Complications of malaria

1. COMPLICATIONS

2. COMPLICATIONS OF FALCIPARUM MALARIA
1. Cerebral malaria- Most serious complication of
falciparum malaria.
Due to plugging of brain capillaries by the
sequestered parasitized RBC leading to vascular
occlusion.
2. Pernicious malaria- It is characterized by
■ Algid malaria
■ Septicemic malaria
■ Black water fever

3. 3. Black water fever-
Characterized by intravascular hemolysis followed
by fever, hemoglobinuria and dark urine.
4. Algid Malaria- Characterized by cold clammy skin
, hypotension, peripheral circulatory failure and
profound shock.
5. Acidosis- Due to accumulation of organic acids
like lactic acid.

4. 6. Severe normocytic, normochromic
anemia.
7. Hypoglycemia
8. Renal failure

5. CHRONIC COMPLICATIONS OF
MALARIA
1. Tropical splenomegaly syndrome - Also
known as hyperactive malaria splenomegaly.
Results from an abnormal immunologic
response to repeated malaria infections and
is characterized by elevated IgM.

6. 2. Quartan malaria nephropathy- It is a
chronic complication seen with P. malaria.
Occurs due to injury to renal glomeruli by
the immune complexes , resulting in
nephrotic syndrome.

7. Treatment of malaria
Anti-malarial drugs are used with various objectives –
 Therapeutic – to eradicate the erythrocytic cycle
 Radial cure – to eradicate the exo-erythrocytic cycle to prevent relapse
 Gametocidal – to destroy gametocytes to prevent mosquito transmission
 Chemoprophylaxis – to prevent infection in non-immune person visiting endemic
areas

8. Uncomplicated malaria
Positive for - P. ovale, P. vivax and P. malariae
Primaquine – to prevent relapse
In case of chloroquine resistance – Quinine
is given – 8 hourly for 7 days plus
doxycycline 100mg/day.
Complicated(falciparum) malaria
Artemisinin based combination therapy
(ACT) is given
Monotherapy with Artemisinin is banned
in India as it promotes resistance.

9. Severe Malaria

10. Anti-malarial drug Resistance
A drug resistant parasite will survive and multiply in a dosage that normally cures the
infection.
Resistance arises from spontaneous point mutations in the genome or gene
duplications.
3 levels of resistance are defined by WHO –
Following treatment,
1. R1 – parasitemia clears but recrudescence occurs
2. R2 – reduction but not a clearance of parasitemia
3. R3 – no reduction of parasitemia
Many strains of P.F. are MDR meaning as resistance to atleast 3 or more than 3 classes
of anti-malarial drugs.
Only sporadic cases of resistance to chloroquine/primaquine have been reported in
vivax malaria.

11. Factors that contribute to emergence of resistance –
1. longer half-life of drug
2. mutation in parasite gene
3. inadequate and irregular usage of drug
4. host immunity
Mechanism of drug resistance –
1. chloroquine resistance in P.F. – mutations in genes encoding for– PfCRT and PfMDR1
– result in impaired transport of chloroquine
2. Resistance to antifolates - like pyrimethamine – due to point mutation in DHFR gene
3. Resistance to artemisinin – not been reported yet, observed in experimental animals

12. WHO guidelines for assessing degree of resistance –
In-vivo methods – resistance assessed on 2 factors – persistence of clinical
manifestations, level of parasitemia
In-vitro tests –
1. WHO micro test – RPMI 1640 medium
2. ELISA – measurement of HRP-2 or pLDH
3. PCR – detect P.F. specific drug resistance genes
Prophylaxis against malaria
1. Chemoprophylaxis – travelers, migrant laborers, military personnel
(a) Short term – Doxycycline, 100mg/day, 2 days before and 4 weeks after
(b) Long term – Mefloquine, 5mg/kg weekly, 2 weeks before, during, 4 weeks after

13. 2. Vector control strategies –
(a) Anti-adult measures –
Residual spraying – DDT, malathion, fenitrothion
Space application- by ultra low volume method of pesticide dispersion
Individual protection – insecticide treated bed nets, repellents, protective clothing
(b) Anti-larval measures –
Larvicide – mineral oil or paris green
Source reduction – reduce mosquito breeding sites
Biological larvicide – Gambusia affinis(fish), Bacillus thuringiensis(bacteria)
3. Vaccination – till date no vaccine is licensed for human use
RTS, S/AS01 – only vaccine – used in children in sub-Saharan africa

14. 1. Malaria is endemic in many countries and is reported to be a
leading cause of death from parasitic infection killing millions
of people globally, with the most number of deaths occurring
in Africa.
Which of the following age group of people are at higher
risk?
a) 10 - 15 years of age
b) > 5 years of age
c) < 40 years of age
d) 10- 25 years of age

15. 2.Which of the following Plasmodium spp is considered
to be the major parasite that leads to leading cause of
human deaths throughout the world annually?
• a) Plasmodium knowlesi
• b) Plasmodium malariae
• c) Plasmodium falciparum
• d) Plasmodium vivax

16. 3.Trophozoites, schizonts, and gametocytes of all the malarial
parasites are seen in the peripheral blood smear except;
a. P. Falciparum
b. P. Malariae
c. P. Ovale
d. P. vivax

