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ID exam 2 > Parasites > Flashcards

Parasites Flashcards

1
Q

parasites are…

A

protozoa or helminth that lives on or in a host and gets food from or at expense of host :(

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2
Q

protozoa are….

A

unicellular eukaryotes.

  • amoebas –> pseudopod mobility
  • sporozoans–> NO pseudopod, falgellar, ciliary motility
  • flagellates –> whip like flag motility
  • ciliates –> hairlike motility
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3
Q

entamoeba histolytic (amoeba)

A
  • dz= ameobiasis
  • transmission= fecal oral, cysts in water
  • dx= trophozoites with engulfed RBCs, cysts in stool
  • tx= metronidazole, iodoquinol for asyx, paramycin
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4
Q

infectious process of entamoeba hitolytica, stages of infection

A

-cysts ingested and differentiate in ileum –> trophozoites –> invade colon epi –> local necrosis, HEMATOG spread –> intestinal/extraintestinal amebiasis

1) trophozoite stage= pseudopods, move along intestine wall, invade, liver
2) infective cyst stage

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5
Q

presentations of entamoeba histo

A

1) asyx carrier (most common –> cysts in stool, contagious, can survive outside host
2) intestinal AMEBIASIS (subacute) –> bloody diarrhea, invasive, abd pain, n/v
3) liver abcesses –> dull RUQ pain, elevated LFT, anchovy paste liver abcesses

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6
Q

primary amoebic meningoencephalitis

A

NAEGLERIA FOWLERI

  • rapidly fatal
  • nuchal rigidity, fevers, n/v, AMS
  • fresh water lakes, summer
  • enters cribiform plate –> olfactory n –> frontal lobe
  • dx= amoebas in CSF
  • tx= ampho B, if you’re lucky
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7
Q

acanthamoeba

A 
trans= nasopharyngeal, breaks in skin
granulomatous amebic encephalitis 
-ha, n/v
-keratitis (contact lenses)
-death
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8
Q

cryptosporidium (sporozoan)

A
  • mild, watery diarrhea in immunocompetent
  • severe diarrhea in AIDS
  • transmission by OOCYSTS in water –> think pools and recreational water supply
  • *can survive chlorination**
  • dx= stool samples with ACID FAST oocsyt
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9
Q

how do you treat cryptosporidium?

A

healthy person: self limiting, nitazoxanide for children

AIDS: antiretrovirals for CD4>100

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10
Q

Where does crypto replicate? Where does entamoeba replicate/ invade?

A

crpyto: intracellular in SMALL I
entemoeba: can replicate in ileum, invades COLON

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11
Q

toxoplasma gondii (sporozoan), modes of transmission (3)

A

1) undercooked meat
2) kitty poop
3) transplacentally to fetus

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12
Q

who is at risk for toxo infx?

A

immunocompromised, pregnant ladies

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13
Q

toxo

A
  • obligate intracellular parasitic protozoa
  • chorioretinitis
  • encephalitis
  • pneumonitis
  • MOST common cause of encephalitis in HIV
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14
Q

congenital toxo triad

A
  • woman WITHOUT previous exposure
    1) chorioretinitis
    2) intracranial calcifications
    3) hydrocephalus

TORCHES yo

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15
Q

Toxo encephalitis in HIV? How do you distinguish from CNS lymphoma?

A

brain abcsess seen as ring enhancing lesion on CT/MRI -_> usually MULTIPLE
TMP/SMX proph for CD4<100

Lymphoma is usu single lesion.

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16
Q

tx of toxo

A

pyrimethamine-sulfadiazine

use pyr-clinda if sulfa allergy

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17
Q

Plasmodium epi

A

> 0.5 million deaths/ year

half are children under 5 in africa

resistance to medications

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18
Q

plasmodium diagnosis/ transmision/life cycle (this might be wrong)

A
  • dx= parasites in RBC
  • transmission= anopheles mosquito
  • life cycle= release sporozoites into bloodstream –> liver, infect hepatocytes –> sporos divide –> merozoites –> merozoites leave liver and infect RBC –> develop into trophozoites –> RBCs get stiff, destroyed by RES –> burst –> release parasite

also, something about schizonts?

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19
Q

sx of malaria/ fever patterns: 1) p malariae 2) p. vivax.ovale 3) p. falciparum

A

sx= fever, HA, anemia, splenogmegaly
-9-14 day incubation
paroxyms= cold, hot fever, sweattttttt it all out

1) malarquatran, every 3 days
2) tertain, every 2 days
3) random, irregular

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20
Q

p. falciparum

A

WORST
cerebral malaria –> insert “sticky” protein into RBC membrane –> CYTOADHERENCE
-clogs up capillaries in brain, kidneys, lungs
-sickle cell trait/ thalassemia, G6PD confers PROTECTION

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21
Q

p. vivaxe/ovale

A
  • relapsing infx (tertian pattern)
  • hypnozoites= dormant form in liver
  • *treat with primaquine
  • only infects reticulocytes
  • schuffner dots –> brick red dots in host erythrocyte
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22
Q

diagnosis:
1) p malariae
2) p. vivax.ovale
3) p. falciparum

A

1) p malariae –>
- trophozoite= band or rectangular
- gametocyte= round
2) p. vivax.ovale
- trophozoite= LARGE, irregular rings
- gametocyte= round
3) p. falciparum
- trophozoite= small ring
- gametocyte= banana like

