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cdc yellowbook > Parasitic (F-L) > Flashcards

Parasitic (F-L) Flashcards

1
Q

what are the 3 species of filarial nematodes that cause Lymphatic filariasis?

A

Wuchereria bancrofti;
Brugia malayi;
Brugia timori.

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2
Q

how do you get Lymphatic filariasis?

A

mosquitoes - Aedes, Anopheles, Coquillettidia, Culex, Mansonia
rural, urban, semiurban settings, day and night

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3
Q

where is Lymphatic filariasis occur?

A

Africa (Egypt, sub-Saharan Africa); Asia (SE Asia, the Indian subcontinent); some southwestern Pacific Islands;
NE coast of Brazil, Guyana, Dominican Republic, Haiti

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4
Q

why is it low risk for short term travelers get lymphatic filariasis?

A

multiple exposures over time is required

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5
Q

what are the symptoms of lymphatic filariasis?

A

adult worms live in human lymphatic and subcutaneous tissues - can be asymptomatic or associated with acute and chronic clinical manifestations involivng moderate to severe lymphedema of the arm, breast, leg, penis, or scrotum;
progression of lymphedema to elephantiasis;

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6
Q

what is tropical pulmonary eosinophilia TPE syndrome?

A

result from immune hyper-responsiveness to microfilariae (due to lymphatic filariasis) in the pulmonary capillaries;

serious, progressive lung disease characterized by fever and nocturnal cough, wheezing, or both

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7
Q

how to diagnose lymphatic filariasis?

A

filarial antibody tests that detect elevated IgG and IgG4 can be useful

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8
Q

how to treat lymphatic filariasis?
lymphedema and hydrocele?

A

DEC (diethylcarbamazine);

4-8 week course of doxycycline (200mg daily) can both serilze adult worms and improve lymphatic pathologic features

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9
Q

what do you need to rule out before initiating DEC (diethylcarbamazine)?

A

co-infection with Onchocerca volvulus - contraindicated due to potential for causing a sevee allergic response (Mazzotti reaction) that especially affects the eyes and skin

DEC must be used extreme caution with patients with Loa loa infection (Loiasis) - due to possible life-threatening side effects in people with high circulating microfilariae loads

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10
Q

what cause liver flukes?

A

trematode flatworms, including
Clonorchis sinensis;
Fasciola hepatica and Fasciola gigantica;
Opisthorchis felineus and Opisthorchis viverrini

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11
Q

what is reservoir hosts for Clonorchis and Opisthorchis spp?

A

cats, dogs, other fish-eating mammals

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12
Q

how do you get liver flukes?

A

eat raw or undercooked freshwater fish

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13
Q

which species of causing liver fluke found mainly in Asia (China, Korea, eastern Russia, Taiwan, Vietnam, japan)?

A

Clonorchis sinensis

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14
Q

where is Fasciola gigantica found ?

A

Africa, Asia

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15
Q

where is Opisthorchis felineus found mainly in?

A

eastern Europe and through central Asia to Siberia, including the Baltic countries, Belarus, Italy, Germany, Greece, Kazakhstan, Moldova, Poland, Romania, Russia, Ukraine

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16
Q

where is Opisthorchis viverrini found in ?

A

Burma (Myanmar), NE Cambodia, Laos, Thailand, central and southern Vietnam

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17
Q

what are the symptoms of Clonorchiasis and Opisthorchiasis?

A

low-intensity infection: asymptomatic/mild symptoms;

high-intensity: nonspecific signs and symptoms - diarrhea, eosinophilia, fatigue, fever, nausea, indigestion, abdominal pain (right upper quadrant), colicky pain-associated with worms obstructing the gallbladder, jaundice, unlarged or tender liver

chronic infection (30 days or more) can complicate - cholelithiasis, cholangitis, cholecystitis, liver abscesses, pancreatitis, cholangiocarcinoma (CCA)

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18
Q

what are the symptoms of fascioliasis - acute and chronic?

A

acute: migratory, invasive, or hepatic phase can last 3-4 months;
abdominal pain, GI symptoms, marked eosinophilia, fever, respiratory symptoms, urticaria

chronic: biliary phase - begin 6 months after infection when immature worms (larval flukes) reach the bile ducts, mature into adult worms (can live 10 or more years) and start to produce eggs - chronic phase reflect biliary tract disease (biliary tract obstruction, cholangitis, cholecystitis) or pancreatitis

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19
Q

how to diagnose liver flukes?

