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Nagasaki Flashcard Extravaganza > Parasites - Helminths > Flashcards

Parasites - Helminths Flashcards

1
Q

What is the causative organism of onchocerciasis?

A

Parasitic worm (nematode/roundworm ->filariae)
Onchocerca volvulus

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2
Q

What transmits onchocerciasis?

A

Blackflies: Simulium

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3
Q

What are the symptoms of onchocerciasis?

A

itching, blindness, leopard skin

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4
Q

What are the tests for onchocerciasis?

A

Tests: skin snipping, antibodies

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5
Q

What is the treatment for onchocerciasis?

A

Ivermectin - ensure does not have loaloa
Doxycyline: consider adding for treatment of Wolbachia (bacteria symbiotic with adult worms)
Avoid treatment with DEC: can cause fatal Mazzotti reaction

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6
Q

where does river blindness occur?

A

90% africa
10% South America/yemen

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7
Q

What is enterobius vemicularis?

A

Pinworm
Soil transmitted helminth
Nematode
Worms have double bulbed oesophagus, will be very full of eggs

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8
Q

What is this?

A

Enterobius
Dome shaped eggs - oval and flat on one side
Colourless

Has a larva in
55X30micromm

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9
Q

What is the lifecycle of enterobius/pinworm?

A

Humans only/definitive host
Eggs consumed in food/soil contaminated
They multiple in gut and mature by the caecum
they have sex in the caecum
Female crawls out at night and lays eggs (goo)
scratch and autoinfect

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10
Q

What is transmission of pinworm?

A

Human to human

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11
Q

where does pinworm occur?

A

Worldwide
Mostly children

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12
Q

What are the symptoms of pinworm?

A

Usually asymptomatic - no EOs
Itchy bum
Perianal rash
Vaginal discharge
Appendicitis!

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13
Q

How do you diagnose pinworm?

A

Perianal or fingernail morning tape test
Test for 6 days

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14
Q

What is the treatment for pinworm?

A

Albendazole

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15
Q

What is the micro of echinococcus granulosus (dog hydatid)?

A

Helminth
Cestode/tapeworm

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16
Q

What is the lifecycle of echinococcus granulosus ?

A

Dog-ungulate, faecal oral to man

Embryonated eggs from dog faeces-> matures in sheep or human
Human is intermediate host
Ingested -> Onc-sphere hatches in gut, penetrates intestinal wall -with> can move from gut to any internal structure esp liver via portal vein
If cysts rupture secondary cysts can move via liberated protoscholex

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17
Q

Where does echinococcus granulosus happen?

A

Where dogs eat offal
Esp Asia, ME, South America

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18
Q

How many have hydatid?

A

1-3million

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19
Q

What is the clinical syndrome of echinococcus granulosus ?

A

Liver cysts - ++ 70%
Liver/biliary dysfunction
Cough 20%
Neuro sx
Anaphylaxis if they burst
Raised EOs

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20
Q

How do you diagnose echinococcus granulosus ?

A

Clinical
Hx of dog contact who eat offal
EOs not always raised

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21
Q

How do you treat echinococcus granulosus ?

A

According to WHO stage
Albendazole/Praziquantel
PAIR
Surgery - risk anaphylaxis (hypertonic solution can de-activate )

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22
Q

What is the host of E-multilocularis?

A

Foxes and other canids - rats can be intermediate
Northern hemisphere

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23
Q

What is the clinical syndrome of e-multilocularis?

A

Alveolar disease
Looks like liver cancer with mets
Very destructive to liver/ not bound within mother cysts

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24
Q

What is this?

A

Echinococcus
Has protoscolex

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25
Q

What is the micro of schistosomiasis?

A

Trematode
Fluke!
Blood fluke

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26
Q

What are the species of schist?

A

Mansoni
Haematobium
Japonicum

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27
Q

Where are the spines of the various schists?

A

Mansoni - lateral
Haematobium - terminal
Intercalatum - terminal
Japonicum - rudimentary - round like flag!

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28
Q

what is the lifecycle of Schisto?

A

Human defecates or urinates in water and releases egg
Eggs hatches to miracidium
Miracidium seeks out snail
Snail intermediate hosts
After 1-2 months a cercaria comes out
Lose tails
Then burrows into human skin, swept away into human circulation via skin->lymphatics-> often to portal blood

Male and female mature in human and crawl into veins -> lay thousands of eggs. J/M -> go into colon. H - via bladder

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29
Q

What is the incubation of schistosomiasis?

A

14-84 days

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30
Q

What is the epidimiology of schistosomiasis?

A

1 in 30 humans
200K deaths
Linked to poor access to sanitation

S.haematobium (120M, SS Africa, Middle East)
S.mansoni (80M, SS Africa, Carib, Brazil) S.japonicum(2M,China,Phillippines,Indonesia) S.mekongi (1M, Cambodia, Laos)

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31
Q

What is the clinical syndrome of schistosomiasis?

A

Asymptomatic
Swimmers itch
Katayama fever 2-10W ( fever, urticaria, cough, GI upset, myalgia, headache) - usually self limits, can be deadly
GI: peri-portal fibrosis, portal hypertension (inflammatory reaction against ++eggs), anaemia, ascites
EO-granulomas
Urine: haematuria, obstruction, bladder carcinoma, increased risk HIV
CNS: seizures, myelitis

Leading cause of death is bleeding

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32
Q

How do you diagnose schistosomiasis?

A

Blood: serology, eosinophilia Faecal: eggs (s.mansoni/japonicum/mekongi) Urine: eggs (s.haematobium), antigen-test
PCR CSF, urine, faeces Imaging: USS

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33
Q

How do you treat schistosomiasis?

A

Katayama and neuroschisto: steroids
Praziquantel SD 8-12 weeks after exposure (20mg / kg),
Repeat after 4-6W
Won’t kill schistosomulae therefore repeat
3D if mekongi/japonicum
Monitor for liver or bladder cancer

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34
Q

How do you control schistosomiasis?

A

MDA praziquantel, sanitation,
target snails
Educate esp rice farmers, fisherman
Nb viable eggs shed for up to six months after treatment

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35
Q

when is urine sample collection best for schisto?

A

Midday

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35
Q

What is the infective and diagnostic stage of schisto?

A

Infective -> cercariae
Diagnostic -> eggs

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36
Q

Which bladder cancer does haematobium give you?

A

SCC
(In developed countries TCC is more common as less schisto)

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37
Q

What is this?

A

Schistosoma Mansoni

Pale yellow or colourless, 150-60. Contains miracidium and lateral spine. Dead eggs are dark or black. Might be RBC in background

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38
Q

What is this?

A

Schistosoma japonica

Pale yellow or colourless 90x65
Rudimentary spine
Faecal debris may appear

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39
Q

What is this

A

Schistosoma haematobium

145x55
Terminal spine
In urine
Intercalcalatum is slightly bigger (175-60) and are acid fast

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40
Q

What is the micro of Tania saginata?

