DIT review - Micro 10 Flashcards
1
Q
Transmission and presentation of Naegleria fowleri
A
- Transmission:
- Swimming in freshwater lakes – associated with water sports
- Enters via cribriform plate
- Presentation:
- Rapidly fatal meningoencephalitiis
- Nuchal rigidity and fever + AMS
- Rapidly fatal meningoencephalitiis
2
Q
Diagnosis and treatment of Naegleria
A
- Diagnosis:
- Lumbar puncture – Amoebas in spinal fluid
- Treatment:
- Amphotericin B
3
Q
Transmission and presentation of Trypanosoma cruzii
A
- Transmission:
- Reduviid bug (“kissing big”) feces deposited in bite, then induced by scratching
- Predominantly in South America
- Presentation:
- Chagas disease:
- Dilated cardiomyopathy, megacolon, megaesophagus
- Chagas disease:
4
Q
Diagnosis and treatment of trypanosoma cruzii
A
- Diagnosis:
- Trypomastigote in blood smear
- Treatment:
- Nifurtimox (knee-high fur mocassins)
5
Q
Transmission and presentation of babesia
A
- Transmission:
- Ixodes tick
- Often coinfected with Lyme disease
- Predominantly in Northeast US
- Presentation:
- Fever, hemolytic anemia, jaundice
- Higher risk in sickle cell disease
6
Q
Diagnosis and treatment of babesia
A
- Diagnosis:
- Blood smear containing ring form or maltese cross
- Treatment:
- Atovaquone + Azithromycin
7
Q
Transmission and general presentation of malaria
A
- Transmission:
- Amopheles mosquito
- Presentation:
- Fever, headache, anemia, splenomegaly
- Symptoms occur when RBCs rupture and release merozoites
8
Q
- What are the 4 plasmodium species
- Describe fever cycles of each
- Which one has dormant form in liver
A
- Different species:
- P. Vivax/Ovale
- Fever cycle – 48 hours (tertian)
- Dormant form (hypnozoite) in liver
- P. malariae
- Fever cycle – 72 hour (quartan)
- P. falciparum
- Fever cycle – irregular fever pattern
- Parasitized RBCs occlude capillaries in brain (cerebral malaria), kidneys, lungs
- P. Vivax/Ovale
9
Q
Describe the life cycle of plasmodium
A
- Malaria is transmitted by Anopholese mosquito, which carry sporozoites in saliva
- Mosquitoes bite human host and mature to trophozoites in liver
- Schizont divides into merozoites which burst from hepatocytes and infect RBCs
- Once inside the RBC, lifecycle continues: trophozoite -> schizont -> merozoite -> infect RBC
- Immature schizont has a ring form in the RBC
- After merozoite infects the RBC, it can also form gametocytes, which are sexual form of plasmodium
- Cycle continues when mosquitoes bite a human and take up RBCs containing gametocytes
10
Q
Diagnosis of Plasmodium
A
- Blood stain with Giemsa stain to see parasites in RBCs (trophozoite ring)
11
Q
Histology specific to P. falciparum
A
- P. Falciparum has banana-shaped gametocyte in blood smear
12
Q
Malaria drug that has a lot of resistance
A
- Chloroquine
- For sensitive species
- Blocks plasmodium heme polymerase
13
Q
What is the reason behind adding Primaquine to Chloroquine
A
- To kill dormant hynozoite in P. Vivax/Ovale
14
Q
Which drugs treat chloroquine-resistant species
A
- Mefloquine
- For chloroquine-resistant species
- Prophylaxis for travelers
- Atovaquone +. Proguanil
- For chloroquine-resistant species
- Prophylaxis for travelers
- For life-threatening disease caused by P. Falciparum
15
Q
Which drugs are used for life-threatening disease caused by P. falciparum
A
- Atovaquone +. Proguanil
- For chloroquine-resistant species
- Prophylaxis for travelers
- For life-threatening disease caused by P. Falciparum
- Quinidine
- For life-threatening disease caused by P. Falciparum
- Adverse effect = cinchonism
- Artesunate
- For life-threatening disease caused by P. Falciparum
16
Q
Transmission and presentation of Leishmaniasis (both cutaneous and visceral)
A
- Transmission:
- Sandfly
- Vertebrae are the hosts
- Presentation:
- Cutaneous leishmaniasis
- Caused by Leishmania baziliensis
- Skin ulcers
- Visceral leishmaniasis (kala-azar)
- Caused by Leishmania donovani
- Spiking fevers, hepatosplenomegaly, pancytopenia, hyperpigmented lesions
- Cutaneous leishmaniasis
17
Q
Diagnosis and treatment of Leishmaniasis
A
- Diagnosis:
- Macrophages containing amastigotes
- Treatment:
- Sodium stibogluconate (T-bone steak) = cutaneous
- Amphotericin = visceral
18
Q
Transmission and presentation of Trichomonas
A
- Transmission:
- Sexual
- Presentation:
- Vaginitis – foul-smelling, greenish discharge; itching and burning; pH > 4.5
- Cervicitis – strawberry cervix
19
Q
Diagnosis and treatment of Trichomonas
A
- Diagnosis:
- Trophozoites (motile) on wet mount
- Treatment:
- Metronidazole (treat patient and partner)
20
Q
Describe transmission and characteristics of Enterobius vermicularis
A
- Sketchy = vermin lady crawling out of hole
- Transmission:
- Fecal-oral
- Characteristics:
- At night, females lay eggs in anus, people then scratch their butts
- Anal pruritus
21
Q
Diagnosis and treatment of enterobius
A
- Diagnosis:
- Tape test
- Treatment:
- Pyrantel pamoate
- Bendazole
22
Q
Describe transmission and travel of bug in Ascaris lumbricoides
A
- Sketchy = lumbering tree man
- Transmission:
- Fecal-oral
- Transmitted by eating eggs in contaminated food or water; eggs hatch in small intestine and larvae migrate through gut wall and into the bloodstream and makes way to lungs; within the lungs they go through the capillaries into the alveoli and ascend into bronchus where they are swallowed and finally mature into adults in the small intestine
- Similar to American dude, but entry is fecal oral, rather than cutaneous
23
Q
Characteristic presentation of Ascaris
A
- Large worms can cause intestinal obstruction (most often ileocecal valve)
- Respiratory symptoms
- Eosinophilia
24
Q
Diagnosis and treatment of ascaris
A
- Diagnosis:
- Eggs in stool
- Treatment:
- Bendazole
25
Which nematodes travel via the blood --\> lungs --\> intestine route?
Ascaris lumbricoides
Strongyloides stercoralis
Acylostoma duodenale / Necator americans
26
Transmission and characteristics of Strongyloides
* Sketchy = strong guy
* Transmission:
* Larvae penetrate skin of soles of feet
* Once inside the bloodstream the larvae will go straight to the lungs and ascend to bronchiole tree and then get coughed up and swallowed; they then mature in the intestine
* Similar to Ascaris, but entry is cutaneous rather than fecal-oral
* Characteristics:
* Autoinfection of host by laying eggs in intestinal wall, where larvae can hatch and re-penetrate the wall and enter bloodstream
* Eosinophilia
27
Diagnosis and treatment of Strongyloides
* Diagnosis:
* Larvae in stool
* Eggs are laid into intestinal wall so don’t pass through stool
* Treatment:
* Bendazole
* Ivermectin
28
Transmission and characteristics of
* Acylostoma duodenale / Necator americanus – Hookworm
* Sketchy = American dude
* Transmission:
* Larvae penetrate skin of soles of feet
* Once inside the bloodstream the larvae will go straight to the lungs and ascend to bronchiole tree and then get coughed up and swallowed; they then mature in the intestine
* Similar to Ascaris, but entry is cutaneous rather than fecal-oral
* Characteristics
* Attach to the gut wall and feed from the capillaries of intestinal villi
* Can develop severe iron deficiency anemia
* Eosinophilia
29
Diagnosis and treatment of americanus
* Diagnosis:
* Eggs in stool
* Treatment:
* Pyrantel pamoate
* Bendazole
30
Transmission of Trichinella spiralis
* Sketchy = Porky trickster
* Transmission:
* Under-cooked meat (especially pork)
* Fecal-oral
31
Characteristics and treatment of Trichinella
* Characteristics:
* Trichinosis – fever, nausea, vomiting, periorbital edema myalgia
* Larvae enter bloodstream and form cysts within striated muscle cells – inflammation of muscles
* Esoinophilias
* Treatment:
* Bendazole
32
Transmission, presentation, and treatment of Onchocerca volvulus
* Onchocerca volvulus
* Sketchy = black fly guy
* Transmission:
* Female blackfly
* Presentation:
* Hyper and hypo-pigmented spots
* River blindness
* Eosinophilia
* Treatment:
* Ivermectin
33
Transmission, presentation, and treatment of Wuchereria bancrofti
* Sketchy = witch
* Transmission:
* Female mosquito
* Presentation:
* Elephantiasis – worms invade lymph node and cause inflammation, blocking the lymphatic vessels
* Eosinophilia
* Treatment:
* Diethylcarbamazine
34
Transmission, presentation, and treatment of Toxocara canis
* Sketchy = wolf man
* Transmission:
* Fecal-oral
* Contamination of food with dog or cat feces
* Larvae enter the body and never mature – that’s why this disease is called visceral larvae migrans
* Presentation
* Blindness
* Eosinophilia
* Organs usually affected = heart, liver, CNS
* Treatment:
* Bendazole
35
