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MSK Week 7 > 2.7.3. Muscle Parasites > Flashcards

2.7.3. Muscle Parasites Flashcards

1
Q

What does DALYs stand for?

A

Disability Adjusted Life Years

Used when looking at global health impact

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2
Q

Define: Phoresis

A

Traveling together, hitching a ride, no interdependency

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3
Q

Define: Commensalism

A

One partner benefits, the other isn’t harmed

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4
Q

Define: Parasitism

A

Generally, one partner is harmed

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5
Q

What is parasitology?

A

It should include all pathogenic nacteria, fungi, etc.

Historically, however, it is restricted to protozoan and metazoan invaders:

Protozoa (malaria)
Nematodes (round worm)
Platyhelminthes (flat worm)
Arthropods (tics)

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6
Q

Trichinella spiralis

A

Globally, one of the most prevalent and clinically important parasites

8-12 species complex

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7
Q

What are two important life cycles in regards to parasites?

A
  1. Domestic Cycle (pigs and rat/transmission from meat scraps)
  2. Sylvatic Cycle (in the forrest/scavenging)
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8
Q

What happens upon infection with Trichinella?

A
  1. Larva forms cyst in muscle of many hosts (usually after eating porks)
  2. From larvae to adult in 30-40 hours
  3. Mate and producing larvae in under 5 days
  4. Live until the T cell response evicts them (generally about a month)
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9
Q

Where are Trichinella larvae deposited?

A

In the mucosa, after which they enter the villous lymphatics and migrate (5-6 microM wide, so they can traverse capillaries)

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10
Q

Nurse cell pathophysiology

A
  1. Larva penetrates myocytes, coil in a spiral and modify myosyncitium to become a nurse cell
  2. Secrete nuclear regulatory factors that alter the way the myocyte behaves
  3. Increased host nuclear division followed by mitochondrial damage (by secreting VEGF)
  4. Loss of muscle protein (actin/myosin) complete by 8 days
  5. Affects Collage Types IV and VI
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11
Q

When does angiogenesis begin and end?

A

About Day 12 after the larva invades the muscle cell and ceases by Day 26

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12
Q

What is a common symptomatic presentation of parasites?

A

Facial edema (specifically, circumorbital)

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13
Q

Other clinical signs of Trichinella

A

Fever, Muscle soreness/pain, GI symptoms, Facial edema, Eosinophilia

Sublingual, retinal and subconjunctival hemorrhages

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14
Q

What do people die from in regards to Trichinella?

A

Myocarditis, encephalitis, pneumonitis

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15
Q

Laboratory signs of Trichinella

A

Eosinophilia, Demonstration of larvae in muscle biopsies, Trichinella-specific antibody response

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16
Q

Treatment for Trichinella

A

Corticosteroids may be life-saving, but they permit longer adult infection

Mebendazole

Albendazole

17
Q

Why does Trichinella show up as a serious life threatening disease in the “clean world?”

A

Because second and future infections are typically self-limiting (people in Africa were exposed as kids and are immune)

18
Q

What do you give a pregnant woman with Trichinella?

A

Pyrantel (only effective in the gut)

19
Q

Prevention and Control of Trichinella

A

Food for pigs is cooked (by law)

Uncooked pork frozen at -15C for 14 days

Public awareness of the dangers of undercooked pork

Controlling pig environments to avoid rodents

20
Q

What is Taenia solium?

A

The pork tapeworm: an intestinal cestode parasite that releases millions of eggs

21
Q

Why is Taenia solium bad?

A

Two types:

Taeniasis (occurs from ingestion the larval form and is generally harmless)

Cysticercosis, the bad type, occurs when larval eggs are ingested
-Skin, muscle, and CNS are affected

22
Q

What is sarcocystis?

A

Protozoa that creates muscle-dwelling cysts (people usually do not know that they have it)

Will see “spotty” soft tissue radiographically

23
Q

Who usually gets toxoplasma?

A

Pregnant women, kids, and the immunosuppressed

24
Q

Emerging parasites of AIDS

A

Microsporidians

Apicomplexans

25
Q

What are microsporidians

A

Intracellular parasite, complex, near to fungi with pronounced gene reduction

26
Q

Types of microsporidians

A

Trachipleistophora hominis & anthropopthera (causes myositis in AIDS patients)

Anncaliia vescicularum

Encephalitozoon spp.

27
Q

Types of apicomplexans

A

Toxoplasma, sarcocystis, and other coccidiosis

28
Q

What is dracunculiasis?

A

Infection by the guinea worm (aka guinea worm disease/GWD)

A person becomes infected when they drink water that contains water fleas infected with guinea worm larvae

29
Q

What is the progression of dracunculiasis?

A

Initially there are no symptoms.

One year later, the person develops a painful burning feeling as the female worm forms a blister in the skin, usually on the lower limb.

The worm then comes out of the skin over a few weeks.

It is very uncommon for the disease to cause death

30
Q

What is used to treat neurocysticercosis?

A

Albendazole

31
Q

What is used to treat flatworm infection?

A

Praziquantel (effective against everything but neurocysticercosis)

32
Q

How do you typically get toxoplasma gondii

A

Consumption of undercooked meat containing cysts or ingestion of cysts from cat feces

33
Q

Why are HIV patients at risk for toxoplasma gondii

A

Can develop into a severe disease:

encephalitis and brain abscesses due to cyst formation in the tissue

34
Q

Clinically, what due brain abscesses appear as on imaging?

A

Multiple enhancing lesions

35
Q

Classic triad of TORCH infections (caused by toxoplasma gondii)

A

Chorioretinitis, hydrocephalus, and intracranial calcification

36
Q

What is used to treat protozoal infections?

A

Pyrimethamine

37
Q

How does pyrimethamine work?

A

Interferes with tetrahydrofolic acid synthesis and by inhibiting the enzyme dihydrofolate reductase (necessary for DNA and RNA synthesis)

38
Q

What is used in combination with pyrimethamine to treat toxoplasmosis?

A

Sulfadiazine

MSK Week 7 (13 decks)

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