Protozoa Flashcards
1
Q
3 indistinquishable Entamoeba on micro
A
histolytica
dispar
moshkovskii
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%
3
Q
Acid Fast Protozoa-3
A
cryptosporidia
isospora
cyclospora.
4
Q
ACT for malaria
A
Artemisinin combo therapy PO
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
6
Q
Adult worms found in stool (fresh or fixed)
A
strongyloides
7
Q
Amoebic liver abscess- Tx
A
flagyl x 5 d and then paromomycin for luminal
surgery if large left lobe or very ill
8
Q
Ampho B treats which amoeba
A
Naegleria
9
Q
Anaplasma and Ehrlichia geo
A
worldwide
10
Q
area world NOT having relapsing malaria
A
Carribean
11
Q
areas with chloroquine sensitive P. falciparum
A
Haiti, Dominican Republic, Carribean
12
Q
Artemether
A
IM for malaria
13
Q
Artemisinin and combo use, SE
A
1st line IV, combo PO
allergy, transient nystagmus
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
15
Q
Atovaquone proganil uses
A
malaria proph
Tx moderate malaria
PJP (atovaquone)
16
Q
Balantidium coli- class, transmission, Sx, Tx
A
protozoa intestinal
FO, pig main reservior
ASx to GI
TTC
17
Q
Babesia Tx (2)
A
clindamycin and quinine OR
atovaquone and azithromycin
18
Q
Babesia vs P. falciparum (4)
A
no gametocyte
pleomorphic rings
Maltese cross
extracellular
19
Q
Balmuthia- person, dz, acuity, CT, Tx, survival
A
adult hispanic male, immunocompromised
granulomatous amebic encephalitis
wks, mos
CT- multiple enhancing pentamidine
8%
20
Q
Benznidazole treats
A
Chagas- acute
21
Q
Best method of detecting strongyloides in stool
A
Agar plate culture showing bacterial trail left by worm
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
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
24
Q
cause of hypoglycemia in malaria (2)
A
liver dysfxn
quinine hyperinsulin
25
Cause of Kal-azar
Leishmania
26
Cause/risk for blackwater fever
falciparum induced RBC lysis -\> hemoglobinuria
higher risk with G6PD
27
Cerebral malaria- eye exam, mortality
Retinal white spots and hemorrhage
20% mortality treated
28
Chagas- number infected, number with cardiac
5 million
1.5 million
29
Chiclero's ulcer caused by
L. mexicana
30
chloroquine- SE, dosing
itch, dizzy, GI, blurry, insomnia weekly
2 wks before, 4 wks after
31
Chronic Chagas- Indeterminate, Determinate, Dx
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
32
Chylothorax think
LF
33
Congenital Chagas risk of chronic
25% chance of chronic if not Tx
34
Congenital toxoplasmosis- source (2), infant findings, Tx
cat litter, raw meat products
chorioretinitis, hydrocephaly cerebral calcifications leading cause of blindness
Tx child with sulfadiazine and pyrimethamine
35
Cryptosporidiosis- micro, transmission, Sx, Dx(4), Tx, resistant, reproduction
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
36
Cryptosporidium is resistant to
Chlorine - like giardiasis and cyclospora
37
Cryptosporidium vs Cyclospora
both acid fact on ZN stain
crypto smaller at 5 microns
cyclospora bigger at 10 microns and have morula
38
Cyclosporiasis- source, micro, Sx, Dx, Tx
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
39
Cystoisospora (Isospora) morphology, Sx, Tx
25-30 micrometer ellipsoidal oocysts (Big)
acid fast wit sporozoites
chronic diarrhea, eosinophilia
Bactrim
40
Dientamoeba fragilis- class, transmission. replication, Tx
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
41
dientamoeba fragilis- class
flagellate not amoeba
causes eos
42
disseminated cutaneous leishmania caused by
L. Aethiopica
43
disseminated histoplasmosis characteristic syndrome, other Sx
Adrenal necrosis and insufficiency -\> hyperK, hypoNa, hypotension
fever, N+V and eosinophilia
44
