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Parasitology > TB and Malaria > Flashcards

TB and Malaria Flashcards

1
Q

What is mechanism of action of Rifampicin?

A

act by inhibiting the bacterial DNA-dependent RNA Polymerase (B subunit)

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2
Q

T/F:
Rifampicin should be taken on an empty stomach ?

A

It is generally taken either at least one hour before meals or two hours after meals.

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3
Q

Commonest side effect of Rifampicin

A

1- Hepatotoxicity
2- orange-red discoloration of body fluids
3- GI symptoms
4- reduce the efficacy of warfarin and contraceptive pills

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4
Q

What is the Mechanism of action of Isoniazid (INH) ?

A

By inhibiting the mycolic acid synthesis (result in inhibiting the formation of the mycobacterial cell wall)

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5
Q

Side effects of INH ?

A

1- Peripheral neuropathy in up to 20% of patients

2- elevated liver enzymes

3- aplastic anaemia , agranulocytosis and thrombocytosis
(needs to be given with vitamin B6 pyridoxin)

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6
Q

T/F
INH is bacteriostatic?
and act on slow dividing mycobacteria?

A

F

Bactericidal
Act on rapidly dividing mycobacteria

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7
Q

What is the mechanism of action of Ethambutol ?

A

Act by inhibiting the synthesis of arabinogalactan , that’s leads to increase permeability of mycobacterial cell wall

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8
Q

T/F
Ethambutol is bactericidal against latent mycobacterium ?

A

F
Ethambutol is bacteriostatic against actively growing TB bacilli.

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9
Q

What are the side effects of Ethambutol?

A

1- main: optic neuritis (C/I in kids < 6 years)
2- Red–green colour blindness
3- arthralgia
4- Hyperuricaemia

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10
Q

what is the mechanism of action of pyrazinamide ?

A

Act by inhibiting enzyme fatty acid synthase (FAS) I , that’s leads to inhibiting the short chain fatty acid synthesis

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11
Q

What are the commonest pyrazinamide side effects?

A

1- Arthralgia (but not Arthritis)
2- Hyperuricaemia but not gout
3- hepatitis (commonest cause of DILI))
4- GI symptoms

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12
Q

T/F
Pyrazinamide can cross blood brain barrier in TB Meningitis?

A

T

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13
Q

T/F:
Pyrazinamide can only work in closed alkaline media ?

A

F
- it works in closed acidic conditions
- In less actively replicating mycobacteria

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14
Q

Organisms thats belong to the Mycobacterium tuberculosis complex family ?

A

1- Mycobacterium tuberculosis
2- Mycobacterium africanum
3- Mycobacterium bovis
4- BCG ( Bacillus Calmette–Guérin)

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15
Q

What is the generation time for MTB ?

A

18 hours

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16
Q

T/F :
Pyrazinamide is bactericidal

A

T

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17
Q

What is the traditional role of pyrazinamide in TB Treatment?

A

play important role in preventing relapses

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18
Q
A
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19
Q

which anti-TB drugs that can cause Drug induced liver injury (DILI)?

A

1- Pyrazinamide
2- INH
3- Rifampicin

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20
Q

Whats is the only anti-TB thats not causing DILI?

A

Ethambutol

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21
Q

What is the only anti-TB that can cause cytopaenia ?

A

Rifampicin

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22
Q

what is Voractiv Film-coated Tablets?

A

single tablet contains:

  • ethambutol
  • isoniazid
  • pyrazinamide
  • rifampicin
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23
Q

What is rifinah 300/150 mg ?

A

Rifampicin 300 mg

Isoniazid 150 mg

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24
Q

All anti TB Drugs are bactericidal except??

A

Ethambutol

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25
Q

What is the LF-LAM test ?

A

It Is the Lateral flow urine lipoarabinomannan assay (LF-LAM) to diagnose active TB

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26
Q

Which pt has higher yield of LF-LAM test?

A

1- HIV positive
2- Lower CD4
3- anaemic Patients

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27
Q

T/F
in TB Culture ,, bacilli can grow faster in solid media in comparison to liquid media ?

A

F
Grow faster in liquid media

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28
Q

T/F
In tb microscopy , ZN stain is more sensitive than Immunofluorescence?

A

F
Immunofluorescence is 10% more sensitive than ZN stain

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29
Q

T/F :
GeneXpert is more expensive and slower than TB Culture?

A

F
less expensive
Faster than culture (only 1 hour )

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30
Q

geneXpert can detect MTB PCR and rpoB gene , what is rpoB gene?

A

Rifampicin resistance gene

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31
Q

T/F:
Miliary TB is classified as pulmonary TB as per WHO Classification ?

A

T

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32
Q

T/F:
Pleural effusion is classified as extra-pulmonary TB ?

A

T

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33
Q

What is TPT?
What are the indication ?

A

Tuberculosis preventive treatment

Indicated in :
1- PLWH
2- Household contact(<5years)
3- other risk factors

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34
Q

how to test for Latent TB?

