MALARIA

Question 1

Organism Type

Answer 1

protozoan parasites of the genus Plasmodium

Question 2

Scientific name:

Answer 2

plasmodium

Question 3

Subtypes:

Answer 3

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

Question 4

Common Name(s):

Answer 4

Malaria is common name in Spanish; (Mal = Bad)

& (aira = Air)

Question 5

Prevalence

Answer 5

Very Common; ~228 million cases annually and ~500,000
deaths. Estimated that Malaria has killed 1 out every 5 humans who
have ever lived.

Question 6

Predisposing Factors

Answer 6

mosquito exposure, operating in endemic areas,

lack of PPE, lack of chemoprophylaxis, lack of bed nets

Question 7

Transmitted Via

Answer 7

female anopheles mosquito

Question 8

Vector

Answer 8

Yes

Question 9

Incubation Period:

Answer 9

7 to 30 days, depending on the species of malaria

infection

Question 10

Vaccine

Answer 10

No

Question 11

Reportable

Answer 11

Yes

Question 12

Lethal

Answer 12

p. falciparum (Yes); P. vivax, P. ovale, P. malariae (maybe)

Question 13

exual cycle in (F) 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 13

Sporogony Phase

Question 14

asexual cycle in human liver

Answer 14

Exoerythrocytic Phase

Question 15

Patient is asymptomatic in this stage

Answer 15

Exoerythrocytic

Question 16

Patient is symptomatic in this stage

Answer 16

Erythrocytic Phase

Question 17

Symptoms

Answer 17

(1) Symptoms can develop as early as 7 days mosquito bite and as late as
several months or more after exposure.
(2) The presentation of Malaria can be broken down into 2 broad
categories: uncomplicated Malaria & Severe Malaria.

Question 18

Uncomplicated Malaria is characterized by:

Answer 18

(a) paroxysmal (cyclical) fever
(b) influenza-like symptoms including chills, headache,
myalgias, and malaise
(c) Jaundice & mild anemia secondary to hemolysis

Question 19

Severe malaria is characterized by:

Answer 19

(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

Question 20

Presentation

Answer 20

(1) Paroxysmal fevers are typical of Malaria and considered a clinical
hallmark of the infection
(a) Cold stage – lasts approximately 1 hour
(b) Febrile stage – lasts 2-6 hours
(c) Diaphoretic stage where fever drops – lasts 2-4 hours
(d) Patient then returns to normal
(e) Cycle repeats itself in 48 – 72 hours depending species
infection
(2) Pathogenesis of paroxysmal fever is 2/2 RBC infection and life cycle
of the parasites
(a) When RBC lyse and schizonts are released, the patient’s
immune system mounts an immune response and develops a
fever
(b) Life cycles of Malaria ranges from 48-72 hours depending on
species

Question 21

Diagnosis is based on

Answer 21

(a) Clinical findings consistent with Malaria infection
(b) Rapid diagnostic testing or laboratory confirmation via blood
smear.

Question 22

Rapid Malaria testing (AMAL)

Answer 22

) Rapid Malaria testing (AMAL):
(a) Detect antigens associated with different malarial species
(b) Gives qualitative result but no quantitative information
regarding parasite density
(c) Both positive and negative RDT results must always be
confirmed by microscopy

Question 23

Treatment options are dependent on:

Answer 23

(a) Species of malaria
(b) Severity of infection
(c) Likelihood of drug resistance (where infection was acquired)
(d) Patient’s age & Pregnancy status

Question 24

Two reliable-supply treatment regimens available in the U.S.

Answer 24

(a) Atovaquone-proguanil (Malarone)

b) Artemether-lumefantrine (Coartem

Question 25

(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 25

Reliable Supply

Question 26

Do not use the same or related drug to treat Malaria as was used for ____

Answer 26

chemoprophylaxis

Question 27

Treatment of uncomplicated Malaria

Answer 27

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

Question 28

Treatment of malaria in areas with chloroquine resistance

Answer 28

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

Question 29

Treatment of severe Malaria

Answer 29

(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 30

Treatment of P.ovale

Answer 30

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

Question 31

Prevention

Answer 31

(1) The most important protective measures are proper clothing and awareness. (2) Long sleeve shirts, long pants, insect repellant, and head nets, will keep mosquitoes from biting. (3) Addition precautions include closed sleeping quarters, insecticides, and prophylaxis.

Question 32

Resistance

Answer 32

(1) Resistance to many drugs in constantly changing and the most up-todate information should be sought from the CDC at www.CDC.gov, or the cognizant EPMU prior to travel to an endemic area. (2) Administration of prophylactic medication should begin 1-2 weeks prior (except for Malarone, Primaquine, & Doxycyline) to the expected embarkation to an endemic area and continued for 4 weeks after leaving the endemic area

Question 33

Disposition

Answer 33

(1) 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. (2) Complications can include neurologic abnormalities, acute renal failure, anemia, metabolic acidosis, hypovolemia, and Acute Respiratory Distress Syndrome.