STEP 1 Protozoa 2 Flashcards
Three types of malaria
How do they all present?
Plasmodium vivax/ovale
P. falciparum
P. malariae
*All present with RECURRENT FEVER, HA, ANEMIA, and splenomegaly
How does vivax/ovale fever present?
What is really important to know about vivax/ovale that has a massive impact on treatment?
48hr tertian fever–fever on 1st and 3rd day
**HYPNOZOITE (dormant form) lives in the LIVER and must be slain
How does falciprarum fever present? Why is this one the most severe?
- Severe, irregular fever patterns
2. **Parasitized RBCs clog capillaries in the brain (cerebral malaria), kidney, and lungs
How does the malariae fever present?
Every 72 hours
How is all malaria transmitted?
Anopheles mosquito
How is malaria diagnosed?
Blood smear…looking for trophozoite rings within RBCs
First-line treatment for malaria? How does this drug work
- Chloroquine
2. blocks plasmodium heme polymerase
Treatment for malaria resistant to chloroquine? Which species is this used for?
- Mefloquine or atovaquone/proguanil (malarone)
2. Falciparum or chloroquine resistant
If malaria infection becomes life-threatening…how to treat? what must be done first?
IV quinidine…test for G6PD deficiency
If vivax/ovale infection, how to treat? Why this way? What must be done first?
- Use chloroquine or malarone
- add PRIMAQUINE for the hypnozoite form
- Must test for G6PD deficiency first
What happens if you treat a malaria pt. with Quinidine or Primaquine and the patient has a G6PD deficiency?
Acute hemolysis
Babesia is the causative agent for what?
Babesiosis
Clinical presentation of Babesiosis? Where does this predominantly occur in the US?
Fever and hemolytic anemia.
Northeastern US
Which patients are at increased risk of severe Babesiosis?
Asplenic patients
Transmission of Babesia?
Ixodes tick
- *Same tick that transmits Lyme Disease
- *Co-infection may occur
Two ways to diagnose Babesiosis?
Blood smear
PCR
What is seen on a blood smear for babesiosis?
- Ring form
2. “Maltese Cross”
How to treat babesiosis?
2 different combinations
Combo #1- STEP 1
Combo #2- DiT and UptoDate
- Atovaquone and Azithromycin
2. Quinine and Clindamycin
Trypanosoma cruzi causes which disease?
Chagas disease
Clinical presentation Chagas disease? Location?
- Dilated cardiomyopathy
- Megacolon
- Megaesophagus
Occurs primarily in S. America
Transmission of T. cruzi?
Reduviid bug bites and poops in the wound
Diagnosis of Chagas?
Blood smear
Tx of Chagas? 2 possible
- Benznidazole OR
2. Nifurtimox
Leishmania donovani causes what?
Visceral or cutaneous leishmaniasis
Clinical presentation of visceral leishmaniasis?
Spiking fevers
Hepatosplenomegaly
Pancytopenia
Transmission of leishmania?
Sandfly
Diagnosis of leishmaniasis?
Blood smear. Looking for macrophages containing AMASTIGOTES (mature form of leishmania that lack flagella)
Tx of leishmaniasis? 2 possible
Amphotericin B (visceral) Sodium Stibogluconate (cutaneous) **Not on STEP 1 but MOA for SS is directly inhibits DNA topoisomerase I leading to inhibition of both DNA replication and transcription.
Trichomonas vaginalis causes what?
Vaginitis…this is considered an STD…unlike Garnerella vaginalis
Clinical presentation of T. vaginalis?
Foul-smelling, frothy, greenish discharge
Itching and burning
Transmission of T. vaginalis?
Sex
Diagnosis of T. vaginalis? 2
- Trophozoites on wet mount
2. Strawberry cervix (15% of patients)
