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IHO Week 3 (EH) > Malaria > Flashcards

Malaria Flashcards

1
Q

what mosquito carries plasmodia

A

anopheles

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2
Q

plasmodium is a _____

A

protozoan

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3
Q

species plasmodium

A

vivax, ovale, malariae, falciparum

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4
Q

which species have low parasite burden

A

vivax, ovale, malariae

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5
Q

which species have high parasite burden

A

falciparum

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6
Q

vivax, ovale, malariae cause

A

mild anemia

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7
Q

which species relapse

A

vivax, ovale

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8
Q

which species cause severe anemia

A

falciparum

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9
Q

what does falciparum cause

A

severe anemia
cerebral and multi-organ symptoms
high-fatality rate

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10
Q

Most common

A

vivax, falciparum

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11
Q

most deadly

A

falciparum

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12
Q

relapses

A

vivax, ovale

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13
Q

life cycle of plasmodium falciparum

A

mosquito digestive tract –> sporozoites in mouth –> hepatic cell in mammal –> schizonts which multiply –> merozoites burst out of cell –> ring form into RBC –> trophozoite –> schizonts –> merozoites, continue in that cycle

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14
Q

morphology: P. falciparum

A

lots of rings

crescent-shaped gametocytes

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15
Q

morphology: P. malariae

A

“rosette” arrangement of merozoites

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16
Q

morphology: P. ovale

A

enlarged red cells

Schuffner’s dots

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17
Q

morphology: P. vivax

A

Schuffner’s dots

enlarged red cells

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18
Q

P. falciparum is able to infect ____ (special)

A

red cells of any age

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19
Q

P. falciparum causes what kind of red blood cell pathology

A

“rosettes” – abnormal binding to endothelium
blood flow is impeded
main cause of death in children = cerebral ischemia

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20
Q

P. falciparum and cytokines

A

Stimulates high production of cytokines
TNF, INF-Υ, IL-1
suppress red cell production, cause fever, tissue damage, and red cell binding to endothelium

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21
Q

malaria: what happens in the patient

A

spleen becomes enlarged
liver enlarged/pigmented
brain vessels get plugged
heart/lungs maybe involved

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22
Q

spleen pathology

A

enlarged
parasites in red cells
super-active macrophages
if chronic: fibrosis, grayish color

