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145 Cards in this Set

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pt presents with weakness, blurry vision and is immunocompromised. If PML is suspected, what virus may be implicated?
JC virus
FYI JC virus only affects IC. 75% of healthy humans have abs to JC
Virus that tends to cause:
respiratory infections
atypical pneumonia
conjunctivitis
gastroenteritis
hemorrhagic cystitis
adeno
parvo
papova
adeno
pox
hepadnavirus
are all apart of what viral family
DNA viruses
what is the specific cell that HSV 1+2 multiply within (contained in the DRG)
fibroblasts
infectious mono
Burkitt's lymphoma (africa)
nasopharyngeal carcinoma (Asia)
during latency, virus resides in B lymphocytes
EBV
Child presents with runny nose, sore throat, and eye redness. Wicked high fever of 105, resides, followed by a 3 day rash. Where does this virus reside in the latency period?
T lymphocytes
HHV-6 Roseola (6th disease)
the virus that cause the common cold belongs to what family of viruses?
Rhinovirus
Picorna family
Influenza A,B, and C are apart of what family of viruses and have what 2 antigens?
Orthomyxovirus
H antigen: hemagglutinin
N antigen: neurominidase
Picornavirus (rhino, Cox AB, polio)
Reovirus (Rotavirus)
Orthomyxovirus (Flu ABC)
Paramyxovirus (Rubeola, paraflu, RSV)
Togavirus (Rubella)
all belong to what family of viruses?
RNA viruses
T/F: the mosquito is the vector for alphavirus, flavivirus, and bunyayvirus

alphavirus - Eastern Equine Virus
flavivirus - yellow fever, dengue fever
bunyavirus - California encephalitis
T
PRIONS:
Kuru and CJ infect ______________, while Scrapie infect _________ and BSE (mad cow disease) infect ___________.
humans
sheep
hamsters (just kidding its cows)
HTLV-1 (human T cell leukemia) causes malignancy how?
activates existing cellular genes like protooncogenes
The HIV genome has only three major genes encoded on two identical single strands of RNA, env, gag, and pol. What to each do?
env - gp41 mediates cell fusion; gp120 binds to CD4 receptor
gag - core capsid protein = p24 serologic marker
pol - reverse transcriptase , integrase, protease
en-fu-vir-tide - block gp41
ma-rav-ir-oc - CCR5 antagonist on CD4 cells so gp120 can't bind
NRTIs (-osine/udine) and NNRTIs - block RT
raltegravir blocks integrase
ritonavir, indinavir, nelfinavir all block protease
Mold that causes farmers lung, fungus ball in lung, especially in IC, septae branch at acute angles
aspergillus
dimorphic fungi that causes pulmonary infection, hides within macrophages, found in bat droppings in the Mississippi and Ohio river valleys?
Histo hides in macrophages
dimorphic fungi that causes URI and can disseminate into skin and bone, has broad buds, forms granulomatous nodules, found in Mississippi and Central America?
Blasto buds broadly
dimorphic fungi that causes pneumonia and meningitis, can disseminate to bone and skin, increased rate after earthquake?
Coccido Crowds, valley fever
yeast that causes meningitis , found in pigeon droppings, cultured on SABOURAUD'S agar, stains with India ink, "soap bubble" lesions in brain
cryptococcus
dermatophytosis (ringworm) and tinea versicolor cause infection where?
cutaneous
Mycetoma and sporotrichosis (rose Gardner's disease) cause infection where and have what features under scope?
subcutaneous
mycetoma - tree shaped
spor - cigar shaped budding yeast
Regarding malaria, the sexual cycle takes place in ________ forming ______. While the asexual cycle takes place in ______ forming ______.
mosquitos; sporozoites
humans; schizonts
Life cycle of MALARIA. Guaranteed COMLEX question.
Sporozoites into blood from mosquito-->sporozoites become merozoites-->merozoites settle in liver-->liver releases merozoites-->merozoites infect RBCs-->ringed shaped trophozoites matures-->forms multinucleated schizonts-->RBC release 10-20 merozoites
cold
Name where the following sporozoa of malaria are found:
sporozoites
merozoites
trophozoites
introduced into blood via mosquito
found in liver
within RBCs
Sudden onset fever, dyspnea, tachypnea caused by a fungus, common in AIDS pts. Tx?
