IID Blood and Tissue Parasites & ClDx clin manif of hemat disease Flashcards
Iron deficiency anemia sx
sx rel to decreased O2 carryign capacity of blood bc less iron, esp older pts, consider colon, pale eyes, blood in stool, constipation or change in stool (left sided colon cancer), high platelet count, low blood cell vol, TIBC tot iron binding cap high, ferriton and iron low means IRON DEFICIENCY, but if TIBC is also low then anemia from other chronic disease
Iron def pap smear
small cells (microcytic) rbcs smaller than lympho
hypo-chromatic aka PALE RBCs
poikolicytosis aka diff size/shape of RBC
Predisposing factors to iron def
loss of iron from menses etc, colon polyp blood loss, colon cancer causes anemia, pencil thin stool L side colon lesion, diet (not enough red meat, vegetarian)
Screening in Iron def
barium enema- white area in colon
apple core lesions-L sided obstruction is sx
screening colonoscopy at age 50 etc
Vitamin C deficiency sx
bleeding gums bruises petechiae red dots LOW HEMOGLOBIN LVL SPLIT CORKSCREW HAIR WEAKNESS from hypotension etc anemia (need vit C as cofactor for bone marrow production with all cell lines)
Vitamin C def on smear
Blue RBCs (recticulocyte), a few of the RBCs are a bit bluish, bc vit C cant help with marrow production
Predisposing factor of Vit C def
malnutrition (diet)
What does vit C def cause (disease)?
what mech is vit C impt for?
vit C px?
- vit C def is SCURVY
- vit C impt for cross linking collagen and is a cofactor for prolyl and lysly hydroxylases
- nutritional defs often overlooked
- vit C def may dev within a month and be fatal
Vitamin B12 def sx
long duration confusion
walking problems (ataxic gait/unsteady)
Paraesthesias (loos of posn/vibration)
Romberg- loss of proprioception
Absent bilateral DTR (deep tendon reflex)
High mean corpusc vol (many causes eg alc)
Elevated METHYLMALONIC ACID (conversion of this acid needs b12 as cofactor)
NOT from ab’s to intrinsic factor
What is vitamin b12 cofactor for
Converting methylmalonic acid
Advanced cases of b12 def can cause
leukopenia, thrombocytopenia
Vitamin B12 deficiencies on histology smear
HYPER-SEGMENTED NEUTROPHILS
Polychromasia (diff colored cells)
Macrocytic RBCs (large RBCs)
blue discorloration not fully mature cells
Predisposing factors to vitamin b12 def
Inadequate absorption of nutrients, can cause pernicious anemia (eg automimm ab’s against intrinsic factor)
OR
Right colonectomy–missing site of B12 absorption (terminal ileum), or gastric bypass surgery
How to treat vitamin b12 def
Replenish Vitamin b12 through injection or sublingual
Which deficiency has high mean corpuscular volume?
Vitamin B12!
Malaria spp and mosquito type
Anopheles
Plasmodium falicparum, ovale, and vivax (last 2 are liver)
Malaria pathology
sporozoites from mosq saliva inj into host, virus enters liver cells, after 7-10 days liver cells lyse and rel infectious merozoites into bloodstresm, which enter RBC and dev into schizonts, some meroz dev into gametocytes to be taken up by another mosq
Malaria pathology in vivox/ovale
can form hypnozoites in liver
Toxins/clin features in malaria
FEVER
cytoadhrence to endothelium
Histo of malaria
dx
thicc smears to find parasites in RBCs thin smear to find spp may be ring form as torophozoite early on diff as meorozoite (stippling) Dx with RDT
Prophylactic tx (3)
Chloroquine if u dont have res (color queen)
doxy (but sun sens)
mefloquine for long time travelers (fly queen w luggage)
Tx for malaria
Artemesinian combo tx (ACT) used worldwide for falciparum (artist painting near scary false mask warrior)
IV artesunate
Malarone (atavaquone&proguinil) (Atova vampire queen w iguana), and COARTAM
Quinine/doxy (dining queen)
Plasmodium falciparum
(false mask guy)
sx
7 d incub Africa etc RBC lysis (RBC headdress) Irreg feverchills (irreg toga) Severe, v high mortality CNS, pulm edema (gold lung plates), renal failure (renal rings), etc bc RBCs occlude brain, kidney and lungs
P falciparum histo
2 red dots on slides
P vivax & P ovale
Sx etc
Hypnozoites (hypnosis warrior) in liver (liver shield)
48 hr fever/chills (days 1, 3)
Spleen enlargement (spleen spot on cow) (can enlarge too much)
What should you treat P vivax (india)/ ovale(W africa) with, and what is important to be careful of?
