Parasites Flashcards
1
Q
Babesiosis co-infection?
A
LYME DISEASE
2
Q
What causes babesiosis?
A
Babesia
3
Q
3 buzz works for babesia?
A
- Maltese cross
- Pear-shaped piroplasm
- Ring stage
4
Q
Northeast US?
A
Babesia microti (overlap with lyme disease)
5
Q
Western US?
A
WA1 piroplasm
6
Q
Europe
A
Babesia divergens
7
Q
How is babesia transmitted?
A
Black legged tick
can be seen in blood transfusions… because it only screens for HIV and HEPC
8
Q
Who usually gets babesiosis?
A
50-60 (but age range is 3 weeks to 86 years)
-Older, immunocompromised
9
Q
What correlates with the severity of babesiosis?
A
Age
10
Q
What influences the severity of babesiosis?
A
Co-infections with B. burgdorferi and A. Phagocytophilum
11
Q
In the average patient, what does babesia cause?
A
Asymptomatic, general symptoms, if high number of parasites… nausea, night sweats, weight loss, hematuria
12
Q
What can be seen with babesiosis in elderly, IC, or asplenic patients?
A
Hemolytic anemia and ARDS (can KILL YOU)
13
Q
Why is B. burgdorferi often co-infected with B. microti (lyme with babesia)?
A
Because the white-footed mouse is a reservoir for both
14
Q
What is seem with coinfection of Lyme and Babesia?
A
More severe symptoms and that the antibiotic therapy for lyme won’t cure babesiosis
15
Q
How do you diagnose babesiosis?
A
- History
- Stained blood smears
- Serology/PCR
- Hamster inoculation
16
Q
What 3 things can be seen on a babesia blood smear?
A
- Ring forms like plasmodium (no hemozoin)
- Pear-shaped trophozoites (piroplasm)
- Maltese cross (rare, but definitive)
17
Q
What would you give a patient for lyme disease?
A
Doxy or amoxicillin (if it was a child)
18
Q
What do you give for babesiosis?
A
DUAL THERAPY (Anti-malaria and an Antibiotic)
- Clindamycin plus quinine
- Atovaquone plus azithromycin
19
Q
What causes African Trypanosomiasis?
A
T. Brucei
20
Q
What are the 2 species of T. Brucei?
A
- Gambiense: West African sleeping sickness (HUMAN RESERVOIR)
- Rhodesiense: East African sleeping sickness (WILD GAME)
21
Q
What transmits T. Brucei?
A
Tsetse fly
22
Q
What happens if the tsetse fly stays in your blood?
A
It multiplies by binary fission (most people will recover)
In your brain = YOU IN TROUBLE SON
23
Q
What are the 3 infections stages of T. Brucei?
A
- Trypanosomal (canchre at site)
- Hemolymphatic (Flu-like/itching)
- Meningoencephalitic
24
Q
What is seen in the meningoencephalitic stage of T. Brucei infection?
A
HA, abnormal behavior, coma, behavioral changes, depression
- Daytime somnolence/nighttime insomnia
- Seizures in kids
25
Which is more severe?
| -Rhodesiense or gambiense
Rhodesiense
26
How do you diagnose T. Brucei?
- Giemsa stain smear of blood, cancre fluid or lymph node aspirate (early) and CSF (late)
- Also elevate WBC count, IgM, and total protein
27
What drug do use to treat the hemolymphatic stage of T. Brucei?
Suramin
| pentamidine isethionate is alternative
28
What drug do you use to treat the CNS stage of T. Brucei?
Melarsoprol
29
What is the American Trypanosomiasis caused by?
T. Cruzi
30
What is the dsiease for T. Cruzi?
Chagas
31
What transmits T. Cruzi?
Blood-sucking rediviis bug--> KISSING BUG
32
What is T. Cruzi in the blood?
Trypomastigote
33
What is T. Cruzi in the tissues
Amastigote
34
Where do the amastigotes from T. Cruzi like to hang out and what do they do?
The hand out in the heart and colon and push the tissues around causing inflammation with macrophages ect. leading to megacolon and myocarditis
35
With Chagas, who you do normally see the eyelid swelling in?
KIDS
36
With T. Cruzi what are the 3 main things we think of it doing?
1. Heart issues- Myocarditis (Number 1 cause)
2. Megacolon
3. Esophagus
37
In chagas disease, the inoculation lesion, a chagoma, is what?
A swollen eye or Romana sign
38
What happens in the acute phase of chagas disease?
It's asymptomatic- Fever, anorexia, lymphadenopathy, myocarditis
-Usually resolves 2-3 mo into chronic asymtomatic stage
39
What is seen in the chronic phase of Chagas disease?
Cardiomyopathy (most serious), GI pathology, weight loss
| -LETHAL
40
What is the main way to diagnose Chagas disease?
Giemsa-stained blood smear (acute infection)
41
What are other methods of diagnosis of chagas?
1. Clinial (usually)
2. Inoculation into mice
3. Culture on special media
4. Zenodiagnosis
42
What can be done to diagnose chronic Chagas?
IFA
43
What are the C's of CHagas?
