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Senior - ID 3 > 16 - Protozoal Infections > Flashcards

16 - Protozoal Infections Flashcards

1
Q

What are protoza?

A 
Highly motile
Unicellular eukaryotes
Predatory/parasitic
Move by cilia, flagella or ameboid motion
Aquatic or terrestrial
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2
Q

Protozoal infections?

A
  • Amebiasis
  • Giardiasis
  • Leishmaniasis
  • Cryptosporidiosis
  • Babesiosis
  • Malaria
  • Toxoplasmosis
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3
Q

Enatomebia histolytica causes?

A

Intestinal and extraintestinal infections

  • Amebic liver abscess
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4
Q

Who gets amebic liver abscess?

A

Men: 7-12x more likely

10% of the world’s pop

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5
Q

Pathyphysiology of amebiasis?

A

Lytic effect on tissue
- histo”lytic”a

Induces self-destruction
- trophozoite colonizes the colon
- invades the intestinal mucosal barrier
- gains access to the circulation
(Commonly infects liver and lung)
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6
Q

Amebic colitis s/s?

A

Weeks of

  • abd pain
  • diarrhea
  • blood stools
Fever (uncommon)
Wt loss w volume depletion
Fulminant colitis
Rectovaginal fistulas
Fulminant or necrotizing colitis
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7
Q

Fulminant or nectorizing colitis mortality?

A

0.5% of pts w amebic colitis

But 40% mortality

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8
Q

Who is more prone to amebic colitis?

A

Poor nutrition
Corticosteroids
Pregnancy
Very young

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9
Q

S/s of amebiac liver abscess?

A

1-2 week hx

  • fever (unlike colitis)
  • RUQ (abdominal pain)

Single abscess - subacute presentation

  • prominent wt loss
  • usually no fever
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10
Q

Amebic liver pts usually have a hx of?

A

Dysentery in the last yr

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11
Q

amebic colitis PE

A

Fever (30%)
Wt loss (40%)
Diffuse abd tenderness
Heme pos stools

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12
Q

Amebic liver abscess PE

A 
Fever (90%)
RUQ tenderness (90%)
Wt loss (50%)
Hepatomegaly (50%)
Jaundice (10%)
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13
Q

Test of choice for amebiasis?

A

PCR

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14
Q

Other labs and imaging for amebiasis?

A 
Stool exam (traditional method)
Stool antigen detection (EIA)
Stool O and P
US - homogenous hypoechoic round lesion
CT scan
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15
Q

Ddx for amebiasis?

A 
Abdominal abscess
Campylobacter
Diverticulitis
IBD
Salmonellosis
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16
Q

Tx for amebiasis?

A

Metronidazol
Tinidazole
Iodoquinol (yodoxin) luminal agent
Paromomycin (humatin) luminal agent

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17
Q

Surgery for amebiasis?

A

Used for fulminant amebic colitis

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18
Q

MC parasite identified in stool specimens in the US?

A

G. Lamblia

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19
Q

Asymptomatic carriage with giardiasis?

A

Asymptomatic carriage rate 3-7%

Can persist for months

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20
Q

What badness does giardiasis cause?

A

Malabsorption

  • alters epithelial structure/function
  • villous atrophy
  • distorted microvilli at attachment site
  • releases cytopathic substances

*mechanism not fully understood

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21
Q

S/s of giardiasis

A 
– Vomiting 
– Low-grade fever (infrequent) 
– Various neurologic Sx
• Irritability
• Sleep disorder
• Mental depression
• Neuroasthenia – Urticaria
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22
Q

S/s of giardiasis in children?

A 
– SX in children -- 40-80%
• Diarrhea 
• Malaise/weakness 
• Abdominal distention 
• Flatulence 
• Abdominal cramps 
• Nausea 
• Malodorous greasy
stools 
• Anorexia 
• Weight loss
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23
Q

PE for giardiasis?

A

Usually nothing

Kids have generalized abd tenderness sometimes

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24
Q

tests for giardiasis?

