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HemOnc > Parasites > Flashcards

Parasites Flashcards

1
Q

Babesiosis co-infection?

A

LYME DISEASE

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2
Q

What causes babesiosis?

A

Babesia

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3
Q

3 buzz works for babesia?

A
  1. Maltese cross
  2. Pear-shaped piroplasm
  3. Ring stage
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4
Q

Northeast US?

A

Babesia microti (overlap with lyme disease)

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5
Q

Western US?

A

WA1 piroplasm

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6
Q

Europe

A

Babesia divergens

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7
Q

How is babesia transmitted?

A

Black legged tick

can be seen in blood transfusions… because it only screens for HIV and HEPC

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8
Q

Who usually gets babesiosis?

A

50-60 (but age range is 3 weeks to 86 years)

-Older, immunocompromised

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9
Q

What correlates with the severity of babesiosis?

A

Age

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10
Q

What influences the severity of babesiosis?

A

Co-infections with B. burgdorferi and A. Phagocytophilum

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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

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12
Q

What can be seen with babesiosis in elderly, IC, or asplenic patients?

A

Hemolytic anemia and ARDS (can KILL YOU)

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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

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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

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15
Q

How do you diagnose babesiosis?

A
  1. History
  2. Stained blood smears
  3. Serology/PCR
  4. Hamster inoculation
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16
Q

What 3 things can be seen on a babesia blood smear?

A
  1. Ring forms like plasmodium (no hemozoin)
  2. Pear-shaped trophozoites (piroplasm)
  3. Maltese cross (rare, but definitive)
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17
Q

What would you give a patient for lyme disease?

A

Doxy or amoxicillin (if it was a child)

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18
Q

What do you give for babesiosis?

A

DUAL THERAPY (Anti-malaria and an Antibiotic)

  1. Clindamycin plus quinine
  2. Atovaquone plus azithromycin
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19
Q

What causes African Trypanosomiasis?

A

T. Brucei

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20
Q

What are the 2 species of T. Brucei?

A
  1. Gambiense: West African sleeping sickness (HUMAN RESERVOIR)
  2. Rhodesiense: East African sleeping sickness (WILD GAME)
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21
Q

What transmits T. Brucei?

A

Tsetse fly

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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

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23
Q

What are the 3 infections stages of T. Brucei?

A
  1. Trypanosomal (canchre at site)
  2. Hemolymphatic (Flu-like/itching)
  3. Meningoencephalitic
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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
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25
Q

Which is more severe?

-Rhodesiense or gambiense

A

Rhodesiense

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26
Q

How do you diagnose T. Brucei?

A
  • Giemsa stain smear of blood, cancre fluid or lymph node aspirate (early) and CSF (late)
  • Also elevate WBC count, IgM, and total protein
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27
Q

What drug do use to treat the hemolymphatic stage of T. Brucei?

A

Suramin

pentamidine isethionate is alternative

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28
Q

What drug do you use to treat the CNS stage of T. Brucei?

A

Melarsoprol

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29
Q

What is the American Trypanosomiasis caused by?

A

T. Cruzi

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30
Q

What is the dsiease for T. Cruzi?

A

Chagas

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31
Q

What transmits T. Cruzi?

A

Blood-sucking rediviis bug–> KISSING BUG

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32
Q

What is T. Cruzi in the blood?

A

Trypomastigote

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33
Q

What is T. Cruzi in the tissues

A

Amastigote

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34
Q

Where do the amastigotes from T. Cruzi like to hang out and what do they do?

A

The hand out in the heart and colon and push the tissues around causing inflammation with macrophages ect. leading to megacolon and myocarditis

35
Q

With Chagas, who you do normally see the eyelid swelling in?

A

KIDS

36
Q

With T. Cruzi what are the 3 main things we think of it doing?

A
  1. Heart issues- Myocarditis (Number 1 cause)
  2. Megacolon
  3. Esophagus
37
Q

In chagas disease, the inoculation lesion, a chagoma, is what?

A

A swollen eye or Romana sign

38
Q

What happens in the acute phase of chagas disease?

A

It’s asymptomatic- Fever, anorexia, lymphadenopathy, myocarditis
-Usually resolves 2-3 mo into chronic asymtomatic stage

39
Q

What is seen in the chronic phase of Chagas disease?

A

Cardiomyopathy (most serious), GI pathology, weight loss

-LETHAL

40
Q

What is the main way to diagnose Chagas disease?

A

Giemsa-stained blood smear (acute infection)

41
Q

What are other methods of diagnosis of chagas?

A
  1. Clinial (usually)
  2. Inoculation into mice
  3. Culture on special media
  4. Zenodiagnosis
42
Q

What can be done to diagnose chronic Chagas?

A

IFA

43
Q

What are the C’s of CHagas?

A

Children, Chagoma, Cardiac, Cruzi, Mega-Colon, Central/SA

44
Q

What drugs are given for acute Chagas when it is still in the blood?

A

Benznidazole or nifurtimox

45
Q

What do you do for chronic Chagas?

