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Clinical pathology > Theme 1- interpreting test results, fungal pathogens, parasites > Flashcards

Theme 1- interpreting test results, fungal pathogens, parasites Flashcards

1
Q

What are ideal tests? What is the correlation between sesnitivity and speicificity?

A

Rarely available in routine practice

High sensitivity and specificity rarely coexist

Increased sensitivity traded for decreased specificity and vice versa

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2
Q

What are strategies to improve tests?

A

Select a more appropriate ‘Normal’ population- compare heart attacks to group of elderly- more normal

Use a combination of tests - e.g. LFT profiles

Combine tests to achieve a diagnostic goal, e.g. neonatal screening for PKU and hypothyroidism

  • Sensitive first line test (low cost)
  • Specific test for screen positives (higher cost)
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3
Q

What are appropiate ‘normal’ populations to test?

A

Patients with similar presenting symptoms

e.g. chest pain

Same age

Same gender

Hospitalised ‘normals’

Same underlying disease

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4
Q

Why do we set cut offs for sensitive screening tests?

A

Sensitive screening test- pick up all the abnormal

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5
Q

What is cut off for specific second-line tests?

A

Readjusting and taking through second line removing the false positives by adjusting the limit

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6
Q

What are factors that affect the reference range?

A
  • Age
  • Gender
  • Diet
  • Pregnancy
  • Time of month- menstruation cycle
  • Time of day- cortisol
  • Time of year- Calcium/Vit D
  • Weight- can dilute yourself with water
  • Stimulus- glucose can change the reference range
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7
Q

What is the diurnal rhythm of cortisol?

A

Cortisol at time of day different- normally taken at 9am or 12am

Reference range is tight- when asleep, during day reference range widens, midnight it narrows again. Gone up at mid-morning- stressed. 8pm- exercise

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8
Q

What is the glucose tolerance test?

A
  • Give someone glucose- fasting ref range is 3-5
  • Glucose intolerance- goes up- normally when diabetic when given glucose
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9
Q

What are substances that can’t use reference ranges?

A

Action Limits

  • Cholesterol- more interested as a risk factor- cut offs to tell us the risk
  • Paracetamol- no normal range as not normally in the body- needed for when poisoned

Therapeutic Ranges - for drugs

  • lithium
  • digoxin
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10
Q

What are the action limits for paracetamol?

A

If patient has overdose, take a measurement and decide whether they get antidote treatment. In the liver it is conjugated with glutathione but when runout liver gets damaged.

Can give treatments to replace glutathione and replace paracetamol into harmless products.

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11
Q

How is advanced glycosylated endprodutcs formed (AGE) formed?

A

Protein + Glucose —-> Advanced Glycosylated Endproducts (AGE)

Non-enzymatic process

Rate of formation proportional to

a) glucose concentration
b) time

May explain long-term complications of diabetes

Scientific basis of commonly used monitoring tests

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12
Q

What is HbA1c?

A
  • HbA1c is stable glycosylated haemoglobin
  • Its percentage concentration indicates cumulative glucose exposure
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13
Q

What are the types of fungi?

A

–Hypha = moulds

–Yeast cells = yeasts

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14
Q

Is fungi eukaryotic or prokaryotic?

A

Eukaryotic microorganisms

Single celled to macroscopic

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15
Q

How do fungi reproduce?

A

Reproduce asexually and/or sexually, spore formation

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16
Q

What are the type of fungal disease?

A
  • Superficial infection
  • Subcutaneous infection
  • Systemic infection
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17
Q

What is a superficial infection? What are the types of fungi?

A

Superficial infection – affecting skin, hair, nails and mucocutaneous tissue

  • Dermatophytes
  • Malassezia
  • Candida
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18
Q

What is subcutaneous infection?

A

Subcutaneous infection – affecting subcutaneous tissue, usually following traumatic implantation

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19
Q

What is systemic infection? What are examples?

A
  • Systemic infection – affecting deep-seated organs
  • Candida
  • Aspergillus
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20
Q

What are dermatophytes? Where do they originate from?

