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13 Cards in this Set
- Front
- Back
-8 yr old schoolgirl visiting US from Malaysia
-1 week history of epigastric pain, flatulence, anorexia, and bloody diarrhea -no eosinophilia -photo - microscopy of stool |
Trichuris Trichiura (whipworm)
-common in SE US -frequently co-exists with ascaris -intraluminal life cycle, eggs ingested -frequently asymptomatic; severe infection - diarrhea, abd pain, tenesmus, rectal prolaps -dx: eggs in stool -tx: mebendazole |
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-42 year old previously healthy professor
-6 week history intermittent diarrhea, flatus, cramps -diarrhea - 8 BM/day, pale, no blood or mucous -no tenesmus -illness began slowly during camping trip to Colorado with loose stools -spontaneous remission for 5-6 days at a time, then recurs |
-Giardiasis (Giardia lamblia)
-prolonged diarrhea -contaminated water -person-person in day care centers -MSM -symptoms resolve spontaneously 4-6 weeks -2 life-cycle stages - trophozoite (binds to epithelial cells, induces inflammation), dormant cyst (in contaminated water, spread person-person) -common in mountainous regions of US -Dx: cysts in stool (see pic), no PMNs in stool -Tx: metronidazole |
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-34 year old woman from Saudi Arabia
-Mild eosinophilia (AEC 500) at time of dx with B cell lymphoma -4 months after chemo - diffuse abdominal pain, bloating, constipation, occasional rectal bleeding -Eosinophils increased to 1000 -Lymphoma cleared, but colonoscopy and bx revealed granulomatous inflammation, prominent eosinophilic infiltrate, surrounding collection of eggs |
-Chronic intestinal Schistosomiasis (another pic) (by Schistosoma mansoni)
-cercariae in fresh water - penetrate human skin - mature to schistosomulae which enter blood - go to venous system of small intestine (S. japonicum) or large intestine (S. mansoni) or bladder (S. haematobium) -snail is intermediate host that produces cercariae -phases: swimmer's itch within 24 hours (penetration of cercariae) -serum sickness (4-8 weeks when worms mature and release eggs, fever, hepatosplenomegaly, elevated IgE and eosinophils, most common with S. japonicum) -chronic - granulomatous rxn from egg deposition -for S. mansoni and japonicum - chronic diarrhea, abdominal pain, blood loss, eosinophilia, liver fxn tests normal -for S. haematobium - hematuria, bladder obstruction, hydronephrosis, recurrent UTIs, bladder cancer |
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Diagnosis and treatment of schistosomiasis
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-diagnosis - urine between 12pm and 2pm or stool
-treatment - Praziquantel |
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Name the organisms from left to right.
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-left - S. mansoni
-middle - S. haematobium (in urine) -right - S. japonicum |
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-40 year old vicar returning from missionary work in Africa
-3 months after return - abdominal distention, fever, periumbilical pain, vomiting, blood-tinged diarrheal stool -denied arthritis, exposure -family history of IBD -PE: acutely ill, distended abdomen, no hepatosplenomegaly, decreased bowel sounds, no pus in stool, no organisms -sigmoidoscopy - multiple punctate bleeding sites with normal mucosa between |
-Entamoeba histolytica
-symptoms depend on bowel invasion - watery diarrhea and non-specific complaints to gradual onset of abdominal pain, bloody diarrhea, tenesmus -fever not usually seen -institutionalized patients, MSM, tourists returning from developing countries, immunocompromised -can be mistaken for UC -steroids worsen -amoebic liver abscesses - RUQ pain referred to right shoulder, high fever, hepatomegaly (50%); can also occur in lung, brain, spleen -amoeba live in bowel wall -tx: most respond to metronidazole, avoid open surgical drainage |
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-20 year old male
-abdominal pain and nausea for several months -more common in the morning -relieved by eating small amounts of food -some diarrhea and irritability -weight loss -pruritis ani -passage of white "bits" |
-Taenia saginata
-ingestion of raw or poorly cooked beef -cows infected by ingestion of human waste containing eggs, contain larvae in their muscle -humans act as host only to adult tapeworm -tx: praziquantel, albendazole, niclosamide |
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Humans can act as both an intermediate and definitive host for what tapeworm?
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Taenia solium (pork tapeworm)
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-Previously healthy 7 yr old girl
-day care -7 day history of watery diarrhea -N/V, abdominal cramps, low grade fever -34 year old AIDS patient -debilitating, cholera-like diarrhea -severe abdominal cramps, malaise, low-grade fever, weight loss, anorexia -red oocysts on acid-fast stain of stool |
-Cryptosporidium parvum
-causes secretory diarrhea -significant cause of death in HIV/AIDS -animal reservoirs -incubation 5-10 days -young children in day care, farming, sexual, contaminated water -dx: stool exam -tx: no treatment, nitazoxamide shortens diarrhea |
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-6 yr old son of farm worker
-cough, fever, wheeze -CXR reveals lobar pneumonia -after 2 days of antibiotics, worm found in bed |
-Ascaris lumbricoides
-in GI tract, few sxs in light infections: N/V, obstruction of small bowel or common bile duct -pulmonary symptoms due to migration -adult ascaris worms - can cause obstruction, volvulus, intussusception, appendicitis, jaundice, pancreatitis, malnutrition -if treating mixed infection, treat ascaris first -tx: mebendazole, pyrantel |
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-11 year old doing poorly in school
-not sleeping well -anorexia -itchy rectum throughout the day -scotch-tape test |
-Enterobius (pinworm)
-preschool and elementary school children, greater in whites -nocturnal anal pruritis -insomnia, emotional symptoms -dx: eggs on perineum (scotch tape test) -tx: mebendazole, pyrantel; repeat tx 2 weeks later |
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-69 y/o far east prisoner of war at VA
-on steroids x3 yrs for COPD -2 month hx of N/V and anorexia -25 lb weight loss -on admission: fever, confusion, can't get out of bed, elevated WBC, eosinophilia -duodenal biopsy above |
-Strongyloides stercoralis
-endemic in SE -immunocompromised - steroids, burns, lymphoma, AIDS -GI symptoms in 2/3 - abdominal pain, bloating, diarrhea, constipation -wheezing, SOB, hemoptysis -eosinophilia common -tx: albendazole |
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-57 y/o farmer presents with profound SOB
-PE: anemic, o/w unremarkable -labs - profound anemia |
-hookworm
-small amount of blood per worm but overall loss is great |