A

Beef tapeworm
Cestode
Humans are definitive host

Can distinguish the Taenia worms by counting the branches of one side of the proglottid

T solium has <10 saginata >16

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41
Q

What is the lifecycle of beef tapeworm?

A

Humans eat undercooked beef - > cyst hatches in small intestine with four sucks on scolex

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42
Q

How big is the beef tapeworm?

A

Metres!
++ Proglottids

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43
Q

What is the clinical syndrome of beef tapeworm?

A

Minimal, mild G symptoms
Passage of proglottids

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44
Q

Where does beef tapeworm occur?

A

World wide
Europe / Asia
Lack of food control and raw beef eating where cows forage

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45
Q

What is this?

A

T.saginata (cannot distinguish them)

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46
Q

What is the treatment of beef tapeworm?

A

Like most tapeworms - Praziquantel SD

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47
Q

How do you diagnose tapeworm?

A

See the worm!
Eggs in faces

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48
Q

What is this?

A

Taenia spp

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49
Q

What is the micro of t.solium?

A

Cestode/tapeworm

Humans are intermediate and definitive host

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50
Q

What is the lifecycle of t.solium?

A

Pigs eat infected eggs on vegetation, oncospheres hatch in pig gut and penetrate/circulate to musculature. Develop to cysticerci in muscle, which humans eat. Scolex attaches to intestine
Humans definitive host for up to 25 years

BUT if you eat contaminated human faeces you become the intermediate host (the pig) - > invades muscles, viscera, brain with cysts

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51
Q

Differences between Tania spp

A

Proglottids not motile in sagnata

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52
Q

How do you control taeniasis?

A

Meat inspection
Cook pork properly

For Cystercercosis -> better hand washing!

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53
Q

What is the clinical syndrome of taeniasis solium?

A

Taeniasis: Asymptomatic Pass worms GI upset

Cystercercosis: Up to 30 years after infection Seizures
↑ICP, hydrocephalus

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54
Q

How to diagnose taeniasis?

A

Faecal microscopy

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55
Q

How to diagnose cystcercosis?

A

Brain MRI good for early, CT good for late
OCP - autoinoculate
Fundoscopy

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56
Q

How to treat cystercercosis?

A

Depends on number, site and viability

  1. Make sure not in eye - needs surgery 1st
  2. Viable (early) 1-2 albendazole plus steroids
    > 2 = steroids plus albendazole/praziquantel
    +++ lesions/ raised ICP-> consider anti TNF/steroids/dual therapy
    If seizures, add AED
  3. Calcified/late
    No role for anti-parasitic drugs]
    AEDS
    Avoid steroids
  4. Extraparenchymal - > sub arach -> prolonged dual therapy with steroids

Intraventricular -> surgery

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57
Q

What is the micro of diphyllobothrium latum?

A

Cestode
Fish tapeworm

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58
Q

What is the epidimiology of diphyllobothrium?

A

SE Asia inc Japan

Millions infected, can be decades

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59
Q

What is the lifecycle of diphyllobothrium?

A

Eggs passed into water via faeces
Eggs embryonate in water
Crustaceans are 1st int host
Develop to procercoid sandfish eat the crustacean
Human eggs the fish

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60
Q

What is the clinical syndrome of diphyllobothrium?

A

Usually asymptomatic
Might pass a long worm
Diarrhea
B12 def - > dementia

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61
Q

What is the control of diphyllobothrium?

A

Sanitation
Cook/freeze fish

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62
Q

What is the treatment for diphyllobothrium?

A

Praziquantel

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63
Q

What is this?

A

Diphyllobothriid eggs are oval or ellipsoidal and range in size from 55 to 75 µm by 40 to 50 µm. There is an operculum at one end that can be inconspicuous, and at the opposite (abopercular) end is a small knob that can be barely discernible. The eggs are passed in the stool unembryonated.

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64
Q

What type of parasite is schistosomiasis?

A

helminth -> platyhelminth -> trematode (fluke)

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65
Q

Roughly how many cases of schistosomiasis are there / year?

A

200 million - mostly Sub Saharan Africa (90%), but anywhere in the tropics, 200K deaths

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66
Q

What is the infective stage of schistosomiasis?

A

Cercariae

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67
Q

What is the diagnostic stage of schistosomiasis, and what samples would you collect?

A

Diagnostic stage = Eggs

S. Haematobium –> urine sample
S. Mansoni, S. Japonicum –> stool sample

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68
Q

What is the intermediate host in the schistosomiasis life cycle?

A

Freshwater snail

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69
Q

Where to the adult worms of s. mansoni / s. japonica live?

A

Mesenteric supply of bowel / rectum

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70
Q

Where do adult worms of s. haematobium live?

A

Urogenital blood supply

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71
Q

What stage in schistosomiasis life cycle comes after the egg stage?

A

Miracidia.
Hatch from eggs on contact with fresh water and swim around in search of a fresh water snail (intermediate host)

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72
Q

What stage of the lifecycle takes place in the definitive host of schistosomiasis?

A

Sporocysts.
Develop inside freshwater snail (definitive host).
Develop from miracidia into sporocyst inside snail

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73
Q

What stage of schistosomiasis lifecycle follows on from sporocysts?

A

Cercariae - infective stage
Develop inside snail from sporocyst.
Released by snail into fresh water supply.
Swim around in water waiting to infect human

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74
Q

What is Katayama fever and what are the clinical features?

A

Katayama fever = schistosomiasis seroconversion.

Features:
- Fever
- Eosinophilia
- Pneumonitis / wheeeze
- Hepatosplenomegaly can be seen

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75
Q

Which species of schistosoma is less likely to cause Katayama fever?

A

S. Haematobium

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76
Q

What are the clinical features of bladder schistosomiasis, and what is the causative species?

A

Causative species = S. Haematobium
- Terminal haematuria
- Granuloma -> secondary obstruction
- Hydroureter
- Bladder carcinoma (squamous cell)

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77
Q

What type of cancer is associated with s. haematobium?

A

Squamous cell carcinoma of bladder

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78
Q

What are the clinical features of urogenital schistosomiasis, and what is the causative species?

A

Causative species = S. Haematobium
- Female infertility (granuloma -> occlude fallopian tube)
- Haematospermia
- Vulvovaginal inflammation

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79
Q

What are the clinical features of pulmonary schistosomiasis, and what is the causative species?

A

Causative species = S. Haematobium
- Pulmonary granulomas
- Chronic cough / SOB
- Egg emboli
- Right heart failure

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80
Q

What are the clinical features of GI schistosomiasis, and what is the causative species?

A

Causative species = S. Mansoni (/ Japonicum)
- GI bleeds
- Tenesmus
- Hepatosplenomegaly
- Portal HTN
- Liver fibrosis
- Rectal prolapse

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81
Q

What are the clinical features of CNS schistosomiasis, and what is the causative species?

A

Causative species = S. Japonicum
- eggs embolising to brain –> focal epilepsy, meningoencephalitis

Caustive species = S. Mansoni / S. Haematobium
- eggs embolising to spinal cord -> cauda equina, transverse myelitis, paraplegia

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82
Q

What might you expect to see on routine bloods of a patient with acute schistosomiasis?