Tx with primaquine! (primal queen blocking hypnosis)
Be careful of GPDH deficiency
Plasmodium malariae
fever chills every 72 hr (days 1 and 4) (quartile buttons 1 and 4 red)
renal failure
Traveler’s malaria
can be from any spp
@ least 10 days incub
no spec sx (ask pt if traveled!), jaundice late (liver spot), normal ish labs but INCREASED total bili and LDH
Why does malaria avoid heterozygous SS pts
bc spleen clears sickled rbcs before virus can burst, less cytoadherence, but homozygotes can still die
(same w thalassemias)
Babesia
vector
sx
“vampire babes”
ioxdes tick (same as lyme, robin), wooded areas, blood transfusion, placenta, NE
asymp unless IC (microtic less severe, divergens more)
Malaria like sx
Sudden severe hemolysis (broken RBC windows)
splenectomy pt (hole in shirt in spleen area)
Babesia histo
dx
Maltese cross (cross in sketchy) and ring formation seen together Dx: malaria like sx but didnt travel to malaria area, smear, pcr, fluor ab, etc etc
Tx
Atovaquone & azithromycin
(atova vampire queen w crows for macrolides)
(can also have quinine and clindamycin)
KINETOPLASTIDS
spp
diff bugs long orgs no good tx bc non oral and have sxe Trypanosom Leishmania
3 types of trypanosoma
T gambiense
T rhodesiense
T cruzi
Trypanosoma cruzi
disease
transmission and bug
location
"cruizin thru che's gas" causes CHAGAS disease from reduviid/triatomine kissing bug poor housing conds S america bug defacates on skin, scratching
T cruzi
Acute, indeterminate, and chronic phase
Unilateral PUFFY EYE (chagoma/romana’s sign)
most asymp except kids
indet: 10-30 yr latency
chronic: organomegaly, cardiomegaly (saddle bag shaped like heart), megacolon (large gas pump), megaesophagus (snake w big throat)
T cruzi tx
NiFURtimox (fur boots on woman)
BENZnidazole
(CRUIZIN in my BENZ with my FUR coat on)
T gambiense
dis
transm
TSETSE FLY
W african sleeping sickness
rural, poor
(“prince bruce to the rescue”)
Trypanosoma gambiense sx
slow dev of wasting, coma, convulsions, etcetc OCCIPITAL ADENOPATHY (pearl necklace)
T gambiense Tx
EFLORNITHINE (IV) (think flowers)
suramin serum and melarsoprol soap if CNS (“i SURe am MELLow when im sleeping”)
T rhodesiense
pop
animal
etc
E africa sleeping sickness
tsetse
males, hunters
T rhod sx
acute febrile, rash w circular large lesion
facial edema, helaptosplenomegaly, adenopathy, CNS/ CSF, cardiac/renal,
Leishmania
trans
area
SAND FLY ("desert mania")
Lutz-new world, phleb-old worldLeishmania
sx
forms
skin lesions (primary form) (painless raised border, looks like syphilis but not in genital)
good Th1 immune resp, self healing
new world: new-WET, old-DRY
- mucocutaneous
visceral: dissem of macros sys, poor th2 resp, high mortality, guy w black rash
Leishmania tx
sodium stibogluconate (steak t-bone offering)
Ancylostoma braziliensis
DOG/CAT HOOKWORM (larva on ground enters skin)
larva migrans dis w inflam
A braziliensis sx
Cutaneous- vvv itchy
prurutic, serpiginous (wavy margins) parasite trying to find dog/cat intestines
toddler in sandbox etc
Ancylostoma braziliensis tx
Oral IVERMECTIN to kill worm
topical thiabenz
Toxocara canis/catis
ROUNDWORM in dogs/cats (“wolfman in screamatodes III)
puppies or kids ingest egg
T canis sx
visceral-sys inflam from worm crawling, fever etc
EOSINOPHILIA (pink marbles), allergy, diarr etc
-ocular, larva in retina, can cause blindness (wearing mask
T canis Tx (and dx)
dx pcr
TX: ALBENDAZOLE (bendy chairs on wolf man)
Baylisascaris procyonis
RACOON ROUNDWORM, have to kill racoon poop with flamethrower
B procyonis sx
V SEVERE
enceph, brain/eye
no good tx, high mortality etc
Filaria (nematodes)
infx has swimming egg stage and adult stage
immune resp
LOW: (loa loa, onchocerca, wuchereria)
Wuchereria bancrofti
Brugian spp
adults in lymphatics
peaks at midnight, trans by mosquitos
W bancrofti sx
asympt
early: usual, retrograde lymphangitis
late sympt phase: chronic edema, elephantitis (MC hammer pants), hydrocele, DLA (skin), nodules/plaques
Wuchereria dx and tx
rapid ag detection
tx: DEC (diet and carb zine)
Ivermectin
Penicillin for DLA immed
Doxy to tx wolbachia that lives in filaria
Onchocerca volvulus
Filarial onchocerciasis causing RIVER BLINDNESS
trans by black flies, painful bite, skin, africa
O volvulus sx
skin disease w nodules in lower extremities and butt, eye disease w worm causing blindness (fly covering eye)
black flies black skin black nodules black sight
Onchocercia dx tx
dx skin snips, dec patch test not used much bc systemic mazzoti
rxn: can cause sepsis like sx from ag storm, blindness/death
Tx: IVERMECTIN, dec
Loa Loa (fliaria loiasis)
EYE WORM adults in subcut tissue microfilaria in blood peaks in morning trans by chrysops fly
Loa loa sx
asymp
allergic, CALABAR SWELLING, non painful
eye worm, non inflam, no perm dmg
Loa loa tx
DEC (blue guy also reading diet and carb zine)
Pt in NE area shows malaria like sx– which microbe?
babesia! (microti LESS severe than divergens)
Oozing nonpainful ulcer with firm raised edges and cetnral crator– which microbe?
Leishmania! (cutaneous)
Inflamed rash on buttocks w squiggly line
and disease process
maybe onchocerca volvulus filaria, cutaneous larva migrans, DOG HOOKWORM, dog poops egg, egg hatches into larva, larva finds human host, worm tries to find dog intestines but cant cross bloodstream so wiggles around and causes inflam
What is an example of a sx Wuchereria bancrofti may cause?
elephantiasis (eg of scrotum) (MC hammer pants), OBSTRUCTS LYMPHATICS (ruffles on armpits)
What do you use to treat issue in girl with chronic slow lymphedema of leg?
WUCHERIA BANCROFTI
tx with PENICILLIN
loa loa sx and dx?
swelling blotchy rash, cellulitis etc
Giemsa stain blood smear
What is a ulcer with firm raised edges and central crater (oozy, nonpainful) called?
swollen epitrochlear node (FOREARM LYMPH NODE)
in cutaneous leishmania
