18c Treatment for Parasitic Infection (Protozoa) Goad

Question 1

What is Toxoplasmosis?

Answer 1

Toxoplasma gondii. 3rd leading cause of death d/t foodborne illness (primarily in immunocompromised and newborns). Can also be transmitted from “cat box disease” or Mother-fetus –> stillborn, miscarriage

Question 2

What is the treatment for Toxoplasmosis?

Answer 2

Pyrimethamine and Sulfadiazine. Clindamycin is alternative. Treat for up to 4 weeks. Treat infants instead of mothers

Question 3

What is Giardia intestinalis?

Answer 3

Giardia lamblia. Backpackers disease. Contaminated ground water. Zoonotic and person to person. MSM transmission

Question 4

What is Giardiasis?

Answer 4

1-2 week incubation. Stool: foul smelling, loose or watery, fatty stools. Stomach cramps, flatulence and upset stomach

Question 5

What is the treatment for Giardia?

Answer 5

Tinidazole (Tindamax): 2nd gen nitromidazole, 2g PO x1 dose w/ food. Metronidazole 2g PO x3d or 250mg TID 5-7 days (not FDA indicated). Nitazoxanide (Alinia): 500mg PO Q12h x3 days. Paromomycin (Humatin): Aminoglycoside; not systemically absorbed, 30mg/kg/day PO for at least 5 days

Question 6

What is the advantage of Metronidazole vs. Tinidazole for Giardiasis?

Answer 6

Metronidazole can be used for infants, while Tinidazole is > 3 years old. Tinidazole is a single PO dose though, while Metronidazole is 3 day or 5-7 day

Question 7

What is Cryptosporidiosis?

Answer 7

Cryptosporidium parvum. Contaminated water. Watery diarrhea, vomiting, abdominal pain. Self-limiting in immunocompetent. More severe disease in AIDS and elderly

Question 8

What is used to treat Cryptosporidium parvum?

Answer 8

Nitazoxanide 500mg PO BID x3 days

Question 9

What is Entamoeba histolytic?

Answer 9

Amoebiasis (Amoebic dysentery). Contaminated hands, food, water. Mild to intestinal perforation

Question 10

What is looked at in a stool sample for Entamoeba histolytic?

Answer 10

Frequency. Form. Color. Ova and Parasites (O&P)

Question 11

What is the spectrum of disease caused by Entamoeba?

Answer 11

Asymptomatic disease (cyst passers). Intestinal Amebiasis. Extraintestinal Amebiasis

Question 12

What is done for Asymptomatic disease (cyst passers) caused by Entamoeba?

Answer 12

Vague GI symptoms, if E. dispar no treatment, if E. histolytica use a luminal agent alone

Question 13

What is done for Intestinal Amebiasis caused by Entamoeba?

Answer 13

Dysentary (diarrhea w/ blood). Metronidazole then a Luminal agent. May need antibacterials for gut perforation

Question 14

What is done for Extraintestinal Amebiasis caused by Entamoeba?

Answer 14

Liver abscess. Same as intestinal plus surgical intervention

Question 15

What is treatment for Entamoeba histolytica?

Answer 15

Broad spectrum (Metronidazole 750mg TID x10 days) PLUS a luminal agent (with cysts): Iodoquinol, Paromomycin, Diloxanide

Question 16

What is American Trypanosomiasis?

Answer 16

Chagas disease. Fecal contamination of bite

Question 17

What is African Trypanosomiasis?

Answer 17

Sleeping sickness. Transmitted by tsetse flies

Question 18

What is Leishmaniasis?

Answer 18

Cause 3 forms: cutaneous, mucosal, and visceral (kala azar). Transmitted by sandfly

Question 19

What is treatment like for Leishmaniasis?

Answer 19

Toxic treatments: Na stibogluconate, Liposomal AMB for visceral

Question 20

What is Hookworm?

Answer 20

Nematode. Ancylostoma duodenale. Necator americanus. Ancylostoma caninum

Question 21

What are the clinical aspects of Hookworm?

Answer 21

“Ground itch” - Nector americanus. Cutaneous “creeping” larvae migrans - A. braziliense. Lung findings: mild to moderate cough, eosinophilic pneumonia. Intestinal disease (blood loss, abdominal pain, diarrhea, weight loss). Chronic disease - anemia (children, pregnant women)

Question 22

What is the treatment for Hookworm?

Answer 22

Albendazole 400mg once (DOC). Mebendazole 100mg BID x3d or 500mg once. Pyrantel pamoate 11mg/kg (max 1g) x3d

Question 23

What is the DOC for Hookworm?

Answer 23

Albendazole 400mg once

Question 24

What is Baylisascaris procyonis

Answer 24

Transmitted by ingesting eggs in raccoon latrines. Neural and ocular larvae migrans (Neural ALWAYS fatal, no effective treatment)