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PARASITOLOGY LEC > BLOOD AND TISSUE NEMATODES 1 > Flashcards

BLOOD AND TISSUE NEMATODES 1 Flashcards

1
Q

Wuchereria bancrofti Brugia malayi

  • Infective stage:
    Diagnostic stage:
  • Mode of transmission:
  • Habitat in humans:
A

Wuchereria bancrofti Brugia malayi

  • Infective stage: Third stage larva
    Diagnostic stage: Microfilaria in blood (sheathed)
  • Mode of transmission: Bite of mosquito (biological vector)
  • Habitat in humans: Lymphatic channels and Lymph nodes
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2
Q

For parasitic survival
____________ is less aggressive than blood

A

lymph

  • no platelet
  • no complement system
  • incomplete coagulation system
  • no granulocytes
  • slow flow

(5)

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3
Q

second leading cause of long term disability affecting both physical and psychological aspects (next to psychiatric illness)

A

Lymphatic Filariasis

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4
Q

Wuchereria brancofti

A

brancoftian filaria

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5
Q

Brugia malaya

A

malayan filaria

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6
Q

Wucheria bancrofti Brugia Malayi

Common name
Final Host
Host adult
Diagnostic stage
Infective stage

A

Brancoftian’s filaria worm malayans filaria worm
Aepheles, aedes, culex Mansonia Bonneae, M. Uniformis
Lower lympathic Upper lympathic
Microfilaria Microfilaria
L3 filariform L3 filariform

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7
Q

Give me the characteristics of Wuchereria Brancofti microfilaria

A

HBNT
Head (1:1)
Body (curve)
nuclei (does not have)
Tail tapper
Pale pink

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8
Q

Characteristics of Brugia

A

Head (2:2)
Body (kinky)
Nuclei (scattered)
Tail tappers

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9
Q

Wuchereria B. Brugia Malayi

Cephalic space
Sheath affinity to Giemsa
Body nuclei
Terminal nuclei
Appearance
Pathology

A

1:1 2:1
unstained stained pink
regulary shaped Overlapping /irregular shaped
none two nuclei
graceful curve kinky/stiff
Brancoftian filariasis Malayan filariasis

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10
Q

Pathogenesis

Infection usually acquired _______________
Take years to manifest

Adult worms in the lymph nodes cause inflammation that obstructs lymphatic vessels ____________

Microfilariae DO NOT cause symptoms EXCEPT for __________

A

childhood
LYMPHEDEMA

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11
Q

Lymphatic Localization:

Adult worm causes ________________ (parasite-induced lymphatic dilatation)

___________ parasite induced endothelial cell proliferation and differentiation leading collateralization to

A

lymphangiectasis
Lymphangiogenesis:

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12
Q

___________
Common among those who grew up outside endemic regions
Characterized by clinical and immunologic hyper-responsiveness to the mature worms

1.
2.
3.
4.
5.

A

“Expatriate syndrome”

Hives, rashes and blood eosinophilia PLUS lymphangitis and lymphadenitis

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13
Q

Clinical Spectrum of Lymphatic Filariasis

1.
2.
3.
4.
5.
6.

A

Pathogenesis
Clinical Spectrum of Lymphatic Filariasis
1. Asymptomatic Microfilaremia
2. Acute Dermatolymphangioadenitis
3. Acute Filarial Lymphangitis
4. Lymphedema and Elephantiasis
5. Genitourinary Lesion such as hydrocoele
6. Tropical Pulmonary Eosinophilia

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14
Q

Asymptomatic Microfilaremia
_____________
Individuals with thousands to millions motile microfilariae in peripheral blood smear but no symptoms (but may have hidden lymphatic and kidney damage)

Main reservoir for infection
Worm has suppressive immunoregulatory mechanism
Inhibition of CD4 T cells was seen in Brugia infection

