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157 Cards in this Set
- Front
- Back
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manifestation of prions?
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spongiform encephalopathies
(kuru, Creutzfeldt-Jakob dz, BSE, variant CJD) |
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what are silver stains used to ID?
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fungi, legionellae, pneumocystis
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what is PAS used to ID?
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fungi, amebae
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what is mucicarmine used to ID?
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cryptococci
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what is the Giemsa stain used to ID?
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campylobacteria, leishmaniae, malaria, parasites
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what defenses prevent organism entry through the skin?
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keratinized layer, low pH, presence of fatty acids
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what are the normal defense mechanisms of the GI tract?
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layer of viscous mucus, lytic pancreatic enzymes and bile detergents, mucosal antimicrobial peptides, normal flora, secreted IgA
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what type of viruses are resistant to bile and digestive enzymes?
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non-enveloped viruses
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what is the mechanism of gastrointestinal disease of staphylococci?
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enterotoxins released in contaminated food
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what is the mechanism of gastrointestinal disease of V. cholerae and ETEC?
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multiply inside mucous layer overlying gut epithelium and release exotoxins that cause epithelium to secrete large amts of fluid
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what is the mechanism of gastrointestinal disease of Shigella, Salmonella, and Campylobacter?
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invade and damage intestinal mucosa and lamina propria and cause ulceration, inflammation and hemorrhage --> dysentery
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what is the mechanism of gastrointestinal disease of Salmonella typhi?
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passes from damaged mucosa thru Peyer patches and mesenteric LNs and into blood, resulting in systemic infection
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what is the mechanism of respiratory disease of influenza virus?
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hemagglutinin proteins bind to sialic acid on epithelial cells, which leads to phagocytosis where the virus replicates, then neuraminidase cleaves sialic acid to release it from the cell
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which bacteria can impair respiratory ciliary activity?
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H. influenzae, Bordetella pertussis, M. pneumoniae
(P. aeruginosa can cause infxn in pts with CF) |
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infections common in pts with CF?
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respiratory infxns with P. aeruginosa, S. aureus, Burkholdaria cepacia
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granulomatous inflammation is usually evoked by what type of infectious agents?
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ones that resist eradication and are ca[pable of stimulating strong T cell-mediated immunity
E.g. M. tuberculosis, Histoplasma, schistosome eggs |
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acute diffuse mononuclear interstitial inflammation is often a response to what?
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viruses, intracellular bacteria or intracellular parasites
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what characterizes cytopathic-cytoproliferative reactions and what is the usual cause?
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cell necrosis or cellular proliferation, usually with sparse inflammatory cells
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mechanisms of immune evasion?
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1. growth in inaccessible areas
2. antigenic variation 3. resistance to innate immune defenses 4. impairment of effective T cell antimicrobial responses |
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what characterizes necrotizing inflammation and what is the usual cause?
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severe tissue necrosis w/o inflammation
caused by rampant viral infection (fulminant HBV), secreted bacterial toxins (C. perfringens), or direct protozoan cytolysis of host cells (E. histolytica) |
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what viruses are specific to the respiratory tract?
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adenovirus
rhinovirus influenza A/B RSV |
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what viruses are specific to the GI tract?
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mumps
rotavirus norovirus hepatitis A-E |
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what viruses are systemic w/ skin eruptions?
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measles
rubella VZV HSV1/2 |
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what viruses are systemic with hematopoeitic disorders?
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CMV
EBV HIV1/2 |
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what are the species of arboviral and hemorrhagic fevers
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dengue virus
yellow fever virus |
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what viruses cause skin/genital warts?
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papillomavirus
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what viruses are specific to the CNS?
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poliovirus
JC virus |
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cell surface receptors of measles (rubeola)?
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CD46 (complement regulatory protein that inactivates C3 convertases)
SLAM (involved in T-cell activation) |
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blotchy, red-brown rash on face, trunk, limbs; ulcerated mucosal lesions in mouth near Stensens duct; follicular hyperplasia and germinal centers in lymph organs; multinucleated cells w/ eosinophilic nuclear and cytoplasmic inclusion bodies?
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Measles (rubeola)
(paramyxovirus) |
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B/L enlarged parotid glands; possible involvement of testes, pancreas, CNS; lesions show interstitial edema, diffuse macrophage, lymphocyte, and plasma cell infiltrates?
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Mumps
(paramyxovirus) |
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usually asxs, but can invade CNS, replicate in motor neurons of spinal cord or brain stem, causing muscular paralysis or respiratory paralysis?
