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GORGAS > Cestodes > Flashcards

Cestodes Flashcards

1
Q

Hymenopolis Nana clinical presentation?

A

Epigastric, diffuse abdominal pain
Anal pruritus and urticaria
Eosinophilia
CHOLANGITIS

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2
Q

Diagnostic stage Hymenopolis Nana? Infective stage?

A

Dx:Eggs in stool
Ix: embryonated eggs

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3
Q

Different types of echinocous?

A

E. Granulosus- cystic HD
E Multilocularis- Alveolar HD
E Vogeli: Polycyclic hydatid disease

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4
Q

E Granulosus infective and diagnostic stage?

A

Infective: embryonated egg
Diagnostic: hydatic cyst

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5
Q

Where is hydatid disease normally in humans?

A

Predominantly in Liver then lungs

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6
Q

What are clinical manifestations of lung disease?

A

Thoracic pain, cough and haemoptysis. If it ruptures- get vomica, pleural and bronchial seeding

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7
Q

Classic sign on CXR of hydatid cysts?

A

Waterlily sign

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8
Q

How do you dx hydatid disease?

A

Imaging to see cysts and then Serology; ELISA, EITB

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9
Q

What are indications for surgery in echinnocous?

A

Large cysts (>10cm)
Superficial, likely to rupture
Infected cysts
Mass effect

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10
Q

What medical tx for hydatid cyst?

A

Albendazole continuous for 6 months
Check WBC and monitor trandaminases every 2 weeks for first 3 months

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11
Q

When do you use albendazole?

A

Inoperable
Peritoneal disease
Cysts in >2 organs

Use 1 week before and 3 months after surgery

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12
Q

When do you use PAIR?

A

CE1 ans CE3A liver cysts
NOT pulmonary

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13
Q

What stages do you watch and wait for liver hydatid cysts?

A

CE4 and CE5

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14
Q

What are the stages of liver cysts?

A

CE1- unilocular, unechoic
<5cm= Albendazole
>5cm= Albendazole + PAIR

CE2- multisepated honeycomb cyst
Tx albendazole and either modified catheterisation or surgery

CE3A- cyst with detached membrane (waterlily sign)
<5cm= Albendazole
>5cm= Albendazole + PAIR

CE3B- cysts with daughter cysts
Albendazole and surgery

CE4- cyst with heterogenous hyper/hypoechoic (no daughter cysts)
Watch and wait

CE5- solid and calcified
Watch and wait

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15
Q

How do you control hydatid disease?

A

Vaccinate dogs ans sheep
Give dogs praziquantel

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16
Q

What is alveolar hydatid disease?

A

Caused by proliferative larval stage of fox tapeworm- echinnocous multilpcularis. Foxes and dog are definitive hosts and rodents are intermediate.
Man gets infected accidently and the metacestode stage develops in the liver

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17
Q

Where is AHD found?

A

Predominatly in Northern hemisphere- Europe, Russia, China, Japan and North America

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18
Q

Site of AHD main pathology,m

A

Liver (99%)
Causes painful hepatomegaly

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19
Q

How do you treat AHD?

A

Albendazole long term + curative surgery

20
Q

What is polycyclic hydatid disease caused by?

A

Echinnocous Vogeli
Found in Central and northern South america

21
Q

What is pathology of polycystic hydatid?

A

Mainly in Liver
Multiple cystic masses
Painful hepatomegaly

22
Q

How do you tx polycystic hydatid?

A

Radical “curative” surgery
Perioperstive and long term albendazole

23
Q

What is dog tapeworm known as?

A

Dipylidium Caninum

24
Q

What are clinical features of Diplydoum Caninum?

A

Abdo pain, diarrhoea, irritability, eosinophilia
Proglotids pass out of anus and seen moving in stool

25
Q

Tx of Dipylidium Caninum?

