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Clin Med > ID: Parasitic infections > Flashcards

ID: Parasitic infections Flashcards

1
Q

list the 3 types of parasites

A
  1. single celled–protozoa
  2. multi celled–worms
  3. Ectoparasites–aka arthropods–scabies and lice
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2
Q

roundwords or?

A

nematodes

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3
Q

flatsworms or?

A

Platyhelminthes

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4
Q

list the subcategories of flatworms

A

tapeworms (cestodes)

flukes (trematodes)

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5
Q

diseases caused by Protozoa (5)

A 
Giardia 
Trich
malaria 
chagas dz 
african sleeping sickness
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6
Q

dz caused by arthropods (4)

A

lice
scabies
mites
fleas

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7
Q

trophozoite

A

protozoa life cycle

  • motile feeding reproducing form
  • surrounded by flexible cell membrane and a cyst–non-motile
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8
Q

cyst of a trophozoite

A

nonmotile, nonmetabolizing, nonreproducing form surrounded by a thick wall
*survives well in the environment and is often invovled in tramssion

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9
Q

list flaglated protoza

A

Leishmania

Trypanosoma

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10
Q

what is commonly associated with helminth infections

A

eosinophilia

aka elevated eosinophil counts

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11
Q

what caues malaria

transmision

A

unicelled parasite–>plasmodium

transmission=mosquitoe bite from the Anopheles genus

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12
Q

what is the MC and most lethal species of the Plasmodium genus

A

Plasmodium falciparum–malaria

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13
Q

Malaria

  • etiology
  • MC where
  • what organ is attacked first and then?
  • CM
  • what happens if untx
A

PLASMODIUM genus
***MC is the Falciparum and most dangerous:

**tropical dz
Liver is attacked first—then RBCs–>lysis

CM

  1. Cyclical fever– cold stage–>hot stage/high fever–>diaphoretic/drenching sweats stage fever is every third day*
    * HA
    * fatigue
    * mylagias
    * N/V/GI s/s
    * splenomealy MC
    * hepatomegaly in 1/3 of PT
    * anemia

untx:
* extensive brain and kidney damage
* *cerebral malaria-AMS, delirium, seicures, coma
* *blackwater fever=kidney

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14
Q

what disease can partialy protect against malaria

A

sickle cell

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15
Q

CM for blackwater fever malaria

A

KIDNEY DAMAGE

  • severe hemolysis
  • hemoglobinuria
  • renal failure
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16
Q

how does malaria relapse

A

the P. vivax and P. ovale species can cause the relapsing due to the hypnozoites latent in the liver
***can cause malaria years later

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17
Q

how to diagnose malaria

A
  1. clinical– fever + recent travel to tropics
  2. Giemsa-stained blood smear: thick and thin
    * THICK=detects precense of organisms
    * THIN=used for species ID
    * **species ID is imp bc of tx
  3. LABS: CBC will show
    * leukopenia
    * hemolytic anemia
    * thrombocytopenia
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18
Q

