L29- Blood and Lymph Pathology II

Question 1

Filariasis is caused by (1) via (2) transmission, commonly in (3) geographical areas.

Answer 1

1- microfilarial nematode (thin, filamentous)
2- arthropod vectors (black flies, mosquitoes)
3- tropical disease, worse in Africa and Brasil, all N. American cases are imported

Question 2

In filariasis, parasites enter the body to interfere with (1) function and cause (2) type damage in their associated organ. It is known to cause (3) specifically.

Answer 2

1- lymphatic function
2- inflammation => damage
3- elephantiasis

Question 3

list the types of filariasis

Answer 3

Lymphatic: Wuchereria bancrofti, Brugia malayi, Brugia timori

Subcutaneous: Loa loa, Onchocerca volvulus

Serous cavity: Mansonella spp.

Question 4

W. bancrofti is transmitted via (1) and infects humans in the (2) form. (2) form will travel to (3) in humans to develop into (4) and return to (5) in order to start producing (6). (1) will ingest (5) and (6) during feeding and allow (6) to develop back into (2) to prepare for another infection.

Answer 4

1- mosquitoes
2- L3 stage filarial larva
3- lymphatics
4- adult males/females worms
5- blood / lymph
6- sheathed microfilariae

Question 5

Lymphatic Filariasis has (1) as the main clinical feature and (2) as the main sign in blood.
Other clinical features:
-(3) can occur in people with improper function lymph systems
-(4) are common feature affecting skin appearance
-(5) can occur in men
-(6) can occur in Asia

Answer 5

1- asymptomatic
2- microfilariae
3- lymphangitis, lymphadenitis, febrile illness
4- bacterial / fungal infections –> hardening/thickening of skin –> elephantiasis
5- hydrocele
6- lung infection (pulmonary tropical eosinophila syndrome): cough, wheezing, fever, eosinophilia

Question 6

Lymphatic filariasis infections are usually acquired during (1) age. Subclinical lymphatic damage may be noted on (2). (3) is the most important clinical sign to noted in these patients. There is also an increased risk for (4). Overall, repeated (3) episodes and (4) may be superimposed to cause the conversion of (5) in lymphatic filarasis to (6).

Answer 6

1- childhood
2- lymphoscintigraphy, US
3- filarial fevers: acute inflammatory episodes
4- recurrent acute bacterial infections (due to fungal infection, cuts, scrapes, poor hygiene)
5- lymphedema
6- elephantiasis

Question 7

Filariasis Dx

Answer 7

Conventional: thick blood film and membrane filter concentration (filter blood to concentrate parasites on slide)

Recent: IFA, ELISA, PCR / DNA probes, US, lymphoscintigraph

Question 8

Filariasis Tx and prevention

Answer 8

Tx:

• anti-filarials
• surgery for hydrocele
• antibacterial / antifungal Tx for elephantiasis

Control: avoid mosquitoes via personal protection + community level vector control

Question 9

Most tick-borne diseases harbor _____ type infections

Answer 9

• bacterial

- viral and protozoa are present, but rarer

Question 10

Babesiosis is caused by (1), which is (non-/motile) and is transmitted via (3). (4) is the main species found in NE and Midwest US. The main reservoirs are (5).

Answer 10

1- Babesia spp., protozoa (parasite)
2- non-motile
3- deer tick
4- Babesia microti
5- dogs, deer, cattle, goat, sheep, horses, rodents (humans are accidental, dead end hosts)

Question 11

Babesia microti:

• (1) are the definitive hosts that spread it, and is found in the (2) forms
• (1)/(2) will infect (3), the main reservoir, where (2) will feed on (4) and then produce (5)
• (6) part of (5) can infect (1) upon its blood meal and form (2) inside (1)

Answer 11

1- deer ticks
2- sporozoites
3- rodents (or other hosts- note humans are dead end hosts)
4- erythrocytes
5- (reproduce asexually) –> trophozoites, merozoites
6- merozoites –> male/female gametes [taken by (1) and converted into (2)]

Question 12

Babesiosis clinical features:

• symptoms are mostly described as (1)
• (2) incubation period
• (3) patients may develop life-threatening disease

Answer 12

1- non-specific, mild-to-moderate viral-like illness that is self-resolving
2- 1-4 wks
3- asplenic Pts, immuno-compromised, organ damage/failure, elderly

Question 13

Babesiosis clinical features:

list the possible complications

Answer 13

• low/unstable BP
• severe hemolytic anemia
• thromboytopenia
• DIC, or consumptive coagulopathy
• organ failure / damage
• death

Question 14

Babesiosis Dx:

• (1) is the technique, indicate why it maybe misdiagnosed
• (2) describe Babesia appearance
• (3) is necessary for confirmation of Dx