A

Intense eosinophilia
Otherwise normal

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83
Q

What might you expect to see on routine bloods of a patient with chronic schistosomiasis?

A

Usually normal
Eosinophilia unlikely
LFT normal unless very late stage
Mild Fe deficient anaemia may be seen (chronic GI / urinary bleeds)

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84
Q

What serological tests might you do for schistosomiasis?

A

IgG - does not distinguish current / past infection

Antibodies - highly specific, correlate with intensity of infection

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85
Q

What microscopic tests might you do for schistosomiasis, including samples and what you expect to see?

A

Urine - S. Haematobium eggs. Filtration / sedimentation increases sensitivity. Most eggs shed around midday

Faeces - S. Mansoni / S. Japonicum
eggs. Kato-katz thick smear

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86
Q

How do you treat schistosomiasis?

A

Praziquantel.
2 doses required - 1 at presentation, 2nd after 3 months
Dose = 20mg / kg for adults and paeds

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87
Q

Why does schistosomiasis need 2 doses of praziquantel?

A

Praziquantel ineffective at killing schistosomules. Allow them time to develop into adults. Hence why repeat dose praziquantel required at 3/12

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88
Q

How do you manage acute schistosomiasis?

A

Prednisolone -> reduce Katayama fever
Give 1st dose praziquantel

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89
Q

How long does viable ova shedding persist for following successful management of schistosomiasis?

A

6 months
–> Important in public health and prevention
–> Some diagnostic confusion may occur

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90
Q

How long do antibodies persist in schistosomiasis?

A

Lifelong
Ineffective at distinguising acute from chronic from previous infection

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91
Q

Name 5 ways to prevent schistosomiasis

A
  1. Mass drug administration
  2. Education
  3. Improve sanitation
  4. Use of personal protective equipment
  5. Snail control
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92
Q

What are principles of MDA in schistosomiasis prevention?

A

Praziquantel to all at risk –> interrupts transmission

Targeting against most at risk is possible
- women (collecting water for household)
- rice farmers
- fisher people
- children

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93
Q

What are principles of snail control in schistosomiasis prevention?

A

Reduce intermediate host –> reduce transmission
Environmental = reduce habitat
Chemical = pesticides

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94
Q

What are principles of sanitation in schistosomiasis prevention?

A

Improving sanitation reduces faecal / urinary contamination of fresh water

Prevents eggs from entering fresh water and continuing life cycle

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95
Q

What is the micro of clonorchis?

A

Trematode - flatworm/fluke
“Chinese liver fluke”

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96
Q

What is the epidemiology of clonorchis?

A

50m infected in Asia

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97
Q

What is the clinical syndrome of clonorchis?

A

Asymptomatic
Early: Fever, urticaria, hepatomegaly Late: Cholangitis, fibrosis, cholangiocarcinoma

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98
Q

What is the diagnosis if clonorchis?

A

Blood: eosinophilia, LFT (obstructive), serology Faecal: eggs (↓ sens) Imaging: USS

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99
Q

What is this?

A

Clonorchis egg

Clonorchis sinensis eggs are small, ranging in size from 27 to 35 µm by 11 to 20 µm. The eggs are oval shaped with a convex operculum that rests on visible “shoulders” at the smaller end of the egg. At the opposite (abopercular) end, a small knob or hook-like protrusion is often visible.

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100
Q

What is the treatment for clonorchis?

A

Praziquantel 2D

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101
Q

What prevents chlonorchis?

A

Cook/ freeze fish
MDA praziquantel

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102
Q

What is the micro of fasciola?

A

Trematode - flatworm/fluke

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103
Q

What is the epidemiology of fasciola?

A

Worldwide; South America (Peru), Europe, Middle East, Asia
~2-17 mill infected

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104
Q

What is the lifecycle of fasciola?

A

Sheep/cattle → snails → aquatic plants → humans

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105
Q

What is the clinical syndrome for fasciola?

A

Asymptomatic
Acute: fever; abd.pain, jaundice
Chronic: malaise,cholangitis, pancreatitis, cholecystitis
Ectopic worms: abscesses other tissues

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106
Q

What is this?

A

Fasciola/liver fluke egg
Yellow brown, large and oval
140-85
Mass of yolk cell and percolated

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107
Q

What is the treatment for fasciola?

A

Triclabendazole

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108
Q

How do you prevent fasciola?

A

Food hygiene

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109
Q

What is the micro of Lung fluke?

A

Lung fluke
(Paragonimus westermani)
Trematode parasite

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110
Q

what is the epidemiology of paragonimus?

A

East Asia; Korea, Japan, China, Phillipines

Westermani is far east

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111
Q

What is the lifecycle of paragonimus?

A

Snails → Crab/crayfish → humans

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112
Q

What is the clinical syndrome of paragonimus?

A

Pulm: cough, haemoptysis Other: abdom. mass; CNS; skin

TB mimic

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113
Q

How is paragonimus diagnosed?

A

Blood: serology, eosinophilia Faecal: eggs
Tissue biopsy: worms Imaging: CXR

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114
Q

What is this?

A

Paragonimus
Operculated, asymmetrical, slightly flat on one side. Mass of yolk cells
70-100 x 50-65

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115
Q

What is the treatment for paragonimus?

A

Praziquantel

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116
Q

What is this?

A

Gnothostoma
Four hooks

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117
Q

What is the micro of Gnathostomiasis
(Gnathostoma spinigerum)

A

Zoonotic nematode - roundworm

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118
Q

What is the epi of Gnathostomiasis
(Gnathostoma spinigerum)?

A

SE Asia + Latin America

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119
Q

What is the lifecycle of Gnathostomiasis
(Gnathostoma spinigerum)?

A

Zoonotic - dogs/pigs, humans acc.hosts: Larvae in raw food (fish, frogs), migrate to skin or tissues

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120
Q

What is the clinical syndrome of Gnathostomiasis
(Gnathostoma spinigerum)?

A

Incubation 2-4 weeks
GI: fever, abd.pain, nausea
Cutaneous: migratory painful pruritic swelling Visceral larva migrans: any tissue (ocular, eosinophilic meningitis, pneumonitis)

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121
Q

What is the diagnosis of Gnathostomiasis
(Gnathostoma spinigerum)?

A

Clinical incl food history Eosinophilia blood & CSF (serology)
Examine worm
Albendazole 21D or
ivermectin 2D CNS: supportive treatment

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122
Q

What is this?

A

Gnathostomiasis
(Gnathostoma spinigerum)

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123
Q

What is the treatment of Gnathostomiasis
(Gnathostoma spinigerum)?

A

Albendazole 21D or
ivermectin 2D CNS: supportive treatment

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124
Q

What is the micro of anisakis?

A

Nematode/roundworm

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125
Q

what is the epidemiology of anisakis?

A

Worldwide; Japan most frequent

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126
Q

What is the lifecycle of anisakis?

A

Zoonotic, humans acc.hosts: larvae to crustaceans → fish/squid → marine mammals (def.host) or humans

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127
Q

What is the clinical syndrome of anisakis?