17. 4. A thin blood smear is used as a specimen for the microscopic
detection of Plasmodia.
Which of the following dyes/stain is used for the identification?
A) Lactophenol cotton blue
b) Giemsa stain
c) Safranin
d) Crystal violet

18. 5.Which is the infective form of the malaria parasite?
a. Oocyst
b. Sporozoite
c. Bradyzoite
d. Tachyzoite

19. 6.Crescent-shaped or banana-shaped gametocytes are seen in infection
with:
a. Plasmodium vivax
b. Plasmodium falciparum
c. Plasmodium ovale
d. Plasmodium malariae

20. 7.Blackwater fever is a special manifestation of malaria caused by;
a. P. Falciparum
b. P. Malariae
c. P. Ovale
d. P. Vivax

21. 8.Name the organ in which the malarial parasite could reside and stay
dormant for up to one year during the transmission of the disease in
humans
a) Kidney
b) Liver
c) Intestines
d) Gall’s bladder

22. 9.Which of the following is the most common type of symptom that
occur in people infected with malaria?
A) Muscle aches and low-grade fever
b) Skin rashes and swollen legs and hands
c) Mouth rashes and itchy skin
d) High-grade fever and chills

23. • 10. Which of the following is the one morphological characteristics
that distinguish P. Vivax and
• P. Ovale from other human malaria parasites?
• A) Maurer’s dots
• b) Schuffner’s dots
• c) Ring stages
• d) Banana shaped gametocytes

24. 11.All types of malaria have flu-like symptoms, after a few days of
infection the individuals could experience periodic febrile attacks, also
known as malarial paroxysms.
Which of the following statements regarding malarial paroxysm is Not
correct?
A) It has three stages, hot, cold, and sweating stages
b) It lasts for about 8 to 12 hours
c) It happens when the RBCs release sporozoites in the blood
d) It is usually 72 hours for P. Malariae and 48 hours for other human
Plasmodium spp

25. 12.Which of the following Plasmodium spp is responsible for the
highest mortality rate annually around the world?
A) P. Knowlesi
b) P. Falciparum
c) P. Malariae
d) P. vivax

26. 13. All of the following statements regarding Plasmodium falciparum
infection are true, Except?
A) P. Falciparum, falciparum name is derived from sickle-shaped
gametocytes
b) Malaria caused by P. Falciparum is also known as “malignant tertian
malaria”
c) It causes severe infections and is known to be the most fatal of all
human malaria
d) Schuffner’s dots are developed and can be observed during
microscopic examination

27. 14.When the sporozoites enter the human blood, they are carried to
the liver where they replicate and develop into merozoites. The
merozoites are released into the blood and the parasites invade RBCs.
Which of the following statements is Not true regarding the
developmental phase of Plasmodia inside the RBCs?
A) The phase is known as the erythrocytic phase of malaria
b)The merozoites go through asexual reproduction
c) The phase lasts for two to three days
d)The merozoites go through sexual reproduction and develop into a
zygote

28. 15.A 7-year-old girl from a malaria-endemic region visited the hospital with fever,
chills, aches, and fatigue. The blood smear method (thick and thin blood smear)
was performed for the microscopic examination, and the intracellular parasite and
its stages were identified, the girl was diagnosed with malaria.
Which of the following statements regarding the general characteristics of
Plasmodium spp is Not correct?
A) There are five known species of Plasmodium that cause infections in human
b) The parasite containing sporozoites are released into the blood via the mosquito
c) The sexual reproduction is completed in mosquitoes whereas asexual in human
RBCs
d) The infection can lead to liver and spleen enlargement

29. 16.All of the following statements regarding recurrent malaria (relapse,
recrudescence, and reinfection) are correct, Except?
A) Some patients develop malaria again after a period of time
b) Recrudescence is due to insufficient treatment, relapse is due to the
reappearance of merozoites from hypnozoites
c) It can be seen in all Plasmodium spp causing malaria
d) The highest rate of relapses occurs with malaria caused by P. vivax

30. 17..Which of the following Plasmodia has general features related to P.
Vivax and infections similar to that caused by P. Falciparum?
A) P. Knowlesi
b) P. Ovale
c) P. Malariae
d) None of the above

31. 18.When the sporozoites enter the human blood, they are carried to
the liver where they replicate and develop into merozoites. The
merozoites are released into the blood and the parasites invade RBCs.
Which of the following statements is Not true regarding the
developmental phase of Plasmodia inside the RBCs?
A) The phase is known as the erythrocytic phase of malaria
b)The merozoites go through asexual reproduction
c) The phase lasts for two to three days
d)The merozoites go through sexual reproduction and develop into a
zygote

32. 19.Malaria drug hydroxychloroquine was falsely reported to be
effective in which type of viral infection in 2020?
A) Dengue
b) Influenza
c) COVID-19
d) Swine flu

33. 20.Of the following statements regarding recurrent malaria (relapse,
recrudescence, and reinfection) are correct, Except?
A) Some patients develop malaria again after a period of time
b) Recrudescence is due to insufficient treatment, relapse is due to the
reappearance of merozoites from hypnozoites
c) It can be seen in all Plasmodium spp causing malaria
d) The highest rate of relapses occurs with malaria caused by P. vivax