A

1- Skin test tuberculin
2- IGRA test

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35
Q

What are the recommended doses of TPT to treat Latent TB?

A

1- isoniazide daily for 6-9 months ( 5mg/kg for adult or 10 mg/kg for kids) max 300 mg

2- Rifampicin 10 mg /kg for adult or 15mg/kg for kids Max 600 mg /day

3- Isoniazide +Rifampicin for 3 months

36
Q

What are the 3 Molecular WHO-recommended rapid diagnostic tests for TB detection?

A

1- LF-LAM
2- genXpert
3- Truenat MTB

37
Q

Treatment duration of CNS TB?

A

4 drugs for first 2 months
(R/H/Z/E)
Followed by 10 months of R/H
Steroids for the first 2-3 weeks

38
Q

What are the 5 groups of Anti-TB Drugs?

A

Group 1:
R/H/Z/E

Group 2:
injectable anti-TB (kanamycin , Streptomycin , Amikacin , capreomycin)

Group 3: Fluroquinolones (Ofloxacin , Moxifloxacin, Levofloxacin)

Group 4: Oral bacteriostatic agents( ethionamide , proteonamide , cycloserine , aminosalicylate PAS)

Group 5 : drugs with unclear role (linezolid , imipenem , clarithromycin , coamoxiclav , co-fazimine , thioacetazone)

Group 6 :New agents:
(delamanid , bedequiline)

39
Q

Eye manifestations of leprosy?

A

1- Lagophthalmos
2- acute and chronic iritis
3- Cataract
4- Loss of sensation in cornea

40
Q

Which T helper cell predominate in TL and LL ?

A

TL:
- TH1 is predominate
- Active cellular mediated immunity

LL:
- TH2 predominate
- Defective cellular mediated immunity

41
Q

Diagnostic test for Leprosy?

A

Clinical :
1- Anaesthetic skin lesion
2- thickened peripheral nerves
Diagostic:
Slit skin smear + for AFB (No culture)

42
Q

What is the Intermittent preventive treatment of malaria in pregnancy (IPTp)
?

A

Sulfadoxine-pyrimethamine (SP) is recommended for all pregnant women from 2nd trimester.

Doses given 1 month apart (at each ANC visit) so that at least 3 doses are received

43
Q

What is the dose of Sulfadoxine-pyrimethamine (SP) as malaria Px in pregnancy

A

Three tablets of SP (each tablet containing 500 mg/25 mg SP) stat from 2nd trimester PLUS:

Low dose folic acid 04 mg daily

44
Q

What is the Perennial malaria chemoprevention ?

A

Administration of antimalarials at specific intervals to children up to 24 months

45
Q

what is the Single most effective intervention for reducing malaria cases since 2001
??

A

LLINs/ ITNs
(Insecticide-treated mosquito nets (ITNs)/ Long-lasting Insecticide-treated nets(LLINs)

pyrethroid insecticides +/- synergist

46
Q

what are the Insecticides that are recommended by WHO for IRS ?

A

four major classes:
carbamates (C): bendiocarb, propoxur
organochlorines (OC): DDT
organophosphates (OP): malathion, fenitrothion, pirimiphos-methyl
pyrethroids (PY):

47
Q

What are the indications of

A

1- Acute uncomplicated falciparum malaria

2- Chloroquine-resistant non-falciparum malaria

48
Q

T/F

Uncomplicated P. falciparum malaria should be treated with an artemisinin combination therapy
and Riamet is the drug of choice

A

T

49
Q

What is Riamet ?

A

Artemether with lumefantrine
20/120 mg tablets

Initially 4 tablets, followed by 4 tablets for 5 doses each given at 8, 24, 36, 48 and 60 hours (total 24 tablets over 60 hours).

50
Q

what is the recommended Tx for sever complicated falciparum malaria ?

A

intravenous artesunate

IV quinine if artisunate is unavailable

51
Q

What is Malarone ?

A

It is Atovaquone -proguanil

52
Q

T/F:
history of mental health issue is C/I to use Mefloquine

A

T

53
Q

T/F:
Chloroquine / proguanil is C/I in epilepsy?

A

T

54
Q

What are the malaria prophylaxis that can be given once weekly ?

A

Mefloquine
2 w before and 4 w after

chloroquine /proguanil
1 w before and 4 w after

55
Q

1- Doxycycline
-Avoid in pregnancy
-1 w before, 4 weeks after travel
Compliance very important

2- Malarone (Atovaquone/Proguanil)
- Acts on liver stages
- shorter duration required (2 days before 7 days after travel)
Can be used in 2nd/3rd trimesters in absence of suitable alternative
Folic acid 5mg daily should be taken for duration of prophylaxis

A

3- Mefloquine
Once weekly regimen
2 weeks before, 4 weeks after
Licensed for use up to 1 year
Can be used in pregnancy; caution in 1st trimester (?inc rate stillbirths)
Several contraindication including history of mental health problems
More frequent S/E

4- (Chloroquine/Proguanil)
Only in areas without resistance
Once weekly dosing; 1 week prior, 4 weeks after travel
Can be used in pregnancy and in children
Contraindicated in epilepsy

56
Q

What are the human protection/ adaptation mechanisms to prevent sever malaria ?

