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GI I > Microbiology-Intestinal Helminths > Flashcards

Microbiology-Intestinal Helminths Flashcards

1
Q

Characteristics of flukes

A

Hermaphrodite trematodes w/ suckers that stick to intestinal walls

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2
Q

You go to the doctor because you have diarrhea, fever, abdominal pain and ulcerations. You at water chestnuts 2 months ago. What fluke might you have?

A

Fasciolopsis buski.

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3
Q

You go to the doctor because you have diarrhea, fever, abdominal pain and ulcerations. You at water chestnuts 2 months ago. How will the doctor diagnose and treat you?

A

He will diagnose you by finding eggs in the stool and treat with praziquantel.

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4
Q

What is the structure of most cestodes?

A

A head w/hooklets to attach to the intestinal lining. They also have flat ribbon-like bodies composed of proglottid segments w/reproductive organs. They absorb food through their body.

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5
Q

You go to the doctor because you have diarrhea, fever, abdominal pain and ulcerations. You ate pork a few months ago. What tapeworm might you have?

A

Taenia solium

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6
Q

You go to the doctor because you have diarrhea, fever, abdominal pain and ulcerations. You ate undercooked beef a few months ago. What tapeworm might you have?

A

Taenia saginatum

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7
Q

You go to the doctor because you have diarrhea, fever, abdominal pain and ulcerations. Labs reveal B12 deficiency. You ate fish a few months ago. What tapeworm might you have?

A

Diphyllobothrium latum

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8
Q

How do you diagnose and treat cestode (tapeworm) infections?

A

Diagnose by eggs/proglottids in stool. Treat w/praziquantel or albendazole

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9
Q

What is the life cycle of taenia?

A

Prey contain larva cysts in striated muscle -> Predator eats cysts -> scolex hatches in small intestine -> cysts shed by host

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10
Q

How can a vegan person get neurocysticercosis?

A

A person who eats undercooked pork will get the tapeworm from ingestion of eggs and then will shed cysts in their stool. If you eat anything contaminated with human feces, you can get cystocircosis from tenia solium even if you don’t eat pork.

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11
Q

3 ways people with neurocysticercosis?

A

Focal neurologic deficit, headaches, seizure or sudden death from herniation due to death of a cyst and subsequent inflammatory response in the brain.

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12
Q

How do you treat a patient with cysticercosis?

A

Albendazole or praziquantel + corticosteroids

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13
Q

What type of parasitic infection can people get from their dogs?

A

E. granulosus larva

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14
Q

A 45 year old man presents with a foot long worm. He had a bone marrow transplant due to hematologic malignancy. What type of worm did he pass?

A

This is not a worm, it is intestinal epithelium because he has graft versus host disease from the transplant

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15
Q

What is the most common type of worm people will pass?

A

Ascaris nematodes. Note that it is really smooth with tapered ends

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16
Q

Do most people get sick by intestinal worm infections?

A

No

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17
Q

How do people die from ascaris?

A

Intestinal obstruction

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18
Q

How do people die from hookworm infections?

A

Severe anemia

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19
Q

How do people die from trichuris infection?

A

Dysentery

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20
Q

Long-term morbidities associated with intestinal nematodes

A

Decreased cognitive performance, reduced physical activity and stunted growth

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21
Q

What population is primarily affected by intestinal nematodes?

A

Preschool age children

22
Q

Do people mostly lose weight with a tapeworm because it is eating your food?

A

Nope, people don’t feel like eating due to intestinal obstruction, mucosal damage with endogenous losses and ulcerations can cause loss of nutrient absorption.

23
Q

A person comes back from overseas with diarrhea. O & P reveals an ascaris ova. Should you be satisfied with that as the final diagnosis?

A

No, these don’t always cause diarrhea, there could be another cause.

24
Q

Outside of GI symptoms, how else do people present with nematode infections?

A

Wheezing from migration through the lungs and allergic manifestations on the skin

25
Q

What causes this?

A

CLM. Dogs carry hookworms and poop on the beach. Hookworms infect people’s skin (cutaneous larva migrans).

26
Q

What determines if a person develops symptoms from nematode infection?

A

The number of worms present

27
Q

Top 3 ways people get infected by nematodes

A

1) Eating eggs in fecally contaminate food 2) Direct penetration through skin 3) Eating infected food

28
Q

Lifecycle of strongyloides and hookworm?

A

Skin -> lungs -> gut

29
Q

Lifecycle of ascaris?

A

Gut -> Liver vessels -> Lungs -> Gut

30
Q

What lab values should make you think of worms?

