Clinical manifest = latin Flashcards
- Mild flu-like illness (non specific)
- Malaria like presentation in severe cases (fever, child, malaise)
- More severe in immunocompromised
- May have positive serology
- Travel history to New England
Babesia microti in US or
Babesia divergens in Europe
- Most asymptomatic
- some have mono-like symptoms with lymphadenopathy
- Congenital disease can cause spontaneous early abortion, overwhelming neonatal infection, mental retardation, microencephaly, seizures
- Choriretinitis
Toxoplasmosis Gondii
Visceral:
- systemic fever, weight loss
- death due to secondary bacterial/viral infection
- opportunistic infection in immunosuppressed
Cutaneous (military):
- chronic skin lesions
- heal down the road with scarring
- volcano phase with raised edges
Mucosal:
- metastic ulcerative mucosal lesions in mouth or airway
Leishmaniasis species
Acute phase (children): - fever, local swelling, periorbital edema (Romana sign), myocarditis, adenopathy
Chronic phase (months to years late in 10-30%)
- Cardiomyopath with CHF, irregular HR
- Megaesophagus/megacolon - flaccid, dilated, won’t contract normally
Immunosuppression may reactivate
History of exposure
Trypanosoma cruzi
SLOW progression ● Fever, lymphadenopathy (post—Winterbottom’s sign) ● Headache, lethargy ● Behavioral change later ● Sleep progressing to coma
Trypanosoma brucei
- trypanosoma gambiense
- trypanosoma rhodesiense
▪ Frequently asymptomatic (low load)
▪ GI symptoms (abd pain, nausea, ulcer like sxs or diarrhea +/- malabsorption)
▪ Respiratory sxs: pulmonary migration may cause Loeffler’s syndrome
▪ Skin rashes of buttocks, waits
▪ Disseminated hyperinfection
● Autoinfection → may be fatal
● Need to check history before any immunosuppressive therapy. Worms can live in the host more than 40 years!
Strongyloides stercoralis
▪ Mostly asymptomatic ▪ Heavy infection → GI symptoms ● Diarrhea, abdominal pain ● Rectal prolapse ● Anemia ● Maybe growth retardation History as migrant worker, int'l travel, rural southeast, travel to tropics
Trichuris trichuria
▪ Low inoculum—asymptomatic
▪ Higher inoculum—major sx and dz
● Iron deficiency anemia—blood loss at attachment site
● Chronic protein malnutrition—compete for nutrients
▪ Skin symptoms early on (intense itching, erythema, popular vesicular rash at site of penetration)
▪ Loeffler’s syndrome with infiltrates, increased eosinophilia—larvae migrated to lungs
Ancylostoma duidende- old,
Necator americanus - new
Light infection:
● Tend to be asymptomatic, discovered when patient passes a worm.
Heavy infection:
● Malnutrition, impaired physical/cognitive function
● Biliary obstruction if worms migrate there
● Lower intestinal obstruction d/t mass effect
o Appendicitis
o Large bowel obstruction
o Pancreatitis
● Lung symptoms—cough, hemoptysis, lung infiltrates transiently on xray, increased eosinophils (Loeffler’s Syndrome/PIE). Asthma like symptoms—worms can be coughed up.
Ascaris lumbricoides
▪ Generally asymptomatic
▪ Mild pruritis ani—perirectal itching/irritation that may affect sleep. Scratching leads to spread.
▪ Occasional vaginitis or fallopian infection/inflammation
▪ Easily spread to family members
Enterobius vermicularis
Nematode
▪ Dermatitis “swimmers itch”
● Penetrating cercariae→papular pruritic rash (minor)
▪ Acute schistosomiasis (Katayama fever)—large # worms
● Worms mature, deposit eggs
● Fever, cough, hepatosplenomegaly, lymphadenopathy (serum sickness) with immune complex formation against egg Ag’s
● Eosinophils in blood due to tissue invasion
● Generally resolves
▪ Chronic schistosomiasis—mature worms, heavy egg deposition
● Fatigue, abdominal pain, diarrhea, hepatomegaly, hematuria/hematemesis
● Liver/intestines/bladder—chronic inflammation with granuloma due to secondary reaction by tissues to eggs. Cause fibrosis/cirrhosis leading to portal hypertension or polyps/diarrhea if in the colon.
● Ascites
● Eggs can lodge in lungs, spinal cord etc
S. mansoni, S. japonicum, S. haematobium
Schistosomes [flatworm or fluke]
Hx: Scandinavia, Finland, Alaska, Siberia, Great Lakes, Japan, Chile, Lakes/Rivers▪
Mild bloating, diarrhea but most asymptomatic
▪ Megaloblastic anemia—vitamin B12 deficiency because worms compete for it
▪ Massive infection → intestinal obstruction or biliary obstruction in some instances
Diphyllobrothrium latum
Fish Tapeworm [cestode]
Hx: Central Asia, East Africa, Central/South American, Near East
▪ Majority asymptomatic
▪ Sometimes non-specific epigastric discomfort
▪ Proglottids may climb through anus
Taenia saginata
Beef Tapeworm [cestode]
Hx: Mexico, Central/South America, SE Asia, India, Philippines ▪ Intestinal infection → asymptomatic
▪ Cysticercosis→disseminated infection “Neurocysticercosis” → seizures, paresis, metal deterioration, meningitis. Think of this in patients with neuro sxs from endemic areas.
Taenia solium
Pork Tapeworm [cestode] - the BAD one
▪ Fever (most commonly), anemia, splenomegaly—all non-specific
- Travel hx: Africa, Sub-saharan Africa
▪ Unusual s/sx:
● —seizures, coma, renal failure and death
Emergency!
o Seizures, renal failure, ARDS, disseminated intravascular coagulation (DIC), severe anemia, hypoglycemia, hypotensive shock,
Plasmodium/ P. falciparum