A
  • Group of moulds seen as causes of disease in skin, hair and nail
  • Originate in soil, other animals or other humans
  • Geophilic- soils
  • Zoophilic- animals
  • Anthropophilic- other humans
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21
Q

What are the disease names for dematophtye infections in the foot, nail and groin?

A

Tinea pedis, tinea unguium and tinea cruris

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22
Q

What are the disease names for dematophtye infections in the limbs and torso skin and scalp, skin and hair?

A

Tinea corporis and tinea capitis

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23
Q

Where are fungal nail infections most common, athletes foot and scalp ringworm?

A

Fungal nail infection, common in the general adult population, probably 5-25% rate, increasing incidence in elderly people

Athlete’s foot more common than onychomycosis, more common in adults (not younger people) and sportsmen.

Scalp ringworm most common among prepubertal children. Recent US survey, tinea capitis found in 6% of children. Estimated global prevalence of 200 million cases.

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24
Q

What are the symptoms of tinea pedis?

A
  • Uni- or bilateral,
  • Itching, flaking, fissuring of skin
  • Plantar: Soles of feet dry and scaly, if skin of whole of foot affected “Moccasin foot”
  • Hyperhidrosis, secondary to infection may increase severity
  • May spread to infect toe nails
  • Typical cause Trichophyton rubrum
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25
Q

What is tinea unguium? What are the symptoms?

A

Thickening, discolouring, dystrophy, four main types

i) Lateral/distal subungual

Ii) Superficial white – usually

in immunocompromised

iii) Proximal
iv) Total nail dystrophy

Typical causes

Trichophyton rubrum and

T. interdigitale

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26
Q

What is tinea curis? What are the symptoms?

A
  • More prevalent in men than women
  • Itching, scaling, erythematous plaques with distinct edges
  • Satellite lesions sometimes present
  • May extend to buttocks, back and lower abdomen
  • Typical cause T. rubrum
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27
Q

What is tinea capitis? What are symptoms?

A
  • Mainly seen in pre-pubescent children
  • Signs range from: slight inflammation, scaly patches, with alopecia, “black dots”, “grey patches” to severe inflammation
  • Kerion celsi: boggy, inflamed lesions, usually from zoophilic dermatophytes
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28
Q

What is tinea corporis? What are the symptoms?

A
  • Circular, single or multiple erythematous plaques
  • May extend from e.g. scalp or groin
  • Invasion of follicle “Majocci’s granuloma”
  • Typical cause , wide range of dermatophytes, anthropophilic or zoophilic
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29
Q

What is the investigation and treatment of dermatophyte infection?

A
  • Investigation: Microscopy and culture
  • Treatment:
  • Topical antifungal therapy: mild disease (self-diagnosis and treatment)
  • Terbinafine, clotrimazole,miconazole
  • Systemic antifungal therapy: severe disease
  • Treat ALL cases of tinea capitis with systemic oral antifungals
  • Griseofulvin, terbinafine, itraconazole (depends on causal species)
  • Topical therapy will NOT be curative (role in reducing spread)
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30
Q

What is malassezia? What are examples?

A

Genus of yeasts

E.g. M. sympodialis, M. restricta and M globosa

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31
Q

Where is malassezia found?

A
  • Part or normal skin flora in all humans from shortly after birth
  • Highest levels on head and trunk
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32
Q

What is the cause of pityriasis versicolor?

A

Malassezia

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33
Q

What is pityriasis versicolor?

A

Hyper- or hypopigmented lesions

Upper trunk

Between puberty and middle age

More common in tropics

Relapsing

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34
Q

What is the diagnosis and treatment of pityriasis veriscolor?

A

Microscopy

  • Yeast cells and hyphal segments “Spaghetti and meatballs”
  • Culture difficult and not interpretable

Treatment

  • Topical antifungals eg. clotrimazole, if fails oral fluconazole or itraconazole
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35
Q

What are candida?

A

•Large genus of yeasts

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36
Q

Where do candida colonise?

A

Often colonises the mucosal sufaces and GI tract in healthy people

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37
Q

What does candida do?