Children, Chagoma, Cardiac, Cruzi, Mega-Colon, Central/SA
44
What drugs are given for acute Chagas when it is still in the blood?
Benznidazole or nifurtimox
45
What do you do for chronic Chagas?
Manage clinical manifestations... like give then a pacemaker for heart issues
46
What causes leishmania?
Flagellated protozoa or hemoflagellates
47
What transmits leishmania?
Sandflies
48
What are the 3 clinical diseases of Leismania?
1. Cutaneous: Skin sores that spontaneously heal
2. Mucocutaneous: Braziliensis
3. Visceral: Donovani
49
What is seen with initial leishmaniasis from braziliensis?
Primary lesion at bite site, flu-like symptoms, usually goes away
50
What happens down the road with braziliensis?
Lesions spread to nasal mucosa, mucosa of hard and soft palate-- nasal obstruction/bleeding, granulation, erosion, ulceration
IT EATS YOUR FACE
51
What causes death in braziliensis?
Respiratory compromise, malnutrition, secondary infections
| -No treatment... supportive care, surgery, ect.
52
What happens in visceral leishmaniasis from donovani?
Skin blackens - Kala azar or black poison
53
Describe the disease process of visceral leishmaniasis?
- Acute onset with flu-like symptoms
- Systemic infection of liver, spleen and BM--> Fever, weight loss, massive hepatosplenomegaly, ABDOMINAL DISTENTION, pancytopenia, hypergammaglobulinemeia (lots of IgG), night sweats,weakness, anorexia, skin hyperpigmentation
54
What happens is viscral leishmaniasis goes untreated?
YOU DIE FROM SECONDARY INFECTIONS
55
How do you diagnose Leishmania?
With a geimsa stain looking for amastigotes
- Mucocutaneous: Cutaneous lesions
- Visceral: Macrophages in BM, liver, spleen
56
What is given for Leishmania?
1. Sodium stibogluconate- Antimony
| 2. Liposomal amphotericin B
57
What are some worms that cause Lymphatic Filariasis?
1. Wuchereia bancrofti (elephantitis)
2. Brugia malayi
3. Onchocerca volvulua: Adrican River Blindness from black fly
4. Loa loa: Affects eye, from deer fly
5. Mansonella perstans
6. M. Streptocerca
7. M. Ozzardi
58
Worms that block the lympatics cause what?
Edema
59
How do all microfilariae migrate?
Blood
| taken up by an athropod vector during a blood meal
60
How are W>Bancrofti and B. Malayi transmit?
Mosquito
61
Where do you see W. Bancrofti and B. Malayi?
Tropical (not in states)
62
What is seen clinically in lymphatic filariasis?
1. Elephantitis
2. Edema
3. Usually unilateral (if it's bilateral, it's usually another cause of edema
63
What does W. Bancrofti cause?
Lymphatic filariasis (elephantitis) or hydrocele and scrotal elephantiasis
64
What does B. Malayi cause?
Pulmonary tropical eosinophilia syndrome-- Nocturnal cough, wheezing, fever, and eosinophilia
65
What is the most practical way to diagnose the microfilariae?
Microscopy
-Really clinical though
66
What else can be done to diagnose microfilariae?
Antigen detection, PCR, and Identification of adult worms
| Ab detection is cross-reactive and not routinely used
67
What is done to treat microfilariae?
IVERMECTIN
- Surgery for the hydrocele
- Diethylcarbamazine is an alternative
68
What are schisotomes caused by?
Blood trematoes- blood flukes
69
What does schistosoma haematobium cause?
BLADDER issues... goes through the venous plexus into the bladder causing hmeaturia and CA
-THIS IS A TYPE 1 CARCINOGEN
70
What does schisosoma mansoni cause?
BOWEL ISSUES...goes through portal vein of liver... it mates and the eggs get in the bloody stool
71
When do schistosomes get in you?
When you are standing in water they penetrate your skin
72
What are 3 other species of schistosomes that you shouldn't pick as an answer?
1. S. japonicum
2. S. mekongi
3. S. intercalatum
73
What is seen in acute disease or Katayama syndrome with schistosomes?
Fever, chills, cough, urticaria, abdominal pain, diarrhea, eosinophilia, occasional CNS lesions
74
What is seen in chronic infection with schistosomes?
Granulomatous reactions and fibrosis in affected organs
75
What do you see bloody diarrhea?
S. Mansoni
76
What do you see with cystitis and ureteritis with hematuria and can progress to bladder cancer?
S. Haematobium
77
What do you see with pulmonary hypertension?
S. Mansoni and S. Japonicum
78
What is often found in the history of someone with schistosomes?
Contact with fresh water- SNAILS
79
What is seen in the stool of patients with schistosomes?
EGGS
80
Microscopy of eggs can be done on what 2 things in schistosomes?
Stool: Mansoni or japonicum
Urine: Haematobium
81
What can ehnance microscopy of schistosomes?
Repeated examinations
-Can also biopsy if needed
82
Where is the spine in haematobium eggs?
TERMINAL
83
Where is the spine in mansoni?
LATERAL (middle)
84
What is DOC for all schistosomes?
Paziquantel (omaniquine is effective against mansoni)
