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CM 1B: ID/EENT > Lecture 9: Parasitic Diseases > Flashcards

Lecture 9: Parasitic Diseases Flashcards

1
Q

What is the main cause of amebic dysentery?

A

Entamoeba histolytica

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2
Q

What is the transmission of amebic dysentery?

A

Fecal-oral, ingestion of cyst form.

Worldwide, mainly in subtropical/tropical

Crowding, poor sanitation, poor nutrition

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3
Q

What are the main hosts for amebic dysentery?

A

Humans

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4
Q

How does mild-moderate amebic dysentery present?

A

Gradual onset diarrhea, abd pain, bloating, AFEBRILE.

PE: Abd distension & tenderness, hyperperistalsis, hepatomegaly

Microscopic hematochezia common

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5
Q

How does moderate-severe amebic dysentery present?

A

Colitis, dysentery with 10-20 bloody stools/day
FEVER, prostration, abd pain, vomiting
PE: abd distension & tenderness, hepatomegaly, hypotension.

Hematochezia common.

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6
Q

Who is severe amebic dysentery MC in?

A

Young children
pregnant pts
malnourished
steroids

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7
Q

What are intestinal complications common in amebic dysentery?

A

Necrotizing colitis, intestinal perforation, mucosal sloughing, hemorrhage, death

Chronic diarrhea with weight loss, bowel ulcerations, amebic appy

Amebomas: localized granulomatous lesions.

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8
Q

What is the extraintestinal complication in amebic dysentery?

A

Amebic liver abscess.

MC in men, causes wt loss and anorexia.

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9
Q

What are the tests for checking for intestinal amebic dysentery?

A

Stool microscopy/O&P - E. histolytica

Preferred:
Stool antigen
Stool PCR

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10
Q

What are the tests for checking hepatic abscess?

A

Anti-amebic antibodies: almost always +

Stool O&P: usually -

Imaging: US or CT liver

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11
Q

What is the treatment for amebic dysentery?

A

Metronidazole (10d) or tinidazole (3d) for trophozoites

Paromomycin (7d) for cysts (PO aminoglycoside)

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12
Q

What causes giardiasis?

A

Giardia lamblia (smiley face protozoa)

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13
Q

How is giardia transmitted?

A

Fecal-oral
MC intestinal protozoan in the US.

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14
Q

What are the risk factors for giardia transmission?

A

Endemic areas: tropical regions
Swallowing dirty water
MSM
Immunocomped

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15
Q

What is giardiasis sometimes called? Why?

A

Beaver fever

Humans, dogs, cats, numerous wild animals are all hosts.

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16
Q

What does symptomatic giardiasis look like?

A

Acute diarrheal syndrome with no vomiting and afebrile. Watery diarrhea only.

Chronic diarrheal syndrome with greasy/frothy diarrhea . No fever or vomiting.

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17
Q

How is giardiasis diagnosed?

A

Stool O&P for cysts and trophozoites without blood/leukocytes.

Preferred:
Stool antigen assay
Stool PCR

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18
Q

How is giardiasis treated?

A

Main: Tinidazole x1 dose

Nitazoxanide for pts 1-3

Metro for infants < 1

TNM

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19
Q

What is nitazoxanide used for? Main SE?

A

Cryptosporidium and giardia.

Only for young pts
Can cause yellow green urine

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20
Q

What two protozoa cause cryptosporidiosis?

A

Cryptospodirium parvum
Cryptosporidium hominis

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21
Q

How is crypto transmitted?

A

Ingestion of oocyst

Swimming pool outbreaks are MC.
MC in HIV+

swimming in crypto

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22
Q

What is unique about crypto survival?

A

Can survive in chlorinated water

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23
Q

How does acute crypto infection present?

A

Watery diarrhea
low-grade fever

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24
Q

How does chronic crypto infection present?

A

chronic diarrhea in AIDS pts.

