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Random infectious dz (inpt) > Parasitic Infections > Flashcards

Parasitic Infections Flashcards

1
Q

Amoebiasis?

A

Entamoeba histolytica: cysts that are viable in the soil and water for wks to mnths

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2
Q

how are amoebia cysts transmitted?

A

fecal to oral, fly droppings, or human to human contact; humans are the only hosts

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3
Q

what is the pathophys behind amoebiasis?

A
  • cysts pass through to the intestines where they hatch

- trophozites invade the mucosa and induce necrosis

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4
Q

where are amebic ulcers most likely to be found?

A

mebic ulcers are typically flask shaped and occur anywhere in the large bowel or termical ileum

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5
Q

how deep do amebic ulcers go?

A

typically limited to the muscularis, but can penetrate the serosa

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6
Q

what are complications of amebic ulcers?

A

if they penetrate the serosa, may cause perforation, abscess, or peritonitis

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7
Q

what are some clinical finding of an amebic infection?

A
  • intestinal
  • colits
  • extratestinal dz
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8
Q

what are sx of intestinal dz?

A

often asx

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9
Q

what are sx of amebic colitis?

A

-mild to moderate (few seimformed stools w/o blood) or SEVERE DYSENTERY (greater number of liquid stolls streaked with blood ro bits of necrotic tissues

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10
Q

what are some pt complaints in an amebic colitis? severe dz?

A
  • cramps, fatigue, weight loss, increased flatulence
  • cycles of remission and recurrence are tyical

-severe: prostrate and toxic with fever, colic, tenesmus, and vomiting

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11
Q

what may physical exam reveal in amebic infxn? (colitis)

A

distention, hyperperistalsis, generalized abdominal tendernes

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12
Q

what are some complications of amebic colitis?

A

appendicitis, bowel perforation, fulminant colitis, massive mucosal sloughing, hemorrhage

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13
Q

what do localized ulcerative lesions of the colon and localized granulomatous lesions of colon potentially cause?

A

pain, intestinal obstruction, hemorrhage

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14
Q

what is an ameboma?

A

a localized granulomatous lesions of the colon

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15
Q

what must amebomas be differentiated from?

A

colon cancer, TB, or lymphogranuloma venereum (via bx that will reveal granulation tissue)

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16
Q

what can extraintestinal amebic dz cause?

A

hepatic amebiasis and amebic liver asscess:

can be asx or result in sx either suddenly or gradually over days to months

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17
Q

what are findings of a extraintestinal amebic dz?

A

fever, pain, tender hepatomegaly, malaise, prostration, sweating, chills anorexia and weight loss

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18
Q

what other signs may pts with EI amebic dz present with?

A

think LUNG

coughing and right lower lung findings: if abscess is in the superior liver

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19
Q

what is a complication of amebic abscess?

A

can rupture and spill into the pleural, peritoneal, or pericardial space which can be fatal

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20
Q

where else and amebiasis present? (rare)

A

metastasize to lungs, brain, or genitalia

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21
Q

diagnostic studes for amebic dz?

A
  • stool specimens
  • sigmoidoscopy, colonoscopy, rectal biopsy
  • serology
  • CBC
  • US, CT, MRI
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22
Q

what will stool specimens reveal in amebic dz

A

reveal cysts or trophozoites

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23
Q

what will scopies and bxo of rectum reveal?

A

ulcers; if collection of exudates found need to be examined for trophozoites

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24
Q

what will serology show in amebic dz?

A

-can detect antiboides of up to 10 years after infection, so can’t be used to differenctiate past from prsent infxn

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25
Q

what will a CBC show in amebic dz?

A

elevated WBC w/o eosinophilia

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26
Q

why get a US,CT, radioisotope or MRI in amebic dz

A

see size and location of abscess

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27
Q

how is an asymptomatic infection treated?

A

with luminal amebicide (diloxanide furoate, iodoquinol, or paromomycin)

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28
Q

what are ADRs of paromomycine?

A

N, D, abdominal crampsI

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29
Q

how are mild to mod infcts of amebic dz treated?

A

with tinidazole or metronidazole + luminal amebicide

alternatives: tetracycline + luminal amebicide followed by chloroquine

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30
Q

what else needs to be done in severe amebid dz infections?

A
  • supportive care
  • electrolyte replacement
  • opioids to control bowel motility

*decrease risk of toxic megacolon

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31
Q

how are hepatic abscesses treated?