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Poliovirus
(unencapsulated RNA enterovirus) |
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What is an arbovirus?
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arthropod-borne virus
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birds are major reservoir; usually asxs, but 20% mild fever, HA, myalgia, 50% maculopapular rash; carries risk of CNS complications w/ acute flaccid paralysis; CCR5 is essential for host immune defense
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West Nile virus
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infxns w/ fever and hemorrhage; wide range of presentations from fever, HA, myalgia, rash, neutropenia, thrombocytopenia to severe hemodynamic deterioration; usually infect endothelial cells
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Viral hemorrhagic fevers
(enveloped RNA viruses: arenavirus, filovirus, bunyavirus, flavivirus) |
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replication in skin and mucous membranes at site of entry causes vesicular lesions; lesions show multinucleated cells with pink-purple intranuclear inclusions visible on Tzanck smear?
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Herpes simplex virus
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which viruses are the α-group chronic latent infections?
what cells infected? |
HSV 1/2, VZV
infect epithelial cells and latent infxn in neurons |
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what are the lymphotropic β-group viruses?
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CMV, Human herpes virus 6 (causes exanthem subitum), Human herpes virus 7
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what are the γ-group viruses?
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EBV, KSHV (HHV-8; cause of Kaposi sarcoma)
Latent virus is in lymphoid cells |
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infxn with rash starting on trunk, spreading to head and limbs, progresses rapidly from macule to vesicle?
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VZV
latent virus in sensory ganglia |
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latently infect monocytes, reactivated when immunity is depressed; asxs or mononucleosis-like infxn in normal pts, severe systemic infxn in neonates and immunocompromised; cells are large w/ large purple inclusions surrounded by clear halo
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CMV
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most common opportunistic pathogen in AIDS pts?
how does it manifest in these pts? |
CMV
mononucleosis-like illness: fever, atypical lymphocytosis, lymphadenopathy, hepatomegaly, mild hepatitis |
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how does CMV avoid host defenses?
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downmodulating MHC I and II moelcules and producing homologues of TNF receptor, IL-10 and MHC I molecules
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what determines whether a person will resolve or be a carrier after HBV infection?
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the effectiveness of the CTL response
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benign lymphoproliferative dz w/ fever, sore throat, lymphadenopathy, splenomegaly, increased WBC (especially large, atypical lymphocytes); B-cells are reservoir of latent infxn; may be associated with B-cell lymphoma in immunocompromised
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EBV
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EBV-associated Burkitt lymphoma is associated with what mutation?
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translocation of the c-myc oncogene into the immunoglobulin heavy chain region
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pyogenic, G+ cocci; grow in clusters
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staphylococci
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what are the virulence factors of S. aureus?
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surface proteins that allow binding to host endothelial cells
polysaccharide capsule resist phagocytosis enzymes that degrade host proteins (lipase - skin abscesses, protein A binds Fc on Ig's to avoid Ab-mediated killing) Hemolysins (damage membranes) Exfoliative toxins (induce skin sloughing by degrading desmoglein 1 which holds epidermal cells together) Enterotoxins (vomiting) Superantigens (shock) |
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what kind of pts do less virulent staphylococci infect?
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catheterized pts, pts w/ prosthetic heart valves, or IV drug abusers (S. epidermidis)
Urinary tract infections (S. saprophyticus) |
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facultative or obligate anaerobic G+ cocci growing in pairs or chains; cause suppurative infxns of skin, oropharynx, lungs, and heart valves
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Streptococci
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how are β-streptococci classified?
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according to their CHO (Lancefield) antigens
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what are the β-streptococci?
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S. pyogenes (Group A)
S. agalactiae (Group B) |
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pathogen that causes pharyngitis, scarlet fever, erysipelas, impetigo, RF, TSS, glmerulonephritis
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S. pyogenes
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pathogen that colonizes female GU tract, causes sepsis and meningitis in neonates and chorioamnionitis in pregnancy
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S. agalactiae
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what are the α-streptococci?
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S. pneumoniae
S. viridans group |
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pathogen that is common cause of adult community-acquired pneumonia and meningitis
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S. pneumoniae
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pathogen that is normal oral flora, causes dental caries and endocarditis
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S. viridans (S. mutans = caries)
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Pathogens that are often abx resistant and cause endocarditis and UTIs
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Enterococci
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Special virulence factors of S. pyogenes?
