Malaria

Question 1

Define

Answer 1

Parasitic infection caused by protozoa of the genus plasmodium

Question 2

What is the most life-threatening species?

Answer 2

Plasmodium Falciparum

Question 3

What type of disease is it?

Answer 3

Notifiable- must be reported to public authorities when diagnosed

Question 4

Where in the world is it prevalent?

Answer 4

Through tropical and subtropical regions - travellers account for majority of disease in Western countries

Question 5

How is it transmitted? (3)

Answer 5

• via a bite by an infected female anopheles mosquito
• Potentially blood transfusion
• Potentially organ transplant

Question 6

RF

Answer 6

• travel to an endemic area
• inadequate chemoprophylaxis
• non-use of an insecticide-treated bed net when in an endemic area

Question 7

CF

Answer 7

• Cyclical (alternating days) fevers with chills and rigors (shivering): Falciparum every 72hrs. Other species- every 48hrs
• haemolytic anaemia- jaundice and dark urine
• Splenomegaly
• Headache
• Weakness
• Myalgia
• Arthralgia
• Anorexia
• Diarrhoea

Question 7

What are protective factors? (2)

Answer 7

• sickle cell anaemia
• G6PD deficiency

Question 8

First line investigation

Answer 8

Giemsa stained thick and thin blood smears
- Thick detects parasites present
- Thin detects species

Question 9

Other investigations?

Answer 9

FBC- check for anaemia
Rapid diagnostic tests- rapid detection of parasite antigen or enzymes

Question 10

What drugs do we give?

Answer 10

Chloroquine (ok during pregnancy) or hydroxychloroquine

Question 11

What do we give once symptoms are resolved to prevent relapse?

Answer 11

Primiquine: it can eliminate dormant malaria parasites in the liver, preventing relapse.

Question 12

What do we give for prevention? (2)

Answer 12

• Avoid exposure (nets/repellent/protective clothing)
• Prophylaxis

Question 13

Complications

Answer 13

• AKI (due to dehydration + hypovolaemia)
• Hypoglycaemia
• Metabolic acidosis
• Severe anaemia
• Seizures
• ARDS

Question 14

Prognosis?

Answer 14

Groups at risk of severe disease include low host immunity, pregnancy, age <5yrs, immunocompromise, older adults