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CMT-uno > Parasitic & Fungal Infections > Flashcards

Parasitic & Fungal Infections Flashcards

1
Q

Toxoplasmosis gondii

what animal is the defifinitive host?

A

cats but also found in birds and many other mammals

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2
Q

toxoplasmosis gondii

Where do you get it from?

A

contaminated soil from cat feces, contaminated undercooked meat.

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3
Q

toxoplasmosis gondii

What are dangers for pregnant mothers?

A

It passes through placenta, moms shouldnt clean cat litter

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4
Q

toxoplasmosis gondii

symptoms

A

Can be asymptomatic
Fever, malaise, headache, sore throat.
Cervical lymphadenopathy

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5
Q

toxoplasmosis gondii

Dx

A

Positive IgG and IgM serologic tests

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6
Q

toxoplasmosis gondii

congenital infection

A

After acute infection of seronegative mothers, CNS abnormalities and retinochoroiditis seen in offspring.

eye issues for baby

Earlier infections more likely to have serious outcomes: SAb, stillbirth, neurologic problems,

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7
Q

toxoplasmosis

infection in immunocompromised

A

Reactivation leads to encephalitis, retinochoroiditis, pneumonitis, myocarditis.
Positive IgG but negative IgM serologic tests.

Encephalitis with necrotizing brain lesions
Chorioretinitis
Pneumonitis

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8
Q

toxoplasmosis

Dx through CT or MRI

A

*Multiple ring-enhancing lesions

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9
Q

toxoplasmosis

Triad of Sx for congenital infection

A

Retinochoroiditis/chorioretinitis
Hydrocephalus
Intracranial calcifications

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10
Q

toxoplasmosis gondii

Tx

for normal, compromised, pregnant

A

usually not needed for immunocompetent.

For AIDS full therapy for 4–6 weeks followed by maintenance therapy with lower doses of drugs.

Treat primary infection during pregnancy to reduce risk of fetal transmission.

Retinochoroiditis: treatment advocated if decrease in visual acuity, multiple or large lesions, macular lesions, significant inflammation, or persistence for over a month.

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11
Q

toxoplasmosis gondii

Medications

A

Pyrimethamine orally once daily plus sulfadiazine(sulfonamide) orally four times daily, with folinic acid/leucovorin once daily.

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12
Q

toxoplasmosis gondii

AIDS treatment/meds

A

HIV+ patents with low CD4+ counts may require prophylaxis with trimethoprim/sulfamethoxazole to prevent symptomatic disease

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13
Q

toxoplasmosis gondii

Tx for pregnant

A

is spiramycin(macrolide) orally three times daily until delivery.
reduces frequency of transmission to fetus by 60%
does not cross placenta,

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14
Q

Toxoplasmosis gondii

prevention

A

Cook meat until no longer pink inside

Cats
Change cat litter box daily (not if pt is pregnant or HIV+)
Hand hygiene
Feed cat well-cooked food

Garden soil: wash hands, wash produce

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15
Q

Amebiasis

What are the infectious agents

A

Entamoeba dispar, Entamoeba moshkovskii, Entamoeba histolytica

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16
Q

Amebiasis

how do you get infected?

A

Ingestion from fecally contaminated food or water by person to person spread
Present worldwide but most prevalent in tropical areas with crowding, poor sanitation and nutrition
Disease follows penetration of the intestinal wall

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17
Q

Amebiasis

Dx

A

Diagnosis is most commonly made by finding organisms in stool
Serologic tests may also be utilized
Liver abscesses can by seen via U/S, CT, or MRI

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18
Q

Amebiasis

Tx

A

metronidazole or tinidazole

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19
Q

amebiasis

prevention

A

Safe water and fruit/vegetable supplies
Sanitary disposal of human feces
Adequate preparing of food
Avoidance of fly contamination
Handwashing

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20
Q

malaria

Transmission and endemic areas

A

Exposure to (female) anopheline mosquitoes in a malaria-endemic area
South and Central America, Africa, the Middle East, Southeast Asia
Caused by Plasmodium parasites
Plasmodium falciparum responsible for nearly all severe disease

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21
Q

plasmodium falciparum

Severe Sx

A

SEVERE
Cerebral malaria, severe anemia, hypotension, pulmonary edema, acute kidney injury, hypoglycemia, acidosis, and hemolysis.

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22
Q

plasmodium

Dx

A

identified through blood smears or rapid test

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23
Q

plasmodium

patho

A

goes to liver then blood infecting erythrocytes

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24
Q

plasmodium

classical presentation
(3 stages)

A

Cold stage (sensation of cold, shivering)
Hot stage (fever, headaches, vomiting; seizures in young children); and
Finally sweating stage (sweats, return to normal temperature, tiredness).

