Malaria

Question 1

What are the 2 main types of malaria

Answer 1

Plasmodium falciparum - most deadly and common

Non-plasmodium falciparum
• p.vivax
• p.ovale
• p.malariae
• p.knowlesi

Question 2

What insect is I spread by

Answer 2

Female Anopheles mosquitos

Question 3

Which types can remain dormant for months/years before activating

Answer 3

P.vivax and P.ovale

Question 4

Features

Answer 4

Fever >39
Sweats
Chills
Myalgia
Diarrhoea, anoxrexia, dehydration

Fever spikes every few days

Question 5

What is used to diagnose

Answer 5

Microscopy of thick or thin blood films

Question 6

How many?

Answer 6

3

If first is negative do two more, each 24 hours apart

Question 7

Who should be notified with a confirmed case of malaria

Answer 7

Public health England

Question 8

What is the management of severe/complicated p.falciparum malaria

Answer 8

IV Artesunate - for 24 hours

THEN

a full course of ACT (artemether + lumefantrine)

Question 9

What is the management of uncomplicated p.falciparum malaria

Answer 9

1st line : ACT (artemether with lumefantrine)

2nd
• quinine or atovaquone/progunail (malaron)

Question 10

Quinine should be given with doxycycline or clindamycin, which one should be avoid in pregnancy and children

Answer 10

Quinine + doxycycline (avoid)

Quinine + clindamycon - yes in children and pregnancy

Question 11

What is the management of uncomplicated p.falciparum malaria in PREGNANCY

Answer 11

2nd - 3rd trimester - ACT

any trimester - Quinine (+clindamcyin)

Question 12

What can quinine cause/adr

Answer 12

Uterine contractions
Hypoglycemia

Question 13

Which drugs are p. .falciparum resistant to and doesn’t me used in its treatment

Answer 13

Chloroquine
Mefloquine

Question 14

What is management for non-falciparum malaria

Answer 14

ALT or Chloroquine

If chloroquine is chosen it is effective for p.malariae or p.knowlesi on its own

BUT

clororquine + primaquine (radical cure) - for p.ovale or p.vivax

Question 15

What does primaquine do

Answer 15

Eradicate hyponozoties (dormant parasites in the liver) - this prevents relapse

Question 16

Screening for GP6D is required before starting which drug and it can cause G6PD deficiency

Answer 16

Primaquine

Question 17

What is the management for complicated/severe non-falciparum malaria

Answer 17

IV artesunate

Question 18

Management of non-falciparum malaria in pregnancy

Answer 18

Same as normal BUT if p.ovale or p.vivax, wait after undelivery or completion of breast feeding

Question 19

If the specifies is unknow, and if the infection is mixed and includes falciparum. How should this be managed

Answer 19

Same as for falciparum

Question 20

Which drugs are used in prophylaxis

Answer 20

Chloroquine
Mefloquine
Doxycycline
Malarone

Question 21

Malarone - how to take

Answer 21

1-2 days before travel

Continue 1 week after return

Question 22

Doxycycline

Answer 22

Start 1-2 days before travel

Continue 4 weeks after travel

Question 23

Chloroquine

Answer 23

Start 1 week before travel

Continue 4 weeks after

Question 24

Mefloquine

Answer 24

Start 2-3 weeks before

Continue 4 weeks after travel

Question 25

Remember continue all for 4 weeks after travel except Malarone (only 1 week)

Question 26

Which 2 drugs can be used for prophylaxis in pregnancy

Answer 26

Chloroquine (mainly) or mefloquine (Malarone should be avoided) (Doxycycline - contraindicated)

Question 27

If Malarone is given during pregnancy, what should also be given

Answer 27

5mg folic acid

Question 28

Features of p.falciparum will usually present whitin how many months

Answer 28

6

Question 29

What is an indication for IV artesunate in the treatment of p.falciparum malaria Remover iv is given in complicated and serious cases

Answer 29

More that 2% of RBC paratasitized

Question 30

Which drug has an ADR of hypoglycemia

Answer 30

Quinine

Question 31

Which drug has an adr of psychosis

Answer 31

Mefloquine

Question 32

Which drug has an adr of abdominal pain and diarrhoea

Answer 32

Malarone

Question 33

Which drug is associated with thrush and photosensitivity

Answer 33

Doxycycline

Question 34

Which drug is associated with G6PD defiency

Answer 34

Primaquine