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Parasitology > W5 Free Living Amoeba & Toxoplasmosis > Flashcards

W5 Free Living Amoeba & Toxoplasmosis Flashcards

1
Q

Give 3 organisms associated with Free Living Amoeba

A
  • Naegleria fowleri
  • Acanthamoeba spp
  • Balamuthia mandrillaris
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2
Q

Describe morphology of naegleria fowleri

A
  • single
  • lobose pseudopodium - to give rapid movement
  • presence of flagellated form
  • cyst: round
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3
Q

Describe morphology of acanthamoeba spp

A
  • small
  • pointed pseudopodium (acanthopodia) - give sluggish movement
  • no flagellated form
  • cyst: square
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4
Q

Describe morphology of balamuthia mandrillaris

A
  • 2 types of pseudopodia: broad lobose pseudopodia & fingerlike pseudopodia
  • cyst: round
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5
Q

Describe life cycle of acanthamoeba spp

A
  1. Cysts live in the their habitat,
  2. Cysts transform into trophozoite and can multiple in binary fission
  3. Amebae in cysts or trophozoite can enter humans in 3 MOT; eyes, nasal passage and ulcerated/broken skin.
  4. Through the eyes, can cause severe keratitis
  5. Through the respiratory and broken skin, enter the CNS thru the hematogenous dissemination and cause the granulomatous amoebic encephalitis, disseminated disease and skin lesions in compromised immune system.
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6
Q

How many forms of acanthamoeba spp

A

2

  • trophozoite
  • cyst
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7
Q

Describe clinical symptoms for granulomatous amoebic encephalitis (GAE)

A
  • occurs in immunodeficient person
  • cause by invading the CNS by hematogenously to the CNS
  • early stage by chronic and slow progression of CNS infection; fever, stiff neck, nausea, vomit and increase intracranial pressure
  • can cause fatal due to invasion of connective tissue and induction of proinflammatory responses
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8
Q

Describe clinical symptoms for acanthamoeba keratitis

A
  • occurs in healthy person
  • infect people with poor usage of contact lenses
  • cornea keratitis
  • unilateral photophobia
  • excessive tearing
  • eye pain
  • eye redness
  • blindness
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9
Q

Give and describe 4 diagnosis for acanthamoeba spp

A
  1. Presence of cysts and trophozoites in brain biopsy
  2. Culture of CSF sample
  3. PCR based technique
  4. Presence of cyst in cornea scrapping by wet mount, histology or culture for Amoebic Keratitis
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10
Q

Treatment for Acanthamoeba spp

A
  • No effective treatment
  • Pentamidine, sulfadiazine, rifampicin and fluconazole
  • Topical biguanide and chlorhexidine for Acanthamoeba Keratitis
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11
Q

Give 2 MOT for balamuthia mandrillaris

A

Entrance of cyst and trophozoite
- thru nasal passage
- ulcerated/broken skin

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12
Q

Give 3 MOT for acanthamoeba spp

A

Entrance of cysts and trophozoite thru
- eyes
- nasal passage to the lower respiratory tract
- ulcerated/broken skin

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13
Q

Describe life cycle of balamuthia mandrilllaris

A
  1. Cyst lives in their habitat can transform into trophozoite
  2. Trophozoite multiple by binary fission and can enter thru nasal passage and broken skin
  3. Amoebic can enter to CNS thru haematogenous disseminated and cause GAE
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14
Q

What are the habitats for acanthamoeba spp?

A
  • soil
  • air
  • natural and treated water
  • seawater
  • sewage
  • swimming pools
  • contact lenses
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15
Q

What is the clinical symptoms for balamuthia mandrillaris

A

granulomatous amoebic encephalitis (GAE)

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16
Q

Give 3 diagnosis for balamuthia mandrillaris

A
  • Presence of trophozoites in the CSF / trophozoites and cysts in brain tissue
  • Molecular diagnosis; PCR on CSF sample
  • This amoeba cannot be culture because not feed on bacteria
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17
Q

Treatment for balamuthia mandrillaris (for GAE)

A

A combination of flucytosine, pentamidine, fluconazole, sulfadiazine and azithromycin

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18
Q

What are the characteristics for naegleria fowleri?

