Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
75 Cards in this Set
- Front
- Back
|
What is malaria?
|
A serious disease caused by a parasite that commonly infects a mosquito that feeds on humans. Malaria is the 5th leading cause of disease from infectious disease.
|
|
|
Is malaria deadly?
|
Malaria is deadly BUT PREVENTABLE.
|
|
|
Background of malaria
|
Malaria was eradicated in the US in the early 1950s.
|
|
|
What are most outbreaks of malaria in the US attributed to?
|
improper prevention measures taken by travelers entering endemic areas who then return with the infection
|
|
|
Where do many deaths from malaria occur?
|
89% of malaria deaths worldwide occur in Africa
|
|
|
In what parts of the world is malaria most prevalent?
|
generally in warmer regions close to the equator
|
|
|
What is the pathology of malaria?
|
Malaria is caused by a unicelluar parasite, NOT bacteria.
|
|
|
What are the 4 Plasmodium species?
|
P. falciparum, P. vivax, P. ovale, P. malariae
|
|
|
Which species cause the majority of clinical cases?
|
P. falciparum and P. vivax
|
|
|
Which species causes the most deaths?
|
P. falciparum
|
|
|
What are the two forms of transmission of malaria?
|
mosquito (MOST COMMON) and blood transfusion
|
|
|
What is the species of mosquito that can transmit malaria?
|
Anopheles mosquito (20 species)
|
|
|
Describe the transmission of malaria via mosquito.
|
Mosquitos are infected by a parasite through a blood meal from an infected person.
The mosquito then transmits the parasite during the next blood meal. [They feed mainly between dusk and dawn.] |
|
|
Where and when was the last "suspected" case of blood transfusion transmitted malaria in the US?
|
HOUSTON IN 2003!!
[Last known case in US was in Pennsylvania in 1998] |
|
|
What are the two cycles of malaria development?
|
exoerythrocytic and erythrocytic cycle
|
|
|
Which two species require special treatment because of their pathogenesis in the human body?
|
P. vivax and P. ovale sporozoites do not immediately develop into exoerythrocytic-phase merozoites, but instead produce hypnozoites that remain dormant for periods ranging from several months. HIDES IN LIVER!!
|
|
|
What are the general signs and symptoms of malaria?
|
Fever, chills, weakness, HA, myalgia, cough
GI: N/V/D |
|
|
What are symptoms of severe malaria?
|
impaired consciousness
anemia (hemoglobin <7) renal failure respiratory distress hypotension jaundice/coagulopathies seizures |
|
|
What are the diagnostic tests for malaria?
|
Microscopic: blood smear (rules out malaria with 3 consecutive negatives)
Antigen detection Molecular diagnosis (PCR) Serology (IFA/ELISA) IFA=indirect fluorescent antibody test ELISA=Enzyme-linked immunosorbent assay |
|
|
MOA of Chloroquine and Hydroxychloroquine
|
inhibits DNA and RNA polymerase
|
|
|
Adverse reactions of Chloroquine and Hydroxychloroquine
|
Retinopathy
H/A, dizziness, abdominal pain, N/V, diarrhea, pruritus |
|
|
Monitoring for Chloroquine and Hydroxychloroquine
|
CBC and ophthalmologic exam
|
|
|
Contraindications for Chloroquine and Hydroxychloroquine
|
visual conditions, hypersensitivity
|
|
|
MOA of Atovaquone-proguanil (Malarone)
|
works synergistically to disrupt the synthesis of folic acid, preventing DNA synthesis
|
|
|
adverse reactions of Atovaquone-proguanil (Malarone)
|
abdominal pain, N/V, cholestasis/liver failure
|
|
|
Monitoring for Atovaquone-proguanil (Malarone)
|
CBC, LFTs, Scr
|
|
|
Contraindications for Atovaquone-proguanil (Malarone)
|
severe renal impairement
|
|
|
MOA for Artemether-lumefantrine (Coartem)
|
binds intraparasitic iron/heme leading to free radical production. also inhibits nucleic acid and protein synthesis
|
|
|
Which malarial medication has the fastest onset of action?
|
Artemether-lumefantrine (Coartem)
|
|
|
adverse reactions for Artemether-lumefantrine (Coartem)
|
cardiovascular: palpitations, QT prolongation
CNS: headache, vertigo GI: anorexia, N/V |
|
|
Monitoring for Artemether-lumefantrine (Coartem)
|
CBC, ECG
|
|
|
MOA for Primaquine
|
disrupts mitochondia and binds plasmodial DNA
|
|
|
Which medication prevents relapse of P. ovale and P. vivax?
|
Primaquine
|
|
|
adverse reactions for Primaquine
|
headache, pruritus, N/V, abdominal cramps
Hemolytic anemia ***G6PD deficiency |
|
|
Monitoring for Primaquine
|
CBC, G6PD deficiency screening
|
|
|
MOA for Quinine and Quinidine
|
inhibits glycolysis and nucleic acid and protein synthesis
|
|
|
adverse reactions for Quinine and Quinidine
|
cardiac: arrhythmias, hypotension, QT prolongation
hepatotoxicity hypoglycemia ototoxicity visual disturbances |
|
|
Contraindications for Quinine and Quinidine
|
hypersensitivity, prolonged QT interval, visual conditions
|
|
|
Monitoring for Quinine and Quinidine
|
CBC, ECG, LFTs, BG (blood glucose), Ophthalmologic exam
|
|
|
MOA for Mefloquine
|
structurally similar to Quinine
|
|
|
adverse reactions to Mefloquine
|
GI: NV, diarrhea, abdominal pain
neurologic: seizure psychiatric: anxiety/depression visual disturbances |
|
|
Monitoring for Mefloquine
|
CBC, ophthalmologic exam
|
|
|
contraindications for Mefloquine
|
history of seizure or psychiatric disorder
|
|
|
What are the anti-microbial medications for malaria?
