Day 1 officially: Malaria, TB and cool cases

Day 1 was awesome. I met more of my classmates and everyone has a pretty interesting story. We have small groups for case rounds and a separate small groups for labs to meet more people.

Really great lecture on Malaria, that went over finer details of pathophys. I really liked how he talked about how the definitive host is the mosquito, and how gametes are picked up, goes to abdo of mosquito, come together for ookinete which penetrates intestinal cell, comes out as an oocyst which then makes 8000 motile sporozoites which migrate to salivary glands.

Further reminder of PfEMP-1 of P. falciparum to ICAM causing cyto-adherence and sequestration.

Stages of the parasite in humans are: ring trophozoite, ameboid trophozoite (P.vivax), and band

(P. malariae, P. Knowlesi), immature then mature schizont, and then gametocytes. Maurer's

clefts are found in P. Falciparum. P. falciparum develop in the bone marrow.

I liked that we went over some practical points related to incubation, pre-patent and sub-patent

periods. He had a slide on details of this comparing 4 species, specifically how the earliest

stage ofmgametocytes appear in periphery, cause this can play a role in autochthonous

transmission (local).nFor example, P. Vivax can form gametes in 3 days as Ovale in 5.

There was another lecture on Epi, take home messages for me is infants 3-6 months are

Protected (from mother’s antibodies), but high mortality in children <2 years of age. Details of

the vector itself (female anopheles), average lif 20-25 days, sporogony last 8-25 days, and

feeding 2-4 days, optical conditions 20 to 30 degrees, humidity of >60, but minimal sporogeny at

T <16, and greater than 35.

They briefly discussed treatment of primaquine regimens, (15 mg daily x 14 days, or 30 mg x 14

days), in Peru they give 30 mg daily x 7 days, or 45 mg/week x 8 weeks in G6DP deficient

individuals.

Cases discussed!

A 41 year old male farmer that had a small papule on thigh that had occurred around 20 years ago, possible in the setting of leach, He was treated with a variety of medications, he had picked at it himself, and finally was diagnosed with chromoblastomycosis. Lesions were verrucous with black grains, he was a farmer. Skin scrapings done with KOH showed medlar bodies. He was on itraconazole 400 mg for ~ 1 year daily but with minimal improvement.

43 year old male farmer from Nasca, works barefoot, had a chronic draining wound to his foot, had white grains. Diagnosed with Madura foot, Actinomycetes, given amikacin x 3 weeks (x 5 cycles) with septra 1 ds po bid. With almost complete improvement. Triad includes tumor, sinus tracts and macroscopic grains. We had discussed that if black grains come out – then it is definitely fungal, but other grain colors aren’t diagnostic of fungal vs bacterial.

A 31 yo male with poorly controlled diabetes, he also had Madura foot, drainage sinuses, white grains, given the chronicity of his infection was offered amputation but currently trying to preserve this.