P. carinii
treatment - TMP/SMX or pentamidine
Cysts invade GI wall, muscles, and brain. Infection via cat turds or undercooked pork. Severe fetal defects. Tx?
toxoplasma gondii
treatment - sulfonamide in 1st trimester, sulfonamide-pyrmethamine all others
"black sickness", GI bleeding, transmitted by insects in tropical areas. tx?
Leishmania donovani (Kala-Azar)
sodium stibogluconate
Donovan kinda sounds like a black guys name. "Hello, my name is Donavan Leishmania and I'm a black guy."
Also, "black sickness" is synonymous for visceral Leishmaniasis
transmitted by insects in the tropics, affects mucous membranes (nose, mouth) resulting in grossly destructive changes (like seriously fucked up). tx?
Leishmania brasiliensis (alien face)
sodium stibogluconate
transmitted by insects in the tropics, causes cutaneous red papules, immune response at bite, ulcerating skin lesions. tx?
Leishmania tropica
sodium stibogluconate
protozoa causes chagas', dilated cardiomyopathy , megacolon/esophagus, in south america. tx?
T. cruzi
Reduviid bug (kissing bug)
treat with nifurtimox
fly bite that causes enlarged lymph nodes, recurring fever, somnolence, and coma. tx?
T. gambiense/T.rhodesiense (more severe)
Tsetse fly (African sleeping sickness)
treat with Suramin, melarsoprol (Sure I'm melatonin...like something a stoner med student would say before going to sleep)
intestinal protozoa, cysts in water, cyst has 4 nuclei, trophozoites have 1 nuclei within RBCs, causes bloody, mucousy diarrhea, forms liver abscesses and can be transmitted sexually. tx?
Entamoeba histolytica
metronidazole (collects electrons that destroy DNA and proteins)
Intestinal protozoa, cysts in water, cysts have 4 nuclei, trophozoites have 2 nuclei and 4 pairs of flagella, escapes the cyst envelope in the duodenum, greasy non-bloody, foul smelling diarrhea. tx?
Giardia lamblia
metronidazole
Intestinal protozoa, cysts in water, excystation in small intestines, trophozoites do not invade gut wall, severe diarrhea in IC, no effective tx.
Cryptosporidium
Parasite with1 nucleus, 4 flagella, asx urethritis in male, foul-smelling, watery, green discharge in female. tx?
Trichomonas
metronidaxzole
immediate host is the snail-->releases larvae (cercariae)-->penetrate human skin-->enter small veins-->pass through right heart and lung-->systemic circulation-->intestinal capillaries-->sexually mature in the portal vein
that my friend is the life cycle of the famous blood fluke (schistosoma)
Given the veins of the colon, small intestine, or bladder. Identify which blood fluke (Schistoma) settles there:
japonicum
mansoni
hematobium
colon - mansoni
small intestine - japonicum
bladder - hematobium
Tissue flukes are endemic to where? aka question stem will most likely include "...recent travel to ______."
South East Asia
Tissue fluke from eating raw fish, settles in the liver and causes bile stones, blockage, and possibly ductal carcinoma
Clonorchis sinensis
Tissue fluke from eating raw crab meat, settles in the lung and causes eosinophilic inflammation and prob a bunch of other pulmonary problems
paragonimus westermani (P for pulmonary)
DOC flukes
praziquantel
Difference in infection of tapeworms (crestodes) based on whether a larvae or egg is ingested
larvae - human becomes the primary host and huge worms chills in gut lumen
egg - human becomes the intermediate host and larvae invade tissue and cause serious disease
T. solium (tapeworm) can be ingested from either undercooked pork (larvae form) or from human poopies (egg form). Where do each eventually settle?
larvae - intestine
egg - brain and eyes (cysticerci)
T. saginata (tapeworm) infects humans that consume undercooked ________ in the ________ form and eventually settle in the _________.