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25
Q

plasmodium

more common presentation

A

Fever
Chills
Sweats
Headaches
Nausea and vomiting
Body aches
General malaise

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26
Q

Plasmosium

clinical manifestations

A

mainlyP falciparum, can include severe anemia; hypotension and shock.(RBCs being blown apart)

Hypoglycemia – diminished gluconeogenesis
Acidosis – microcirculatory flow affected, anaerobic glycolysis
Renal impairment - infarcts, capillary leakage
Pulmonary edema - sequestration of parasitized RBCs in lungs and/or cytokine-induced leakage from pulmonary vasculature

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27
Q

plasmodium

Tx

A

Chloroquine is first line

P. falciparum is somewhat resistant, use Artemisinin (artesunate, artemether) generates free radicals that damage parasite proteins

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28
Q

plasmodium

Tx for severe malaria

A

Medical emergency – IV Artesunate
Maintenance of fluids and electrolytes
Respiratory and hemodynamic support
Potential blood transfusions/anticonvulsants/antibiotics/hemodialysis

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29
Q

Plasmodium

prevention

A

Bed nets, insecticides
Travelers to endemic areas:
Chloroquine
Malarone
Mefloquine
Doxycycline
Primaquine
Tafenoquine

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30
Q

Pinworms

A

Most common helminth infection in US
Enterobius vermicularis
Usually children under 18 (typically 5-14), or those who are institutionalized

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31
Q

Enterobius vermicularis (pinworm)

Main route of infection

A

oral after scratching
or exposure to eggs from contaminated food/fomites

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32
Q

Enterobius vermicularis

pathophys

A

Eggs hatch in duodenum and larvae migrate to cecum. Females mature in a month, and remain viable for about another month; migrate through anus nocturnally to deposit large numbers of eggs on perianal skin

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33
Q

Enterobius vermicularis

Most telling Sx

A

Perianal pruritus, particularly at night

INTENSE ITCHING AT NIGHT, possible bacterial infection from scratching

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34
Q

Enterobius vermicularis

Dx

A

listen to hx and Characteristic eggs on perianal skin detected using clear sticky tape (Scotch tape test)
Sometimes worms seen in feces

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35
Q

Enterobius vermicularis

Tx

A

Oral single dose: albendazole, mebendazole

Redose in 2 weeks because of frequent reinfection

Treat family members and Washing clothes and bedding in hot water to kill eggs

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36
Q

what are helminths

A

worm parasites

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37
Q

hookworm agent

A

Ancylostoma duodenale and Necator americanus

Found in feces of infected animals
Look for patients who were walking barefoot
common in tropic/subtropic regions

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38
Q

hookworm life cycle

A

Eggs deposited on warm moist soil and hatch, releasing larvae that are infective for a week
*Patient will sometimes report walking barefoot

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39
Q

hookworm

life cycle

A

larvae penetrate skin and migrate in bloodstream to pulmonary capillaries.
In lungs, larvae penetrate into alveoli and are carried by ciliary action upward to bronchi, trachea, mouth.
After being swallowed, they reach & attach to small bowel mucosa and mature to adult worms.
Attach to intestinal mucosa and suck blood. Blood loss is proportionate to worm burden.

40
Q

hookworm

Signs and Dx

A

Transient pruritic skin rash and lung symptoms
Anorexia, diarrhea, abdominal discomfort
Iron deficiency anemia
Characteristic eggs and occult blood in the stool

41
Q

hookworm

clinical manifestation

A

Often asymptomatic
Anemia due to blood loss in gut
Blood loss in stools not visibly apparent
New infection: epigastric pain, anorexia, diarrhea
Chronic infection: abd pain, anorexia, diarrhea, iron-deficiency anemia, protein malnutrition

42
Q

hookworm

Dx

A

characteristic eggs in stool
possible blood in stool

43
Q

hookworm

Tx

A

ivermectin single dose or albendazole once daily for 3 days

44
Q

tapeworms

main beef and pork agent

A

*Beef: Taenia saginata (eating raw or undercooked beef)
*Pork: Taenia solium (eating undercooked pork)

45
Q

tapeworms

Sx

A

Patient complains of GI symptoms, potentially including anorexia and weight loss

46
Q

tapeworms

Dx

A

egg in stool

47
Q

tapeworms

Tx

A

usually a single dose of praziquantel

48
Q

Ascariasis

Ascaris lumbricoides

A

most common intestinal helminth, LARGE white worms, common in children

contaminated soil is ingested

49
Q

Ascaris lumbricoides

Sx and Dx

A

Most are asymptomatic
Heavy infection may cause intestinal discomfort
Malnutrition and/or even *obstruction
Diagnosis made by ID of eggs in stool or after adult worm emerges from mouth, nose, or anus

