Parasites Flashcards by Akira Shishido

how fast does classic cutaneous larve migrans migrate?

2cm/day

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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.

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Patient with recractory asthma from cambodia. Will start long-term systemic steroids.

What should you check?

strongy

can precipitate hyperinfection syndrome

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fever, gram negative sepsis and cough in a patient who recently started steroids

strongy hyperinfection syndrome

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strongy

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ascaris lumbricoides

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schisto mansoni

(mesenteric veins)

(its a fluke)

praziquantel

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28F with crampy abdominal pain

colonoscopy reveals white papules

biopsy reveals egg with granulomatous inflammation

schistosoma

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praziquantal treats all…..

trematodes (flukes)

(except fasciola - liver fluke rx with tricalbendazole)

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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

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clonorchi and opisthorchis both can live 50 years and cause

chinese and southeast asian liver flukes

biliary obstruction

cholangiocarcinoma

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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

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cough and eosinophilia after eating raw crayfish

paragoniums westermanii

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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)

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what exam should you always perform in a neurocysticercosis patient?

ophtho

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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

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skin-lungs-gut

gut-liver-lungs-gut

strongyloides and hookworms

ascaris

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what is the most common nematode that causes loeffer’s syndrome?

ascaris

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picture (barium) sillhouette of a worm

Rx?

ascaris

albendazole

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mild abdominal pain and anemia

ancylostoma, necator (hookworms)

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50m from ecuador just diagnosed with COPD and needs steroids- what should you do?

treat empirically with ivermectin

or, check strongy Ab and stool

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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

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Dx?

Rx?

lymphatic filariasis

Dx: biopsy/blood smear circulating antigen

Rx: DEC

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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