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Infectious Diseases > Lecture 4: Protozoan Infections > Flashcards

Lecture 4: Protozoan Infections Flashcards

1
Q

worms (hemlinths) vs protozoa

  1. which is unicellular?
  2. which is large?
  3. which causes infections in blood, tissue and intestines
A

worms (hemlinths) vs protozoa

  1. unicellular = protozoa
  2. large = worms
  3. infections in blood, tissue and intestines = protozoa
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2
Q

What are the 2 types of blood protozoa infections

A

Blood protozoa infections

  1. malaria
  2. Babesiosis
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3
Q

Blood Protozoa infections: Malaria

  1. what genus causes malaria
  2. name 4 types occuring in humans
    - which causes most deaths
A

Blood Protozoa infections: Malaria

  1. genus = plasmodium
  2. 4 types = P. vivax, ovale, malariae, + falciparum (most deaths)
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4
Q

Blood Protozoa infections: Malaria epidemiology

  1. where (country) do most deaths occur and in what age group?
  2. what other group is at incr risk for severe dz/death
A

Blood Protozoa infections: Malaria Epi

  1. Deaths MC in Africa and in < 5
  2. pregnant women = incr risk of severe dz + death
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5
Q

Blood Protozoa infections: Malaria Transmission

  1. what is the vector + definitive host for malaria
  2. humans = intermediate host, meaning what type of reproduction occurs

note: rare forms = blood transfusion, vertical

A

Blood Protozoa infections: Malaria Transmission

  1. vector = FEMALE mosquitos (anopheles)
  2. humans = intermed host –> asexual reproduction
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6
Q

How does the malarian parasite cause the cyclical fever seen w/malaria

A

parasite rel into blood –> rupture of RBCs –> cyclical fever

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7
Q

Uncomplicated Malaria (all species)

1. What is the pattern of fever paroxysms
3 steps
2. what is the fever accompanied by (3) ?

A

Uncomplicated Malaria (all species)

  1. Chills –> Fever –> sweats (cyclical w/high spikes)
  2. Fever a/w HA, N/V
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8
Q

Complicated Malaria

  1. what the MC species that causes this?
  2. what is this d/t
  3. why is considered a medical emergency
A

Complicated Malaria

  1. MC species = plasmodium falciparum
  2. d/t cytoadherence
  3. medical emergency b/c may cause death in 24 hrs
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9
Q

Pt presents w/ cyclical pattern of fevers with spikes as high as 40C. Pt also presents w/ seizures and opisthotonic posturing. w/ further testing black spots are seen in retinal vessels/brain.

What type of malaria is this?
What species is the cause

A

Cerebral Malaria

cause = P. falciparum

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10
Q

Pt presents w/ cyclical pattern of fevers. w/ further testing you note severe hemolysis, hemoglobinuria and renal failure

name of this d/o?
a/w with what species

A

dx = blackwater fever
(hemolysis, hemoglobinuria and renal failure)

cause = P. falciparum

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11
Q

Pt presents w/ cyclical pattern of fevers. On exam you note HSM, signs of shock, and resp distress. Labs show: pancytopenia, Hypoglycemia, acidosis, and incr AST, ALT + Cr

What type of malaria is this?

A

Dx = complicated malaria

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12
Q

Malaria and Resistance

  1. in malaria endemic areas does resistance develop quickly or slowly?
  2. what does incomplete resistance w/malaria mean?
  3. how does “semi immunity” occur?
A

Malaria and Resistance

  1. malaria endemic areas –> resis develops slowly
  2. incomplete resis = ppl have immunity to clinical manif but not to malaria infxn
  3. semi-immunity occurs w/constant exposure
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13
Q

Malaria and Genetic factors

  1. what is required on RBCs for P. vivax to bind/invade?
  2. what two traits are protective vs malaria
    - which protective vs P. falciparum
A

Malaria and Genetic factors

  1. Duffy antigen needed for P vivax to bind/invade RBCs
  2. Sickle cell trait + Beta thalassemia = protective vs malaria
    - sickle cell trait = vs P. falciparum specifically
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14
Q

