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Trop Med > Cestodes > Flashcards

Cestodes Flashcards

1
Q

What causes hydatid disease?

A

Larval stage of Echinococcus Granulises

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2
Q

What is the species?

A

Echinococcus Granulises - note thick neck (differentiates it from T.Solium), double row hooks

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3
Q

What species is this?

A

Dibothriocephalus latus

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4
Q

What steroid sparing agents can be used for long course steroids in subarachnoid neurocysticercosis?

A

MTX or TNF inhibitors

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5
Q

What is this and what does it cause?

A

Calcified lesions of NCC. Taenia Solium. Can still cause seizures.

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6
Q

What causes symptoms in neurocysticercosis?

A

Parenchymal inflammation
Calcified cysticeri - causes inflammation and scarring
Ventricular cysticerci - causes hydrocephalus
Subarachnoid cysticerci - arachnoiditis

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7
Q

What is this?

A

Larval stage of T.Solium

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8
Q

Name the species and the structures

A
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9
Q

Life cycle of T.Solium?

A

Pigs ingest eggs
Oncospheres hatch and penetrate intestine -> muscle
Cystercirci develop

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10
Q

What species is this?

A

Dibothricephalus latus adult

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11
Q

What is the Rx for Taeniasis (either species)?

A

Praziquantel

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12
Q

Name the species

A

H.Diminunata - thick head, no hooks

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13
Q

What is this?

A

Echinococcus Granulosus sensu lato

Hooks - double crown of hooks- and 4 suckers
Only 3-4 proglottids

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14
Q

What species is this?

A

Dibothricephalus latus adult

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15
Q

What species is this?

A

Taenia species (cannot tell them apart)

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16
Q

What are the names of the stages of dibothrocephalus latus species?

A

coracidium (larval stage 1) -> procercoid (larval stage 2) -> plerocercoid (advanced larval stage)

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17
Q

What are the treatment options for hydatid disease in liver?

A

CE1 - simple cyst. <5cm albendazole, 5-10cm PAIR and ABZ, >10cm surgery
CE2 - MOCAT or Surgery +/- albendazole
CE3a - <5cm albendazole, 5-10cm PAIR, >10cm surgery
CE3b - MOCAT or Surgery +/- albendazole
CE4 and CE5 - dead cysts, watch and wait

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18
Q

Rx of subarachnoid neurocysticercosis?

A

LONG course of anti parasitic drugs (ABZ or both, data emerging on combo therapy)
Steroids key, or alternative
If compression of ventricle - shunt/surgery
Can cause strokes

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19
Q

How do humans become infected with taenia solium/taenia saginata?

A

Eating uncooked pigs/beef, ingest oncospheres from tissue (larval form)

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20
Q

What are the hosts in hymenolepis nana?

A

Intermediate: insects
Humans/rodents ingest arthropods containing cystercircoid - embryonated eggs (infective stage)
Definitive: Humans, rodents

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21
Q

How does echinococcosis present?

A

asymptomatic for years before the cysts grow large enough to cause symptoms in the affected organs.

  • Lung - pressure effect
  • Liver - pressure effect
  • Rupture of cyst: fever, urticaria, eosinophilia, and potentially anaphylactic shock

RARELY
spleen, kidneys, heart, bone, and central nervous system, including the brain and eyes

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22
Q

What species is this?

A

Taenia Saginata (>12 uterine branches)

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23
Q

What are the intermediate and definitive hosts of dibothricephalus latus?

A

Intermediate: 1. Crustaceans 2.Fish
Definitive: Mammals (including humans)

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24
Q

NCC you think that all the cysts intraparenchymally are calcified, what to do?

A

Do MRI to ensure all cysts are calcified to guide further management

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25
Q

What species is this?

A

Taenia species (striated outer layer and embryo has hooks)

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26
Q

Which is the only tapeworm not to have 4 suckers?

A

Dibothriocephalus latus

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27
Q

Treatment of choice for H.Diminuta?

A

Praziquantel

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28
Q

What species is this?

A

Dibothriocephalus latus

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29
Q

What is this?

A

H.Diminuta

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30
Q

How do you manage calcified lesions in NCC?

A

AEDs

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31
Q

Subarachnoid cysts in base of the brain ∆ of NCC. What key clinical concern?

