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Infectious disease > Parasitic Diseases and Antiparasitics > Flashcards

Parasitic Diseases and Antiparasitics Flashcards

1
Q

presentation of amebiasis

A
  1. Intestinal Disease - Mild-Moderate - gradual onset diarrhea, abd pain, bloating, usually afebrile
    - PE - abd distension, abd tenderness, hyperperistalsis, hepatomegaly
    - Microscopic hematochezia is commonly found
    - Periods of remission-recurrence may last for weeks
  2. Moderate-Severe - colitis, dysentery with 10-20 bloody/watery stools per day
    - High fevers, prostration, vomiting, abd pain
    - PE - abd distension, abd tenderness, hepatomegaly, hypotension
    - Hematochezia is common
    - MC - in young children, pregnant pts, malnourished, pts on steroids
    MC: Asx, noninvasive commensal organism
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2
Q

complications with amebiasis

A
  1. Acute - necrotizing colitis, intestinal perforation, mucosal sloughing, hemorrhage, death
  2. Chronic - chronic diarrhea with weight loss, bowel ulcerations, amebic appendicitis
  3. Amebomas - localized granulomatous lesions
    - Pain, obstructive symptoms, hemorrhage
  4. Extraintestinal Disease
    - Amebic Liver Abscess
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3
Q

what is the MC extraintestinal manifestation

A

Amebic Liver Abscess
* abd pain, fever, enlarged/tender liver, anorexia, wt loss
* MC - men; can occur without any hx of colitis
* Can rupture (fatal)

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4
Q

how do you diagnose amebiasis

Intestinal Disease, Hepatic Abscess

A
  1. Intestinal Disease
    * Stool Microscopy/O&P - E. histolytica
    trophozoites and cysts
    * Stool antigen test
    * Stool PCR
  2. Hepatic Abscess
    * Anti-amebic antibodies - almost always +
    Stool O&P or antigen - often negative
    * Imaging - US/CT of liver
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5
Q

Tx for amebiasis

A
  1. Initial
    - metronidazole (10 days) or tinidazole (3 days)
  2. Followed by
    - paromomycin
    - PO aminoglycoside

initial eliminates E. histolytica **trophozoites **
f/u eliminates E. hi

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6
Q

prevention of amebiasis

A
  1. Avoid fruits, vegetables, and
    water in endemic areas
  2. Handwashing
  3. Boiled water
  4. Thoroughly cooked food

Central and South America,
India, Indonesia, tropical
and sub-Saharan Af

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7
Q

what is the MC intestinal protozoal pathogen in US

A

Giardiasis

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8
Q

risk factors of Giardiasis

A
  1. Travelers to Giardia-endemic areas
    - Tropical regions with poor sanitation
  2. Swallowing contaminated water during wilderness or recreation travel
  3. Men who have sex with men
  4. Immunocompromised
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9
Q

incubation for giardiasis

A

1-3 weeks

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10
Q

presentation of giardiasis

symptomatic disease

A
  1. Acute Diarrheal Syndrome
    - diarrhea, wt loss, dehydration
    - afebrile, no vomiting
  2. Chronic Diarrheal Syndrome
    - Diarrhea
    - Greasy or frothy, foul-smelling stools
    - abd cramps, bloating, flatulence, nausea, malaise; no fever or vomiting
    - Symptoms can persist weeks to months

MC not discernible

May see malabsorption in chronic

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11
Q

how do you diagnose giardiasis

A
  1. Stool Microscopy/O&P
    - (+) cysts and trophozoites
  2. Stool antigen assay for Giardia
  3. Stool PCR for Giardia

No blood or leukocytes

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12
Q

tx for giardiasis

A
  1. tinidazole
  2. nitazoxanide - for pts 1-3
  3. metronidazole - for pts < 12 months
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13
Q

which antiparasitic drug interferes with normal reproduction cycle of Cryptosporidium and Giardia

A

Nitazoxanide (Alinia)

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14
Q

SE of Nitazoxanide (Alinia)

A

usually minimal - GI upset, HA, dizziness, discolored (bright yellow) urine

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15
Q

how is cryptosporidiosis spread?

