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Clinical Medicine I > Protozoa & helminths > Flashcards

Protozoa & helminths Flashcards

1
Q

What are symptoms of entamoeba/amebiasis?

A

can be asymptomatic, or Intestinal = bloody diarrhea, abdominal pain, colitis, fever

2-4 week incubation period

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2
Q

What is the cause of the most severe intestinal destruction of entamoeba/amebiasis?

A

E. histolytica

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3
Q

What can severe entamoeba/amebiasis look like?

A

extraintestinal amebiasis and abscesses –> spreading to liver with hepatomegaly, RUQ pain, weight loss, high fever

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4
Q

What can progress to necrotizing colitis with intestinal perforation and mucosal sloughing?

A

entamoeba/amebiasis
40% mortality rate

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5
Q

What are some risks of entamoeba/amebiasis?

A

tropical/subtropical crowding, poor sanitation, poor nutrition

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6
Q

How is entamoeba/amebiasis transmitted?

A

Ingestion of cysts, fecal-oral, person-person, human excrement, flies

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7
Q

How do you diagnose intestinal entamoeba/amebiasis?

A
  • stool microscopy
  • stool antigen testing
  • stool PCR**
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8
Q

How do you diagnose entamoeba/amebiasis hepatic abscesses?

A

US, CT, MRI; anti-amebic antibodies in serum
elevated liver enzymes

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9
Q

How do you treat entamoeba/amebiasis?

A

metronidazole or tinidazole + luminal agent (diloxanide, iodoquinol, paromomycin)

alternate = tetracycline + chloroquine

surgical aspiration of hepatic abscesses

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10
Q

What is Naegleria Fowleri?

A

free living amoeba common in lakes and heated swimming pools, soil, sewers, tap water

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11
Q

What causes primary amebic meningoencephalitis and subsequent CNS infection?

A

Naegleria Fowleri

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12
Q

What are symptoms of Naegleria Fowleri?

A

5 day incubation and rapidly fatal
* early: headache, fever, stiff neck, lethargy
* 1-2 days later: photophobia, palsies of 3, 4, 6 nerves, N/V, behavioral abnormalities, seizures, AMS
* 7-10 days: coma and death

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13
Q

How can you diagnose Naegleria Fowleri?

A

elevated intracranial pressure
CSF: high WBC count, elevated protein, low glucose
motile trophozoites w/ centrifuged CSF wet mount
MRI: extensive edema and necrosis of front lobes

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14
Q

When should you consider diagnosis of Naegleria Fowleri?

A

w/ purulent meningitis w/o evidence on G staining, antigen detection assay, and culture relevant history

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15
Q

How do you treat Naegleria Fowleri?

A

They don’t really know, but it’s a combo of:
* amphotericin b
* rifampin
* fluconazole
* miltefosine
* azithromycin
* steroids

prognosis is poor

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16
Q

What is giarda?

A

Little flagella in upper small intestine that spreads through a trophozoite and cyst (infectious and can srvive a lot) – through fecal-oral, and water/food contamination

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17
Q

What’s the most common parasitic protozoan infection?

A

giarda

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18
Q

What are signs of giarda?

A

acute: profuse and watery, rarely bloody or mucus
50% - asymptomatic
chronic: abdominal cramping, bloating, flatus, malaise, anorexia
no fever or vomiting
Stools = greasy, frothy, foul smelling w/o blood, pus, or mucus
weight loss, malabsorption

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19
Q

What puts someone at risk for giarda?

A

Poor sanitation - young children, outbreaks in households, day care centers, residential facilities:
1) travelers to endemic areas
2) drinking from contaminated water during recreational wilderness travel
3) partners performing anal sex
4) impaired immunity

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20
Q

How do you diagnose giarda?

A

PCR stool assays
antigen stool assays

dx = wet mount of stool w/ mobile trophozoites or cysts

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21
Q

How do you treat giarda?

A

metronidazole, tinidazole

Paromomycin = safe in pregnancy

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22
Q

How do you prevent giarda?

A

water must be filtered, boil water for 1 minute, disposal of diapers/good hand hygiene

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23
Q

What predisposes you to malaria?

A

history of travel to endemic areas like the tropics, South/Central America, Middle East, India, Southeast Asia and Africa

young children, pregnant patients, travelers w/o exposure

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24
Q

What’s the most severe strain of malaria?

A

P falciparum with 24-48 hr cyclces

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25
Q

What are signs and symptoms of malaria?

A

acute headache and fatigue to irregular paroxysms and cycles of fever and sweats

then, myalgia, arthralgia, cough, chest pain, abdominal pain, anorexia, N/V/D

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26
Q

What cycles do the malaria bugs p vivax and ovale have?

