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86 Cards in this Set
- Front
- Back
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What is the etiological agent of "giant intestinal roundworms?
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Ascaris lumbricoides
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Most common prevalence of ascariasis
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Tropical/subtropical
Not common in US |
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Source of transmission for ascariasis
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Contact with contaminated feces
Contaminated vegetables or direct hand to mouth transmission from soil |
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Most common carrier of ascariasis
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Pigs
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Invasiveness of humans includes the following locations for ascariasis
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Small Intestine
Lungs Blood stream |
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Three stages of clinical manifestation in ascariasis
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Larval Stage: cough, fever, pneumonia like
Adult Stage: Depends on 'worm load'. Either asymptomatic or development of bolus occurs. Can cause blocking or twisting of bowel. |
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What is "erratic ascariasis"
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Adult ascaris worms migrate to vital organs causing serious and sometimes life threatening illnesses of the brain, lungs, liver and gall bladder
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Diagnosis of Ascariasis
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CBC shows eosinophilia
Stoom exam |
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Treatment for Ascariasis
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Albenazole 1 po x 3 days
(Pyrantel for pregenant women) |
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Cysticercosis is most commonly known as
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Tape worms
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Etiological agent of cysticercosis
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Taenia solium
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Two disease states of cysticercosis
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Taeniasis: eggs hatch, larvae released into stomach and they become worms
Cysticercosis: larvae can penetrate and eventually encyst in various tissues |
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Prevalence of cysticercosis
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Seen in developing countries
Rare in US |
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Source of transmission of cysticercosis
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Contaminated food
Pork, fruits, vegetables |
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Invasiveness of cysticercosis
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Muscles, brain, heart, eyes, spine
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Signs and symptoms of cysticercosis
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Adult worms rarely cause symptoms
Symptoms develop after many years when larvae die, causing increased inflammation |
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Most serious form of cysticercosis
Sign and symptoms? |
Neurocysticercosis
Seizures (70% of pts), chronic headache, hydrocephalus, and meningitis |
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Diagnosis of neurocysticercosis
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CT and MRI of the brain
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Hallmark of neurocysticercosis
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"starry sky" or "fireflies" along with cerebral edema of the brain on CT or MRI
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Cerebral Spinal Fluid will show _____ in cysticercosis
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Elevated lymphocytes
Eosinophilia Low glucose High Protein |
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Treatment for cysticercosis
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Dilantin to control sizures
Prednisone to reduce swelling Albendazole 400 mg po x 15days to kill living cysts |
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What is the etiological agent of pinworms?
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Enerobius vermicularis
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Pinworms (enterobiasis) is known by the saying...
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"Itchy buns, Sucky thumbs syndrome"
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Who is most likely to be affected by pinworms
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Children worldwide
(Humans are the only host) |
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Describe the transmission of pinworms?
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Eggs are transmitted on food, hands, drink, and via fomites (especially bedding and clothing)
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Signs and symptoms of pinworms
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Most patients are asymptomatic
Some, especially children, have perianal pruritis that worsens at night. Insomnia, weight loss, bed wetting and even irritability |
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Diangosis of pinworms
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Cellophane tape over the perianal skin for 3 consecutive nights in a row is about 90% successful in capturing evidence of the worm
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Treatment for pinworms
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Albendazole (abx) or OTC pyrantel
Take one single dose and then repeat in 2-4 weeks *treat all members of the household* Wash linens thoroughly and keep hands clean to prevent accidental reinfection |
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What are the two etiological agents of hookworm (intestinal roundworms)
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Ancylostoma duodenale (old world)
Necator americanus (new world) |
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Prevalence of hookworm
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Nearly 25% of the world population is infected, though it is not common in the US
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Transmission of hookworm
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Soil contaminated with human feces