A
  1. Ingestion of oocyst form of parasite
  2. Swimming pool outbreaks

MC in HIV+ pts, but can be seen in immunocompetent pts as well

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16
Q

incubation of crytosporidiosis

A

1-14 d

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17
Q

presentation of cryptosporidiosis

A
  1. Acute - 5-10 days of diarrhea; other s/s for up to 2 weeks
    - Watery, nonbloody diarrhea
    - N/V, abd pain, cramping
    - Low-grade fever possible
    - May have milder or asx course
  2. HIV/AIDS Patients - typically chronic
    - Chronic diarrhea
    - Malabsorption and wt loss
    - Extraintestinal disease - Pulmonary infiltrates and dyspnea; Biliary tract infection and sclerosing cholangitis
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18
Q

diagnosing crypto

A
  1. Stool microscopy/O&P with acid-fast stain
  2. Stool antigen assay for Cryptosporidium
  3. Stool PCR testing

No blood or leukocytes

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19
Q

tx for crypto

A
  1. Acute form - self-limiting; supportive
  2. nitazoxanide or paromomycin
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20
Q

which protozoa is Often linked to foodborne outbreaksin US from imported produce
Endemic to Haiti, Peru, Nepal

A

Cyclosporiasis

Ingestion of oocyst form of parasite

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21
Q

incubation of Cyclosporiasis

A

2-14 d

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22
Q

presentation of cylcosporiasis

A
  1. Asx
  2. Symptomatic Disease
    - May see a flu-like prodrome
    - Watery diarrhea, nausea and abdominal cramping
    - Fatigue, malaise, anorexia
  3. Immunocompromised Pts
    - More severe, prolonged symptoms
    - Chronic, fulminant watery diarrhea and weight loss
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23
Q

diagnosing cyclosporiasis

A
  1. Stool microscopy/O&P with acid-fast stain
  2. Colonoscopy with biopsy
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24
Q

tx for cyclosporiasis

A
  1. First-line - TMP-SMX (Bactrim)
  2. Second-line options
    - Ciprofloxacin (Cipro)
    - Nitazoxanide (Alina) - May be good for pts with sulfa allergy
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25
Q

which protozoa is a very common cause of GU infections

A

Trichomoniasis

Trichomonas vaginalis

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26
Q

Trichomoniasis is MC seen in who?

A

women
Especially non-Hispanic black females

Annual screening in HIV+ and higher-risk
Female pts recommended

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27
Q

incubation of trichomoniasis

A

5-28 d

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28
Q

presentation of tichomoniasis

A
  1. Asx - M>F
  2. Symptomatic Females
    - Discharge - Frothy, yellow/green nonmalodorous
    - Pain - Vulvovaginal discomfort, abd pain
    - Dysuria, dyspareunia, pruritus
    - PE - inflamed vaginal mucosa and cervix with punctate hemorrhages; “Strawberry Cervix”
  3. Symptomatic Males
    - Dysuria
    - Scant, thin urethral discharge
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29
Q

how do you diagnose trichomoniasis

A
  1. Wet prep
    - motile, flagellated organisms
  2. Rapid antigen testing
  3. Nucleic acid assay (PCR)
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30
Q

tx for trichomoniasis

A
  1. Tinidazole or Secnidazole
  2. metronidazole
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31
Q

which protozoa is one of the leading causes of deaths from foodborne illness in US

A

Toxoplasmosis

Toxoplasma gondii

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32
Q

incubation of toxoplasmosis

A

1-2 wks

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33
Q

presentation of toxoplasmosis

A
  1. Primary Infection (Immunocompetent)
    - GI tract → lymphatics → disseminated
    - Asx - MC
    - Symptomatic - mono-like - fever, malaise, sore throat, HA, myalgias, LAD, HSM
    - Rare - hepatitis, meningoencephalitis,
    polymyositis, retinochoroiditis
  2. Primary Infection (Immunocompromised)
    - Reactivated - in AIDS pts, pts on immunosuppressive rx, cancer pts
    - MC presentation - encephalitis with necrotizing brain lesions
    - Fever, HA, signs of focal brain lesion
    - May also see retinochoroiditis, pneumonitis, myocarditis
  3. Congenital Infection
    - Mother - +/- s/s
    Overall infection risk increases as
    pregnancy progresses
    - Severe infection risk decreases as
    pregnancy progresses
    - Early - stillbirths, spontaneous abortions possible
    - Neuro - seizures, psychomotor retardation, deafness, hydrocephalus
    - Other s/s - fever, jaundice, HSM, V/D, pneumonitis, myocarditis, retinochoroiditis
    - Mild - normal at birth with later development of LAD, HSM, CNS or eye disease
    - Late - retinochoroiditis - in teenagers/young adults
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34
Q

how do you diagnose toxoplasmosis

A
  1. Serum IgM and IgG antibody detection
  2. ID of parasite on tissue biopsy
  3. PCR of amniotic fluids, blood, CSF, body fluids
  4. Cx body fluids

