Paragonimus, House Dust Mites & Loeffler’s Syndrome Flashcards
Mention limitations of serodiagnosis of p
Cross-reaction with other trematode infections
Can be avoided by excretory secretory antigens
Imaging modalities used for Paragnimus diagnosis & findings
X-ray: nodular or ring shadows, patchy infiltation & cavities, sometimes calcified cyst.
CT: worm cysts, soap bubble appearance in cerebral lesions
Drug of choice for Paragonimus treatment
Praziquantel (Biltricide)
Breeding site of house dust mites is
Beds
Conditions which favour house dust mites growth
Warm, damp & inadequately aired
Main food of house dust mites is
Human skin scales, organic debris
Describe moulting of house dust mites
Incomplete metamorphosis egg to larvae to nymph to adult
Mention reactions caused by house dust mites & their feces
Bronchial asthma & allergic rhinitis & atopic dermatitis
Describe control measures of house dust mites
Vacuum cleaning, washing sheets & blankets, airing of rooms, applying benzyl benzoate to mattresses and carpets
Mention parasites causing Loeffler’s syndrome
HAS
GR: Strogyloidiasis causes most severe Loeffler’s
Due to increase larvae load caused by autoinfection
DD of Loeffler’s syndrome
- VLM characterized by long-term illness (many months)
- Katamaya syndrome characterised by splenomegaly & long-term illness (2-3 months)
- Tropical pulmonary eosinophilia, responds to DEC
What is detected in sputum in Loeffler’s syndrome
Larvae, abdundant eosinophils, Charcot Leyden crystals
X-ray of Loeffler’s syndrome shows …..
Ground glass appearance
Duration of Loeffler’s syndrome
3 weeks
Manifestations of patent phase of P.w.
T.B.
Site of P.w lesions in lung commonly is ….
Upper right quadrant
Content & strcture of lung cysts of Paragonimus
Granuloma with formation of thick fibrous cysts which may become sclerotic surrounding adults which can live in pairs/triplets contaning numerous eggs & Charcot Leyden crystals.
When does chronic phase of P.W. occur?
3-4 months post-infection
Mention the events of life cycle corresponding to acute pulmonary phase
It occurs during migration of immature flukes through the lung and accompanied by high eosinophilia can cause acute pneumonitis.
Epidemiology of Paragonimus
Not in Egypt but in Far East, West Africa, South & central America
MOT of Paragonimus
Ingestion of encysted metacercaria in improperly cooked or prepared crab or crayfish.
Definitive & reversoir hosts of Paragonimus
Human - D
Dogs, cats, pigs, wolf & fox - R
1st intermediate host, stage penetrating it & 2nd intermediate host
1st: Semisulcospira libertina
Penetrating: microcercus cercaria
2nd: crustaceans, crabs & caryfish
Mention the infective & diagnostic stages of Paragonimus
I:encysted metacercaria
D: immature operculated eggs
Adult has …. suckers, the tegument is provided with ……., it is a ….., having 2…..testes & ovary. …… are formed of fine follicles olt paragonimus is ….. in colour, has …….. n lateral sides.
Reddish-brown, 2 (oral & ventral), spines, hermaphrodite, lobed, vittelaria.
Mention advatages of serology in Paragonimus
- Early diagnosis
- Diagnosis of acute & extrapulmonary p.
- Diagnosis of chronic p.
- Follow-up of treatment as Ab decline 6-12 months
Limitations of sputum examination
Not present in prepatent period, very scarce in patent period
Mention specimens in which egg of Paragonimus can be recovered
Sputum, stool, gastric lavage, pleural effusion fluid, fine needle aspiration
Describe shape & shell of egg of Paragonimus
Oval with wide top & narrow bottom
Thick shell & operculated
DD of Paragnimiasis
- Other causes of pneumonia with eosinophilia, Loeffler’s (HAS)
- Tuberculosis
- Cerebral p. should be differentiated from other cerebral lesions (S.japonicum, E.granulosus, T.solium)
Mention complications of P.westermani
Bronchopneumonia, lung abscess, empyema, pneumothorax, pyothorax, fulminating abdominal cavity & cerebral lesions, 2ry bac inf.
Write a short note on cerebral paragnimiasis
Behaviour of parasite is similar to that in lung with cyst formation, it causes eosinophilic meningitis & sometimes calcification. Affects occipital and/or temopral lobes
C/P: Headaches, epileptic fits, hemiplegia.