first line tx for uncomplicated P. falciparum malaria

  • alternative?
  • add on agent to kill latent species to prevent recurrence
A

Chloroquine

Hydroxychloroquine is alternative

Add on: Primaquine

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19
Q

TX for chloroquine-resistant P. Falciparum

1st and 2nd line

A

first line: Atovaquone/Proguanil or Artemisinin combination therapy

second: doxycycline, tetracycine, or clindamycin PLUS quinine sulfate

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20
Q

life threatening malaria infection tx

A

IV quinidine gluconate

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21
Q

prophylaxis for malaria if traveling

-sensitive and non resistant areas

A

Chloroquine for the chloroquine sensitive areas

chloroquine resistant areas: doxycycline, mefloquine or atovaquone-proguanil

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22
Q

what day of malaria infection does PT develop splenomegaly

A

4th day

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23
Q

what causes Chagas Dz

A

Trypanosoma cruzi

24
Q

vector for chagas dz

A

reduviid bug— kissing bug

bc it most commonly bites humans around the mouth or eyes

25
Q

what cells are MC affected by Trypanosoma cruzi

A

myocardial
glial
reticuloendothelial cells

26
Q

complications from Trypanosoma cruzi or chagas DZ

A

dilated cardiomyopathy

GI ddz

27
Q

what is the leadig cause of CHF in latin america

A

Trypanosoma cruzi or chagas DZ

28
Q

CM for Chagas DZ

A

Acute phase:
*facial edema and a nodule near bite
*bite around the eye–>unilateral palpebral swelling–>ROMANAS SIGN
+fever +lymphadenopathy +hepatosplenomegaly

Chronic: not everyone develops this form

  • CARDIAC–>dilated cardiomyopathy, CHF, arrythmias (MCC of death)
  • GI=
    1. megacolon—constipation, colicky abd pain, bloating
    2. megaesophagus–dysphagia and regurg of food
  • CNS=destruction of glial cells
29
Q

Diagnosis for Chagas DZ– each phase

A

Acute phase–>peripheral blood smear will show trypomastigotes– flagellated

chronic phase

  1. ELISA
  2. EKG
  3. ECHO
30
Q

TX for chagas dz

A

acute phase or PT without significant cardiac or GI disease:
*****benznidazole or Nifurtimox for 90-120 days

No treatment for chronic form with signiicant cardiac or GI dz

31
Q

what causes african sleeping disese

A

Trypanosoma brucei gambiense
and
Trypanosoma brucei rhodesiense

32
Q

vector for african sleeping dz

A

Tsetse fly

33
Q

Trypanosoma brucei hambiense causes?

-severity of dz

A

african sleeping sickness along water courses in WEST africa

-chronic course over several years

34
Q

Trypanosoma brucei rhodesiense

A

causes afican sleeping sickness along arid regions of EAST africa

-acute, rapidly progressive dz

35
Q

CM for african sleeping sickness

A

EARLY STAGE–hemolytic stage

  • painless chancre at the bite site 2-3 days after bite
  • intermittent fever, malaise, HA, joint pain, itching
  • generalized or regional lymphadenopathy– usually LARGE– MC cervical LNs–> Winterbottom’s sign

LATE STAGE–CNS stage

  • encephalitis: HA, insomnia, mood changes
  • muscle tremors
  • slurred speech
  • day-time somnolence and coma
36
Q

what causes the sleepiness in african sleeping sickness

A

tryptophol realsed by the dz

37
Q

how to diagnose african sleeping sickenss- both stages

A

EARLY

  • blood smears or aspirate from enlarged LN
  • ELISA

LATE
*presence of trypanosomes

38
Q

TX for african sleeping sicness

-both strains

A

Trypanosoma brucei gambiense

  • early=Pentamidine
  • late=Eflornithine and Nifurtimox

Trypanosoma brucei rhodesiense

  • early= Suramin
  • late=Melarsoprol +/- Nifurtimox
39
Q

toxoplasmosis is caused by

A

toxoplasma gondii

40
Q

toxoplasmosis

  • cm
  • diagnosis
  • tx-pregnant and not pregnant
A

primary infection: usually asympto for immunocompetent adults
-some can resemble mononucleosis

Reactivation

  • **encephalitis–MC in AIDS pt with CD4<100
  • **Chorioretinitis: posterior uveitis, eye pain and decreased visual acuity
  • pneumonitis: fever, dyspnea, nonproductive cough– similar to PCP pneumonia

diagnosis:
1. microscopic examination of Giemsa-stain— crescent shaped trophozoites during acute infections
2. immunofluorescence assay/ELISA–>anti-toxoplasma IgG antibody
3. MRI–>multiple ring enhancing lesions

tx:
1. Sulfadiazine or clindamycin PLUS Pyrimethamine
* *add folic acid/leucovorin to prevent depletion

  1. if pregnant: spiramycin

Prophylaxis: for PT with CD4 <100

  1. Trimethoprim-sulfamethoaxazole (Bactrim DS)
  2. Alternative: Dapson + Pyrimethamine & Leucovorin
41
Q

when can mother transmit toxoplasmosis to fetus?