A

Praziquantel
Niclosamide

26
Q

What is diphyllobothrid linked to (fish tapeworm)

A

Vitamin B12 deficiency

27
Q

How do you diagnose diphyllobothriasis?

A

Egg in stool
Tx with praziquantel single dose

28
Q

How do you get T Saginata?

A

Undercooked beef
You shed the eggs or proglottids in stool
Need single dose praziquantel

29
Q

What is Taena Asiatica?

A

Found in East Asia
Cyst is found in liver of pigs
Ingested Pork Liver (cysticeri in pigs)

30
Q

What is the global distribution of neurocysticercosis?

A

Anywhere with pigs
Endemic in Asia, Africa, Latin America

31
Q

How do you get Taenia Solium?

A

Humans eat cysticercus in pork meat and get T Solium
Or autoinfection of ingesting ova leads to cysticerosis

32
Q

What is pathogenesis of neurocysticercosis?

A

Viable cysts suppress host inflammatory response
Older cysts lose the ability to suppress this inflammation
Parenchyma inflammation leads to seizures

33
Q

What are the diff pathogenesis of neurocysticercosis?

A

-Parenchyma cysticerci; inflammation
-calcified cysticerci; inflammation
-Ventricular cysticerci; obstructive hydrocephalus
-SA cysticeri; arachnoiditi assoc with vasculitis/stroke

34
Q

What is the most common form of cysticerosis from India?

A

A single enhancing lesion
Need anti epileptics

35
Q

How do different forms of cysticercosis present?

A

SA: Chronic meningitis, stroke
Calcified: Chronic epilepsy
Ventricular: Obstructive hydrocephalus
Single enhancing: benign prognosis
Multiple cystic: recurrent seizures

36
Q

How does ocular cysticercosis prsent?

A

Retinal, intravitreala and anterior chamber
Tx is usually surgical removal

37
Q

What is the absolute criteria of neurocysticercosis?

A

Ocular cysticercosis
Seeing scolex within cystic lesion on neuroimaging
Histological demonstration of parasite from biopsy of brain or spinal cord lesion

38
Q

What is major vs minor vs confirmatory neuroimaging criteria?

A

Major: cystic, enhancing or calcified lesions of NCC
Minor: Obstructive hydrocephalus, meningeal enhancement
Confirmatory: resolution

39
Q

What is exposure critera?

A

Antibody or antigen detected
Cysticercosis outside of CNS
Household contact with T solium
Seizures or obstructive hydrocephalus
Prior residence in endemic village

40
Q

What is the enzyme linked imminotransfer blot or Western blot for cysticercosis?
Drawbacks?

A

Uses parasite glycoproteins and immunoblotting
Response to any 7 glycoproteins bands is considered positive
Sensitivity and specificity excellent, but Not in single or calcified lesions

41
Q

Tx of NCC?

A

Anti epileptics + Praziquantel + albendazole + steroids especially for multiple cystic lesions
Praziquantel inhibits the break down of albendazole so boosts its effect
Combo therapy therefore recommended

42
Q

How do you manage SA NCC?

A

Several months to over a year of albendazole
Prolonged course of anti-inflammatories
Methotrexate and Etanercept used to taper steroids
Follow up with MRI or Ag assays to see resolution

43
Q

How do you treat NCC in ventricles?

A

3rd and lateral ventricles– endoscopic removal
4th ventricles– Flexible scopes
Usually don’t need shunting afterwards

44
Q

What should you do before giving antiparastic drugs for NCC?

A

Eye exam

45
Q

How do you prevent cysticercosis?

A

mass chemotherapy of humans and pigs
Vaccinate pigs

46
Q

What is a contraindication to antiparasitics?

A

Untreated raised ICP

47
Q

Key points from lecture:

A

Ventricular NCC better outcomes if surgically removed, usually neuroendoscopy
SA NCC requires anti-inflammatories, intensive combo antiparasitics, Methotrexate and neuroendoscopy

GORGAS (33 decks)

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