A

48 hour cycles (tertian)

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27
Q

What cycle does p malariae have?

A

72 hr cycles (Quartan)

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28
Q

What do convulsions mean in malaria?

A

CNS progression

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29
Q

What will you see in a PE on a malaria patient?

A

anemia, jaundice, hepatomegaly, splenomegaly

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30
Q

How do you treat non-falciparum malaria?

A

chloroquine

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31
Q

How do you treat p vivax or p ovale malaria?

A

chloroquine and primaquine (check for G6PD deficiency!)

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32
Q

How do you treat uncomplicated p falciparum malaria?

A

combo:
arthemer-lumefantrin (US)
artesunate-amodiaquine (Africa)

33
Q

How do you treat severe malaria?

A

admission
IV/IM artesunate
or
IV quinine or quinidine, oral ACTs, rectal meds

34
Q

What are signs of severe malaria?

A

signs of severe illness, organ dysfunction, high parasite load
neuro: alteration of consciousness, seizures, coma
Severe anemia, hypotension/shock, noncardiogenic pulm edema/ARDS AKI, hypoglycemia, acidosis, hemolysis w/ jaundice, hepatic dysfunction, retinal hemorrhages, bleeding abnormalities, 2ndary bacterial infections

35
Q

How do you diagnose severe malaria?

A

Giemsa-stained blood smears-repeat 8-24 hr intervals
Rapid antigen test = can have false negative

36
Q

What chemoprophylaxis can you offer for malaria?

A
  • chloroquine
  • malarone
  • mefloquine
  • doxycycline
37
Q

What are the four types of toxoplasmosis?

A

1) asymptomatic, mild febrile illness –> dormant until immunocomp
2) congenital
3) retinnochorditis
4) immunocomp

38
Q

What does regular toxoplasmosis start out as?

A

1-2 weeks –> mild fever, fatigue, non-tender lymphadenopathy w/ headache, sore throat, rash, mylagias, hepatosplenomegaly

39
Q

What is retinochoroiditis toxoplasmosis?

A

weeks to years after congenital
- affecting retina and choroid of eye – most commonly late presentation
- in teens, young adults
- eye pain, photophobia, vision changes, w/o systemic symptoms

40
Q

In who is immunocompromised toxoplasmosis common?

A

reactivation in AIDs, cancer patients, immunosuppression, drugs
Risk of encephalitis w/ multiple necrotizing brain lesions

41
Q

How can you diagnose toxoplasmosis?

A

IgM and/or IgG

PCR available, but not reliable
tachyzoites and/or cysts in histopathologic examination

WITH encephalitis: CT or MRI ring enhancing lesions

42
Q

In what is toxoplasmosis common?

A

CATS

43
Q

How do you treat toxoplasmosis?

A

No treatment necessary unless pregnant, severe, or affects vision:
- pyrimethamine + sulfadiazine w/ folinic acid
- OR clindamycin and TMP/SMZ

monitor WBC and platelets weekly

44
Q

What do you use in 1st trimester pregnancy for toxoplasmosis instead of pyrimethamine?

A

use spiramycin instead (but must treat baby too)

45
Q

What are signs of congenital toxoplasmosis?

A

fever, hypothermia, jaundice, V/D, hepatosplenomegaly, pneumonitis, myocarditis, thrombocytopenia, anemia, blueberry muffin rash

chorioretinitis, hydrocephalus, intracranial calcifications

46
Q

What does congenital toxoplasmosis cause?

A

spontaneous abortion, stillbirths, severe neonatal disease, neuro manifestations, chorioretinitis (MCS), seizures, psychomotor retardation, deafness, hydrocephalus

47
Q

What are symptoms of trichomoniasis?

A

male - nongonoccal urethritis, discharge
female - vaginitis w/ copious discharge and itching, dysuria, dyspareunia, abdominal pain

48
Q

What would you see on a PE of trichomoniasis?

A

copious discharge, malodorous, frothy, yellow-green color, punctate hemorrhages “strawberry cervix”

49
Q

How do you diagnose trichomoniasis?

A

wet mount – motile organism POC antigen and nucleic acid amplification asays

50
Q

How do you treat trichomoniasis?

A

metronidazole or tinidazole

51
Q

What are the signs of hookworm (roundworm)?

A

“ground itch” pruritic, maculopapular at skin penetration –> serpinigous tracks
THEN
dry cough, wheezing, low fever w/ larvae migration in lungs
1 month later: epigastric pain, diarrhea, anorexia –> anemia and protein malnutrition (pallor, weakness, dyspnea, heart failure, hypoalbuminemia, edema, ascites)

52
Q

Where is hookworm (roundworm)?