Doxycycline malaria prophylaxis
Daily 2 days before to 4 weeks after
45
dry cutaneous leishmania caused by
L. tropica
46
Echinococcus geo
multilocularis- northern hemisphere
granulosis- world
47
eflornithine treats
T.b.gambiense
48
Ehrlichia- reservior, vector
white tailed deer
Lone Star tick
49
Entamoeba histolytica infective forms, micro
mature cyst and trophozoite
15 microns, 4 nuclei
50
Entamoeba histolytica Tx, Dx
Flagyl followed by luminal (parmomycin, Diloxamide furoate)
Dx by serology
51
Entamoeba histolytica- lesion, number, descriptor
usually single liver abscess, esp right lobe
"anchovy paste" is digested liver trophozoites in lining
52
eosinophilic meningitis- agent, Tx
angiostrongylisasis
Tx surgical, meds no help
53
Giardia is resistant to
Chlorination
54
Giardia infectious species, micro
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
55
Giardia incubation, Tx (MATON, them PI)
1-14 d
Metronidazole, albendazole, tinidazole, oxaminoquine, nitazoxanide,
Followed by iodoquinol or paramomycin (kills cysts)
56
Hyper reactive malarial splenomegaly test
Pos IgM
57
Hyperreactive malarial splenomegaly (tropical splenomegaly) - cause, Sx
recurrent malaria infections
anemia, fevers, secondary infections
58
Leischmania species (6) and Sx
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
Leishmania everywhere EXCEPT
SE Asia
60
Visceral Leishmania found in which countries (6)
Brazil Sudan Ethiopia India Nepal Bangladesh
61
leishmania recidivans caused by
L. tropica
62
Leishmania treatment (visceral-4) (skin-3)
antimonial/stibogluconate
miltefosine
amphotericin B
paramomycin
stibogluconate, meglumine antimonate, or miltefisone
63
Leishmania vector
sand-fly (Phlebotomus and Lutzomyia)- night biter
64
Leishmania-vector (2), reservoir, clinical (3), Dx, Tx (4- AAMP)
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
Loa Loa Sx, Dx, Tx
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
Malaria causing nephrotic syndrome
P. malariae
67
Malaria diagnostic methods
RDT to HRP2 (histadine rich) smear- thick use Giemsa (use methanol on thin to protect RBC)
68
Malaria fever periodicity
Tertian 48h- vivax, ovale
Quartran 72h- malariae
69
Malaria having sequestration and why
P. falciparum due to cytoadherence
70
Malaria in pregnancy- Tx, prophylaxis
quinine Mefloquine 2nd and 3rd for proph
71
Malaria key Tx points (4)
avoid overhydration
hypoglycemia
secondary bacterial (esp kids)
transfusion Hgb
72
malaria life cycle
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
malaria proph in kids- (4)
chloroquine, mefloquine; doxy \> 8 YO, malarone \> 5 kg
74
Malaria proph in pregnant and BF
Chloroquine and mefloquine class B
pregnant BF- any chloroquine, mefloquine, preferred but doxycycline, malarone if benefits outweigh risks
75
malaria proph in pregnant
chloroquine, mefloquine
76
Malaria Tx in US
quinidine and doxy
77
Malaria vector and cycle SHSMT
Anopheles Mosquito
sporozoite -\> liver -\> hypnozoite -\> schizont -\>
rupture to release merozoites -\> RBC -\> trophozoite -\> gametocyte or schizont
78
malarone indications (3)
prophylaxis, moderate malaria, PJP
79
Mansonella transmitted by (2)
Culicoides (midges) AND Simulium (black fly)
80
Mefloquine malaria prophylaxis
Weekly 2 weeks before to 4 weeks after
81
mefloquine SE
neuro, psych, GI, dreams, (Black box prolonged dizzy), cardiac arrythmia
82
Melasoprol treats
T.b.rhodesiense
83
Microsporidia- source, micro, Dx
water containated by bird
2-3 microns with belt
trichrome stain, chromotrope, calcofluor, IFA, PCR, elctron microscopy
84
miltefosine treats (2)
Leishmania,
2nd line free-living amoeba
85
Most common HIV headache in Africa? in Asia?
