Bafl Exam 3: Protozoa And Worms

Front 1

Leishmaniasis takes three forms:

1.

2.

3.

Back 1

Leishmaniasis takes three forms:

1. cutaneous - restricted to skin

2. mucocutaneous - skin and mucosal surfaces

3. visceral- organs of reticulo-endothelial systems

Front 2

what are the 2 morphologic forms of leishmaniasis? Which is the infective form?

Back 2

Promastigotes (infective) in the vector (sand fly)

Amastigotes (in histiocytes of host)

Front 3

vector for what?

Back 3

Phlebotamus, Old World Leishmaniasis

Transmits: leishmania tropica, leishmania major

(butt is a little rounder than Lutzomyia of New World)

Front 4

vector for what?

Back 4

Lutzomyia, New World Leishmaniasis

Transmits: L mexicana, L braziliensis, L peruviana, L guyanesis, L panamensis

all names of places!!!!

(butt is a little pointier than Phlebotamus of Old World)

Front 5

possible vectors?

Back 5

This is cutaneous Leishmaniasis

Vectors could be phlebotamus (old world) or lutzomyia (new world)

Front 6

Is disseminated cutaneous leishmaniaisis a Th1 or Th2 response?

Back 6

Th1 --> more effective in eradicating the organisms

Front 7

Pathogen? Clinical course?

Back 7

1st will get cutaneous ulcer, then will get mucosal lesions within 5-20 years

Old World: L aethiopica

New World: L braziliensis

Front 8

Clinical symptoms of Kala-azar?

Back 8

Visceral leishmaniasis!

1st get cutaneous ulcer, then get visceral disease 1-36 months later

Macular hyperpigmentation in later stages (kala-azar = black fever)

Fever, wasting, cough, LAD, HSM, enteritis, oronasal/GI hemorrhage, PNA all can cause death in 2 years if not treated

Front 9

What is Marque Sign?

Back 9

amastigotes in histiocytes in Leishmaniasis

Front 10

'but doc, I had visceral leishmaniasis YEARS ago, did it come back?'

Back 10

NOPE

post kala-azar dermal leishmaniasis

sequel to visceral leish that may arise several years after successful treatment of primary infection

Front 11

Treatment for:

cutaneous leish

mucocutaneous leish

visceral leish

Back 11

cutaneous- self resolving, but can use sodium stibogluconate antimony

mucocutaneous- pentavalent antimonials

visceral- pentavalent antimonials

Front 12

What are the major adverse side effects of pentavalent antimonials? Which are most commonly used?

Back 12

Megluminie antimoniate and sodium stibogluconate

used to treat mucocutaneous and visceral

cardiotoxicity (prolonged QT interval and ST-T wave changes), pancreatitis, hepatitis, thrombocytopenia

Front 13

TOC for amebiasis? Skin findings with amebiasis?

Back 13

Entamoeba histolytica

less than 1% have cutaneous lesions (abscess, direct extension of rectal amebiasis to perianal/genital)

TOC: metronidazole

Front 14

Vector for?

Back 14

Reduvid bug

American trypanosomiasis (Chagas disease)

Front 15

Vector for?

Back 15

Tse Tse fly

African trypanosomiasis (african sleeping sickness)

Front 16

Vector and cause of Chagas disease? Clinical course?

Back 16

Reduvid bug/ trypanosoma cruzi

Acute phase: lasts up to 2 months, fever, malaise, edema of face, romana sign, parinaud sign (romana plus periauricular LAD), macular eruptions

Intermediate phase: positive serology, asymptomatic

Chronic phase: myocarditis, megaesophagus, megacolon

Front 17

disease?

Back 17

Winterbottoms sign

posterior cervical LAD

seen with West African trypanosomiasis

Front 18

East vs West Trypanosomiasis, which more commonly gets cutaneous signs?

Back 18

East (rhodesiense)

Front 19

causative agents for african trypanosomiasis?

Back 19

East: trypanosoma brucei rhodesiense

West: trypanosoma brucei gambiense

Front 20

Skin symptoms associated with toxoplasmosis? Treatment?

Back 20

acquired- nodules, macular/papular/hemorrhagic eruptions

congenital- blueberry muffin

treat with sulfadiazine + pyrimethamine

Front 21

How does infection with the following Nematodes present?

1. strongyloides stercoralis

2. ancyclostoma caninum

3. gnathostoma dolorosi

4. anycyclostoma braziliense

5. dracunculus medinesis

Back 21

1. strongyloides stercoralis- larva currens (think of a racing current), moves 5-10cm/hr, disseminated thumbprint purpura near umbilicus with widespread petechiae

2. ancyclostoma caninum- rare cause of larva migrans

3. gnathostoma dolorosi- d/t eating raw fish

4. anycyclostoma braziliense- larva migrans (2cm/day)

5. dracunculus medinesis- from contaminated drinking water

Front 22

Cutaneous larva migrans is caused by what organism? Host?

Back 22

Larva of cat and dog hookworms --> ancyclostoma caninum and ancyclostoma braziliense

natural host is the dog and cat

Front 23

10 year old F presents after a vacation in mexico. Parents reported spending time sitting on the beach. MOC reports very slow expansion of the lesion. Most likely organism? Host?

Back 23

Cutaneous larval migrans-- anycylostoma braziliense (more common than canium)

remember, strongyloides stercoralis causes larva currens (5-10cm/hr)

cats and dogs are the host

Front 24

treatment for cutaneous larva migrans?

Back 24

albendazole, ivermectin

Front 25

Feared complication of Cutaneous Larva Migrans?

Back 25

Loeffler syndrome: patchy lung infiltrate

Front 26

Vector for?

Back 26

Black fly Simulium

Vector for onchocerca volvulus --> onchocerciasis

Front 27

Clinical presentation of onchocerciasis? Cause?

Back 27

Cutaneous changes:

onchocercomas (nodules of worms)

thick/wrinkled skin

atrophy and pigment loss with perfollicular sparing on shins (leopard skin)

chronic lymphatic obstruction (huge scrot)

conjunctivitis

keratitis

Front 28

Onchocerciasis treatment?

Back 28

oral ivermectin

adding doxycycline to treatment regimen kills the intracellular endosymbionts bacteria Wolbachia, which leads to nematode sterility and inhibits larval development

Front 29

Fiariasis is infection of the lymphatic system with tissue round worms by mosquito vectors... two pathogens?

Back 29

Wuchereria bancrofti

Brugia malayi

Front 30

3 MC species of schistosomiasis? Where do they infect?

Back 30

1. S. haematobium (urinary)

2. S. japonicum (GI)

3. S. mansoni (GI)

Front 31

Chronic infections with S. mansoni and S. japonicum can lead to...

Back 31

hepatic fibrosis, cirrhosis --> portal hypertension

Front 32

Chronic infection with S. haematobium can lead to...

Back 32

carcinoma of the bladder

Front 33

Intermediate host for schistosomiasis?

Back 33

snail

Front 34

Cysticercosis is d/t ingestion of the eggs of...

1.

2.

3.

4.

Back 34

1. taenia solium (pork)

2. taenia saginata (beef)

3. diphyllobothrium latum

4. hymenolepsis nana