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