A

Endemic normals

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15
Q

____________________________________
Most common acute manifestation of filariasis
1.
2.
3.
4.
5.

Recurrent and lasts ________ days
_______ incidence reports per patients

A

Acute Dermatolymphangioadenitis (ADLA)
Localized pain, lymphadenitis, lymphangitis, cellulitis, local warmth
1-16 days
1.5-7 incidence reports

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16
Q

____________________
Same lesion as cellulitis which is caused by Group A ____________
Current evidence revealed that ________is bacterial in origin

A

Acute Dermatolymphangioadenitis (ADLA)
Streptococcus pyogenes

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17
Q

________________________
Directly caused by adult worms that died spontaneously following treatment or (evidence macrofilaricidal efficacy)
Characterized by lymphangitis that progresses distally along the vessel producing a __________cord
Self-limited

A

Acute Filarial Lymphangitis (AFL)
“palpable”

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18
Q

Characteristic Feature: ________ and _________ in and around the lymphatic walls
Dead calcified adult worms: ________, _______
_______________ most common manifestation of chronic lymphatic filariasis

A

Lymphedema and Elephantiasis
fibrosis and cellular hyperplasia
elicit immune response
→ lymphatic blockage
Lymphedema
→ Elephantiasis

Lymphedema

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19
Q

_____________
Results in the obstruction of lymphatics of __________
Clear or straw colored hydrocele fluid accumulate in closed sac of testis
Wuchereria bancrofti&raquo_space;> Brugia malayi

A

Hydrocoele
Tunica vaginalis

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20
Q

_____________
* Caused by rupture of lymphatics in the kidney and manifesting as __________
Blockage into the ___________ nodes divert lymph into renal lymph nodes causing them to rupture

A

Chyluria
milky urine
retroperitoneal lymph

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21
Q
  • A bacterium that infects the filarial worms can also contribute to the chronicity of the filariasis
  • Once released from the dead worm, it can induce inflammation
A

Wolbachia

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22
Q

Microfilaria not found in blood but may be found in tissues such as lungs and tissues
Caused by immunologic hyperresponsiveness to filarial infection (allergic reaction)
Paroxysmal nocturnal cough and eosinophilia
Misdiagnosed as bronchial asthma or TB

A

Tropical Pulmonary Eosinophilia

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23
Q

Thick Blood Smear

Specimen collection best done at night
____________
__________periodicity of the parasite

____________________
Stimulates microfilariae into coming out to the peripheral circulation allowing daytime collection of blood smear

A

8pm to 4am
Nocturnal
Diethylcarbamazine Provocative Test

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24
Q

________________
-Preferred method
-Easier to do
-Can be used to diagnose a case with no microfilaria present in the blood
_________________
If low intensity infection

A

Circulating Filarial Antigens (CFA) Detection
Knott Concentration Method

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25
Q

_____________
Collect 1 mL of blood + 10mL formalin. Shake. (Formalin lyses RBC)
Centrifuge. (If no centrifuge, allow the tube to stand in upright position for 12 hours)
Decant the supernatant fluid.
Examine a drop of sediment on slide and cover slip.
A portion of sediment may be spread on a slide as thick smear and stain with Giemsa

A

Knott Concentration Method (KCM)

26
Q

Treatment

__________): drug of choice
Effective against adult and microfilaria
Given for _____ days
Also good for _______
Adverse events: ____________
Due to the destruction of the adult worm and release of Wolbachia

A

Diethylcarbamazine (DEC
12 days
TPE
fever, myalgia, headache, cough lasting 24-48 hours; self-limited symptomatic treatment

27
Q

Treatment
___________: not effective against adult worms and TPE
Has same adverse effects as DEC but are milder
Must be given for one year

A

Ivermectin

28
Q

Treatment

___________ has added benefit of clearing intestinal helminths
Must be given 6 to 12 months
__________ anti-Wolbachia (bacteria inside filaria that is essential for growth, development, embryogenesis, and survival of filaria) May be given before the DEC

A

Albendazole
Doxycycline:

29
Q

Treatment

Pain reliever
Antibiotics for secondary bacterial infection
Proper foot care program
Washing the foot 2 x a day especially the skin folds
Tap dry the affected limb
Raising limbs at night to reduce swelling
Surgery for hydrocoele

A

PAPS

30
Q

Prevention and Control

Interrupt transmission of parasite via _________
Annual Diethylcarbamazine (DEC) plus Albendazole or Ivermectin in endemic area

Personal Protective Measure against mosquito

A

preventive chemotherapy

31
Q

Loa loa
* Infective stage: ___________
Diagnostic stage: ___________
* Mode of transmission: __________
* Habitat in humans: _____________

A

Loa loa
* Infective stage: Third stage larva
Diagnostic stage: Microfilaria in spinal fluid, urine, CSF, blood (sheathed)
* Mode of transmission: bite of infected Chrysops fly
* Habitat in humans: Adults are in subcutaneous tissue

32
Q

LL
Means ___________
Found in _____________
Vector: __________

A

Loa loa
worm worm
West Africa and Ethiopia African Eye Worm
Chrysops fly (Deer fly, Horse fly, Mango fly) DHM

33
Q

__________
* a transient subcutaneous swelling marking the migratory course through the tissues of the adult filarial eye worm of the genus Loa

  • The most common display of infection is the localized allergic inflammations called ______________ that signify the migration of the adult worm in the tissues away from the injection site by the vector.
A

Calabar Swelling

34
Q

_________
visible movement of the adult worm across the surface of the eye; cause _________, _______, ________

A

eye worm
congestion,
itching, pain,
and light sensitivity but little damage

35
Q

Diagnosis
Diurnal Periodicity of Loa loa microfilaria
Daytime __________: Peripheral blood
Identification of adult worm in the eye
Antibody test for Loa loa

A

(10am to 2PM)

36
Q

Characteristics of loa loa

A

Sheath stains lightly or not at all
The nuceli in the body are coarse and crowded
The body has irregular curves and can take on a corkscrew appearance
Nuclei extend to tip of tail

37
Q

Treatment
_____________
Effective against microfilariae and adult worms
__________
May be given if DEC is not effective after repeated treatment
____________ of adult worm

A

Diethylcarbamazine (DEC)
Albendazole
Surgical removal

38
Q

Prevention

A

May take weekly Diethylcarbamazine if visiting endemic area
Use insect repellant
Use clothing that covers most of the skin

39
Q

Onchocerca volvulus
* Infective stage: ____________
Diagnostic stage: ____________
* Modes of transmission: ______________
* Habitat in humans: _____________________

A

Onchocerca volvulus
* Infective stage: third stage larva
Diagnostic stage: (1) Microfilaria in subcutaneous tissue (2) Adult in subcutaneous nodules
* Modes of transmission: bite of Simulium (black fly)
* Habitat in humans: Adults are found in subcutaneous nodules

40
Q

Characterized by cutaneous and ocular pathology that occurs after the invasion and death of microfilariae in the skin and eye while adult worms are enclosed in nodules (onchocercomas) in the subcutaneous and deeper tissues.

A

Onchocerciasis

41
Q

Pathogenesis
_______is an eye and skin disease.
Symptoms are caused by the ___________-, which move around the human body in the subcutaneous tissue and induce intense inflammatory responses when they die.
* The presence of microfilariae in the eye and indeed in the skin usually does not cause much problem. On the other hand, dead or dying microfilariae trigger an inflammatory cascade that leads to tissue damage associated with the disease.
* Wolbachia species have been found to be endosymbionts of O. volvulus adults and microfilariae, and are thought to be the driving force behind most of O. volvulus morbidity.

A

Onchocerciasis
microfilariae

42
Q

Pathogenesis
* Onchocerciasis is an eye and skin disease.
__________ most serious manifestation
* Simulium sp. black flies, intermediate hosts that require fast-flowing water for their breeding and development
the disease is thus restricted to areas adjacent to river systems.

