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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
What is the LF-LAM test ?
It Is the Lateral flow urine lipoarabinomannan assay (LF-LAM) to diagnose active TB
26
Which pt has higher yield of LF-LAM test?
1- HIV positive 2- Lower CD4 3- anaemic Patients
27
T/F in TB Culture ,, bacilli can grow faster in solid media in comparison to liquid media ?
F Grow faster in liquid media
28
T/F In tb microscopy , ZN stain is more sensitive than Immunofluorescence?
F Immunofluorescence is 10% more sensitive than ZN stain
29
T/F : GeneXpert is more expensive and slower than TB Culture?
F less expensive Faster than culture (only 1 hour )
30
geneXpert can detect MTB PCR and rpoB gene , what is rpoB gene?
Rifampicin resistance gene
31
T/F: Miliary TB is classified as pulmonary TB as per WHO Classification ?
T
32
T/F: Pleural effusion is classified as extra-pulmonary TB ?
T
33
What is TPT? What are the indication ?
Tuberculosis preventive treatment Indicated in : 1- PLWH 2- Household contact(<5years) 3- other risk factors
34
how to test for Latent TB?
1- Skin test tuberculin 2- IGRA test
35
What are the recommended doses of TPT to treat Latent TB?
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
What are the 3 Molecular WHO-recommended rapid diagnostic tests for TB detection?
1- LF-LAM 2- genXpert 3- Truenat MTB
37
Treatment duration of CNS TB?
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
What are the 5 groups of Anti-TB Drugs?
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
Eye manifestations of leprosy?
1- Lagophthalmos 2- acute and chronic iritis 3- Cataract 4- Loss of sensation in cornea
40
Which T helper cell predominate in TL and LL ?
TL: - TH1 is predominate - Active cellular mediated immunity LL: - TH2 predominate - Defective cellular mediated immunity
41
Diagnostic test for Leprosy?
Clinical : 1- Anaesthetic skin lesion 2- thickened peripheral nerves Diagostic: Slit skin smear + for AFB (No culture)
42
What is the Intermittent preventive treatment of malaria in pregnancy (IPTp) ?
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
What is the dose of Sulfadoxine-pyrimethamine (SP) as malaria Px in pregnancy
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
What is the Perennial malaria chemoprevention ?
Administration of antimalarials at specific intervals to children up to 24 months
45
what is the Single most effective intervention for reducing malaria cases since 2001 ??
LLINs/ ITNs (Insecticide-treated mosquito nets (ITNs)/ Long-lasting Insecticide-treated nets(LLINs) pyrethroid insecticides +/- synergist
46
what are the Insecticides that are recommended by WHO for IRS ?
four major classes: carbamates (C): bendiocarb, propoxur organochlorines (OC): DDT organophosphates (OP): malathion, fenitrothion, pirimiphos-methyl pyrethroids (PY):
47
What are the indications of
1- Acute uncomplicated falciparum malaria 2- Chloroquine-resistant non-falciparum malaria
48
T/F Uncomplicated P. falciparum malaria should be treated with an artemisinin combination therapy and Riamet is the drug of choice
T
49
What is Riamet ?
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
what is the recommended Tx for sever complicated falciparum malaria ?
intravenous artesunate IV quinine if artisunate is unavailable
51
What is Malarone ?
It is Atovaquone -proguanil
52
T/F: history of mental health issue is C/I to use Mefloquine
T
53
T/F: Chloroquine / proguanil is C/I in epilepsy?
T
54
What are the malaria prophylaxis that can be given once weekly ?
Mefloquine 2 w before and 4 w after chloroquine /proguanil 1 w before and 4 w after
55
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
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
What are the human protection/ adaptation mechanisms to prevent sever malaria ?
1- Sickle cell trait, α-thalassemia 2- O blood group (protection from severe disease) 3-Duffy blood group negativity (Plasmodium vivax malaria)
57
What is the ring stage of malaria?
it is the immature trophozoite which released from schizont rupture
58
What is Malarone , what are S/E and how can be used?
Atovaquone/ proguanil GI /Rash/headache Daily tablets 2 days before and 1 week after return (can increase INR if pt on warfarin)
59
What is Larium, what are S/E and how can be used?
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
T/F: Yellow fever is live attenuated and can be given as IM?
Live attenuated Can be given as S/Q
61
What is the infective stage of Malaria ?
Sporozoites
62
What stage of malaria will be taken by Mosquitoes during blood meals?
Gametocytes
63
Which malaria sp are able to form liver hypnozoites from liver infected cells
P vivax P ovale
64
T/F: P. vivax merozoites preferentially invade reticulocytes
T
65
after how many days after infection of liver cells the hypnozoites can form in vivax and ovale
after 28 days while schizont can form after 7 days only
66
T/F; sporozoites Development time in mosquito takes ≥ 9 days ?
T
67
T/F Gametocytes formation in human during falciparum infection takes 7-10 days ?
T
68
What are the 3 RDT target antigens of malaria?
1- pLDH- similar in all species 2- Histidine-rich protein (HRP2)- P. falciparum only 3- Aldolase- produced by all species
69
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
T
70
T/F: In vivax malaria Merozoites largely restricted to invading immature reticulocytes
T
71
Why P Vivax is More resistant to control measures than P. falciparum?
1- can transmit at low parasite densities 2- has earlier appearance of gametocytes (before symptoms) <7 days 3- hypnozoites in the liver (→ relapses)
72
T/F: Duffy negative blood group can protect from sever Vivax infection? Why?
T P Vivax requires Duffy antigen receptor to invade RBCs
73
T/F P ovale usually sequestrate in spleen ?
F Ovale Doesn’t sequestrate
74
What Malaria spp shows enlarged RBCs and ‘comet’ forms in BF?
P ovale
75
What is the cause of Quartan malaria ?
P Malariae
76
which plasmodium spp can cause Parasitaemias that's often below level of detection by microscopy?
P malariae
77
Which plasmodium spp can cause classic ‘band’ form in BF?
P malariae
78
Which plasmodium sp most likely to cause nephrotic syndrome in kids?
P malariae
79
T/F: p malariae Can present with fevers, malaise and splenomegaly years decades after leaving an endemic area
T But no hypnozoites
80
how to eradicate liver hypnozoites in vivax and ovale ?
Primaquine (G6PD testing)- - 14 day course (0.25 – 0.5mg/kg/day) or: - 7 day course (0.5mg/kg/day)
81
How to treat uncomplicated malaria in Pregnant and breastfeeding women?
1- During first trimester treat with Artemether + Lumefantrine 2- Other ACTs can be used in 2nd and 3rd trimesters
82
What are the special precautions when treating uncomplicated malaria in HIV pt?
1- Avoid artesunate + SP(sulphadoxine pyrimethamine ) if on co-trimoxazole 2- Avoid artesunate + amodiaquine if they are being treated with efavirenz or zidovudine.
83
T/F: Treat pregnant women in their first trimester who have chloroquine-resistant P. vivax malaria with quinine.
T
84
How to eradicate liver hypnozoite in pt known to have G6PD deficiency ?
By primaquine base at 0.75 mg/kg bw once a week for 8 weeks, with close medical supervision
85
what are the RDTs for malaria that detect pan-malaria antigen ?
1- pLDH ( can be used as test for cure) 2- Aldolase
86
Which malaria RDTs is species specific antigen?
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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