Cryptococcus (CN 6)
penicillinosis
86
Naegleria- person, dz, acuity, CT, Tx, survival
child male, immunocompetent in summer
Primary amebic miningoencephalitis (PAM)
acute CT- edema, increased ICP
ampho B 2%
87
Nerve most affected by cryptococcosis
CN 6 abducens due to increased ICP
88
Nifurtimox treats
T. cruzi (2nd line acute)
T.b.gamb (non CNS)
89
Nitazoxanide- dz
Giardia cryptosporidia E. histolytica cyclospora
90
Nystagmus side effect
Artesunate
91
Only 2 protozoa causing eosinophilia
Isospora belli
Sarcocystis
92
Oxaminiquine-dz (3)
Giardia
cryptosporidia
E. histolytica
93
P. falciparum- RBC size, rings, inclusions, parasitemia
nl
delicate, headphone, applique Mauers clefts (countable)
high
94
P. knowelsi- size, forms, parasitemia
nl bands high
95
P. knowlesi geo, host
Asia, monkey
96
P. malariae complication
Nephrotic syndrome
97
P. malariae endemic in
sub Africa and S. Am
98
P. malariae tx
chloroquine
99
P. malariae- RBC size, rings, inclusions, parasitemia, cycle, complication
nl
thicker, more stages
daisy merzoite
low
Quartran = 72 h
nephrotic syndrome
100
P. ovale- RBC size, shape, inclusions, parasitemia, geo
big
fimbriated
schuffners stippling
about 10 meroziotes in schizont
low
Sub-Saharan Africa, South America
tertian + 48 h
101
P. Vivax complication
Splenic rupture
102
P. Vivax endemic in
Asia, East Africa, S. Am, ME
103
P. vivax- RBC size, shape, inclusions, parasitemia, cycle, geo, complication
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
paromomycin treats...(3)
Leishmania
Entamoeba
Cryptosporidium
105
Pentamidine treats (2) amoeba
Acanthamoeba, Balmuthia
106
pentamidine treats (3)
T.b.gambiense without neuro
acanthamoeba
balmuthia
107
Pentavalent antimonial compund sodium stibogluconate (Pentostam) Tx
Leishmania
108
Percent of untreated acute Chagas progressing to chronic
25%
109
Post kala-azar dermal leishmaniasis- Sx, time, geo
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
Primaquine for which malaria and other, why, contraindications
vivax and ovale hypnozoite liver stage, also gametocytes
also Tx PJP
AVOID pregnancy, G6PD
111
primaquine- dosing, SE
2 days before to 7 days after
G6PD, GI
112
Protozoa with eosinophilia
isospora
113
Quinine SE
tinnitus, hypogycemia
114
RBC variants that are protective against malaria (4)
SS
G6PD
thalassemia
ovalocytosis
115
Skin lesions resembling pizza
Leishmania
116
Soil Transmitted Helminths (4)
Ascaris, hookworms (2), Trichuris
117
Sowda
Onchocerciasis in Yemen
more calf- Lichenified, pruritic, hyperpigemented lesion on one limb
118
Species of malaria related to kidney dz
Falciparum \> malariae \> vivax.
No ovale
119
stibogluconate- antimonial treats...
Leishmania
120
suramin treats
T.b. rhodiense without neuro
121
time of day to look for microfilariae in smear
noon- Loa
midnight oncho
122
Treatment for ocular microsporidia
Oral ALB and topical fumagillin
123
Treatment for toxoplasma (2)
Sulfadiazine, pyrimethamine
124
Treatment for visceral leishmania (MAPS)
miltefosine, ampho B, paramomycin, Sodium stibogluconate
125
Trichomonas- % without Sx, Dx in men, Tx
50% women, most men ASx
testing poor in men
Flagyl OK in pregnancy
126
Trypanosoma brucei gambiense- geo, vector, reservoir, acuity, parasitemia, special finding, Tx
West river
tsetse
man
long, low
Winterbottoms
acute- pentamidine
Chronic- eflornithine QID (PLUS nifurtimox to reduce dosing frequency)
127
Trypanosoma brucei rhodesiense- geo, vector, reservoir, acuity, parasitemia, Sx (3), Tx
East savannah
tsetse
animal/bushbuck
short (\< 3 mo)
high
HSM, rash, DIC
melarsoprol (suramin if no CNS) (S+M)
128
Trypanosoma brucei vector
Tsetse
129
Trypanosoma cruzi- dz, geo, source (5), micro
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
Tx for cutaneous leishmaniaisis
Sodium stibogluconate, meglumine, antimonate, miltefisone, diflucan, Ampho B or heat
131
Tx pregnant, BF with malaria
1st- clinda, quinine 2nd and 3rd- artes + clinda OR quinine + clinda
BF- NOT dapsone, primaquine, doxy
132
Use of malaria serology
NOT diagnostic Useful for malaria hepatosplenomegaly
133
Vector for T.cruzi, intermediate host
Triatomine feces, many animals
134
visceral leishmania caused by, cycle, Sx, Tx
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
wet cutaneous leishmania caused by
L. major
136
What percent acute Chagas progresses to chronic
25
137
Which cell types do each malaria species infect
Falciparum- all
Malariae- old
Ovale and Vivax- young
138
which type of pregnant have higher risk with malaria
primagravid, young
139
Winterbottoms sign
T.bruci.gambiense post cervical LAD
140
Worldwide leading cause of congenital blindness
Toxoplasma
141
worms from raw fish (1 cetstode; 2 nematode; 4 trematode)
Cestode-Diphyllobothrium
Nematode- capillaria, Ansiakiasis
Trematode- (tiny) clonorchis, opisthorchis, metagonimiasis, heterophyiasis
142
worms from water plants
fasciola, fasciolopsis
