STEP 1 Protozoa 2

Question 1

Three types of malaria

How do they all present?

Answer 1

Plasmodium vivax/ovale
P. falciparum
P. malariae
*All present with RECURRENT FEVER, HA, ANEMIA, and splenomegaly

Question 2

How does vivax/ovale fever present?

What is really important to know about vivax/ovale that has a massive impact on treatment?

Answer 2

48hr tertian fever–fever on 1st and 3rd day

**HYPNOZOITE (dormant form) lives in the LIVER and must be slain

Question 3

How does falciprarum fever present? Why is this one the most severe?

Answer 3

1. Severe, irregular fever patterns

2. **Parasitized RBCs clog capillaries in the brain (cerebral malaria), kidney, and lungs

Question 4

How does the malariae fever present?

Answer 4

Every 72 hours

Question 5

How is all malaria transmitted?

Answer 5

Anopheles mosquito

Question 6

How is malaria diagnosed?

Answer 6

Blood smear…looking for trophozoite rings within RBCs

Question 7

First-line treatment for malaria? How does this drug work

Answer 7

1. Chloroquine

2. blocks plasmodium heme polymerase

Question 8

Treatment for malaria resistant to chloroquine? Which species is this used for?

Answer 8

1. Mefloquine or atovaquone/proguanil (malarone)

2. Falciparum or chloroquine resistant

Question 9

If malaria infection becomes life-threatening…how to treat? what must be done first?

Answer 9

IV quinidine…test for G6PD deficiency

Question 10

If vivax/ovale infection, how to treat? Why this way? What must be done first?

Answer 10

1. Use chloroquine or malarone
2. add PRIMAQUINE for the hypnozoite form
3. Must test for G6PD deficiency first

Question 11

What happens if you treat a malaria pt. with Quinidine or Primaquine and the patient has a G6PD deficiency?

Answer 11

Acute hemolysis

Question 12

Babesia is the causative agent for what?

Answer 12

Babesiosis

Question 13

Clinical presentation of Babesiosis? Where does this predominantly occur in the US?

Answer 13

Fever and hemolytic anemia.

Northeastern US

Question 14

Which patients are at increased risk of severe Babesiosis?

Answer 14

Asplenic patients

Question 15

Transmission of Babesia?

Answer 15

Ixodes tick

• *Same tick that transmits Lyme Disease
• *Co-infection may occur

Question 16

Two ways to diagnose Babesiosis?

Answer 16

Blood smear

PCR

Question 17

What is seen on a blood smear for babesiosis?

Answer 17

1. Ring form

2. “Maltese Cross”

Question 18

How to treat babesiosis?
2 different combinations
Combo #1- STEP 1
Combo #2- DiT and UptoDate

Answer 18

1. Atovaquone and Azithromycin

2. Quinine and Clindamycin

Question 19

Trypanosoma cruzi causes which disease?

Answer 19

Chagas disease

Question 20

Clinical presentation Chagas disease? Location?

Answer 20

1. Dilated cardiomyopathy
2. Megacolon
3. Megaesophagus
   Occurs primarily in S. America

Question 21

Transmission of T. cruzi?

Answer 21

Reduviid bug bites and poops in the wound

Question 22

Diagnosis of Chagas?

Answer 22

Blood smear

Question 23

Tx of Chagas? 2 possible

Answer 23

1. Benznidazole OR

2. Nifurtimox

Question 24

Leishmania donovani causes what?

Answer 24

Visceral or cutaneous leishmaniasis

Question 25

Clinical presentation of visceral leishmaniasis?

Answer 25

Spiking fevers Hepatosplenomegaly Pancytopenia

Question 26

Transmission of leishmania?

Answer 26

Sandfly

Question 27

Diagnosis of leishmaniasis?

Answer 27

Blood smear. Looking for macrophages containing AMASTIGOTES (mature form of leishmania that lack flagella)

Question 28

Tx of leishmaniasis? 2 possible

Answer 28

``` 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. ```

Question 29

Trichomonas vaginalis causes what?

Answer 29

Vaginitis...this is considered an STD...unlike Garnerella vaginalis

Question 30

Clinical presentation of T. vaginalis?

Answer 30

Foul-smelling, frothy, greenish discharge | Itching and burning

Question 31

Transmission of T. vaginalis?

Answer 31

Sex

Question 32

Diagnosis of T. vaginalis? 2

Answer 32

1. Trophozoites on wet mount | 2. Strawberry cervix (15% of patients)