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M protein (prevents bacteria from phagocytosis)
C5a peptidase (degrades chemotactic complement) Pyrogenic exotoxin (causes fever and rash in scarlet fever) |
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Virulence factor of S. pneumoniae?
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Pneumolysin (cyosolic bacterial protein released on cell disruption which lyses host cell membranes and activates classical pathway of complement activation)
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How does S. mutans cause caries?
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metabolizes sucrose to lactic acid and secretes HMW glucans that promote bacterial aggregation
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what differentiates infxns by Staph and Strep?
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diffuse interstitial neutrophilic infiltrates w/ MINIMAL host tissue destruction
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G+ rod w/ clubbed ends that causes disease characterized by durable membrane at the site of growth in oropharynx, exotoxin-mediated damage to heart, nerves, and other organs
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C. diptheriae
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necrosis of epithelium by this pathogen causes production of a dense fibrinosuppurative exudate resulting in a tough, dirty gray to black, superficial membrane in airway
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C. diptheriae
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virulence factor of C. diphtheriae?
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phage-encoded A-B toxin
B binds cell and allows entry of A A inactivates EF-2 via ADP-ribosylation, blocking protein synthesis release of toxin in pharynx causes epithelial necrosis w/ fibrinosuppurative exudate |
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Is there immunization against C. diphtheriae?
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Yes, but does not protect against infxn, only against lethal effects
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G+ facultative intracellular rod; food-borne sepsis and meningitis in elderly and immunosuppressed, placental infections, granulomatosis infantiseptica; identified by finding bacteria in CSF, exudative inflammation w/ neutrophils.
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Listeria monocytogenes
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virulence factors of L. monocytogenes?
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bind to E-cadherin on epithelial cells and are internalized; use listeriolysin O and two phospholipases to escape phagolysosome; ACTA induces actin polymerization to propel bacteria into adjacent cells
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what can happen with Listeriosis in pregnant women?
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amnionitis which can cause abortion, stillbirth or neonatal sepsis (granulomatosis infantiseptica)
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what macrophage activator is crucial to killing of L. monocytogenes?
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IFN-γ
(IFN-γ-activated macrophages kill phagocytosed listeria, C3-activated macrophages do not) |
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Spore-forming G+ rod common in animals that have had contact with contaminated soil; lesions exhibit necrosis w/ neutrophils and macrophages and large, boxcar-shaped extracellular bacteria in chains
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B. anthracis
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Syndromes produced by anthrax?
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Cutaneous: painless, pruritic papules --> edematous vesicles --> black eschar
Inhalational: release of toxins causes hemorrhagic mediastinitis; prodromal fever, cough, and chest/abd pain rapidly leads to sepsis, shock, death GI: n/v, abd pain --> severe, bloody diarrhea, death |
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Virulence factors of anthrax?
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A-B toxin: B = protective factor (binds host cell)
A = edema factor (converts ATP to cAMP --> water efflux) or lethal factor (protease that kills cells by destroying mitogen-activated protein kinase kinases) |
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aerobic, G+, grows in branched chains; cause opportunistic indolent respiratory infxn w/ CNS dissemination mostly in pts T-cell immune deficiency
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Nocardia asteriodes
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pathogen that causes indolent illness with fever, weight loss, and cough; arrange in branching filaments, stain with modified acid-fast stains; sites of infection have suppurative response with central liquefaction and surrounding granulation and fibrosis (w/o granulomas)
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Nocardia asteroides
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Major aerobic G- bacterial infections
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Neisseria
Whooping cough (B. pertussis) Pseudomonas aeruginosa Plague (Yersinia pestis) Chancroid (Hemophilus ducreyi) Granuloma inguinale (Klebsiella granulomatis) |
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small, G- aerobic diplococci; cause suppurative, bacterial meningitis esp in <2 y.o., invasive dz occurs in crowded conditions
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Neisseria meningitidis
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What confers increased risk of Neisseria meningitis?
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C5-C9 complement deficiencies
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In males, causes symptomatic urethritis; in females, often asxs, can lead to PID; in neonates, can cause blindness; usually manifests in genital or cervical mucosa, pharynx or anorectum
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N. gonnorhoeae
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Prevention of gonorrheal blindness in neonates?
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otic drops of silver nitrate or antibiotics
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Neisseria: mechanism of immune evasion?