Foul-smelling stool
Malabsorption and weight loss
Extraintestinal disease

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25
What two things appear in extraintestinal disease in a crypto infection?
Biliary tract infection Sclerosing cholangitis CBS
26
How is crypto diagnosed?
Stool O&P with acid fast stain. Stool antigen assay Stool PCR
27
How is crypto treated?
Acute is supportive and self-limiting. Can use nitazoxanide or paromomycin.
28
What causes cyclosporiasis?
Cyclospora cayetanensis
29
What is the MC transmission of cyclosporiasis?
Foodborne outbreaks in the US from imported produce.
30
How does symptomatic cyclosporiasis present?
Flu-like prodrome phase Watery diarrhea Fever only 1/4 of pts. 2+ weeks Note: Cyclo = cycles, Prodrome and then diarrhea
31
How does cyclosporiasis present in immunocomped pts?
Severe and prolonged Chronic and fulminant watery diarrhea
32
How is cyclosporiasis diagnosed?
Preferred: Stool microscopy/O&P with acid-fast stain Colonoscopy with biopsy. No rapid antigen test! cycle fast
33
What is the first-line treatment for cyclosporiasis?
Bactrim x10 days. Also used as prophylaxis in AIDS. Cycle back
34
What are the second-line treatments for cyclosporiasis?
Cipro Nitazoxanide (not as well studied) (good for sulfa allergy pts)
35
What causes trichomoniasis?
Trichomoniasis vaginalis
36
How is trichomoniasis transmitted?
STI Very common cause of GU infections MC in women, esp. non-hispanic black females.
37
Who is recommended to get annual screenings for trichomoniasis?
HIV+ and high-risk females
38
How does symptomatic trichomoniasis present in females?
Frothy, green, yellow non-malodorous vaginal discharge. Vulvovaginal pain/discomfort Dysuria, dyspareunia, pruritis Strawberry cervix
39
How does symptomatic trichomoniasis present in males?
Dysuria Scant, thin urethral discharge
40
How do you diagnose trichomoniasis?
Wet prep of vaginal or urethral secretions: Presence of motile, flagellated organisms. Rapid antigen testing Nucleic acid assay (PCR)
41
How do you treat trichomoniasis?
Tinidazole or secnidazole x1 dose Metronidazole x 1week possibly Must treat sexual partners TSM are letters in trichomoniasis and not trichinosis
42
What causes toxoplasmosis?
Toxoplasma gondii
43
How is toxoplasmosis transmitted?
Fecal-oral Cats, cat litter, undercooked pork/meat One of the leading causes death from foodborne illness in US. Usually only immunosuppressed or pregnant ppl get severe s/s.
44
What is the definitive host for toxoplasmosis?
Cats
45
How does toxoplasmosis present in immunocompetent people?
GI tract => lymphatics => disseminated Symptomatic: mono-like. Rare: hepatitis, meningoencephalitis, polymyositis, retinochoroiditis
46
How does toxoplasmosis present in immunocompromised people?
Reactivated in AIDS pts, pts on immunosuppressive rx, cancer pts. MC: encephalitis with necrotizing brain lesions.
47
How does a congenital toxoplasmosis infection present?
Early: still birth, spontaneous abortion Neuro: seizures, psychmotor retardation, deafness, hydrocephalus. Other s/s: fever, jaundice, HSM, V/D, pneumonitis, myocarditis, retinochoroiditis Mild: Normal at birth, but later development of LAD, HSM, CNS, or eye disease. Late: Retinochoroiditis Eye and brain symptoms
48
What is the general recommendation for pregnant women regarding toxoplasmosis?
Stay away from cats and cat litter.
49
How do you diagnose toxoplasmosis?
Serum Ig detection ID of parasite via tissue biopsy PCR of amniotic fluids, blood, CSF, etc Body fluid culture
50
What is not recommended for toxoplasmosis?
Routine pregnancy screening NOT RECOMMENDED
51
How is toxoplasmosis treated?
Immunocompetents do not require tx in acute disease. Pregnancy: spiramycin (reduce transmission risk) Immunodeficiency/fetal infection: pyrimethamine + Sulfadiazine DO NOT USE pyrimethamine early in pregnancy due to teratogenic effect.
52
What is the MC of malaria?
Plasmodium FALCIPARUM
53
How is malaria transmitted?
Bite of infected Anopheles FEMALE mosquito. Highest transmission: Sub-saharan africa
54
How does malaria present acutely?
Periodically: 1. cold phase 2. hot phase 3. sweating stage
55
When is malaria risk greatest relative to travel?
Within 2 months of exposure (falciparum malaria)
56
What are the complications of severe malaria?
Coma (Cerebral malaria) Severe anemia, DIC, hemolysis Secondary bacterial infections
57
How is malaria diagnosed?
Giemsa-stained blood smears (preferred) PCR/rapid assays
58
What is malaria treatment dependent on?
Depends on species, area and status, etc....
59
What is the treatment for non-falciparum malaria?
Chloroquine (resistance increasing) First-line usually based on region now.
60
What is the treatment for resistant non-falciparum malaria and falciparum malaria?
ACTs (artemether-lumefantrine) (Coartem)
61
What is the treatment for severe malaria?
IV artesunate from CDC.
62
What do all malaria pts require?
Hospitalization and treatment.
63
What drug categories treat selective malaria?