A

Esosinophilia and high IgE levels

31
Q

A Nigerian woman presents with 5 years of constant cramps lower abdominal pain. She has had multiple o/p’s which were all negative. Labs reveal elevated eosinophils and IgE. What should you do to narrow your diagnosis?

A

Get another o/p and make sure the lab is thorough

32
Q

What worm will crawl out of the host if the host is anesthetized?

A

Ascaris, the most common intestinal nematode in humans.

33
Q

Why do you likely not have ascaris if o/p x3 is negative?

A

Female ascaris produce 200,000 eggs per day! Note the eggs.

34
Q

Why do you always want to treat an ascaris infection even if the patient is asymptomatic?

A

They could grow to obstruct the intestine, biliary tract and pancreatic duct.

35
Q

A patient presents with dyspnea, dry cough and eosinophilia. Sputum culture reveals Charcot-Leyden crystals. He is later diagnosed with an ascaris infection. How does this explain his symptoms?

A

Loeffler’s syndrome, this is like a walking pneumonia or transient asthma that occurs from larvae passing through the lungs.

36
Q

How long does it usually take before you can diagnose someone with ascaris?

A

2-3 months.

37
Q

What worms are a major cause of anemia and loss of plasma?

A

Hookworms: ancylostoma duodenale and necator americanus. These worms are “vampires of the gut” because the suck blood and secrete anticoagulants to keep the blood coming. Note the eggs.

38
Q

How do you get infected by hookworms?

A

They crawl up a blade of grass and wait to jump on to people’s skin.

39
Q

Why aren’t hookworms like other soil transmitted helminths?

A

Typically you develop partial immunity, but in hookworms, susceptibility to the hookworm goes up until about age 30 and plateaus

40
Q

A patient presents with wheezing, dyspnea, dry cough, urticarial rash, mild abdominal pain and fatigue. Labs reveal iron deficiency anemia. You treat her for a hookworm infection and it goes away. What might she present with if she had another infection in the future?

A

Ground itch. This is papulovesicular dermatitis at the site of entry due to previous sensitization to the worm from previous infection.

41
Q

How do you treat a hookworm infection?

A

Mebendazole or albendazole

42
Q

A patient presents with rectal prolapse and the nematode shown below. What is your diagnosis?

A

Whip worm (trichuriasis). It threads its head in the epithelium of the GI tract.

43
Q

A patient presents with loose and frequent stools, tenesmus, bloody and mucus stools and rectal prolapse. o/p reveals a football shaped nucleus. Where is this likely found in the GI tract?

A

Cecum. Whip worm goes to the cecum after it hatches.

44
Q

A 41 year old Ecuadorian man presents with 1 month of abdominal pain and 30 pound weight loss over 3 months. He initially presented with fevers, chills, sweats and diarrhea, but now has none of these symptoms. Labs reveal eosinophilia and a negative stool o/p. Why don’t you give him steroids until you have treated him with albendazole?

A

Steroids suppress the immune system. Strongyloides does not give off a lot of larvae in the stool so o/p is often negative. Strongyloides can take over in the case of steroid use and kill the patient. You always want to treat a patient who comes from a place with endemic strongyloides before giving immunosuppressive drugs.

45
Q

Does ascaris get worse with corticosteroids?

A

No, it cannot replicate inside of you like strongyloides can.

46
Q

What causes the rashes shown below?

A

Strongyloides larvae sometimes penetrate the intestinal wall and migrate to the lungs. The migration creates this rash called larva currens.

47
Q

A patient comes to the hospital and is diagnosed with lupus. She is puts on high dose corticosteroids. 2 days later she has gram negative E. coli sepsis. What is the true diagnosis if stool o/p was positive for larvae?

A

Strongyloides hyperinfection syndrome. Millions of larvae form in the intestinal mucosa from steroid use.

48
Q

A patient comes to the hospital and is diagnosed with lupus. She is puts on high dose corticosteroids. 2 days later she has gram negative E. coli sepsis. Why is she septic if this is due to strongyloides?

A

Larvae puncture the intestine and let out E. coli.

49
Q

How do we typically diagnose strongyloides?

A

Serology or treat with ivermectin.

50
Q

What worms cause itchy bottom syndrome? How do people get this infection?

A

Pinworms. When the female is ready to lay eggs, she releases eggs around the anus. Eggs are transmitted fecal-orally.

51
Q

How do you diagnose someone with pinworm?

A

O/Ps are not helpful. “Scotch tape test” around the anus will show the eggs. Most of the time you don’t need to confirm it, treatment of the whole family with mebendazole will cure most cases.

GI I (47 decks)

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