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antigenic variation of surface attachment proteins (pili proteins and OPA proteins)
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disseminated infection of this pathogen causes septic arthritis accompanied by a rash of hemorrhagic papules and pustules
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N. gonorrhoeae
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G- coccobacillus that causes a laryngotracheobronchitis that causes bronchial mucosal erosion, hyperemia and copious mucopurulent exudate w/ peripheral lymphocytosis resulting in violent paroxysms of coughing
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Bordetella pertussis
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Virulence factors of B. pertussis?
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virulence factors coordinated by BVGS transmembrane protein; pertussis toxin ADP-ribosylates and inactivates guanine nucleotide-binding proteins, resulting in failure in transmitting signals from host plasma membrane receptors thus paralyzing cilia.
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Opportunistic, aerobic G- bacillus; frequently seen in CF, burns, or neutropenia; in neutropenic pts, can cause extensive necrosis by vascular invasion w/ subsequent thrombosis
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P. aeruginosa
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virulence factors of P. aeruginosa?
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Pili and adherence proteins (bind to epithelial cells and lung mucin)
Endotoxin Exotoxin A (inhibits protein sythesis by ADP-ribosylating EF-2) Exoenzyme S (ADP-ribosylates RAS and G proteins that regulate cell growth and metabolism) Alginate (forms slimy biofilm to protect it from Ab, complement, phagocytes, and abx) |
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Which bacteria use exotoxin A?
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Corynebacterium diphtheriae and Pseudomonas aeruginosa
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Necrotizing pneumonia in terminal airways in a fleur-de-lis pattern with pale centers and red, hemorrhagic peripheral areas along with G- vasculitis w/ thrombosis and hemorrhage suggests what pathogen?
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P. aeruginosa
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G- facultative intracellular bacteria that proliferate in lymphoid tissue; cause ileitis, mesenteric lymphadenitis, pneumonia, sepsis w/ neutrophilia
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Yersinia (pestis, enterocolitica, pseudotuberculosis)
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Acute, ulcerative genital infxn, most common in Africa and SE Asia
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Chancroid (Hemophilus ducreyi)
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histological appearance of ulcer formed by chancroid?
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contains neutrophils and fibrin w/ underlying zone of granulation tissue, necrosis, and thrombosis and lymphoplasmacytic infiltrate
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sexually transmitted minute, encapsulated coccobacillus; endemic in tropical and subtropical regions; untreated leads to scarring, associated with lymphatic obstruction and elephantiasis of external genitalia
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Klebsiella granulomatis (Granuloma Inguinale)
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slender, aerobic, acid-fast rods growing in straight or branching chains
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Mycobacterium
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what increases the risk of Tb?
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poverty, overcrowding, chronic debilitating illness, diabetes, Hodgkin lymphoma, chronic lung dz (particularly silicosis), chronic renal flr, malnutrition, alcoholism, immunosuppression
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When will PPD detect active Tb infection?
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2-4 wks after initial infection
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what does a positive PPD indicate?
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pt has T cell-mediated immunity to mycobacterial antigens; does not differentiate between infection and disease
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causes of false negatives in PPD?
causes of false positives in PPD? |
False Neg: some viral infxns, sarcoidosis, malnutrition, Hodgkin lymphoma, immunosuppression, overwhelming active Tb disease
False Pos: infxn by atypical mycobacteria, prior vaccination with BCG |
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What are the primary cells infected by M. tuberculosis?
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Macrophages
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Progression of normal M. tuberculosis infxn?
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1. bacteria enter macrophages because macrophages bind bacterial lipoarabinomannan
2. bacteria block phagosome-lysosome fusion and proliferate 3. 2-4 wks after infxn, T cells specific to M. tuberculosis proliferate and make IFN-γ 4. IFN-γ activates macrophages to kill bacteria via N2O synthase |
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what are the characteristic pathologic manifestations of Tb?
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caseating granulomas and cavitation
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Fosamax
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Alendronate
a-LEN-droe-nate |
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what is "secondary" Tb?
how is it characterized? |
pattern of dz arising in a previously sensitized host;
insidious onset of wt loss, low grade fever, and night sweats; increasing amts of mucoid to purulent sputum, 50% have hemoptysis |
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What is the Ghon complex? With what is it associated?
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lung and draining lymph node granulomas
associated with primary Tb |
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what manifestation of Tb is more common in advanced HIV?
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extrapulmonary involvement
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Common environmental bacteria causing widely disseminated infxn characterized by abundant acid-fast organisms in macrophages of immunocompromised hosts?
