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Parasitic & Fungal Infections Flashcards

1
Q

Toxoplasmosis

caused by what?

parasite name

A

Toxoplasma gondii

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2
Q

Toxoplasmosis

transmission

3 modes, host species

A
  • fecal oral
  • transplacental transmission
  • inoculation via blood transfusion/organ transplantation

cats = hosts

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3
Q

Toxoplasmosis

Signs/sx in typical population

4 sx, 1 sign, 1 statement?

A
  • can be asx
  • fever, malaise, headache, sore throat
  • cervical lymphadenopathy
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4
Q

Toxoplasmosis

effects of congenital infections

in offspring

A

CNS abnormalities
retinochoroiditis
hydrocephalus
intracranial calcifications

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5
Q

Toxoplasmosis

infections reactivation can lead to?

4

A
  • reactivation leads to encephalitis, retinochoroiditis, pneumonitis, myocarditis
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6
Q

Toxoplasmosis

Dx

5 different things

A
  • serology (IgG or IgM)
  • PCR (amniotic fluid, blood, CSF)
  • observation of parasites in stained tissues (meh)
  • isolation from blood/other fluids (meh)
  • CT or MRI of brain
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7
Q

Toxoplasmosis

what will CT or MRI show?

A

multiple ring-enhancing lesions

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8
Q

Toxoplasmosis

IgG Serology
IgM Serology

general population vs immunocompromised

A
  1. IgG will be positive in all populations
  2. IgM will only be positive in the non-immunocompromised individuals
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9
Q

Toxoplasmosis- Congenital

when in pregnancy are infections more likely to have serious outcomes?

A

earlier infection

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10
Q

Toxoplasmosis- Congenital

outcomes from early infection

A
  1. spontaneous abortion
  2. stillbirth
  3. neurologic problems
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11
Q

Toxoplasmosis

Complications of infections in immunocompromised

AIDS/cancer

A
  1. encephalitis with necrotizing brain lesions
  2. chorioretinitis
  3. pneumonitis
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12
Q

Toxoplasmosis

how to treat general population vs immunocomp

A
  • self limiting
  • Immunodeficient: full therapy for 4-6 wks followed by maintenance therapy with lower dosese
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13
Q

Toxoplasmosis

what to treat in pregnancy

A

treat primary infection to reduce risk of fetal transmission

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14
Q

Toxoplasmosis

when to treat- retinochoroiditis

A

treatment ok if decrease in visual acuity, multiple/large lesions, macular lesions, inflammation, >1 mo in duration

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15
Q

Toxoplasmosis

Meds- general population

meds, freq

A
  • pyrimethamine (PO QD)
  • sulfadiazine (PO, QID hrs)
  • folinic acid/leucovorin QD
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16
Q

Toxoplasmosis

Meds- pregnancy

A
  • spiramycin PO Q8 hrs until delivery
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17
Q

Toxoplasmosis

Prophylaxis dose HIV+ pts

when/what to use

A
  • use in pts with low CD4 counts
  • Trimethoprim/sulfamethoxazle
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18
Q

Toxoplasmosis

Prevention

3 categories

A
  • fully cook meat
  • cat related care
  • hygiene when gardening
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19
Q

Amebiasis

parasites of concern

3: entamoeba……

A

Entamoeba dispar
Entamoeba moshkovskii
Entamoeba histolytica

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20
Q

Amebiasis

transmission

A

fecal oral
waterborne

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21
Q

Amebiasis

signs/sx

5- which is most common?

A
  • abd pain
  • diarrhea
  • severe infections
  • extraintestinal disease
  • liver abscess (MOST COMMON)
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22
Q

Amebiasis

dx

3 things

A
  • stool test
  • serologic testing
  • U/S, CT, MRI for liver abscess
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23
Q