A

Incubation < 48 h Epigastric pain, vomiting Allergic manifestations

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128
Q

What is the diagnosis of anisakis?

A

Clinical Eosinophilia Endoscopy worms (serology)

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129
Q

What is the treatment for anisakis?

A

Self-limiting days-weeks Endoscopic removal (albendazole)

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130
Q

How to prevent anisakis?

A

Cook/freeze fish

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131
Q

What is whipworm’s proper name?

A

Trichuris triciura - a GI nematode

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132
Q

What is epidemiology of trichuris/whipworm?

A

Tropics, 25% worldwide Anthroponosis

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133
Q

What is the lifecycle of whipworm?

A

Faecal-soil-oral
Ingest eggs, larvae → adult in GI tract, release eggs

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134
Q

What is the clinical syndrome of whipworm?

A

Asymptomatic
Mild infection: abd.distention, flatulence Heavy infection: dysentery, tenesmus, RECTAL PROLAPSE!!

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135
Q

What is the diagnosis of trichuris?

A

Faecal OCP - the one with plugs either end!
PCR
Enteroscopy adult worms

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136
Q

How big are the adult whipworms?

A

3-5cm

137
Q

What is this fella?

A

Whipworm
Mucoid plugs each end

138
Q

What is the treatment of whipworm?

A

Albendazole or mebendazole 3D* (+ ivermectin 3D →
↑ cure rates)

139
Q

What is the IPC of whipworm?

A

Sanitation

140
Q

What is the proper name of giant roundworm?

A

Ascaris spp

141
Q

What is the epidemiology of giant roundworm/ascariasis?

A

Tropics, >1 billion worldwide, Asia>Africa>SA Anthroponosis (A.suum zoonotic from pigs)

142
Q

What is the lifecycle of giant roundworm/ascaris?

A

Faecal-soil-oral
Eggs to larvae GI tract→ larvae to bloodstream, mature in lungs →oesophagus → GI tract lay eggs

143
Q

What is this?

A

Ascariasis/giant roundworm

Fertilized and unfertilized Ascaris lumbricoides eggs are passed in the stool of the infected host. Fertilized eggs are are rounded and have a thick shell with an external mammillated layer that is often stained brown by bile. In some cases, the outer layer is absent (known as decorticated eggs).

144
Q

What is the clinical syndrome of ascariasis?

A

Asymptomatic
GI upset
LOFFLERS!!
GI obstruction
Ectopic: liver, biliary → sepsis

145
Q

What is the diagnosis of giant roundworm?

A

Eosinophilia
Faecal OCP
PCR
Adult worms stool

146
Q

What is the macroscopic appearance of ascariasis/giant roundworm?

A

15cm-35cm
Adults of both sexes possess three “lips” at the anterior end of the body.
May form bolus

147
Q

What is the treatment of ascariasis?

A

Albendazole or mebendazole SD*

148
Q

What is the IPC of ascariasis

A

Sanitation
MDA

149
Q

What causes hookworm?

A

Ancylostoma spp esp duodenale

150
Q

What is the epidemiology of hookworm?

A

Tropics, 500 mill., anthroponosis (except maybe a.ceylanicum)

151
Q

What is the life cycle of hookworm?

A

Fecal-soil-skin; larvae through skin to circulation →lungs → GI tract mature to adults and lay eggs

152
Q

What is the clinical syndrome of hookworm?

A

“Ground itch” rash
GI upset, anemia, malnutrition (Löfflers)

(“ground itch”) associated with filariform (L3) larvae penetration, and respiratory involvement including eosinophilic pneumonia may be observed may occur during larval pulmonary migration A second urticarial rash may subsequently develop during pulmonary migration. Patients have reported vague gastrointestinal disturbances and eosinophilia (sometimes referred to as Wakana syndrome) following peroral infection.

153
Q

What is the diagnosis of hookworm?

A

Faecal OCP PCR Eosinophilia

154
Q

What is this fella?

A

Hookworm egg
Thin shell, segmented ovum (up to 8)
65x45
Ancylostoma duodenale, necator americanus

155
Q

What is the treatment of hookworm?

A

Albendazole SD or mebendazole 3D* Iron supplement

156
Q

What is the control of hookworm?

A

Sanitation, shoes

157
Q

Who is this guy?

A

Hookworm
Rhabditiform (L1) larvae that hatch from eggs are 250-300 µm long and approximately 15-20 µm wide. They have a long buccal canal and an inconspicuous genital primordium. Rhabditiform larvae are usually not found in stool, but may be found there is a delay in processing the stool specimen
DDX strongy

158
Q

What causes cutaneous larva migrans?

A

Humans being accidental host of dog hookworm

159
Q

What is the clinical syndrome of cutaneous larva migrans?

A

Worm burrows into subcutis: cannot penetrate further
Cutaneous larva migrans; 1-2cm/day for weeks to months

160
Q

What is the diagnosis of cutaneous larva migrans?

A

Clinical exam

161
Q

What is the treatment of cutaneous larva migrans?

A

Ivermectin or albendazole

162
Q

What is strongyloides?

A

GI nematode/roundworm
Caused by strongyloides stercoralis
Sometimes called threadworm

163
Q

What is the epidemiology of strongy?

A

Tropics/subtropics, ~600 mill infected
Anthroponosis

164
Q

What is the lifecycle of strongy?

A

Faecal-soil-skin BUT
can complete life-cycle in humans (autoinfection)
Dogs may host

165
Q

What is the infective stage of strongy?

A

Filariform (L3)
larvae

166
Q

What is the clinical syndrome of strongy?

A

Larva currens , urticaria
Löfflers
GI; diarrhea, pain, nausea, anemia Immunosuppressed: hyperinfection syndrome (pneumonia, meningitis, sepsis, death)

167
Q

What is larva currens?

A

a linear eruption in which the larvae migrate under the skin causing an itchy, nonindurated wheal with a red flare that moves rapidly and disappears in a few hours

168
Q

What is the diagnosis for strongy?

A

Clinical
Faecal OCP/PCR
Blood: Eosinophilia, serology Hyperinfection: Larvae in sputum/tissues

169
Q

Who gets strongy hyper infection?

A

HIV
Steroids

170
Q

How is strongy treated?

A

Ivermectin 2D (more if hyperinfected)

171
Q

What is the IPC of strongy?

A

Sanitation
MDA
Shoes
Test&treat before immunosuppression

172
Q

What is this guy?

A

L2 rhabditiform larva of S. stercoralis in unstained wet mounts of stool. Note the short buccal canal and the genital primordium (red arrows), but longer intestinal tract than seen in an L1.

173
Q

What is the micro of lymphatic filariasis?

A

Wuchereria bancrofti/Brugia malayi/timori

Tissue nematode (roundworm)

174
Q

What is the epidemiology of lymphatic filariasis?

A

~50 million cases (90% W.bancrofti), Tropics: SE Asia, Africa, Pacific

175
Q

What is the vector of lymphatic filariasis?