Routine pregnancy screening - not recommended

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35
Q

tx for toxoplasmosis

A
  1. Immunocompetent - none for acute
  2. Pregnancy - Spiramycin (reduces transmission risk)
  3. Immunodeficiency/Fetal Infection - pyrimethamine + sulfadiazine
    - not used in early pregnancy

Pyrimethamine is teratogenic

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35
Q

Plasmodium falciparum MC causes what infection

A

malaria

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36
Q

what infection is transmitted by the bite of infected Anopheles female mosquito in endemic areas

Transmitted by Vector (mosquito) in endemic regions

A

malaria

Highest transmission - Sub-saharan Africa

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37
Q

incubation of malaria

A

9-14 days

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38
Q

describe the pathogenesis of malaria

A
  1. Sporozoites injected into the bloodstream, travel to liver
  2. Hepatocytes become infected, release merozoites
  3. Merozoites infect erythrocytes
  4. Becomes disseminated through bloodstream
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39
Q

clinical presentation of malaria

acute attack

A
  1. Prodrome - HA and fatigue
  2. Malarial paroxysm - High fever, chills, sweats
    * General - malaise, anorexia, fever
    * GI - abd pain, N/V/D
    * MSK - myalgias, arthralgias
    * Cardiopulmonary - chest pain, dry cough
    * Neuro - seizures, HA
    * Exam - may be benign; May show signs of anemia, jaundice, mild HSM
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40
Q

Recent Travel

Risk for falciparum malaria is greatest within ____ of exposure

time frame

A

2 months

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41
Q

presentation of malaria

complications/severe

A
  1. Severe illness, organ dysfunction, or high parasite load
    * Peripheral parasitemia >5% or >200,000 parasites/mcL
  2. Neuro - altered consciousness, repeated seizures, coma (“cerebral malaria”)
  3. Heme - severe anemia, hemolysis, DIC, other bleeding abnormalities
  4. CV - hypotension and shock
  5. Pulm - ARDS, pulmonary edema
  6. GI - jaundice, hepatic dysfunction
  7. Renal - acute kidney injury
  8. Metabolic - acidosis, hypoglycemia
  9. Infectious - secondary bacterial infections (pneumonia, Salmonella)
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42
Q

how do you diagnose malaria?

A
  1. Giemsa-stained blood smears
  2. PCR/Rapid Assays
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43
Q

tx of malaria is dependent on what?

A
  1. type (species) of the infecting parasite
  2. area where the infection was acquired and its drug-resistance status
  3. clinical status of the patient
  4. Any accompanying illness or condition
  5. Pregnancy status
  6. Drug allergies, and DDI
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44
Q

First-line for susceptible (non-falciparum) malaria

A

Chloroquine
Resistance is increasing
First line drugs now based on region acquired

45
Q

First-line for Falciparum and resistant non-falciparum malaria:

A

ACTs: Artemisinin-based combination therapy
- Contain a SA artemesinin and LA partner drug
- Artemether-lumefantrine (Coartem)

46
Q

what tx to use if resistance to ACT therapy/inability to tolerate

A
  1. Malarone (atovaquone-proguanil)
  2. Quinine + tetracycline, doxycycline, or clindamycin
  3. Mefloquine (Lariam) - resistance increasing
47
Q

first line tx for severe malaria

A
  1. IV artesunate - must be obtained from CDC
  2. IV quinidine/IV quinine - no longer available in the US
48
Q

antimalarial drugs - Quinoline Derivatives

A

Chloroquine
Quinine/Quinidine
Mefloquine (Lariam)
Primaquine

49
Q

what is an Antifolate antimalarial drug

A

Atovaquone-proguanil (Malarone)

50
Q

what are the Artemisinin Combination Therapy (ACT)
for malaria

A
  1. Artemether-lumefantrine (Coartem) - approved in the US
  2. Artesunate-amodiaquine (Camoquin)
  3. Artesunate-mefloquine
  4. Artesunate-pyronaridine
  5. Artesunate-sulfadoxine-pyrimethamine
  6. Dihydroartemisinin-piperaquine
51
Q

which antimalarial drug class has activity against the erythrocytic stage of infection

A

Quinoline Derivatives

52
Q

which quinoline derivatives also kills intrahepatic forms and gametocytes (seen with P. vivax and P. ovale)

A

Primiquine

53
Q

First line for tx and prophylaxis of susceptible pathogens for malaria

A

Chloroquine

54
Q

which drug
accumulates in parasite food vacuole and complexes with heme, preventing heme breakdown and allowing cytotoxic free heme to accumulate

A

Chloroquine

55
Q

which antimalarial drug has a rapid onset - clears fever in 24-48 hrs and parasitemia in 48-72 hrs