Malaria and Pregnancy/other

  1. when is a pregnant women more at risk for death from malaria
  2. What is malaria a/w in pregnancy (3 things)
  3. what group other than preg women are at risk for developing severe death from malaria d/t lack of immunity
A

Malaria and Pregnancy

  1. preg women more at risk for death in 1st preg (lose resis)
  2. malaria a/w: anemia, LBW and infant mortality in preg
  3. non-immune adult travelers = risk for developing severe death from malaria d/t lack of immunity
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15
Q

2 main tests used to Dx malaria?

- what is seen w/each

A

Dx Malaria

  1. thick + thin blood smears –> parasite in RBCs
  2. Rapid diagnostic tests (RDT) –> test for parasite antigen in blood
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16
Q

Tx of malaria

  1. what drug is 1st line if no resistance to it?
  2. what is name of PO drugs given in combo
  3. what are the 2 drug options for sever malaria
  4. what is the tx regimen for P. ovale or vivax (2 drugs)
A

Tx of malaria

  1. Chloroquine = 1st line in sensitive areas
  2. ACT = artemisinin combo therapy
  3. severe malaria –> IV quinidine or IV artesunate (artemisinin)
  4. P. ovale or vivax –> chloroquine (for active phase) –> primaquine (tx hypnozoite phase)
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17
Q

what are the main 2 ways to prevent malaria in travelers

A

Prevention of malaria in travelers

  1. decr exposure to mosquitos (ITNs, insect repellent, cover skin)
  2. ppx (depends on area)
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18
Q

Control Strategies of Malaria for Endemic areas: ITNs

  1. why are they used
  2. what are some cons a/w w/them?
A

Control Strategies of Malaria for Endemic areas: ITNs

  1. used to decr mortality (in kids + preg)
  2. cons: uptake, cost, resistance, LLINs, re-tx needed Q6-12 mos
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19
Q

Control Strategies of Malaria for Endemic areas: IPTp (Intermittent Preventative Tx in preg)

  1. how many times ppx given while preg?
  2. what does it protect against? (2 things)

Note: also IPTi (for infants)

A

Control Strategies of Malaria for Endemic areas: IPTp (Intermittent Preventative Tx in preg)

  1. given > 2x while preg
  2. protects vs anemia + LBW
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20
Q

Control Strategies of Malaria for Endemic areas

  1. what is the name for vector control?
  2. main chemical used?
A

Control Strategies of Malaria for Endemic areas

  1. vector control = IRS (indoor residual spraying)
  2. MC chemical = DDT
    (others organophosphates, Pyrethroids, carbamates)
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21
Q

Babesiosis

  1. what is the MC type of species that infects humans in US?
  2. how is this dz mainly transmitted? (gen + spp)
  3. what animal is the reservoir for this dz
A

Babesiosis

  1. MC species infecting humans in US = B. microti
  2. transmission = tick (lyodes scapularis)
  3. resevoir = white-footed mouse
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22
Q

Pt w/ functional asplenia due to sickle cell dz travels to Cape Cod and develops a fever, chills, fatigue, and HA.
On blood smear you see maltese cross pattern.

Dx?

note: other endemic area = midwest
note: other groups at high risk = elderly, HIV +

A

Dx = Babesiosis

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23
Q

what dz other than Babesiosis involves tick lyodes scapularis
- conseq of this?