A

Vector: mosquitoes
W.Bancrofti anthroponosis, B.Malayi zoonotic (cats/primates reservoir)

176
Q

What is the lifecycle of lymphatic filariasis?

A

Mosquito bites human and transmits L3 larvae - develop into larvae in lymphatics, release MF into blood. After being eaten by mosquito, develop into adults in mosquito hindgut

177
Q

What is the clinical syndrome of lymphatic filariasis?

A

Adult worms cause disease
Acute: fever, lymphadenopathy, tropical pulmonary eosinophilia
Chronic: lymphedema extremities, dermal sclerosis, hydrocele

178
Q

How do you diagnose lymphatic filariasis?

A

Night blood film (mf) Serology/antigen immunoassay Ultrasound
Eosinophilia

179
Q

What is this?

A

Lymphatic filariasis

The microfilariae of Wuchereria bancrofti are sheathed and measure 240—300 µm in stained blood smears and 275—320 µm in 2% formalin. They have a gently curved body, and a tail that is tapered to a point. The nuclear column (the cells that constitute the body of the microfilaria) is loosely packed; the cells can be visualized individually and do not extend to the tip of the tail. Microfilariae circulate in the blood

180
Q

When do you take bloods for lymphatic filariasis?

A

Midnight

181
Q

What is the treatment of lymphatic filariasis?

A

Doxy 4-6 weeks (kills symbiotic wolbachia-bacteria, sterilizes adult worms)
DEC (NOT if oncho or loa loa) (ivermectin, albendazole)

182
Q

What is the IPC of Lymphatic Filariasis?

A

Vector control
MDA DEC (not in oncho or loa loa area)

183
Q

What is loa loa also known as?

A

a filarid nematode commonly referred to as the African eye worm.

184
Q

What is the epidemiology of loa loa?

A

10 mill cases Central/west Africa

185
Q

What is the vector of loa loa?

A

Vector: Deer fly (Chrysops)

186
Q

What is the lifecycle of loa loa?

A

Adult worms migrate through SC tissue, mf in blood

187
Q

What is the clinical syndrome of loa loa?

A

Adult worms cause disease
* Asymptomatic
* Calabar swellings
* Eye worm

188
Q

How do you diagnose loa loa?

A

Day blood film
Eye worm clinical
Eosinophilia

189
Q

What is this?

A

MF of loa loa
– Microfilariae of Loa loa are sheathed and measure 230-250 µm long in stained blood smears and 270-300 µm in 2% formalin. The tail is tapered and nuclei extend to the tip of the tail. Microfilariae circulate in the blood.

190
Q

What is the treatment of loa loa?

A

Dependent on microfilaria- burden;
* >8,000/ml: Albendazole
* <8,000 DEC
No wolbachia!

Low - DEC 3 weeks
Moderate - ivermectin stat then DEC for 3 weeks
High - Albendazole 3 weeks with steroid cover then DEC 3 weeks

191
Q

What is the micro of Mansonellosis?

A

Mansonella ozzardi
Mansonella perstans
Mansonella streptocerca

192
Q

What is the epidemiology of mansonellosis?

A

SS-Africa, Central/South America Vector: Midges or black fly

193
Q

What is the life cycle of mansonella?

A

Infective stage L3 larvae
Diagnostic stage MF

194
Q

When should MF be taken in lymphatic filariasis, loa loa and masonella?

A

Loa loa—midday (10 AM to 2 PM)
Brugia or Wuchereria—at night, after 8 PM
Mansonella - does not really display periodicity

195
Q

How do you diagnose Mansonella?

A

Blood film mf
Eosinophilia

196
Q

What is the clinical syndrome of mansonella?

A

Doxy (wolbachia) DEC/ivermectin/albendazole (combination?)

197
Q

What causes Dracunculiasis?

A

Tissue nematode/roundworm - Guinea Worm

198
Q

What is the epidemiology of guinea worm?

A

< 20 cases/year, SS Africa

199
Q

What is the vector of guinea worm?

A

Vector: Cyclops water flea

200
Q

What is the life cycle of guinea worm?

A

Water with larvae → adult SC, female migrate skin surface, ulcer with larva

201
Q

what is the clinical syndrome of guinea worm?

A

Ulcers, itch, swelling

202
Q

What is the management of guinea worm?

A

Extract worm

203
Q

What is the IPC of guinea worm?

A

Filter water
Education
Vector control

204
Q

what is the micro of trichinella

A

T.spiralis, a zoonotic nematode / roundworm

205
Q

What is the epidemiology of trichinella?

A

Worldwide, ~10.000 cases/year Carnivore hosts (pigs, bears)

Occurs in hunters, eating boars

206
Q

What is the lifecycle of trichinella?

A

Dog/cat faeces with eggs ingested → larvae through intestines to tissues, cannot mature in humans

207
Q

What is the clinical syndrome of trichinella?

A

Fever, myalgia, urticaria, facial/periorbital edema.
Complications: Myocarditis, meningoencephalitis

208
Q

How is trichinella diagnosed?

A

Clinical incl food history Eosinophilia
↑ creatine kinase Serology (> 3 weeks)
Muscle biopsy

209
Q

What is the treatment of trichinella?

A

Albendazole (severe + steroids)

210
Q

What is the IPC of trichenella?

A

Cooking and inspection of meat

211
Q

What is the micro of toxocara?

A

T canis, T cati
Zoonotic nematode/roundworm

212
Q

What is the epidemiology of toxocara?

A

Worldwide, ↑tropics, children

213
Q

What is the lifecycle of toxocara?

A

Zoonotic, humans acc.hosts: Dog/cat faeces with eggs ingested → larvae through intestines to tissues, cannot mature in humans

214
Q

What is the clinical syndrome of toxocara?

A

Visceral larva migrans: fever, rash, LN, pneumonia, hepatitis, meningitis/seizures Ocular larva migrans: mimic retinoblastoma, unilateral vision loss

215
Q

How is toxocara diagnosed?

A

Serology
Eosinophilia
Larvae; pathology, endoscopy

Diagnosis of toxocariasis relies mostly on indirect means, particularly serology, since larvae are trapped in tissues and not readily detected morphologically. While visualization of larvae in histologic sections provides unequivocal diagnosis, the probability of capturing a larva in a small biopsy specimen is low. Since the larvae do not develop into adults in humans, a stool examination would not detect any Toxocara eggs.

216
Q

How is toxocara treated?

A

Most self-limiting Severe: albendazole + Steroids

217
Q

What is the micro of anisakiasis?

A

Anisakis simplex - zoonotic trematode!
The japanese fish one

218
Q

What is the epidemiology of anisakiasis?

A

Worldwide mostly Japan

219
Q

What is the lifecycle of anisakiasis?

A

Zoonotic, humans acc.hosts: larvae to crustaceans → fish/squid → marine mammals (def.host) or humans

220
Q

What is the diagnosis of anisakiasis?

A

Clinical
Eosinophilia
Endoscopy worms (serology)

221
Q

What is the management of anisakiasis?

A

Self-limiting days-weeks Endoscopic removal (albendazole)

222
Q

What is the IPC of anisakiasis?