A

1- Sickle cell trait, α-thalassemia
2- O blood group (protection from severe disease)
3-Duffy blood group negativity (Plasmodium vivax malaria)

57
Q

What is the ring stage of malaria?

A

it is the immature trophozoite which released from schizont rupture

58
Q

What is Malarone , what are S/E and how can be used?

A

Atovaquone/ proguanil

GI /Rash/headache

Daily tablets
2 days before and 1 week after return
(can increase INR if pt on warfarin)

59
Q

What is Larium, what are S/E and how can be used?

A

Mefloquine

Neuropsycosis , depression , self harm and suicide ideation
Cardiac conduction defects
C/I in renal and liver disease

250mg po once weekly
4 weeks before and 4 weeks after

60
Q

T/F:
Yellow fever is live attenuated and can be given as IM?

A

Live attenuated
Can be given as S/Q

61
Q

What is the infective stage of Malaria ?

A

Sporozoites

62
Q

What stage of malaria will be taken by Mosquitoes during blood meals?

A

Gametocytes

63
Q

Which malaria sp are able to form liver hypnozoites from liver infected cells

A

P vivax
P ovale

64
Q

T/F:
P. vivax merozoites preferentially invade reticulocytes

A

T

65
Q

after how many days after infection of liver cells the hypnozoites can form in vivax and ovale

A

after 28 days
while schizont can form after 7 days only

66
Q

T/F;
sporozoites Development time in mosquito takes ≥ 9 days ?

A

T

67
Q

T/F

Gametocytes formation in human during falciparum infection takes 7-10 days ?

A

T

68
Q

What are the 3 RDT target antigens of malaria?

A

1- pLDH- similar in all species

2- Histidine-rich protein (HRP2)- P. falciparum only

3- Aldolase- produced by all species

69
Q

T/F:
The main antigenic ligands responsible for cytoadherence and antigenic variation is P. falciparum Erythrocyte Membrane Protein-1 (PfEMP1) family, encoded by var gene family

A

T

70
Q

T/F:

In vivax malaria Merozoites largely restricted to invading immature reticulocytes

A

T

71
Q

Why P Vivax is More resistant to control measures than P. falciparum?

A

1- can transmit at low parasite densities

2- has earlier appearance of gametocytes (before symptoms) <7 days

3- hypnozoites in the liver (→ relapses)

72
Q

T/F:
Duffy negative blood group can protect from sever Vivax infection?

Why?

A

T

P Vivax requires Duffy antigen receptor to invade RBCs

73
Q

T/F
P ovale usually sequestrate in spleen ?

A

F
Ovale Doesn’t sequestrate

74
Q

What Malaria spp shows enlarged RBCs and ‘comet’ forms in BF?

A

P ovale

75
Q

What is the cause of Quartan malaria ?

A

P Malariae

76
Q

which plasmodium spp can cause Parasitaemias that’s often below level of detection by microscopy?

A

P malariae

77
Q

Which plasmodium spp can cause classic ‘band’ form in BF?

A

P malariae

78
Q

Which plasmodium sp most likely to cause nephrotic syndrome in kids?

A

P malariae

79
Q

T/F:
p malariae Can present with fevers, malaise and splenomegaly years decades after leaving an endemic area

A

T
But no hypnozoites

80
Q

how to eradicate liver hypnozoites in vivax and ovale ?

A

Primaquine (G6PD testing)-
- 14 day course (0.25 – 0.5mg/kg/day)
or:
- 7 day course (0.5mg/kg/day)

81
Q

How to treat uncomplicated malaria in Pregnant and breastfeeding women?

A

1- During first trimester treat with Artemether + Lumefantrine

2- Other ACTs can be used in 2nd and 3rd trimesters

82
Q

What are the special precautions when treating uncomplicated malaria in HIV pt?

A

1- Avoid artesunate + SP(sulphadoxine pyrimethamine ) if on co-trimoxazole

2- Avoid artesunate + amodiaquine if they are being treated with efavirenz or zidovudine.

83
Q

T/F:
Treat pregnant women in their first trimester who have chloroquine-resistantP. vivaxmalaria with quinine.

A

T

84
Q

How to eradicate liver hypnozoite in pt known to have G6PD deficiency ?

A

By primaquine base at 0.75 mg/kg bw once a week for 8 weeks, with close medical supervision

85
Q

what are the RDTs for malaria that detect pan-malaria antigen ?

A

1- pLDH ( can be used as test for cure)
2- Aldolase

86
Q

Which malaria RDTs is species specific antigen?

A

1- Histidine -rich protein 2 (HRP2 ) - for falciparum , can remain +ve for 3 weeks

2-P Vivax specific LDH

Parasitology (5 decks)

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