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What is the most lethal form of malaia?
P. falciparum__malignant tertian malaria
What are the characteristics of the infection?
- Fever recurs every 3rd day
- No secondary tissue forms --> no relapses
What is the most common form and its characteristics?
- P. vivax --> benign tertian malaria
- Fever every 3rd day, has secondary tissue forms --> relapses
Which form is similar to P. vivax?
How often does the fever recur c P. malariae?
- Every 4th day
- No secondary tissue forms
What is the only Rx that can attack extraerythrocytic cryptozoites in the liver?
Primaquine (tissue schizonticide)
What is the most effective way of preventing malaria?
Avoid being bitten (the researcher who figured this out won a Nobel Prize, but so did Al Gore)
What is the DOC for sensitive organisms?
Chloroquine: clinical cure for all forms or a prophylactic
How has resistance developed to this Rx?
Transport pump removes it from parasite
What are the pharmacokinetics?
- Oral (well absorbed) or parenteral
- Accumulates in melanin-rich tissues
- Has a long 1/2 life of 3-5 days
- Low levels in blood for long time is perfect recipe for development of resistance
What are the toxicities? (better profile than quinine)
- Cardiac arrest if administered too fast
- Contraindicated in pts c psoriasis or porphyria
What is the DOC for complicated, chloroquine-resistant plasmodia?
Quinidine gluconate (quinine) + doxycycline
What are the toxicities of quinine?
- Cinchonism: tinnitus, HA, dizziness, flushing, visual changes
- Hypotension and QT prolongation c IV administration
- Hemolysis in G6PD deficient pt
- Insulin release ? hypoglycemia
- Uterine contractions (still the DOC for resistant P. falciparum in pregnancy)
- Blackwater fever: hypersensitivity that causes hemolysis and hemoglobinuria
What is the use of doxycycline?
- Combined c quinidine gluconate in Tx of chloroquine-resistant malaria
- Used prophylactically against MDR malaria
What is the DOC for prophylaxis of chloroquine-resistant plasmodia?
What is the major adverse effect of mefloquine?
CNS disturbance: seizures, psychosis, nightmares
What antimalarials inhibit folate metabolism?
Pyrimethamine, proguanil, pyrimethamine + sulfadoxine
How is proguanil used?
Combined c chloroquine for prophylaxis
How is pyrimethamine + sulfadoxine used?
For presumptive Tx of malaria if person is showing Sx
What is the DOC for uncomplicated, chloroquine-resistant malaria?
- Atovaquone + proguanil (Malarone)
- Also alternative prophylaxis against chloroquine resistant P. falciparum
How is it given?
What is the only tissue schizonticide?
Primaquine --> won't suppress disease once devloped
What are its adverse effects?
- Hemolytic anemia in G6PD deficiency
- Teratogenic --> do not give in pregnancy
What is the DOC for prophylaxis? [BOOM]
If chloroquine-resistant prophylaxis? [BOOM]
- Mefloquine (CNS side effects)
- Alternatives: doxycycline, Malarone
If multidrug-resistant prophylaxis? [BOOM]
Doxycycline (no alternative in pregnancy)
What is the DOC for Tx?
What is used to treat chloroquine-resistant P. falciparum?
For Tx of chloroquine-resistant P. vivax?
Quinine + doxycycline
For prevention of relapse?
What is used for severe malaia?
Quinidine + doxycycline, clindamycin, or tetracycline