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Tropical Medicine > Protozoa > Flashcards

Protozoa Flashcards

1
Q

3 indistinquishable Entamoeba on micro

A

histolytica

dispar

moshkovskii

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2
Q

Acanthamoeba- person, dz (3), acuity, CT, Tx, survival

A

adult male, immunocompromised

granulomatous amebic encephalitis, corneal ulcer, skin granuloma

wks, mos

CT- multiple enhancing

pentamidine

15%

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3
Q

Acid Fast Protozoa-3

A

cryptosporidia

isospora

cyclospora.

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4
Q

ACT for malaria

A

Artemisinin combo therapy PO

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5
Q

Acute Chagas- Sx, Tx

A

chagoma at site of inoculation- classic Romana’s sign fever, ? HSM

most not dx at this stage and then become chronic

Benznidazole or Nifurtimox

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6
Q

Adult worms found in stool (fresh or fixed)

A

strongyloides

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7
Q

Amoebic liver abscess- Tx

A

flagyl x 5 d and then paromomycin for luminal

surgery if large left lobe or very ill

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8
Q

Ampho B treats which amoeba

A

Naegleria

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9
Q

Anaplasma and Ehrlichia geo

A

worldwide

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10
Q

area world NOT having relapsing malaria

A

Carribean

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11
Q

areas with chloroquine sensitive P. falciparum

A

Haiti, Dominican Republic, Carribean

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12
Q

Artemether

A

IM for malaria

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13
Q

Artemisinin and combo use, SE

A

1st line IV, combo PO

allergy, transient nystagmus

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14
Q

Artesunate- mode, preg, resistance

A

IV malaria therapy, artemether is IM

safe in 2nd 3rd pregnancy

not available US (use quinidine)

some resistance noted in Asia

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15
Q

Atovaquone proganil uses

A

malaria proph

Tx moderate malaria

PJP (atovaquone)

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16
Q

Balantidium coli- class, transmission, Sx, Tx

A

protozoa intestinal

FO, pig main reservior

ASx to GI

TTC

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17
Q

Babesia Tx (2)

A

clindamycin and quinine OR

atovaquone and azithromycin

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18
Q

Babesia vs P. falciparum (4)

A

no gametocyte

pleomorphic rings

Maltese cross

extracellular

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19
Q

Balmuthia- person, dz, acuity, CT, Tx, survival

A

adult hispanic male, immunocompromised

granulomatous amebic encephalitis

wks, mos

CT- multiple enhancing pentamidine

8%

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20
Q

Benznidazole treats

A

Chagas- acute

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21
Q

Best method of detecting strongyloides in stool

A

Agar plate culture showing bacterial trail left by worm

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22
Q

Blastocyctis hominis- class, source, Dx, Sx

A

straminophile

FO and autoinfective

Seen on O+P permanent stains

Usually ASx, Diarrhea, Abdominal pain, Nausea, Perianal pruritis, flatulence

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23
Q

calabar- agent, appearance, location

A

LoaLoa

transient localized swelling/angioedema to adult worm

More on face and extremities

itchy, NOT red

resolve 2-4 d, recur

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24
Q

cause of hypoglycemia in malaria (2)

A

liver dysfxn

quinine hyperinsulin

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25
Q

Cause of Kal-azar

A

Leishmania

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26
Q

Cause/risk for blackwater fever

A

falciparum induced RBC lysis -> hemoglobinuria

higher risk with G6PD

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27
Q

Cerebral malaria- eye exam, mortality

A

Retinal white spots and hemorrhage

20% mortality treated

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28
Q

Chagas- number infected, number with cardiac

A

5 million

1.5 million

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29
Q

Chiclero’s ulcer caused by

A

L. mexicana

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30
Q

chloroquine- SE, dosing

A

itch, dizzy, GI, blurry, insomnia weekly

2 wks before, 4 wks after

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31
Q

Chronic Chagas- Indeterminate, Determinate, Dx

A

Indeterminate form- no Sx, nl EKG and CXR, nl ECHO, (RBBB OK); 75% remain here

Determinate- decades later, 25% of UnTx acute, -> Chagas cardiomyopathy and/or Chagas Gastrointestinal Megasyndromes {Megacolon, Megaesophagus)

