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Protozoal infections Flashcards

1
Q

protozoa causing bloody diarrhea

A
  • Entamoeba

- Balantidium

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2
Q

symptoms caused by entamoeba histolytic

A
  • bloody diarrhea
  • ulcers
  • liver abscesses
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3
Q

epidemiology of entamoeba

A
  • associated with camping/hikers

- fecal oral transmission - cysts are passed in stool

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4
Q

lifecycle of entamoeba

A
  • only cyst form is infectious
  • ingest cyst, stomach acid erodes cyst leading to growth and invasion
  • trophozoites are the actively replicating form and indicates parasitic infection
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5
Q

pathogenesis of entamoeba

A
  • gastric acid stimulates excystation
  • local necrosis of large intestine
  • destruction of epithelial cells
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6
Q

clinical disease of entamoeba

A
  • ab pain and cramps, colitis, bloody diarrhea
  • weight loss and anorexia
  • liver abscess - flask shaped ulcer, fever, RUQ pain, tenderness
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7
Q

treatment of entamoeba

A
  • non-invasive: paramomycin

- invasive: metronidazole followed by paramomycin

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8
Q

MOA of metronidazole

A
  • destabilizes DNA
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9
Q

epidemiology of balantidium coli

A
  • ciliate: only spp that infects humans
  • fecal oral transmission
  • pigs are reservoirs
  • infection from ingested cysts
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10
Q

clinical disease of balantidium coli

A
  • watery diarrhea WITH blood and pus
  • ab pain, nausea, anorexia
  • secondary bacterial infections of GI mucosa
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11
Q

treatment for balantidium coli

A
  • tetracycline

- metronidazole and iodoquinol are alternatives

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12
Q

epidemiology of giardia

A
  • fecal oral via cysts
  • beavers and muskrats are reservoirs
  • more common in campers and hikers and also in daycares
  • most often transmitted from contaminated water
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13
Q

clinical disease of giardia

A
  • explosive watery diarrhea
  • foul smelling stools
  • ab cramps
  • can progress to malabsorption syndrome - steatorrhea (foul smelling (malodorous), mushy, greasy stool)
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14
Q

diagnosis of giardia

A
  • microscopic examination of stool
  • bilobed nuclei, looks like a horseshoe crab
  • has flagellum
  • falling leaf motility
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15
Q

treatment and prevention of giardia

A
  • treat with metronidazole
  • boil water and treat carriers
  • cysts can survive in chlorinated water
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16
Q

epidemiology of cryptosporidium

A
  • mainly affects children (peak age around 5)

- can be severe in IC patients - lethal in AIDS, #1 cause of AIDS associated diarrhea

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17
Q

pathogenesis of cryptosporidium

A
  • oocyst is infectious form
  • stains acid fast
  • resistant to chlorination
  • water born disease
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18
Q

lifecycle of cryptosporidium

A
  • infects intestinal epithelial cells

- oocyst is infectious and diagnostic form

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19
Q

clinical disease of cryptosporidium

A
  • asymptomatic to severe disease
  • self limited (1-2 wk) enterocolitis
  • watery diarrhea, dehydration, weight loss, ab pain, fever, N/V
  • in AIDS pts, can shit up to 50 times a day
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20
Q

diagnosis of cryptosporidium

A
  • acid fast staining

- pink is positive and green is negative

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21
Q

treatment of cryptosporidium

A
  • replace fluids and electrolytes
  • nitazoxanide for immunoCOMPETENT patients
  • HAART therapy for AIDS patients
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22
Q

epidemiology of isospora belli

A
  • humans are only known reservoir
  • more prevalent in AIDS pts
  • outbreaks are commonly seen in day cares and mental institutions
  • fecal oral: mature oocysts ingested and reside in epithelium
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23
Q