A

tinidazole or metronidazole plus a luminal amebicided followed by chloroquine

*if no response to tx w/in 3 days abscess should be drained

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32
Q

what are some complications of hepatic abscesses?

A

bacterial infxn, bleeding, peritoneal spillage

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33
Q

when is the recommended follow up time after amebic treament?

A
  • at least 3 stool exams at 2-3 days intervals starting 2-4 wks after the end of tx
  • colonoscopy can also be used to confirm
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34
Q

what is postdysenteric colitis?

A

may occur after severe amebic infection, but is usally self-limited, but may be a trigger for ulcerative colitis

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35
Q

where are hookworms endemic to?

A

moist tropics and subtropics

  • southeastern US
  • humans are the only host
36
Q

how are hookworms transmitted?

A

eggs are passed in the stool and hatched in moist soil

37
Q

how long do the hookworm larvae last?

A
  • hours to weks
  • penetrate skin and migrate int the bloodstream to the pulmonary capilliaries, where they destroy alveoli and are carried by cilia to the mouth

-

38
Q

what happens once hookwork larvae are swallowed

A

the larvae attach to the samll bowel mucosa and suck blood

-once mature they release eggs to continue the cycle

39
Q

what is a light infection defined by? hookworm

A

1000 eggs/g feces

40
Q

what is a moderate hookworm infection?

A

2000-8000 eggs/g feces

41
Q

what are some clinical findings in a hookworm infections?

A

-site of penetration is pruritic

42
Q

what kind of rash is seen at the site of a hookworm penetrations?

A

erythematous dermatitis with maculopapular or vesicular eruption

-scratching can cause secondary bacterial infections

43
Q

what are clinical features of the pulmonary stage of hookworm infexn?

A

-cough, wheeze, blood-tinged sputum, low grade fever

44
Q

what are clinical fx of the intestinal stage if light hookworm infxn and adequate iron intact?

heavy infections?

A
  • asx
  • anorexia, D, vague pain, ulcer-like epigastric sx
  • severe infxn: anemia, protein loss, and malabsroption
45
Q

why do hookworms cause anemia?

A

they cause the laceration of capillaries and ingest extravasated blood

46
Q

what may lead you to think a pt is infected with a parasite?

A

eosinophilia that is unexplained most likely due to the attachment of adult worms to the intestinal mucosa

-rupture RBC and degrae the Hb (why you see a hypochromic anemia)

47
Q

dx of hook worm

A

eggs can be seen in stool examination, coupled with clinical manifestation and good history

  • eosinophilia
  • hypochromic microcytic anemia
48
Q

tx of hook worm

A

albendazole

alternative: mebendazole or pyrantel

49
Q

what are ADRs of albendazole? mebendazole?

A

abdominal pain, D, rash, uticaria,

rare: seizure, hepatitis, increased LFT
mebendazole: monitor liver fxn and CBC-neutropenia and agranulocytosis

50
Q

what antihelminth drug should not be given to kids younger than 5?

A

pyrantel

51
Q

what does supportive hookworm tx include?

A

high-protein diet, vitamines, and ferrous sulfate

52
Q

what is cysticercosis

A

pork tapeworm that can infect brain

53
Q

how is cysticercosis tx?

A

praziquantel that affects parasite cell membrane permeabilty

54
Q

how does mebendazole and abendazole work?

A

by inhibiting formation of worm microtubules that prevents the uptake of glucose necessary for parasitic metabolism

55
Q

what are pinworm?

A

enterobiasis ( Enterobius vermicularis

56
Q

what are the only host for pinworms?

A

humans!

children are often more affected than adults

57
Q

what is the life cycle of a pinworm?

A

adult worms are loosely attached to tthe mucosa, primarily in the cecum

  • gravid F pass through the anus to lay eggs on the perianal skin (can lay a SHIT TON OF EGGS)
  • this usually occurs at night
58
Q

how long are the pinworm eggs viable for outside the host?

A
  • 2-3 wks
59
Q

how are pinworms spread?

A

via hands, food, drink, and fomites

  • eggs swallowed and hatch in the duodenum,
  • larvae pass to the cecum and mature in 3-4 wks
60
Q

what is the lifspan of a pinworm?

A

30-45 days

61
Q

clinical findings in a pinworm infxn?

A
  • most asx
  • perianal pruritus (crawling sensation worse at night)
  • insomnia, weight loss, enuresis, and irritability
62
Q

what may a PE show in a pt affected w/ pinworms?