A

Lyme Dz –> can get co-infected w/both

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24
Q

What are the complications of Babesiosis

A

complications of Babesiosis

  1. ARDs
  2. hemolysis
  3. CHF
  4. Renal failure
  5. death
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25
Q

Tx of Babesiosis: severe or symptomatic dz

  1. what are 2 combo options (2 drugs each)
  2. what if pt is HIV +
  3. how do you r/o co-infection w/lyme dz
A

Tx of Babesiosis

  1. tx options - Atovaquone + azithromycin or…
    clinda + quinine
  2. HIV + –> long term suppressive Tx
  3. r/o co inf w/lyme dz by serology for borrelia burgdorferi
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26
Q

what protozoa has an owl eyed faced, pear shaped, flagellated trophozite

A

Giardiasis (Giardia intestinalis or lamblia)

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27
Q

What is the reservoir for Giardia

A

beavers –> “beaver fever

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28
Q

Pt coming back from camping trip and is now c/o of abd cramping + bloating, nausea, wt loss, malaise and anorexia. He says recently his stool has been loose, foul smelling. on fecal examination you notice trophozites and cysts in the stool

Dx?

A

Giardiasis (Giardia intestinalis or lamblia)

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29
Q

what are the 3 main ways to test for/dx Giardia

A

Dx Giardia

  1. fecal examination
  2. fecal antigen test
  3. PCR
30
Q

2 major abxs used to tx Giardia

A

tx Giardia

  1. Metronidazole
  2. Tinidazole - one dose
31
Q

What is the pathogenic bug that causes amoebiasis?

- can you differentiate it from the non-pathogenic bug on microscopy?

A

Amoebiasis

  • pathogenic bug = entamoeba histologica
  • CANNOT be differentiated from non-pathogenic bug on microscopy
32
Q

Amoebiasis

  1. where is it MC?
  2. What 2 groups is it MC seen in for the US?
  3. what is the route of transmission?
A

Amoebiasis

  1. MC in tropically areas w/crowded living conditions + poor sanitation
  2. US = MC in hispanic males + immigrants (asia, pacific islands)
  3. transmission = fecal oral
33
Q

30 y/o male Hispanic pt presents w/ gradual onset of diarrhea, abd pain, wt loss, fever, and dysentery. On rectal exam you obtain and + heme stool sample

Dx?

A

Dx = Amoebic colitis

34
Q

immigrant for pacific islands presents w/diarrhea, abd pain, wt loss, fever, jaundice and cough for past 4 wks. on exam you note Hepatomegaly and aspiration reveals “anchovy paste”

dx?
cause?

A

Dx = liver abscess

cause = amoebiasis

35
Q

What is the main way of dx Amoebiasis + why?

A

Main Dx = stool antigen detection

- can differentiate b/t 2 species

36
Q

Tx for invasive amoebiasis (colitis, liver abscess)

  1. drug for active phase
  2. drug for cysts

what is the only drug given for Asx pts?

Note: also give fluids

A

Tx for invasive amoebiasis (colitis, liver abscess)

  1. drug for active phase = Metronidazole
  2. drug for cysts = luminal agent

Asx = luminal agent only

37
Q

Which intestinal protozoa is transmitted person to person (day care), zoonotic (farm + animal handlers) and waterborne via swimming pools + public drinking water

A

Crpytosporidium parvum

38
Q

Intestinal Protozoa: Crpytosporidium parvum

  1. what 2 groups is it MC in?
A

Intestinal Protozoa: Crpytosporidium parvum

MC in kids and HIV + pts

39
Q

5 y/o kid presents with chronic, watery diarrhea, wt loss, abd pain, fever, N/V and FTT. On exam you note signs of dehydration. You perform a modified acid test that comes back (+) for red, round protozoa

Dx?

A

Crpytosporidium parvum

40
Q

HIV (+) pt presents w/ chronic watery diarrhea, wt loss, abd pain, fever and N/V. You check is CD4 count and it is 150

Dx?

A

Crpytosporidium parvum

41
Q

Crpytosporidium parvum

Other than Modified acid fast test, what other type of microscopy test can be used to Dx Crpytosporidium parvum?

2 antigen tests?