A

PCR - test of choice
- can also do Enteric parasite panel (EPP)

Stool exam (trophozites/cysts)
Stool EIA
Entero-test/duodenal biopsy (alternate test)
X-ray (non-diagnostic)

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25
Q

Ddx for giardiasis?

A
  • Crohns disease
  • Cryptosporidosis
  • IBS
  • Malabsorption
  • Sprue
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26
Q

Tx of giardiasis

A

Tinidazole
Metronidazol

  • may resolve spontaneously
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27
Q

Where is leishmaniasis found?

A

88 countries

  • tropics/subtropics
  • rainforest
  • C. And S. America
  • W. Asia
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28
Q

90% of visceral leishmaniasis is found in?

A 
India
Nepal
Bangladesh
Sudan
Brazi;
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29
Q

Leishmaniasis is divided into?

A

Cutaneous form
Mucocutaneous
Visceral
Viscerotropic

30
Q

Leishmaniasis cutaneous includes?

A
  • localized
  • diffuse
  • leishmaniasis recidivans
  • post-kala-azar dermal leishmaniasis
31
Q

How is leishmaniasis spread?

A

Vector-borne disease

Zoonosis
- sandflys

32
Q

Leishmaniasis is a?

A

Obligate intracellular protozoa

- leishmania

33
Q

2 main forms of leishmaniasis?

A

Cutaneous leishmaniasis

Visceral leishmaniasis (kala-azar)

34
Q

What factors determine the form of the disease?

A

Leishmania species
Geographic location
Immune response of the host

35
Q

Cutaneous leishmaniasis s/s?

A 
Lesions at feeding site
1+ sores
Change in size/appearance over time 
Raised edge and central crater
Possible crust/scab
Painless (normally)
Painful (2ndary infection)
Regional lymphadenopathy
36
Q

Visceral (kala-azar or black fever) s/s?

A 
Systemic infection 
(liver/spleen/bone marrow)
- recurrent high fevers
- wt loss
- splenomegaly/hepatomegaly
- post kala-azar dermal leishmaniasis
- opportunistic (HIV)
37
Q

Splenomegaly with leishmaniasis?

A

Spleen can be bigger than lier

38
Q

PE for cutaneous leishmaniasis?

A 
Systemic signs absent
Small red papule (2cm)
- ulcerates 
- found on exposed areas of skin
Regional adenopathy
Satellite lesions
Subq nodule (possible)
39
Q

Visceral leishmaniasis physical exam

A
  • bouts of fever
  • hepatosplenomegaly
  • wasting/weakness
  • darkening of skin
  • diarrhea
  • pancytopenia
40
Q

Characteristic finding of visceral leishmaniasis?

A

Darkening of the skin

41
Q

Labs and imaging of leishmaniasis?

A

Isolation form tissue
Serology - (not cutaneous)
ELISA
Culture

Cutaneous made by appearance

42
Q

MC leishmaniasis diagnostic tool?

A

Isolation of organism from tissue

- giemsa-stained slides of the relevant tissue

43
Q

Ddx for leishmaniasis?

A

Basal cell carcinoma
Impetigo
Malaria

44
Q

Definition of mild leishmoniasis?

A

<4 lesions

None are

  • > 5cm
  • cosmetically sensitive areas
  • not in joints
45
Q

Mild disease tx?

A

Paromomycin ung (investigational drug)

LN2 (consultation w ID services)

May spontaneous resolve in 6 mo

Slide 48 (doesnt make sense)

46
Q

Who gets aggressive therapy (leishmoniasis)

A
  • Face lesion
  • not healing (months)
  • joint involvement
  • hand and feet (secondary infection likely)
  • local dissemination
  • immunocompromised host
  • 5-10 lesions
  • > 4-5cm
47
Q

Tx of leishmaniasis?

