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Tropical Parasites > Malaria > Flashcards

Malaria Flashcards

1
Q

Name the different parasites responsible for malaria

A 
Plasmodium falciparum
Plasmodium ovale
Plasmodium vivax
Plasmodium malariae
Plasmodium knowlesi
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2
Q

What is the vector responsible for spreading malaria

A

Female Anopheles mosquito

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3
Q

What are the stages in the life cycle of Plasmodium in humans?

A

Sporozoite
Merozoite
Trophozoite
Gametozoite

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4
Q

What factors give people immunity against malaria

A 
Sickle cell
Beta thalassaemia
Duffy negative
G6PD deficiency
Acquired after long exposure
Maternal antibodies for first 6 months
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4
Q

What are the symptoms of malaria?

A 
Fever with paroxysm
Tertian, malariae is quartan
SOB
Jaundice
Flu like
Diarrhoea
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5
Q

What are the complications if malaria?

A 
Falciparum
- anaemia
- hyperreactive malarial splenomegaly syndrome 
Vivax
-splenic rupture
-relapse (+ovale)
Malariae
-nephrotic syndrome
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6
Q

What are the clinical features of severe malaria

A 
GCS<11
Multiple convulsions
Generalised weakness
SBP<80
CRT>3s
Pulmonary oedema
ARDS
Jaundice
Abnormal bleeding
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7
Q

What are the laboratory features of severe malaria

A 
Hb < or equal 5
Acidosis: pH<7.3, Lac>5, BE>8, HCO3 <15
BGL <2.2
Creatinine >265
Urea>20
Parasitaemia >10%
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7
Q

How do you diagnose malaria?

A

Clinical diagnosis VERY inaccurate
Three blood films or RDTs
Thick and think films
RDTs detect HRP2 of P.falciparum and pLDH of the others

Presence of malaria parasite in endemic areas does not mean it is the cause of the symptoms

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8
Q

What are the consequence of chronic malaria?

A 
Anaemia 
Hyperreactive malarial splenomegaly 
-anaemia,2ndry bacterial infections, fever, pancytopenia 
-responds to prolonged antimalarials
Burkitts lymphoma
Quartan malarial nephropathy
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9
Q

What are the consequences of malaria in pregnancy?

A 
Increased risk of malaria if pregnant
Low birth weight
Anaemia
Hypoglycaemia 
Pulmonary oedema
Premature birth
Foetal death in severe malaria 
Congenital malaria
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9
Q

What is the general management of malaria?

A 
All require antimalarials
Analgesia
Treat hypoglycaemia 
Consider broad spec antibiotics
LP if low GCS
Transfuse if needed
Dialysis if needed
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10
Q

How do you treat uncomplicated falciparum malaria?

A

Artemisinin-based combination therapy for 3 days

Fixed dose combos

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11
Q

List some ACTs and their features

A 
Artemether and lumefantrine
-take with milk
Artesunate amd amodiaquine
-mainly West Africa
Artesunate and mefloquine
-suitable for areas of multi drug resistance but expensive 
Dihydroartemesinin and piperaquine
Artesunate and sulfadoxine-pyrimethanine
-only useful in some parts of Africa 
Artesunate and doxy/tetra/clinda
-only to be used in hospital setting and fit rare Tx failures
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12
Q

What would you add for falciparum infection in a low transmission area?

A

Single dose primaquine

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13
Q

How would you treat uncomplicated malaria infection in a pregnant women in her first trimester?

A

7 days quinine and chloroquine or clindamycin

15
Q

How would you treat uncomplicated ovale and vivax infection?

A

ACT

Plus 14 day course primaquine to prevent relapse

17
Q

What are the side effects of quinine?

A

Hyperinsulinaemic hypoglycaemia
AKI
Liver failure

18
Q

How to treat complicated malaria?

A

IV or IM artesunate or artemether for at least 24hrs then 3 days ACT

23
Q

What are the features of cerebral malaria?

A 
Seizures (doesn't mean CM in children)
Focal Neuro
Retinal haemorrhages
Not meningism
Neuro sequelae in 5%
24
Q

What is the benefit of using artemisinin based therapy for malaria?

A

Rapid reduction in parasitaemia

Gametocytocidal so reduces transmission

25
Q

How do we prevent malaria?

A

Chemoprophylaxis
-travellers, pregnant women in Africa, seasonally to <5s in Sahel region
Vector control
-DEET or picaridin repellents
-pyrethroid only long lasting treated bednets
-IRS
Vaccination
-RTS,S/AS01 for children in moderate falciparum transmission

26
Q

What s the recommended IPT in pregnancy for malaria?

A

In Africa provide sulfadoxine-pyrimethamine to all women in first or second pregnancy
At least three doses at least 1 month apart from T2

27
Q

What is the IPT of malaria in infants?

A

In mod to high transmission in Africa give sulfadoxine-pyrimethamine to under 1yr olds at the time of 2nd and 3rd DTP vaccines

28
Q

What is the seasonal malaria chemoprophylaxis recommendation?

A

In Sahel region give monthly amodiaquine and sulfadoxine-pyrimethamine to all children under 6during each season

29
Q

When should you start and stop taking malaria chemoprophylaxis?

A

1week before and 4wks after

30
Q

What drugs are used for malaria chemoprophylaxis and what are their SEs?

A 
Atovaquone-proguanil
-well tolerated
Mefloquine 
-nausea, dreams, acute psychiatric reaction
-can be used in pregnancy 
Doxycycline 
-GI, photosensitivity
Primaquine
Proguanil and chloroquine 
-pregnant women but for low risk areas only
-falciparum resistance
31
Q

What are the pillars of the Global Technical Strategy for malaria?

A

Universal access to malaria prevention, diagnosis and treatment
Accelerate towards elimination and malaria free status
Transform malaria surveillance into a core intervention

32
Q

What are the causes of respiratory distress in malaria Pts?

A

Profound metabolic acidosis
ARDS
2ndry bacterial infection
Air hunger due to severe anaemia

33
Q

What causes black water fever?

A

Massive haemoglobinuria
Quinine
G6PD deficiency
….with malaria

37
Q

What is the relationship between HIV and malaria?

A

Malaria increases HIV VL

HIV increases the incidence of malaria and severe malaria complications

Tropical Parasites (27 decks)

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