Amebiasis

Tx

A

metronidazole or tinidazole

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24
Q

Malaria

mode of transmission

A

exposure to female anopheline mosquitoes in a malaria endemic country

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25
# Malaria where is malaria endemic? | 5 things
* South America * Central America * Africa * Middle East * Southeast Asia
26
# Malaria parasite responsible
*plasmodium falciparum*
27
# Malaria Pathophys
1. upon bite, mosquitoes inject sporozoites which infect hepatocytes 2. Merozoites are released by liver and rapidly infect RBCs 3. Mulitple rounds of reproduction = systemic infection (can spread to others if bitten by mosquito) 4. infected cells lyse which dumps toxins into bloodstream 5. infected RBCs adhere to vein walls
28
# Malaria "Classical" presentation (not usually how it is) | 3 stages
1. Cold Stage (chills) 2. Hot Stage (fever, HA, v, seizures) 3. Sweating Stage (sweats, fatigue)
29
# Malaria Common Sx | 8
* fever/chills/sweats * headaches * n/v * body aches, malaise
30
# Malaria Clinical Findings | 7 things
1. severe anemia 2. hypotension 3. pulmonary edema 4. AKI 5. hypoglycemia 6. acidosis 7. hemolysis
31
# Malaria why does severe anemia occur?
RBCs getting blasted apart by parasites
32
# Malaria why does hypoglycemia occur?
reduced gluconeogenesis
33
# Malaria why does acidosis occur?
microcirculatory flow affected, anaerobic glycolysis
34
# Malaria why does renal impairment occur?
infarcts, capillary leakage
35
# Malaria why does pulmonary edema occur?
sequestration of parasitized RBCs in lungs and/or cytokine-induced leakage from pulmonary vasculature
36
# Malaria Dx
* parasite in peripheral blood smears * urine dipstick for antigen
37
# Malaria Tx | First Line
Chloroquine- use only when no suspected resistance
38
# Malaria Tx- chloroquine resistance
Artemisinin
39
# Malaria Tx- severe malaria
* IV Artemisinin * Maintenance of fluids/electrolytes * resp/hemodynamic support
40
# Malaria prevention
* bed nets/insecticides * travelers can take prophylactic abx
41
# Malaria which meds are used prophylactically in travelers?
* chloroquine * malarone * mefloquine * doxycycline * primaquine * tafenoquine
42
what are helminthic infections?
worms :)
43
# *Enterobius* (Pinworms) caused by what worm?
*Enterobius vernicularis*
44
# *Enterobius* (Pinworms) who usually gets sick?
chilren under 18 or those in congregate settings
45
# *Enterobius* (Pinworms) mode of transmission
oral after scratching exposure to eggs on contaminated food/fomites
46
# *Enterobius* (Pinworms) Pathophys
1. eggs hatch in duodenum 2. larvae migrate to cecum 3. females mature after 1 mo, are viable for another mo after 4. migrate through anus nocturnally to deposit eggs on perianal skin
47
# *Enterobius* (Pinworms) Key sign to watch for | PPP
**perianal pruritus** particularly at night
48
# *Enterobius* (Pinworms) Dx
characteristic eggs on perianal skin using clear tape worms seen in feces
49
# *Enterobius* (Pinworms) Tx
1. Albendazole or mebendazole (paralyzes parasite)
50
# *Enterobius* (Pinworms) when to redose?
2 wks after tx because of frequent reinfection
51
# *ancylostoma duodenale* and *necator americanus* (Hookworm) what have patients usually have done prior to infection?
walked barefoot
52
# *ancylostoma duodenale* and *necator americanus* (Hookworm) Life Cycle
1. eggs deposited via feces into warm moist soil 2. eggs hatch into larvae that are infective for a week 3. larvae contact skin and travel via bloodstream to pulmonary capillaries 4. in lungs, larvae penetrate into alveoli and are carried via cillia into upper airway & then swallowed. 5. Once in the GI tract, they attach to bowel mucosa & mature into adults where they suck blood
53
# *ancylostoma duodenale* and *necator americanus* (Hookworm) what is blood loss proportionate to?
worm burden
54
# *ancylostoma duodenale* and *necator americanus* (Hookworm) Signs/Sx | 7 things
* transient pruritic skin rash (can "see" worm through skin) * pulmonary sx * anorexia, diarrhea, abd discomfort * iron def anemia * blood/eggs in stool
55
# *ancylostoma duodenale* and *necator americanus* (Hookworm) Dx
* characteristic eggs in stool
56
# *ancylostoma duodenale* and *necator americanus* (Hookworm) Tx
* ivermectin PO * albendazole PO 3 days
57
# Tapeworms *Taenia saginata*
tapeworm from eating raw or undercooked beef
