Cough from the Tropics Flashcards
Best test for parasites
CBC looking for eosinophilia
WBC will also be pretty high
IgE modestly elevated
Esosinophilia causes
Allergy and asthma
Vasculitis
Certain infections (fungi (coccy), parasites
Malginancy (lymphoid, Hodgkins)
Adrenal insufficiency
Cholesterol embolism sx
PIE syndromes
Pulmonary infiltrates and eosinophilia
Speific infection including parasites
Drug-induced lung dz but NOT HS pneumonitis***
TB support and against
Primary sx include cough, dyspnea, and WL…may or may not have hemoptysis
CAN be trnasmitted to others
Chronic
Radiographic variation
NO fever, wheezing, or eosinophilia
Histoplasmosis and coccidio and eosinophilia
NOT a fature unless adrenal involvement with hypoadenalism present
Yes, coccidio…most common fungal but exposure not expected in KY
Milirary patterns
Histo, blasto, TB
Do NOT just assume they have TB
Allergic asthma
Hodgkins
Churg-Strauss
Lower degree of esoinio…NO miliary pattern
Radiography shows thoracic adenopathy and NOT miliary pattern
Think sinus problems….Multisys vasculitis…will have extr-pulmonary dz…fever and weight loss common…most have asthma
TB
Ascaris
Paragonimus
Filariasis
Slowly progressive
Acquiring a GI parasite by fecal oral route that is benign and self-limited
Acquiring a pulm parasite by ingesting contaminated sushi that is chronic
Lymphatic pathogen by insect bite..large scrotum
Ascaris
Most 1 billion
Acquireed through ingestion of eggs
Migration of larvae through lungs may produce transient pulm sx…radiographic opacitis and eosinophilia (Loeffler’s)
Worms die and unless re-infected, pulm findings disappear
Hookworm similar except route is dermal penetratioon
Strongyloidea
Helminth through dermal penetration by larva
Can survive in chronic state of parasitism due to autoinfection…eosinophilia and a lifelong frined
COmpromised immunity can lead to hyperinfection where they migrate and can cause polymicrobial bacterial sepsis
Eosinophilia may be absent with steroids
Present throughout tropics, subtropics, and endemic to appalachia
Dx via ELISA
Echinococcosis
LIvestock and canines
Acquired via ingestion of eggs
Cysts that have mass effect (liver more than any other)
Contain multiple protoscolices
Cyst rupture can produce anaphylaxis and other acute manifestation (massive effusions or biliary obstruction)
Alveolar echinoccocis is often fatal if untreated
Paragonimiasis
Acquired via ingestion of raw or undercooked shellfish
Adults get cysts, producing pneumonic infiltrates, cavities, and pleural efusions
Hemoptysis - mimics TB
Differences is eosionophilia
Lymphatic filariasis
Most in INdia, Nigeria, Bangladesh and indonesia
Mosquito bite transmission
Adult worms in lymphatic vessels, large parasite burdens may produce obstruction and elephantiasis of geninal and lower extremities
Microfilariae migrate at night in blood stream to coincide with peak mosquito feeding
NOT pitting edema, but “doughy”
TPE
Think south asians
HS response ot migrating microfilariae due to Wuchereria bancroft and brugai malagy
.5% of infected pts
Sx begin as wheezing, cough and dyspnea worse at night (like asthma)
Fever, malaise and WL uncommon
Profound blood eosionphilia
Reticulonodular or miliary opactics in mid and lower lung zones
May lead to pulm HTN with granulomatous vasculitis becoming fribortic (and fatal) if untreated)
TPE dx and tx
Eosinophilia above 3,000 cells?mm^3
Appropriate exposure (mos in endmic area)
High anti-filarial ABs
Paradoxial lack of microfilariae in blood (cleared quick)
Response to tx
Diethylcarbamazine for 21 days