A

most tropical and subtropical areas

53
Q

What’s hookworm (roundworm) caused by?

A

ancylostoma duodenale and necator americanus that developed in soil –> penetrates skin –> migrates to body

54
Q

How do you diagnose hookworm (roundworm)?

A

eggs in feces - Ova and parasite test

CBC - microcytic anemia, eosinophilia, hypoalbuminemia
occult blood in stool

55
Q

How do you treat hookworm (round worm)?

A

Alebndazole single dose or mebendazole

pyrantel pamoate

iron supplements for anemia, blood transfusion
endemic = mass treatment of children

56
Q

What type of bacteria can carry a tapeworm (cestode) and is found in beef/pork?

A

taenia saginata & solium

57
Q

What type of bacteria can carry a tapeworm (cestode) and is found in fish?

A

diphyllobothrium latum

58
Q

What type of bacteria can carry a tapeworm (cestode) and is found in dwarf?

A

hymenolepis nana

59
Q

What are symptoms of a cestode of taeniasis?

A

asymptomatic or nausea, anorexia, epigastric pain, anxiety, headache, dizziness, urticaria

60
Q

What are the symptoms of a cestode of diphyllobothriasis?

A

asymptomatic or fatigue, diarrhea, numbness, dizziness, allergic symptoms
megaloblastic anemia, B12 deficiency, is key here

61
Q

What are the key symptoms of a cestode of hymenolepiasis?

A

asymptomatic or crampy abdominal pain, diarrhea, anorexia, weight loss, fatigue, pruritus ani
anemia, dizziness, irritability, sleep disturbances, seizures, and jaundice

62
Q

How do you diagnose cestodes?

A

Eggs or proglottids in stool (ova or parasite stool)

Usually need 2-3 specimens

May have eosinophilia

B12 deficiency for diphyllobothriasis

63
Q

What is the treatment for cestodes?

A

noninvasive = single dose praziquantel
alternative = nicolsamide

64
Q

What’s the treatment for dwarf cestodes?

A

increased dose = praziquantel
repeat dose after 1 week
re-examine stool to check

65
Q

What are the two types of invasive cestode/cysticercosis?

A

Neurocystericercosis and extraneural

66
Q

What characterizes neurocystericercosis?

A
  • seizures, neuro deficits, altered cogniton, psych disease
  • intracerebral, subarachnoid, spinal cord lesions, intraventricular cysts
  • ocular lesions years before symptoms start
67
Q

What characterizes extraneural cysticercosis?

A
  • asymptomatic nodules, with discomfort when inflamed
  • MC include muscle/subq tissue involvement
68
Q

What causes invasive cestodes?

A

T. solium
direct human-fecal contamination

69
Q

How do you diagnose invasive cestodes?

A
  • Neuroimaging
  • CT & MRI: multiple parenchymal cysts, calcification
  • ELISA and immunoblot assays
  • brain biopsy
  • excisional biopsy of skin or muscle lesion
70
Q

How do you treat neurocysticercosis?

A

albendazole, praziquantel, adjunctive corticosteroids

71
Q

When should antiparasitic therapy not be administered to treat neurocysticercosis?

A
  • untreated hydrocephalus
  • high cyst burden w/ diffuse cerebral edema
  • presence of calcififed lesions
72
Q

How do you treat extraneural invasive cestodes?

A

NSAIDs, excision for symptomatic solitary lesions

73
Q

What is echinococcosis (tapeworm)?

A

large cystic lesions in liver or lung (any organ)
asymptomatic, often found incidentally
cysts can rupture = severe allergic reaction w/ fever & hypotension

may have = abdominal pain, chest pain, biliary obstruction, cholangitis, portal hypertension, cirrhosis, bronchial obstruction

74
Q

What causes echinococcosis?

A

canine feces w/ parasite eggs, granulosus and multicularis

75
Q

How do you diagnose echinococcosis?

A

imaging: US or CT - large cyst w/ daughter cysts

IgG ELISA assay - most sensitive confirmatory

76
Q

How can you treat echinococcosis?

A

long course of albendazole

77
Q

What indicates enterobiasis (pinworm)?

A

nighttime perianal itching
insomnia, restlessness, enuresis, impetigo, abdominal pain, nausea, vomiting

78
Q

How do you diagnose enterobiasis?

A

worms found on skin, NOT on stool

“Tape test” – microscopic exam, best done at night right before bathing and in the morning
repeat over 3 days

79
Q

How do you treat enterobiasis?

A

albendazole, mebendazole
pyrantel pamoate 1 dose

wash all bedding!

Clinical Medicine I (33 decks)

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