A
  • A thermophilic amoeba
  • has 3 forms; trophozoite, flagellated form and cysts
  • cannot withstand chlorine at 2 ppm and saline at 0.7%
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19
Q

Where does naegleria fowleri resides?

A
  • warm water (hotspring)
  • thermal water discharge plant
  • poor chlorinated recreational water
  • poor chlorinated tap water
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20
Q

1 MOT for naegleria fowleri

A

Swimming and diving in warm water in which trophozoite penetrate the nasal mucosa

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21
Q

Describe life cycle/pathogenesis of naegleria fowleri

A
  1. Cysts reside in warm water
  2. Cysts can transform into trophozoite
  3. Trophozoite can turn into flagellated form
  4. MOT penetrate the nasal mucosa
  5. Amoeba enter the brain via olfactory nerve to cause primary amoebic meningoencephalitis (PAM) in healthy individuals
    6.
22
Q

Describe the primary amoebic encephalitis in naegleria fowleri and (not their 2 stages symptoms)

A
  • Highly fatal because progressive rapidly (1-9 days) and similar to bacteria meningitis
23
Q

Describe PAM symptoms in 2 stages in naegleria fowleri

A

Stage 1
1. Severe frontal headache
2. Fever
3. Nausea
4. Vomiting

Stage 2
1. Stiff neck
2. Seizures
3. Altered mental status
4. Hallucination
5. Coma

24
Q

Give 3 diagnosis of naegleria fowleri

A

CSF examination, microscopy examination (wet film/stained with Giemsa stain) - observe motile trophozoites

Culture of naegleria fowleri in CSF

Molecular diagnosis of PCR on CSF samples

25
Q

2 treatments for naegleria fowleri

A
  1. Amphotericin B
  2. Combination therapy- miconazole and sulfadiazine
26
Q

Give 5 prevention and controls for free living amoeba

A
  1. Store reusable lenses in proper storage case
  2. Replace contact lenses according to the schedule prescribed
  3. Clean contact lenses based on manufacturer’s guideline
  4. Cleaned hands before handling the contact lenses
  5. Use fresh cleaning/disinfecting solution
27
Q

What organism cause toxoplasmosis?

A

toxoplasma gondii

28
Q

Give 3 forms of toxoplasma gondii

A

tachyzoites
bradyzoites in tissue cysts
sporulated oocyst

29
Q

Describe the sporulated oocyst in toxoplasmosis

A
  • only develop in cat’s intestine thru sexual reproduction
  • shed in feces and pass in the environment
  • become sporulated when exposed to environment
  • become resistant to new environment
30
Q

Describe tachyzoites in toxoplasmosis

A
  • a crescent shape
  • rapid proliferation in acute infection
  • can invade any nucleated cells
  • multiple by internal budding
31
Q

Describe sporulated oocyst in toxoplasmosis

A
  • a dormant form
  • containing bradyzoites
  • can be digested by gastric digestion to release bradyzoites to penetrate the cells
  • found in chronic infections in brain, eyes and skeletal muscle
32
Q

4 MOT of toxoplasmosis

A
  1. Eating undercooked meat containing tissue cysts
  2. Consume contaminated food, water and hands containing the sporulated oocyst
  3. Blood transfusion/organ transplantation from infected donor
  4. Transfer from mother to fetus
33
Q

Who is the definitive host, its 3 forms and what reproduction reside within this host in toxoplasmosis

A

-Cat
-3 forms; oocyst, tachyzoites, and tissue cyst
- sexual reproduction

34
Q

Who is the intermediate host, its 2 forms and what reproduction reside within this host in toxoplasmosis

A
  • animals; cattle, sheep and swine
  • humans
  • 2 forms; tachyzoite and tissue cysts
  • asexual reproduction
35
Q

Describe life cycle of toxoplasmosis

A
  1. Cat shed the feces containing the unsporulated oocyst
  2. Intermediate host (bird and rodents) consume the soil, water and plant materials containing the oocysts
  3. Oocysts transform into tachyzoites shortly after ingestion
  4. Tachyzoites localized in neural and muscle tissue and develop into tissue cysts containing bradyzoites
  5. Other cats can become infected after consuming intermediate host harboring tissue cyst
  6. Animals bread for human consuming infected with ingestion of sporulated oocyst in the environment
  7. 4 MOT of the toxoplasmosis
    - eating undercooked meat containing tissue cysts
    - consume food/water contaminated with sporulated oocyst
    - blood transfusion/organ transplantation from infected donors
    - mother to fetus transfer
36
Q

How does toxoplasmosis organism develop in the definitive host?