50
Q

Fluke spp and transmission

A

Clonorchis sinensis
Opisthorchis viverrine
Fascilla hippatica

Undercooked fish, crabs, water plants in endemic areas

51
Q

Roundworm agent and transmission

A

Trichinella spiralis
Trichinosis
Muscle tissue damage
Spread by ingestion of raw, most commonly pork

52
Q

trichinosis

Sx

A

are asymptomatic; however, GI complains may be present
Can progress to fever, *myalgias, periorbital edema, headaches, cough, rash

53
Q

Trichinosis

Dx

A

elevated muscle enzymes, serological tests, proceeding to muscle biopsy only if necessary

54
Q

trichinosis

Tx with early detection

A

mebendazole, albendazole

55
Q

Filariasis

A

Wuchereria bancrofti

56
Q

Wuchereria bancrofti

Sx

A

Chronic progressive swelling of extremities and genitals

(elephantitis)

57
Q

Loiasis (Loa loa)

transmission and Sx

A

Transmitted by chrysops flies
Larvae develop into adult worms and *migrates to eye

58
Q

Rocky Mountain Spotted Fever
Agent, transmission, endemic area, time of year

A

Rickettsia rickettsii
Exposure to infected tick bite in an endemic area
Half of cases are from 5 states: North Carolina, Tennessee, Oklahoma, Missouri, and Arkansas
Usually seen in May-August when ticks are most active

59
Q

Rickettsia rickettsii

Patho

A

R. rickettsii likes to damage vascular endothelial cells.
Direct vascular injury; endothelial cells produce prostaglandins that cause increased vascular permeability
Hyponatremia from release of antidiuretic hormone as an appropriate response to hypovolemia/reduced tissue perfusion (leaky vasculature}

60
Q

RMSF

Sx

A

fever/headache/rash; fever/rash/history of tick bite
rash is delayed

non blanching rash

Early phase, nonspecific signs/symptoms: fever, headache, malaise, myalgias, arthralgias
Nausea is common. Children may have severe abdominal pain

may be fatal

61
Q

RMSF

Rash

A

90% of patients, not usually at initial contact with clinician
*Rash on palms and soles is highly characteristic

62
Q

RMSF

Rash first presentation

A

First peripherally on wrists/ankles; spreads
centripetally. Involvement of palms/soles is important Dx feature.

63
Q

RMSF

CBC with diff

A

Usually normal WBC at presentation, left shift. May be anemia, thrombocytopenia, hyponatremia
As illness progresses, thrombocytopenia becomes more severe

64
Q

RMSF

Tx

A

doxycycline 100mg twice daily for 5-7 days (10-14 days for severe cases); treat until afebrile for 2-3 days

65
Q

Lyme disease agent, transmission, region, time

A

most common
Caused by Borrelia burgdorferi
Infection transmitted to humans by blood-feeding anthropods: mosquitoes, ticks, fleas
Most cases are reported from the northeastern and north central regions of the US
Occurrence more common late spring and summer (May to July)

66
Q

Lyme disease

Early localized

A

ncludes erythema migrans “bulls-eye” rash with central clearing(EM – next slide) and nonspecific flu-like findings that can include myalgias, arthralgias, headaches, and fatigue.

67
Q

lyme disease

Early disseminated

A

(weeks to several months after tick bite): can include acute neurologic (aseptic meningitis with headache and stiff neck or facial palsy) or cardiac involvement (with arrhythmias); may be first manifestation of Lyme disease.

68
Q

Lyme Disease

Late stage

A

(months to few years after the onset of infection; may not be preceded by early localized or disseminated disease): arthritis in one/few joints is most common, neurologic manifestations (encephalopathy or polyneuropathy) can occur.

69
Q

lyme disease

Dx

A

Exposure to tick habitat + erythema migrans or at least 1 late manifestation of the disease + lab confirmation
Dx confirmed by antibody testing using enzyme immunoassay or immunofluorescence assay; confirmation of positive result with Western blot

70
Q

Lyme diseae

Tx

A

Prophylactic antibiotics following tick bites in recommended in certain high-risk situations: doxycycline 200mg orally

Doxycycline 100mg orally twice daily for 10 days

71
Q

Histoplasma capsulatum

Histoplasmosis transmission and region

A

Exposure to bird and bat droppings; common along river valleys (esp. *Ohio River and Mississippi River valleys).
Fungus isolated from soil contaminated
Infection presumably takes place by inhalation

72
Q

Histoplasma capsulatum

Sx

A

More respiratory symptoms seen

73
Q

Pts most at risk for parasitic or fungal infections

A

Cancer, children, AIDS, immunocompromised

74
Q

Histoplasma capsulatum

Clinical presentation

A

More respiratory symptoms seen
Mostly asymptomatic, variable symptoms from mild to severe
Usually have respiratory symptoms if present
Past infection - pulmonary and splenic calcification noted incidentally
More severe infections typically have symptoms as atypical pneumonia
Can have a macular/papular rash

75
Q

Chronic Pulmonary Histoplasmosis
Xrays:

A

apical cavities, nodules, infiltrates

76
Q

Histoplasmosis

who is affected?

