Questions and Answers
What is the primary species of Plasmodium responsible for the majority of malaria cases?
Which symptom is commonly associated with malaria?
What is a hallmark of Plasmodium falciparum infection during pregnancy?
What is the major difference in clinical presentation between uncomplicated and complicated malaria?
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Which of the following statements about the blood stage of malaria is true?
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Which of these stages is NOT a part of the Plasmodium lifecycle?
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Which is a common consequence of cytoadherence in malaria?
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Which is NOT a common symptom of malaria?
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What is the primary diagnostic method recommended for identifying malaria parasites in blood?
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Which of the following conditions is classified as severe malaria?
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Which treatment is recommended for uncomplicated malaria in pregnancy during the second and third trimester?
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What is the initial loading dose of Quinine recommended for severe malaria treatment?
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What is the purpose of intermittent preventive treatment (IPTp) in malaria control?
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Why might a rapid test miss low parasitaemia cases?
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What is the recommended treatment regimen for severe and complicated malaria after the initial loading dose of artesunate?
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What significant pattern should be noted in the history of a patient suspected to have malaria?
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Study Notes
Introduction
- Malaria is a tropical disease caused by the Plasmodium parasite, predominantly Plasmodium falciparum (75% of cases).
- Sub-Saharan Africa is significantly impacted, with 1 in 4 women having malaria during childbirth.
- Transmission occurs via bites from female Anopheles mosquitoes, which carry various Plasmodium species: Malariae, Falciparum, Vivax, Ovale, and Anolesi.
Pathophysiology
- Malaria progresses through a two-phase lifecycle: pre-erythrocyte phase and blood stage.
- The blood stage involves the infection of red blood cells (RBCs), leading to cell membrane alterations.
- Infected RBCs adhere to blood vessel walls, disrupting microcirculation in vital organs such as the brain and kidneys.
- Key feature: Parasitic sequestration in the placenta, affecting host defense and splenic processes.
- No sequestration in mild cases of Plasmodium infection by Vivax, Ovale, or Malariae.
Signs and Symptoms
- Common symptoms include nonspecific fever, chills, headache, muscle pain, vomiting, diarrhea, cough, and general malaise.
- Signs may involve jaundice, elevated temperature, perspiration, pallor, splenomegaly, and respiratory distress.
Clinical Manifestation
- Two classifications:
- Uncomplicated: General nonspecific signs without severe symptoms.
- Complicated: Severe cases featuring prostration, impaired consciousness, respiratory distress, pulmonary edema, jaundice, severe anemia (Hb < 8 g/dL), thrombocytopenia, acidosis, renal impairment or oliguria, and potential gram-negative septicemia.
Diagnosis
- Essential factors in diagnosis include travel history to malaria-endemic areas.
- Diagnosis methods:
- Thick smear for parasitemia detection and initiation of therapy.
- Thin smear for species identification.
- Rapid tests for malaria antigens, although they may miss low parasitemia.
Treatment
- Artemisinin-based therapies recommended, notably Coartem (artemether/lumefantrine), for uncomplicated malaria in pregnant women during the second and third trimesters.
- Severe malaria treatment follows a specific regimen:
- Artesunate: 2.4 mg/kg initially at 0, 12, and 24 hours, then switch to oral treatment.
- Quinine: 20 mg/kg loading dose in 5% dextrose over 4 hours, followed by 10 mg/kg IV every 8 hours alongside clindamycin (450 mg IV every 8 hours).
- Intermittent preventive treatment: Sulfadoxine-pyrimethamine and insecticide-treated nets (ITN) crucial for prevention.
- Prompt diagnosis and treatment are essential for managing malaria and associated anemia.
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Description
This quiz covers essential information about malaria, including its causes, particularly the Plasmodium parasite, and the impact on sub-Saharan Africa. It also explores the lifecycle of malaria, the pathophysiological aspects, and common symptoms associated with the disease.