A

if mother is newly infected DURING pregnancy

42
Q

triad for CM in congential toxoplasmosis

A
  1. chorioretinitis–inflammation of choroid in eye
  2. encephalitis/hydrocephalus
  3. intracranial calcifications
43
Q

diagnosis for congenital toxoplasmosis

A

ELISA for anti-toxoplasma IgM antiboies

44
Q

which antibodies do we test for:

  1. non congential toxoplasmosis
  2. congential toxoplasmosis
A

non congential–> anti-toxoplasma IgG

congential–> anti-toxoplasma IgM

45
Q

three main groups of helminths

A

nematodes
cestodes
trematodes

46
Q

types of nematodes

A

roundworms
pinworms
hookworms
whipworms

47
Q

types of cestodes

A

beef, pork and fish tapeworms

48
Q

types of trematodes

A

flukes— each one is IDed whre in the body it is located

49
Q

Roundworms

-name ?

A

Ascariasis–GIANT roundworm infection

50
Q

Ascariasis

  • caused by?
  • transmission
  • CM
  • can lead to?
  • diagnosis
  • tx: preg and not preg
A

Ascaris Lumbricoides
soil transmission

CM: depends on worm load

  1. small load: asympto
  2. larger load: vague abd s/s: anorexia, nausea, vomiting, abdominal discomfort
  3. HIGH load: intestinal obstruction–MC, hepatic or biliary manifestations
    * can cause Ascaris pneumonia*

diagnosis: stool O/P
+eosinophilia

TX:

  1. albendazole or Mebendazole
  2. pregnant: pyrantel (only after 1st trimester)
51
Q

which is the largest intestinal nematodes as adults?

A

ascariasis

52
Q

two species of nematode worms associated with?

  • transmission and the cycle
  • can cause?
A

hookworm infection

  1. Necator americanus–US and australia
  2. Ancylostoma doudenale–

transmission= eggs deevlop into larvae in soil contaminated with dog or cat feces–penetrate skin–travel through venous circulation—lungs–coughed up—swallowed–enter intestines—dev into mature adults–attach to the blood vessels and can cause anemia

53
Q

cm of hookworm infection
diagnosis hookworkm
-tx?

A

phase 1 (skin)–very pruritic erythematous maculopapular dermatitis (feet and ankles MC)— resolves few days

phase 2 (transpulmonary)–>MC asympto

pahse 3 (GI): N/V/D

phase 4 (anemia): blood los at the site of attachment in the small intestine 
*****major impact of hookworm infection

Diagnosis:

  1. CBC: hypochromatic microcytic anemia
  2. Eosinophilia: increased IgE
  3. stool guaiac: +
  4. Stool O/P: eggs in stool

TX:

  1. ***Albendazole or Mebendazole or Pyranetel
  2. iron supplements and vitamins
54
Q

what is the major impact of hookworm infection

A

anemia

55
Q

Enterobius vermiclaris

  • pathogen?
  • occurs in?
  • MC IN?
  • diganosis
  • tx
  • preg tx
A

pinworms
only occurs in humans– no animal resvoir or vector***

transmission: fecal-oral with contaminated fomites
MC in: school age kids 5-10YO

CM:

  1. perianal itching–esp at night (bc eggs are laid at night)
  2. severe cases: abdominal pain, nausea, vom

Diagnosis:

  1. cellophane tape test or pinworm paddle test—early in Am to look for eggs under a micrscope
  2. O/P—- will NOT show eggs but the adult worms

TX:

  1. Albendazole, Mebendazole or Pyrantel–only kill adult worms in COLON and not the eggs– so re-treatment is needed x2 weeks
  2. pregnant– Pyrantel

Clin Med (52 decks)

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