Parasitic worm infections

Question 1

enterobius vermicularis

Answer 1

pinworm infection where the eggs hatch in small intestine and larvae become adults worms and live and lay eggs in peranal folds.

Question 2

adult enterobius vermicularis infection presents as

Answer 2

asymptomatic but can have nighttime anal pruritis as adults lay eggs in perianal skin folds. Adults live for 1-2 months and lay up to 10K eggs.

Question 3

diagnosis of pinworm infection is by

Answer 3

scotch tape test before defecation or bathing to retrieve eggs

Question 4

treatment is pinworm

Answer 4

treat entire household and all dwelling members Albendazole and personal hygiene and washing linens

Question 5

Endemic areas for Strongyloides are:

Answer 5

southeastern US and southeast asia (laos and cambodia)

Question 6

abdominal pain, history of pneumonia, peripheral eosinophilia and endemic travel

Answer 6

strongyloides stercoralis

Question 7

infection of strongyloides begins

Answer 7

with larvae infecting humans through the skin of the feet. larvae travel to lungs and up the tracheobronchial tree where they are swallowed. Larvae then enter the intestine and mature into adult worms and produce eggs that transform into larvae. Larvae are then excreted into feces and cycle takes 3-4 weeks

Question 8

can have these complications in an immunocompromised pt:

Answer 8

see large worm burden and hyperinfection syndrome can disseminate to lungs, liver, heart and CNS and endocrine glands to cause shock and multiorgan failure

Question 9

pts who are from Laos, southeast US with unexplained gram negative bactremia should get tested for:

Answer 9

strongyloides see hyperinfection with gram negative bacteremia E coli from hematogenous spread

Question 10

presentation of strongyloidosis

Answer 10

asympotmatic present with intermittent abdominal pain pulmonary symptoms that is misdiagnosed as asthma and worsened with corticosteroids

Question 11

diagnosis of strongyloides even if negative stool studies

Answer 11

diagnose with larvae in stool serology ELISA for IgG can be positive for strongyloides even if negative stool studies

Question 12

two negative stool tests need a

Answer 12

duodenal aspiration string test

Question 13

empiric treatment of strongyloides

Answer 13

ivermectin preferred and albenazole is alternate

Question 14

amebic liver abscess treatment

Answer 14

metronidazole + luminal agent like paromomycin to eradicate coexisting intestinal infection

amebic abscesses are caused by Entamoeba histolytica

amoeba invades intestinal mucosa through portal vein.

Question 15

hepatic amebic liver abscess presentation

demographics

Answer 15

Infection of liver is asymptomatic until hepatic necrosis results in abscess development - see pain, fever, and leukocytosis

See amebic liver abscesses in pts who live in edemic areas: I_ndia, Africa or Central or South America._

Present with symptoms about 3-5 months after infection. Nearly all pts have positive serological sutides after infection.

Question 16

diagnosis of hepatic amebic abscess

Answer 16

positive serological studies for E histolytica

See U/S abd with detection of pyogenic liver abscess, CT abdomen is preferred but both are equally sensitive for detection.

Question 17

Do we use meropenem for treatment of amebic liver disease?

Answer 17

No.

Meropenem is used to treat pyogenic liver abscess and no role in treatment of amebic abscess.

Question 18

pt with 2 weeks of watery diarrhea and lives in Mexico. Stool antigen and serology positive for Entamoeba histolytica. What to treat with

Answer 18

metronidazole.

don’t pick albendazole or praziquantel.