clinical disease of isospora belli

A
  • mimics giardiasis with malabsorption syndrome

- steatorrhea

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24
Q

diagnosis of isospora belli

A
  • oocyst found in feces is elliptical
  • cryptosporidium is round
  • microscopic examination of iodine-stained stool smears
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25
triad for isospora belli diagnosis
- acid fast staining - malabsorption - watery diarrhea
26
treatment for isospora belli
- TMP-SMX
27
characteristics of cyclospora cayetanensis
- resembles cryptosporidium excepts infects immunoCOMPETENT patients - explosive watery diarrhea - fecal contaminated water or food (raspberries or basil)
28
clinical disease of cyclospora cayetanensis
- low grade fever, fatigue, anorexia, abdominal pain, N/V
29
diagnosis of cyclospora cayetanensis
- stains acid-fast | - fluoresces blue under UV light
30
treatment of cyclospora cayetanensis
- TMP-SMX
31
latin name for pinworms
- enterobius vermicularis
32
common name for enterobius vermicularis
- pinworm
33
transmission of enterobius vermicularis (pinworm)
- fecal oral - eggs are "sticky" - eggs can be transmitted on fomites - autoinfection occurs - common in children 5-9 years old
34
clinical disease of enterobius vermicularis (pinworm)
- intense perianal itching at night - prickling pain - diarrhea during acute infection - migrating worms may get lost: vaginal itching and granuloma formation
35
diagnosis of enterobius vermicularis (pinworm)
- cellophane (scotch) tape method | - only used for this type of worm
36
treatment for enterobius vermicularis (pinworm)
- mebendazole
37
latin name for roundworms
- ascaris lumbricoides
38
common name for ascaris lumbricoides
- roundworm
39
transmission of ascaris lumbricoides (roundworm)
- fecal oral - contaminated food or water - eggs can survive for months
40
lifecycle of ascaris lumbricoides (roundworm)
- ingest egg | - egg hatches and travels to liver, heart, lungs, etc.
41
clinical disease for ascaris lumbricoides (roundworm)
- dependent on number of eggs - few eggs - asymptomatic - early phase: large migrate to lungs producing fever, nonproductive cough, dyspnea, wheezing - late phase: diffuse or epigastric pain, N/V, bolus can obstruct and perforate bowel - can be lethal
42
diagnosis of ascaris lumbricoides (roundworm)
- CBC may show eosinophilia - sputum may show larvae - eggs in stool: knobby coated, oval shaped, bile stained
43
treatment for ascaris lumbricoides (roundworm)
- albendazole | - if pregnant then use pyrantel pamoate
44
toxocariasis (roundworm)
- dog and cat roundworms
45
symptoms of toxocariasis (roundworm)
- larvae can penetrate any tissue: lungs, heart, liver, kidney, skeletal muscle, eyes, CNS is most common - bleeding, necrosis, eosinophilic granulomas
46
diagnosis of toxocariasis
- eggs found in pet feces | - eggs NOT found in human feces
47
treatment for toxocariasis
- albendazole
48
latin name for whipworm
- trichuris trichiura
49
- transmission of trichuris trichiura (whipworm)
- fecal oral | - prevalent in southern appalachian range and gulf coast states
50
clinical disease of trichuris trichiura (whipworm)
- light infections (100): ab pain, vomiting, anorexia, weight loss, diarrhea (can be bloody), tenesmus, rectal prolapse
51
diagnosis of trichuris trichiura
- barrel (football) shaped eggs, plugged ends | - RBC and WBC present
52
treatment of trichuris trichiura
- albendazole
53
latin name for hookworms
- ancylostoma duodenale | - necator americanus
54
epidemiology of hookworms (N. americanus)
- penetrate into feet | - go to lymphatics, blood, heart, lungs, cough them up and then swallow into GI tract
55
early symptoms of hookworms (N. americanus)
- itching, localized maculopapular eruption on foot - low grade fever - mild cough, wheezing when worm in lungs
56
late symptoms of hookworms (N. americanus)
- N/V, diarrhea - microcytic and hypochromic anemia - fatigue and dyspnea
57
chronic disease of hookworms (N. americanus)
- emaciation, physical and mental retardation
58
diagnosis of hookworms (N. americanus)
- early infection: eosinophilia, normal stool - patchy infiltrate on chest X-ray (migrating larvae) - GI infection: non-bile stained, segmented eggs in stool - iron deficiency anemia
59
treatment of hookworms
- abdendazole | - iron therapy for anemia
60
anclyostoma braziliense (hookworm)
- dog and cat hookworm | - humans are accidental hosts
61
clinical disease of anclyostoma braziliense
- cutaneous larval migrans: ground itch, creeping eruption - Loeffler syndrome: pulmonary infiltrates with peripheral eosinophilia - at risk: children (sandboxes), beaches
62
treatment for anclyostoma braziliense
- thiabendazole
63
worm infections where humans are accidental hosts
- toxocariasis: dog and cat roundworms | - anclyostoma brazilense: dog and cat hookworm
64
latin name for threadworm
- strongyloides stercoralis
65
common name for strongyloides stercoralis
- threadworm
66
clinical disease of strongyloides stercoralis (threadworm)
- pneumonitis similar to hookworm - occur in IC patients - diarrhea can be bloody, malabsorption - symptoms like peptic ulcer, peripheral eosinophilia
67
chronic infection of strongyloides stercoralis (threadworm)
- hyperinfection syndrome: profound diarrhea, malabsorption, electrolyte imbalance, meningitis, secondary bacteremia - seen in IC patients
68
diagnosis of strongyloides stercoralis (threadworm)
- Baermann funnel gauze method