A

Chloroquine

56
Q

SE of Chloroquine

A

usually minor; pruritis (MC); HA, N/V, abdominal pain, malaise

57
Q

Drug of choice for elimination of dormant liver cysts (P. vivax, P. ovale)

antimalarial drug

A

Primaquine

58
Q

what drug is typically used after tx with chloroquine or quinine

A

Primaquine

59
Q

SE of Primaquine

A

prolonged QT, cardiac dysrhythmia, N/V/D, abdominal pain

60
Q

CI with primaquine

A

G6PD Deficiency, pregnancy, breastfeeding

61
Q

which quinoline derivative:
Often used for prophylaxis - can be dosed weekly
Greater problems with toxicity when used therapeutically

A

Mefloquine

62
Q

SE of Mefloquine

A

cardiac dysrhythmias, psychologic disturbances, seizures, N/V/D, HA, abdominal pain

63
Q

CI with Mefloquine

A

hx of seizure disorder
hx of major psychiatric disorders
hx of dysrhythmia

64
Q

which antimalarial is
Derived from the bark of the South American cinchona tree
a class IA antiarrhythmic agent

A

Quinine/Quinidine
MOA not well understood

65
Q

SE of Quinine/Quinidine

A

“cinchonism” - nausea, HA, tinnitus, blurred vision, dizziness
1. Hypersensitivity - rash, angioedema, urticaria, bronchospasm
2. Hematologic - hemolysis, agranulocytosis, leukopenia, thrombocytopenia
3. Cardiac - ECG changes (prolonged QT), arrhythmias

66
Q

Quinine/Quinidine is often combine with what abx to shorten tx/toxicity

A

doxycycline

67
Q

which antimalarial interferes with folate metabolism, blocking nucleic acid synthesis

A

Atovaquone-proguanil (Malarone)

68
Q

SE of Atovaquone-proguanil (Malarone)

A

generally well tolerated
N/V, HA, abdominal pain, pruritis; transient AST/ALT elevation

69
Q

which antimalarial
encourages formation of free radicals that damage parasite; active against all forms

A

Artemether-lumefantrine (Coartem)

Derived from leaves of Artemisia annua, an herb used in Chinese medicine

70
Q

which antimalarial has the fastest parasite clearance times of any antimalarial
Rapid absorption, rapid onset

A

Artemether-lumefantrine (Coartem)
Short half-life - not good for chemoprophylaxis, and only given in combo regimens

71
Q

SE of Artemether-lumefantrine (Coartem)

A

generally well tolerated
HA, N/V/D, anorexia
Rare - neutropenia, hemolysis, anemia

72
Q

what are the 3 Taeniasis

A
  1. Taenia saginata (beef tapeworm)
  2. Taenia solium (pork tapeworm)
  3. Diphyllobothrium latum (fish tapeworm)
73
Q

transmission of tapeworms

A

ingestion of cysts in undercooked meat

74
Q

incubation of tapeworms

A

2-3 months

75
Q

proglottids in stool is MC in what parasitic infection?

A

Tapeworms (Taeniasis)

76
Q

which tapeworm specifically causes prolonged infection leading to B12 deficiency

A

Diphyllobothrium latum - fish

77
Q

presentations of tapeworms

A
  1. Noninvasive (Intestinal)
    * May be asymptomatic
    * May have abdominal pain, nausea,
    * diarrhea, flatulence, hunger, wt loss
    * Eosinophilia is possible
  2. Invasive - Cysticerosis (Brain)
    * Altered cognition, psychiatric s/s, seizures,
    * HA, focal neuro deficits
    * Important cause of epilepsy in Latin America, SE Asia
78
Q

how do you diagnose tapeworms?

A

Microscopic identification of proglottids and
eggs in feces

79
Q

tx for tapeworms

A
  1. Intestinal - praziquantel (Biltricide)
  2. Neurocysticercosis - controversial
    * Clearance of cysts vs. inflammatory response to dead/dying pathogens
    * When pharmaceutical treatment performed - albendazole
80
Q

which antiparasitic drug allows increased calcium to enter parasitic cells, causing muscle spasms and paralysis and leading to worm detachment from host

A

Praziquantel (Biltricide)

81
Q

CI of Praziquantel (Biltricide)

A

allergy to medication, ocular cysticercosis

82
Q

DDI of Praziquantel (Biltricide)

A

antimalarials
grapefruit juice
cimetidine

83
Q

SE of Praziquantel (Biltricide)

A

GI upset, HA, dizziness
May see secondary inflammatory response following pathogen death

84
Q

what parasite have its larvae penetrate skin and migrate through bloodstream to lungs, eventually ending up in the intestines

