Malaria

Question 1

What is icterus?

Answer 1

jaundice

Question 2

Life cycle of malaria? (3)

Answer 2

1. upon mosquito bite, gametocytes fuse and sporozoites develop
2. sporozoites enter lymph vessel to lymph nodes as well as capillaries
3. from capillaries, they enter liver cells
4. liver cells rupture and release merozites
5. RBC are penetrated by merozites
6. asexual reproduction
7. development into gametocytes
8. uptake in blood during mosquito meal

Question 3

How many times does a mosquito bite? why?

Answer 3

• twice
• once to infect you
• once to feed off you

Question 4

The clinical outcome of malarial infection in a patient depends on what?

Answer 4

• convergence of many parasite, host, geographic, and social factors
• this may result in a range of possible outcomes, from asymptomatic infection to severe disease and death

Question 5

Pathogenesis of malaria? (4)

Answer 5

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Question 6

Evasion of immune mechanism by Plasmodia?

Answer 6

• genome diversity
• cytoadherence, intraerythrotic sequestration, rosetting and knob formation
• switching “on” and “off” genes

Question 7

How many countries are now malaria free? how many still have transmission?

Answer 7

• free: 109
• still transmit: 99
• proportion of worlds population who live in malaria endemic regions has decreased from 70% to 50%

Question 8

When is fever produced during the malaria life cycle?

Answer 8

-when the schizonts mature at 48 hour intervals

Question 9

Woman with seizures following fever case? (10)

Answer 9

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Question 10

Man with jaundice and fever case? (11)

Answer 10

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Question 11

Immunity for malaria?

Answer 11

• people can live with it for decades or die from it overnight
• immunity is patchy and incomplete
• drugs work, except when they don’t
• vaccine makers create ever more promising failures

Question 12

Male refugee case? (12)

Answer 12

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Question 13

What is the gold standard for determining malaria?

Answer 13

-thick and thin peripheral blood smears

Question 14

Plasmodia are?

Answer 14

intra-erythrotic

Question 15

What is the most lethal form of malaria?

Answer 15

P. falciparum

Question 16

What is the most common form and may cause relapse?

Answer 16

P. vivax

Question 17

What are the different ways of diagnosing a malarial infection? (16)

Answer 17

• direct visualization of parasites
• detection of parasite biomarkers
• detection of host biomarkers

Question 18

What are some signs and symptoms of malaria?

Answer 18

• fever
• severe anemia
• nephrotic syndrome
• splenomegaly

Question 19

How does one get cerebral malaria?

Answer 19

-malaria parasites are sequestered in small blood vessels

Question 20

Man with fever, chills case? (17)

Answer 20

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Question 21

When is malaria considered severe?

Answer 21

when more than 5% of RBCs are parasitized

Question 22

Signs and symptoms of severe malaria?

Answer 22

• jaundice
• pulmonary edema
• gingival bleeding
• ARDS

Question 23

Why could a relapse occur?

Answer 23

• due to the formation of hypnozoites in liver
• symptoms are triggered under stress
• types: P. vivax, P. ovale

Question 24

What is the major public health intervention in malaria?

Answer 24

doors and window screens

Question 25

What is a testimony to malarias evolutionary ingenuity?

Answer 25

- the mosquitos ability to exploit almost any type of water natural ponds, marshes, irrigation ditches, and used tyres - a malady mentioned on clay tablets by members of an ancient civilization in 4000 BC is yielding its secrets to 21st century scientists

Question 26

P. vivax is not so benign? (23)

Answer 26

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Question 27

Why was the CDC established?

Answer 27

- established in 1946 to control malaria - called the Communicable Disease Center (CDC) - 1970 became Center for Disease Control - 1992 became Center for disease Control and Prevention

Question 28

What is a common way to provide protection against malaria?

Answer 28

- insecticide treated bed nets - "the best doctor prevents the disease" - malaria can be suppressed but rebounds when pressure is released

Question 29

Why do bed nets work so well to prevent malaria?

Answer 29

- highly efficacious - very scalable - simple - inexpensive - durable - acceptable - relatively free from service delivery constraints - have collateral benefits against other infectious diseases - they reflect the "rank" and "class" of people using them (from cheap cotton to silk to gold)

Question 30

What is Artemisinin annua?

Answer 30

- herbal medicine - remarkably effective against malaria