A

Cook/freeze fish

223
Q

What is Angiostrongyliasis?

A

Infection with zoonotic nematode - Angiostrongylus cantonensis

224
Q

what is the epidemiology of angiostrongyliasis?

A

Asia (India, Thailand, Vietnam), Caribbean

225
Q

What is the epidemiology of angiostrongyliasis?

A

Zoonotic, humans acc.hosts: larvae rat faeces → snails → humans, migrate to CNS → adults

226
Q

What is the clinical syndrome of angiostrongyliasis?

A

Incubation 6-30 days Eosinophilic meningitis

227
Q

What is the diagnosis of angiostrongyliasis?

A

Clinical
Eosinophilia blood & CSF CSF-PCR

228
Q

what is the treatment of angiostrongyliasis?

A

Resolves spontaneously
Treating worms might make worse

229
Q

What causes Gnathostomiasis?

A

Gnathostoma spinigerum)
Zoonotic nematode

230
Q

What is the epidemiology of gnathostomiasis?

A

SE Asia + Latin America

231
Q

What is the lifecycle of gnathostomiasis?

A

Larvae in raw food (fish, frogs), migrate to skin or tissues

232
Q

What is the clinical syndrome of gnathostomiasis?

A

Incubation 2-4 weeks
GI: fever, abd.pain, nausea
Cutaneous: migratory painful pruritic swelling Visceral larva migrans: any tissue (ocular, eosinophilic meningitis, pneumonitis)

233
Q

How is gnathostomiasis diagnosed?

A

Clinical incl food history Eosinophilia blood & CSF (serology)

234
Q

How is gnathostoma treated?

A

Albendazole 21D or
ivermectin 2D
CNS: supportive treatment (treating worms might make it worse)

235
Q
A

Brugia timori microfilariae
on Thick Blood Film

Large microfilariae
Has a sheath that stains pink
3 nuclei in tail (.’. Tri-nucleated for Timori)

Disease: Lymphatic Filariasis

Vector: Culicine Mosquitoes

Tx: DEC (diethylcarbamazine) +/- Doxy

Thick bloodfilms for microfilariae, also stained with Giemsa

236
Q
A

Onchocerca volvulus microfilariae
on Dry smear impressions from skin snip

Large microfilariae
NO sheath
Empty globular head & empty blunt tail (O = nothing .’. empty)

Disease: Subcutaneous Filariasis & Onchocerciasis - River blindness

Vector: Simulium Black fly

Tx: Ivermectin +/- Doxy. NOT DEC.
(Caution if Loaloa coinfection)

Also stained with Giemsa

237
Q
A

Brugia malayi microfilariae
on Thick Blood Film

Large microfilariae
Has a sheath that stains pink
2 nuclei in tail (.’. Bi-nucleated for Brugia)

Disease: Lymphatic Filariasis

Vector: Culicine Mosquitoes

Tx: DEC (diethylcarbamazine) +/- Doxy

Thick bloodfilms for microfilariae, also stained with Giemsa

238
Q
A

Brugia malayi microfilariae
on Thick Blood Film

Large microfilariae
Has a sheath that stains pink
2 nuclei in tail (.’. Bi-nucleated for Brugia)

Disease: Lymphatic Filariasis

Vector: Culicine Mosquitoes

Tx: DEC (diethylcarbamazine) +/- Doxy

Thick bloodfilms for microfilariae, also stained with Giemsa

239
Q
A

Brugia malayi microfilariae
on Thick Blood Film

Large microfilariae
Has a sheath that stains pink
2 nuclei in tail (.’. Bi-nucleated for Brugia)

Disease: Lymphatic Filariasis

Vector: Culicine Mosquitoes

Tx: DEC (diethylcarbamazine) +/- Doxy

Thick bloodfilms for microfilariae, also stained with Giemsa

240
Q
A

Wucheria bancrofti microfilariae
on Thick Blood Film

Large microfilariae
Has a sheath that stains pink
NO nuclei in tail

Disease: Lymphatic Filariasis

Vector: Culicine Mosquitoes

Tx: DEC (diethylcarbamazine) +/- Doxy

Dx: optimum time is at night (between 22:00-02:00)

Thick bloodfilms for microfilariae, also stained with Giemsa

241
Q
A

Wucheria bancrofti microfilariae
on Thick Blood Film

Large microfilariae
Has a sheath that stains pink
NO nuclei in tail

Disease: Lymphatic Filariasis

Vector: Culicine Mosquitoes

Tx: DEC (diethylcarbamazine) +/- Doxy

Dx: optimum time is at night (between 22:00-02:00)

Thick bloodfilms for microfilariae, also stained with Giemsa

242
Q
A

Loaloa microfilariae
on Thick Blood Film

Large microfilariae
Has a sheath that does NOT stain pink .’. Ghost sheath
Many nuclei in tail which go to the tip

Disease: Subcutaenous Filariasis & African Eyeworm

Vector: Chrysops deer fly

Tx: Albendazole to dec. Mf then DEC
(DEC & IVM can produce severe SE’s in high Mf counts)

Thick bloodfilms for microfilariae, also stained with Giemsa

243
Q

How to distinguish the different creeping eruptions?

A

CLM in dog and cat hookworm. “Ground itch” can also be seen with human hookworm and threadworm infections. The cutaneous manifestations of threadworm (Strongyloides stercoralis) is referred to as larva currens and is differentiated by its rapid migration, perianal involvement, and wide band of urticaria.

244
Q

What kind of parasite is strongyloides?

A

Helminth –> nematode

aka ‘threadworm’

245
Q

What viral infection is commonly associated with strongyloides?

A

HTLV-1

246
Q

What is the clinical syndrome of strongyloides infection?

A

Usually asymptomatic

Acute phase: larva currens + loefflers + eosinophilia + diarrhoea

Chronic phase: diarrhoea <–> constipation, malabsorption, obstruction

247
Q

What is the clinical syndrome of strongyloides hyperinfection?

A

Hx of immunocompromise (steroids)

Diarrhoea + ileus + HSM + CNS meningitis / encephalopathy

Gram -ve sepsis –> death

248
Q

How is strongyloides diagnosed?

A

Rhabditiform larvae on stool microscopy –> insensitive, Baermann filter increases sensitivity

Culture on agar –> tracking

Serology, stool ELISA

249
Q

How is strongyloides treated?

A

Ivermectin

200mg / kg for 2 days

Repeat after 2/52 to treat autoinfection

Not recommended in pregnancy

250
Q

What is the infective stage of strongyloides life cycle?

A

Filariform larvae in environment / on skin around anus

251
Q

What is the diagnostic stage of the strongyloides life cycle?

A

Rhabditiform larvae in stool microscopy

252
Q

What are the two parts of the strongyloides life cycle?

A

Free living and parasitic

253
Q

In strongyloides infection, where to the adult worms live and lay their eggs?

A

Live = intestine
Eggs = intestinal mucosa

254
Q

How can strongyloides be prevented?