beef; larvae; intestines
D. latum (tapeworm) infects humans that consume raw ______ in the _____ form, that eventually settle in the ______.
fish; larvae; intestines
Tapeworm that infects humans d/t ingestion eggs in dog turds. Cysts can form in liver, anaphylaxis if cysts rupture. 3rd year note: surgeons inject ethanol before removal to neutralize antigens
Echinococcus granulosus
Eliminates tapeworms (rapid review)
DOC tapeworms (first aid)
niclosamide
-bendazoles
intestinal roundworms (nematodes) are found in _______ where ________ _____ are deposited or used as fertilizer
soil; human feces
pinworm infection d/t ingestion of eggs. pruritis ani and night and + scotch tape test
enterobius vermicularis
roundworm infection d/t ingestion of eggs. worms live in colon, larvae migrate to lung, and eggs are visible in feces
ascaris lumbricoides
hookworm infection d/t penetration of skin by larvae. Intestinal infection can cause anemia (blood sucker)
necator americanus
roundworm infection d/t larvae in soil that penetrate skin and can cause vomiting, diarrhea, and anemia. Can cause hyperinfective syndrome in IC pts (Tends to migrate to lung adult stage ~2 weeks)
strongyloides stercoralis
roundworm infection d/t consumption of undercooked pork. Larvae invade skeletal mm (encyst) and can cause periorbital edema.
trichinella sprialis
roundworm infection d/t ingestion of dry goods contaminated with eggs. May cause bloody diarrhea and iron deficiency anemia and rectal prolapse in severe infections.
Trichuris trichiura (whip whorm, trichi trichi)
roundworm infection d/t mosquito bite. Adult worms live in lymph nodes and blockage occurs, leading to elephantitis after aboot a year
wuchereria bancrofti
Roundworm infection d/t bite from female black fly. Causes hyperpigmented skin and river blindness, Microflariae in tissue and eye can cause allergic reaction
onchocerca volvulus
Roundworm infection d/t drinking contaminated water. Sx are skin inflammation and ulceration.
dracunculus medinensis
Roundworm infection d/t bite from deer, horse, or mango fly. Causes swelling in skin and worm can be visualized crawling in conjunctiva. Gross.
loa loa
Roundworm infection d/t consuming food contaminated with eggs. Causes granulomas. Can lead to blindness and visceral larva migrans
toxocara canis
NOW YOU CANIS SEE ANYMO'
Parasite infection d/t bite from ixodes tick (same vector as Borrelia burgdorferi) found in the Northeastern US. Sx are fever and hemolytic anemia. Blood smear shows RBCs with "Maltese cross"
Babesia (babesiosis)
Infection with measles before age two may lead to which rare progressive encephalitis?
subacute sclerosing panencephalitis
neuro-degeneration followed by death
mycobacterium TB in AIDS likely at a CD4 count above__________and CXR shows
myobacterium avium-intracelluare affects CD4 less than_______.
400
initially normal d/t impaired immune response
100
Apparently the plague (Yersinia pestis) is still endemic to the Southwestern US, New Mexico area
what you didn't know that?
For a post-influenza bacterial pneumonia with cavity lesions, think of staph. aureus. What does that look like again?
gram-positive, catalase postive, coagulase positive coccus
Apparently S. saprophyticus is resistant to ciprofloxin and the mechanism is d/t chromosomal mutations (topo 4 and dyrase)
Shoulda became a mayor.
Spirochete that is question mark shaped, found in water contaminated with animal urine. Fluke-like sxs fever, headache, abdominal pain. Hawaii has the highest incidence
leptospira interrogans
For the following, describe the toxic mechanism:
anthrax
botulinum
cholera
C. perfringens (alpha toxin)
diptheria
E. coli (labile toxin)
pertussis
shigatoxin
streptococcal erythrogenic toxins
tetanus
edema factor (adenylate cyclase->fluid loss, lethal factor->apoptosis
prevents release of ACh
increase adenylate cyclase ribosylates GTP-binding protein
alpha toxin is a lecithinase
Inhibits EF-2
Activates Adenylate cyclase
Increases cAMP via activating Gαi
decreases protein synthesis by inhibiting 60s
superantigens increase cytokine production
inhibits the release of glycine and GABA
Identify the following:
Gram-negitive curved rods isolated on alkaline medium
Gram-negative curved rods that grow at 107 degrees
Gram-negative, non-fermenting rods
Gram-negative rods, ferment lactose
Gram-negative rods, non lactose fermenters, H2S positive
Vibrio vunificus
A patient infected with schistosoma haematobium will likely present how?
