Parasites Flashcards
how fast does classic cutaneous larve migrans migrate?
2cm/day
56M hx of asthma p/w epigastric discomfort x 3 weeks. Also has intermittent nausea and loose stools. Recently returned from Peru and also notes dry cough and wheezing when symptoms started.
Dx?
Rx?
How long should you follow after treatment?
Strongy
Ab+
Ivermectin
serial stool eams or ant-Strongy Ab x 1-2 years. Because parasite can autoinfect. Eggs hatch and larve mature in intestinal lumen.
Treat all patients with strongy regardless of symptoms.
Patient with recractory asthma from cambodia. Will start long-term systemic steroids.
What should you check?
strongy
can precipitate hyperinfection syndrome
fever, gram negative sepsis and cough in a patient who recently started steroids
strongy hyperinfection syndrome
strongy
ascaris lumbricoides
schisto mansoni
(mesenteric veins)
(its a fluke)
praziquantel
28F with crampy abdominal pain
colonoscopy reveals white papules
biopsy reveals egg with granulomatous inflammation
schistosoma
praziquantal treats all…..
trematodes (flukes)
(except fasciola - liver fluke rx with tricalbendazole)
fever, myalgias, headache and urticaria
eosionphilia, increased LFT
How to confirm Dx?
This is Katayama Fever (acute schisto)
really, you can’t
serology and stool O/P frequently negative
clonorchi and opisthorchis both can live 50 years and cause
chinese and southeast asian liver flukes
biliary obstruction
cholangiocarcinoma
nodules, pruritic papular eruptions, orange peel skin, keratitis
how to dx?
Rx?
onchacerciasis/river blindness
Dx: Skin Snip
Rx: multiple rounds of ivermectin
Doxy also works
cough and eosinophilia after eating raw crayfish
paragoniums westermanii
Patient with neurocystercosis has 3 viable (non calcified) cysts. No evidence of increased ICP. What is treatment?
albendazole AND praziquantel
+steroids
(1-2 cysts albendazole only, increased ICP - steroids and surgery)
what exam should you always perform in a neurocysticercosis patient?
ophtho
50F develops anaphylaxis after sustaining a hard ground level fall
confirm dx?
echinococcus - fall caused liver cyst to rupture
liver us
IgG 85% sensitive for liver cysts
50% sensitive for pulmonary cysts
skin-lungs-gut
gut-liver-lungs-gut
strongyloides and hookworms
ascaris
what is the most common nematode that causes loeffer’s syndrome?
ascaris
picture (barium) sillhouette of a worm
Rx?
ascaris
albendazole
mild abdominal pain and anemia
ancylostoma, necator (hookworms)
50m from ecuador just diagnosed with COPD and needs steroids- what should you do?
treat empirically with ivermectin
or, check strongy Ab and stool
A 6 yo boy from Indiana who has a pet dog and likes to play in a
sandbox presents with fever, hepatosplenomegaly, wheezing, and
eosinophilia. He has never travelled outside the continental U.S.
Toxocara canis
Dx?
Rx?
lymphatic filariasis
Dx: biopsy/blood smear circulating antigen
Rx: DEC
southwestern US patient 3 deep nodules near cervical spinal cord
onchacerca lupi
Onchocerca lupi an infection of wolves
- as with O. volvulus, is transmitted by blackflies
- 6 human cases reported to date
- 3 with deep nodules near cervical spinal cord
- Southwestern U.S.(Arizona, New Mexico, Texas)
skin nodules, pruritic papules, keratitis
onchacerciasis
Dx: serology or skin snip
Rx: ivermectini or doxy
Hunter with muscle pain and periorbital edema
trichinella
Dx: biopsy/serology
Rx: albendazole/steroids
eosinophili meningitis in hawaii
angiostrongylus
supportive - steroids? antihelminthic therapy controversial
stomch pain after sushi
anisakis
the reason we freeze sushi
endoscopizcally removed
ceviche
frogs, reptiles
cutaneous larve migrans
gnathostoma
rx with 3 weeks of albendazole
- Vivax or Ovale - RBC is larger than surrounding suggesting reticulocyte.
- Favor vivax over ovale given no fimrbiation of the cell
- More than 12 merozoites in the schizont favors Vivax
- Ovale usually not more than 8
- Falciparum schizonts are ‘sequestered’
*
Gametocyte of vivax (falciparum is falciform or banana)
Ovale usually more fimbriation
23F develops severe abdominal pain and vomiting several hours after eating sushi of wild caught Pacific salmon. Endoscopy reveals 2cm nematode in gastric mucosa
Anisakis simplex
Must be removed endoscopically
can cause anaphylaxis
58F from japan presents with cough productive of dark brown sputum with specks of blood. WBC 15 20% eos. CT showing cavitary lesions.
Paragonimus Westermanii
endemic in asia
fluke that travels to the lungs after being ingested with raw fish.
*often does NOT cause fever
*treat with praziquantel
*Paragonimus kellicotti in US from crayfish
what mosquito carries yellow fever?
47 yo sheep farmer from bolivia presents with fevers, abdominal pain and diarrhea. Admits to eating his own sheep and watercress by nearby lake.
Dx?
Rx?
Fascioloa Hepatica
(endemic to bolivia/peru)
Unlike other flukes, requires triclabendazole
What does ivermectin treat?
strongyloides and Onchocerca volvulus
What does praziquantel treat?
Flat worms: cysticerci, clonorchis, schistosoma
What does DEC treat?
Filarial worms: loa loa, wucheria
how
how does albendazole work?
Inhibits microtubule formation in worms - impairs ability to absorb nutrients
38M from Africa with keratitis.
Dx/Rx?
Onchocerca volvulus (nematode)
Ivermectin
severe disease BAND trophozoite
Knowlesi
schuffner dots
vivax or ovale (think oval for ovale)
basil, raspberries, cilantro
Latin America
Dx/Rx?
Cyclospora!
8-10 um on mAF stain of stool
Bactrim
CD4<100
Diarrhea
Dx/Rx?
Cryptosporidium
Resistant to chlorine! (swimming pools)
5um
No proven therapy - reduced IS, nitazoxanide?
Ancylostoma or Necator (hookworm)
(Larvae penetrate human skin)
Rx: albendazole
abdominal discomfort, generalized pain.
B12 deficiency
Rx?
D. latum
Praziquantel
Katayama Fever (schisto)
Dx sero (often absent in poop at this stage)
Rx with prednisone+praziqunatal - then retreat in1 month to kill mature worms
Treatment of paragonimiasis
Praziquantal
keratitis from tap water washing of glasses
acanthamoeba
treatment for entoaemeba histolytica
metronidazole PLUS luminal agent (paramomycin)
How big is cryptosporidium?
What is the treatment for cryptosporidium?
4-6um
nitazoxanide (but in HIV they really just need ART)
8-10uM
bactrim
What parasites cause biliary disesase?
fasciola hepatica
clonorchi/opisthorcis
Ascaris (can migrate to biliary tree and cause cholangitis)
schistosoma mansoni and japonicun can cause granulomatous hepatitis
Parasitic causes of HSM
schistosomiasis, Visceral Leishmaniasis
also toxocara (think kids)
cutaneous leish treatment
Uncomplicatated: topical paramomycin
Complicated: azoles, miltefosine (UNK MOA)
species of visceral leish
donovani, infatum, chagasi (new world)
Treatment of Toxo for Sulfa-allergic patient
Pyramethamine + Clindamycin