A 
Sodium stibogluconate (pentostam U.K.)
- hard to get/not FDA approved (CDC)
Meglumine antimoniate (glucantime France)
- not in US
Liposomal amphotericin B (AmBisome)
Impavido (miltefosine) p.o.
Fluconazole (cutaneous)
ThermoMed Radio freq heat
48
Q

Who is most likely to get cryptosporidiosis?

A

Kids 1-5 yrs

HIV/AIDS

49
Q

Mortality rate for cryptosporidiosis?

A

Usually its aids pts (50%)

50
Q

Cryptosporidiosis is?

A

Cryptosporidium parvum, hominis

51
Q

Infection rate with cryptosporidiosis?

A

Highly infections

  • oocysts are very resistant
  • only need a small dose
52
Q

Cryptosporidiosis is found?

A

Water

- even chlorinated water

53
Q

Where in the body does cryptosporidiosis infect?

A

Healthy pax:
- jejunum

AIDS:
- whole gi tract

54
Q

Why does cryptosporidiosis cause diarrhea?

A

We dont know

Malabsorption maybe

55
Q

S/s of cryptosporidiosis (besides asymptomatic)

A 
Watery diarrhea
Occasional pancreatic involvement
Wt loss
Abd pain
Fever (low grade)
N/V

Short lived in healthy
Not so in CD4 <200

56
Q

Cryptosporidiosis PE?

A

Non-specific GI findings

  • abd tenderness
    • RUQ
    • Epigastric tenderness
  • hyperactive bowel sounds
  • icterus (rare)
  • ascites (rare)
57
Q

Labs for cryptosporidiosis?

A

EPP, PCR (preferred)

  • GI biopsy
  • EIA available

New tests are able to ID species

58
Q

___ is not indicated with cryptosporidiosis?

A

Imaging studies

59
Q

Ddx for crypto?

A
  • amebiasis
  • campy
  • choledocholithiasis
  • cholelithiasis
  • giardiasis
60
Q

Tx for crypto?

A

Immunocompetent

  • no therapy req
  • nitazoxanide (maybe)
  • symptomatic care

Immunocompromised
- HAART therapy

(Abx and antimicrobials are not effective)

61
Q

What causes babesiosis?

A

B. Divergens

B. Microti

62
Q

Where is babesiosis found?

A

US:

  • long island NY
  • nantucket/marthas vineyard MA

World
- europe and asia

63
Q

Babesiosis is aka?

A

Tick-borne “malarialike” illness

64
Q

Clinical sx form babesiosis is?

A

2/2 parasitism of RBCs

Capillary blockage/microvascular stasis

RBC fragments involve

  • spleen
  • kidney
  • CNS
  • Liver
65
Q

Babesiosis S/S

A 
Fatigue 
- hemolytic anemia
Fever
Same symptoms as malaria
- chills -> fever -> diaphoresis -> prostration 
- malarial paroxysm

S/s are related to the degree of RBC parasitemia

66
Q

S/s of babesiosis are more sever if?

A 
Hx of splenectomy
- more fulminany
- prolonged clinical course
- overwheliming infection
- fatal outcome
Elderly/immunospuuressed
Transmitted in utero
67
Q

Which is of the babesiosis is more severe?

A

B. Divergens&raquo_space; B. Microti

68
Q

PE for babesiosis?

A

Few

Minority get

  • jaundice
  • spelnomegaly
69
Q

Babesiosis labs and imaging

A 
Wright or giemsa stain
Serology
CBC 
ESR elevated
LFTs mild elevation
70
Q

Ddx for babesiosis?

A

Malaria
Lyme disease
Rocky mountain spotted fever

71
Q

Tx for babesiosis

A
  • Atovaquone (Mepron) + azithromycin (Zithromax)
    – Clindamycin (Cleocin) + quinine (Formula Q)
    • Preferred regimen for severe babesiosis
    – Supportive therapy
    – Severe patients
    • Hospitalization
    – Exchange transfusion
    may be considered
72
Q

In wine there is wisdom, in beer there is freedom in water there is bacteria

A
  • banjamin franklin

Senior - ID 3 (11 decks)

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