A

normally immunocompromised pts

77
Q

Histoplasmosis

Dx

A

Sputum culture rarely positive, maybe in chronic disease
Antigen testing in acute disease.
Chest x-ray
Combination of urine and serum antigen assays: 83% sensitivity for Dx acute pulmonary.
Blood or bone marrow cultures (immunocompromised patients with acute disseminated disease) positive >80% of the time, take several weeks for growth.

78
Q

Histoplasmosis

Tx

A

Most cases resolve within 4 weeks
Progressive localized disease and mild/moderately severe nonmeningeal disseminated disease, treatment of choice is itraconazole (disrupts cell membrane integrity)
Orally for up to 12 weeks depending on severity of illness
Severe disease:
IV amphotericin B for 1-2 weeks followed by itraconazole for total of 12 weeks
Patients with AIDS-related histoplasmosis require lifelong suppressive therapy withitraconazole orally

79
Q

Cryptococcosis

Cryptococcosis

A

Cryptococcus neoformans
*Pacific northwestern region
*Look at occupation (Farmer?)
*Most common cause of fungal meningitis.

80
Q

Cryptococcosis

where is it found?

A

Found worldwide in soil and on dried pigeon dung

81
Q

Cryptococcosis

Clinical presentation

A

Pulmonary
Varies from mild/moderate cough to ARDS
CNS
Meningitis and encephalitis
Altered mental status, ataxia, headache, coma
Visual disturbance common
Pustular skin rash

82
Q

Cryptococcosis

Dx

A

***Sputum culture (if having more pulm symptoms)
*Lumbar puncture: **
increased opening pressure, variable ↑WBCs, increased protein, decreased glucose
India ink stain of CSF reveals budding, encapsulated fungi.

83
Q

Pneumocystitis

PJP

A

Pneumocystis jirovecii pneumonia (PJP)
Overt infection is a subacute interstitial pneumonia that occurs among older children and adults with altered immunity
Cancer, transplants, AIDS, receiving corticosteroids
*Occurs in up to 80% of AIDS patients who are not receiving prophylaxis

84
Q

PJP

Clinical presentation

A

Usually limited to pulmonary
Onset may be subacute with only dry cough or shortness of breath
Hard to cough anything up due to thick secretions
May present with spontaneous pneumothorax and/or additional symptoms of fever, fatigue, weight loss
Note decreased oxygen saturation on exam

85
Q

PJP

Dx

A

Sputum cultures
Positive beta-D-glucan** (detects fungal cell wall)
**Chest x-ray & CT scan** (next slides)
**Ground glass opacification
Can start empiric therapy for PJP if disease is suspected clinically

86
Q

PJP

Tx

A

Oral trimethoprim-sulfamethoxazole is the preferred treatment

87
Q

Coccidioidomycosis

A

Valley fever
Coccidioides immitis or C. posadasii
*Found in soil and causes infections when inhaled
*Southwestern US and parts of Mexico and Central South America

88
Q

Valley fever

Acute infection

A

: influenza-like illness, fever, backache, headache, fatigue, and cough. Erythema nodosum common

89
Q

valley fever

dissemination

A

Dissemination may result in meningitis, bony lesions, or skin and soft tissue abscesses
Common infection in patient with AIDS

90
Q

Aspergillosis

Agent

A

Aspergillus fumigatus
Inhalation of spores of fungus

91
Q

Aspergillosis

Predisposing factors

A

** leukemia, bone marrow or organ transplantation, corticosteroid use, advanced AIDS**

92
Q

Aspergillosis

Most common cause of non-candida invasive fungal infection

A

Most common cause of non-candida invasive fungal infection in *transplant recipients and in patients with hematologic malignancies

93
Q

Aspergillosis

what are the most common disease sites

A

Pulmonary, sinus and CNS are most common disease sites

94
Q

Aspergillosis

Tx

A

antifungal drugs

95
Q

Fluke Sx

A

Most aSx or mild GI

If untreated progress to serious disease, advanced GI

96
Q

Fluke Dx and Tx

A

Clinical findings or eggs in stool

Praziquantel

CMT-uno (54 decks)

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