
falciparum
vivax
ovale
malariae
knowlesi
9
Q
mc transmission of malaria
A
mosquito
10
Q
besides mosquito, 4 other modes of transmission for malaria
A
transfusion
organ transplant
needle sharing
mother to fetus
11
Q
malaria is a parasite of the
A
RBC
12
Q
1st lifecycle of malaria affects the __,
if undetected, it moves to __
A
liver
RBC
13
Q
__ hx is very important in suspected malaria
A
travel
14
Q
gs (and most sensitive) test for malaria
A
blood smear → thick AND thin
15
Q
blood smear for malaria determines (2)
A
species
%parasitemia
16
Q
when is blood smear for malaria ideally done
A
during episode of fever
17
Q
less sensitive test for malaria
A
rapid diagnostic tests
PCR (more sensitive than rapid)
18
Q
rapid tests for malaria need confirmation via
A
microscopy
19
Q
prevention for malaria (5)
A
insect repellent
caution at night
mosquito netting
permethrin containing clothes, tents etc
malaria chemoprophylaxis
20
Q
what insecticide should be used for malaria prophylaxis
A
permethrin
21
Q
what prophylaxis for malaria has resistance issues
A
chloroquine
22
Q
chemoprophylaxis options for malaria (5)
A
atovaquone
doxycycline
mefloquine (lariam)
primaquine
tafenoquine (arkoda, krintafel)
23
Q
mc used malaria prophylaxis
A
atovaquone/proguanil (malarone)
24
Q
dosing for atovaquone/proguanil (malarone)
A
daily through 7 days after return
25
malaria prophylaxis causes sun sensitivity
doxycycline
26
dosing for doxycycline prophylaxis
through 30 days after return
27
which class of malaria prophylaxis should be avoided in pt's w. g6pd deficiency
**quines →**
chloroquine
mefloquine (lariam)
primaquine
tafenoquine (arkoda, krintafel)
28
which malaria prophylaxis has a high rate of s.e
mefloquine (lariam)
29
s.e of mefloquine (lariam)
dpn
confusion
night terrors
hallucinations
30
dosing for mefloquine
weekly through 4 weeks post return
31
what malaria drug is used for prophylaxis AND antirelapse
primaquine
*used in combo w. other prophylaxis*
32
protozoa mc associated w. recurrent malaria
p vivax
33
dosing for primaquine
daily for 7 days after return
34
newest malaria prophylactic
tafenoquine (arkoda, krintafel)
35
dosing for tafenoquine (arkoda, krintafel)
3 days prior to travel
then weekly thru 1 week after return
36
benefit of tafenoquine (arkoda, krintafel)
shorter dosing duration
37
tx in US for malaria
atovaquone/proquanil 4 tablets po qd x 3 days
38
malaria infections are more severe in
pregnant
39
best malaria prophylaxis for pregnant pt
avoid travel to malaria regions
40
only fda approved prophylaxis for pregnant
chloroquine
mefloquine
41
what malaria prophylactic is contraindicated in pregnant
doxycycline
42
malaria and pregnancy is associated w. (3)
premature births
spontaneous abortions
stillbirth
43
dengue fever is also called
bone break fever
44
sx of dengue fever (3)
**extreme muscle/body aches**
fatigue
fever
45
what kind of virus is dengue fever
flavivirus
46
dengue fever is endemic to (3)
asia
central america
africa
47
reinfections w. the same strain of dengue are usually \_\_,
reinfection w. different strain of dengue can be \_\_
same strain: less severe
different strain: more severe
48
can we test for different strains of dengue
no!
49
tx for dengue
symptomatic
50
\_\_ is absolutely contraindicated in tx for dengue
bc it can cause \_\_
NSAIDs
hemolytic anemia
51
the __ mosquito causes west nile virus
culex
52
is the culex mosquito found in US?
yes, it is prevalent in US
53
west nile virus can be asymptomatic, or symptoms can include (6)
ha
ams
fever
body aches
rash
meningitis
54
prevalence of rash in west nile virus
1 in 150
55
symptom that is unique to wnv
flaccid paralysis
56
flaccid paralysis in wnv can be \_\_
or become \_\_
self-limiting
permanent
57
dx for wnv
IgG/IgM serologies in blood or spinal fluid
58
tx for wnv
supportive
59
tick borne illnesses (3)
lyme dz
rickettsial dz
babesia
60
pathogen responsible for lyme dz
spirochete borrelia burgdorferi
61
what type of tick causes lyme dz
ixodes ricinius (deer tick)
62
lyme dz is endemic which parts of the US (3)
northeastern
north central
coastal regions
63
incubation period for lyme dz
3-32 days
64
4 types of sx associated w. lyme dz
dermatologic
rheumatologic
neurologic
cardiac
65
dermatologic sx associated w. lyme dz
erythema migrans w.in 30 days of exposure
66
stages of lyme dz
1. early
2. conduction abnormalities
3. persistent
67
sx of stage 1 of lyme dz (4)
**erythema migrans in 75%**
fever
myalgias
fatigue
68
sx of stage 2 of lyme dz
AV block in 5%
+/- onset of bell's palsy
+/- lymphocytic meningitis
69
sx of stage 3 of lyme dz
arthritis type sx
70
t/f chronic lyme dz is clinically validated
f!