A
  • Cause of superficial mucosal (oral and vaginal) disease “thrush”, also occasionally skin disease and keratitis
  • Cause of systemic disease, once present in circulatory system, can infect almost any organ in the body
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38
Q

What does oral candidosis do?

A

Angular cheilitis- inflammation in the corners of the mouth

Chronic hypoplastic (oral leukoplakia)- white spots (top pic)

Chronic atrophic erythema- red lesion on tongue (bottom pic)

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39
Q

What is the epidemiology of oral candidosis?

A
  • HIV/AIDS – sometimes even with Anti-retroviral therapy, T-cell immunity important to prevent mucosal candidosis
  • Antibiotic use – suppresses normal bacterial flora, less competition for yeasts
  • Head and Neck cancer – radiotherapy and chemotherapy affect salivary secretions
  • General debilitation in hospitalised patients e.g. in ICU – increases colonisation and risk of oral disease
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40
Q

What is candida vulvovaginitis? Who does if effect? What are the symptoms?

A
  • Affects 70-80% all women at least once during child-bearing years
  • Inflammation of vaginal epithelium, may extend to labia majora
  • Pruritis, burning sensation, +/- discharge
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41
Q

How do you diagnose superficial candiosis?

A

Clinical diagnosis and empiric therapy

Culture with identification and antifungal sensitivity testing where appropriate eg. Recurrent disease

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42
Q

What is the treatment for superficial candidosis?

A
  • Usually oral azoles, fluconazole highly effective
  • Resistance in normally sensitive species (e.g. Candida albicans) or naturally resistant species (Candida krusei) can be problem
  • Do NOT use oral fluconazole or other azoles in pregnant women, this increases risk of teratologies (e.g. heart defects), use topical azoles eg clotrimazole
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43
Q

What is systemic candidosis? Where does it infect?

A
  • Candida sp can infect almost any organ in the body
  • Defined by site of infection
  • Usually acquired from colonised skin or mucosal sites, or from GI tract
  • Usually seen in the compromised host
  • Candida albicans still most common, other species also occur
  • Disseminated disease may be identified from blood culture
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44
Q

What are candida oesophagitis symptoms? Caused by what?

A
  • Candida oesophagitis in 10-20% patients with oropharyngeal disease
  • Pain/difficulty on eating/swallowing
  • Mainly in HIV
  • Diagnosed by endoscopy with biopsy
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45
Q

What is candidaemia?

A

Candida in blood culture

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46
Q

How do you treat candidaemia?

A
  • Remove lines (where possible)
  • Start antifungal therapy
  • Check eyes and heart
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47
Q

What is candida chorioretinitis?

A

Chorioretinitis is an inflammation of the choroid (thin pigmented vascular coat of the eye) and retina of the eye

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48
Q

What is candida endophthalmitis?

A

Endophthalmitis is inflammation of the interior cavity of the eye, usually caused by infection.

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49
Q

What disease can be caused due to candidaemia?

A

Risk of occular candidosis (OC) following candidaemia 3-25%. Of those patients:

Chorioretinis c. 75% OC

Endophthalmitis- white balls seen on fundoscopy c. 25% OC, requires intravitreal antifungals

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50
Q

What is candida endocarditis?

A

Vegetations seen on heart valves

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51
Q

Candidaemia can cause candida endocarditis. What are the symptoms and what causes it?

A
  • Vegetations seen on heart valves
  • Fever, weight loss, fatigue, heart murmur
  • IV drug abusers, valve surgery
  • Difficult to treat without valve replacement
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52
Q

Where is urinary tract candida infection found?

A

Ascending from genital tract infection/colonisation or from catheterisation

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53
Q

Who is likely to have urinary tract candida infection?

A

More common in women, diabetics, damaged/abnormal urinary tracts, ICU patients

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54
Q

What is candiduria?

A

Candiduria (isolation of Candida from urine) common, may or may not be significant

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55
Q

What is candida peritonitis?

A

Complication of peritoneal dialysis

Perforation of bowl during surgery (mixed bacterial/yeast infection)

56
Q

Symptoms of candida peritonitis?