A

Manage clinical manifestations… like give then a pacemaker for heart issues

46
Q

What causes leishmania?

A

Flagellated protozoa or hemoflagellates

47
Q

What transmits leishmania?

A

Sandflies

48
Q

What are the 3 clinical diseases of Leismania?

A
  1. Cutaneous: Skin sores that spontaneously heal
  2. Mucocutaneous: Braziliensis
  3. Visceral: Donovani
49
Q

What is seen with initial leishmaniasis from braziliensis?

A

Primary lesion at bite site, flu-like symptoms, usually goes away

50
Q

What happens down the road with braziliensis?

A

Lesions spread to nasal mucosa, mucosa of hard and soft palate– nasal obstruction/bleeding, granulation, erosion, ulceration
IT EATS YOUR FACE

51
Q

What causes death in braziliensis?

A

Respiratory compromise, malnutrition, secondary infections

-No treatment… supportive care, surgery, ect.

52
Q

What happens in visceral leishmaniasis from donovani?

A

Skin blackens - Kala azar or black poison

53
Q

Describe the disease process of visceral leishmaniasis?

A
  • 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
Q

What happens is viscral leishmaniasis goes untreated?

A

YOU DIE FROM SECONDARY INFECTIONS

55
Q

How do you diagnose Leishmania?

A

With a geimsa stain looking for amastigotes

  • Mucocutaneous: Cutaneous lesions
  • Visceral: Macrophages in BM, liver, spleen
56
Q

What is given for Leishmania?

A
  1. Sodium stibogluconate- Antimony

2. Liposomal amphotericin B

57
Q

What are some worms that cause Lymphatic Filariasis?

A
  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
Q

Worms that block the lympatics cause what?

A

Edema

59
Q

How do all microfilariae migrate?

A

Blood

taken up by an athropod vector during a blood meal

60
Q

How are W>Bancrofti and B. Malayi transmit?

A

Mosquito

61
Q

Where do you see W. Bancrofti and B. Malayi?

A

Tropical (not in states)

62
Q

What is seen clinically in lymphatic filariasis?

A
  1. Elephantitis
  2. Edema
  3. Usually unilateral (if it’s bilateral, it’s usually another cause of edema
63
Q

What does W. Bancrofti cause?

A

Lymphatic filariasis (elephantitis) or hydrocele and scrotal elephantiasis

64
Q

What does B. Malayi cause?

A

Pulmonary tropical eosinophilia syndrome– Nocturnal cough, wheezing, fever, and eosinophilia

65
Q

What is the most practical way to diagnose the microfilariae?

A

Microscopy

-Really clinical though

66
Q

What else can be done to diagnose microfilariae?

A

Antigen detection, PCR, and Identification of adult worms

Ab detection is cross-reactive and not routinely used

67
Q

What is done to treat microfilariae?

A

IVERMECTIN

  • Surgery for the hydrocele
  • Diethylcarbamazine is an alternative
68
Q

What are schisotomes caused by?

A

Blood trematoes- blood flukes

69
Q

What does schistosoma haematobium cause?

A

BLADDER issues… goes through the venous plexus into the bladder causing hmeaturia and CA

-THIS IS A TYPE 1 CARCINOGEN

70
Q

What does schisosoma mansoni cause?

A

BOWEL ISSUES…goes through portal vein of liver… it mates and the eggs get in the bloody stool

71
Q

When do schistosomes get in you?

A

When you are standing in water they penetrate your skin

72
Q

What are 3 other species of schistosomes that you shouldn’t pick as an answer?

A
  1. S. japonicum
  2. S. mekongi
  3. S. intercalatum
73
Q

What is seen in acute disease or Katayama syndrome with schistosomes?

A

Fever, chills, cough, urticaria, abdominal pain, diarrhea, eosinophilia, occasional CNS lesions

74
Q

What is seen in chronic infection with schistosomes?

A

Granulomatous reactions and fibrosis in affected organs

75
Q

What do you see bloody diarrhea?

A

S. Mansoni

76
Q

What do you see with cystitis and ureteritis with hematuria and can progress to bladder cancer?

A

S. Haematobium

77
Q

What do you see with pulmonary hypertension?

A

S. Mansoni and S. Japonicum

78
Q

What is often found in the history of someone with schistosomes?

A

Contact with fresh water- SNAILS

79
Q

What is seen in the stool of patients with schistosomes?

A

EGGS

80
Q

Microscopy of eggs can be done on what 2 things in schistosomes?

A

Stool: Mansoni or japonicum
Urine: Haematobium

81
Q

What can ehnance microscopy of schistosomes?

A

Repeated examinations

-Can also biopsy if needed

82
Q

Where is the spine in haematobium eggs?

A

TERMINAL

83
Q

Where is the spine in mansoni?

A

LATERAL (middle)

84
Q

What is DOC for all schistosomes?

A

Paziquantel (omaniquine is effective against mansoni)

HemOnc (8 decks)

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