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Clinical Medicine Lecture - Professor Kramer > Infectious Disease - Helminth Infestations 2 > Flashcards

Infectious Disease - Helminth Infestations 2 Flashcards

1
Q

Amebiasis patho?

A

Cysts of Entamoeba are viable in the soil and water for weeks to months

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2
Q

Most pathogenic organism for Entamoeba?

A

Entamoeba histolytica most pathogenic

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3
Q

Entamoeba transmission to humans via?

A

fecally contaminated food or water

fly droppings

human-to-human contact

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4
Q

Amebiasis: once ingest, cysts pass through the investing where they _____?

A

hatch

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5
Q

Amebiasis: ______________ invade mucosa and induce ________.

A

Trophozoites

necrosis

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6
Q

Amebic ulcers typically are _____ shaped and occur anywhere in the _____ bowel or ________ _____.

A

flask shaped

large bowel

terminal ileum

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7
Q

Amebic ulcers are usually limited to the __________ layer, and if the penetrate they ______ the can cause what three things?

A

muscularis layer

if they penetrate the serosa it can cause Perforation, Abscess, Peritonitis

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8
Q

Amebiasis demographic?

A

Mostly tropical and subtropical

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9
Q

Hx of mild Amebiasis?

A

Cramps
Fatigue
Weight loss
Increased flatulence

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10
Q

Hx of severe Amebiasis ?

A

Fever
n/v

*sometimes you can be asymptomatic **

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11
Q

PE of mild Amebiasis?

A

Abd Distention

Hyperperistalsis ( active bowel sounds )

generalized abdominal tenderness

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12
Q

PE of severe Amebiasis ?

A

Prostrate

toxic with fever

Tenesmus ( pressure on the rectum that makes you feel like you need to have a bowel movement ; but you don’t have anything there it is just the pressure )

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13
Q

Diagnostic lab for Amebiasis? Results?

A

Stool O&P - cysts or

trophozoites

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14
Q

If severe: diagnostic lab for Amebiasis? Results?

A

Colonoscopy / Sigmoidoscopy - flask shaped ulcerations

Biopsy- Ulcers, trophozoites

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15
Q

If concern for abscess, especially liver, lab for Amebiasis? Results?

A

CT, MRI, ultrasound = Identify size and location of hepatic abscesses

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16
Q

Labs to consider for Amebiasis ? Results?

A

CBC - WBC count = Elevated, no eosinophilia

LFT - minimal changes

Serum antibodies - up to 10 years after infection, cannot be used to differentiate

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17
Q

Amebiasis CBC results?

A

WBC count is moderately elevated
but without eosinophilia

  • you don’t get the eosinophilia like most of the parasites we have ( because it is walled off so much)- more abscesses not like a diffuse infection -“more of an isolated thing”**
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18
Q

Amebiasis complications?

A

Cycles of remission and recurrence typical

Hepatic or pulmonary abscess
Rupture may be fatal

Ameboma– Localized ulcerative lesions of the colon and localized granulomatous lesions of the colon

Additional GI complications - Appendicitis, bowel perforation, fulminant colitis, massive mucosal sloughing, hemorrhage, bacterial infection, bleeding, and peritoneal spillage.

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19
Q

Amebiasis prognosis ?

A

good w/ tx

high mortality w/o tx

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20
Q

Amebiasis tx: all?

A

Luminal amebicide

  • (diloxanide furoate, iodoquinol, or paromomycin)**
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21
Q

Amebiasis mild infection tx?

A

luminal amebicide

Plus tinidazole or metronidazole ( Flagyl)

  • Tetracycline followed by chloroquine**
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22
Q

Severe Amebiasis tx?

A

IV hydration , electrolyte replacement

Plus Chloroquine

if not better in 3 days the I/D

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23
Q

Opoids decrease _____ motility and lower risk of _____ _________.

A

bowel motility

lower risk of toxic megacolon

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24
Q

Amebiasis Hepatic abscess tx?

A

luminal amebicide

tinidazole or metronidazole
followed by chloroquine

If no response within 3 days of initial treatment, incision and drainage

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25
Q

Parasite of Malaria?

A

Parasite is Plasmodium

Vivax

Malariae

Ovale

Falciparum - good prognosis , except for cases involving P. falciparum ( more severe case when it comes to exposure- more neurologic componet to it and anemic type symptoms more)

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26
Q

Malaria transmission is through the bite of the ________ mosquito?

A

Anopheles mosquito

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27
Q

Malaria incubation period ranges between _ and __ days

A

8-60 days

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28
Q

Malaria: once passed to humans ___________ invade hepatocytes and mature as tissue _________

A

sporozoites

schizonts

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29
Q

_________ escape the liver and invade ____, where they multiply and cause rupture of the RBC within __ hrs

A

Schizonts

RBCs

48 hrs

  • cycle of invasion, multiplication, and red blood cell rupture continues **
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30
Q

Hx of Malaria stages?

A

Stages:

  1. shaking chills (the cold stage)
  2. fever (the hot stage)
  3. diaphoresis (the sweating stage)

Patients are fatigued between attacks.

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31
Q

If you have malaria is there a release of Tissue necrosis factor?

A

Yes there is a release of TNF

because of

Fatigue
Headache
Dizziness
GI  complaints
Myalgias
Arthralgias
Backache
dry cough
32
Q

Malaria PE?

A

fever

rigors

hepatosplenomegaly

*best clinical indication = hepatomegaly for the entire process of the disease - even through the symptomatic an asymptomatic stages **

33
Q

Malaria screening? Results?

A

CBC - anemia, reticulocytosis, thrombocytopenia, leukocytosis or luekopenia

LFT - Elevated Bilirubin, elevated enzymes

34
Q

Malaria diagnostic lab?