A

Cause vasculitis of blood vessels - therefore cause stroke.
Can also grow very big, cause mass effect, may cause compression on ventricles causing hydrocephalus.
Rx with ABZ (maybe with PZQ - studies are being done- and long course)

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32
Q

Other symptoms of NC apart from seizures?

A

Headaches, blurred vision

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33
Q

Name the species

A

H.Nana head - single row hooks, low rostellum

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34
Q

What is cysticercosis?

A

Disseminated larval stage of taenia solium from ingestion of eggs

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35
Q

Which cestode does not have 4 suckers?

A

Dibothriocephalus latus

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36
Q

Neuroimaging criteria for neurocysticercosis

A

Major: Cystic, enhancing, or calcified lesions suggestive of NCC
Minor: Obstructive hydrocephalus, Meningeal enhancement
Confirmatory: resolution

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37
Q

What does cysts in the subarachnoid space of the spine cause?

A

Radiculitis, paraparesis

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38
Q

What is the intermediate host for Echinococcus granulises?

A

Intermediate: sheep
Definitive: Dog
Accidental: humans

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39
Q

Definitive treatment of the T.Solium parasite?

A

PZQ plus ABZ (if >1 lesion)
PLUS STEROIDS (death of parasite causes increased inflammation and seizures)

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40
Q

How do humans contract T.Solium?

A

Ingestion of T.Solium eggs (Causes cysticercosis)
Ingestion of larvae would cause Taeniasis (the tapeworm)

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41
Q

Which cestodes are intestinal? Which are tissue?

A

All intestinal except echinococcus (tissue) and T.Solium which is tissue and intestinal

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42
Q

What is this?

A

H.Nana (polar filaments, granular space between shells)

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43
Q

What is the dwarf tapeworm?

A

Hymenolepis species

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44
Q

Name the species

A

Echinococcus

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45
Q

Which of the cestodes are tissue cestodes?

A

T.Solium (tissue and intestinal)
Echinococcus (tissue)

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46
Q

What investigations can you do for echinococcus?

A

Imaging: CXR/CT/US
Serology – Western Blot

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47
Q

Name the species

A

Cysticercis (larva), Taenia solium

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48
Q

What does a single enhancing lesion of neurocysticercosis usually cause?

A

Benign prognosis

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49
Q

What are the main cestodes causing human disease?

A

Tapeworms

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50
Q

Small CE2 small cyst, an option instead of PAIR?

A

MOCAT - modified catheterisation technique if small
Same for CE3b
PAIR contraindicated for these, and medical therapy doesn’t work

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51
Q

Why does hymenolepis not cause human disease?

A

Larval stage instantly becomes scolex (hence why doesn’t cause human disease)

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52
Q

Treatment of choice for hymenolepis nana?

A

Praziquantel

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53
Q

What is the intermediate host for hymenolepis nana and diminuta?

A

Arthropods - fleas, beetles

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54
Q

How Is hymenolepis diminuta transmitted?

A

Cystercirci of hymenolepis diminuta ingested from arthropod

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55
Q

Name the species

A

Taenia Saginata adult

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56
Q

> 100 cysts in neurocysticercosis?

A

Consensus management - no agreement but probably steroids and antiparasitics

57
Q

Key principle of treating neurocysticercosis?

A

Manage the symptoms/effect of the disease is key
Antiepileptics
Hydrocephalus shunting

58
Q

What is the name for the rat tapeworm?

A

Hymenolepis Diminuta

59
Q

Which stage of the life cycle must humans ingest to get echinococcosis?

A

ingesting eggs

60
Q

Criteria for diagnosis of neurocysticercosis?

A

Complex!
One absolute

61
Q

What is the Rx of echinococcus?

A

CE1 and CE3a - <5cm Albendazole, 5-10cm PAIR, >10cm Surgery (albendazole after)

CE2 and CE3b <5cm albendazole, >5cm surgery (albendazole after)

CE4 and CE5 - watch and wait

62
Q

Characteristic features of dibothriocephalus latus?

A

Fish tapeworm
Proglottids are wide, long tapeworm
B12 deficiency key presenting feature

63
Q

Multiple intraperitoneal cysts of hydatid disease. Rx?

A

Surgery to remove as many cysts as possible and then albendazole

64
Q

Treatment of neurocysticercosis?

A

Anti epileptics
Steroids
Praziquantel and albendazole (if <3 lesion, just ABZ ok if 1-2 lesion)

65
Q

Name the species

A

Hymenolepis diminunata

66
Q

Prevention of neurocysticercosis?

