Parasitic Diseases of the lungs Flashcards
Parasites known to affect the lungs
Ascaris, Hookworm, Strogyloides, schistosoma
Helminth that cause pulmonary hypertension
Schistosoma or Oriental blood fluke
Causative agent of TPE
Wuchereria bancrofti
Visceral larva migrans
toxocara
Also nown as simple pulmonary eosinophilia, characterzied by transient pulmonary infiltrates associated with peripheral eosinophilia
Loeffler’s syndrome
Pathogenesis of Loeffler’s sydnrome
hypersensitivty response to an ingested or inhaled antigen
Toxic eosinophilic products
major basic protein
Eosinophil cationic protein
Eosinophil derived neurotoxin
Paralysis of cilia, causing cough and difficulty in breathing
Ciliastasis
Results in asthma like symptoms, can be misdiagnosed as bronchial asthaama and pneumonia
Loeffler’s syndrome
-release of PAF and leukotrienes contributing to bronchospasm
Embolization of microfilariae or eggs which degenerate and expose antigens to the local immune system can lead to?
Grranuloma formation
Most common roundworm parasitism in the philippines
Ascariasis (Ascaris lumbricoides)
Life cycle of ascaris lumbricoides
Lumen of small intestine -> Unfertizied egg -> fertile eggs -> ingested -> larvae -> intestinal mucosa -> portal -> systemic -> lungs -> bronchial tree to the throat and are swallowed.
Sputum findings of Ascariasis
eosinophils, charcot leyden crystals, sometimes larvae
Causative sp. of hookworming infction
Necator americanus, ancylostoma duodenale
___ and _____ are observed during the lung migration phase of hookworms
Transient pulmonary infiltrates and eosinophilia
Large number of larvae causing nausea, vomiting dyspnea and high eosinophilia.
Wakuna disease
type of anemia caused by hookworm
microcytic hypochromic anemia
Volume of blood/day consumed by hookworms
30 to 150 uL/day
Transmission of Strongyloides stercoralis
skin penetration
Acute phase of Strongyloidiasis
Diarrhea
Chronic phase of strongyloidiasis
Dormant infection
Large numbers of recently larvae burrow through the intestine and migrate to the lungs
Hyperinfection syndrome
Most common cause of schistosomiasis in the philippines
Schistosoma japonicum (hardest to control)
Most common complication of schistosomiasis
pulmonary hypertension
*Fibrous State
Chronic pulmonary Manidestation schistosomiasis
Chronic cough and dyspnea
Production of thick, blood tinged sputum or frank hemoptysis
Patchy infiltrates, coin lesions
Abnormal looking mucosa of the rectum is sampled and analyze under microscope
Rectal imprint
COPT
circumoval precipitin test
Associated with immune hyperresponsiveness to Wuchereria bancrofti and brugia malayi
Lymphatic filariasis and tropical pulmonary eosinophilia
SIgns of LF
filariasis, lymphedema, hydrocoele
Acquried through ingestion of inadequately cooked or pickled crustacean
Paragonimus
Foodborne trematode
Paragonimus westermani
Characterstics of P. westermani
Plump val, reddish brown fluke
7.5 -20mm long, 4-6 mm wide and 3-5 mm thick
Hermaphroditic
With two suckers (oral and ventral)
Life cycle of P westermanii
Embtyonated eggs _> miracidia ->snail -> sporocysts - > rediae -> cercariae -> human infection -> metacercariae excyst in the duodenum -> lungs
Juvenile worms can elaborate hydrolytic enzymes like _____ which are important in invasion biology
cysteine proteases
Pathology of Paragonimiasis
Generalized fibrosis
Cystic dilatation
Persistent pneumonia
cyst formatin
Destroys the protective covering of the cyst so that the immune system can appropriately eliminate the invading parasite
Praziquantel
Egg depositin starts -___ weeks ater infection (paragonimus)
5-6
Sputum of pt with paragonimiasis
rusty, with the color of clotted blod
Extrapulmonary paragonimiasis
Cerebral, abdominal (Spleen and liver), subcutaneous and miscellaneous forms
Concentration technique for light paragonimiasis infection
3% NaOH
Paragonimiasis wasfirst described by?
Musgrave
First intermediate host of P. westermani
Antemelania asperata
Antemelania dactylus
2nd intermediate hosts of P. westermani
Sundathelpusa philippina
Varuna literata
Reservoir host of P. westermanii
Cats, dogs, rats
Paratenic host of P. westermanii
Pig
Treatment for P. westermanii
Praziquantel (25 mg/kg 3x daily (203 days)
Follow up to treated patients.
Repeat sputum exam after 90 days after treatment.
Triclabendazole
First line drug
This now the recommended drug of choice by WHO
10mg/kg for two doses in a single day
10 mg/kg single dose, high cure rates, better tolerated and better