69
treatment of strongyloies stercoralis (threadworm)
- ivermectin
70
reservoir of trichinella spiralis
- pork, undercooked bear meat | - larvae form found in striated muscle
71
clinical disease of trichinella spiralis
- acute stage: larvae invade tissue: fever, diffuse myalgias, eosinophilia, periorbital edema - late stage: lethal when heart, brain and lungs infected
72
diagnosis of trichinella spiralis
- outbreak traced to infected pork or beat meat - encysted larvae in meat or muscle biopsy - pt presents with diffuse muscle pain- diffuse myalgias - CBC - marked eosinophilia
73
treatment of trichinella spiralis
- albendazole
74
transmission of anisakis simplex
- roundworm of marine fish | - higher incidence where raw fish is eaten
75
clinical disease of anisakis simplex
- within hours after ingested of undercooked (raw) fish - violent ab pain, N/V - severe eosinophilic granulomatous response if larvae pass into bowel - can mimic Crohns
76
hosts for all flukes
- all flukes have clam or snail intermediate hosts
77
characteristics of fluke eggs
- all flukes (and tapeworms) have operculated eggs
78
latin name for giant intestinal fluke
- fasciolopsis buski
79
common name for fasciolopsis buski
- giant intestinal fluke
80
epidemiology of giant intestinal fluke
- ingestion of contaminated water chestnuts - look like leeches or tiny tadpoles - travelers from china, vietnam, thailand, india, malaysia
81
clinical disease of giant intestinal fluke (fasciolopsis buski)
- diarrhea alternating with constipation | - malabsorption syndrome with malodorous, greasy stools
82
diagnosis of giant intestinal fluke
- large, bile stained, operculated eggs in stool
83
treatment of giant intestinal flukes (fasciolopsis buski)
- praziquantel
84
latin name for sheep liver fluke
- fasciola hepatica
85
transmission of sheep liver fluke
- infection from contaminated water plants
86
clinical disease of sheep liver fluke (fasciola hepatica)
- URQ pain, fever, chills, eosinophilia, hepatitis, biliary obstruction
87
treatment of fasciola hepatica
- bithionol
88
latin name for chinese liver fluke
- clonorchis sinensis
89
transmission of chinese liver fluke
- consumption of undercooked freshwater fish
90
clinical disease of clonorchis sinensis
- fever, diarrhea, epigastric pain, hepatomegaly, anorexia, jaundice
91
treatment of clonorchis sinensis
- praziquantel
92
3 main species of schistosomes
- Schistosoma haematobium (bladder): terminal spine - S. japonicum (bowel) - S. manosin (bowel): lateral spine
93
transmission of schistosomes
- penetrate skin when swimming, burrow in and cause itching (swimmers itch)
94
clinical disease of schistosomes
- acute (Katayama syndrome): swimmers itch, fever, chills, cough, urticaria, ab pain, diarrhea, eosinophilia - chronic: granulomatous reactions and fibrosis, bloody diarrhea (S. mansoni mostly), associated with clay pipestem fibrosis around portal vein
95
diagnosis of schistosomes
- leukocytosis, eosinophilia, polyclonal gammopathy - S. mansoni: egg larva is oval shape and curved anterior end with lateral spine, found in stool - S. japonicum: smallest eggs, oval shaped, spine not distint, found in stool - S. haematobium: terminal spine, large egg, found in urine
96
treatment of schistosomes
- praziquantel
97
general characteristics of cestodes (tapeworms)
- flat and ribbon like - head has cup shaped suckers and hooks - segmented bodies: proglottids - eggs in feces are diagnostic - all eggs are operculated
98
epidemiology, transmission, and clinical disease of Taenia solium (pork tapeworm)
- undercooked pork - in larvae ingested in meat: mostly GI symptoms - ab discomfort, diarrhea, indigestion - cystericercosis is dangerous - eggs ingested in contaminated water, vegetables
99
diagnosis of taenia solium
- proglottids and eggs in feces
100
- treatment of taenia solium
- praziquantel
101
symptoms of neurocystericercosis
- hydroencephalitis, mengitis, nerve damage, seizures, visual defects
102
diagnosis of neurocystericercosis
- imaging studies for calcified cysticeri | - (CT,MRI) - big calcified cysts seen on MRI
103
treatment for neurocystericercosis
- praziquantel, albendazole | - steroids, surgery
104
latin name for beef tapeworm
- taenia saginata - does not cause neurocystericercosis in humans - diagnosis and treatment identical to T. solium infection
105
latin name for fish tapeworm
- diphyllobothrium latum
106
transmission and reservoir of fish tapeworms
- undercooked freshwater fish | - wild animal reservoirs: bears, minks, walruses, canine
107
clinical disease of fish tapeworms
- most are asymptomatic - associated with depleted serum vitamin B12 - megaloblastic anemia, neurological manifestations: painful tingling, fatigue, weakness, loss of coordination, confusion, weight loss
108
treatment of fish tapeworm
- niclosamide - praziquantel alternative - vitamin B12 supplementation
109
Echinococcus spp.
- tapeworms of carnivores in sheep-raising areas | - humans are intermediate hosts
110
clinical disease of echinococcus spp.
- hydatid cyst disease - liver and lung where cysts develop: ab pain, hepatic mass, bile duct obstruction - lungs: chest pain, cough, hemoptysis - death from anaphylactic shock after rupture of cysts
111
diagnosis of echinococcus spp.
- CBC- eosinophilia | - X-rays for cysts in lungs, bone and muscle
112
treatment for echinococus
- surgery | - albendazole and mebendazole are DOCs

GI 3 (12 decks)

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