A

Direct immunofluorescence

2 antigen tests

  • EIA
  • PCR
42
Q

Tx of Crpytosporidium parvum

  1. if the pt has HIV
  2. Otherwise give?
A

Tx of Crpytosporidium parvum

  1. if the pt has HIV–> ARVs
  2. Otherwise –> Nitazoxanide
43
Q

What are the 2 types of dzs caused by Trypanosomiasis

A

Trypanomiasis Diseases

  1. HAT - Human African Trypanosomiasis
  2. Chagas Dz (American Trypanosomiasis)
44
Q

Trypanosomiasis: HAT

  1. what are the names of the 2 types of HATs caused by Trypanosoma brucei
  2. what is the vector for HAT (how transmitted to humans)
A

Trypanosomiasis: HAT

  1. Gambesian HAT and Rhodesian HAT
  2. Vector: Tsetse fly
45
Q

Trypanosomiasis: HAT 2 types (Rhodesian + Gambian)

  1. which type occurs in West Africa + no animal reservoir
  2. which type occurs in East Africa w/ cattle reservoir
A

Trypanosomiasis: HAT 2 types (Rhodesian + Gambian)1.

  1. occurs in West Africa + no animal reservoir = Gambian HAT
  2. occurs in East Africa w/ cattle reservoir = Rhodesian
46
Q

Trypanosomiasis: HAT 2 stages of illness

  1. where are the tryps found in the early stage + what lesion characterizes this stage/where
  2. where are tryps found in late stage
  3. what does the late stage lead to? and therefore HAT is called ______
A

Trypanosomiasis: HAT 2 stages of illness

  1. early stage –> tryps in blood + LNs (enlarged)
    - painless chancre at site of bite
  2. Late stge –> tryps in CSF
  3. Late stage –> coma + death –> “ Sleeping Sickness”
47
Q

Winterbottom’s Sign in HAT

  1. what is it
  2. a/w Gambian or Rhodesian HAT
A

Winterbottom’s Sign

  1. posterior cervical adenopathy
  2. a/w Gambian HAT
48
Q

Pt presents w/ intermittent fever, posterior cervical adenopathy, constant HAs, diurnal somnolence, nocturnal insomnia, behavior changes, and wasting. Sxs present over 6 months

Which type of HAT is this?

A

Gambian HAT

49
Q

What is the difference b/t Gambian and Rhodesian HAT

A

Rhodesian HAT develops more rapidly than Gambian (weeks vs mos-yrs)

50
Q

Dx HAT

  1. Microscopy w/Giemsa staining
    - what 2 things taken as samples
    - what do you test in late stage dz
  2. what test can ONLY be used for Gambian HAT
A

Dx HAT

  1. Microscopy w/Giemsa staining
    - samples from LN aspirate or blood
    - late stage dz –> test CSF
  2. Test ONLY be used for Gambian HAT
    - CATT agglutination/blood test
51
Q

Trypanosomiasis: Chagas Dz

  1. what is the cause
  2. where is dz burden highest (2 places)
  3. classic name given to vector of this dz (and real name of MC)
  4. Vector’s ideal habitat
A

Trypanosomiasis: Chagas Dz

  1. cause = Treponema cruzi
  2. dz burden highest = Subcentral/south Am
  3. vector = “kissing bug” (Triatoma MC) or Rhonius
  4. Vector’s ideal habitat = adobe houses/roofs; b/t bricks
52
Q

Trypanosomiasis: Chagas Dz

  1. what 2 signs a/w ACUTE dz
  2. what 3 things a/w CHRONIC dz
A

Trypanosomiasis: Chagas Dz

  1. ACUTE = Chagoma, Romana’s sign
  2. CHRONIC = CHF, dilated cardiomyopathy, Mega colon/esophagus
53
Q

Trypanosomiasis: Chagas Dz (acute)

  1. what is a Chagoma
  2. what is Romana’s sign
A

Trypanosomiasis: Chagas Dz (acute)

  1. Chagoma = indurated/inflam nodule at bite site
  2. Romana’s sign = unilat periorbital swelling
54
Q

Trypanosomiasis: Chagas Dz Dx

  1. what test can be used to Dx acute AND chronic
  2. what test is spp used to Dx acute
  3. what test is spp used to Dx chronic
A