(humans are the only host) |
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Invasiveness of hookworm
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Small intestines, skin, bloodstream, heart, & lungs
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Pathology behind developing hookworm
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Larvae are swallowed and attach to the small bowel mucosa to suck blood. Mature female worms lay eggs and then are eliminated from the body
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What is the difference between light and moderate infections
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Light = 1000 eggs/ gram of feces
Moderate = 2000-8000 eggs / gram |
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Describe the three stages of hookworm including signs and symptoms
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Ground itch: erythematous dermatitis at site of penetration
Pulmonary stage: coughing, wheezing, low fever Intestinal stage: light may be asymptomatic with adequate intake of iron but heavy includes anorexia, diarrhea, pain, ulcer even anemia and protein loss |
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Diagnosis for hookworm
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Eggs found in feces
Positive for occult blood sample, anemia Eosinophilia may be found |
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Treatment for hookworm
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Pryantel or albendazole 1 po x 3 days
(same as which other worm?) Supportive tx- high protein and vitamins |
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Etiological agent of toxoplasmosis
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Toxoplasma gondii (protozoa)
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Prevelance of toxoplasmosis
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About 23% of US adults are infected
Populations world-wide see up to 95% infection rates |
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Invasiveness of toxoplasmosis
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Tissue cysts seen in skeletal muscle
(also in eye, myocardium and brain) |
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Four types of transmission of toxoplasmosis
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Zoonotic: feral cates who ingest oocytes
Foodborne: tissue cysts in undercooked/raw meat and unwashed veggies Congenital: "vertical transmission" Other: organ transplant, blood transfusion |
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At what point are the oocytes infective?
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2-5 days after excreted by cats and up to 18 months afterwards
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Signs and symptoms of toxoplasmosis
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80-90% of healthy people are asymptomatic
May only present with mild flu-like symptoms or mono-like symptoms with lymphadenopathy Parasite remains tissue-latent and tissue cysts will become reactivated w/ immunosupression |
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Toxoplasmosis and immunocompromised patients
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If you have previously NOT been infected and do become infected, symptoms are much worse.
May present with focal encephalitis, HA, cough, motor weakness, fever, AMS, and coma. |
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Toxoplasmosis and pregnancy
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New infections are worse than existing
Serious consequences for baby: miscarriage, stillborn, chorioretinitis, microcephaly, jaundice Transmission in the 1st trimester is more serious but less common |
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Diagnosis of toxoplasmosis
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Compatible clinical syndrome + serological testing
PCR testing of amniotic fluid CT shows multiple ring enhancing lesions Ultrasound is definitive but it is too late for baby |
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Treatment of toxoplasmosis
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Only recommended for immunocomp/pregnant pts
Pyrimethamine AND Sulfadizine (anti-malarial and Abx) Sprimycin is the abx for pregnant women, but not yet approved by the FDA |
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Etiological agents of Malaria
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Plasmodium vivax
Plasmodium malariae Plasmodium knowlesi Plasmodium falciparum ETC... |
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Source of transmission for malaria
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Anopheles mosquito
Mosquito ingests parasites, parasites mature, mosquito transfers parasite to humans to invade liver and RBCs |
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Invasiveness of malaria
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Blood stream and liver
P. falciparum can cause cerebral malaria |
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Three hallmark cyclical stages of malaria
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Cold stage: shaking chills
Hot Stage: fever Sweating stage: diaphoresis |
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Signs and symptoms of malaria
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Cyclical 3-stage attacks
Fatigue between attacks Release of cytokines and TNF causes HA, fatigue, dizziness, GI complaints, pain and backache |
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Most serious malarial infection
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P. falciparum
14-17% mortality even with tx "complicated malaria" May cause: cerebral malaria, hyperpyrexia, anemia, tubular necrosis, etc... |
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Diagnosis for malaria
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1. Hx 2. Symptoms 3. Blood Smear
Blood films stained with Giemsa and examined at 8 hr intervals for 3 days 5-20% of RBC will be infected Antibodies present 8-10 days later, too late for dx |
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Factors to consider before treating malaria
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1. which species
2. clinical progression/ patient status 3. geographic location and drug resistances |
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Treatment for severe malaria
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IV Quinidine gluconate AND doxy
When RBC infection is <1% continue with oral meds |
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Malaria prevention
