Jackson Tissue & Lymphatic Parasites

Front 1

Describe the following for Leishmania:
1. classification
2. chief characteristics

Back 1

1. flagellated protozoa
2. multiplies w/in macrophages
-intracellular amastigote w/in monocytes

Front 2

Describe the following for Leishmania:
1. most common clinical presentation
2. modes of transmission
3. endemic areas

Back 2

1. small papules -> nodules -> ulcerated lesions on skin
2. bite by a sandfly (phlebotomus)
3. africa, middle east, south america, asia

Front 3

list the insect vector(s) that transmit leishmaniasis to humans

Back 3

sandfly

Front 4

describe the clinical presentation of visceral leishmaniasis (kala-azar)

Back 4

Onset in weeks to months
Fever, chills, weight loss, diarrhea, anemia, hepatosplenomegaly, enlarged lymph nodes
May see darkening of the skin (forehead, temples, around the mouth)
May be rapidly fatal if untreated (severe anemia, hemolysis, hypersplenism)
- most prevalent in India

Front 5

describe the chief characteristic(s) of leishmania

Back 5

ulcerated skin lesions

Front 6

Describe the following for American Trypanosomiasis:
1. classification
2. chief characteristics

Back 6

1. protozoa
2. passed by kissing bug

Front 7

Describe the following for American Trypanosomiasis:
1. most common clinical presentation
2. modes of transmission
3. endemic areas

Back 7

1. acute (1-2 weeks) = usually mild fever, fatigue, rash. swelling at infection site; unilateral swelling of the eye (Romana's sign), rarely myocarditis
chronic (10-30yrs) = palpitations, dyspnea, syncope due to enlarged heart, altered HR, rhythm (may be fatal)
- dysphagia or constipation (due to mega-esophagus, colon)
2. bite by the kissing beetle
3. south, central america

Front 8

list the insect vector(s) that transmit trypanosomiasis to humans

Back 8

kissing bug
tsetse fly

Front 9

Explain the significance of antigenic variation displayed by trypanosomes to the development of immunity

Back 9

this allows it to escape from immune cell destruction by changing surface antigens presented, thus when cell-mediated immunity is developed, it will no longer be effective (ie specific IgG, etc)

Front 10

describe african trypanosomiasis:
1. most common clinical presentation
2. modes of transmission
3. endemic areas

Back 10

1. early stage = Ulcer at site of tsetse fly bite, fever, lymphadenopathy (posterior cervical nodes enlarged [winterbottom sign]), myalgia, & diarrhea
late stage = CNS involvement
2. tsetse fly
3. Africa

Front 11

describe african trypanosomiasis:
1. causative organism
2. chief characteristics

Back 11

1. trypanosoma b. rhodesiense
2. antigenic variation - via variant surface glycoproteins. this allows it to escape from immune cell destruction via change in surface antigens

Front 12

describe the chief characteristic(s) of trypanosoma

Back 12

cardiomyopathy
feces from kissing bug
VSG, antigenic variation

Front 13

Describe the following for Schistosoma:
1. classification
2. chief characteristics

Back 13

1. worm
2. characteristic life cycle: infective cercariae obtained in contaminated water thru skin -> liver portal system (mating occurs) -> larval form migrates to GI tract, lungs -> eggs passed in feces/urine -> into water & snails take it up & defecate releasing infective cercariae
- egg (170um) w/lateral spine seen on microscopy in stool sample is diagnostic

Front 14

Describe the following for Schistosoma:
1. most common clinical presentation
2. modes of transmission
3. endemic areas

Back 14

1. early stage = skin rash, fever, chills, headache, cough, arthralgia, lymphadenopathy, abdominal pain, splenomegaly, eosinophilia
chronic stage = eosinophilic granuloma, ascites, esophageal bleeding from varices, hematuria/hematochezia, CNS problems
2. contact w/contaminated water
3. central, south america

Front 15

briefly describe the schistosoma life cycle, especially regarding human infection

Back 15

infective cercariae penetrate skin to infect person. travels to portal vein system & male/female produce larval eggs which have enzymes allowing them to penetrate tissue & exit into GI tract. eggs are then passed in feces or urine, eaten by snails in fresh water which then pass on infective cercariae

Front 16

what precautions should you tell a pt to take if they are traveling to an area endemic with schistosomiasis?

Back 16

don't bathe in contaminated water

Front 17

describe the chief characteristic(s) of schistosoma

Back 17

infective form penetrates skin
eosinophilia
fever, malaise, rash, hepatosplenomegaly, abdominal pain & distention

Front 18

Describe the following for Wuchereria/Brugia:
1. classification
2. chief characteristics

Back 18

1. nematode; lymphatic filaria worms
2. infective larvae is injected by mosquito
- microfilarial worms are deposited into blood stream by mosquito. travels to lymphatics where adult worms develop in lymphatics/nodes. overtime w/repeated injections, the macrofilarial worms block lymphatics leading to swelling of limb, genitalia (depending on node)

Front 19

Describe the following for Wuchereria/Brugia:
1. most common clinical presentation
2. modes of transmission

Back 19

1. repeated infection by mosquito over time (months-years) can lead to elephantiasis
-caused by repeated injection of microfilaria & subsequent sequestration & growth of macrofilaria in lymphatics
- severe lymphedema w/hyperpigmentation & hyperkeratosis
2. mosquito vector

Front 20

describe the chief characteristic(s) of wuchereria

Back 20

mosquito vector
lymph blockage
eosinophilia

Front 21

Describe the following for Onchocerca:
1. classification
2. chief characteristics

Back 21

1. filarial worm
2. microfilaria reside in skin, eyes

Front 22

Describe the following for Onchocerca:
1. most common clinical presentation
2. modes of transmission
3. endemic areas

Back 22

1. development of visual disturbance, blindness, painless subcutaneous nodules, sagging skin developing over months to years
2. blackfly
3. rivers in Africa, south america, middle east

Front 23

describe the chief characteristic(s) of onchocera

Back 23

black fly vector
eosinophilia

Front 24

what precautions should you tell a pt to take if they are traveling to an area endemic with lymphatic filariasis?

Back 24

drug precautions are only needed if planning on staying for an extended period of time. use mosquito repellent

Front 25

A soldier recently home from duty in Iraq was seen in the local clinic for ulcerated skin lesions on the face and left ear. The patient was in otherwise good health. An aspirate taken from one lesion was sent to the laboratory. A Giemsa-stained smear showed mononuclear cells that contained small oval parasites:
1. what is the causative organism?

Back 25

1. leishmania

Front 26

A 60-year old male patient presents with mild dyspnea, especially upon exertion, fatigue, and occasional mild chest pain. He reports episodes of dizziness and mild dysphagia. The patient lived in South America for 30 years prior to coming to the U.S:
1. what is the Dx
2. what is the causative organism

Back 26

1. chagas disease
2. trypanosoma cruzi