Trypanosomiasis: Chagas Dz Dx

  1. Test to Dx acute AND chronic = PCR
  2. Test to Dx acute = microscopy
  3. Test to Dx chronic = serology (IgG for T.cruzei)
55
Q

Trypanosomiasis: Chagas Dz Tx

  1. class of drugs used for Tx? general length of Tx needed? effective?
  2. what other 2 Tx options avail?
A

Trypanosomiasis: Chagas Dz Tx

  1. drug class = antiparasitic drugs, not very eff (long duration, mos)
  2. 2 other Tx options
    - pacemaker
    - heart transplant
56
Q

Pt living in South Am in adobe house presents w/ malaise, fever, unilateral R eye swelling and inflamed nodule on her R eye. Further workup reveals myocarditis and ECG changes.

Dx?

A

Dx = Acute Chagas Dz

57
Q

Pt living in South Am in adobe house presents w/ CHF. Further workup reveals that dilated cardiomyopathy also present. on XR you see dilated esophagus and colon

Dx?

A

Dx = chronic Chagas dz

58
Q

Leishmaniasis

- vector for this dz?

A

Leishmaniasis

- vector = female sandfly

59
Q

Leishmaniasis

- what are the 3 major types of it?

A

Leishmaniasis

  1. Visceral Leishmaniasis (VL)
  2. Cutaneous Leishmaniasis (CL)
  3. Mucocutaneous Leishmaniasis
60
Q

What is the name of the main type of VL

A

Kala-azar

61
Q

Leishmaniasis: VL/Kala-azar

  1. 2 countries MC in
  2. what type of infxn is it in HIV/AIDS pts
  3. what is reservoir
  4. what types of cells does it invade/where
A

Leishmaniasis: VL/Kala-azar

  1. MC in = india + sudan
  2. opportunistic infxn in HIV/AIDS pts
  3. reservoir = dogs
  4. invades phagocytes in liver, LN, bone marrow
62
Q

Leishmaniasis: VL/Kala-azar

- invades phagocytes in liver, LN, bone marrow –> causing _______

A

Leishmaniasis: VL/Kala-azar
- invades phagocytes in liver, LN, bone marrow –> causing
skin rxn

63
Q

3 y/o Pt in India presents w/ fever, wt loss, HSM, and hyperpigmentation. PE reveals HSM. Labs reveal pancytopenia and hypergammaglobulinemia

Dx?

A

dx = Kala-azar (VL)

64
Q

Leishmaniasis: VL/Kala-azar

  1. main way to Dx? (w/what 2 things as samples?)
    others: microscopic visualization of amastigotes and serology
A

Leishmaniasis: VL/Kala-azar

  1. main way to Dx = PCR of blood or Bx
65
Q

Leishmaniasis: VL/Kala-azar

  1. ToC in US

note untreated –> death

A

Leishmaniasis: VL/Kala-azar

  1. ToC in US = amphotericin B
66
Q

Pt who initially had an small erythematous papules w/ an ulcer on his hand that has since healed. He now has a raised, bordered scar. Initially he had no pain but now says he has pain at the site.

Dx?

A

Dx = CL (Cutaneous Leishmaniasis)

67
Q

CL (Cutaneous Leishmaniasis)

- main way to Dx it?

A

Main way to Dx = Bx

68
Q

Tx for CL

- mild vs mod dx: flip over to see (lot)

A

Tx for CL

  1. mild dz
    - topical paromoycin
    - heat therapy
    - intralesional antimony
  2. mod dz
    - pentavalent antimony
    - Flu/Ketoconazole
    - PO miltefosine
69
Q

What is the dz a/w only the species L. braziliensis, which is only located in central/south america

A

Mucocutaneous Leishmaniasis

  • only species = L. braziliensis
70
Q

Pt presents w/destructive mucosal lesions in mouth and nose. Years ago the patient had cutaneous lesions that have since resolved.

Dx?

A

Mucocutaneous Leishmaniasis

Infectious Diseases (9 decks)

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