protozoa cases

Question 1

Toddler is brought to your clinic with loose, foul-smelling stools, cramping and bloating, and weight loss. She had a fever last week, but hasn’t had one since. The mom says other children at the daycare have experienced similar symptoms. What could be the cease, what is the long term concern for this patient, and how do you test for it?

Answer 1

Giardia

May be asymptomatic or acute as seen in the toddler with steatorrhea (fat malabsorption). If not treated, this could become a chronic infection which causes toddlers “failure to thrive”. It is contracted by food, untreated water, or fecal-oral, and is naturally found in beavers. Test this child by using a gelatin tablet with a string attached “string test” which will collect the sample for you, or a fecal antigen test. Other children in the daycare may be symptomatic from an outbreak, or not since most children are asymptomatic with giardia.

Question 2

Your AIDS patient has started what he calls “the wasting syndrome thing” with horrible diarrhea and an extreme weight loss over the past several weeks. What bug causes this, and how would you test for it?

Answer 2

Cryptospondium Parvum: Cryptosporidious/ wasting syndrome

Obligate Intracellular

This bug “bunts” the villi in your intestines, destroying your ability to maintain proper nutrition. Diarrhea and malnutrition last months.

Question 3

A 30 yo Hispanic male presents to your clinic in the united states with complaints of fever, bloody diarrhea, and right upper quadrant pain for five weeks. CT scan shows “flask shaped” ulcers on his large intestine, and a possible abscess on his liver. What might be causing all of this?

Answer 3

Entamoeba Histolytica

This bug is seen in Hispanic americans, males more than females. It is either fecal oral or sexually transmitted. Starts as a nonspecific febrile disease with right upper quadrant pain, then for > 4 weeks of symptoms the patient has blood diarrhea and possible weight loss. This bug is the Only protozoa which can infiltrate the large intestine, leaving “flask shaped ulcers”. It can also form abscesses on the liver “anchovy paste”.
Test with fecal sample with PCR or antigen test.

Question 4

Patient in east Africa has been experiencing malaise/ myalgias for months. Now, she presents with a severe headache. You provide her with NSAIDs, but there is no relief. What should you be worried about, and how can you test for it?

Answer 4

African sleeping disease/ trypanosmias/ HAT

Carried by the tsetse fly, it has a latent period lasting from months to years until the patient has a severe HA that cannot be helped by meds. Most patients in the early stages have Winterbottom’s sign- bilateral cervical lymphadenopathy. This patient is past that in the CNS stages of the infection. This leads to coma and death. Tests show increased ESR and IgM. Spinal tap may show organisms.
Rhodesia = more acute, east and southern Africa
Gambian = west and central Africa

Question 5

Otherwise healthy teenager in Florida presents with strange swelling of his eyelids and periorbital. He says he’s been having shortness of breath while running, and sharp chest pain. Upon exam, he has an enlarged liver. What’s the parasite?

Answer 5

T. Cruzi/ Chagas/ new world trypo.

This patient has Romana sign (swelling of periorbitals) and symptoms of myocarditis. This disease is only found in the Americas, and is transferred by the kissing bug. Chronic infections lead to megacolon, megaesophagus, and extreme myocardial destruction.
Test for this by getting a serum test for T Cruzi IgG, PCR, and an ekg. You can also do a lymph node biopsy to look for the bugs.

Question 6

A toddler is brought to the clinic in India with a strange, leprosy-like rash. Mom says that the child has been having fevers on a daily basis that peak twice a day. The child has bite marks on her legs and mom states that the neighborhood playground has sandflies. What should you be worried about?

Answer 6

Leishmani Donovani/ Kalazar

Transmitted by Sandflies to toddlers and HIV patients. Has a daily double spike in fevers during which the patient is not as sick as you would expect of malaria. A leprosy like rash forms.
Aspirate bone marrow or spleen. Doing a test on the dermal rash is not licensed in the united states.
Serum test for rK39 antibody.