A

Hookworms

Helminth

85
Q

etiology of Hookworms

A

Ancylostoma duodenale
Necator americanus

86
Q

incubation of hookworms

A

4-8 wks

87
Q

pt presents with
pruritic maculopapular rash
fever, wheezing, dry cough
Bloating, abdominal pain, anorexia, nausea, diarrhea
what is their diagnosis

A

Hookworms
Can also see low protein, anemia
In children - may lead to cognitive delay and impaired growth

88
Q

diagnosing hookworms

A
  1. Stool microscopy/O&P - microscopic eggs in feces
  2. Rapid stool PCR testing
  3. Often also see anemia, blood in stool, hypoalbuminemia
89
Q

tx for hookworms

A
  1. Albendazole
  2. Mebendazole
  3. 3-day regimen (100 mg BID)
  4. Tx for anemia and low protein as appropriate
90
Q

Albendazole (Albenza)

A

Benzimidazoles

91
Q

Mebendazole (Vermox, Emverm)

A

Benzimidazoles

92
Q

which benzimidazole should be taken with a high-fat meal or snack

A

Albendazole (Albenza)

93
Q

what antiparasitic drug inhibits helminth microtubule formation and glucose uptake

A

Benzimidazoles

94
Q

DDI of Benzimidazoles

A

antimalarials
grapefruit juice
cimetidine
anticonvulsants

95
Q

SE of benzimidazoles

A

Abdominal pain, N/V/D

96
Q

which benzimidazole may cause elevated LFTs and/or, in long-term tx, neutropenia or agranulocytosis

A

Albendazole

97
Q

Pinworms (Enterobiasis) is Mc in what demographic

A

school-age children

98
Q

incubation of Pinworms (Enterobiasis)

A

1-2 months

99
Q

a 10y/o presents with
Perianal pruritus, especially nocturnal
excoriation and secondary impetigo of perianal skin
what is their diagnosis?

A

**Pinworms (Enterobiasis)
**
asx - majority of pts
Children may also have insomnia, restlessness, enuresis

100
Q

diagnosing pinworms

A

eggs and/or adult worms on perianal skin
* “Scotch tape test”/“Paddle test” - in early AM - examined microscopically
* eggs are NOT found in feces

101
Q

tx for pinworms

A
  1. Albendazole or mebendazole - Repeat in 2 weeks!
  2. Tx of infected family members and close contacts
  3. Washing bed sheets, clothing
  4. Avoid perianal scratching
  5. Education on hand hygiene
102
Q

transmission of Trichinosis

A

Ingestion of larvae from undercooked pork or other meat
Typically in areas where pigs feed on garbage

103
Q

incubation of trichinosis

A

1-7 days

104
Q

presentation of trichinosis

A
  1. GI stage - V/D, abdominal pain
  2. Systemic - larvae migration
    - Fever, myalgias, periorbital edema, eosinophilia
    - May see HA, cough, dyspnea, hoarseness, dysphagia, rash, eye hemorrhages
    - Peak in 2-3 wks; can last for 2 months
  3. Severe - signs of muscle involvement
    - Muscle pain and weakness
    - Myocarditis, pneumonitis, encephalitis
105
Q

how do you diagnose trichinosis

A
  1. Elevated serum muscle enzymes (CK, LDH, AST)
  2. ELISA assay 2+ weeks after infection - cross-reactive with other parasites
  3. Muscle biopsy
106
Q

tx for trichinosis

A
  • No specific treatment for full-blown trichinosis
  • If suspected early - albendazole or mebendazole may limit intestinal infection
  • Supportive - analgesics, antipyretics, bed rest, steroids
  • Prevention - thoroughly cooking meat
107
Q

what is the MC intestinal helminthic infection worldwide

A

Roundworms (Ascariasis)

108
Q

incubation of Roundworms (Ascariasis)

A

6-8 weeks

109
Q

presentations of roundworms

A
  1. asx - up to 85% of pts
  2. Migration through Lungs
    * General - Fever, eosinophilia
    * Pulmonary - Dry cough, dyspnea, chest pain
    * May see eosinophilic pneumonia
  3. Intestinal Manifestations
    * +/- eosinophilia
    * Bloating, decreased appetite, obstruction
    * Pancreatitis, appendicitis, cholangitis
    * May be coughed up, vomited up, or passed rectally
    * May migrate and emerge through nose or anus
110
Q

diagnosing roundworms

A
  1. Stool microscopy/O&P - microscopic eggs in feces
  2. Emergence of adult worms (cough, nose, anus, feces)
111
Q

tx for roundworms

A
  1. Albendazole
  2. Mebendazole

similar to hookworms

Infectious disease (15 decks)

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