Malaria

Question 1

Subtypes of malaria

Answer 1

P. falciparum,
P. vivax,
P. ovale,
P. malariae

Question 2

How is Malaria transmitted?

Answer 2

Female anopheles mosquito

Question 3

Malaria incubation period

Answer 3

7 to 30 days, depending on the species of malaria
infection

Question 4

True/False
Malaria is vaccine preventable

Answer 4

False

Question 5

What types of Malaria are lethal?

Answer 5

P. falciparum
P. malariae (maybe)

Question 6

Malaria – Lifecycle, What phase?
Sexual cycle in Female Anopheles Mosquito:
(a) Begins when a female anopheles mosquito takes a blood meal
from an infected human.
(b) Ends when the mosquito salivary glands are filled with
malaria parasites

Answer 6

Sporogony Phase

Question 7

Malaria – Lifecycle, What phase?
Asexual cycle in human liver (Patient is asymptomatic in this stage):
(a) Female anopheles mosquito takes another blood meal from an uninfected human and injects parasite into blood stream, infecting them.
(b) Parasites make its way to the liver via lymph system and blood stream.
(c) Parasites undergo asexual maturation in liver cells.
(d) When fully matured, parasites burst out of liver cells & are released into the bloodstream.

Answer 7

Exoerythrocytic Phase

Question 8

Malaria – Lifecycle, What phase?
Asexual reproduction in RBCs (Patient is symptomatic in this stage)
(a) Matured parasite released from the liver attach to red blood cells in the blood stream.
(b) Parasite asexually reproduce inside RBCs, forming new parasites in each infected RBC.
(c) Infected RBCs then burst & release more merozoites that infect other RBCs.
(d) RBCs lysing causes massive inflammation and decreases O2 carrying capacity (anemia).

Answer 8

Erythrocytic Phase

Question 9

What phase of Malaria is Symptomatic?

Answer 9

Erythrocytic

Question 10

The presentation of Malaria can be broken down into what 2 broad
categories?

Answer 10

Uncomplicated Malaria & Severe Malaria

Question 11

What broad category of malaria
(a) Paroxysmal (cyclical) fever
(b) Influenza-like symptoms including chills, headache,
myalgias, and malaise.
(c) Jaundice & mild anemia secondary to hemolysis

Answer 11

Uncomplicated Malaria

Question 12

What broad category of malaria?
(a) Small blood vessels infarction, capillary leakage and organ dysfunction
(b) Altered consciousness
(c) Hepatic failure & renal failure
(d) Acute respiratory distress syndrome
(e) Severe anemia

Answer 12

Severe malaria

Question 13

__________ are typical of Malaria and considered a clinical
hallmark of the infection

Answer 13

Paroxysmal fevers

Question 14

Malaria Paroxysmal Fevers
(a) Cold stage – lasts approximately ____
(b) Febrile stage – lasts ____ hours
(c) Diaphoretic stage where fever drops – lasts ____ hours
(d) Patient then returns to normal
(e) Cycle repeats itself in ____ hours depending on species of
infection

Answer 14

a) 1 hour
b) 2-6
c) 2-4
e) 48 – 72

Question 15

Life cycles of Malaria ranges from ____ hours depending on
species.

Answer 15

48-72

Question 16

Consider _____ in any febrile patient returning from a malaria
endemic country.

Answer 16

malaria

Question 17

What is diagnosis based on for Malaria?

Answer 17

-Clinical findings consistent with Malaria infection
-Rapid diagnostic testing or laboratory confirmation via blood
smear.

Question 18

True/False
For simplicity you can use the same or related drug to treat Malaria as the one used for chemoprophylaxis.

Answer 18

FALSE

Question 19

What are reliable-supply treatment regimens available in the U.S for Malaria

Answer 19

(a) Atovaquone-proguanil (Malarone)
(b) Artemether-lumefantrine (Coartem)

Question 20

What does this define?
(a) Complete course of approved treatment regimen obtained in
the U.S.
(b) Is not counterfeit or substandard
(c) No adverse interactions with the patient’s other medicines,
including prophylaxis
(d) Will not deplete local resources in the destination country

Answer 20

Reliable Supply

Question 21

Treatment of Uncomplicated Malaria

Answer 21

(a) Chloroquine phosphate 1g (600mg base) PO
(b) THEN 0.5g in 6 hours
(c) THEN 0.5g daily for 2 days

Question 22

Treatment of malaria in areas with chloroquine resistance

Answer 22

Malarone (Atovaquone 250mg/Proguanil 100mg) 4 tabs PO QD for 3 days

Question 23

Treatment of Severe Malaria

Answer 23

(a) Artesunate 2.4mg/kg IV at 0, 12, 24, 48 hours
(b) Followed by Doxycycline 100mg BID x 7 days after parenteral therapy

Question 24

Treatment of P.ovale

Answer 24

(a) ADD primaquine 52.6mg (30mg base = 2 tablets) PO QD x
14 days
(b) Added to regiment for hypnozoites

Question 25

What are the most important protective measures for Malaria

Answer 25

proper clothing and awareness

Question 26

Administration of Malaria prophylactic medication such as Chloroquine, & Mefloquine
1. should begin __-___ weeks prior to the expected embarkation to an endemic area
2. and continued for __ weeks after leaving the endemic area

Answer 26

1. 1-2 weeks
2. 4 weeks

Question 27

True/False
Malaria - Disposition
Patients presenting with signs and symptoms of the mild form of
the disease can be retained onboard.

Answer 27

FALSE
Even patients presenting with signs and symptoms of the mild form of the disease should be evacuated to definitive medical care facility as soon as possible

Question 28

Malarone, Primaquine, & Doxycycline; start _ days prior to entry & continue till __ days after departing
- Doxycycline to be continued till ____ after departing

Answer 28

2 days prior, 7 Days
Doxy 1 month after leaving

Question 29

True/False
Malaria - Disposition
Patients presenting with signs and symptoms of the mild form of
the disease can be retained onboard.

Answer 29

FALSE
Even patients presenting with signs and symptoms of the mild form of the disease should be evacuated to definitive medical care facility as soon as possible

Question 30

True/False
Malaria - Disposition
Patients presenting with signs and symptoms of the mild form of
the disease can be retained onboard.

Answer 30

FALSE
Even patients presenting with signs and symptoms of the mild form of the disease should be evacuated to definitive medical care facility as soon as possible

Question 31

Treatment of Uncomplicated Malaria

Answer 31

(a) Chloroquine phosphate 1g (600mg base) PO
(b) THEN 0.5g in 6 hours
(c) THEN 0.5g daily for 2 days