A

Wear shoes

Sanitation –> no poo containing rhabditiform larvae can enter environment

Mass drug administration with ivermectin

255
Q

What are the appearances of rhabditiform strongyloides larvae on microscopy?

A

Short mouth / buccal entrance

Bulbar oesophagus approx 1/3 length of body

256
Q

What are the appearances of filariform strongyloides larvae on microscopy?

A

2x size of rhabditiform

Notched tail

Oesophagus approx 50% of body length (no bulb like in rhabditiform)

257
Q

Can you distinguish taenia spp on microscopy?

A

Not on eggs

Proglottids - count branches

> 13 = saginata

Saginata scholex also does not have hooks

258
Q

What is this?

A

Bean shaped macronucleus

Balantidium coli

Tx: metronidazole

259
Q

When is the best time to take bloods for Loa Loa?

A

Midday

260
Q

How is Loa Loa managed?

A

Check for coinfection with onchocerca –> Mazzotti reaction

Increasing dose DEC over 3/52
Cover with steroids if high microfilariae burden

261
Q

What is the infective stage of Loa Loa life cycle?

A

L3 microfilariae (larvae)

262
Q

What is the diagnostic stage of Loa Loa life cycle?

A

Sheathed microfilariae

263
Q

Loa Loa vector

A

Chrysops horsefly

264
Q

Loa Loa features on microscopy

A

Ghost sheath
Dense nuclei
Nuclei loa and loa in tail

265
Q

How can Loa Loa be prevented?

A

Avoid Chrysops horse fly

Weekly DEC as prevention

266
Q

River Blindness causative organism

A

Onchocerca volvulus

267
Q

Onchocerca volvulus vector

A

Simulium black fly - day biter

268
Q

River blindness distribution

A

Near fast flowing water (simulium blackfly breeds in highly oxygenated water)

90% Africa
10% South America

269
Q

Onchocerca volvulus infective stage

A

L3 microfilariae

270
Q

Onchocerca volvulus diagnostic stage

A

No sheathed microfilariae in SKIN

271
Q

Onchocerca volvulus clinical features

A

Subcutaneous nodules over bony prominence containing adult worm - up to 40cm

Leopard skin –> patchy depigmentation

Hanging groin –> loss of skin elasticity on groin and buttocks, overhanging skin containing LNs

BLINDNESS –> punctate keratitis, iritis, chorioretinitis, optic atrophy

272
Q

How is river blindness diagnosed?

A

SKIN SNIPS –> microfilariae on microscopy

Slit lamp to examine eye for microfilariae

273
Q

How is river blindness managed?

A

IVERMECTIN: once every 6 months to kill microfilariae. Need to give for whole life span of adult worms (not killed by ivermectin) which can be 20 years or so

DOXYCYCLINE: 6 weeks therapy to kill wolbachia symbiotics (reducing adult and microfilariae burden)

AVOID DEC –> Mazotti reaction

274
Q

DEC and onchocerca volvulus - yay or nae?

A

NAE –> Mazotti reaction

DEC –> kills onchocerca volvulus –> massive host immune response –> ARDS and death

275
Q

How is onchocerciasis prevented?

A

MDA with ivermectin every 6/12 in at risk populations

VECTOR CONTROL spraying of blackfly simulium habitat

BITE PREVENTION Avoid simulium black fly bites (day biter) by wearing long clothes and insect repellant

276
Q

Onchocerca volvulus microscopic appearance key features

A

Its in SKIN

Large
No sheath
Spatula head
Empty head, empty tail

277
Q

Lymphatic filariasis causative organisms?

A

Wucheria Bancrofti
- Global
- 90%

Brugia Malayi
- SE Asia
- 10%

Brugia Timori
- Indonesia only
- Small minority

278
Q

Lymphatic filariasis vector

A

Mosquito
- aedes
- culex
- anopheles

279
Q

Infective stage lymphatic filariasis (various organisms)

A

L3 microfilariae

280
Q

Diagnostic stage lymphatic filariasis (various organisms)

A

Sheathed microfilariae in peripheral blood

281
Q

Pathophysiological stage lymphatic filariasis (various organisms)

A

Adult worms in lymphatics, females grow up to 10cm

282
Q

Clinical syndrome lymphatic filariasis

A

ACUTE: dying worms –> descending lymphangitis, fever. Common in limbs, breasts, testes

CHRONIC: recurrent lymphangitis + blocking adult worms –> lymphoedema –> elephantitis

283
Q

How is lymphatic filariasis diagnosed?

A

Microfilariae in blood (exhibit periodicity) after filtration and staining

Take bloods at MIDNIGHT (reflect vector behaviour - night biters)

…unless you’re in the Western Pacific, in which case the mosquitos bite at midday –> midday bloods

Card antigen testing available for w. bancrofti antigen only

284
Q

How is lymphatic filariasis managed?

A

Albendazole + DEC / Ivermectin

Albendazole = adult worm killing
DEC / ivermectin = microfilarae killing

Avoid DEC if oncho / loa loa, or if intercurrent acute lymphangitis (worsens symptoms)

285
Q

How can lymphatic filariasis be prevented?

A

MDA: Albendazole + DEC / ivermectin

VECTOR CONTROL: get rid of mosquito IRS / destroy larval habitat etc

BITE PREVENTION: bed nets, DEET

286
Q

Wuchereria bancrofti key features on microscopy

A

Pink sheath
Few, distinct nuclei
Empty tail (“bankrupt”)

287
Q

Brugia malayi key features on microscopy

A

Pink sheath
Two large nuclei in tail

288
Q

Brugia timori key features on microsopy

A

Ghost sheath
Large empty head (“Tim has an air head”)
Multiple distinct nuclei in tail

289
Q

Mansonella species and distribution

A

Mansonella perstans - global

Mansonella ozardi - S. America only

Mansonella streptocera - Africa only

290
Q

Mansonella vector

A

Midgie (culicoides)

291
Q

Where do adult mansonella worms like to live

A

Peritoneum
Pericardium
Pleural cavity

292
Q

Clinical syndrome mansonella

A

Usually asymptomatic

Migratory swellings follow microfilariae (like Loa Loa)

Rarely pericarditis, pleuritis

Systemic signs may include eosinophilia, lymphadenopathy, fever, pruritis

293
Q

Diagnosing mansonella

A

Microfilariae in peripheral blood

Do not demonstrate periodicity

294
Q

How is mansonella treated

A

Ivermectin / mebendazole +/- DEC

295
Q

How is mansonella prevented?

