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Phase 2a - ICS > Protozoa > Flashcards

Protozoa Flashcards

1
Q

What is protozoa?

A

“One celled animals”

Single cell with nucleus
(Eukarytoic)

> 30,000 species.

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2
Q

What are the five major groups of protozoa?

A

Flagellates
Microsporidia
Sporozoa
Amoebae
Cilliates

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3
Q

Examples of flagellates protozoa?

A

Trypanosoma spp.
Leishmania spp.
Trichomonas vaginalis
Giardia lamblia

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4
Q

African trypanosomiais is caused by what organisms?

A

Sleeping sickness - caused by:

  • Trypanosoma brucei gambiense (West Africa) and rhodesiense (South East Africa).
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5
Q

What are the symptoms of sleeping sickness?

A

Chancre
Flu like symptoms
CNS involvement
Coma & death

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6
Q

How is sleeping sickness diagnosed?

A

Visualising trypomastigotes on blood film or CSF.

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7
Q

Chagas disease (trypanosoma cruzi) acute phase:

A

Flu like symptoms

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8
Q

Chagas disease chronic phase:

A

Cardiomyopathy
Megaoesophagus
Megacolon

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9
Q

What are the vectors for African Trypanosomiasis and American Trypanosomiasis?

A

Tsetse fly and triatomine bug (kissing bug) respectively.

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10
Q

Leishmaniasis is spread by what?

A

Through the bite of sandfly.

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11
Q

What are the clinical pictures of Leishmaniasis?

A

Cutaneous
Mucocutaneous
Visceral

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12
Q

Cutaneous and mucocutaneous Leishmaniasis result in what?

A

Ulceration and destruction. Often superadded infection.

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13
Q

How is cutaneous and mucocutaneous L. diagnosed?

A

Through biopsy - amastigotes seen.

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14
Q

What are the signs and symptoms of visceral L. (kala azar)?

A

Fever
Weight loss
Massive splenomegaly
Hepatomegaly
Anaemia
High fatality without treatment

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15
Q

Trichomonas vaginalis

A

Sexually transmitted.

Mostly asymptomatic but dysuria and yellow frothy discharge often present (fishy smell).

Treated with Metronidazole.

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16
Q

Giardiasis

A

Faeco-oral spread.

Diarrhoea, cramps, bloating, flatulence. Recent travel.

Trophozoites seen in stool.

Treated with Metronidazole.

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17
Q

Amoebiasis

A

Caused by Entaemoeba histolytica.

Faeco-oral spred.

Dysentry, colitis, liver and lung abscesses.

Trophozites in stool.

Treated with metronidazole followed by a luminal amoebicide.

18
Q

Cryptosporidiosis

A

Waterborne infection caused by Cryptosporidium spp.

Watery diarrhoea, vomiting, fever, weight loss.

Oocytes seen in stool.

Self-limiting, severe disease in immunocompromised.

19
Q

Toxoplasmosis

A

Toxoplasma gondii.

Ingestion of contaminated food and water or feline faeces.

Disseminated disease, toxoplasma encephalitis, chorioretinitis.

Maternal infection can be devastating in pregnancy.

20
Q

What is the vector for malaria?

A

Female anopheles mosquito - through their bite.

21
Q

What are the 5 species that can cause human disease?

A

Plasmodium falciparum
Plasmodium ovale
Plasmodium vivax
Plasmodium malariae
Plasmodium knowlesi

22
Q

Which one of the five causative agents causes the most severe disease?

A

Falciparum.

23
Q

What are the diagnostics for malaria?

A

Blood film shows plasmodium ovale trophozite.

24
Q

What are some of the symptoms of malaria?

A

FEVER
Chills
Headache
Myalgia
Fatigue
Diarrhoea
Vomiting
Abdominal pain

25
Q

What are the signs of malaria infection?

A

Anaemia
Jaundice
Hepatosplenomegaly
“Black water fever” = haemolysis - Hb is then passed to the urine.

26
Q

What causes the cyclical fever?

A

When trophozoite develops into a schizont, it then ruptures and re-infects another RBC.

27
Q

What is an additional quality of P. falciparum?

A

Obstructed microcirculation. RBCs ability to adhere to endothelial cells.

In situe rosetting -> vascular occlusion.

28
Q

Cerebral malaria causes what?

A

Vascular occlusion causes drowsiness, raised ICP, seizures, coma and eventually death.

Drowsiness can also be due to hypoglycaemia.

29
Q

What are the complications of malaria in the lung?

A

The lungs can be directly affected through vascular occlusion.

Anaemia and lactic acidosis can cause a fast respiratory rate (tachypnoea) through compensatory mechanisms.

Increased vascular permeability causes fluid to leak directly into the lungs causing pulmonary oedema.

30
Q

ARDS in malaria:

A

ARDS – Acute Respiratory Distress Syndrome

SOB due to anaemia

SOB due to lactic acidosis (compensatory)

SOB due to increased vascular permeability 🡪 pulmonary oedema

31
Q

Malaria complications in the kidneys:

A

Vascular occlusion
Dehydration
Hypotension
Heamolysis
Heamoglobulinuria

Renal failure can occur due to…

A direct effect through vascular occlusion

Hypoperfusion secondary to dehydration (fever) or hypotension

Haemolysis creating products that can be nephrotoxic

Proteinuria
Fatigue
Haematuria

32
Q

Thrombocytopenia in malaria

A

Thrombocytopenia occurs through platelet aggregation and therefore reduced circulating platelets

Generalised inflammation activates the coagulation cascade, causing clotting factors to be used up.

This then causes DIC (disseminated intravascular coagulation) – lots of micro clots have formed in the blood, but a lack of circulating clotting factors causes bleeding.

33
Q

What does bleeding in malaria result in?

A

Epistaxis
Abnormal bleeding
Worsening anaemia

34
Q

How does complicated malaria lead to shock?

A

Hypotension
Tachycardia
Drowsy
Pale

People with complicated malaria often go into shock

Pro-inflammatory cascade causing vasodilation.

Anaemia (if bad enough) can cause cardiogenic shock.

Gram negative sepsis can occur from increased vascular permeability in the bowel 🡪 so gram negative bacteria colonising the bowel can enter the bloodstream.

Bleeding causes a hypovolaemic shock.

Increased vascular permeability means that intravascular fluid can leak out into the “third space”.

35
Q

Complicated malaria affects which systems?

A

Cerebral
ARDS/Pulmonary oedema
Renal failure
Sepsis
Bleeding/Anaemia

36
Q

What are the treatment options for uncomplicated malaria?

A

ACTs - Artemesinin-based combination treatments such as Riamet.

Others include quinine and doxycycline.

PO Chloroquine.

37
Q

What are the treatment options of complicated malaria?

A

IV artesunate (IV quinine + doxycycline).

38
Q

What are the supportive measures for malaria?

A

Cerebral: antiepileptics

ARDS: oxygen, diuretics, ventilation

Renal failure: fluids, dialysis

Sepsis: broad spectrum antibiotics

Bleeding/Anaemia: blood products

Exchange transfusion if huge parasite burden.

39
Q

Which species can develop hypnozoites (thus lead to relapse?)

A

P. ovale and vivax can form hypnozoites in the liver. This can lead to relapses months or years later.

40
Q

Relapses are treated with what?

A

Primiquine to eliminate hypnozoites.

41
Q

Primiquine treatment can cause what?

A

Haemolysis if the individual is G6PD deficient.

Phase 2a - ICS (43 decks)

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