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Vaccines: RTS or PfSPZ
Chemoprophylaxis: recommended for travelers Chloroquine is an anti-malarial drug for prophylaxis *Cannot be used for tx if given as prophylactic |
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Etiological agent of trichinosis
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Trichinella spiralis
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Transmission of trichinosis
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Humans are accidental hosts caused by eating larvae cysts within poorly cooked pork
Especially in places where pigs eat garbage and trash |
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Invasiveness of trichinosis
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INtestines, bloodstream, lungs, brain, muscle tissues
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Signs and symptoms of trichinosis
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Most infections are asymptomatic
Heavy infection includes diarrhea, abdominal pain, vomiting followed by fever, muscle pain/weakness/swelling |
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Diagnosis of trichinosis
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CBC shows leukocytosis with marked eosinophilia
Elevated CK Muscle biopsy is the DEFINITIVE DX Coiled trichinella larvae (nurse cells) present |
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Treatment for trichinosis
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Albendazole (helps prevent movement into muscle cells)
If there is tissue invasion, bed rest, analgesisc, antipyretics |
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Describe the shape of spirochetes
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Gram-negative
Motile Cork-screw like bacteria |
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What are two examples discussed involving spirochetes
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Lyme disease
Syphilis |
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Etiological agent of lyme disease
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Borrelia burgdorferi
(gram negative spirochete) |
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Transmission of lyme disease
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Ixodes tick from deer, to white-footed mouse, to humans
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How long must the tick attach for in lyme disease?
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48-72 Hours to transmit the spirochete
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Incidence is by age for lyme disease
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5-9 year old children
50-54 year old adults |
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Hallmark of lyme disease
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Erythema migrans
"bull's eye rash" |
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Describe the 3 stages of lyme disease
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1: Primary-erythema migrans of skin
2. Early dissemination throughout body 3: Late involvement of immune responses. |
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Discuss primary lyme disease
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Erythema migrans- bull's eye lesion (15 cm diameter)
Begins 1 mo after tick bite Painless with possible itching and burning |
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Discuss secondary lyme disease
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Dissemination throughout body
Flu like illness: malaise, myalgia, arthralgia CNS involvement: HA, meningitis, Bell's palsy 1% w/ cardiovascular involvement |
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Discuss tertiary lyme disease
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Systemic disease develops month-years after primary
MC complaint is joint pain and swelling Chronic encephaly, fatigue and sleep disorders |
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Diagnosis of lyme disease
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HX, clinical manifestations, serology
ELISA shows IgG and IgM Western blot confirms |
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Treatment of lyme disease
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Doxycycline 100mg po x 10days
May push to 30 days if infection is severe |
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Can you vaccinate for lyme disease
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It is no longer available
Perform thorough tick checks! |
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Etiological agent of Rocky Mountain Spotted Fever
(RMSF) |
Rickettsia rickettsii
Gram negative bacterium spirochete Non-motile Obligate intracellular parasite |
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Transmission of RMSF
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Dermacentor variablilis (dog tick)
Dermacentor andersoni (wood tick) Must attache for 6-10 hours |
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Hallmark feature of RMSF
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Petechial rash beginning on palms and feet
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How does RMSF spread
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Ticks feed on blood of infected animals, mate, and the spirochete is transferred to the eggs
Spirochete enters body via blood and lymphatic system |
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Complications of RMSF
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Vasculitis
Can cause hemorrhage in skin, GI tract, lungs, heart, pancreas and other vital organs... |
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Signs and symptoms of RMSF
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Petechial rash: flat, pink, NOT itchy--day 6 after onset
Fever Nausea/vomiting Severe HA Later S/S: abdominal pain, joint pain, diarrhea |
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Diagnosis of RMSF
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Hx and clinical manifestations
WBC is normal Thrombocytopenia is present Skin biopsy with staining on fluorescent microscope |
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Treatment of RMSF
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O2 or intubation and fluids
Doxycycline po BID x 3days then 100 mg po BID x4d Chloramphenicol is the other option |
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Mortality of RMSF
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20% mortality with no treatment
5% even with treatment |