71
dx for lyme dz (2)
hx of exposure
ELISA followed by western blot
72
problem w. serology for lyme dz
often negative in 1st few weeks
73
adult tx for lyme dz
doxycycline 100 mg po bid x 21 days
74
tx for lyme dz \< 8 yo
amoxicilin 50 mg/kg/day divided into 3 doses (q 8 hr) x 14-21 days
75
tx for lyme dz in pregnant pt
amoxicillin
76
what do you think when you see maltese cross formation in RBC
babesia
77
what type of tick causes babesia
ixodes scapulaaris
78
sx of babesia (4)
hemolytic anemia
fatigue
body aches
+/- fever, hsm, hepatomegaly
79
tx for babesia
atovaquone 750 mg po bid
PLUS
azithromycin 500-1,000 mg qd x 7-10 days
80
what pathogen causes spotted fever/rocky mtn spotted fever
rickettsia
81
occurrence of spotted fever
worldwide
southeastern US
82
cardinal sx of spotted fever
maculopapular rash progressing to petechiae
83
maculopapular rash associated w. spotted fever starts on \_\_
and spreads to \_\_
hands/feet
body
84
other sx associated w. spotted fever
fever
ha
abd pain
85
dx for spotted fever (2)
PCR
acute AND convalescent sera
86
sera testing for spotted fever
87
tx for spotted fever
doxycycline 100 mg po bid x 14 days
88
tx for spotted fever in pregnancy
chloramphenicol
89
what do you think when you see morulae
anaplasma and ehrlichia
90
what are morulae
inclusions in wbc
91
sx of anaplasma and ehrlicia (2)
fever
myalgia
92
anaplasma and ehrlichia are __ borne
tick
93
colorado tick fever is primarily found in colorado and
idaho
94
what do you think when you see **pain behind the eyes,** fever, rash, ha
colorado tick fever
95
lab findings of colorado tick fever
low platelet counts on CBC
96
tx for colorado tick fever
supportive
platelets normalize in a few weeks
97
what flavivirus has a cross rxn w. wnv
zika
98
sx of zika (2)
f/n/v
body aches
99
main risk of zika is in __ population
pregnant
100
what congenital birth defect is associated w. zika
microcephaly
101
dx for zika
PCR on serum and/or urine
IgM
102
tx for zika
supportive
103
pt ed for pt w. travel hx to zika zone
3 months of abstinence → can spread in seminal fluid
104
what drug should be avoided in zika
nsaids
105
stages of yellow fever
incubation
acute
relapse
106
incubation period of yellow fever
3-6 days
107
sx of acute yellow fever
fever
myalgias
ha
backache
n/v
**followed by initial improvment**
108
what % of pt's relapse after acute yellow fever
15%
109
what do you think when you see, jaundice, hemorrhagic sx, shock, multiorgan failure
relapse of yellow fever
110
\_\_% of the 15% of pt's w. relapsed yellow fever die
50%!
111
yellow fever is a \_\_virus
flavivirus
112
dx for yellow fever is based on (3)
area of travel
clinical presentation
hx of immunization
113
definitive dx for yellow fever
contact cdc for guidance
*serology and nucleic acid available but not reliable*
114
is there a tx for yellow fever
no!
115
what tx should be avoided in yellow fever (and all flaviviruses)
NSAIDs
116
can anyone administer the yellow fever vaccine
no! need certification
117
yellow fever vaccine is a __ vaccine
and should be avoided in \_\_
live
pregnancy
118
caution in yellow fever vaccine in pt's \> \_\_
dt risk for \_\_
60 yo
yellow fever vaccine associated viscerotropic dz (YFV-AVD)
119
what are the flaviviruses we need to know (4)
yellow fever
dengue fever
west nile virus
zika virus
120
pharm to avoid in flaviviruses dt risk of hemorrhagic dz
NSAIDs
121
what are flaviviruses
RNA viruses w. arthropod vectors that cause serious human dz
