Parasites Flashcards
Outbreaks of Giardia lamblia occur when?
How is it transmitted?
- When sewage contaminates drinking water
- Transmitted through poorly purified water, often seen in travelers and campers
What occurs upon ingestion of Giardia lamblia?
What are the signs and symptoms?
- After ingestion of the cyst, Giardia converts to the trophozoite form and cruises down and adheres to the small intestine wall, does NOT invade
- Coats small intestine, interfering with fat absorption, leading to steatorrhea
- Sx: bloating, flatulence, and foul-smelling diarrhea
- Pt’s often experience significant weight loss and deficiencies in Vits A, D, E, and K
How is the Dx of infection with Giardia lamblia made?
- Examination of stool for trophozoites
- Can perform an ELISA stool antigen test
What are the symptoms of Entamoeba histolytic infection?
Where can it invade?
- Abdominal pain, bloody diarrhea; can also cause intestinal amebiasis (ulceration along colon)
- Can invade liver and form amoebic abscesses –> RUQ pain w/ hepatomegaly
- May also invade lung and form pulmonary abscesses
How is Entamoeba histolytic transmitted; what forms does it take during its life cycle?
- Cyst form can be transmitted fecal-orally or in contaminated water.
- MSM are common carriers
- Differentiates in trophozoite form which is the motile feeding form, that can cruise along intestinal wall and is invasive
How is Entamoeba histolytica diagnosed?
How can you tell if their is active disease or the person is an asymptomatic carrier?
- Stool O and P looking for presence of cysts or trophozoites
- Trophozoites w/ endocytosed RBCs in their cytoplasm suggest active disease
How is Cryptosporidium transmitted?
Describe its life cycle.
- Fecal-oral route; contaminated water sources
- Ingested as round cyst that contains 4 motile sporozoites, its life cycle occurs within intestinal epithelial cells
- Creates oocysts which are then released into the feces
What are the signs and symptoms of Cryptosporidium?
Who is most at risk?
- Watery diarrhea and abdominal pain in healthy individuals
- Immunocompromised pts (AIDS, cancer, transplants): may develop severe, protracted diarrhea that is life-threatening
How is Toxoplasmosis gondii transmitted; who is most at risk?
- Ingestion of cysts in undercooked meats (raw pork) or foot contaminatd with cat feces
- Kitty litter boxes are MOST COMMON source for exposure in the U.S.
- Pregant women and immunocompromised are most at risk
How does Toxoplasmosis gondii affect immunocompromise patients, especially those with AIDS?
- Fever, LN, liver, and spleen enlargement and pneumonia
- May also lead to Toxoplasma encephalitis: seizures, gait instability, weakness, or sensory losses
- Infection of the retina, chorioretinitis, is also common
What is the most common CNS infection in AIDS patients?
Toxoplasma encephalitis
If a pregnant woman is infected with Toxoplasmosis gondii, she may transplacentally infect the fetus, what are the characteristics of congenital toxoplasmosis?
- Chorioretinitis, blindness, hydrocephalus/seizures, mental retardation, microcephaly, and encephalitis
- If infection is acquired early in gestation, may result in stillbirth
How can clinical reactivation of Toxoplasmosis gondii infection affect an infant later in life?
- Most commonly results in retinal inflammation (chorioretinitis, which can cause blindness)
- Peak incidence is the second or third decade of life
Diagnosis of Toxoplasmosis gondii in AIDS patients and fetuses can be done how?
What are the classic findings?
- Ring (contrast)-enhancing lesions on CT or MRI
- Examination of retina will reveal retinal inflammation
- Serology will show elevated immunoglobulin titers
What does Trypansoma brucei rhodesiense and gambiense cause?
What is the vector?
Where is it endemic?
- African sleeping sickness
- Vector is Tsetse fly
- Endemic to Western and SE Africa
After being bit by the Tsetse fly, how does the trypomastigo of Trypansoma brucei rhodesiense and/or gambiense cause infection?
What are the signs and symptoms?
