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MID EXAM 2 > Intestinal Nematodes > Flashcards

Intestinal Nematodes Flashcards

1
Q

Burden of neglected tropical diseases

A

affect the 1.4 billion people who live on little or no money, usually by contact with contaminated soil or water.

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2
Q

Mortality from the NTDs is related to… ?

A

parasite burden/polyparasitism. It is common for a school aged child living in a rural area of the tropics to be infected with all three of the most prominent soil transmitted helminths (STHs).

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3
Q

The three major STH infections are

A

The Unholy Trinity

  • Ascariasis- caused by roundworm >800 million cases
  • Trichuriasis- caused by whipworm >600 million cases
  • Hookworm- caused by hookworms, >500 million cases
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4
Q

How do STH infections promote poverty?

A

They are often CHRONIC, so worms survive in the GI tract for years resulting in

1) physical growth retardation
2) intellectual and cognitive delays
3) Cause adverse pregnancy outcomes
4) Reduce productive capacity/worker productivity

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5
Q

Common features of STH infections

A

Blood esosinophilia (most of the time) and tx with BZAs

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6
Q

MOA of BZAs, the name of the two options and when to use which one

A

MOA: binds to helminth specific tubulin.
Mebenedazole: not absorbed from GI tract, so used to treat intestinal nematodes
Albendazole: metabolite is absorbed from GI tract, used for systemic infections

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7
Q

What are Nematodes?

A

Roundworms!
Classification of parasites goes: Helminths or protozoa
Helminths breaks down into Nematodes, trematodes, and Cestodes

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8
Q

Intestinal Nematodes:

A 
Ascaris Lumbricoides
Hookworm
Trichuris trichiura
Enterobius vermicularis
Strongyloides stercoralis
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9
Q

How long do Intestinal helminths survive in host?

A

Years, but do not generally reproduce w/in human host- they can mate but must have part of the life cycle outside the host and get reintroduced (strongyloides and echinococcus are exceptions)

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10
Q

What causes Eosinophilia?

A

The tissue migration phases of helminths

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11
Q

Ascaris lumbricoides life cycle

A

1) Ingest egg
2) stomach acid releases larvae and they are absorbed in deodenum
3) moves into blood/circulation where they are carried to the LUNGS
4) mature further in the lungs, penetrate alveolar walls, ascend the bronchial tree to the throat and are swallowed back down
5) develop in small intestines where they can live up to two years, mate, and release more eggs in the fesces

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12
Q

Ascaris lumbricoides symptoms

A

1) usually asymptomatic
2) pulmonary phase- asthma like phase, migration phase; also called Loeffler’s pneumonitis- EOSINOPHILIC
3) If there’s high worm burden there may be abdominal pain and intestinal obstruction

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13
Q

Ascaris Lumbricoides worm migration sx

A

Eosinophilic, biliary obstruction and & oral expulsion; also pancreatitis and cholangitis

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14
Q

Ascaris Chronic ix signs

A

impaired nutrition and gwoth retardation

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15
Q

Ascaris dx

A

microscopic demonstration of ova in fecal sample
OR
after treatment visualization of adult worms

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16
Q

Ascaris tx

A

SINGLE DOSE of oral antihelminthic drug recommended by WHO (just tell us the drug??)

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17
Q

Fun Ascaris egg facts

A
  • extremely hardy and resistant to dessication/heat

- females lay 200,000 eggs a day

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18
Q

Trichuris trichura type of worm

A

Whipworm!

19
Q

Life cycle of Trichuris trichura

A

No migration phase, once they are ingested they stay in the colon where they embed in the mucosa. Up to 4cm long and females lay 4-20k eggs a day

20
Q

Trichuris sx

A

Usually asymptomatic, but with heavy ix, sequelae include:

1) Trichuris dysentery syndrome
2) trichuris colitis
3) recotal prolapse

21
Q

Trichuris dx

A

Eggs in feces- Bipolar plugs

22
Q

Trichuris tx

A

Oral anthelminthic drug: Albendazole, mebendazole, or ivermectin- upt to 3 days for heavy ix

23
Q

HOOKWORM SPECIES—- Diem’s said know these and how long their chronic ix last

A

1) Necator americanus- 3-5 years

2) Ancylostoma duodenale- 1 year

24
Q

Which species is more common?