|
Doxyclycline, Tetracycline, Clindamycin
|
|
|
MOA for anti-microbial medications
|
inhibits protein synthesis
|
|
|
Which medications have the longest onset of action?
|
anti-microbials
|
|
|
Contraindications to anti-microbials
|
Doxycycline and tetracycline should NOT be used in pregnancy and in children under 8 years old
|
|
|
What regions have the highest estimated relative risk for infection for travelers?
|
West Africa, Oceania
|
|
|
What measures are indicated for travelers in regions that have the highest estimated relative risk for infection?
|
mosquito avoidance + chemoprophylaxis
|
|
|
What measures are indicated for travelers in regions that have moderate risk for infection?
|
mosquito avoidance + chemoprophylaxis
|
|
|
What regions have moderate risk for infection?
|
other parts of Africa, South Asia, South America
|
|
|
What regions have lower risk for infection?
|
Central America, other parts of Asia
|
|
|
What measures are indicated for travelers to regions that have lower risk for infection?
|
mosquito avoidance only
|
|
|
What are types of mosquito avoidance measures?
|
well-screened areas: mosquito bed nets (preferably insecticide-treated nets)
wearing clothes that cover most of the body effective mosquito repellent (DEET) |
|
|
What is the chemoprophylaxis for Chloroquine-sensitive areas?
|
Chloroquine
Start: 2 weeks before departure Stop: 8 weeks after returning Hydroxychloroquine Start: 1-2 weeks before departure Stop: 4 weeks after returning |
|
|
What is the chemoprophylaxis for Chloroquine-resistant areas?
|
Doxycycline
Start: 1-2 days before departure Stop: 4 weeks after returning Mefloquine Start: 2-3 weeks before departure Stop: 4 weeks after returning |
|
|
What is the chemoprophylaxis for Mefloquine-resistant areas?
|
Atovaquone/proguanil
Start: 1-2 days before departure Stop: 1 week after returning |
|
|
What is the chemoprophylaxis for P. vivax endemic areas?
|
Primaquine
Start: 1-2 days before departure Stop: 1 week after returning Off-label |
|
|
Treatment Goals
|
Treatment once diagnosis is confirmed by laboratory
Rapid diagnosis of Plasmodia spp. by blood smears Initiate treatment within 48-72 hours of presentation |
|
|
Treatment regimens are guided by:
|
Clinical status of the patient
Infecting plasmodium species Drug susceptibility of the infecting parasite -- Determined by geographic area where infection was acquired |
|
|
What species cause uncomplicated malaria and how are they treated?
|
P. vivax, P. ovale, and P. malariae
Treated with oral meds |
|
|
What are signs and symptoms of severe malaria?
|
impaired consciousness
anemia (hemoglobin less than 7) renal failure respiratory distress hypotension jaundice/coagulopathies seizures |
|
|
How is uncomplicated P. falciparum treated in a chloroquine sensitive area?
|
Chloroquine
OR Hydroxychloroquine |
|
|
What is the first line treatment for uncomplicated P. falciparum in a chloroquine resistant area?
|
Atovaquone-proguanil
Artemether-lumefantrine |
|
|
What is the second line treatment for uncomplicated P. falciparum in a chloroquine resistant area?
|
Quinine
PLUS Doxyclycine Tetracycline OR Clindamycin |
|
|
What is the THIRD line treatment for uncomplicated P. falciparum in a chloroquine resistant area?
|
Mefloquine
|
|
|
How is uncomplicated malaria with P. Malariae treated?
|
Same as P. falciparum with chloroquine-sensitive treatment
Chloroquine OR Hydroxychloroquine |
|
|
How is uncomplicated malaria with P. ovale treated?
|
Chloroquine
OR Hydroxychloroquine PLUS Primaquine |
|
|
How is uncomplicated malaria with Chloroquine-sensitive P. vivax treated?
|
Chloroquine
OR Hydroxychloroquine PLUS Primaquine |
|
|
Which species do not show chloroquine resistance?
|
P. ovale and P. malariae
|
|
|
How is chloroquine resistant P. vivax treated?
|
Primaquine + Quinine + Doxycycline OR Tetracycline
Primaquine + Atovaquone-proguanil OR Mefloquine |
|
|
How is severe malaria treated?
|
Quinidine gluconate IV
PLUS Doxycycline Tetracycline Clindamycin |
|
|
What is the only drug that is approved for severe malaria?
|
Artesunate (alternative to IV quinidine)
|
|
|
What is the eligibility criteria for Artesunate?
|
Severe malaria disease
Inability to take oral medications Lack of timely access to intravenous quinidine Quinidine intolerance/contraindication/failure |
|
|
What is the medication regimen for a patient taking Artesunate?
|
NOT TO BE TAKEN ALONE
Artesunate PLUS Atovaquone-proguanil Doxycycline OR Mefloquine |
