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Malaria Tutorial

Group 3
7 jumps
1. Clarifying unfamiliar terms
2. Problem definitions
3. Brainstorm
4. Analyzing problem
5. Formulating learning issues
6. Search journal
7. Reporting
Tutorial group 3
Maarja Vaarsi
Tanel Lepik
Lizz van Duin
Isabelle van der
Lennart Wasmoeth
Eveline Verheij
Hannah Brand
1. Carifying unfamiliar terms
1. Schuffners stipplings? =Characteristics of
P.ovale/P.vivax
2. Liver steatosis? = fatty liver
2. Problem definitions
1. Differential diagnosis?
2. Why does he have liver steatosis? Why does he have high
levels of triglycerides?
3. Why does he have fever?
4. What does parasitaemia of 1.5% mean?
5. Why does he still have malaria although he was treated
with chloroquine?
6. Why was the disease latent for 4 years?
7. What is the mechanism of hematuria?
8. How can previous mild malaria lead to severe malaria?
9. Does he have both P.vivax and P.ovale infection?
3. Brainstorm (1)
1. DD:
Malaria
Dengue
Leptospirosis
Influenza
Hepatitis
Typhoid fever
Leukaemia
Babesiosis
3. Brainstorm (2)
2. Why does he have liver steatosis? Why does he have
high levels of triglycerides?
Spirozytes go into the liver cells and destroy hepatocytes.
As a result fat cells accumulate in the gaps.
KEEP IN MIND!
3. Why does he have a fever?
Infection
Fever rises when red blood cell break and merozytes go
into the bloodstream to infect other cells
KEEP IN MIND!
3. Brainstorm (3)
4. What does parasitaemia of 1.5% mean?
1.5% of all the red blod cells is infected (?)
Normal value for P.vivax/ovale infection

5. Why does he still have malaria although he was treated


with chloroquine? Why was the disease latent for 4 years?
P.ovale can exist latent in liver up to 3 years (4 years??)
High resistency to chloroquine (previous treatment was not
efficient)
Trigger for malaria to ativate again? Some kind of
immunodeficiency (HIV)!
3. Brainstorm (4)
6. What is the mechanism of hematuria?
Malaria destroyes red blood cells, Hb goes into the
bloodstream and goes into the urine (prerenal
hematuria?)

7. How can previous mild malaria lead to severe malaria?


Treatment was not efficient
Parasite was resistent to chloroquine?
Reactivation of malaria because of overreaction of the
immune system???
4. Analyzing problem (1)
1. DD:
Malaria:
PRO: symptoms, fever fluctuation, laboratory
findings, history
CON: previously treated malaria, no return to
endemic area
Dengue:
PRO: thrombocytopenia, hepatomegaly, fever
CON: cyclic fever, fever for 12 day (not up to 7)
4. Analyzing problem (2)
Leptospirosis:
PRO: fever, tachycardia, hematuria
CON: cyclic fever
Influenza:
PRO:fever, no response to AB, tachycardia
CON:fever for too long, fatty liver, no pulmonary
symptoms
Hepatitis:
PRO: fatty liver, fever
CON: no blood contact, no fluctuations in fever
4. Analyzing problem (3)
Typhoid fever:
PRO: cyclic fever, endemic area
CON:no GI tract symptoms, no response to
medication
Leukaemia:
PRO: splenomegaly, low platelet count, acute
disease
CON: blood stream result, too high/cyclic fever
4. Analyzing problem (4)
Babesiosis:
PRO: same symptoms
CON:less severe, no vector
Formulating learning issues
1. Fatty liver? High levels of triglyceramia?
2. What was the trigger for reactivation?
3. How can mild malaria lead to severe malaria?
4. Why is fever cyclic?
5. What is the effect of the treatment with
chloroquine?
6. Is it possible to be infected with P.vivax and
P.ovale at the same time?
6. Search journal (1)
1. Fatty liver? High levels of triglyceramia?
Malaria parasites and its toxins infect liver cells,
they get bigger and gaps appear in the
cytoplasma and the gaps are filled with fat
cells mostly.
Malaria parasite induces lipolysis of adipose
tissue and the excess fatty acids are used to
synthesize VLDL
6. Search journal (2)
2. What was the trigger for reactivation?
There doesnt have to be a specific trigger. But it
can be immunodeficiency-HIV etc.
Plenary discussion question!
3. Why is the fever cyclic?
Merozytes burst out of red blood cells and infect
new red blood cells. It takes a certain time.
When they burst out, fever rises.
6. Search journal (3)
4. How can mild malaria lead to severe malaria?
Plenary discussion question!

5. What is the effect of the treatment with


chloroquine?
It targets infected red blood cells. Primaquine
targets infected liver cells.
6. Search journal (4)
6. Is it possible to be infected with P.vivax and
P.ovale at the same time?
Maybe, but in this case molecular studies (PCR)
showed that it was only P.vivax.
END

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