nemotode cases Flashcards
Child presents with distended abdomen and a history of productive cough. What is the most likely parasite?
Ascaris Lumbricoides: giant roundworm.
Travels from small intestines -> lungs (Loeffler’s Pneumonia) -> intestines again. Generally presents as “surgical abdomen” in children after the large worm forms an obstruction of the small intestine.
Patient has had bloody diarrhea off and on for several weeks. Another Dr. provided the child with antibiotics a month ago, but it did not help the problem. Which parasite might be responsible?
Trichurius, Trich: whipworm.
Heavy infections cause bloody diarrhea, colitis, and rectal prolapse.
A mother arrives with her two children- a toddler and a ten year old. They were both recently visiting family in Puerto Rico. The toddler has had seizures without a fever. The older child tests positive for strabismus and a retinal exam shows strange “streaks”. What parasite could be affecting them?
Toxocara: dog/cat roundworm, commonly found in Puerto Rico.
Presents as a Visceral disorder in toddlers with seizures.
Presents in eyes with strabismus and larval tracts in older children’s retinae.
A woman who traveled to Brazil within the past year presents with fatigue, and mild confusion. Her labwork shows severe anemia. What is your first guess as a possible parasitic infection?
Necatar Americanus: Hookworm
This bug travels through skin, commonly found on blades of grass and in Brazil/ other humid tropical locations in south America. Upon infesting the small intestines, each worm can destroy up to .2 ml a day in blood, causing severe anemia, fatigue, and impaired cognition.
Child presents with strange blisters on both feet that have been “creeping” into new growths over the past week. He recently was in Florida on a trip with his family. If you rule out other causes and consider a parasite, what might be causing this?
Ancylostoma Caninum/Braziliense : Cutaneous Larvae Migrans, aka: creeping eruptions
Caused by canine hookworm.
Found on warm coastlines such as the gulf coast. Skin infection. Appear like burn blisters.
A two year old is brought in. Mom says the kid has been irritable in the morning, has lost her appetite, and seems to be having difficulty sleeping. When you check her for rashes, you note scratch marks on her butt. What is the most likely cause? How would you test this?
Enterobius Vermicularis: Pinworm
These bugs tend to lay eggs at night around the perianal area. Kids scratch in sleep, suck thumb, cycle continues.
You need to test for this by doing the “scotch tape” test on the area, preferably in the morning before a bowel movement. Pinworm usually cannot be seen by normal sample. If positive you should treat all family members.
A patient being treated for cancer at your hospital in Kentucky is referred from his normal oncology appointment to the ER with dehydration secondary to severe watery diarrhea and a developing wet cough. He looks toxic. The nurse mentions that while he was changing into a gown, she noted a large rash on his butt. What should you be worried about as a parasite?
Strongyloides Stercoralis: Threadworm
Autoinfection and Hyperinfection in immunocompromised patients is considered a potentially fatal syndrome called Strongyloides. It is common in Appalachia and may present with Loeffler’s Pneumonia, an Urticaria rash from the bugs on his butt, severe watery diarrhea, and other malignancies.
A teenager presents in your clinic in Alaska, stating he had a terrible stomach flu last week, but now he is still having muscle pain. You note that he has inflammation around his eyes. When asked what he ate, he said he and his buddies took frozen bear steaks on a camping trip and cooked them on the fire. What should you test for, and how would you test?
Trichinella Spiralis: Trichonellosis
This bug infects through undercooked pork or bear, and is still found in Alaska/ Greenland/ Inuit populations.
It has two phases: 1. the intestinal phase and 2. the muscle phase. If untreated it can cause an outbreak in the community and heart failure.
The best test is through a muscle biopsy.
12 year old boy presents to your clinic while on a mission in sub-Saharan Africa. He complains that his left leg is starting to swell. To rule out a DVT, you use the clinic’s ultrasound but discover that his inguinal lymph node as “dancing sign”. What parasite does he have?
W. Bancrofti: most common cause of Lymphatic Filiaris.
This bug infiltrates the lymphs, leading to edema. He is developing elephantits.
It is transmitted by mosquitos. We have a rapid card detector for this.
Returning Peace Corp member presents for post deployment physical, complaining of headaches, fever and strange focal points of swelling on his arms. He admits that sometimes his lips have been swelling, too. He states that he was recently in West Africa in a desert location. What parasite should be checked, and should you test in the day or night?
Loa Loa: African eye worm spread by the Chrysops Fly.
West and central Africa, a common issue in returning expatriates/ peace corp members. Presents with angioedema, “Calabar” swelling, pruritus, fevers, headache, and sometimes the worm shows up in the conjunctiva but not always.
UNLIKE most parasites, this bug is best found on a blood test during the daytime– it won’t be visible at night.
A different individual from the recent Peace Corp deployment enters your office with a strange “orange peel” appearance to the skin on his arm. This volunteer was based near a large river for several months. What parasite should you check for, and how?
O. Volvulus: River blindness, spread by Similum Blackfly
which lives near rivers in Africa, and sometimes in south America.
Presents with changes in skin (pruritus, folds, depigmentation and orange peel appearance). If not treated, the visual consequences may not be noticed for decades when it’s too late.
Requires a skin biopsy. It will not show up on serum.
Your overly motivated world-traveling preceptor on rounds points out a deep blister on a patients foot and pimps you, asking what parasite could hypothetically cause that if we were in Ethiopia?
Dracunculus medinensis: Guinea worm
Ingested by drinking untreated water. It travels from intestines into subq tissue and bursts out of a large blister on the extremities. Very rare now.