A

Fever, abdominal pain, nausea, vomiting

57
Q

What is diagnosis and treatment of candida peritonitis?

A

Diagnosis by culture of Candida from peritoneal fluid

Treatment by source control/drainage and antifungals

58
Q

What is the diagnosis and treatment of systemic candidosis?

A

Diagnosis:

Culture, ideally from sterile site, blood, peritoneal fluid etc

Imaging results

Treatment:

Depends on Candida sp. sensitivity, severity, need for oral agent

Echinocandins, e.g. Anidulafungin (IV)- for systemic infections

Azoles, e.g. Fluconazole (oral)- could be followed up for systemic infections

Liposomal Amphotericin B (IV)

59
Q

What are aspergillus?

A

Genus of moulds – filamentous fungi

Producing airborne spores

60
Q

How are you exposed to aspergillus?

A

Exposure to Aspergillus spores universal by inhalation- everyone breathes it in

Airways may be colonised by Aspergillus sp.

61
Q

What is aspergillosis?

A

Reaction to inhaled Aspergillus,

Space occupying/non invasive – lung cavity

62
Q

What does aspergillosis cause?

A

Allergic reaction – Asthma, cystic fibrosis (CF)

-Allergic bronchopulmonary aspergillosis, allergic sinus disease

Chronic infection – Chronic lung disease

-Chronic pulmonary aspergillosis

Invasive infection – immunocompromised (leukaemia)

-Invasive pulmonary aspergillosis, invasive aspergillus sinusitis

Aspergillus sinusitis

63
Q

What is aspergilloma?

A
  • Patients with cavities in lungs derived from previous tuberculosis, sarcoid, surgery
  • Form solid balls of fungus
  • Aspergillomas are often indolent (cause little pain), but may break up causing haemoptysis and are potentially fatal
64
Q

What occurs when you have allergic forms of aspergillosis?

A

Asthma and CF

  • Allergic Bronchopulmonary aspergillosis
  • Wheezing, breathlessness, loss of lung function, bronchiectasis
  • Airways inflammation
  • Raised total IgE
  • IgE and G reaction to Aspergillus
  • Responds to steroids sometimes antifungal therapy added
65
Q

What does Chronic pulmonary aspergillosis (CPA) worsen?

A

Chronic obstructive pulmonary disease

66
Q

Symptoms of Chronic pulmonary aspergillosis (CPA)

A

Chronic respiratory symptoms, cough, wheezing, breathlessness, chest pain

67
Q

Diagnosis of CPA?

A

Consolidation, cavitation on chest computerised tomography (CT)

Positive culture of Aspergillus from sputum and BAL

Positive for Aspergillus IgG

68
Q

What is invasive aspergillosis?

A

Haematological malignancy, stem cell and solid organ transplant

69
Q

What does invasive aspergillosis cause?

A
  • Low neutrophil counts
  • Angioinvasion of lung tissue
  • Dissemination in c. 25% of cases to extrapulmonary sites
  • Halo and air crescent signs on chest CT
  • Moderate to poor prognosis, even with aggressive antifungal therapy
70
Q

Diagnosis of aspergillosis?

A

Diagnosis:

Culture

Serology (study of serum and other bodily fluids)

Imaging

71
Q

Treatment of aspergillosis?

A

Treatment

  • Aspergilloma try to resect the balls
  • Allergic aspergillosis treat with steroids +/- antifungals
  • CPA and invasive aspergillosis treat with antifungals, itraconazole and voriconazole, amphotercin B
72
Q

Summary of fungal pathogens

A

Dermatophytes

  • Infect skin hair and nails
  • Low morbidity, high incidence

Malassezia

  • Yeasts part of normal flora, cause of pityriasis versicolor

Candida

  • Causes both superficial and systemic disease
  • Can infect any organ in the body
  • Infection usually from patients own colonised mucosa

Aspergillus

  • Causing pulmonary or sinus disease
  • Inhalation of Aspergillus spores
  • Effect depends on host reaction, or lack of reaction, from allergy to invasive disease
73
Q

What is a parasite?

A

An organism which lives in or on another organism (its host) and benefits by deriving nutrients at the other’s expense.

