Parasitic infections of the Lungs

Question 1

Parasitic infections of the lung occur worldwide among only immunocompromised patients

T/F

Answer 1

F

Parasitic infections of the lung occur worldwide among both immunocompetent and immunocompromised patients

Question 2

Parasitic infections of the lung

• They may mimic ________ and malignancy in clinical presentations and radiographic findings

Answer 2

tuberculosis

Question 3

Paragonimiasis

• Aetiologic agent: ______________

• Mode of acquisition: by _________________ such as a _________ or __________

Answer 3

Paragonimus westermani

eating crustacean hosts ; crayfish or freshwater crab

Question 4

Epidemiology of paragonimiasis

• Asia, Africa, and Latin America.
• Risk factor: consuming _____________________, meat from reservoir hosts.
• 3 million people infected.

Answer 4

uncooked freshwater crabs and crayfish

Question 5

Pathogenesis of paragonimiasis

• The ________ of the human lung fluke, Paragonimus westermani ______ in the human gut
• the young worms ________, where they become ______________

•______, released by the ______ worms, move up the _____ to the ______, are expectorated or _______ and are then passed in the feces.

Answer 5

metacercariae

excyst; migrate to the lungs

encapsulated in lung tissue

Eggs; adult; trachea; pharynx

swallowed

Question 6

Pathogenesis of paragonimiasis

•Eggs in the lung induce _____________, forming _________ around the eggs.

• Adult lung flukes appear as _________ nodules approximately _____ in size within the lung

• worms can also be found in ectopic sites (_____,______, and __________ ).

Answer 6

an inflammatory response

granulomas; grayish-white; 1 cm

brain, liver, and intestinal wall

Question 7

worms of paragonimus westermani can also be found in ectopic sites

T/F

Answer 7

T

Question 8

Clinical features of paragonimiasis

• fever, chills, and ________.
• cough
•___________ sputum (_______)
• severe _________
• severe neurologic disease( _______ paragonimiasis):

Answer 8

eosinophilia

Dark blood-tinged; haemoptysis

chest pain.; cerebral

Question 9

Clinical features of paragonimiasis

• severe neurologic disease

–______ problems, _____ weakness
– convulsive seizures
– May also affect ________ sites, the _________, and the ______

Answer 9

visual; motor

subcutaneous

abdominal cavity, and the liver.

Question 10

Lab diagnosis of paragonimus

Identifying ________in the sputum, swallowed eggs in the _____, or _______ and _____ in biopsy specimens.

Multiple examinations of stool and sputum may be necessary.

Serologic tests like Enzyme immunoassay tests
Molecular

Answer 10

expectorated eggs

feces; worms and eggs

Question 11

Treatment, Prevention, and Control of paragonimiasis

•___________; ___________ is alternative.
• Education on proper preparation of food
• preventing contamination of water sources with human and animal feces

Answer 11

triclabendazole

praziquantel

Question 12

Hydatid disease

• Caused by _______ of ________ species

• definite hosts: members of the _____ family (______ and _______).

Answer 12

larvae

Echinococcus tapeworm

Canidae

dogs and foxes

Question 13

Hydatid disease

• Most cases are caused by ____________ which has a worldwide distribution

• Although most cysts form in the _______, 20–30% form in the _______

Answer 13

Echinococcus granulosus

liver; lung

Question 14

Hydatid disease : Pathogenesis

• Humans become ___________ hosts after eating food contaminated with eggs,

• the ingested eggs hatch, releasing larvae which migrate from the ______ to the ________.

• The eggs travel to the ______ or _____ and (slowly or rapidly?) develop into hydatid cysts over a period of
___________

Answer 14

accidental intermediate

gastrointestinal tract; circulation

liver or lungs

Slowly ; several months or years.

Question 15

In hydatid disease

Occasionally, lung cysts form after ____________ spread of parasites following the _______________

Answer 15

transdiaphragmatic

rupture of liver cysts.

Question 16

Clinical features of hydatid disease

• May be asymptomatic for years

• chest pain, cough, _____ or ———-

• may cause symptoms due to ———— of adjacent structures,

• Symptoms due to release of antigenic material is from the ______

• Cysts may become _________ causing ——— or _________ formation.

Answer 16

haemoptysis or pneumothorax

compression; cyst

secondarily infected

empyema or lung abscess

Question 17

Clinical features of hydatid disease

• Symptoms due to release of antigenic material is from the cyst

– ________ reaction with fever, ____________ and __________ and, rarely, ____________

Answer 17

hypersensitivity

wheeze and urticaria

anaphylaxis.