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M. avium-intracellulare Complex
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What is the result of systemic arterial dissemination of M. tuberculosis to peripheral organs, meninges, and bone marrow?
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Systemic miliary tuberculosis
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slowly progressive infxn that affects skin and peripheral nerves (due to bacteria growing only in cooler tissues of the periphery); results in disabling deformities?
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Leprosy (M. leprae)
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Insidious infxn leading to dry, scaly skin lesions lacking sensation, w/ asymmetric peripheral nerve involvement; on microscopy, few bacteria are found?
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Tuberculoid leprosy
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Systemic infxn with disfiguring cutaneous thickening and nodules, w/ nervous system damage d/t bacterial invasion into perineural macrophages and Schwann cells; on microscopy, aggregates of lipid-laden macrophages and abundant bacteria?
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Lepromatous (anergic) leprosy
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What determines which kind of leprosy an infected individual will have?
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T-helper lymphocyte response
(tuberculoid = Th1 cells make IL-2 and IFN-γ; lepromatous = weak Th1 response followed by ineffective Th2 response) |
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neuronal involvement dominates which type of leprosy?
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Tuberculoid
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G-, slender corkscrew-shaped bacteria with axial periplasmic flagella?
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Spirochetes
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Infxn characterized by development of firm, nontender, raised red lesion on site of infxn 3 wks after inoculation; bacteria are present in the lesion and exudate has infiltrate of plasma cells, macrophages, lymphocytes and proliferative endarteritis
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Primary syphilis
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5-13 wks after inoculation, cutaneous spread of this pathogen causes maculopapular, scaly or pustular lesions on the palms or soles of feet, condylomata lata, and silvery-gray erosions of mucous membranes, all of which are painless; also lymphadenopathy, mild fever, malaise, wt loss
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Secondary syphilis
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chronic infection that can cause aortic valve insufficiency and aortic aneurysms, chronic meningovascular dz, tabes dorsalis, general paresis; increased inflammatory cells, protein, or decreased glucose in CSF
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Tertiary syphilis
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Disease associated with necrotic, rubbery masses which form in bone, skin and oral mucosa
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Benign tertiary syphilis
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Risks associated with congenital syphilis?
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intrauterine death, perinatal death, nasal discharge and congestion, sloughing of the skin, hepatomegaly, skeletal abnormalities
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When can VDRL and RPR detect syphilis infection?
When do they become negative? |
4 to 6 wks after infection
Tertiary syphilis |
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What is the best test for detection of early syphilis infection?
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immunofluorescence of chancre exudate
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what sx is seen in all stages of syphilis?
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endarteritis (inflammation of arterial inner lining; endothelial cell activation and proliferation --> intimal fibrosis)
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the triad of interstitial keratitis, Hutchinson teeth, and 8th nerve deafness are the late manifestations of what disease?
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congenital syphilis
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What pathogen is transmitted by body lice or ticks and is clinically manifested by shaking chills, fever, HA, and fatigue, followed by DIC and multi-organ failure?
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Borrelia recurrentis (relapsing fever)
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what pathogen causes an erythematous papule with a pale center with fever and lymphadenopathy during the acute phase; skin lesions, migratory arthralgias and myalgias, arrhythmias and meningitis during the second stage; and chronic, destructive arthritis and encephalitis in the late chronic stage?
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Lyme disease (Borrelia burgdorferi)
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what is the usual cause of abscesses?
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commensal bacteria from adjacent sites, usually anaerobic>aerobic
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G+, anaerobic bacilli that cause cellulitis and myonecrosis of wounds, food poisoning and small bowel infection?
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Clostridium perfringens, C. septicum
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this pathogen proliferates in wounds and causes spastic paralysis
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Clostridium tetani
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MOA of tetanospasmin?
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blocks release of GABA
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pathogen that grows in canned foods and releases a toxin that blocks release of ACh leading to repiratory and skeletal paralysis
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Clostridium botulinum
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important toxin of C. perfringens and MOA?
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α-toxin
degrades lecithin (component of cell membranes), thus destroying RBCs, PLTs, muscle cells, can also cause nerve sheath damage |
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MOA of botulinum toxin?
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blocks synaptobrevin which mediates fusion of NT-vesicles with neuron membrane, thus preventing ACh release at the neuromuscular junction
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small, G- obligate intracellular bacteria that may be asxs or may cause urethritis, epididymitis, prostatitis, PID, pharyngitis, conjunctivitis, perihepatic inflammation and proctitis
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Chlamydia trachomatis
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which serotypes of chlamydia cause urogenital infections and inclusion conjunctivitis?