A

Mass chemotherapy of humans and pigs

67
Q

Single lesion parasite Rx?

A

Albendazole only (do not need combination therapy)

68
Q

Treatment of dibothriocephalus latus?

A

Single dose praziquantel

69
Q

Name the species

A

Proglottid, adult taenia solium (<12 uterine branches)

70
Q

Which of the tapeworms can cause auto infection?

A

Hymenolepis nana

71
Q

NCC causing aggressive encephalitis. Mx?

A

Symptomatic - AEDS
Steroids and mannitol
When inflammation resolved, can decide re: antiparasitics.

72
Q

How does hymenolepsis present?

A

*Headache, weakness, dizziness, weight loss
* Epigastric or diffuse abdominal pain, nausea,
loose bowel movements or diarrhoea
* Anal pruritus, urticaria
* Sleep and behavioural disturbances

73
Q

How do you know when to stop antiparasitics in subarachnoid NCC?

A

CSF antigen test and WCC

74
Q

Which of the cestodes does not have a genital pore laterally?

A

Diphyllobothriasis

75
Q

Treatment of T.Saginata?

A

Single dose praziquantel

76
Q

Species in Asia similar to Taenia saginata?

A

T.Asiatica (pigs are host though)

77
Q

Diagnosis of neurocysticercosis made how?

A

Neuroimaging
Hisotpathology (definitive)
Serology

78
Q

Classic clinical hx of neurocysticercosis?

A

Young person aged 10-40
Seizures new onset
Single enhancing lesion on CT head - in India and US
Multiple lesions in Latin America

79
Q

What is the definition of incidental host, intermediate host, definitive host, accidental host, paratenic host?

A
  • Intermediate host: the parasite reproduces asexually and harbours the larval stage
  • Incidental host: A host that becomes infected, but is not required for the maintenance of the population of a pathogen
  • Paratenic host:?
  • dead end host: parasite lives but cannot continue its life cycle
  • Definitive: the parasite reproduces sexually or harbours the adult stage
80
Q

What is the orgnaism and diagnosis?

A

Neurocysticercosis
T.Solium

81
Q

What species is this?

A

Taenia Solium (<12 uterine branches)

82
Q

Name the species

A

Echinococcus granulises - similar to taenia but no hooked embryo

83
Q

How can you diagnose tapeworms?

A

Eggs in faeces
Adult in intestine
Larvae in tissue causing disease (depending on type)

84
Q

Difference between CE2 and CE3b?

A

CE2 more complex septated cysts but no solid component
CE3b - solid component with multiple daughter cysts

85
Q

What is this?

A

H.Nana
Hooks and thick neck
Single row hooks

86
Q

symptoms of Dibothriocephalus latus?

A

IBS like syndrome
Abdominal pain, colicky, loose stools

87
Q

Contraindication for anti parasitic meds in neurocysticercosis?

A

Raised ICP (inflammation following death of parasite will raise ICP further)

88
Q

What is a paratenic host?

A

A host not needed in the life cycle, but act as reservoirs in which different larval stages of the parasite can persist but not develop further

89
Q

Which species of Echinococcus is found in Northern hemisphere more?

A

E. multilocularis

central and northern Europe, Central Asia, northern Russia, northern Japan, north-central United States, northwestern Alaska, and northwestern Canada.

90
Q

Name the species

A

Echinococcus Granulises

91
Q

Which species is this?

A

dibothriocephalus latus

92
Q

How do you diagnose dibothriocephalus latus?

A

Ova or tapeworm segments in stool

93
Q

What is the Rx of choice for ocular neurocysticercosis?

A

Surgical removal - Rx will cause inflammation (which causes blindness)

94
Q

How do you contract Taenia saginata?

A

Ingestion of uncooked beef

95
Q

Treatment of single enhancing lesion in neurocysticercosis?

A

Single therapy with albendazole
Steroids and Prazi

96
Q

Which hydatid cysts can be rx with PAIR?

A

Liver cysts only

97
Q

What must you do during PAIR for hydatid disease?

A

Test for bilirubin (before inject the alcohol) as would cause biliary sclerosis

98
Q

What should you test for before starting Rx for neurocysticercosis?

A

Screen for TB and strongyloides

99
Q

Name the species

A

Hymenolepis Nana

100
Q

What is the organism for fish tapeworm?

A

dibothriocephalus latus

101
Q

What is water Lilly sign? How would you manage?