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23
Q

treatment of malaria

A
  • primaquine for vivax/ ovale hypnozoites –> TEST G6PD
  • chloroquine –> blocks plasmodium heme plymerase
  • *lots of resistance
  • mefloquine/atovaquone for choloroquine resistant regions
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24
Q

what can you tx malaria with in patients with G6Pd

A

IV quinidine, artesunate

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25
Q

giardia lamblia

A
  • foul smelling, steatorrhea, bloating, flatulence
  • cysts in water
  • dx with multinucleated trophozoites or cysts in stool
  • tx= METRO
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26
Q

giardiasis

A

fecal oral

  • 10-25 cycts req for dz
  • cysts ingested –> become trophozoites in duodenum, attach to duodenal villi
  • malabsorption and hypersecretion of Cl-
  • dx= TEAR shaped cysts in tool, owl eye nuc, four flagella
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27
Q

diarrhea of giardia

A

NON inflammatory

  • can cause secondary lactose intolerance
  • most common cause of nonbacterial diarrhea in US
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28
Q

trichomonas vaginalis

A

-sexually transmitted (no cysts, rarely leaves host)
-asymtomatic carrier
-acute vaginitis
-urethritis (men)
dx= vaginal wet mount shows MOTILE pear shaped flagellated trophooites
-tx= metro

29
Q

acute vaginitis presentation

A
  • burning, itching, dysuria
  • STRAWBERRY cervix
  • green, foul smelling vaginal discharge
  • pH > 4.5
30
Q

leishmania

A
  • intracellular parasite in macrophages
  • transmission by sandfly
  • leads to visceral , cutaneous, mucocutaneous
  • dx= bx with AMASTIGOTES in macs
  • tx= amphotericin B, sodium stibogluconate
31
Q

visceral leishmaniasis

A

BLACK FEVER

  • spiring fevers, HSM, pancytopenia
  • skin hyperpigmentation (black fever)
32
Q

cutaneous leishmaniasis

A

braziliensis –> skin ulcers

-erythematous papule at sandfly bite that ulcerates

33
Q

mucocutaneous leish

A

lesions confined to skin, mucous membranes and cartilage

34
Q

trypanosoma cruzi

A

CHAGAS

  • kissing bug –> painless bite/ defecation of reduviid bug
  • acute vs chronic
35
Q

acute chagas

A
  • chagoma= inflammatoin at bite site
  • romana’s sign –> swelling inflammation around eyelids from bug in conjunctiva
  • dx= flagellated trypomastigotes on blood smear
  • tx= bendizole, nifurtimox
36
Q

chronic chagas

A 
dilated cardiomyopathy
cardiac arrhythmias
megacolon
megaesophagus
achalasia

dx= chronic infection= parasitemia below detecable range

37
Q

trypanosoma brucei

A

AFRICAN SLEEPING SICKNESS

  • tsetse fly
  • enlarged lymphonodes
  • cycling fever –> many different serotypes –> exhausts immune system
  • tx= suramin for blood, melarsoprol for CNS
38
Q

general info about cestodes

A

segmented organization with scolex (round head) and proglottids (body segments)

type of platyhelminthes (flat worms)

39
Q

taenia solium (flatworm)

A

PORK

  • intestinal tapeworm –> ingest larvae in pork
  • cysticercosis/neurocysticercosis –> ingest eggs contaminated with feces
  • dx by proglottids/ eggs in stool or calcifications on CT/MRI (brain or muscle)
  • SWISS CHEESE PATTERN
  • tx= praziquentel, albendazole, corticosteroids
40
Q

taenia saginata (tapeworm)

A 
BEEF
-attach to small I, pass eggs in feces
-asymptomatic usu
-malnutrition, abd discomfort
tx= praziquantel
41
Q

difference in appearance between t. saginata and t. solium?

A

solium has circle of HOOKLETS

saginata has no hooklets

both have four suckers

42
Q

echinococcus granulosus (tapeworm)

A

DOG

  • hydatid cysts in liver, lung, brain –> cause anaphylaxis if ag are released from cyst rupture
  • organ displacement/ dysfunction from cyst growth
  • “eggshell” calcification
  • tx= albendazole
43
Q

precatuionary (necessary) measure in removal of echinococcus cysts?

A

inject larvicidal solution before removal!!

ethanol or hypertonic saline –> will kill daughter cysts before removal

44
Q

diphyllobothrium (tapeworm)

A

FISH (also largest)

  • larvae mature into adults in small I
  • consume food and B12
  • megaloblastic anemia
  • tx= praziquantel
45
Q

what are trematodes?

A

flukes

  • non segmented
  • mature in LIVER
  • incomplete digestive tubes
  • schistomsoma
  • clonorchis sinesnsis
46
Q

schistosoma

A

snails= host

  • excrete cercariae into fresh water –> penetrate skin –> enter blood
  • adults flukes migrate AGAINST PORTAL VENOUS FLOW
  • dx= eggs in stool/urine
  • tx= praziquantel
47
Q

which part of the schistosoma life cycles causes infection? how does it evde the immune system?