trypomastigotes in blood, amastigotes in tissue

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32
Q

Chylothorax think

A

LF

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33
Q

Congenital Chagas risk of chronic

A

25% chance of chronic if not Tx

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34
Q

Congenital toxoplasmosis- source (2), infant findings, Tx

A

cat litter, raw meat products

chorioretinitis, hydrocephaly cerebral calcifications leading cause of blindness

Tx child with sulfadiazine and pyrimethamine

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35
Q

Cryptosporidiosis- micro, transmission, Sx, Dx(4), Tx, resistant, reproduction

A

4-5 microns

FO, prolonged in environment

watery diarrhea usually self-limited, rare extraintestinal (pulm and ocular)

wet mount, modified acid fast, DFA, Differential interference contrast (DIC, Nomarksi)- same as cyclospora

nitazoxanide if ABx needed

resistant chlorine and iodine

sexual and asexual

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36
Q

Cryptosporidium is resistant to

A

Chlorine - like giardiasis and cyclospora

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37
Q

Cryptosporidium vs Cyclospora

A

both acid fact on ZN stain

crypto smaller at 5 microns

cyclospora bigger at 10 microns and have morula

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38
Q

Cyclosporiasis- source, micro, Sx, Dx, Tx

A

water, basil, raspberries

9 micron acid fast

Asymptomatic, Diarrhea, GI

sexual and asexual reproduction

oocysts in stool, mature in soil

modified acid fast, DFA, interference contrast - same as cryptosporodia

Bactrim

resistant chlorine and iodine

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39
Q

Cystoisospora (Isospora) morphology, Sx, Tx

A

25-30 micrometer ellipsoidal oocysts (Big)

acid fast wit sporozoites

chronic diarrhea, eosinophilia

Bactrim

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40
Q

Dientamoeba fragilis- class, transmission. replication, Tx

A

flagellate (not amoeba)

Fecal oral transmission

Can exist without human hosts in the environment

Immediately infective

Binary fission (asexual)

-> eosinophilia

Tx – iodoquinol, paromomycin, tetracycline or metronidazole

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41
Q

dientamoeba fragilis- class

A

flagellate not amoeba

causes eos

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42
Q

disseminated cutaneous leishmania caused by

A

L. Aethiopica

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43
Q

disseminated histoplasmosis characteristic syndrome, other Sx

A

Adrenal necrosis and insufficiency -> hyperK, hypoNa, hypotension

fever, N+V and eosinophilia

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44
Q

Doxycycline malaria prophylaxis

A

Daily 2 days before to 4 weeks after

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45
Q

dry cutaneous leishmania caused by

A

L. tropica

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46
Q

Echinococcus geo

A

multilocularis- northern hemisphere

granulosis- world

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47
Q

eflornithine treats

A

T.b.gambiense

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48
Q

Ehrlichia- reservior, vector

A

white tailed deer

Lone Star tick

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49
Q

Entamoeba histolytica infective forms, micro

A

mature cyst and trophozoite

15 microns, 4 nuclei

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50
Q

Entamoeba histolytica Tx, Dx

A

Flagyl followed by luminal (parmomycin, Diloxamide furoate)

Dx by serology

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51
Q

Entamoeba histolytica- lesion, number, descriptor

A

usually single liver abscess, esp right lobe

“anchovy paste” is digested liver trophozoites in lining

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52
Q

eosinophilic meningitis- agent, Tx

A

angiostrongylisasis

Tx surgical, meds no help

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53
Q

Giardia is resistant to

A

Chlorination

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54
Q

Giardia infectious species, micro

A

G. duodenalis, G. intestinalis, G. lambia

Giardia cysts are 10 microns with 4 small nuclei.

