(ID)- Malaria

Question 1

What is the most common type of malaria?

Answer 1

Plasmodium falciparum
80%

Question 2

How is malaria spread?

Answer 2

Female Anopheles mosquitoes

Question 3

What are the different types of malaria?

Answer 3

Plasmodium falciparum
Plasmodium vivax
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi

Question 4

Outline the life cycle for the spread of malaria

Answer 4

Spread by female Anopheles mosquitoes at night

Feeding mosquito takes infected blood, parasites reproduce in the mosquito gut, producing sporozoites

Mosquito bites and injects sporozoites

Sporozoites travel to the liver and mature into merozoites which enter and infect RBCS

Merozoites reproduce in RBCs, which then rupture releasing merozoites into the blood causing haemolytic anaemia

Question 5

What are hypnozoites?

Answer 5

Dormant sporozoites in the liver for months or years before reactivation

Question 6

What types of malaria do you get hypnozoites?

Answer 6

Plasmodium vivax and ovale

Question 7

How often are merozoites released in different types of malaria?

Answer 7

P. vivax and ovale
Every 48 hours, causing a fever spike every other day
(tertian malaria)

P. falciparum
More frequent (subtertian) or irregular fever spikes

P.malariae
Every 72 hours (quartan)

Question 8

How does malaria present?

Answer 8

1-4 weeks after exposure

Fever with sweats and rigors (spiking very high every 48 hours)
Fatigue
Myalgia
Headache
Nausea and vomiting

Question 9

What signs on examination are there for malaria?

Answer 9

Pallor (anaemia)
Hepatosplenomegaly
Jaundice (bilirubin released during RBC rupture)

Question 10

How is malaria diagnosed?

Answer 10

Malaria blood film
Sent in EDTA bottle

Question 11

What is needed to exclude malaria?

Answer 11

Three negative samples taken over three consecutive days due to parasites being released from RBCs every 48-72 hours

Question 12

Who advises on management of malaria?

Answer 12

Infectious diseases team

Question 13

How is uncomplicated malaria treated?

Answer 13

First line
Riamet

Second line
Quinine + doxycycline
Quinine + clindamycin
Malarone
Chloroquine (increasing resistance)
Primaquine

Question 14

When should patients NOT be given primaquine?

Answer 14

G6PDH deficiency
Causes severe haemolysis

Question 15

How is severe or complicated malaria treated?

Answer 15

Artesunate, first choice (haemolysis side effect)
Quinine dihydrochloride

Question 16

What are the complications of P.falciparum malaria?

Answer 16

Cerebral malaria
Seizures
Reduced conscioussness
AKI
Pulmonary oedema
DIC
Severe haemolytic anaemia
Multi-organ failure and death

Question 17

What prophylaxis is given for malaria prevention?

Answer 17

Mosquito spray
Mosquito nets and barriers
Medical advice if symptoms develop
Antimalarial medication

Question 18

What antimalaria medications are given for prophylaxis?

Answer 18

Malarone
Doxycycline
Mefloquine

Question 19

What are the side effects of doxycycline?

Answer 19

Diarrhoea
Thrush
Skin sensitivity to sunlight (increasing risk of sunburn and skin reactions)

2 days before travel and until 4 weeks after travel

Question 20

What are the side effects of mefloquine?

Answer 20

Psychiatric side effects
- Anxiety
- Depression
- Abnormal dreams

Can also cause
- Psychosis
- Seizures

Weekly from two weeks before until 4 weeks after