Pneumonia, Helminth and protozoal

Question 1

1) what is the causative agent of pneumonia and who is most at risk?
2) what is used as a measurement of severity?

Answer 1

1) Pneumocystis jirovecii (Pneumocystis carinii)
2) occurs in immunosuppressed patients; it is a common cause of pneumonia in AIDS.
3) Blood gas measurement is used to assess disease severity.

Question 2

what drug is the treatment of choice for mild to moderate pneumocystis pneumonia?

Answer 2

1) Co-trimoxazole in high dosage

2) if above C/I Atovaquone

Question 3

what drugs are used to treat severe pneumocystis pneumonia?

Answer 3

1) Co-trimoxazole in high dosage, given by mouth or by intravenous infusion
2) if above C/I Pentamidine isetionate given by IV infusion

Question 4

outline the management of moderate to severe pneumocystis pneumonia infections associated with HIV?

Answer 4

1) prednisolone is given by mouth for 5 days, then reduced to complete 21 days of treatment.
2) Corticosteroid started at the same time as the anti-pneumocystis, no later than 24–72 hours afterwards; and withdrawn before anti-pneumocystis treatment is complete.

Question 5

Who should be offered Prophylaxis against pneumocystis pneumonia?

Answer 5

1) all patients with a history of the infection
2) everely immunocompromised. Prophylaxis should continue until immunity recovers.
3) Co-trimoxazole orally drug of choice for prophylaxis. it is given daily or on alternate days (3 times a week) to improve tolerance
4) Inhaled pentamidine isetionate- if above C/I

Question 6

outline how threadworms (pinworms, Enterobius vermicularis) are transmitted and the treatment

Answer 6

1) Adult live for longer than 6 week. ova must be swallowed and exposed digestive juices
2) Mebendazole - in patients of all ages over 6 months. It is given as a single dose; as reinfection is very common, a second dose may be given after 2 weeks.
(OTC- over 2 years)

Question 7

what is the drug of choice for ascaricides (common roundworm infections)

Answer 7

Mebendazole

Question 8

what is the drug of choice for tape worm?

Answer 8

Niclosamide ( ‘special-order’ )- causes GI upset, lightheadedness, and pruritus; it is not effective against larval worms.

Question 9

1) what problems can Hookworms (ancylostomiasis, necatoriasis) cause in humans?
2) what is the drug of choice for hookworms?

Answer 9

1) live in the upper small intestine and draw blood
2) An iron-deficiency anaemia may occur therefore both the infection and anemia would require treatment
3) Mebendazole has a useful broad-spectrum activity

Question 10

how is Cutaneous larva migrans (creeping eruption) treated?

Answer 10

1) treated with topical tiabendazole

2) Multiple infections respond to ivermectin, albendazole

Question 11

what is the drug of choice for acute invasive amoebic dysentery

Answer 11

1) Metronidazole- very effective against vegetative forms of Entamoeba histolytica in ulcers
2) Tinidazole is also effective
3) Treatment is followed by a 10-days of diloxanide furoate.