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64 Cards in this Set

  • Front
  • Back
Giardia lamblia
- Giardiasis, bloating, farting, foul smelling fatty diarrhea, seen in camper and hikers
- Cysts in water transmission
- Seen trophozoites or cysts in stool
Entamoeba histolytica
- Amebiasis, bloody diarrhea (dysentary), liver abcess, RUQ pain, flask-shaped ulcer
- Cysts in water
- Serology/trophozoites (RBC's in cytoplasm) or multinucleated cysts in stool

treat w/ metronidazole and iodoquinol
Cryptosporidium
- Severe diarrhea in AIDS, mild disease (watery diarrhea) in normal people
- Cysts in water transmission
- See cysts on acid fast stain
- Treat w/nitozoxanide, or clean water
GI Protozoa
Giardia lamblia, Entamoeba histolytica, Cryptosporidium
CNS protozoa
Toxoplasma gondii, Naegleria fowleri, Trypanosoma brucei/gambiense/rhodesiense
Toxoplasma gondii
- Brain abcess in HIV (ring enhancing brain lesions on CT)
- Congenital toxo = classic triad (chorioretinitis, hydrocephalus, and intracranial calcifications)
- Transmission from cysts in meat or CAT LITTER, crosses placenta
- Treat - sulfadiazine and pyrimethamine
Naegleri fowleri
- Rapidly fatal meningoencephalitis
from swimming in fresh water lakes, enter via cribiform plate
"think NALGENE bottle / fresh water containing NAEGLERIA"
- Amoebas in spinal fluid
- Treat - amphotercin
Trypanosoma brucei/gambiense/rhodesiense
African sleeping sickness, enlarged lymph nodes, recurring fever (antigenic variation), somnolence, coma

from Tse Tse fly, painful

blood smear

treat w/ Suramin (blood borne) or Melarsoprol (CNS)

"it SURe is nice to go to sleep: MELAtonin helps with sleep"
Hematologic Protozoan Infections
Plasmodium falciparum, vivax, ovale, malariae, and babesia

Malaria causes - fever, headache, anemia, splenomegaly

from mosquitos (anopheles)

see on blood smear, trophozoites, merozoites (RBC)

treat - choloroquine to start (blocks plasmodium heme polymerase), add mefloquine if resistant

***for Vivax/Ovale use PRIMAQUINE for dormaint liver form hypnozoite****
P. vivax, P. ovale
48 hr cycle
Dormant hypnozoite form (in liver) = Primaquine
P. falciparum
severe, irregular fever patterns, parasitized RBC's, occlude brain capillaries, kidneys, lung
Tx - choloroquine
P. malariae
72 hr cycle
Tx - choloroquine
Babesia
Babesiosis: fever and hemolytic anemia, in NE USA, asplenia = increased risk for severe dx***

from Ixodes tick, often w/lyme dx coinfection

see "maltese cross" on blood smear, or ring form

Tx - quinine, clindamycin
Visceral protozoal infections
Trypanosoma cruzi, Leishmania donovani
Trypanosoma cruzi
Chagas disease, dilated cardiomyopathy, megacolon, megaesophagus

from Reduviid bug (Kissing Bug)

Seen on blood smear

Tx - Benznidazole and/or Nifurtimox
Leishmania donovani
visceral leishmaniasis, Kala azar, spiking fevers, hepatosplenomegally, pancytopenia

from Sandfly

see macrophages containing 'amastigotes'

Tx - sodium stibogluconate
Trichomonas vaginalis
vaginitis, foul smelling greenish discharge, itching and burning

Parasitic STD

see trophozoites on wet mount (MOTILE*)

Tx - Metronidazole (patient & partner)
Nematodes
round worms

Intestinal - Enterobius vermicularis (pinworm), Ascaris lumbricoides (giant roundworm), Trichinella spiralis, Strongyloids stercoralis, Ancylostoma duodenale, Necator americans (hookworms)

Tissue - Dracunculus medinensis, Onchocerca volvulus, Loa Loa, Wuchereria bancrofti, Toxocara canis
Enterobius vermicularis
pinworm, from food contaminated w/eggs, intestinal infection, causes anal pruritus (scotch tape test)

Tx - "Worms are bendy, treat with mebendazole"
Ascaris lumbricoides
giant roundworm, ingest, can see eggs in stool

#1 cause of Loeffler's syndrome --> eosinophilic pneumonitis

Tx - bendazoles
Trichinella spiralis
from undercooked meat (pork), inflammation of muscle (larvae encyst in muscle), periorbital edema

Tx - Bendazoles
Strongyloides stercoralis
larvae in soil penetrate skin, intestinal infection, causes vomitting, diarrhea, and anemia

Tx - bendazoles or ivermectin
Ancylostoma duodenale, Nectator americanus
hookworms, larvae penetrate skin of feet, intestinal infection, cutaneous larvae migrans, can cause anemia

Tx - bendazoles or pyrantel pamoate
Dracunculus medinensis
in drinking water, skin infalmmation & ulceration

Tx - Niridazole, prolonged extraction
Onchocerca volvulus
from female Blackfly, causes hyperpigmented skin and RIVER BLINDNESS, "BLACK flies, BLACK skin, BLACK sight"

Tx - IVERmectin (rIVER blindness)
Loa Loa
from deerfly/horsefly/mango fly, causes swelling in skin (can see worm crawling in conjunctiva during the DAY)