The parasite derives all benefits from the association and the host may either be harmed or may suffer the consequences of this association (a parasitic disease)

74
Q

Host definition

A

Host = an organisms which harbours the parasite

75
Q

Symbiosis definition

A

Symbiosis = living together; close, long term interaction between two different species

76
Q

Mutualism defintion

A

Mutualism = an association in which both species benefit from the interaction eg Egyptian plover and crocodile

77
Q

Parasitism defintion

A

Parasitism = an association in which the parasite derives benefit and the host gets nothing in return but always suffers some injury eg Tick feeds on animals blood – can also pass on infections to host such as Lyme disease

78
Q

Commensalism definition

A

Commensalism = an association in which the parasite only is deriving benefit without causing injury to the host eg Remora fish – attach themselves to whales or shark and eat their left overs

79
Q

What is a definitve host?

A

Definitive host

Either harbours the adult stage of the parasite or where the parasite utilizes the sexual method of reproduction

In the majority of human parasitic infections, man is the definitive host

80
Q

What is a reservoir host?

A

Reservoir host- infects into cattle before host

An animal or species infected by a parasite which serves as a source of infection for humans or other species

81
Q

What is an intermediate host?

A

Intermediate host

Harbours the larval or asexual stages of the parasite

Some parasites require two intermediate hosts in which to complete their life cycle

82
Q

What is a paratenic host?

A

Paratenic host

Host where the parasite remains viable without further development

83
Q

Types of parasite

A
  • Protozoa
  • Helminths
  • Arthropods
84
Q

What is a protozoa?

A

Protozoa:

Single celled organisms- can be free-living or parasitic in nature and multiply in humans

Microparasite

85
Q

What are protozoa normally transmitted by?

A

GI parasites typically transmitted by faecal –oral route

Blood parasites transmitted by arthropod vector (insects)

86
Q

What are the subdivisons of protozoa?

A
  • Flagellates
  • Amoeboids
  • Sporozoans
  • Trypanosomes
87
Q

What are helminths?

A

Helminths:

large multicellular organisms adults generally visible by eye.

Adults cannot multiply in humans

88
Q

What are types of helminths?

A
  • Platyhelminths (flatworms)
  • Nemastodes (round worms)

Macroparasites

89
Q

Types of platyhelminths (flatworms)?

A
  • Cestodes- tapeworms
  • Trematodes- flukes
90
Q

What are types of nematodes (round worms)?

A
  • Intestinal nematodes
  • Tissue nematodes
91
Q

What is the subdivion of arthropods?

A

Ectoparasites

92
Q

What are ectoparasites?

A

Ectoparasites:

broadly include blood sucking arthropods and those that burrow into skin.

93
Q

What are subdivions of ectoparasites?

A
  • Insects
  • Lice
  • Mites
  • Arachnid (ticks)
94
Q

What are the types of life cycles?

A
  • Direct
  • Simple indirect
  • Complex indirect
95
Q

What is a direct life cycle?

A

Direct life cycle. (Science: epidemiology) a life cycle in which a parasite is transmitted directly from one host to the next without an intermediate host or vector of another species.

Infective eggs eaten by bird

Bird sheds parasite eggs into environment

Eggs mature in the environment and become infective

Start cycle again

96
Q

What is an indirect cycle?

A

An indirect life cycle is a type of a life cycle wherein a parasite is transmitted from one host to another by using a vector or by an intermediate host of another species.

Bird sheds parasite eggs into the environment in faeces

Different parasite eats the eggs

Eggs then develop in the parasite and the bird then eats it

97
Q

What is a complex indirect lifecycle?

A

Those that must infect more than one host species to complete their life cycles.

  • Bird excretes in water
  • Frogs eat it
  • Fish eat the frog
  • Bird eats the fish
98
Q

What is an ascariasis?

A

Macroparasite: Intestinal nematode

Peak prevalence in 3-8 year olds

Areas of poor hygiene

99
Q

Life cycle of ascariasis?

A

Ingested into the mouth into the cut, excreted then goes back in from eating the eggs

Acquired by ingestion of eggs

100
Q

What are the symptoms of ascariasis?

