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trop med > Eosinophilia & meningitis in tropics > Flashcards

Eosinophilia & meningitis in tropics Flashcards

1
Q

What is an abnormal eosinophil count?

A

> 5-10%
450-500mm3

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2
Q

What causes raised eosinophils?

A

Helminths plus
Aspergillus
Cocci
Scabies, myiasis
Cystoiospora (plus sarcocystis)
Congenital toxo
HIV - allergies, eosinophilic folliculitis
Drug reactions
Asthma
Dermatitis
IBD
Malignancy
Hypereosinophilic syndrome
Psoriasis
Vasculitis

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3
Q

What are the common causes of eosinophilia caused by helminth?

A

Acute schistosomiasis
Strongyloides
Filarias (Loa, Oncho, Mansonella, lymphatic)
Hookworms (including CLM)
Acute ascariasis
Trichinosis
Larva migrans syndromes (Toxocara, Baylisascaris, Angiostrongylus, Anisakis,
Gnathostomiasis, Fascioliasis, other flukes)

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4
Q

When to suspect a helminth based eosinophil count?

A

> 1500 absolute count - likely to be a worm

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5
Q

Acute katayama fever causing raised eosinophils. ∆ made how?

A

Serology (can be -ve)
Most will have negative stool

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6
Q

Why does katayama fever occur in schistosomiasis? Most common symptom?

A

Egg laying begins
Not detectable in stool or urine

Fever, cough

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7
Q

Fever, respiratory symptoms and swimming in Africa with eosinophils. ∆ to exclude?

A

Schisto (all other helminths mostly present GI symptoms)

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8
Q

Rash, GI and respiratory symptoms in immigrant from Asia, most likely ∆?

A

Strongyloides

Most patients are asymptomatic

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9
Q

Patient from Amazonia area, presenting with gram -ve meningitis and bacteraemia, always rule out what?

A

Strongyloides

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10
Q

Army soldier presenting with eosinophilia but no rash. ∆?

A

Hookworm - no rash human hookworm

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11
Q

Migratory swellings with eosinophilia from DRC? Confirmatory tests?

A

Loa Loa (migratory - calibar swellings)

Blood smear for microfilaria

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12
Q

5 yr old girl been playing with dogs in Thailand, presents with fever, abdo pain and diarrhoea with a rash and eosinophilia. Always think of?

A

Toxocara canis - visceral larva migraña

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13
Q

Larva migrans syndromes - causes?

A

Toxocara
Baylisascaris
Angiostrongylus
Gnathostomiasis
Acute Ascaris
Paragonimus
Acute Fascioliasis

TBAG - zoonotic helminths causing LM

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14
Q

Migratory nodules with eosinophilia?

A

Gnatho
Paragon
Fasciola
Sparagonis

ALL MOVE

Fixed nodules - cystercircosis and onchocercosis

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15
Q

pulmonary infiltrates and eosinophils?

A

1) Fleeting infiltrates (Loeffler’s):
Larva migrans (Schisto, Strongyloides,
Toxocara, Ascaris, Hookworm)
NASA for nematodes + schisto and toxocara

2) Localized infiltrates: Paragonimus,
Echinococcus

3) Diffuse infiltrates: Tropical Pulmonary
Eosinophilia due to Filariasis

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16
Q

Eosinophilia in tropics crucial part of hx re: symptoms?

A

GI symptoms
Resp symptoms
Skin symptoms

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17
Q

Neurological symptoms in returning traveller with eosinophilia. Which organisms are you worried about?

A

Acute schistosomiasis, Angiostrongylus, gnatho, neurocysticercosis

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18
Q

Tests in a patient returning from tropics with eosinophilia?

A

Confirm eosinophilia, check urinalysis
Stool for Ova and Parasites x 3
Urine, blood smear
Serology: schistosomiasis, filariariasis,
strongyloidiasis, toxocariasis
Consider IgE level, CXR

19
Q

Common causes of eosinophilia caused by helminth

A

1) Trematode - schisto
2) Nematode human - hookworm, strongy
3) Zoonotic nematode - CLM (dog hookworm), toxocara, gnathostoma
4) Filarial parasites (only in central and West Africa)

20
Q

What are the most common causes of meningitis?

A

Strep pneumo, Meningococcus,
Hemophilus Influenza

21
Q

4 symtoms/signs of meningits?

A

Headache, fever, neck stiffness, decreased GCS

22
Q

Classic LP findings for aseptic/bacterial/chronic meningits?

A
23
Q

When would you not do an LP before a CT head in a resource poor setting?