A

Blood smear with Giemsa stain (or Wright stain) - diagnostic test of choice

Giemsa or Wright stain

examined at 8-hour intervals for 3 days during and between attacks

infected red blood cells ranges from 5% to 20%

35
Q

Malaria labs to consider?

A

Plasmodium abs

appear 8 to 10 days later

too late for diagnostic benefit in most cases

persist for 10 years, making the distinction between old and new infection difficult

36
Q

Malaria complications?

A

Infection with P. falciparum can be much more severe and can manifest as :

cerebral malaria
hemolytic anemia

hyperpyrexia
noncardiogenic pulmonary edema
acute tubular necrosis
adrenal  insufficiency,
cardiac dysrhythmias ( heart blocks )
37
Q

Malaria: uncomplicated initial tx?

A

Chloroquine - it lyses the parasite itself

used prophylaxtly if traveling to endemic areas

if chloroquine resistant… then use mefloquine

38
Q

Malaria: severely ill patients tx?

A

chloroquine, quinine, or quinidine IV PLUS

doxycycline OR
clindamycin

39
Q

malaria alternative tx drugs?

A

atovaquone and proguanil (Malarone)

Mefloquine

Hydroxychloroquine

atovaquone/doxycycline

40
Q

Toxo organism?

A

T gondii

41
Q

what is T gondii?

A

an obligate intracellular protozoan

42
Q

What is the most common host of toxo?

A

cats

43
Q

Humans are infected with toxo after ingestion of a _____ usually from undercooked ____ or contaminated by cats.

A

cyst

meat

44
Q

Toxo incubation period?

A

1-2 weeks

45
Q

Types of toxo?

A

Immunocompetent
Immunocompromised
Congenital

46
Q

Toxo Hx immunocompetent?

A

mild fever

malaise

47
Q

Toxo Hx immunocompromised?

A

encephalitis

chorioretinitis

Pneumonitis

48
Q

Toxo Hx congenital?

A 
Neurologic :
Seizures
psychomotor retardation  ( simple tasks - opening up a can or cap off the milk)
Deafness
Hydrocephalus

Retinochoroiditis

49
Q

Toxo PE immunocompetent?

A

Generalized tender lymphadenopathy

50
Q

Toxo PE immunocompromised?

A

Encephalitis– meningismus

Chorioretinitis
visual disturbance
Necrosis of retina

Pneumonitis– adventitious lung sounds

51
Q

Toxo PE congenital?

A

Neurologic

eye

52
Q

Toxo diagnostic labs? Results?

A

tissue culture: +

53
Q

Toxo screening during pregnancy lab?

A

IgG or IgM toxoplasmosis

54
Q

Toxo labs to consider?

A

Sabin-Feldman dye test
ELISA
indirect fluorescent antibody test
agglutination tests

*all these tests will be positive if the is a current Toxoplasmosis infection**

55
Q

Toxoplasmosis diagnostic criteria?

A

Exposure
Chorioretinitis
Tissue culture– +
Optional serologic tests (will be +)

56
Q

Toxoplasmosis complications?

A

Encephalitis

Retinochoroiditis

Congenital transmission

57
Q

Toxo tx if immunocompetent or uncomplicated?

A

no Tx necessary

58
Q

Toxo Tx if immunocompetent but significant symptoms?

A

pyrimethamine oral PLUS

sulfadiazine 2-4 weeks

59
Q

Toxo Tx if immunocompromised?

A

pyrimethamine oral PLUS
sulfadiazine 4-6 weeks

the sulfa component is just for a longer period

60
Q

Toxo Tx if pregnant and not transmitted to fetus?

A

Spiramycin - reduces frequency of transmission (does not cross the placenta)

61
Q

What pharmacologic agent do you want to add to you Toxoplasmosis Tx to prevent bone marrow suppression?

A

Folinic Acid

62
Q

Toxo Tx if pregnant and transmitted to fetus?

A

take complete regimen

63
Q

Patho of FUO?

A

Most cases represent unusual manifestations of common diseases

Usually not rare or exotic diseases

64
Q

Causes of FUO to consider?

A

Tuberculosis
Endocarditis
gallbladder disease
HIV

65
Q

what percent of fevers will relapse with no dx?

A

75%

66
Q

what percent of persistent fevers are unexplained?

A

15%

67
Q

Patho of FUO: most causes of FUO in adults?

A

Infections (25–40%)

Cancer (25–40%) - isolate cancers

Autoimmune (10–20%)

*PE is least common ( 20%)- 20% PE patients have fever **

68
Q

Patho of FUO: most causes of FUO in children?

A

Infections (30–50% of cases)

Autoimmune (10–20%)

Cancer rare (5–10% of cases)

69
Q

Hx and PE of FUO?

A

Fever

rest of exam is unremarkable

70
Q

FUO screening labs?

A

CBC

CMP

UA

71
Q

FUO if indicated labs to run?

A 
TSH
CXR
CSF- LP
PCR
Cultures of blood or urine
72
Q

Diagnostic criteria for FUO?

A

Fever over 38.3°C (100.9F)on several occasions

Illness of at least 3 weeks

Diagnosis has not been made after three outpatient visits or 3 days of hospitalization

73
Q

FUO Tx?

A

monitor closely

AVOID - steroids - b/c they suppress the immune system

74
Q

When to refer with FUO?

A

progressive weight loss

immunocompromised

75
Q

When to admit with FUO?

A

rapidly declining with weight loss

Neutropenic fever - 1500 neutropenic, 500 ( neutropenia)

Clinical Medicine Lecture - Professor Kramer (28 decks)

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