A

Lung Migration:

Loefflers syndrome- dry cough, dyspnoea, wheeze, haemoptysis, eosinophilic pneumonitis

Intestinal Phase:

Malnutrition

Malabsorption

Migration – into hepatobiliary tree and pancreas

Intestinal obstruction

Worm burden

101
Q

What is the treatment for Ascariasis?

A

Treatment: Albendazole

Prevents glucose absorption by worm

Worm starves-detaches-passed PR

102
Q

What is schistosomuasis sp.?

A

Macro-parasite (Helminth- Platyhelminth- Trematode/Fluke)

Also known as “Bilharzia” – in Africa

103
Q

Schistosomiasis- Life Cycle?

A
  • Live for about 10 years
  • Defecate in water
  • Eggs hatch
  • Infects snails
  • Snails release cercariae
  • Skin penetration
  • Into liver

Snails as intermediate host

104
Q

Incubation period? Symptoms?

A

Initial infection Incubation period 14- 84 days

Often asymptomatic

Symptomatic acute infection /Katayama syndrome

rash, fever, headache, myalgia, and respiratory symptoms.

Often with eosinophilia and hepato- and/or splenomegaly.

  • Swimmers itch
  • Katayama fever
  • Chronic Schistosomiasis (can persist for years)
  • Effects of eggs in distant sites: spine, lung
105
Q

What are the public health risks of schistosomiasis?

A
  • Undernutrition, ? via the suppression of appetite and inflammation-mediated cachexia.
  • Anaemia
  • Hepatic fibrosis and associated increased risk of oesophageal varices
  • Renal failure
  • Bladder tumours
  • Increased risk of transmission of HIV: Serodiscordant heterosexual couples in Zambia. Increased risk of HIV or acquisition, and all-cause death
106
Q

How do you diagnose schistomiasis?

A

Urinary

Terminal Stream Microscopy

Serology

Hepatic/Intestinal

Stool Microscopy

Rectal Snip Microscopy

Serology

107
Q

Treatment for schistosomiasis?

A

Praziquantel (parazinoisoquinoline derivative)

108
Q

How do you control schistomiasis?

A
  • Chemical treatment to kill snail intermediate hosts
  • Chemoprophylaxis
  • Avoidance of snail infested waters
  • Community targeted treatment, education and improved sanitation
109
Q

What is hydatid disease? Who is the normal host?

A
  • Macro-parasite (Platyhelminth- Cestode-Tapeworm)
  • Human is accidental host
  • Usual hosts are sheep and dogs
  • Found all over the world wherever sheep are farmed
  • Caused by Echinococcus sp.
110
Q

Life cycle of Hydatid disease?

A
  • Sheep ingest the eggs in their faeces
  • Dog eat sheep
  • Get infected
  • We get infected from foecal matter by accident
111
Q

What are the clinical problems of Hydatid disease?

A
  • Cysts: 70% liver, 20% lungs
  • May remain asymptomatic for years
  • Mass effect
  • Secondary bacterial infection
  • Cyst rupture- hypersensitivity
112
Q

Treatment for Hydatid disease?

A

Treatment:

Albendazole + praziqantel for daughter cysts ( E granulosus)

113
Q

What is malaria?

A

Micro-parasite (protozoa- sporozoan)

4 human species of Plasmodium:

P. falciparum

P. vivax

P. ovale

P. malariae

+ Monkey species P. knowlesi (only in monkeys)

114
Q

What is Strongyloidiasis?

A

Strongyloidiasis is infection by a roundworm, or nematode

Problem is it can autoinfect- reinforcing the disease for many years and spreads via sexual transmission

115
Q

Treatment for strongloids?

A

Ivermectin 200 µg/kg for 2 days

Or Albendazole 400mg bd for 7 days

116
Q

Control of stronglyloides?

A
  • Wear shoes when you are walking on soil
  • Avoid contact with faecal matter or sewage.
  • Proper sewage disposal and faecal management
117
Q

What is the vector for malaria?

A

Anopheles as a vector

118
Q

What are the clinical problems of malaria?

