Bhl Week 4: Malaria, Babesia, And Filarial Worms

Front 1

List 4 plasmodium species which cause Malaria.

Which is the most severe?

Back 1

1. Plasmodium malariae
2. Plasmodium vivax
3. Plasmodium ovale
4. Plasmodium falciparum <-- MOST SEVERE

Front 2

List 3 ways malaria can be transmitted.

Back 2

1. Bite from Anopheles mosquito
2. Trans-placentally
3. IV drug use

Front 3

Which plasmodium species has the longest incubation time and which has the shortest?

Back 3

Longest --> P. malariae (18 - 40 days)
Shortest --> P. falciparum (8 - 11 days)

Front 4

Which disease involves recurring cycles of fever, chills and profuse sweating?

Back 4

Malaria
(due to cytokines induced in response to RBC waste products)

Front 5

Which Plasmodium species results in benign tertian cycle of symptoms over a period of 48 hours?

Back 5

1. P. vivax
2. P. ovale

Front 6

Which plasmodium species results in a quartan cycle of symptoms over a period of 72 hours?

Back 6

P. malariae

Front 7

Which plasmodium species results in a malignant tertian of symptoms with no regular cycle?

Back 7

P. Falciparum

Front 8

How is the diagnosis of malaria made?

Back 8

Finding infected RBCs on thick and thin Giemsa-stained blood smears

Front 9

List some severe consequences of Falciparum malaria.

Back 9

1. Hemorrhage and necrosis in brain (cerebral malaria) and other organs
2. Hemoglobinuria ("blackwater fever")

Front 10

Which plasmodium species may show Mauer's dots on microscopic examination?

Back 10

P. falciparum

Front 11

Which plasmodium species will show Schuffner's dots on microscopic evaluation?

Back 11

P. vivax, P. ovale

Front 12

What is the treatment for malaria?

Back 12

Vivax, ovale, malariae, and chloroquine-sensitive falciparum:
1. Chloroquine (blood stages)
2. Primaquine (liver stages)

Chloroquine-resistant falciparum:
1. Quinine + doxycycline
2. Quinine + pyrimethamine-sulfadoxine

Front 13

Which phrophylactic drug is good for last-minute travelers and why?

Back 13

Atovoquone/ Proguanil (Malarone)
*Drug is started 1-2 days before traveling

Front 14

How long must you take Atovoquone after traveling?

Back 14

7 days

Front 15

What are the cons of Atovoquone?

Back 15

1. Cannot be taken by pregnant or breast-feeding women
2. Cannot be taken by people with severe renal impairment
3. Expensive

Front 16

Why is Chloroquine a good choice for long trips?

Back 16

It is taken only weekly

Front 17

Which prophylactic anti-malarial drug can be used in all trimesters of pregnancy?

Back 17

Chloroquine

Front 18

Which prophylactic anti-malarial drug may be preferred by people planning to do lots of hiking, camping, and swimming in fresh water?

Back 18

Doxycycline
*Broad spectrum antiobiotic

Front 19

How many days before travel must Doxycycline be started?

Back 19

1-2 days before travel

Front 20

What are the cons of doxycycline?

Back 20

1. Cannot be used by pregnant women
2. Significant GI side effects

Front 21

What is an advantage of Mefloquine?

Back 21

Can be taken weekly

Front 22

What are 2 cons of Mefloquine?

Back 22

1. High levels of resistance
2. Neurologic complications

Front 23

Atovoquone is an applicable anti-malarial for which travel regions?

Back 23

All regions

Front 24

Doxycycline is an applicable anti-malarial for which travel regions?

Back 24

All regions

Front 25

Mefloquine is an applicable anti-malarial for which travel regions?

Back 25

All areas EXCEPT Southeast Asia

Front 26

Primaquine is an applicable anti-malarial for which travel regions?

Back 26

P. vivax or P. ovale endemic areas

Front 27

List 5 prophylactic anti-malarial drugs.

Back 27

1. Atovoquone
2. Choloroquine
3. Doxycycline
4. Mefloquine
5. Primaquine

Front 28

Which anti-malarial is the most effective in preventing P. vivax?

Back 28

Primaquine

Front 29

Is Primaquine a good choice for shorter or longer trips?

Back 29

Shorter trips
(only have to take the medicine 7 days after traveling)

Front 30

Which anti-malarial cannot be used by patients with G6PD deficiency?

Back 30

Primaquine

Front 31

When can Primaquine be safely used by breast-feeding women?

Back 31

Only after child has been tested for G6PD deficiency

Front 32

How is Babesia transmitted?

