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Tropical Medicine > Malaria > Flashcards

Malaria Flashcards

1
Q

Sporogony

A

asexual multiplication, mosquito –>sporozoites (INFECTIVE)

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2
Q

Schizogony

A

asexual multiplication in the man (Schizonts which burst merozoites)

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3
Q

Malaria life cycle

A

Mosquito injects sporozoites into the human (infection). The sporozoites travel to the liver for hepatocyte invasion. The sporozoites burst and release merozoites and enter into a blood cell. They form a ring trophozit and undergo a sexual reproduction into gametocytes. The mosquito gets the gametocytes and it forms into a zygote–>ookinete->oocyst–>and travels to the midgut of the mosquito. Int heh midgut of the mosquito, it gbecomes sporozoites and goes into the salivary gland.

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4
Q

Schuffners dots

A

P vivax and P ovale -enlarge the RBC

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5
Q

Ziemann’s stippling

A

P malariae

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6
Q

Sinton and Mulligan’s stippling

A

P knowlesi

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7
Q

Maurers clefts

A

P falciparum

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8
Q

What is cytoadherence

A

Happens in P falciparum. PfEMP-1 (Pf Erythrocyte membrane protein 1) Helps sequester parasite in visceral capillaries and venules. Causes endothelial injury and avoids parasite clearance in the spleen

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9
Q

Quotidian Fever

A

q24 hours schizogony: P knowlesi

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10
Q

Tertian Fever

A

q48 hours schizogony, P falciparum, P vivax, P ovale

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11
Q

Patent parasitemia

A

parasitemia detected by optic microscopy (>50p/uL)

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12
Q

sub-patent parasitemia

A

parasites present in the blood but not detected by optic microscopy <50p/uL

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13
Q

Pre-patent period

A

Time between infection and detection b y optic microscopy

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14
Q

Incubation period

A

time between infection and the onset of symptoms

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15
Q

Recrudescence

A

renewed detection of parasitemia arising from survival of undetectable erythrocytic parasites

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16
Q

Relapse

A

renewed detection of parasitemia arising from survival of exo-erythrocytic parasites (hypnozoites): Vivax and Ovale

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17
Q

Reinfection

A

Renewed detection of parasitemia arising from a NEW mosquito bite

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18
Q

Pyrogenic density

A

level of parasitemia at which fever occurs. Lower in nonimmunes <10,000 pf/uL

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19
Q
A

Plasmodium Vivax
Tx: Chloroquine + Primaquine
Enlarges the RBC

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20
Q

Uncomplicated Malaria

A

A patient who presents with symptoms of malaria and a positive parasitological test but NO features of severe malaria

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21
Q

Uncomplicated Hyperparasitemia

A

Patients who have >4% parasitemia but no signs of severity. They are at risk for severe malaria and resistance and treatment failure

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22
Q

What is severe malaria

A

Defined as 1 or more of the following:
-Impaired consciousness GCS<11
-Prostration (weakness)
-Convulsions (>2 in 24 hours)
-Pulmonary Edema
-Significant Bleeding
-Shock
-Acidosis
-Hypoglycemia
-Hgb <5
-Cr>3
-Tbili>3 or jaundice
-Hyperparasitemia >5%

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23
Q

Definitions of hyperparasitemia

A

> 4% without signs of severe malaria
2% in non-immune (i.e. travelers)
4% in endemic regions (i.e. “immune”
10% in all settings

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24
Q

What is the most common ACT that is also safe in pregnancy

A

artemether-Lumefantrine (AL)

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25
Q

Explain why you need ACT

A

Artemisin is rapidly acting, short half life, will kill parasite in the blood and gametocytes
You need a partner drug to be longer acting and clear the remaining parasite. Also will help reduce resistance

26
Q

What is the definition of chloroquine resistance

A

treatment failure at day 28 >10%

27
Q

What happens to malaria parasitemia in HIV+?

A

2-3 fold increase in parasitemia in HIV+ as compared to non HIV patients. (Inversely corelated with CD4 count)

28
Q

True or false-HIV + patients that are infected with malaria are at higher risk for developing severe malaria

A

True -increased prevalence of clinical malaria; increased prevelenace of parasitemia, increased parasite density

29
Q

In HIV +Children with malaria, what do you expect to see?