Question 18

Laboratory diagnosis of hydatid disease

• FBC : _________ in about 50% of cases
• Serological tests
• Percutaneous aspiration of cysts reveals protoscolices/ hydatid sand

Answer 18

eosinophilia

Question 19

Treatment of hydatid disease

•_________________
•_____________ ± ________

Answer 19

Surgical excision of cysts

Albendazole

praziquantel

Question 20

Entamoeba histolytica

_______________ disease is the most common complication of amoebic liver abscess

Answer 20

Amoebic pleuropulmonary

Question 21

Entamoeba histolytica
Amoebic pleuropulmonary disease

commonly occurs by __________ from a (superior or inferior ?) (low or right?) lobe hepatic abscess through the ________ into the (left or right?) (upper or lower?) lobe of the lung

Answer 21

direct extension

Superior; right

diaphragm; right; lower

Question 22

Entamoeba histolytica

presents with cough, pleuritic pain and dyspnoea.

T/F

Answer 22

T

Question 23

Entamoeba histolytica lung infection

may also occur following __________ spread of organisms to the ______ or ______ spread from the liver to the _______

Answer 23

haematogenous

lungs

lymphatic

Diaphragm

Question 24

Entamoeba histolytica

Intrathoracic complications include _______________ into the pleural cavity with empyema formation which carries a mortality of 15–35%.

Infiltration of the lung parenchyma may result in _______ or _______ formation.

hepatobronchial fistula leading to expectoration of ‘________–like’ purulent sputum can develop.

Rarely, a bronchobiliary fistula may occur causing ________

Answer 24

rupture of an amoebic liver abscess

pneumonia or lung abscess

anchovy sauce

bile expectoration

Question 25

Malaria

•__________ of infected erythrocytes in the lungs initiates regional production of _________ that increase capillary permeability, leading sequentially to pulmonary edema, dyspnea, hypoxia, acute lung injury, and acute respiratory distress syndrome (ARDS).

Answer 25

Sequestration

inflammatory cytokines

Question 26

Malaria
• Sequestration of infected erythrocytes in the lungs is Most common with P. _______

Answer 26

falciparum

Question 27

Pulmonary toxoplasmosis

• Pulmonary toxoplasmosis in the immunodeficient patient may appear in the form of _______ pneumonitis, _________ pneumonitis, ________, pleural effusion, empyema

Answer 27

interstitial

necrotizing

consolidation

Question 28

Pulmonary toxoplasmosis

• The pneumonitis is associated with the development of ______ or ________ exudate.

Answer 28

fibrinous or fibrinopurulent

Question 29

Pulmonary toxoplasmosis

•________ may be found in alveolocytes, alveolar macrophages,pleural fluid, or extracellularly within alveolar exudate.

Answer 29

Tachyzoites

Question 30

Pulmonary toxoplasmosis

• T.gondii DNA may be demonstrated in _______________ (BAL) fluid by the PCR.

Answer 30

bronchoalveolar lavage

Question 31

Loeffler’s syndrome

• Loeffler’s syndrome is caused by larval migration of nematodes such
as ______,_______, or _________(especially toxocariasis) into the alveoli which triggers __________ leading to respiratory symptoms including cough, wheeze, dyspnoea, chest pain, fever and _________.

The illness usually resolves spontaneously after _______

Answer 31

Strongyloides, Ascaris or hookworm

an allergic response

haemoptysis

several weeks.

Question 32

. Strongyloidiasis

symptoms may occur in the initial stages of lung migration.

T/F

Answer 32

T

Question 33

Strongyloidiasis

• In the immunocompromised respiratory symptoms may be non-specific and, apart from gastrointestinal complaints, symptoms of ________ might be the only feature.

Answer 33

asthma

Question 34

Strongyloidiasis

• new onset _____ or _______ of asthmatic episodes +immunosuppression may be due to S stercoralis

Answer 34

bronchial asthma

worsening

Question 35

Strongyloidiasis

• In immunosuppressed patients with hyperinfection, symptoms and signs consistent with ___________ may be seen.

Answer 35

adult respiratory distress syndrome

Question 36

Strongyloidiasis

• In disseminated disease, extensive ____________________ may be seen

Answer 36

intra-alveolar haemorrhage

Question 37

Schistosomiasis
• Acute schistosomiasis (_______) may present with fever, cough, dyspnoea, rash and arthralgias.

Answer 37

Katayama fever

Question 38

Other causes of pneumonitis

List 5

Answer 38

MEALT

Microsporidia

Encephalitozoonidae (E. hellem)

Acanthamoeba

Leishmaniasis

Trypanosomiasis