A
  • Parasites rupture red cells, block capillaries and cause inflammatory reaction
  • Fever & Rigors (alt. days with falciparum malaria, every 48hrs or 72hrs with benign malaria)
  • Cerebral malaria (confusion, headache, coma)
  • Renal failure (black water fever)
  • Hypoglycaemia
  • Pulmonary oedema
  • Circulatory collapse
  • Anaemia, Bleeding and DIC
119
Q

What is the erythrocytic cycle?

A

Upon release, the merozoites invade the red blood cells where they undergo another asexual cycle

120
Q

What is the erythrocytic cycle of malaria?

A

24 hrs

P.knowlesi- monkey malaria

48hrs P.falciparum, P.vivax & P.ovale

72hrs

P.malariae

121
Q

Treatment for Flaciparum malaria?

A

Antimalarials-

co-artem (artemether/lumefantrine), atovaquone - proguanil

Complicated: IV artesunate – must complete a full oral course when able to stop iv

Supportive therapy

Management of seizures, pulmonary oedema, acute renal failure and lactic acidosis

Exchange transfusion may be helpful in hyperparasitaemia

122
Q

Treatment for non-flaciparum malaria?

A

Plasmodium vivax, ovale, malariae and knowlesei

Treatment:

Oral chloroquine

Primaquine

123
Q

Control of malaria?

A
  • Insecticide spraying in homes
  • Larvicidal spraying on breeding pools
  • Filling in of breeding pools- stop spread to other places
  • Larvivorous species introduced in to mosquito breeding areas
  • Use of insecticide impregnated bed nets
  • Chemoprophylaxis
124
Q

What is cryptosporidiosis caused by?

A

Caused by Cryptosporidium parvum and hominis (micro-parasite, sporozoan)

125
Q

How is Cryptosporidiosis spread?

A

Human to human spread with animal reservoir (cattle, sheep, goats)

Faecal-oral spread

126
Q

What does cryptosporidiosis cause?

A

Watery diarrhoea with mucus (no blood)

Bloating, cramps, fever, nausea, vomiting

127
Q

Treatment for cryptosporidiosis?

A

Symptomatic:

  • Rehydration etc.
  • Nitazoxanide

For immunocompromised:

  • Paromomycin (to kill parasite)
  • Nitazoxanide (effectiveness is unclear)
  • Octreotide (reduce cramps and frequency)
  • HIV patients, HAART should be quickly initiated
  • For severe cases may need to use combination therapy parmomycin, nitazoxanide and azithromycin
128
Q

How to control cryptosporidiosis?

A

Human-Human:

Hand hygiene

  • Filter or boil drinking water
  • Isolate symptomatic patients in healthcare setting
  • Ensure symptomatic children are kept away from school

Animal-Human:

  • Pasteurise milk and dairy products
  • Boil or filter drinking water if camping
129
Q

What is trichomoniasis caused by? What is it?

A
  • Caused by Trichomonas vaginalis
  • Flagellated protozoan
  • Sexually transmitted
130
Q

What are the symptoms of trichomoniasis?

A
  • Men = asymptomatic
  • Women = smelly vaginal discharge, dyspareunia, dysuria and lower abdominal discomfort, punctuate haemorrhages on cervix (“strawberry cervix”).
131
Q

Treatment for trichomoniasis?

A

Metronidazole

132
Q

How to prevent trichomonisais?

A

General advice about prevention of STIs

Use of barrier contraceptive methods if sexually activate

133
Q

What is Giardiasis? How is it transmitted?

A

Flagellated protozoan

Faecal oral transmission

134
Q

Clinical symptoms of giardiasis?

A

Spectrum of disease: asymptomatic carriage to severe diarrhoea and malabsorption. Can cause chronic disease

Symptoms: usually last 1-3 weeks

Diarrhoea

Abdominal pain

Bloating

Nausea and vomiting

135
Q

Treatment of giardiasis?

A

Metronidazole/tinidazole

136
Q

Prevention of giardiasis?

A

Hygiene measures

Boling water

137
Q
A

Clinical pathology (8 decks)

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