A

reveal worms in the anus or stool

63
Q

what are complications of scratching?

A

excoriations and secondary skin infections like impetigo

64
Q

what are complications of untreated pinworm?

A

-vuvlvovaginitis, diverticulitis, appendicities, cystitis, and granulomatous rxns

65
Q

how is pin worm dx?

A

pinworm paddle test: piece of cellophagne tape over the perianal skin, three tries over 3 consecutive nights yields a 90% sucess rate

66
Q

what is a common adr of metronidazole?

A

GI upset
dysgeusia
black hairy tongue

67
Q

tx of pinworm

A

albendazole, mebendazole or pyrantel given in a single dose and then repeated 2-4 weeks later

**hand washing and linen washing!!!!!

68
Q

malaria vector?

A

anopheles mosquitoes

  • eradicated in US, but about 1500 imported cases each year
  • may cause local outbreaks bc of this
69
Q

what are the common malaria causes? (species)

A

plasmodium vivax, plasmodium malariae,

plasmodium ovale, plasmodium faciparum

70
Q

what bacteria cuases the highest mortality rate after infection?

A

p. falciparum due to “clustering” of infected cells in brain causing cerebral malaria

71
Q

what is the life cycle/transmission of the malaria causing parasite?

A

1) the mosquito ingests the parasite, and sporozoites mature and get transferred to humans via saliva
2) the sporozoites invade the hepatocytes and mature as tissue schizonts. the schizonts escape the liver and invade RBC, where they multiply and cause rupture of the cell w/in 48 hours
3) the cycle of invasion, multiplication and RBC rupture continues

72
Q

what is the incubation period for p. facipram

A

7-30 days, which can be very prolonged when on antimalarials

73
Q

what is a delayed illness malaria?

A

This can happen particularly with P. vivax and P. ovale, both of which can produce dormant liver stage parasites; the liver stages may reactivate and cause disease months after the infective mosquito bite.)

74
Q

what is the typical malarial attack?

A

lasts 6-10 hours:
a cold stage (sensation of cold, shivering)
a hot stage (fever, headaches, vomiting; seizures in young children)
and finally a sweating stage (sweats, return to normal temperature, tiredness)

*rarely seen

75
Q

what contributes to the clinical presentation of malaria?

A

release of tissue necrosis factors and cytokines leads to fatiuge, HA, dizzy, GI coplaints, maylagia, arthralgias, backache and dry cough

76
Q

what PE may been seen if sx last longer than 4 days?

A

liver and spleen enlargement

77
Q

what are sx of infection with P. falciparum?

A

cerebral malaria, hyperpyrexia, hemolytic anemia, noncardiogenic pulmonary edem, actue tubular necrosis , adrenal insufficiency, cardiac dysrhythmias,
ARDS

*caused by RBC adhering to small blood vessels (cytoadherence) and causin small infarcts, capillary leakage, and organ dysfunction

78
Q

what are clinical features of P. falciparum infxn?

A

pallor, petechiae, jaundic, hepatomegaly, and or splenomegaly

79
Q

dx for malaria?

A

-blood films
‘-CBC
antibodies

80
Q

what will you seen on blood films positive for malaria?

A

Blood smear with Geimsa stain or Wright stane

Thick and thin preparations

Gold standard, but requires reagents & experience interpreting
Also need specimen during acute infection or may get negative smear

what may be the percentage of infected RBC? 5-20%

81
Q

can you look at antibodies for malaria?

A

not really,

antibodies will apper 8-10 days later, but that is too late for diagnostic benefit

antibodies also persist for 10 years, making the distinction btw old and new infection difficult

82
Q

tx of malaria

A 
chloroquine 
atovaquone-proguanil (Malarone®)
artemether-lumefantrine (Coartem®)
mefloquine (Lariam®) 
quinine
quinidine
doxycycline (used in combination with quinine)
clindamycin (used in combination with quinine)
83
Q

what can you sues in areas where chloroquine is resistant?

A

use mefloquine

84
Q

what are side effects of chloroquine?

A

GI sx, HA, PRURITIS, dizziness, blurred vision, malaise, urticaria

85
Q

what is the best medicine for malaria?

A

prevention!!!!

86
Q

What must you check before starting someone on primaquine?

A

if they have G6PD deficiency

Random infectious dz (inpt) (8 decks)

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