A

Echinococcus - hydatid disease
Specifically in keeping with ruptured cyst
ABZ and PZQ
May also need surgery

102
Q

What should you do if a hydatid cyst ruptures?

A

Give ABZ and PZQ (prevent seeding) for a few months

103
Q

Which group of patients usually present with lung hydatid disease?

A

Paediatric population

104
Q

Splenic cyst of hydatid disease?

A

Surgical removal unless very small, and consider medical Rx or PAIR

105
Q

What is this?

A

Echinococcus Granulosus sensu lato

106
Q

What is the pork tapeworm?

A

Taenia solium

107
Q

What is the infective stage of Taenia solium?

A

Cysticercis - ingestion of larva from autoinfection

108
Q

Which species of adult tapeworm is this?

A

Taenia Solium
2 rows of hooks

109
Q

Name the species

A

Taenia solium - 2 rows of hooks on rostellum. 4 suckers

110
Q

Diagnostic stage of taenia solium?

A

Proglottids and eggs in faeces

111
Q

How do humans get infected with hymenolepis nana?

A

Ingest the cysticercoid infected arthropods or eggs (either)

112
Q

What causes of neurocysticercosis?

A

Larval stage of T.Solium
Host response - parenchymal inflammation

113
Q

What are the absolute criteria for neurocysticercosis

A

Biopsy of brain or spinal cord histology confirmation
Subretinal cysticercus
Scolex with cystic lesion on neuroimaging

If non of this need neuroimaging criteria

114
Q

What is a cestode/nematode/trematode?

A

Tapeworm/round worm/fluke

115
Q

What is this?

A

H.Diminuta

116
Q

Which species of adult tapeworm is this?

A

Taenia Saginata
No hooks
Thin neck

117
Q

Hydatid cysts in spine, brain and heart, abdominal cavity, bronchi, urinary tract?

A

Surgery

118
Q

Name some anatomical features of cestodes?

A

No GI tract, flat in shape, proglottids and scolex.

119
Q

What is this?

A

H.Diminuta

120
Q

Management of intraventricular neurocysticercosis?

A

Endoscopic removal used for cysticerci in the 3rd and lateral ventricles

121
Q

What is the beef tapeworm?

A

Taenia saginata

122
Q

Name the species.

A

Taenia Saginata

123
Q

WHO Grading of Echinococcus?

A

Water lily sign - CE3a

124
Q

Neurocysticercosis with ring enhancement around cysts but not calcification, how would you manage?

A

Steroids and ABZ/PQL - even though the ring enhancement means that immune system -> inflammation and likely to calcify, this process is faster with antiparasitics

125
Q

Exposure and clinical criteria for neurocysticercosis

A

Specific antibody or antigen-detected

Cysticercosis outside of the CNS (biopsy, calcified lesions on xray)

Household contact with T solium infection

Seizures or obstructive hydrocephalus

Prior residence in an endemic village

126
Q

What do you need to do on long term albendazole?

A

Monitor transaminases and WCC

127
Q

What is this and what does it cause?

A

Calcified lesions of neurocysticercosis
Chronic epilepsy

128
Q

Hydatid cyst with detached membranes in lung. How would you manage?

A

Remove it surgically as risk of infection very high

129
Q

What is the definitive hosts for dibotriocephalus latus?

A

Humans
Fish eating mammals
Birds

Fish - paratenic host

130
Q

Subarachnoid neurocysticercosis causes?

A

Meningits, stroke

131
Q

How do you know when to stop Rx for NCC in subarachnoid space which needs long term Rx?

A

Antigen testing and PCR

132
Q

What is the species for the dwarf tape worm?

A

Hymenolepis Nana

133
Q

What species is this?

A

Dibothriocephalus latus

134
Q

New onset seizures in the tropics?

A

Neurocysticercosis (30% due to this!!!)

135
Q

What is the transmission of dibothriocephalus latus?

A

Fish tapeworm

Ingestion of uncooked fish

136
Q

What is the definitive/intermediate host of echinococcus? What is the organism?

A

echinococcus granulosus
Intermediate: sheep
Definitive: Dog

137
Q

Most common human Cestode?

A

H.Nana

138
Q

Which of the cestodes cause auto infection?

A

H.Nana
T.Solium

139
Q

Tribolium fly - intermediate host for?

A

H.Diminuta

Trop Med (49 decks)

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