Back 32

1. Bite from deer tick (Ixodes scapularis)
2. Blood transfusion

Front 33

List some symptoms associated with Babesiosis.

Back 33

Largely asymptomatic, but possible symptoms include:
1. Fever
2. Chills
3. Malaise
4. Fatigue
5. Hepatosplenomegaly
6. Hemolytic anemia

*Following incubation period of 1 - 4 weeks.

Front 34

How is the diagnosis of Babesiosis made?

Back 34

Finding infected RBCs on thick and thin Giemsa-stained blood smears

Front 35

How is intraerythrocytic Babesia distinguished from Plasmodium?

Back 35

Babesia are pleomorphic, non-pigmented, and can appear vacuolated.

Front 36

What are the treatments for Babesiosis?

Which of these is the preferred treatment?

Back 36

1. Atovaquone + Azithromycin
2. Quinine + Clindamycin <-- PREFERRED due to fewer adverse side-effects

Front 37

Sleeping sickness/ African trypanosomiasis is a result of which 2 flagellates?

Back 37

1. Trypanosoma brucei gambiense
2. Trypanosoma brucei rhodesiense

Front 38

Trypanosoma brucei gambiense is endemic to which region?

Back 38

West Africa

Front 39

Trypanosoma brucei rhodesiense is endemic to which region?

Back 39

East Africa

Front 40

How are Trypanosoma brucei gambiense and rhodesiense transmitted?

Back 40

Bite of the tsetse fly

Front 41

What are some symptoms associated with Sleeping sickness?

Back 41

1. Skin ulcer/chancre at bite site
2. Fever, lymphadenopathy
3. Demyelinating encephalitis (HA, insomnia, and mood changes)
4. Muscle tremors, slurred speech, apathy
5. Somnolence and coma

Front 42

How is the diagnosis of Sleeping sickness made?

Back 42

1. Examine aspirates from chancre or lymph nodes for parasites (early during infection)
2. Identification of trypamastigotes in blood smears

Front 43

Humans are a primary reservoir for which trypanasoma brucei flagellate?

Back 43

T. brucei gambiense

Front 44

Which African trypanosomiasis is a chronic illness (late CNS involvement)?

Back 44

T. brucei gambiense

(Duration: months - years)

Front 45

What is the duration of illness of East African trypanosomiasis?

Back 45

< 9 months
(acute illness with early CNS involvement)

Front 46

How do you treat Pre-CNS Gambiense?

Back 46

Pentamidine

Front 47

How do you treat Pre-CNS Rhodesiense?

Back 47

Suramin

Front 48

How do you treat Post-CNS gambiense and rhodesiense?

Back 48

Melarsoprol

Front 49

Which organism is responsible for Diphyllobothriasis?

Back 49

Diphyllobothrium latum

Front 50

How is Diphyllobothriasis latum transmitted?

Back 50

Ingestion of larvae in undercooked fish

Front 51

Which parasitic infection may result in megaloblastic anemia?

Back 51

Diphyllobothriasis latum

Front 52

What sort of symptoms may be experienced with Diphyllobothriasis?

Back 52

Usually asymptomatic
Symptoms may include: nausea, diarrhea, abdominal cramps, weakness, and salt craving

Front 53

How is Diphyllobothriasis diagnosed?

Back 53

Identification of eggs in stool

Front 54

What is the drug of choice for Diphyllobothriasis?

Back 54

Praziquantel

Front 55

Which two organisms cause similar diseases -- Lymphatic filariasis or elephantitis.

Back 55

1. Wuchereria bancrofti
2. Brugia malayi

Front 56

How are Wuchereria bancrofti and Brugia malayi transmitted?

Back 56

Mosquito bite

Front 57

What symptoms may be experienced in the early stages of lymphatic filariasis or elephantiasis?

Back 57

1. Headache
2. Nausea
3. Local lymphadenitis, orchitis, and hydrocele

Front 58

What symptoms may be experienced in the late stages of lymphatic filariasis or elephantitis?

Back 58

1. Lymphatic obstruction --> lymphedema
2. Thickening of skin --> elephantitis
3. Lymphagitis and cellulitis

Front 59

How is the diagnosis of Lymphatic filariasis or elephantitis made?

Back 59

1. Identification of microfilaria in blood smears
(**Blood should be drawn late at night for Wuchereri and in the morning for Brugia)

2. Antigen detection and PCR assays

Front 60

What is the drug of choice for microfilariae?

Back 60

Diethylcarbamazine