58
# Tapeworms *Taneia solium*
tapeworm from eating undercooked pork
59
# Tapeworms *Diphyllobothrium latum*
tapeworm from undercooked freshwater fish
60
# Tapeworms *hymenolpeis nana*
tapeworm from food contaminated w/ human feces
61
# Tapeworms signs/sx | 3
1. GI sx 2. anorexia 3. wt loss
62
# Tapeworms Dx
eggs in stool
63
# Tapeworms tx
praziquantel x1
64
# Ascariasis what is the most common intestinal worm?
*ascaris lumbricoides*
65
# Ascariasis mode of transmission?
ingestion of eggs in contaminated food
66
# Ascariasis pathophys
1. larvae hatch in small intestine 2. penetrate the blood-stream 3. migrate to lungs 4. travel via airway back to GI tract
67
# Ascariasis Dx
* most are asx * dx made by ID of eggs in stool/worms
68
# Ascariasis Tx
* mebendazole * albendazole * pyrantel pamoate
69
# Fluke caused by which 3 things?
1. *clonorchia sinensis* 2. *opisthorchis viverrine* 3. *fasicola hepatica*
70
# Fluke mode of transmission
* humans get ill by eating undercooked fish, crabs, crayfish, water plants in endemic areas
71
# Fluke sx
most are asx mild GI complaints
72
# Fluke dx
* clinical findings * eggs in stool
73
# Fluke tx
Praziquantel
74
# Trichinosis (Roundworm) causative agent?
*trichinella spiralis*
75
# Trichinosis (Roundworm) mode of transmission
ingestion of raw pork
76
# Trichinosis (Roundworm) sx | 7 sx
* primarily asx * GI sx, fever, myalgias, periorbital edema, HA, cough, rash
77
# Trichinosis (Roundworm) dx
* elevated muscle enzymes * serological tests * muscle biopsy (last resort)
78
# Trichinosis (Roundworm) tx
mebendazole albendazole
79
# Filariasis caused by what?
*wuchereria bancrofti*
80
# Filariasis signs & sx
* episodic attacks of lymphangitis * fever * chronic progressive swelling of extremities & genitals
81
# Loiasis transmitted by?
chrysops flies
82
# Loiasis when adults, migrate to where?
eye
83
# Rocky Mountain Spotted Fever causative agent
*rickettsia rickettsii*
84
# Rocky Mountain Spotted Fever mode of transmission
tick bite
85
# Rocky Mountain Spotted Fever pathophys
* *R. rickettsii* damanges vascular endothelial cells * endothelial cells produce prstaglandings that cause increased vascular permeability * hyponatremia from release of ADH as a response to hypovolemia/leaky vasculature
86
# Rocky Mountain Spotted Fever signs & sx
* classic: fever, HA, rash, hx of tick bite * general: malaise, myalgias, arthralgias
87
# Rocky Mountain Spotted Fever describe rash
* rash in approx 90% of pts * rash on palms, soles
88
# Rocky Mountain Spotted Fever Lab results | initial vs more progressed
1. normal WBC, maybe left shift 2. thrombocytopenia becomes more severe
89
# Rocky Mountain Spotted Fever lab testing
* serial serologic examinations by indirect fluorescent antibody can retrospectively confirm diagnosis
90
# Rocky Mountain Spotted Fever empirical abx therapy
* doxycycline (100mg PO, QID, 5-7 days) * 10-14 days if case was severe * Chloramphenicol is second choice
91
# Rocky Mountain Spotted Fever prevention
* protective clothing * tick-repellent * prophylaxis is not recommended
92
# Lyme Disease caused by?
*borrelia burgdorferi*
93
# Lyme Disease location? seasonality?
* northeastern and north central US * late spring to summer
94
# Lyme Disease Stages
1. early localized 2. early disseminated 3. late
95
# Lyme Disease describe the early localized stage
* erythema migrans * bulls-eye rash w/ central clearing * non-specific flu like sx
96
# Lyme Disease describe the early disseminated stage
* weeks to several months after bite * acute neurologic sx (palsy, aseptic meningitis) * cardiac involvement (arrhythmias)
97
# Lyme Disease describe the late stage
* months to years after infection onset * arthritis * encephalopathy or polyneuropathy
98
# Lyme Disease common sites of tick bites
thigh groin axilla
99
# Lyme Disease Dx | 3 criteria & 2 tests
* exposure to tick habitats * erythema migrans * 1 late manifestation of disease * lab confirmation: ab testing, pos western blot test
100
# Lyme Disease Tx
1. Doxycycline (100mg PO, Q12 hrs, 10 days)
101
# Lyme Disease prophylaxis tx
doxycycline 200mg PO
102
# Histoplasmosis caused by what?
*Histoplasma capsulatum*
103
# Histoplasmosis mode of transmission
exposure to bird and bat droppings (common along Ohio/Mississippi river valleys)
104