hematuria
S. haematobium has a predilection for the bladder veins
chronic infection leads to fibrosis of the bladder and can lead to squamous cell carcinoma
What do the following have in common:
M. tuberculosis
B. anthracis
N. asteroides
B. pertussis
P. aeruginosa
N. meningitidis/gonorrheae
They are obligate aerobes
MUST have a plentiful oxygen supply
What do the following have in common:
B. abortus
C. jejuni
Strep species
Spirochetes (treponema, borreila and leptospira)
All are Microaerophillic
No O2 requirement, rely on fermentation, and can tolerate low concentrations of O2 via superoxide dismutase
What do the following have in common:
Clostridium species
Actinomyces israelii
Bacterodies fragilis
All are obligate anaerobes
They CANNOT tolerate ANY O2 bc they do not posses any cellular mechanisms to remove radicals
What do the following have in common:
staph species
corynbacterium diphtheriae
Facultative anaerobe
Their good anywhere
Diarrhea cha, cha, cha. Most likely causes in the following age groups:
Acute infectious
-adult
-children
-bloody
-parasitic
Chronic infectious
+ WBC in stool
- WBC in stool
Food associated
Norwalk virus
Rotavirus
Campylobacter jujuni
Giardia lamblia (US)
Campylobacter jujuni
Norovirus and rotavirus
Salmonella
Describe the bacteria that tends to cause the following:
Otitis media
pneumonia
meningitis
Gram positive, catalase negative cocci in chains that produces α hemolysis
Describe the bacteria that tends to cause the following:
sepsis/meningitis in neonates
colonizes the rectum of the adult
Gram positive, catalase negitive cocci in chainsthe produces ß hemolysis (clear), bacitracin resistant
Describe the bacteria that tends to cause the following:
pharyngitis
tonsillitis
impetigo
scarlet fever
PSGN
Gram positive, catalase negative cocci in chains, produces ß hemolysis (clear), bacitracin sensitive
Describe the bacteria that tends to cause the following:
Sub-acute endocarditis
Marker for colon cancer if present in any patient
Strep bovis
Gram positive, catalase negative cocci in chains
Three toxins produced by Bacillus anthracis
Edema factor
Protective antigen - pores in cell membranes to allow entry of EF and LF (protective anti-body formed to protective antigen)
Lethal factor - blocks the messenger system for cell growth
Farmer presents with dry cough, severe respiratory distress, fever, and is tired. X-ray shows widened mediastinum and blood in the pleural cavity
Pulmonary anthrax most likely from the wool of a beast
Farm hand presents with vomiting, abdominal pain, bloody diarrhea, Recently consumed a very well done porterhouse steak.
GI anthrax
spores are heat resistant, so don't eat cheap steak
DOC regimen for anthrax
DOC penicillin (only after strain is proven sensitive)
until then:
ciprofloxin or doxycyline
+
clindamycin and/or rifampin
AND
continue regimen or penicllin for 60 days for bioterrorsim related or 7-10 days for non-bioterrorism
Risk for anthrax vaccine?
Guillain-Barre recurrence in those with a hx of the disease
Immunocompromised Pt presents with watery diarrhea, fever, myalgia, and abdominal cramps. Cytology shows chinese lettering.
How does organism move from cell to cell? Common source?
Listeria monocytogenes
moves via actin rockets
dairy products, undercooked hotdogs
tx with parental penicillin or TPM/SMX if pen allergic
Ingestion of spores that germinate in beef or chicken, spores germinate and become bacterial cells that proliferate and produce α toxin (lecithinase) that disrupts membranes with phospholipase C activity. When will the diarrhea be seen? Other infections possible?
C. perfringins
6 hours, resolves in 24 hours
gas gangrene and myonecrosis
Best way to confirm infection with C. dif?
