Malaria Flashcards

1
Q

What organism causes malaria?

A

Most are 5 species of plasmodium, of which most infections are Plasmodium Falciparum

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2
Q

Describe the life cycle of malaria?

A

1) Female Anopheles Mosquito injects sporozoites into the blood during feeding
2) They migrate to liver and produce merozoites
3) Merozoites replicate in RBCs
4) 2nd mosquito drinks RBCs containing gametocytes
5) Gametocytes –> Zygote –> Sporozoites in the mosquito

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3
Q

How does malaria present?

A
  • fever
  • rigors
  • aching bones
  • abdo pain
  • headache
  • dysuria
  • frequency
  • sore throat
  • cough
Signs 
•	none
•	splenomegaly
•	hepatomegaly
•	mild jaundice
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4
Q

What are the advanced presentations of malaria?

A
  • Cerebral Malaria
  • Blackwater Fever
  • Pulm. Oedema
  • Jaundice
  • Severe Anaemia & associated symptoms
  • Algrid Malaria
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5
Q

What characterises cerebral malaria?

A

Coma
Convulsions
Altered mental status

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6
Q

What are the features of blackwater fever?

A

Severe haemolysis by merozoites –> Anaemia, haemoglobinuria & renal failure

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7
Q

What is algrid malaria?

A

hypotension –> Shock

Due directly to the malaria or to concomitant septicaemia

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8
Q

How do we test for malaria?

A

Thick and thin blood films - shows up parasitaemia

Quantitative buffy coat (QBC)

RApid antigen test

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9
Q

How does QBC work?

A

Centrifuge the blood so you can visualise a layer of parasitized RBCs (allows you to quantify the infection)

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10
Q

Whats special about the rapid antigen test?

A

It can be done with no training and no access to a lab, so great for the developing world

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11
Q

What factors would indicate severe/complicated malaria?

A
  • Impaired consciousness
  • Hypoglycaemia
  • Parasite count >2%
  • Haemoglobin <8mg/dl
  • Spontaneous bleed or DIC (disseminated Intravascular Coagulation)
  • Haemoglobinuria
  • Renal impairment or Acidosis
  • Pulm oedema or ARDS
  • Shock (Algrid Malaria)
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12
Q

How do we treat uncomplicated Malaria with P. falciparum?

A

3 Days or Riamet which is Artermether and Lumefantrine together.
3 days of malarone
3 days od eurartemism
7 days of quinine

This is because a lot of strains are resistant to chloroquine and to multiple drugs so combination therapy is best

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13
Q

How do we treat complicated malaria with P. Falciparum?

A

IV Artesunate

IV quinine

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14
Q

How do we treat non-falciparum malaria?

A

3 Days of chloroquine/ RIAMET
Actually the best drug but almost all falciparum is resistant now so only used for other types like Plasmodium Ovale.

If they have plasmodium Ovale or Vivax add 14 days of primaquine.

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15
Q

What measures can prevent malaria infection?

A
  • Bed nets & mesh windows
  • Anti-malarials e.g. malarone
  • Mosquito sprays e.g. DDT
  • Drainage of standing water to remove breeding grounds
  • Larvacides
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16
Q

Try to think of some tests/signs you might want to check when assessing a suspected malaria patient?
Use the complications as a guide

A
  • Temp & Hydration
  • Blood lactate & ABG for acidosis
  • U&Es + Creatinine
  • LFTs
  • Urinalysis
  • Blood Cultures
  • Clotting screen
  • FBC
  • Glucose