Transmission, presentation, and treatment of Loa loa
* Sketchy = swamp monster
* Transmission:
* Deer fly, horse fly, mango fly
* Presentation:
* Transient angioedema – local subcutaneous swelling
* Worm crawling under conjunctiva
* Eosinophilia
* Treatment:
* Diethylcarbamazine
* Bendazole
36
Describe the 2 different species of Taenia
Including transmission, intermediate host, and hooks/no hooks
* Taenia = tents and carousel
* Caused by eating cysts/larvae in undercooked meat
* Species:
* Taenia solium = pig under tent with sun and sold sign
* Intermediate is pig
* Has hooks on head when seen in hook O&P
* Taenia saginata = cow under sagging tent
* Intermediate is cow
* No hooks
37
What are the 2 different presentations of Taenia, their causes, and their treatment
* Taeniasis = Intestinal tapeworm
* From ingestion of _larvae_ via undercooked pork
* GI problems, malabsorption
* Treat with Praziquantel
* Neurocysticercosis
* From ingesting _eggs_ via water contaminated with animal feces (sketchy = poop water with eggs in fron of carousel)
* Seizures, Swiss cheese head CT
* Treat with Bendazole
38
Transmission of Diphyllobothrium latum
* Diphyllobothrium latum = port-a-potty
* Transmission:
* Ingestion of undercooked fish
* This is the largest tapeworm
39
Presentation and treatment of Diphyllobothrium
* Presentation:
* Diarrhea
* B12/Cobalamin deficiency – megaloblastic anemia
* Treatment:
* Praziquantel
* Noclosamide
40
Transmission of Echinococcus granulosus
* Sketchy = cocker spaniel
* Transmission:
* Dogs are definitive host
* Humans are intermediate host
* Transmitted via dog feces
41
* Presentation:
* Hydatid cysts on liver with eggshell calcifications on cyst on liver CT
* Rupture of cysts can cause anaphylaxis
* Cyst must be injected with ethanol or hypertonic saline before removal
* Eosinophilia
* Treatment:
* Surgical removal of cysts
* Vs. liver cyst of Enteromoeba which is treated pharmaceutically
* Bendazole
Presentation and treatment of Echinococcus
* Presentation:
* Hydatid cysts on liver with eggshell calcifications on cyst on liver CT
* Rupture of cysts can cause anaphylaxis
* Cyst must be injected with ethanol or hypertonic saline before removal
* Eosinophilia
* Treatment:
* Surgical removal of cysts
* Vs. liver cyst of Enteromoeba which is treated pharmaceutically
* Bendazole
42
Transmission of Schistosoma
* Snails are host
* Transmission via penetration of human skin
* Swimmers are at risk
43
Describe the path of Schistosoma once they enter the bloodstream
* After gaining access to bloodstream, worms are carried to liver where they mature into the adults; adults lay eggs in humans who poop and pee in water; snails in the water become intermediate hosts
* Once adults mature in liver, they like to migrate to other parts of the body depending on which type of Schistosoma they are (are 3 different types)
* Worms will migrate against the portal flow to reach venous destination
44
Describe the shape of the egg and presentation of S. Mansoni
* S. Mansoni = merman
* Egg with large lateral spine
* Presentation:
* Swimmers itch
* Portal HTN – Gi hemorrhage, abd pain, liver cirrhosis, jaundice
45
Describe shape of egg and presentation of S. Japonicum
* S. Japonicum = Japanese tourist
* Egg with have small/absent spine (almost perfectly round)
* Presentation:
* Swimmers itch
* Portal HTN – Gi hemorrhage, abd pain, liver cirrhosis, jaundice
46
Describe shape of egg and presentation of S. Haematobium
* Egg will have a large terminal spine
* Presentation:
* Swimmers itch
* Hematuria
* Squamous cell carcinoma of bladder
47
Describe transmission and egg shape of Chlonorchis sinensis
* Transmission:
* Snails are intermediate host
* Worm transferred from snails to fish
* Transmission via ingestion of undercooked fish
* Eggs:
* Operculated eggs on O&P (wearing a yamaca)
48
Describe presentation of Clonorchis
* Pigmented gallstones
* Biliary fibrosis
* Cholangiocarcinoma
49
Describe transmission, presentation, and egg of Parogonimus westermani
* Parogonimus westermani = penguin
* Transmission
* Snail is intermediate host
* Transmitted via consumption of raw or undercooked crab meat
* Presentation:
* Chronic cough with bloody sputum
* Egg:
* Operculated eggs on O&P (wearing a yamaca)
50
What is the treatment for all flukes (trematodes)
Praziquantel