# Histoplasmosis pathophys
1. conversion into yeast cells 2. engulfed by phagocytes in lungs 3. organism proliferates and then lymphohematogenous spread to other organs
105
# Histoplasmosis sx
1. usually asx 2. if sx, then respiratory & macular/papular rash 3. can be mild to severe
106
# Histoplasmosis what do severe infections usually have?
atypical pneumonia
107
# Histoplasmosis Presentation when disseminated in immunocompromised pts
* CNS lesions * adrenal lesions/insufficiency * pancytopenia * pulmonary: cavities, nodules, infiltrates variable presentation
108
# Histoplasmosis Dx | 5 things
* sputum culture (rarely pos) * Antigen testing * CXR * urine + serum antigen assays * blood/bone marrow cultures
109
# Histoplasmosis Tx | immunocompetent pts
* observation if mild sx and immunocompetent * most cases resolve in 4 wks * itraconazole (PO, 12 wks)
110
# Histoplasmosis tx | immunodeficient/severe disease
* hosp: amphotericin B IV (1-2 wks) followed by itraconazole (PO, 12 wks)
111
# Histoplasmosis who might require lifelong suppressive therapy?
pts with AIDS related infection
112
# Cryptococcosis mainly caused by
*cryptococcus neofromans*
113
# Cryptococcosis risk factors
* chemotherapy for hematologic malignancies * Hodgkin lymphoma * corticosteroid therapy * structural lung disease * transplant recipients * TNF-alpha inhibitor therapies * AIDS
114
# Cryptococcosis approx 80% of *Cryptococcal* infections are ?
opportunistic infection in pts with AIDS
115
# Cryptococcosis most common cause of fungal ____ | type of infection
meningitis
116
# Cryptococcosis mode of transmission
* inhalation * no P2P transmission
117
# Cryptococcosis pathophys
* tissue destruction is through increasing fungal burden
118
# Cryptococcosis outcomes of tissue desctruction | 2 things
1. pulmonary disease w/ pneumonia 2. CNS disease
119
# Cryptococcosis signs/sx | pulmonary, CNS, integum
1. pulmonary: variable (mild/mod cough to ARDS) 2. CNS: meningitis, encephalitis, delerium, ataxia, HA, coma, visual disturbance 3. pustular skin rash
120
# Cryptococcosis Dx | 3 tests, 2 to do if sx dissemination to specific spots
* lumbar puncture * antigen detection in blood * biopsy of lesions * MRI of brain if mass lesion is suspected * if pulm sx: sputa
121
# Cryptococcosis tx in immunocompetent | med, freq, duration asx vs sx
* fluconazole (PO, QD, 6-12 mo) asx: 6 mo sx: 12 mo
122
# Cryptococcosis Tx in severe pulm or CNS disease
Amphotericin B IV QD Flucytosine PO Q6 hrs Fluconazole PO QD
123
# Pneumocystosis (PJP) caused by?
*pneumocystis jirovecii pneumonia*
124
# Pneumocystosis (PJP) mode of transmission
airborne transmission of spores
125
# Pneumocystosis (PJP) who gets infected with this?
* immunodeeficient pts (cancer, transplants, AIDS, corticosteroids)
126
# Pneumocystosis (PJP) % of AIDS pts that this occurs in? criteria for it occuring?
* 80% * in AIDS pts who are not receiving prophylaxis
127
# Pneumocystosis (PJP) signs & sx | 7 things
* limited to pulm * dry cough, SOB * thick secretions * spontaneous pneumothorax * fever, fatigue, wt loss
128
# Pneumocystosis (PJP) Dx | 3 things
* sputum cultures * pos beta-D-glucan * CXR and CT scan
129
# Pneumocystosis (PJP) Tx
start empirically trimethoprim-sulfamethoxazole (PO)
130
# Coccidioidomycosis (Valley Fever) caused by?
*coccidioides immitis* *coccidioides posadasii*
131
# Coccidioidomycosis (Valley Fever) sx & signs of acute infection | 7 things, mainly
* ILI ( fever, myalgia, HA, fatigue, cough) * erythema nodosum
132
# Coccidioidomycosis (Valley Fever) what can dissemination result in? | 3 things
meningitis, bony lesions, skin/soft tissue abscesses
133
# Coccidioidomycosis (Valley Fever) who has disseminated infections most often?
AIDS patients
134
# Coccidioidomycosis (Valley Fever) Dx
* chest imagin * serologic useful * supportive care/self-limited
135
# Aspergillosis caused by?
*aspergillus fumigatus*
136
# Aspergillosis mode of transmission
* inhalation of spores of fungus * most common cause of non-candida invasive fungal infection in transplant recipients/pts with hematologic malignances
137
# Aspergillosis risk factors | 5 thigns
* leukemia * bone marrow * organ transplant * corticosteroid use * advanced AIDS
138
# Aspergillosis most common disease sites | 3
1. pulm 2. sinus 3. CNS
139
# Aspergillosis Dx
detection of galactomannan in serum
140
# Aspergillosis Tx
antifungal drugs

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