A
  • cat (definitive host consume the intermediate host infected)
  • oocyst transform into tachyzoites shortly after ingestion
  • tachyzoites localized in neural and muscle tissue and develop into bradyzoites in tissue cysts
  • tissue cyst walls collapse by gastric digestion to release the bradyzoites
  • bradyzoites penetrate various cells and undergo sexual reproduction to produce micro and macrogamete
  • microgamete and macrogamete produce oocyst to be release in the environment
37
Q

4 type of toxoplasmosis clinical presentation

A
  1. Congenital toxoplasmosis
  2. Acquired toxoplasmosis
  3. Toxoplasmosis in Immunocompromised patient
  4. Ocular toxoplasmosis
38
Q

Describe the congenital toxoplasmosis with symptoms

A
  • acquired from mother to fetus transfer
  • cause; stillbirth, severe defect after birth and shortly die after birth
  • severity of fetal is high in 1st trimester
  • some asymptomatic
  • symptomatic; hydrocephaly, microcephaly, intracerebral calcification and jaundice
39
Q

Describe the toxoplasmosis in immunocompromised patients with symptoms

A
  • classified as opportunist infection
  • invasion of CNS
  • major symptoms: toxoplasma encephalitis (caused by reactivation of chronic infection)
    another symptoms: myocarditis, retinochoroiditis, pneumonitis, and myocytic/myalgia
39
Q

Give symptoms for acquired toxoplasmosis

A
  • mostly asymptomatic
  • cervical lymphadenopathy
  • splenomegaly
  • fever
  • headache
  • myalgia (muscle pain)
40
Q

Describe the ocular toxoplasmosis with symptoms

A
  • due to milder congenital toxoplasmosis
  • symptoms: retinochoroiditis caused by rupture of tissue cyst in the eye
  • can lead to degeneration / loss of eyesight
41
Q

List 4 laboratory diagnosis of toxoplasmosis

A
  1. serodiagnosis
  2. microscopy examinations
  3. molecular diagnosis
  4. Imaging CT scans and MRI
42
Q

Describe the golden standard of laboratory diagnosis in toxoplasmosis

A
  • serodiagnosis
  • detection of IgM and IgG in the body
  • IgM appears after 2 to 4 weeks after exposure and disappear after 8 weeks
  • IgG appears 4 months after exposure and remain within 24 months and 10 years
    -IgG avidity test: low avidity; recent infection & high avidity; past infection
43
Q

Describe the other 3 laboratory diagnosis (except the golden standard)

A
  1. Molecular diagnosis - PCR use to detect the parasite in the blood
  2. Microscopy examination - use giemsa staining with blood, brain and bone marrow
  3. Imaging CT scans and MRI - lesion on the brain
44
Q

Treatment of toxoplasmosis for 1st trimester

A

spiramycin

45
Q

Drug of choice for toxoplasmosis

A

Pyrimethamine with sulfadiazine + folinic acid

46
Q

Treatment for asymptomatic toxoplasmosis

A

No treatment

47
Q

Treatment for ocular toxoplasmosis

A

Pyrimethamine + sulfadiazine
OR
Pyrimethamine + clindamycin

48
Q

Treatment for AIDs patients in toxoplasmosis

A

Trimethoprim sulfamethoxazole

49
Q

8 prevention and control for toxoplasmosis

A
  1. Freeze meat at suitable temperature
  2. Cook properly the meat
  3. Wash fruits and vegetables thoroughly
  4. Wash the kitchen utensil, cutting board after and before preparing the food
  5. Avoid drinking untreated drinking water
  6. Wear gloves when gardening
  7. Keep the cat’s sandbox cover
  8. Wash hands with soap after handling with cat’s litter/gardening

Parasitology (3 decks)

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