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Flashcards in Malaria and Babesiosis Deck (35)
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1

Most parasitic disease have

Acute and chronic phases

2

Types of hosts

Host - animal on or within a parasite can establish an infection
Definitive - adult phase or sexual reproductive phase occurs
Intermediates - larval or asexual phase of life cycle...obligatory for completion of life cycle
Accidental - Dead end and cannot reproduce

3

Periods of parasites

Incubation - time to symnptoms
Prepatent period - time to detection
Patent period - time during which detection can occur in the body

4

Malaria genus and transmission

Plasmodium
Anopheles mosquito

5

Species of malaria

Falciparum (most severe and causes most issues)
Vivax - most prevalent
Ovale
Malariae

Restricted to a single vertebrate host

6

Anopheles mosquito

Only the female can transmit
Bloodmeal needed for eggs
4-5 times during life they will lay eggs
Undergo sexual cycle completion in the mosquito

7

Life cycle of plasmodium

INfectious form - sporozoite from the mosquio
Then to liver (extraerythrocytic stage with no symptoms)...differentiate and form schizonts which produce merozoites...merozoites are what infect RBCs
Then to erythrocytic stage where symptoms occur...merozoites differentiate to ring stage...trophozoite increases mass by eating and undergoes mitosis without cytokineses...cytokinesis occurs to make RBC schizont...merozoites released and infectious to RBCs
A small subset will become gametocytes that will go back to mosquito to make sporozoites

8

Thick and thin blood smears

Thick requires more experience
Thin is longer but easier

9

Detection of malaria

Detection of erythrocytic stages establishes active infection
ID the species
History
Drug sensitivity/resistance profile
Can see ring stage with nucleus at head of the ring

10

Prepatent periods for each species

Occurs in the liver...up until erythrocytic cycle commences
Falcip - 6-12 days
Vivax - 10-17 days
Ovale - 14 days
Malariae - 28-35 days

11

Basic symptoms of erythrocytic malaria

High fever with periodicity defined by releasing of paraiste from blood cells

12

Tertain and Quartran malarias

Tertian - vivax and to a degree, falciparum
Quartran - malariae

13

Number of merozoites released from the liver

Correlates with severity of dz - falcip will have most and malariae has least

14

IMportant of hemoglobin for malaria

Where most nutrients come for parasitic growht in RBC

Hemoglobin degraded in the food or digestive vacuole...leaves behind toxic heme...detoxed by polymerizing into hemozoin (malarial pigment)

15

Chloroquine target

Heme polymerization and its inhibition

16

Plasmodia modification to cell membrane and cytosol

Cell membrane - Knobs that have adhesive ability to bind endothelial cells...important in cerebral malaria

Cytosol - TVN and maurers clefts

17

Plasmodium falciparum

Incubation of 8-24 days
Pre-patent - 5-12 days
Patent - 4-6 weeks (treated), 18 months (untreated)

Relapses due to erythrocytic stage

Tertian malaria but not always exactly

Infects mature erythrocytes (50,500000 parasites/mL)
As many as 2.5 million

18

P falcip symptoms

Headache
Coma and death can occur in 24 hours
Can cause cerebral malaria - plasmodium infected erythrocytes stick to capillaries and other RBCs...blockage of blood vessels leads to coma and death

19

Adhesive properties of cerebral malaria

Knob parasite proteins PfEMP-1 (Var family)
Exhibit antigenic variation which challenges immune system

20

P falcip in pregancny

Blocks placental circulation to the fetus
Cannot cross the barrier like Toxo gondii
Risk highest for first pregnancy
LEad to fetal anoxia, fetal edema, or abortion after 1st trimester

21

Renal and P falcip

Blackwater fever with anoxia and acidosis
Hemoglobinuria
Acute renal failure
Mortality - 20-30%

22

P vivax

Rarely fatal
Regular tertian pattern
Incubation - 12-18 days
Prepatent - 8-17 days
Patent - 5-7 years

High potential of rescrudence...due to liver stages (dormant liver schizonts called hypnozoites)

23

P vivax blood smear

Parasitemia is lower at 20,000/ mL
Infects reticulocytes more often

Enlarged, schauffners dots, and rings

P ovale is similar to P vivax

24

P malariae

Old erythrocytes
Very long patent period
Reactivation in heptaocytes
Quartan pattern for fevers

25

Quinine and chloroquine

Block hemozoin ofrmation...attacks erythrocytic stages
Resistance is problem
Used for prophylaxis

26

Mefloquine

Only in regions with chloroquine and drug resistant forms
Neuro complications???
Erythrocytic cycle

27

Pyrimethamine and sulfonamides

Uncomplicated malaria...don't used in SE asia of S america

28

Proguanil

Component of combination therapy to retard resistance

29

Doxyclyclin and clindamycin

Target the apicoplast (used in combo with others)

30

Arteminisin/quinhousu

Last resort in cerebral malaria...high reactivation rates

31

Atovaquone

Mitochondrial respiration in blood stages

32

Primaquine

Only one for liver stages
Used to prevent reactivation of all but P falciparum

33

Babesia

Use mammals as IM hosts
Transmitted by ixodes ticks (same as lyme dz)
No liver stage
Divide by binary fission

34

Bebesia infection in humans

B microti
Asymptomatic mostly but splenomectomised patients are at highest risk
Between May and Septmeber
Symptoms - fever, generalizxed flu
Incubation - 1-4 weeks, prepatent - 1 weeks
Diagnosis - blood smear
Tx - can used quinine/clindamicin or atovaquone/azithromycin but normally self resolving

35

What to look for on smear of babesia

Maltese cross