Quinoline derivatives Antifolate (atovaquone-proguanil) ACT (artemether-lumefantrine or artemether-amodiaquine)
64
What are quinoline derivatives mainly for in regards to malaria?
Activity vs erythrocytic stage of infection, since malaria eats hemoglobin.
65
What is the main SE of chloroquine?
pruritis
66
When is primaquine used?
After tx with chloroquine.
67
What are the CIs of primaquine?
G6PD Pregnancy Breastfeeding pregnant primaquine
68
Which antimalarial drugs are dosed weekly for prophylaxis?
Mefloquine Chloroquine MCW
69
What antimalarial drug has a SE of cinchonism?
Quinine/Quinidine
70
When do we use arteminisin derivatives for malaria?
Fast parasite clearance in combo regimen. NOT for prophylaxis due to short half-life.
71
If a patient books a trip to Africa and is leaving in the next 3 days, what antimalarials can they take for prophylaxis?
Primaquine Atovaquone-proguanil Doxycycline PAD themselves
72
If a patient is pregnant but is going to an area with high rates of malaria, what antimalarials can they take?
Chloroquine Mefloquine Weekly & pregnancy same
73
What are the 3 causative organisms for tapeworms/taeniasis?
Taenia saginata (beef) Taenia solium (pork) Diphyllobothrium latum (fish)
74
Where do tapeworms live?
In your intestine, growing up to several feet long.
75
Which tapeworms incubates the fastest?
Fish
76
What is the MC finding of intestinal tapeworms?
Proglottids in stool
77
What kind of deficiency can a fish tapeworm cause?
B12
78
How does invasive tapeworm present?
Cystericosis Altered cognition, psychiatric s/s, seizures, etc. Known for causing epilepsy in LA and SEA
79
How do you diagnose a tapeworm infection?
Microscopic identification of proglottids in stool
80
How do you treat intestinal taeniasis?
Praziquantel x 1 dose.
81
How do you treat neurocysticercosis?
Albendazole but may cause massive inflammation in brain.
82
What exactly does albendazole do?
Worm detachment, which may cause secondary inflammation when they die.
83
What are the causative organisms for hookworms?
Ancylostoma duodenale Necator americanus
84
How do hookworms transmit?
Transcutaneous or ingesting larvae. MC in tropical/subtropical with 1billion prevalence worldwide.
85
How does a hookworm infection present?
Pruritic maculopapular rash at site of infection Fever, wheezing, dry cough, bloating, abd pain.
86
What is the concern regarding a hookworm infection in children?
Cognitive delay and impaired growth
87
How do we diagnose a hookworm infection?
Stool microscopy/O&P: eggs in feces Rapid stool PCR Anemia, blood in stool and hypoalbuminemia
88
How is hookworm treated?
Albendazole x1 dose Mebendazole x 1-3 days HAM
89
What should you take with albendazole?
High-fat meal or snack
90
Which benzimidazole can cause neutropenia/agranulocytosis?
Albendazole in long-term
91
What is the causative organism for pinworm/enterobiasis?
Enterobius vermicularis
92
How is enterobiasis transmitted?
Fecal-oral Egg ingestion MC in school-age children
93
How does enterobiasis typically present?
Perianal pruiritis, especially nocturnal. Secondary impetigo and excoriation perianal pinworms
94
How is enterobiasis typically diagnosed?
Scotch-tape test in the early AM, getting the eggs from the perianal skin.
95
How is enterobiasis treated?
Albendazole x1 dose or Mebendazole x1 dose Repeat in 2 weeks. AM treatment, PM symptoms
96
What is the causative organism for trichinosis?
Trichinella spiralis
97
How is trichinosis transmitted?
Larvae in undercooked pork or meat. MC for US: ingesting wild game
98
How does normal trichinosis present?
V/D, abd pain. Systemic: fever, myalgia, periorbital edema, eosinophilia, HA, cough. etc.
99
How does severe trichinosis present?
Muscle pain and weakness Myocarditis, pneumonitis, encephalitis
100
How is trichinosis diagnosed?
-Elevated serum muscle enzymes (CK, LDH, AST) -ELISA assay 2+ weeks after infection (but cross-reacts with other parasites) -Muscle biopsy Trichinosis lives in your muscles?
101
How is trichinosis treated?
Early: albendazole or mebendazole. Supportive. TAM Full-blown = no specific treatment.
102
What is the causative organism for roundworms/ascariasis?
Ascaris lumbricoides
103
How is ascariasis transmitted?
Fecal-oral MC intestinal helminth infection worldwide.
104
Who usually presents with heavy ascariasis?
Children
105
How does ascariasis present lung wise?
Lung migration: -fever, eosinophilia -dry cough, dyspnea, chest pain -eosinophilic pneumonia sometimes
106
How does ascariasis present intestinal wise?
-+/-eosinophilia -bloating, decreased appetite, obstruction -pancreatitis, appendicitis, cholangitis -coughed up, vomited up, passed rectally -emerging through nose or anus
107
How is ascariasis diagnosed?
Stool microscopy/O&P: eggs in feces Adult worms out of bodily orifices.
108
How is ascariasis treated?
Same as hookworm Albendazole x1 dose Mebendazole x1 or 3 AAM HAM TAM

CM 1B: ID/EENT (27 decks)

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