A

Increased prevalence/severity of anemia
Increased transfusion requirements
increased prevalence of coma, hypoglycemia
increased prevalence of concomittant bacteremia

30
Q

what happens to hgb in HIV+ Malaria infections

A

hgb drops fast after malaria infection. slow to recover

31
Q

What is the 2nd/third cause of severe morbidity in HIV patients

A

malaria

32
Q

what is the mean CD4 count decline per year for:
1 malaria episode
2 malaria episodes
3 malaria episodes

A

5/uL for 1 malaria
84/uL for 2 malaria episodes
142/uL for >3 malaria episodes

33
Q

Bactrim in HIV + prevents from what

A

Malaria
PCP
Toxoplasma

34
Q

What happens to HIV RDTs during malaria episode

A

Specificity decreases

35
Q

What happens to viral load of HIV in malaria

A

it transiently increases

36
Q

if a child is taking zidovudine-containing regimen and is treated with artesunate/amodiaquine for malaria, what side effect to be aware of?

A

neutropenia

37
Q

genetic traits that protect from severe malaria

A

sickle cell *
alpha thal, b thal, g6pd, blood group O

38
Q
A

NEURO: GCS<11 (adults); Children <2 Blantyre
>2 seizures in 24 hours
prostatitis (weakness)

CV: Acidosis Bicarb <15 /kussmaul
BE>8
Lactate>5
SHOCK SBP<70 *children <80 adults

PULM: ARDS , SpO2<92%, RR>30

ABD: Jaundice, Tbili>3 WITH parasitemia>100,000

RENAL: ARF: Cr>3 or BUN>20

ENDO: Hypoglycemia <40

HEME: Bleeding , Hgb <5 in children, <7 in adults together with parasite count >10,000

ID: Hyperparasitemia P falciparum parasitemia >10%

39
Q

Ruptured spleen can happen in what plasmodium species

A

P vivax malaria

40
Q

Children with severe malaria clinical findings

A

-Prostrated (unable to sit)
-Comatose (unable to localize to pain) (blantyre<2)
-Acidotic breathing with nasal flaring and intercostal muscle use

41
Q

Cerebral Malaria definitions/clinical features

A

“Unarousable coma” GCS<11, Blantyre<2 WITH post ictal coma at least 30 minutes after last seizure; confirmed P falciparum

-Coma
-Convulsions (can have non-clonic status in children)
-Symmetrical UMN lesion
-Dysconjugate gaze
-Abnormal posturing, pouting, fontal release
-Retinopathy

42
Q

malarial retinopathy looks like

A

-White centered hemorrhages, vessel color change, peri and extra macular whitening

43
Q

Children with cerebral malaria clinical features

A

raised ICP, impaired oculo-vestibular reflexes, flaccid muscle tone, convulsions

5-30% fatality of cerebral malaria
10% of survivors have long term neuro-psych deficits

44
Q

how many children die from cerebral malaria? how many have long term neuro-psych deficits?

A

5-30% fatality
10% survive

45
Q

If survived cerebral malaria, what sequelae can you have as a child

A

cortical blindness, involuntary movements, hemiplegia, spasticity, cognitive and learning defects

46
Q

why are pregnant women at risk for malaria

A

lose their innate immunity, placenta chondroitin sulfate A is a good receptor for the parasite to bind to

47
Q

What is IPTp for pregnant women

A

Recommended for pregnant women in moderate high malaria transmission areas Africa: 4 antenatal clinic visits, they should get sulfadoxine-pyrimethamine (SP) by DOT and folic acid daily

*If P falciparum mutations are prevalent, Rx dihydroartemisinin-piperaquine and insecticide treated bed nets

48
Q

What is the treatment of severe malaria in areas with established artemisin resistance ?

A

Give parenteral artesunate + parenteral quinine, then can switch to Triple artemisinin combination therapy

49
Q
A

severe vivax malaria: can see splenic rupture

50
Q

pLDH RDT

A

Detects vivax, falciparum, malariae, ovale

51
Q

Predictors of malaria without parasite demonstration

A

Splenomegaly, thrombocytopenia, hyerbilirubinemia

52
Q

false negatives of RDTs

A

low parasitemia, some other plasmodium, HIGH faclciparum (Prozone effect), MUTATIONS (not with HRP2)

53
Q

what parasite level is needed for RDTs

A

500p/uL

54
Q

highest areas of resistance to chloroquine

A

indonesia, papa new guinea

55
Q

child with severe malaria -cerebral signs, what to consider

A

translocation of gram negatives-cover with ceftriaxone

56
Q

when do you transfuse a child

A

4-6 and shock OR below 4 always

57
Q

what is the maximum parasitemia in a thick film

A

5+ (100 parasites /field)

58
Q

4+ parasitemia

A

10-100 parasites/field

59
Q

3+ parasitemia

A

1-10 parasitemia/field

60
Q

Malaria ppx for SE ASia (Thailand, Cambodia, Lao, Myanmar)

A

malarone (for lao and myanmar)

Tropical Medicine (19 decks)

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