A

River blindness:

43
Q

Pathogenesis
____________The large adult female worms are contained within fibrous nodules or onchocercomas in subcutaneous or deeper tissues.
The smaller adult males appear to circulate from nodule to nodule to inseminate the females

A

Onchocercoma

44
Q

Pathogenesis
____________ due to allergic reaction - towards the migrating microfilariae

  • The more common generalized form presents with subclinical or intermittent dermatitis that may progress to skin hyperpigmentation or depigmentation (lizard skin) and atrophy with loss of elasticity (hanging groin)
A

Pruritus, dermatitis

45
Q

-
Biopsy of Skin Nodules: Adult worm with Wolbachia

A
  • Wet Mount
  • Stained with Giemsa or Hematoxylin
46
Q

Sheathed, no nuclei in the tip of the tail

A
  1. Wuchereria Brancrofti
47
Q

Sheathed, 2 distinct nuclei in the tip of the tail

A

Brugia malayi

48
Q

Sheathed, nuclei extending to the tip of the tail

A

Loa loa

49
Q

Unsheathed, no nuclei in the tip of the tail

A

Onchocerca volvulus

50
Q

Treatment and Prevention
___________ kills larvae but not the adult
Thus should be given every 6 months for the life span of the adults (10-15 years)
______________ kills Wolbachia
Old drugs but no more recommended:
________________ Kills adult accelerrates river blindness

A

Ivermectin
Dioxcycline
Diethylcarbamedazine

51
Q

Prevention of loa loa

A

Prevention
Insect repellant
Wearing clothes covering skin

52
Q

Dracunculus medinensis

Infective stage:
Diagnostic stage:
Mode of transmission:
Habitat in humans:

A

third stage larva
female worm and rhabditiform larva
drinking water with infecting copepods
maturation takes place in abdominal cavity

52
Q

Dracunculus medinensis

Infective stage:
Diagnostic stage:
Mode of transmission:
Habitat in humans:

A

third stage larva
female worm and rhabditiform larva
drinking water with infecting copepods
maturation takes place in abdominal cavity

53
Q

fiery serpent
little dragon from medina
guinea worm

A

dracunculus medinensis

54
Q

The ________ dies in the host tissue, while the ________ migrates to the host’s subcutaneous tissue.
The ________ causes the formation of a blister on the skin’s surface, generally on the lower extremities, though occasionally on the hand or scrotum.
When the blister ruptures, the female slowly emerges over the course of several days or weeks

A

Dracunculus medinensis
male
female
female

55
Q

______________
_____________: as it emerges to the subcutaneous tissue, it release toxic chemical
________
If fails to reach the skin →
Gets calcified in the joint _________
Reaches CNS→ ___________
Abscess and swelling when worms rupture
Secondary bacterial infection on blisters or ulcers

A

Dracunculus medinensis
Female adult worm
rash at site, diarrhea, localized edema, reddish papule, blister, and itching
arthritis
paraplegia

56
Q

Diagnosis
Recovery of adult worm from the blister
Fluid discharged by the worm: ______

A

L1 larvae

57
Q

Treatment
Manual Removal of Adult Female Worm

A

Submerging the affected body part in water to help coax the worm out.
TREATMENT
The site is then cleaned thoroughly.
Then, slight pressure is applied to the worm
as it is slowly pulled out of the wound.
To avoid breaking the worm, pulling should stop when resistance is met.
Full extraction of the female guinea worm usually takes several days.

58
Q

Maximum length of dracunculus medinensis

A

31 inches (800 mm)

59
Q

Treatment
Antihistamine
___________: for severe allergic manifestations
Anti-helminthic Agents:
-
-
-

A

Epinephrine
Thiabendazole, metronidazole, and mebendazole

60
Q

prevention of dracunculus medinensis

A

CVSP

Prevention
Case Containment
Safe drinking practices
Vector Control
Patient education

PARASITOLOGY LEC (11 decks)

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