Toxin ELISA for toxins A and B
Pt presents with Kussmaul respirations, hyperthermia, NV, dehydration and altered mental state. He complains of facial pain. What he be worked up for and result if not?
pt is in DKA
Facial pain may indicate mucor sinusitis, Dx with sinus CT, and treat with amphotericin B
mortality is 50%
Bacterial meningitis in neonates, elderly, and IC
Gram positive rod
Listeria
Bacteria that causes meningitis and also the ability to cause hemorrhagic destruction of the adrenal cortex
Gram negative diplococci, + capsule, + oxidase, cultured on chocolate agar
Nesseria
WFS
Most common cause of meningitis in adults that can progress from otitis media, sinusitis, or bacteremia
Gram positive diplococci, + capsule, catalase -, α hemolysis
Most common cause of neonatal meningitis
Gram positive cocci in chains, catalase -, ß hemolysis, bacitracin resistant
Common cause of neonatal meningitis, pink colonies on MacConkey's agar
Gram negative rod, motile, ferments lactose
Bacterial meningitis that may present like aseptic meningitis d/t difficult gram staining and culturing out of CSF. Seen in IC, neonates, and elder;y
Gram positive rod
Listeria
start ampicillin
Chronic meningitis, acid fact bacillus stain negative, culture negative for TB. Two possible options to make the dx
MRI for TB and all granulomatous meningitisshows "basliar meningitis"
or
+ PCR
AIDS patient presents with sxs of meningitis and CD4 count is less than 100. ML causes will show what on India ink stain
shows large halo around the organism, which is the capsule, that does not take up the ink
Buzzwords:
Congenital encephalitis transmitted across the placenta
Causes neonatal hydrocephalus, MR, periventricular calcifications
Multiple, ring-enhancing lesions
AIDS pt with CD4 < 200 get TMP/SMX prophylaxis
Cat turds
Toxoplasma
Viral encephalitis
Affects the temporal lobe causing hemorrhagic encephalitis
Cowdry intranuclear inclusion bodies
sx olfactory hallucinations
double-stranded, enveloped, linear DNA virus
Viral encephalitis in IC
Infection in pregnancy-->miccoencephaly, MR, HSM, retinitis
Giant cells with eosinophilic inclusions in cytoplasm and nucleus
Double stranded linear enveloped DNA virus
Penetrates BBB by living in monocytes causing progressive dememtia
Single stranded + sense linear, enveloped icosahedral RNA togavirus
Viral encephalitis in children
Affects gray and white matter
Damsons inclusion bodies
Measles
Neuro syphilis d/t 2 or 3 syphilis
2 - d/t lymphocyte meningitis
Tertiary
Meningovascular syphilis:
Causes meningeal adhesions
Argyll Robertson pupil
Heubner's arteritis

Parenchymal syphilis:
Tabes dorsalis - bilateral demyelination of posterior spinal cord
dementia paralytica - cortical atrophy (psychosis and personality change)
Number one cause of brain abcesses
Gram positive catalase negative cocci in chains
Eosinophilic granulomas in the brain
schistosomiasis
Small, pink papules, white core, with an indented center. If seen in kids genitals think sex abuse
Mulluscum contagiosum
Neonate born with brain calcifications, seizures, MR, nerve deafness, and heart defects. Mom was asx throughout pregnancy
Cytomegliac inclusion disease (CMV)
MC cancer in AIDS
inactivates RB
uncontrolled cell growth
malignancy of vascular endothelium
B cells become neoplastic-->primary effusion lymphome
HHV-8
What do the following have in common:
RSV
Flu A B C
parainfluenza virus
RSV
Measles
Mumps
Rubella
Rabies
Hepatitis
HTLV
HIV
Arbovirus
Enveloped RNA viruses
What do the following have in common:
Polio
Cox A and B
echovirus
Hep A
Rhinovirus
Rotavirus
Norwalk virus
Naked RNA viruses
Flu that is endemic because of the surface glycoproteins H and N
Flu A
Barking cough and stridor d/t subglottitis and steeple sign d/t swelling of soft tissue around the trachea
Parainfluenza virus
Enveloped RNA virus
Enveloped RNA virus
#1 cause LRTI of infants
#1 otitis media and pneumonia in elderly
tx with ribavrin
RSV
How to distinguish btw Rubella (German measles) and Rubeloa (measles)
Rubella and Rubeloa both show fever, malaise, rash on face that spreads downward, BUT Rubella has classic auricular lymphadenopathy. Own the diagnosis. BECOME THE DIAGNOSIS