Trophozoites 15 microns, 2 large nuclei and 4 pairs of flagella

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55
Q

Giardia incubation, Tx (MATON, them PI)

A

1-14 d

Metronidazole, albendazole, tinidazole, oxaminoquine, nitazoxanide,

Followed by iodoquinol or paramomycin (kills cysts)

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56
Q

Hyper reactive malarial splenomegaly test

A

Pos IgM

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57
Q

Hyperreactive malarial splenomegaly (tropical splenomegaly) - cause, Sx

A

recurrent malaria infections

anemia, fevers, secondary infections

58
Q

Leischmania species (6) and Sx

A

L. aethiopica -> disseminated cutaneous

L. major -> wet cutaneous (exudative)

L. tropica causes dry cutaneous (and visceral), also known as leishmaniasis recidivans. Classically cheek lesions.

L. donovani -> visceral

L. mexicana -> Chiclero’s ulcer on ear

L. braziliensis, L. guyanensis, L. panamensis (New world)-> mucocuteaneous

59
Q

Leishmania everywhere EXCEPT

A

SE Asia

60
Q

Visceral Leishmania found in which countries (6)

A

Brazil Sudan Ethiopia India Nepal Bangladesh

61
Q

leishmania recidivans caused by

A

L. tropica

62
Q

Leishmania treatment (visceral-4) (skin-3)

A

antimonial/stibogluconate

miltefosine

amphotericin B

paramomycin

stibogluconate, meglumine antimonate, or miltefisone

63
Q

Leishmania vector

A

sand-fly (Phlebotomus and Lutzomyia)- night biter

64
Q

Leishmania-vector (2), reservoir, clinical (3), Dx, Tx (4- AAMP)

A

Phlebotomus sand fly- Old World, Lutzomyia- New World

many animals

NNN media for cutaneous, serology for VLM

Human Skin (pizza), mucocutaneous (New- braziliensis), visceral/Kala-azar (donovani), post kalaazar dermal (Old- donovani)

Sodium stibogluconate- pentavalent antimonial, ampho B, paramomycin, miltefosine

65
Q

Loa Loa Sx, Dx, Tx

A

eye worm, calabar, renal, cardiac

noon smear, PCR (serology cross-reacts)

high parasitemia -> ALB x 21d, IVM x1 and then DEC

low parasitemia -> DEC (MF and adult)

66
Q

Malaria causing nephrotic syndrome

A

P. malariae

67
Q

Malaria diagnostic methods

A

RDT to HRP2 (histadine rich) smear- thick use Giemsa (use methanol on thin to protect RBC)

68
Q

Malaria fever periodicity

A

Tertian 48h- vivax, ovale

Quartran 72h- malariae

69
Q

Malaria having sequestration and why

A

P. falciparum due to cytoadherence

70
Q

Malaria in pregnancy- Tx, prophylaxis

A

quinine Mefloquine 2nd and 3rd for proph

71
Q

Malaria key Tx points (4)

A

avoid overhydration

hypoglycemia

secondary bacterial (esp kids)

transfusion Hgb

72
Q

malaria life cycle

A

mosquito injects sporozoite

liver: schizont matures and ruptures releasing merozoites

RBC: merozoite matures to ring stage trophozoite

matures into merozoite OR gametocyte

(hyponozoites in liver vivax and ovale)

73
Q

malaria proph in kids- (4)

A

chloroquine, mefloquine; doxy > 8 YO, malarone > 5 kg

74
Q

Malaria proph in pregnant and BF

A

Chloroquine and mefloquine class B

pregnant BF- any chloroquine, mefloquine, preferred but doxycycline, malarone if benefits outweigh risks

75
Q

malaria proph in pregnant

A

chloroquine, mefloquine

76
Q

Malaria Tx in US

A

quinidine and doxy

77
Q

Malaria vector and cycle SHSMT

A

Anopheles Mosquito

sporozoite -> liver -> hypnozoite -> schizont ->

rupture to release merozoites -> RBC -> trophozoite -> gametocyte or schizont

78
Q

malarone indications (3)

A

prophylaxis, moderate malaria, PJP

79
Q

Mansonella transmitted by (2)

