GI Protozoa

Question 1

Bloating, flatulence, foul-smelling fatty diarrhea

Answer 1

Giardia lamblia

Question 2

Giardia transmission

Answer 2

cysts in water

Question 3

Giardia Dx

Answer 3

Check stool for A) trophozoites or B) cysts

Question 4

Giardia Tx

Answer 4

Metronidazole

Question 5

triad of bloody diarrhea, liver abscess, RUQ pain

Answer 5

Entamoeba histolytica (these Sx are amebiasis)

Question 6

E histolytica transmission

Answer 6

cysts in water

Question 7

E histolytica Dx

Answer 7

2 methods: 1)cysts with multiple nuclei in stool (but cannot differentiate between this an Entamoeba dispar.) or 2)serology with trophozoites containing RBCs in cytoplasm

Question 8

E histolytica Tx

Answer 8

Metronidazole (or iodoquinol for ASx cyst passers)

Question 9

Severe diarrhea (AIDS pt) or watery diarrhea (immunocompetent)

Answer 9

Cryptosporidium

Question 10

Crypto transmission

Answer 10

cysts in water

Question 11

Crypto Dx

Answer 11

Cysts on ACID FAST stain

Question 12

Crypto Tx

Answer 12

Prevention (filtering) from immunocompetent; nitazoxanide for AIDS pts

Question 13

GI Parasites

Answer 13

Giardia, E histolytica, Crypto

Question 14

GI parasite transmission

Answer 14

cysts in water

Question 15

Which GI parasite(s) would you confirm Dx by checking stool?

Answer 15

Giardia, E histolytica

Question 16

Which GI parasite(s) would you confirm Dx with serology?

Answer 16

E histolytica

Question 17

Old man face on micro

Answer 17

Giardia

Question 18

Cysts on micro

Answer 18

Giardia, E histolytica

Question 19

RBCs in cytoplasm/multiple nuclei on micro

Answer 19

E histolytica

Question 20

Bloody diarrhea

Answer 20

E histolytica

Question 21

nonbloody diarrhea

Answer 21

Giardia, Cyclospora cayetanesis

Question 22

Can nonbloody diarrhea from Giardai/Cyclospora happen in immunocompetent people?

Answer 22

Yes

Question 23

E histolytica mvmt?

Answer 23

Pseudophilia (creeping cytoplasm projections)

Question 24

E histolytica epidemiology?

Answer 24

Developing world.

Question 25

Problem with E histolytica stool sample analysis?

Answer 25

cannot differentiate between E histolytica and E dispar.

Question 26

Most common E histolytica Sx?

Answer 26

none, usually ASx

Question 27

E histolytica trophozoite-> cyst progression

Answer 27

trophozoite->precyst (2 nuclei+chromatoid bodies/ribos+food vacuoles)->cyst (4 nuclei)

Question 28

E histo Active vs carrier?

Answer 28

Stool sample-active has RBCs in cyst cyto, carrier does not

Question 29

Metrodinazole train (indicated bugs, AEs)

Answer 29

The metro runs over Ehistolytica, Giardia, Trichomonas, and anaerobic cocci/bacilli (GET out of his way). No drinking on train (upset stomach, disulfaram effect). If you eat the train get metallic taste in mouth.

Question 30

Giardia outbreaks occur when…

Answer 30

sewage contaminates drinking water

Question 31

Giardia MOI

Answer 31

ingestion->cyst->intestinal coating, which prevents fat absorption. Does not invade wall so no blood

Question 32

Crypto prevalence

Answer 32

25% of US has been infected

Question 33

Crypto clinical scenarios

Answer 33

Contaminated water sources, infants in daycare, travelers

Question 34

Severe diarrhea in immunocompromised person

Answer 34

Cyclospora, Isospora (also think about crypto)

Question 35

Cyclospora/Isospora Dx

Answer 35

stool microscopy (ACID FAST)

Question 36

Acid fast GI Parasites

Answer 36

Cyclospora/Isospora, Crypto

Question 37

Cyclospora/Isospora Tx

Answer 37

trimethoprem-sulfamethodaxole

Question 38

Cyclospora associated food

Answer 38

raspberries