Answer 14

1- blood smears: often misdiagnosed as malaria –> RBCs will appear similar

2- Babesia microti appears w/in RBCs as pear-shape / elliptical form (rarely as tetrad / maltese cross)

3- IFA (at CDC lab)

Question 15

Babesiosis Tx and prevention

Answer 15

Tx: antibiotics, quinine

Control: avoid ticks and skin exposure, insect repellents, full-body exams, removal of ticks from clothes / pets

Question 16

describe Plasmodium and list the relevant species

Answer 16

(for malaria)
-non-motile protozoa

-P. malariae, P. falciparum, P. vivax, P. ovale

Question 17

plasmodium / malaria is spread via…..

Answer 17

Female Anopheles mosquito

Question 18

Malaria will present with (1) symptoms and (2) as its hallmark feature. (3) will occur as a result of protozoal feeding which will eventually lead to (4).

Answer 18

1- (flu-like sxs) fever, HA, muscle pain, nausea
2- periodic cycles of chills, high fever, rigors/cold feeling (paroxysms) every 48-72 hrs
3- RBC lysis
4- splenomegaly

Question 19

describe Sxs of malaria on day 1

Answer 19

1) COLD: dry skin, pale, cold, rapid pulse, low volume (1 hr)
2) HOT: high fever, full rapid-bounding pulse (2-6 hrs)
3) sweating (2-4 hrs, as fever declines)

Question 20

(1) species of plasmodium are related to Benign tertian, where (2) is the more prevalent species of (1). (1) will usually infect and feed on (3). (1) are able to produce this effect because of (4) property, which occurs every (5- time)

Answer 20

(dormant in liver- allows for periodic symptoms)
1- P. vivax, P ovale
2- P. vivax
3- immature RBCs (as opposed to mature RBCs)
4- hypnozoite reforms and lies latent in liver
5- 48 hrs

Question 21

P. malariae causes (1) malaria and infects (2). Although (3) is unable to occur, (1) occurs and is described as (4).

Answer 21

1- Quartan malaria
2- mature RBCs
3- relapse after eradication (no hypozoites form)
4- 72hr cycl`e paroxysms

Question 22

P. falciparum causes (1) malaria and infects (2). (1) is characterized by (3).
-(4) are serious complications that can develop + (5) in the brain and (6) in the kidney

Answer 22

1- malignant tertian malaria
2- immature and mature RBCs
3- daily cycles of fever, sweating, shaking chills

4- severe hemolytic anemia, shock
5- blocks cerebral blood flow => coma, death (cerebral malaria)
6- (damage = ‘Blackwater fever) darkened urine

Question 23

Malaria Dx:

• (1) species are clinically difficult to diagnose
• Dx in non-endemic areas requires (2) signs / components
• Dx in endemic areas requires (3) signs / components
• (4) list the direct diagnostic testing

Answer 23

1- P. vivax, P. falciparum
2- fever, anemia, hepatosplenomegaly (+ travel)
3- age, transmission patterns

4:

• Molecular: PCR, detects parasitic nucleic acids
• Rapid Tests: IFA, ELSA (parasitic Ag)
• **blood smear: contains parasites (GOLD standard)
• thick/thin smears

Question 24

(1) is the gold standard test for malaria diagnosis. Blood samples are taken at (2) point and prepared in (3) and (4) fashion with (5) stains.

Answer 24

1- blood smear
2- between paroxysms episodes
3- thick film: assessment of more infected RBCs, more sensitive
4- thin film: single RBC visualization to identify internal features (ring forms, gametocytes)
5- Giemsa, Wright’s stains

Question 25

list the P. falciparum complications:

• (1) kidney
• (2) liver
• (3) lungs
• (4) GIT
• (5) brain, + mortality rate and results in children

Answer 25

1- ARF
2- jaundice, fever
3- pulmonary edema
4- v/d

5- cerebral malaria: delirium –> coma –> death

• 20% case fatality in this complication
• 10% of children that survive cerebral malaria => long-term neuro-psychological deficits

Question 26

Malaria:

• (inc/dec) incidences in pregnant women because of (2)
• (3) are the possible complications in mother, and fetus- due to (4)

Answer 26

1- increase
2- mosquitoes are more attracted to pregnant women
3- maternal mortality, abortion, still birth, premature delivery, low birthweight
4- vertical transmission

Question 27

list the natural genetic protections against malaria and include the 1 acquired immunity

Answer 27

Genetic:

• SCD, α/β-thalassemia, G6PD deficiency
• hemolytic anemia
• Duffy Ag mutation

Acquired: repeated malarial infections => semi-immunity / partial immunity => absence of typical malarial symptoms