A

Midge vector control

296
Q
A
297
Q

Threadworm / pinworm causative organism

A

Enterobius vermicularis

298
Q

Threadworm / pinworm infective and diagnostic stage

A

Infective: enterobius vermicularis embryonated egg

Diagnostic: enteroboius vermicularis egg (perianal ski, fingernails –> sellotape)

299
Q

What type of parasite is enterobius vermicularis

A

Nematode

non soil transmitted (faecal oral)

300
Q

Threadworm / pinworm management and prevention

A

Single dose albendazole
Whole family, whole class at school

Strict hand hygiene
Short nails
Wash bedding and clothes at 60 deg

301
Q

Whipworm causative organism

A

Trichura trichuris, soil transmitted nematode

302
Q

Whipworm infective / diagnostic / pathophysiological stage and where they are found

A

INFECTIVE:
Trichuris trichura embryonated egg found in soil

DIAGNOSTIC
Trichuris tricura unembryonated egg found in stool

PATHOPHYSIOLOGICAL
Trichuris trichura adult worm found in caecum

303
Q

Whipworm clinical features

A

Abdo pain + diarrhoea (+/- blood) + rectal prolapse

Mostly seen in children
Coinfection with ascaris common

304
Q

Whipworm treatment and prevention

A

3 days of:
albendazole / ivermectin / mebendazole

Prevention:
Hand hygiene
MDA

305
Q

Ascaris causative organism, infective, diagnostic, and pathophysiological stage

A

Ascaris lumbricoides = nematode

Infective stage = ascaris lumbricoides embryonated egg

Diagnostic stage = ascaris lumbricoies fertilised / unfertilised eggs in stool

Pathophysiological stage = adult worms in small bowel

306
Q

Ascaris clinical syndrome

A

Loefflers

Abdo discomfort, malabsorption
Obstruction, intususception (worm bolus)

307
Q

How is ascaris treated and prevented?

A

Single dose albendazole / mebendazole

Prevention = better sanitation, not allowing human faeces into environment, MDA

308
Q

Toxocara clinical syndrome

A

VISCERAL LARVA MIGRANS
Eosinophilia + fever + HSM + bronchospasm

OCCULAR LARVA MIGRANS:
Acute unilateral loss of visual acuity

309
Q

Toxocara diagnosis

A

Difficult
Larva rarely identified

ELISA + symptoms + eosinophilia + history of exposure to cat / doggie poo

310
Q

Toxocara management

A

5/7 albendazole

311
Q

Hookworm causative organism

A

Necator americanus (human hookworm)

Ancylostoma duodenale (dog / cat hook worm)

Nematodes

312
Q

Hookworm transmission / infective stage

A

Filariform larvae directly penetrating skin

Ingestion of hookworm egg

313
Q

Hookworm clinical features

A

Larva migrans - usually on foot where filariform larva has penetrated

Loefflers

IDA (toothed worm –> persistent bleeding at intestinal insertion site)

314
Q

Diagnosing hookworm

A

Ova in stool

315
Q

Managing and preventing hookworm

A

Management = stat albendazole

Prevention =
footwear
preventing stool in environment (latrine)
MDA (50% prevalence = 6 monthly, 20% prevalence = annually)

316
Q

Trichinella causative organism, infective stage, diagnostic stage…

A

Organism = trichinella spp

Nematode

Infective = encysted larvae within meat muscle

Diagnostic = encysted larvae within host striated muscle

317
Q

Trichinella blood and diagnosis

A

High CK, High LDH, high eosinophil

PCR + antibodies

Muscle biopsy

318
Q

Preventing trichinella

A

Cook meat properly

319
Q

Trichinella management

A

Albendazole if early
Doesn’t treat muscle larvae
Symptomatic

320
Q

How is angiostrongy contracted?

A

Infective stage = angiostrongyloides cantonensis larva in snail / crustacean –> ingested

Angiostrongyloides cantonensis = nematode, found in SE Asia

Aka “ratworm”

321
Q

Angiostrongyloides clinical syndrome

A

Eosinophilic meningitis
Host immune response to dead and dying worms

322
Q

Dwarf tapeworm causes, infective stage, diagnostic stage, distribution

A

Dwarf tapeworm = hymenolepsis nana / hymenolepsis dimunata (cestode)

Infective and diagnostic stage = embryonated egg

Distribution = mediterranean

323
Q

Angiostrongyloidiasis diagnosis

A

LP:
high opening pressure, high WCC, eosinophils, high LDH. Larva rarely seen.

CSF –> PCR

324
Q

Guinea worm causative organism

A

Dracunculiasis medinensis (nematode)

325
Q

How does one acquire a guinea worm

A

Consuming L3 larvae (infective stage)

Water contaminated with copeopods (crustacean) that have eaten the larvae

Consuming fish / frogs that have consumed the copeopods that have consumed the larvae

326
Q

Describe guineaworm eradication programme ( 3 tactics )

A
  1. IDENTIFY ENDEMIC AREAS
    - surveillance
    - detection
    - reporting
  2. INTERVENTION
    - safe drinking water supply
    - water filters
    - education
  3. CONTAINMENT
    - prompt treatment
    - lifecycle interruption with insecticides in infected bodies of water
327
Q

Taenia management and prevention

A

Praziquantel single dose

Prevent: proper cooking of meat
better sanitation - no faeces in environment

328
Q

Cysticercosis management

A

AED + Steroids mainstay

Only treat active lesions
<2 = albendazole
>2 = albendazole + praziquantel

329
Q

Taenia infective stage (tapeworm)

A

Cystercerci in meat

Solium = pork
Saginatum = beef

330
Q

How does one acquire cystercerci

A

Consuming taenia solium egg

Autoinfection if you have a taenia solium worm and you faecally orally contaminate yourself

Consumption of egg from environment (on vegetables for example) if human faeces is in environment

331
Q

Dwarf tapeworm treatment

A

Single dose praziquantel

332
Q

Fish tapeworm causative organism, infective stage, diagnostic stage

A

Organism = diphyllobothrum latum

Infective stage = plecocercoid (raw fish)
Diagnostic stage = egg / proglottid in stool

333
Q

Fish tapeworm treatment

A

Praziquantel

334
Q

Fish tapeworm clinical syndrome

A

B12 deficiency

Otherwise asymptomatic

335
Q

Hydatid causes, hosts, infective stage

A

Echinoccus granulosus
- host = cattle, sheep, goat

Echinococcus multilocularis (rare)
- host = dog, fox

= cestodes

Infective stage = embryonated egg in faeces of host animal

335
Q

How can hydatid disease be prevented?

A
  1. Praziquantel to dogs and foxes
  2. Prevent dogs and foxed from consuming carcasses (where they get their tapeworms from)
  3. Prevent faecal oral contamination of human food from livestock / dog / fox faeces
336
Q

Fasciola hepatica / gigantica infective and diagnostic stages

A

Infective = metacercariae (water cress)

Diagnostic = unembryonated egg (stool)

337
Q

Fasciola clinical syndrome

A

ACUTE
Fever + GI symptoms + hepatomegaly 6/52 after ingestion of metacercariae

CHRONIC
Biliary pbstruction + malabsoprtion of fat soluble vitamins

338
Q

Fasciola diagnosis

A

Eosinophilia

Stool x 3 for unembryonated egg (only after 3/12 infection)

Serology

339
Q

Fasciola management and prevention

A

MANAGEMENT
Single dose triclabendazole

PREVENTION
Don’t use animal poo fertiliser on water cress
Don’t eat watercress that has come from a field with livestock

340
Q
A

Nagasaki Flashcard Extravaganza (34 decks)

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