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23
Q

brain vessels pathology

A

red cell rosettes
hypoxia around vessels
eventual, ischemia

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24
Q

incubation

A

1-2 weeks

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25
prodrome
flu-like illness
26
paroxysms
fever/chills, sweating, myalgia
27
quotidian
daily | falciparum
28
tertian
every 48 hrs | vivax, ovale
29
quartan
every 72 hrs | malariae
30
host resistance (2 ways)
inherited red cell alterations | partial immune-mediated resistance
31
inherited red cell alterations
Hemoglobinopathies (e.g., sickle cell) Thalassemias G6PD deficiency RBC antigens (ABO, Duffy)
32
partial immune-mediated resistance
Develops over time in patients in endemic areas Reduces severity of disease P. falciparum uses antigenic variation
33
blood type and binding
O - least adhesive (cannot bind to endothelium) | A and or B most
34
diagnosis
sxs and hx ID plasmodia in red cells on regularly-stained blood smear (gold standard) rapid immunochromatographic tests sometimes used (quicker but less accurate)
35
The science that deals with drugs, their sources, appearance, chemistry, actions, mechanism of action and use
pharmacology
36
The practical branch of medicine dealing with the treatment of disease
therapeutics
37
best plan for malaria
DON'T GET BIT use of netting and insect repellents avoid areas and exposure during high insect activity
38
plan B
prophylaxis treat active malaria use radical cure if indicated
39
considerations in treatment?
which area? resistance? persistent hepatic forms? clinical status of disease?
40
which species have resistance?
falciparum, vivax
41
which ones have latent forms
ovale, vivax
42
what treats latent malaria
primaquine
43
best choice suppressive prophylaxis - prevention of malaria | alternative?
chloroquine atovaquone/proguanil
44
best choice suppressive prophylaxis - prevention of malaria in CHLOROQUINE RESISTANT alternative?
atovaquone/proguanil doxycycline or mefloquine
45
treatment of acute attack for all plasmodium except resistant
oral chloroquine
46
treatment of acute attack for chloroquine resistant P. falciparum
quinine sulfate + doxycycline alternative: atovaquone/proguanil OR artemether/lumefantrine or Mefloquine
47
treatment of acute attack for chloroquine resistant P. vivax
Quinine sulfate + doxycycline alternative: mefloquine
48
treatment of severe disease
parenteral quinidine gluconate + doxycycline alternative: artesunate + oral drug when tolerated
49
radical cure
primaquine phosphate
50
which drugs act at primary liver stage
pyrimethamine/sulfadoxine atovaquone/proguanil primaquine
51
what drugs act at hypnozoite stage
primaquine
52
what drugs act RBC asexual stage
all (chloroquine, mefloquine, quinine, quinidine....) but primaquine
53
what drugs act at RBC gametocyte
chloroquine quinine, quinidine artesunate primaquine
54
chloroquine basis for selectivity
The parasitized RBC concentrates Chloroquine at least 25 fold more than unparasitized RBC. Chloroquine accumulates in the acid pH of the food vacuole.
55
chloroquine mechanism
parasite digest hgb and makes FPIX which is toxic - parasite heme polymerase turns it to hemozoin (not toxic) chloroquine binds to FPIX and prevents conversion to hemozoin
56
adverse effects chloroquine
low dose prophylaxis - no tox acute attack doses: dizziness, headache, itching, vomiting, skin rashes difficulty in visual accommodation large doses for prolonged periods can cause severe eye damage and even blindness
57
main AE chloroquine
eye issues
58
what is more toxic than chloroquine but no resistance yet
quinine, quinidine
59
mechanism quinine/quinidine
parasite digest hgb and makes FPIX which is toxic - parasite heme polymerase turns it to hemozoin (not toxic) chloroquine binds to FPIX and prevents conversion to hemozoin
60
AE quinine
Acute attack doses – Cinchonism tinnitus, blurred vision, nausea, headache, decreased hearing acuity permanent damage to vision, balance and hearing can result
61
Anti-arrhythmic drug that blocks Na and K currents
quinidine
62
quinine used in
Used in chloroquine resistant P. falciparum
63
quinidine used in
Intravenous for severe malaria
64
AE quinidine
Cardiac problems - so patients need cardiac monitoring
65
mefloquine mechanism
Disrupts sequestration of heme as hemozoin (same as chloroquine)
66
AE mefloquine
Sometimes nausea, vomiting, dizziness, visual or auditory disturbances May cause disorientation, hallucinations and depression
67
main AE mefloquine
neuropsychiatric reactions
68
indications mefloquine
Indicated only for the treatment and prevention of Chloroquine resistant P. falciparum
69
atovaquone given with
proguanil
70
atovaquone MOA
unique | Depolarizes parasitic mitochondria and inhibits their electron transport
71
proguanil given w/
atovaquone
72
proguanil MOA
metabolite of proguanil inhibits dihydrofolate reductase selective for the plasmodial enzyme Enhances the mitochondrial toxicity of atovaquone Reduces the frequency of atovaquone resistance
73
proguanil not active against
hepatic stages of P. vivax or P. ovale
74
A/P onset
slow
75
A/P effectiveness against exo-erythrocytic forms
unclear | Proguanil concentrates in erythrocytes
76
A/P use
replacing mefloquine for prophylaxis
77
AE of A/P
GI disturbances
78
Artemisinins and combinations
+mefloquine +lumefantrine don't use alone (resistance)
79
mechanism artemisinins
Heme iron in the malarial pigment acts on the drug to produce free radicals that damage parasite proteins Inhibits a calcium ion ATPase in P. falciparum
80
artemisinins onset and efficacy
rapid and potent activity against even multi-drug resistant organisms
81
lumefantrine mechanism
unknown
82
lumefantrine effective against
erythocytic stage
83
give lumefantrine with
artemether Rapid initial reduction in parasite biomass afforded by artemether and subsequent clearance of remaining viable parasites by the more slowly eliminated lumefantrine
84
primaquine use
Drug of choice to eliminate hepatic forms of P. vivax and P. ovale Eradicates hypnozoite forms dormant in liver Some prefer to wait for the low risk of relapse rather than face potential side-effects of the drug.
85
mechanism primaquine
Unknown | Possibly by generation of reactive oxygen species or by interfering with electron transport in the parasite
86
AE primaquine
occasional GI distress, nausea, headache, pruritis, leukopenia Hemolytic anemia in people with a glucose-6-phosphate dehydrogenase deficiency

IHO Week 3 (EH) (5 decks)

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