A

eggs in stool; duodenal or biliary aspirates;
serologic testing can be useful for fascioliasis diagnosis during the acute phase

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20
Q

how to treat fascioliasis?

A

triclabendazole - first line
(nitazoxnide can be helpful in some patients)

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21
Q

how to treat clonorchiasis and opisthorchiasis?

A

praziquantel - first line
(albendazole - alternate)

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22
Q

which parasite cause lung fluke, Paragonimiasis?

A

Paragonimus westermani

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23
Q

how do you get lung fluke infection?

A

eat raw or undercooked freshwater crab or crawfish

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24
Q

where are Paragonimus species are found in?

A

western Africa, the Americas, Asia

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25
Q

what are the symptoms of lung fluke?

A

acute: occur within 2 days to 2 weeks after ingestion
chronic: symptoms like tuberculosis - shortness of breath, cough, hemoptysis

extrapulmonary infections can occur - CNS involvment is serious;

eosinophilia especially during the larval migration stage

26
Q

how to diagnose lung fluke?

A

eggs in stool or sputum;
serologic test is helpful

27
Q

what parasite cause Giardiasis?

A

anaerobic protozoan parasite Giardia duodenalis (formerly known as G. lamblia or G. intestnalis)

28
Q

how do you get Giardiasis?

A

fecal-oral route;
moderate chlorine tolerance - transmission through drinking and recreational water

29
Q

what are the symptoms of Giardias?

A

1-2 weeks after exposure and resolve 2-4 weeks;
abdominal cramps, anorexia, bloating, diarrhea (foul smelling, greasy stools), flatulence, nausea;
2-5 loose stools per day, increasing fatigue;
upper GI symptoms, weight loss,
reactive arthritis, irritable bowel syndrome, other chronic symptoms sometimes occur;
children - severe giardiasis can cause development delay, failure to thrive, malnutrition, stunted growth

30
Q

how to diagnose Giardia?

A

exam 3 stool specimens over several days;
new molecular enteric panel assays;
microscopy with direct fluorescent antibody testing;
microscopy with trichrome staining, enzyme immunoassay kits, rapid immunochromatographic cartricge assays, molecular assays;
only Molecular testing (DNA sequencing) can identify the genotypes and subtypes of Giardia

31
Q

how to treat Giardiasis?

A

metronidazole, tinidazole, nitazoxanide;
alternative - furozolidone, paromomycin, quinacrine

32
Q

what is helminths?

A

parasitic worms

33
Q

what are helminths that infect the intestine?

A

Ascaris lumbicoides (Ascaris or roundworm);
Ancylostoma duodenale (hookworm);
Necator americanus (hookworm);
Trichuris trichiura (whipworm)

34
Q

how do you get Ascaris and whipworm infection?

A

ingest eggs of Ascaris, whipworm, and some hookworm;
feces deposited in soil - infective larvae of Ascaris and whipworms develop in the fertile eggs and, if ingested by a human host, hatch and develop into adult worms over several months.

35
Q

what is soil-transmitted helminths (STH) and what are they?

A

nematode worms that are known to be transmitted through soil;

Ascaris lumbicoides, Ancylostoma duodenale, Necator americanus, Trichuris trichiura, Strongyloides stercoralis (threadworm)

36
Q

how do you get hookworm infection?

A

skin transmission;
hookworm eggs are not infective - need larvae to mature in soil before they become infective;
larvae penetrate the skin of people walking barefoot on contaminated soil; Ancylostoma duodenale also can be transmitted when larvae are ingested

37
Q

what is Ascaris suum? how is this transmitted to human?

A

pig roundworm - infection occurs when ingestion of infectious eggs shed in pig feces

38
Q

what are the symptoms of Ascaris infection?

A

ppulmonary symptoms (Loffler syndrome) - marked eosinophilia and fever - occur in a few patients when larvae pass through the lungs;

39
Q

what are the symptoms of heavy roundworm infection?