A
  • eggs

- molecular mimicry

48
Q

presentations of schistosoma (6) (maddy)

A

1) cercarial dermatitis (swimmer’s itch) –> days
2) ACUTE SCHISTOSOMIASIS –> 1-2 months post infx
3) chronic schisto –> mo-years post infx
4) intestinal schisto –> pain, diarrhea, bleeding, Fe defic
5) hepatosplenic schisto –> HSM, periportal fibrosis, portal HTN
6) GU schisto –> #1 cause of squamous cell carc of bladder

49
Q

what are nematodes like?

A

round worms

  • non segmented organization with complete digestive tube
  • dx is made by eggs in stool
  • tx is benzimidazoles
50
Q

enterobius vermicularis (pinworms)

A
  • most common US helminth
  • intestinal roundworm
  • perianal itching
  • trans= fecal oral
  • females migrate out of butt hole to lay eggs
  • dx= scotch tape test (gross)
  • tx= benzimidiazoles, pyrantel pamoate
51
Q

why do we do the scotch tape test? for what org?

A

enterobius vermicularis

bc eggs are NOT found in stool

52
Q

ascaris lumbricoides

A

giant roundworm

  • more common worldwide, tropical
  • transm= fecal oral
  • dx= stool microscopy
  • tx= benzimidazoles, ivermectin
53
Q

describe transmission/ infection with ascaris lumbricoides

A

intestinal infection
-ingest ova –> hatch in SI –> larvae penetrate intestinal wall –> migrate hemato/ lymphatic to LUNGS

larvae mature in alveoli –> ascend bronchial trea –> swallowed back into SI

54
Q

sx/ presentation of lumbricoides?

A

-most are asymptomatic….. but….

  • Loeffler’s syndrome –> hypersensitivity eos pneumonitis
  • obstruction of bowel lumen
  • can cause biliary obstruction
55
Q

trichuris trichiura

A

whipworm

  • intestinal parasite
  • assoc with poor hygiene + tropical climates
  • fecal oral
  • stool examination shows eggs football/ barrel shaped
56
Q

strongyloides stercoralis (threadworm)

A
  • fecal cutaneous
  • penetrates the skin on FEEEEEET –> enter blood stream
  • eggs mature in SI, swallowed, reinfect
  • autoinfection
57
Q

sx/dx/tx of strongyloides

A 
sx= pneumonia+ gastroenteritis
dx= larvae in stool (not eggs), eosinophilia
tx= benzimidazoles, ivermectin
58
Q

necator americanus (hookworm)- symptoms

A

pneumonia
gastroenteritis
Fe def anemia –> secrete anticoag, worm eats your blood

59
Q

necator americanus (hookworm)- tranmission

A

fecal cutaneous

  • penetrate skin of feel
  • enter bloodstream
  • go to lungs, enter alveoli
  • cause PNA
  • swallow larvae, mature in small intestine
60
Q

onchocerca volvulus (tissue roundworm)

A

river blindness

  • human= definitive host
  • female black fly
  • mature into adult form subq –> release microfilariae –> can cause allergic rxn
  • LIZARD SKIN-> hyperpigmented pruritc rash
61
Q

river blindness

A

onchocerca volvulus
-microfilariae get to eye
-major cause of blindness
tx= ivermectin

62
Q

wuchereria bancrofti

A
  • obstruction of lymphatics
  • mosquito transmission
  • obstructs lymphatics
  • dx= blood with microfilariae
  • tx= DIETHYLCARBAMAZINE
63
Q

elephantiases

A

-wuchereria bancrofti
-lymphatic filariasis –> lymphedema
-scrotum, arms, breast
ONLY ADULTS DO ELEPHANTIASIS

tx= diethylcarbamazine

64
Q

tropical pulmonary eosiniphilia

A

wuchereria bancrofti

  • microfilariae in lung
  • immediate hypersensitivity reaction (increased IgE, eos)
  • wheezing at night
  • tx= diethylcarbamazine
65
Q

whats the time frame of infection of wuchereria bancrofti

A

female mosq deposits larvae in skin –> go to lymph nodes

after ONE YEAR larvae mature into adult worms –> trigger inflammation!

66
Q

s mansoni vs s haematobium

A

s mansoni= eggs have LATERAL spine –> fibrosis, inflammation

s haematobium= eggs with terminal spine –> BLADDER CANCER

67
Q

differentiate a smear of trypnosoma cruzi vs leishmania donovani

A

t. cruzi= chagas –> TRYPOMASTIGOTE, extracellular, flagella that begins at one end of org and comes out the other

leishmania –> AMASTIGOTE, intracellular, no flag

68
Q

romana’s sign

A

periorbital edema seen in acute chagas

69
Q

clonorchis sinensis

A

trematode

  • undercooked fish
  • snail= intermediate host
  • causes biliary tract inflammation –> pigmented gallstones
  • CHOLANGIOCARCINOMA
  • tx= praziquental

ID exam 2 (16 decks)

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