A

Culicoides (midges) AND Simulium (black fly)

80
Q

Mefloquine malaria prophylaxis

A

Weekly 2 weeks before to 4 weeks after

81
Q

mefloquine SE

A

neuro, psych, GI, dreams, (Black box prolonged dizzy), cardiac arrythmia

82
Q

Melasoprol treats

A

T.b.rhodesiense

83
Q

Microsporidia- source, micro, Dx

A

water containated by bird

2-3 microns with belt

trichrome stain, chromotrope, calcofluor, IFA, PCR, elctron microscopy

84
Q

miltefosine treats (2)

A

Leishmania,

2nd line free-living amoeba

85
Q

Most common HIV headache in Africa? in Asia?

A

Cryptococcus (CN 6)

penicillinosis

86
Q

Naegleria- person, dz, acuity, CT, Tx, survival

A

child male, immunocompetent in summer

Primary amebic miningoencephalitis (PAM)

acute CT- edema, increased ICP

ampho B 2%

87
Q

Nerve most affected by cryptococcosis

A

CN 6 abducens due to increased ICP

88
Q

Nifurtimox treats

A

T. cruzi (2nd line acute)

T.b.gamb (non CNS)

89
Q

Nitazoxanide- dz

A

Giardia cryptosporidia E. histolytica cyclospora

90
Q

Nystagmus side effect

A

Artesunate

91
Q

Only 2 protozoa causing eosinophilia

A

Isospora belli

Sarcocystis

92
Q

Oxaminiquine-dz (3)

A

Giardia

cryptosporidia

E. histolytica

93
Q

P. falciparum- RBC size, rings, inclusions, parasitemia

A

nl

delicate, headphone, applique Mauers clefts (countable)

high

94
Q

P. knowelsi- size, forms, parasitemia

A

nl bands high

95
Q

P. knowlesi geo, host

A

Asia, monkey

96
Q

P. malariae complication

A

Nephrotic syndrome

97
Q

P. malariae endemic in

A

sub Africa and S. Am

98
Q

P. malariae tx

A

chloroquine

99
Q

P. malariae- RBC size, rings, inclusions, parasitemia, cycle, complication

A

nl

thicker, more stages

daisy merzoite

low

Quartran = 72 h

nephrotic syndrome

100
Q

P. ovale- RBC size, shape, inclusions, parasitemia, geo

A

big

fimbriated

schuffners stippling

about 10 meroziotes in schizont

low

Sub-Saharan Africa, South America

tertian + 48 h

101
Q

P. Vivax complication

A

Splenic rupture

102
Q

P. Vivax endemic in

A

Asia, East Africa, S. Am, ME

103
Q

P. vivax- RBC size, shape, inclusions, parasitemia, cycle, geo, complication

A

big

amoeboid

schuffners stippling

about 20 meroziotes in schizont

low

tertian + 48 h

Asia, Sub-Saharan Africa (East Africa), South America, North America, Middle East

splenomegaly

104
Q

paromomycin treats…(3)

A

Leishmania

Entamoeba

Cryptosporidium

105
Q

Pentamidine treats (2) amoeba

A

Acanthamoeba, Balmuthia

106
Q

pentamidine treats (3)

A

T.b.gambiense without neuro

acanthamoeba

balmuthia

107
Q

Pentavalent antimonial compund sodium stibogluconate (Pentostam) Tx

A

Leishmania

108
Q

Percent of untreated acute Chagas progressing to chronic

A

25%

109
Q

Post kala-azar dermal leishmaniasis- Sx, time, geo

A

hypopigmented lesions (macules, papules, nodules) facial edema no sensory changes in the lesions

up to 20 years after

most common in Sudan but is also seen in India

110
Q

Primaquine for which malaria and other, why, contraindications

A

vivax and ovale hypnozoite liver stage, also gametocytes

also Tx PJP

AVOID pregnancy, G6PD

111
Q

primaquine- dosing, SE

A

2 days before to 7 days after

G6PD, GI

112
Q

Protozoa with eosinophilia

A

isospora

113
Q

Quinine SE

A

tinnitus, hypogycemia

114
Q

RBC variants that are protective against malaria (4)