Atypical pneumonia with high fever, non-productive cough, headache and hypoxia. CXR homogeneous translucency infiltrates without cavitation
SARS
"ground glass"
Southeast US
encephalitis
mosquito vector
bird reservoir
hosts are human and horses
EEE
Alphavirus
WEE is the exact same except Western US
South America
Fever, headache, sx free, fever again, jaundice, hematemesis and hematochezia
Reservoir monkeys
Yellow fever
Warm humid enviroments
High fever, rash, bone and joint pain, sx free, fever and rash again
Mosquito vector
Dengue fever
Dengue hemorrhagic fever is re-exposure
sxs high fever, shock d/t hemorrhage, SEVERE
Area is diffuse
Fever, confusion, ascending mm weakness and paralysis (elderly)
Mosquito vector
Crow reservoir
West Nile Encephalitis (flavivirus)
Rocky mountains
High fever, headache, retro-eye pain, severe muscle pain, remission days, fever for several weeks
wood tick (dermacentor) vector
Colorado tick fever
Western US
Flu-like sxs-->acute respiratory failure, high mortality rate even with hospitalization
Deer mouse vector and reservoir
Hantavirus (Bunyavirus)
Fever, HA, diarrhea, vomit, hemorrhage and shock, DIC
100% mortality rate
Bio-warfare agent
Ebola hemorrhagic fever (Filovirdiae; RNA virus)
Myoclonal jerks, seizures, death 1-3 years
Caused by Rubeola (measles)
subacute sclerosing panencephalitis
memory deficits, ataxia, rigidity
terminal state = akinesia and mute
Human tissue
CJD
Ataxia, memory impairment
sheep brains
Scrapie
Lymphadenopathy, HSM, lytic bone lesions, skin lesions
Adult human T cell leukemia/lymphoma
HTLV-1 retrovirus
Routine blood count shows unexpectedly low numbers of one or more kinds of normal blood cells, or after unexplained bruises or recurrent infections in an otherwise apparently healthy patient.
Malignant B lymphocytes
HCL
HTLV-2
Natrual immunity to HIV is d/t rapid mutation of what
env gene - surface glycoproteins gp41 and 120
Pneumonia in kids, elderly, IC
acute onset with rigors
# CAP
↑AIDS and asplenic
Gram positive cocci, catalase - α hemolysis optochin sensitive
TB of spine
Presents with multiple compression fractures
Pott's disease
TB causing cervical lymphadenopathy
Scrofula
Sunburn rash with goosebumps
Appears initially on trunk, becomes generalized within a few days
Strawberry tongue
Rash worse in pits and groin
Scarlet fever
Gram positive cocci in chains, ß hemolysis, bacitracin resistant
Red/purple rash in HIV patients
Transmission via young cats and fleas
Bartonella henselae
Seen in typhoid fever
High fever, weakness, myalgias, splenomegaly, constipation.
High fever with relative bradycardia
Small pink papules in groups of 1-2 dozen on trunk
tx for chronic carrier state = removal of gallbladder (S. typhi hangs here)
Rose spots
Initial ↑PCO2, followed by ↑HCO3
Sedation, COPD
resp acidosis
Primary ↓HCO3 followed by ↓PCO2
Ketoacidosis, lactic acidosis
Metabolic acidosis
Initial ↓PCO2 followed by ↓ HCO3
anxiety, mountain climbing
Respiratory alkalosis
Initial ↑HCO3 followed by ↑PCO2
Loops, vomiting
metabolic alkalosis
site of active resorption of glucose, aa
Active secretion of protons
PCT
CAse inhibitors work here
Main absorption at the following:
Duodenum/jejunum
Duodenum
Terminal ilium
Carbs and amino acids
Iron
B12 and bile salts
Gastrin
released by vagus n, EtOH, basic pH in stomach
-->HCL secretion, ↑motility, ↓emptying
Secretin
released in response to acidic pH in duodenum
-->HCO3 release from pancreas
GIP
Released in response to glucose and fat in duodenum
-->insulin release
Hypokalemia with hypertension
not hypernatremic
Conn's (hyperaldesterone)
Hypotension (Na+ loss)
Hyperkalemia
metabolic acidosis
pigmentation
ADDISONS (hypoaldesterone)
Kiddos milestones:
chin up
chest up
knee push
sits alone, stands with help
crawls on stomach
stands holding furniture
walks when led
stands alone walks alone
1
2
6
7
8
10
11
14
15 month
Amoeba that causes keratitis in healthy contact lens users
Acanthamoeba castellanii
MC tape worm in the US
No intermediate animal needed
One infection results in 100s-1000s of worms
Southeast US
Hymenolepsis nana