- Travels in blood stream to LNs and CNS
- Recurrent fever, headache, dizziness, and LN swelling
- CNS sx’s develop: drowsiness in daytime, behavioral changes, difficulty walking, slurred speech, and finally coma and death
What causes the intermittent (recurrent) fevers in African Sleeping Sickness?
- Trypanosomes are covered with variable surface glycoprotein (VSG)
- Undergoes constant antigenic variation - evades host immune system - thus there are waves of new Ags producing reccurent fevers
How is diagnosis of Trypansoma brucei rhodesiense and gambiense made?
- Blood smear w/ evidence of Trypomastigotes in peripheral blood
- Can also test LNs, or spinal fluid
What is Naegleria fowleri associated with?
What kind of organism is it?
How does an infected patient present and what is the prognosis?
- Fresh water (watersports, swimming, camping)
- Is an amoeba
- Pt presents with fever, headache, stiff neck, nausea and vomiting, which is similar to a bacterial meningitis; usually with a hx of swimming one week earlier
- RAPIDLY FATAL!
What is the CSF content of someone with acute meningoencephalitis caused by Naegleria fowleri?
How is the diagnosis made?
- High neutrophil count, low glucose, and high protein, exactly like bacterial meningitis!!!
- Lumbar puncture to dx; motile amoebas in CSF
Where is Trypansoma cruzi prevalent?
Which disease does it cause?
How is it transmitted and through what vector?
- Southern U.S. (Texas), Mexico, South and Central America
- Chagas disease
- Transmitted through the vector, Reduviid bug (AKA “kissing bug), which bites around victims mouth anddeposits feces, which are introduced into the blood through scratching
How can acute Chagas disease be diagnosed?
- Blood smear to visualise motile trypanosomes
- Xenodiagnosis: sensitive test, grow bugs in lab and let feed on pt.
What occurs in Acute and Chronic Chagas’ Disease?
- Acute: a hardened, red area, called a chagoma develops at site of parasite entry. Followed by fever, malaise, and swollen LNs
- May result in tachycardia and ECG chagnes. CNS involvement can result in severe meningoencephalitis
- Resolves in about a month and patients enter an asymptomatic, intermediate phase
- Chronic: sets in 10-20 yrs later causing MEGAcolon, extreme constipation, MEGA-esophagus, anddilated cardiomyopathy
How is Babesia transmitted, what is the vector and the reservoir?
Where is it found?
What does infection cause?
- Reservoir is the white-footed mouse
- Carried by Ixodes tick, and spread to humans and farm animal through saliva of tick
- NE United States
- Causes Babesiosis: malaria-like infection!
What are symptoms of Babesiosis?
Who is at high risk if infected?
- Malaria-like sx’s including fever and hemolysis, as it invades RBCs
- Asplenic and sickle cell disease pt’s are at greatest risk for severe infection
What visual characteristic allows for the diagnosis of Babesiosis and differentiation from Malaria?
Which lab technique used?
- Maltese cross (X-shaped) appearance in RBCs formed by Tetrad of merozoites
- Seen with wright-stained thick blood smears or Giemsa,
What is the vector for transmission of Plasmodium malariae, vivax, ovale, falciparum, and knowlesi?
Describe the events that occur once a person is infected and the life cycle of this protozoa?
- Transmitted via Anopheles mosquitos carrying sporozoites in saliva; bites human host
- Travel to liver where they mature to trophozoites –> schizont –> merozonites which burst liver cell causing release into the bloostream where they can infect RBCs
- Some merozonites will change into male/female gametocytes. These cells circulate and will be taken up by a biting mosquito; continuing the cycle of infection
What type of fever cycle does Plasmodium malariae have?
Quartan fever cycle: causing a regular 3-day cycle of fevers and chills, followed by sweats as P. malariae bursts from RBCs every 72 hours
What type of fever cycle does Plasmodium vivax and ovale have?
What do they produce in the liver?
- A tertian fever cycle: chills and fever, followed by sweats every 48 hours
- Produce dormant hypnozoites in the liver, which can grow years later, causing relapsing malaria
What type of fever cycle does P. falciparum follow?
- Is the most common and deadly of the Plasmodia, bursts red cells more irregularly, between 36-48 hours