A

intestinal discomfort, impaired nutritional status, obstruction

40
Q

what does hookworm infection cause?

A

lead to anemia due to blood loss and chronic protein deficiency, particularly in children

41
Q

what does whipworm infection cause?

A

chronic abdominal pian, blood loss, diarrhea, dysentery, rectal prolapse

42
Q

how to treat hookworm and Ascaris?

A

albendazole and mebendazole

43
Q

how to treat whipworm?

A

albendazole + ivermectin

44
Q

which parasite cause Leishmaniasis?

A

obligate intracellular protozoan parasites;
>20 Leishmania species

45
Q

what are different Leishmaniasis forms?

A

visceral leishmaniasis (VL, most severe);
cutaneous leishmaniasis (CL);
mucosal leishmaniasis (ML)

46
Q

how do you get cutaneous leishmaniasis?

A

through the bites of infected female phlebotomine sand flies;
occupational (lab) exposures;

47
Q

where does Cutaneous Leishmaniasis occur?

A

Afria (tropical region and N. Africa);
Asia (central and SW Asia);
S. Europe (France, Greece, Italy, Portugal, Spain, Mediterranean islands)
The Middle East
Mexico, all in Central America, most S. America; Texas, Oklahoma;
CL not found in Canada, Chile, Uruguay

47
Q

which times of the day does sand flies bite?

A

sand flies bite at night; less active during the hottest part of the day - but still bite if they are disturbed

48
Q

what are the symptoms of Cutaneous Leishmaniasis?

A

dermatologic - 10% are asymptomatic; closed or open sores, develop on exposed areas of the skin within several weeks or months after infection; sores progress to ulcer; lesions usually painless (but painful if superinfected with bacteria); satellite lesions, regional lymphadenopathy, and nodular lymphangitis can occur

49
Q

what are the symptoms of Mucosal Leishmaniasis?

A

parasite spread from skin to mucosal surfaces of the nose or mouth and cause sores in these areas; destruction of the mouth, nose, laryn, pharynx, if advanced.

50
Q

how to diagnose cutaneous leishmaniasis?

A

chronic, nonhealing skin lesions;
lab - detect parasite or DNA;
serologic test not useful

51
Q

how to treat leishmaniasis?

A

ML - systemic therpy
CL - topical or systemic

oral: miltefosine to treat CL caused by 3 WEstern Hemisphere species - Viannia subgenus: Leishmania braziliensis, L. guyanensis, L. panamensis; ML caused by L. braziliensis - in adults and adolescents 12 and up who weigh 30 kg and up, and not pregnant or breastfeeding

parenteral: liposomal amphotericin B

52
Q

what is the primary causing parasite of Visceral Leishmaniasis?

A

Leishmania infantum (=L. chagasi), and L. donovani.

53
Q

what organs does Visceral Leish affect?

A

bone marrow, liver, spleen & more

54
Q

how do you get visceral leish?

A

infected female sand flies, congenital transmission and parenteral transmission through blood transfusions and needle sharing also reported

55
Q

where are VL found?

A

Eastern Hemisphere - Africa (East Africa); Asia (Indian subcontinent and central and southwest Asia);
southern Europe; the Middle East

Western Hemisphere - Brazil mostly, some else where in Latin America

90% occur on the Indian subcontinent, in Bangladesh, India, Nepal, East Africa (Ethiopia, Kenya, Somalia, South Sudan, Sudan), and Brazil

56
Q

what are the symptoms of VL?

A

fever, hepatosplenomegaly (especially splenomegaly), night sweats, weight loss;
lymphadenopathy can occur

lab - pancytopenia (anemia, leukopenia, thrombocytopenia), high total protein, low albumin, hypergammaglobulinemia

latent infection can manifest years to decades after exposure

57
Q

person has unexplained fever illness with pancytopenia and splenomegaly. he has hemophagocytic lymphohistiocytosis. what can you suspect?

A

VL

58
Q

how do treat VL?

A

liposomal amphotericin B;
miltefosine - VL with L. donovani who are 12 years and up, 30 kg up, not pregnant or lactating;

Pentavalent antimonials (e.g. meglumine antimoniate, sodium stibogluconate) are used in endemic areas, except for India

59
Q
A

cdc yellowbook (26 decks)

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