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D through K
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which serotypes of chlamydia cause lymphogranuloma venereum (chronic, ulcerative disease in Asia, Africa, Caribbean and S. America)?
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L1, L2, and L3
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which serotypes of chlamydia cause trachoma (ocular infection of children)?
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A, B, and C
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G-, intracellular bacilli that cause epidemic typhus, scrub typhus erlichiosis and spotted fever?
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Rickettsiae
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Type of Rickettsial infxn with lesions that range from a rash w/ small hemorrhages, to skin necrosis and gangrene w/ internal organ hemorrhages
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Epidemic typhus (R. prowazekii)
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Pathogens that predominantly infect vascular endothelial cells causing vascular leakage from endothelial damage, resulting in hypovolemic shock w/ peripheral edema, pulmonary edema, renal failure and CNS manifestations
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Rickettsiae
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which organisms proliferate in endothelaila cells, causing endothelial swelling, thrombosis and vessel wall necrosis (manifesting as gangrene of tips of fingers, nose, earlobes, scrotum, penis and vulva), w/ a perivascular cuff of mononuclear inflammatory cells?
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Typhus and spotted fever (Rickettsiae)
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What disease is caused by infection of neutrophils or macrophages and manifests as fever, HA, malaise, progressing to respiratory insuff., renal failure, and shock?
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Erlichiosis (Rickettsiae transmitted by ticks)
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this infxn causes a hemorrhagic rash over the entire body, including palms and soles, and is common in SE and south-central US?
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Rocky Mountain Spotted Fever (Rickettsia rickettsii)
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candida produces what diseases in healthy ppl?
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vaginitis and diaper rash
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who is susceptible to superficial candidiasis?
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burn victims, diabetics
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fungus that is spore at 20degC, forms germ tubes at 37degC; pseudohyphae
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candida
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heavily encapsulated monomorphic yeast that causes meningitis that appear as soap-bubble lesions in the brain; found in soil, pigeon droppings
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cryptococcus
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mold that causes pulmonary allergy in healthy ppl, serious sinusitis, pneumonia and invasive dz in IC; septate hyphae branching at acute angles
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aspergillus
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Mold with irregular nonseptate hyphae branching at wide (90+ deg) angles; cause dz in ketoacidotic diabetics and leukemic pts
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mucor
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intracellular protozoa that causes cyclic fever, anemia, cerebral sxs, renal flr, pulmonary edema, splenomegaly; first invades hepatocytes, then ruptures and infects RBCs
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Plasmodium
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protozoa that parasitizes RBCs and causes fever and hemolytic anemia; transmitted by ixodes tick; in RBC, has ring stages, Maltese cross
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Babesia
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intracellular protozoa transmitted by sandfly; causes chronic inflammatory dz of skin, mucous membranes; visceral dz has spiking fevers, hepatosplenomegaly, pancytopenia; macrophages contain amastigotes
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leishmania
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extracellular protozoa that cause recurring fever, enlarged LNs, splenomegaly and progressive brain dysfxn --> death; red-rubbery chancre at site of insect bite
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Trypanosoma
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intracellular protozoa that uses cell lysosome to activate; causes dCM, megacolon, megaesophagus, predominantly in S. America
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Chagas dz (Trypanosoma cruzi)
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Nematode whose larvae in soil penetrate skin --> lungs --> trachea --> mucosa of intestines cause vomiting, diarrhea, anemia, can autoinfect
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Strongyloides
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Ingestion of this helminth larvae in pork --> cysticercosis, neurocysticercosis, mass lesions in brain, also found in muscles, skin, heart
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Taenia solium
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eggs in dog feces; hatch in duodenum; can cause cysts in liver, lungs, or bones
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Echinococcus granulosus (hydatid disease)
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nematode from undercooked meat, usually pork; causes inflammation of muscle (coiled larvae encyst in striated muscle), periorbital edema
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trichinella spiralis
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snails are host of this parasite, cercariae penetrate skin, cause granulomas, fibrosis, inflammation of spleen and liver
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Schistosoma
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nematode transmitted by mosquito, causes blockage of lymphatic vessels --> fibrosis, hyperkeratosis (elephantiasis)
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Wuchereria bancrofti (lymphatic filariasis)
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nematode transmitted by black flies; causes hyperpigmented, chronically itchy skin and "river blindness"
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Onchocerca volvulus
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