Health Care Missions SG3

The most deadly and parasitic disease that typically kills you

Malaria (4th leading cause of death in the world)

The bark of which tree was chewed to cure malaria

Cinchona tree (“Fever Bark Tree")

What was isolated from that bark of the cinchona tree

Quinine

What drug was later produced for malaria

• Chloroquine

• Bitter taste

In the 1940s what was used in the US to eliminate the mosquito that transmitted malaria

DDT

Malaria broken apart means

Bad air

• Belief back then was that it came from foul smells

>94% of deaths from malaria occur among what population

• African children

• Kills an African child every 30 seconds

• Adults can develop partial immunity

• 5 years of age is most vulnerable time

What latitudes is malaria found

60N and 40S

What things affect transmission of malaria

Temperature, humidity, rainfall, and altitude

Considered to be the deadliest animal in the world

Mosquito

How to mosquitos trace their prey

• Scent

• Lactic acid

• Other ingredients in perspiration

• CO2 exhalation

Malaria is caused by a single celled parasite called

Plasmodium

Malaria emerges from the bite of the

• Female anopheles mosquito

• Requires parasite, vector, host

Inside the body, the parasite multiplies how many times every 2 days

• 10

• By the time it emerges from liver it has replicated 40,000 times

Life cycle of malaria

• Sporozoites enter blood with saliva

• Merozoites released into blood leading to main symptom of anemia

Most severe species of malaria that causes cerebral malaria and is the most prevalent on the continent of Africa is

Plasmodium Falciparum

Benign more milder type of malaria which can have relapse and is most prevalent in Asia and the Americas is

Plasmodium Vivax

Two less common forms of malaria and can reoccur decades after infection

• Ovale

• Malariae

Malaria originally believed to only exist in monkeys

Knowlesi

Most common types of malaria

• Vivax

• Falciparum

Diagnosis of Malria

• RDT dipstick

• Detects antigens in whole blood

• Results in 2-15 minutes

Malaria in pregnancy increases the risks for

• Miscarriage

• Stillbirth

• Prematurity

• LBW infant

• Death

Pregnant women with malaria S/S

• Anemia

• Low blood sugar

• Pulmonary edema

General S/S for being malaria

*Think FLU w/anemia*

HA, fever, teeth-chattering chills, malaise with body aches, loss of appetite and N/V, vague abdominal pain, diarrhea, splenomegaly, hepatomegaly, anemia

S/S of cerebral malaria

High fever (>104 or 105), repeated generalized convulsions, unarousable coma, severe anemia, low blood sugar, acidosis and circulatory collapse

Cerebral malaria complications

• Black-water fever (affects kidneys)

• Neurological deficits (sticky RBCs)

• Circulatory collapse

• Pulmonary edema

• Infection

• Aspiration pneumonia

• Acidosis

• Spontaneous bleeding

• Hypoglycemia

• Jaundice

Treatment for cerebral malaria

*Seizure precautions*

• Turn on side

• Tepid sponge bath

• Stop seizures with valium

• Kill the parasite with IM or IV artesunate

• IV quinine

• Check hct or hgb

• Rehydrate

• Monitor I&O

Drugs that treat malaria

• Chloroquine

• Fansidar

• Coartem

Treatment of choice for uncomplicated benign malaria

• Coartem (ALU)

• Africa has resistance to Chloroquine

What two drugs does coartem consist of

*(ALU)*

• Artemether 20 mg

• Lumefantrine 120 mg

Drug of choice for cerebral malaria

Quinine

Toxic S/S of quinine and administration

Low BS, low BP, overdose causes deafness and blindness, increases r/f black water fever

• Must be diluted in dextrose and given IV over 4hrs

Newest drug for cerebral malaria

• Artesunate

• Can be given IV push

• Not used if pregnant

Malaria prophylaxis (prevention) drugs

• Malarone: daily, take with food

• Doxycycline: daily, don't use with kids, take with food

• Mephloquine

Side effects of Doxycycline

• Photosensitivity

• Diarrhea

• N/V

• Women may develop vaginal yeast infections

Side effects and administration of Mephloquine

• Taken 1x a week

• Dizziness, vivid dreams, sleep disturbances, anxiety, depression, psychosis, and seizures

Prevention of Malaria

• Use treated nets especially at night

• Keep them from biting you

• Insecticides DEET

• Screens on windows

• Cover legs and arms

• Clean up stagnant water

• Spraying houses

• Fish feed on larva

New vaccine against Malaria

• 40% effective

• 4 injections

An organism that lives in or on an organism of another species (its host) and benefits by deriving nutrients at the other's expense

Parasite

Diagnosis and treatment of parasites can be calculated by

Where you are in the world

Parasites rarely

Travel alone

Nemathehelminthes

Roundworms

• *Need Helmets*

Platyhelminthes

Flatworms

• *Flat, Plat*

Two types of Protozoa

• Entamoeba histolytica

• Giardia lamblia

Elongated, cylindrical worms equipped with hooks or teeth for attachment, resistant to digestive enzymes and love carbs

Nemathelminthes

Roundworm with about 100% infectious rate in countries closest to the border (Asia, Africa, Latin America)

Ascaris lumbricoids (largest intestinal worm)

Ascaris life cycle

• Swallow

• Stomach

• Small intestines

• Lungs

• Trachea

• Small intestines

How long does ascaris life cycle take

2-3 months

Three phases of ascaris symptoms

• Respiratory (asthma)

• Intestinal (obstruction)

• Psychological (migration)

Preventions of ascaris

• Latrines

• Hand washing