A

Necator- the one with the cutting plates mouth In some places, the entire population has hookworm. About 25% of the world’s poor has it, $22 million DALYs lost annually

25
Q

Hookworm life cycle

A

1) larvae in soil, PENETRATE SKIN (do not ingest), enter bloodstream, reach heart, lung capillaries
2) Larvae enter alveolar spaces, migrate up trachea, are swallowed
3) adults mature in small intestine, mate, eggs go into feces, end up on soil/grass, lather, rinse, repeat.

26
Q

Hookworm Infection sx

A

1) BLOOD LOSS- 25 necator worms = 1mL intestinal blood loss/day= .55 mg Fe=pediatric daily iron requirement
IRON DEFICIENCY ANEMIA and protein malnutrition

27
Q

Hookworm blood loss is proportional to what?

A

Worm burden

28
Q

At risk populations for hookworm

A

1) children 2) women of child-bearing age

29
Q

Pediatric Hookworm disease progression

A

1) Iron deficiency anemia, Protein malnutirion
2) growth stunting, impaired intellectual dev’t, memory/cognition, reduction in school attendance/performance
3) impact on health, education and economic development

30
Q

Hookworm dx

A

fecal examination

31
Q

Hookworm tx

A

single dose of anthelminthic drug

32
Q

WHO resolution for STH

A

regular treatment of high risk groups- school aged children, they’re likely to get reinfcted within 4 months so just treat again. Also, the Diems is working on a vaccine

33
Q

Cutaneous Larva Migrans bug/location and tx

A

Ancylostoma caninum/braziliense- dog/cat hookworm also called “creeping eruption” … google a pic, it’s a creepy creeping, itching, painful eruption. Common in people returning from overseas and in Florida/Gulf Coast- same single dose anthelminthic

34
Q

Strongyloidiasis bug and epi

A 
#4 most common STH, usually Strongyloides stercoralis. Found in tropical in subtropical regions pretty much in every continent accoridng these stupid notes. Also, Appalachians of US (think strong Appalachian man, yummy!)
Reservoir: dogs and non-human primates
35
Q

Strongyloidiasis life cycle

A

1) larvae penetrate intact skin like with hookworms
2) do the creepy penetrate the intestines, to the lung, creep up, swallow thang
3) Diemert noted that the female don’t need no man,they strong beezys- parthenogenesis. look it up if you care.

36
Q

Strongy Sx (this is a doozy)

A

Infection is usually low grade unless you are immunosupressed then you get”
1) Mild GI sx, abdominal pain, diarrhea
2) Larva currens: rash secondary to larval migration through skin ESPECIALLY cristal’s fave- perianal skin
3) pulmonary migration phase- dyspnea, cough wheeze, EOSINOPHILIA, MIGRATORY infiltrates on CXR
4) Hyperinfection- severe versions of all the sx above
5) dissemination- the migrating wormys carry intestinal bacteria with them and cause sepsis! with metastatic abscesses, gram (-)meningitis
THIS IS ALL TO SAY, MORTALITY IS HIGH unless treated early

37
Q

Strong dx

A

Eosinophilia + fecal microscopy or agar plate tacking migrating larvae

38
Q

Strongy Prevention/control

A

Prevention: improve sanitation, minimize skin contact with contaminated soil (why am i even typing this, so obvious)
Hyperinfection prevention: screen before immunosuppresion or if HTLV-1 +

39
Q

Enterobius Vermicularis Life Cycle

A

Heather ingested the eggs sucking on her thumb, then the larva hatched and hung out in her intestines til it went to her anus to lie some eggs on her perianum. She then scratched her butt and put her thumb back in her mouth.

40
Q

Enterobius vermicularis sx

A

Itchy butt and therefore restless itchy butt sleep and vaginal ix

41
Q

Enterobius vermicularis dx

A

I got scotch tape and put it on her butt, 3x

42
Q

Enterobius vermicularis tx

A

antehelminthic drug- single dose, REPEAT IN 2 WEEKS and treat all family members

43
Q

Toxocariasis- Dog or cat Ascarsis Syndromes

A

humans are infected incidentally- usually dog or cat ascaris

1) Visceral larva Migrans- 1-3yrs old, pneumotitis, hepatitis, Eosinophilia, sx resolve in 4-8 wks
2) Ocular Larva Migrans- >5yrs old- eye stuffs that can result in permanent blindness

44
Q

Anisakiasis

A

1 day after eating sushi- this usually affects big fish but then we eat it raw and get intense pain, then the wormy dies

MID EXAM 2 (11 decks)

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