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CR3 > Malaria > Flashcards

Malaria Flashcards

1
Q

Define malaria

A
  • systemic
  • tropical parasitic infection
  • of RBCs
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2
Q

Cause of malaria

A

Plasmodium spp

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3
Q

Transmission of malaria

A
  • Female anopheles mosquitoes bite
  • congenital
  • blood transfusion
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4
Q

5 protozoal species of genus plasmodium

A
  • plasmodium falciparum (commenst, complicated)
  • P vivax (uncomplicated relapsing)
  • Ovale (uncomp, relapsing)
  • Malariae (uncomp, doesn’t relapse)
  • Knowlesi (only in certain parts of SE Asia)
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5
Q

Incubation period

A

7-30 days

  • shorter in falciparum
  • longer in malariae
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6
Q

Stable Transmission Features

A
  • populations continuously exposed
  • high background immunity
  • young children suffer acutely
  • epidemics unlikely
  • Sub-Saharan Africa and Oceania
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7
Q

Unstable Transmission

A
  • fluctuating rates
  • low background immunity
  • adults and children suffer acutely
  • epidemics likely
  • Asia and Latin America
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8
Q

Sub-Sharan Africa organism

A

P. vivax 10%

More cases than Asia

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9
Q

Asia organism

A

P. vivax 45%

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10
Q

Main risk for acquiring malaria in tropical travellers

A

Failure to take effective prophylaxis

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11
Q

Airport Malaria

A

Stowed away in aircrafts or luggage

Infect people who haven’t been abroad

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12
Q

Malaria Life in Liver

A
  • sporozoites enter hepatocytes
  • develop into schizonts which contain daughter merozoite cells
  • only for vivax and ovale
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13
Q

Hypnozoites

A

Some sporazoites enter dormancy stage

- cause relapses weeks-years later

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14
Q

Pathogenesis

A
  • infected erythrocytes adhere to host endothelium
    = microvascular occlusion
    = metabolic derangement and acidosis
    = intravascular haemolysis
  • schizont rupture evokes cytokine response
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15
Q

Falciparum malaria

A

infects all ages of RBCs

  • leads to greater parasitaemias
  • sequestrates
  • majority of deaths caused by it
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16
Q

Which plasmodiums don’t sequestrate

A

Vivax
Malariae
Ovale

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17
Q

Which are mild malaria organsims

A

Vivax

Knowlesi

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18
Q

Diagnosis

A

Light microscopy gold standard
Giemsa stain
Thick and thin blood smears

19
Q

Thick blood film

A
  • sensitive
  • allows examination of greater volume of RBCs
  • concentrates parasites as RBCs lysed
20
Q

Thin blood film

A
  • for species identification
  • determines level of parasitaemia
  • less sensitive than thick
21
Q

P falciparum on film

A
  • numerous fine rings
  • double chromatin dots
  • cell multiple parasitisation
  • schizonts rare
  • red cells not enlarged
22
Q

P vivax on film

A
  • thick signet ring forms
  • trophozoites ameboid appearance
  • enlarged red cells
23
Q

P ovale on film

A
  • oval shaped trophozoite
  • comet like red cells
  • enlarged red cells
24
Q

P. malariae on film

A
  • broad band

- red cells not enlarged

25
Q

P. knowlesi on film

A
  • ring stages resembling P. falciparum
  • mature stages indistinguishable from P. malariae
  • molecule methods needed for diagnosis confirmation
26
Q

Antigen Detection

A
  • histidine rich protein 2 (HRP-2) associated with P. falciparum
  • plasmodium associated LDH (pLDH)
27
Q

Clinical Presentation

A
  • fever
  • headache
  • muscle aches
  • diarrhoea
  • vomiting
28
Q

History questions

A
  • presenting symptoms
  • foreign travel = when, where, prophylaxis, compliance, duration, drug type
  • pregnant? (complication risk)
  • immunocomptence status (HIV, cancer, transplant recipients)
  • drug history (previous prophylaxis, allergies, drug-drug interactions?)
29
Q

Examination

A 
Vital signs A to G
E = exposure
F = fluids
G = glucose
- give oxygen
- position patient
- establish fluids
- look for signs of severity
30
Q

Signs of severe malaria

A
  • impaired consciousness or seizures
  • renal impairment
  • acidosis <7.3
  • hypoglycaemia <2.2mmol
  • ARDS or pulmonary oedema
  • Hb 80g/L
  • spontaneous bleeding/disseminated intravasc. coagulation
  • shock
  • haemoglobunuria (w/o G6PD deficiency)
  • parasitaemia >10%
31
Q

Renal impairment diagnosis

A

Oliguria >0.4ml/kg bodyweight per hour
OR
creatinine >265mmol/l

32
Q

Management of malaria

A
  • seek expert advice
  • anti-pyretic therapy
  • rehydration carefully if indicated as risk of pulmonary oedema
  • other supportive measures
  • nursing on HDU/ITU ward
  • non falciparum perhaps OP management
  • notify local PH team
33
Q

Uncomplicated P. falciparum treatment

A
  • oral therapy
  • malarone
  • riamet
  • quinine & doxy or clinda
34
Q

Non-falciparum treatment

A

chloroquine followed by primaquine

- check G6PD status

35
Q

Riamet

A

ACT (artemisinin combination therapy)

Artemether-lumefantrine

36
Q

Malarone

A

Atovaquone-Proguanil

37
Q

Severe complicated P. falciparum treatment

A

IV artesunate (preferred)
OR
IV Quinine (cardiac & blood glucose monitoring)
Oral therapy as for uncomplicated once improved
Check blood film daily

38
Q

Indications for IV therapy

A

Severe complicated P. falciparum
parasitaemia >2% or presence of shizonts
Vomiting
Pregnancy

39
Q

Prevention of malaria

A

Awareness of risk
Bite prevention
Chemoprophylaxis
Prompt diagnosis and treatment

40
Q

Public Awareness

A

National Travel Health Network and Centre
NHS: GPs, infection specialists
Public Health bodies, PH England
Media

41
Q

Bite Prevention

A

DEET based insect repellants
Bed nets, insecticide treated
Clothing

42
Q

Chemoprophylaxis

A

Travel clinics
Evidence based guidelines
Regimes vary for diff countries depending on malaria species and anti-malarial resistance patterns
No regime is 100% protective so need to use combination of protective measures

43
Q

Vector control

A

Insecticide treated nets
Indoor residual spray
Genetically modified mosquitoies

44
Q

Immunisation

A

On going development

CR3 (30 decks)

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