Malaria

Question 1

Malaria

5 species

Answer 1

• Plasmodium vivax
• Pl falciparum
• Pl ovale
• Pl malariae
• Pl knowlesi

Question 2

Malaria

Definitive host?

Answer 2

Host where the sexula phase of the parasite takes place
* Female anopheles culicifacies mosquito

Question 3

Malaria

Intermediate host

Answer 3

Human

Question 4

Malaria

Which species have hypnozoites

Answer 4

• Pl vivax
• Pl ovale

Question 5

Malaria

Hypnozoites

Answer 5

Live stage of the parasite in the human. Cause relapses of fever

Question 6

Malaria

Life cycle stages

Answer 6

• Human- Sporozoite stage, Pre- erythrocytic stage, erythrocytic stage, Gametocyte formation
• Mosquito - Sporogonic stage

Question 7

Malaria

Sporozoite stage

Answer 7

Infected mosquito bites humans and inject sporozoites.

Question 8

Malaria

Sporozoites

Answer 8

infectious form of the parasite

Question 9

Malaria

Pre- erythocytic stage

Answer 9

• Sporozoites enter the liver within minutes from the bite
• Invade hepatocytes and multiply
• 1-2 weeks after they become merozoites
• Liver cells rupture and release merozoites into blood
• Hypnozoites in Pl. Ovale and vivax stay dormant and cause relapses months or years later.

Question 10

Malaria

Erythrocytic stage

Answer 10

• Merozoites infect RBCs
• Inside RBCs they become trophozoites and feed on Hb.
• Trophozoites»»> schizonts»» divide and form merozoites»» continue infecting RBCs.
• This infecting RBCs stage gives Sx

Question 11

Malaria

Gametocyte formation stage

Answer 11

• Merozoites become gametocytes inside humans
• Gametocytes circulate in blood stream

Question 12

Malaria

Sporogonic stage

Answer 12

• Mosquito bites infected humans
• gametocytes enter the mosquito
• Gametocytes develop into male and female gametes in the female mosquito stomach
• Gametes fuse and form zygotes
• zygotes»> ookinete»> form sporozoites

Question 13

Malaria

Incubation period of Pl. falciparum

Answer 13

around a week ( 7-10 days)

Question 14

Malaria

Incubation period of Pl. vivax

Answer 14

around 1- 2 weeks ( 10- 12 days)

Question 15

Malaria

Incubation period of Pl. malariae

Answer 15

18- 40 days ( around a month)

Question 16

Malaria

Clinical manifestations of malaria is due to….. stage of the plasmodium life cycle

Answer 16

erythrocytic stage - infect RBCs

Question 17

Malaria

Febrile paroxysms stages

Answer 17

• Cold stage
• Hot stage
• Sweating stage

Question 18

Malaria

Cold stage

Answer 18

• 15- 60 mins
• Intense cold and uncontrollable shivering

Question 19

Malaria

Hot stage

Answer 19

• 2-6 hrs
• intense high fever, severe headache, Nausea, Vomiting

Question 20

Malaria

Sweating stage

Answer 20

• Drenched in severe profuse sweating
• temp drops rapidly

Question 21

Malaria

Fever periodicity

Answer 21

Synchronous rupture of mature schizonts

Question 22

Malaria

Fever periodicity is not seen in

Answer 22

falciparum

Question 23

Malaria

Sx

Answer 23

• Headache
• Anorexia
• lethargy
• myalgia
• diarrhea
• Abd pain
• cough
  * fever w chills and rigors
• Nausea
• Vomiting

Question 24

Malaria

Signs

Answer 24

• Fever
• Anemia
• jaundice ( mild)
• Hepatosplenomegaly
• NO RASH OR LYMPHADENOPATHY

Question 25

# Malaria CLINICAL CLUES FOR MALARIA!!

Answer 25

* Fever w chills and rigors * Recent travel Hx to India, Africa * Pallor + Jaundice

Question 26

# Malaria DDs for chills and rigors

Answer 26

* Acute pyelonephritis * Cholangitis * Abscess

Question 27

# Malaria Complications of falciparum

Answer 27

* Cerebral malaria * Confusion * Coma +/- fits * Unusual focal signs * Variable tone, extensor posturing, upgoing plantar, dysconjugate gaze * **Metabolic acidosis** * **Hypoglycemia** * ARF - ATN, hemoglobinuria * Pulm edema * ARDS

Question 28

# Malaria Hemoglobinuria is due to

Answer 28

intravascular hemolysis

Question 29

# Malaria Black water fever

Answer 29

malaria due to hemoglobinuria ( dark urine)

Question 30

# Malaria Dx to confirm the parasite

Answer 30

Thick film of blood

Question 31

# Malaria Dx to identify the species

Answer 31

thin film of blood

Question 32

# Malaria Rapid stick test ?

Answer 32

to detect the malaria Ag

Question 33

# Malaria Ix

Answer 33

* serial thick and thin film * Rapid stick test * FBC- reduced Hb, Plts * BU and SE for falciparum renal failure * Urinalysis - hemoglobinuria, proteinuria, cells

Question 34

# Malaria Mx for P. vivax

Answer 34

* Chloroquine for 3d>>>> Primaquine for 14 d ( to destroy hypnozoites and gametocytes)

Question 35

# Malaria Mx for P falciparum ( uncomplicated)

Answer 35

* Artemisinin based combo therapy (ACT) >>>> single dose of primaquine ( to get rid of gametocytes)

Question 36

# Malaria Mx of P falciparum ( severe and complicated)

Answer 36

* IV artesunate ( more effective than IV quinine) * Once improving and can take oral meds , except children < 5 years should be given ACT ( weight appropriate) * Followed by a single dose of primaquine

Question 37

# Malaria primaquine ADRS

Answer 37

can cause hemolysis in pts w G6PD deficiency

Question 38

# Malaria What should be done ideally before giving primaquine

Answer 38

check G6PD levels

Question 39

# Malaria Differences between P falciparum and vivax

Answer 39

**Pl. vivax** * Entry into reticulocytes * Single parasite in one RBC * Enlarged RBCs * hypnozoites + * Round gametocytes **Pl. falciparum** * Can enter into any stage of the RBC * Multiple parasites in one RBC * Not enlarged * No hypnozoites * Crescenteric shaped gametocytes