A

Focal neurology
New onset seizures
GCS <!0
Severe immunocompromise

24
Q

Antibiotic of choice in most cases of bacterial meningitis?

A

Ceftriaxone (plus ampicillin in listeria/strep agalacticae)

25
Q

Specific antibiotic for bacterial meningitis for the following pathogens?
- Strep pneumonia
- Hib
- meningococcal
- Listeria
- Ecoli
- Salmonella

A
26
Q

Organism responsible for meningitis in elderly man in south east Asia, classically in areas of pig raising, open wound, hx of alcohol and T2DM?

A

Streptococcus suis

27
Q

Bacterial causes of meningitis to think about in tropics?

A

TB
Rickettsia,
Orientia
Lepto
B pseudomallei

All present aseptic meningitis

28
Q

Picture of CSF analysis in TB meningitis?

A

High protein
Low glucose
Mildly raised WCC 100-500 with mainly mononuclear (lymphocytes)

29
Q

Who is at risk of listeria meningitis?

A

Compromised - newborns, elderly, chronic disease, Assoc contaminated milk products/Associated with processed meat

30
Q

What are the common presenting symptoms of subacute meningitis?

A

Gradual onset (days to months)
Symptoms HA, nausea, confusion,
cranial nerve palsies
Fevers, sweats, wt loss variable

31
Q

Causes of subacute onset meningitis?

A

Tuberculosis
Cryptococcal disease
Spirochetes - Syphilis, Lyme
Other fungi -e.g. Histo, Cocci
Other bacteria - Brucella,
Melioidosis, Scrub typhus,
Parasites (T solium)

32
Q

How quick to give Antibiotics in any suspicion of bacterial meningitis?

A

2 hrs

33
Q

Subacute meningitis CSF analysis?

A

20-500 WCC Mononuclear
Glucose <45
Protein 50-500

34
Q

Haemoptysis, cough, SOB, conjunctiva insuffusion, fever and jaundice. Very high bilirubin. Diagnosis?

A

Leptospirosis

35
Q

Fever, cough, weight loss, oral lesions. Bilateral infiltrates, central and perihilar shadowing on CXR. Diagnosis?

A

Paracocci

36
Q

Non HIV patient presenting with cryptococcus, lung presentation most likely?

A

Pulmonary nodule

37
Q

HIV infected patient from high jungle with 2 months hx of fever, dry cough, very low CD4. Miliary pattern on CXR/CT chest with very high LDH and pancytopenia. Diagnosis?

A

Histoplasmosis - high LDH and pancytopenia
High LDH caused by histo and lymphoma
PCP does not cause LDH rise or pancytopenia

38
Q

42 year old male with cough and haemoptysis for 2 years from the highlands of Peru. Peripheral sub pleural nodule in lower lung field on CT chest with eosinophilia. Diagnosis?

A

Paragonimus

39
Q

Fungal causes of TB mimickers re: pulmonary presentation?

A

Histo
Crypto
Paracocci
PCP

40
Q

32 year old male with SOB, cough, haemoptysis, lives in rural highlands. Rapidly progressive over 2 days, shocked. Lobar consolidation on CXR, gram neg bacilli on gram stain. ∆?

A

Yersinia Pestis
Primary or sec from a bubo
Rx: ciprofloxacin, aminoglycoside

41
Q

45 yr old fever, cough, pleuritic chest pain. Lives in French Guyana. Transaminases high, blood culture negative, platelets 100. Consolidation of lower lobe on CXR.

A

Coxiella Burnetii- Q fever
Contaminated livestock
Acute and chronic presentation (osteomyelitis, endocarditis)
Lung involvement: lobar segmental pneumonia, round or wedge shaped opacities
Diagnosed with serology
Rx: doxy

42
Q

65 yr old male from Texas with no symptoms found to have a nodule on CXR.

A

Dirofilaria immitus
Vector borne - aedes and anopheles
Asymptomatic but with eosinophilia
Single well demarcated pulmonary nodule
Diagnosis- excision, no Rx.

43
Q

55 yr old female with chills, headache, SOB, progressive over 2 days. 2 relatives died of lymhoma. Gram -ve sepsis - grown in CSF and Blood. Diagnosis?

A

Stongyloides, from HTLV and hyper infection with gram negative sepsis.
Miliary pattern, ground glass, nodular lesions of stongy hyper infection.
Intestinal mucosal thickning.

44
Q

28 year old male from Honduras, works bare foot, presents with SOB, wheezing. CXR some bilateral infiltrates. Eosinophilia. ∆

A

Hookworm and Loefflers syndrome

trop med (49 decks)

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