A

SS

G6PD

thalassemia

ovalocytosis

115
Q

Skin lesions resembling pizza

A

Leishmania

116
Q

Soil Transmitted Helminths (4)

A

Ascaris, hookworms (2), Trichuris

117
Q

Sowda

A

Onchocerciasis in Yemen

more calf- Lichenified, pruritic, hyperpigemented lesion on one limb

118
Q

Species of malaria related to kidney dz

A

Falciparum > malariae > vivax.

No ovale

119
Q

stibogluconate- antimonial treats…

A

Leishmania

120
Q

suramin treats

A

T.b. rhodiense without neuro

121
Q

time of day to look for microfilariae in smear

A

noon- Loa

midnight oncho

122
Q

Treatment for ocular microsporidia

A

Oral ALB and topical fumagillin

123
Q

Treatment for toxoplasma (2)

A

Sulfadiazine, pyrimethamine

124
Q

Treatment for visceral leishmania (MAPS)

A

miltefosine, ampho B, paramomycin, Sodium stibogluconate

125
Q

Trichomonas- % without Sx, Dx in men, Tx

A

50% women, most men ASx

testing poor in men

Flagyl OK in pregnancy

126
Q

Trypanosoma brucei gambiense- geo, vector, reservoir, acuity, parasitemia, special finding, Tx

A

West river

tsetse

man

long, low

Winterbottoms

acute- pentamidine

Chronic- eflornithine QID (PLUS nifurtimox to reduce dosing frequency)

127
Q

Trypanosoma brucei rhodesiense- geo, vector, reservoir, acuity, parasitemia, Sx (3), Tx

A

East savannah

tsetse

animal/bushbuck

short (< 3 mo)

high

HSM, rash, DIC

melarsoprol (suramin if no CNS) (S+M)

128
Q

Trypanosoma brucei vector

A

Tsetse

129
Q

Trypanosoma cruzi- dz, geo, source (5), micro

A

Chagas

Central and S. America

triatomine feces in bite, drinking acai orsugar cane extract, blood transfusions, BF, congenital (5% risk), and organ transplant

big kinetopast

130
Q

Tx for cutaneous leishmaniaisis

A

Sodium stibogluconate, meglumine, antimonate, miltefisone, diflucan, Ampho B or heat

131
Q

Tx pregnant, BF with malaria

A

1st- clinda, quinine 2nd and 3rd- artes + clinda OR quinine + clinda

BF- NOT dapsone, primaquine, doxy

132
Q

Use of malaria serology

A

NOT diagnostic Useful for malaria hepatosplenomegaly

133
Q

Vector for T.cruzi, intermediate host

A

Triatomine feces, many animals

134
Q

visceral leishmania caused by, cycle, Sx, Tx

A

L. donovani , L. tropica, L. infantum

promastigotes invade macrophages -> amastigotes

Fever, anorexia, wasting, splenomegaly

MAPS- Antimonial (alt ampho B, paramomycin, miltefosine- PO)

many die from antimonial arrythmia

135
Q

wet cutaneous leishmania caused by

A

L. major

136
Q

What percent acute Chagas progresses to chronic

A

25

137
Q

Which cell types do each malaria species infect

A

Falciparum- all

Malariae- old

Ovale and Vivax- young

138
Q

which type of pregnant have higher risk with malaria

A

primagravid, young

139
Q

Winterbottoms sign

A

T.bruci.gambiense post cervical LAD

140
Q

Worldwide leading cause of congenital blindness

A

Toxoplasma

141
Q

worms from raw fish (1 cetstode; 2 nematode; 4 trematode)

A

Cestode-Diphyllobothrium

Nematode- capillaria, Ansiakiasis

Trematode- (tiny) clonorchis, opisthorchis, metagonimiasis, heterophyiasis

142
Q

worms from water plants

A

fasciola, fasciolopsis

Tropical Medicine (7 decks)

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