Tx - diethylcarbamazine
Wuchereria bancrofti
female mosquito, cause blockage of lymphatic vessels (ELEPHANTIASIS), takes 9 months to 1 year after bite to develop elephantisis symptoms
Must get blood culture AT NIGHT

Tx - diethylcarbamzine
Toxocara canis
food contaminated w/ eggs, causes granulomas (if in retina = blindness), and visceral larval migrans (worm moves around body, 'creeping lesion')
Tx - diethylcarbamzine
Cestode
Tapeworms

Taenia solium, Diphyllobothrium latum, Echonococcus granulosis
Taenia solium
ingestion of undercooked pork = intestinal tapeworms
ingestion of undercooked eggs = cystercercosis/neurocystercercosis, mass lesions in brain "swiss cheese"

Tx - praziquantel, bendazoles (if neuro)
Diphyllobothrium latum
ingestion of larvae in raw freshwater fish, causes vit. B12 deficiency and anemia

Tx - praziquantel
Echinococcus granulosus
eggs in dog feces/wolves when ingested causes cysts in liver, can cause anaphylaxis if echinococcal antigens are released from cysts
Surgeons inject ethanol or hypertonic saline to kill daughter cyst before removal
Tx - bendazoles
Trematodes
Flukes - treat w/praziquantel

Schistomas, Clonorchis sinensis, Paragonimus westermani
Schistosoma
snails are host, cercariae penetrate skin of humans, causes granulomas/fibrosis/inflammation of spleen and liver, can lead to SCC of bladder

Tx - praziquantel
Clonorchis sinensis
undercooked fish, causes inflammation of the biliary tract - pigmented gallstones also associated with cholangiocarcinoma

Tx - praziquantel
Paragonimus westermani
undercooked crab meat, causes inflammation and 2* bacterial infection of lung, causing hemoptysis

Tx - praziquantel
Nematodes routes of infection - ingested or cutaneous
Ingested = Enterobius, Ascaris, Trichinella
"You'll get sick if you EAT these"

Cutaneous = Strongyloides, Ancylostoma, Necator
"These get into your feet from the SANd"
Giardia lamblia Tx
metronidazole
Entamoeba histolytica Tx
metronidazole and iodoquinol
Cryptosporidium Tx
Water tx
Choloroquine MOA
blocks plasmodium heme polymerase
Brain Cysts, Seizures
cystercercosis
Liver Cysts
echinococcus granulosus
B12 Deficiency
Diphyllobothrium latum
Biliary Tract Disease
Clonorchis sinensis
Hemoptysis
Paragonimus westermani
Portal HTN
Schistosoma mansoni
Hematuria, Bladder Cancer
Schistosoma haematobium
Microcytic Anemia
Ancylostoma, Necator
Perianal pruritis = enterobius
Histoplasmosis
Systemic Mycosis - PNA
Mississippi & Ohio River Valleys
macrophage filled with histoplasma
bird/bat droppings
Chest X-ray shows a widen mediastinum
Tx - amphotericin B
Blastomycosis
Systemic mycosis
Cold = Mold; Heat = Yeast
East of Mississippi
Inflammatory lung disease w skin & bone nodules
broad based buds (same size as RBCs)
Tx - amphotericin B
Paracoccidioidomycosis
Latin America (rarest, most severe)
Budding yeast with "Captain's Wheel"
Tx - amphotericin B
Coccidioides immitis
SW & Mexico
PNA in immunocompetent disseminated disease to bone & skin in immunocompromised
& meningitis
Spherules filled with endospores larger than RBCs
see in 10% KOH prep or Silver stain
Culture on Sabouraud's Agar
Tx - amphotericin B
Valley Fever
Acute Coccidioidomycosis
self-limited flulike illness with fever, cough, chest pain, and weight loss
Erythema nodosum
Cryptococcus neoformans
Heavily encapsulated yeast, polysaccharide
Not dimorphic
Found in soil, pigeon droppings
Inhalation with hematogenous spread
Major virulence factor
Inhibits phagocytosis and downregulates Th1 responses
"Soap Bubble" lesions in brain
Aspergillus fumigatus
Seen in AIDS & post-TB, CGD and CF
Not dimorphic
branches arise at acute (∼45°) angles
Candida albicans
oral and esophageal thrush
dimorphic
Tx - oral fluconazole
Pneumocystosis
Interstitial pneumonitis with a mononuclear infiltrate composed predominantly of plasma cells
Yeast, Inhaled
Diagnosis on biopsy or lavage
Pathology shows disc shaped yeast on methenamine silver stain of lung tissue
**PPX with bactrim when CD4 under 200**
Tinea Versicolor
Caused by malasezia furfur
Hot, humid weather causing hypopigmented patches
"Spaghetti & Meatball" on KOH
Tx - topical miconazol, selenium sulfide
Tinea Misc.
Pruritic lesions with central clearing resembling a ring caused by dermatophytes
Dermatophytes (3)
1. Microsporum
2. Tricophyton
3. Epidermophyton
Mucormycosis
DKA & Leukemia
Cribiform plate
Rhinocerebral, frontal lobe abscesses
Necrotic eschar on face
Sporotrichosis
Dimorphic cigar shaped budding yeast
"Rose Gardener's Disease" (thorn prick)
Ascending lymphangitis with pustules
Tx - itraconazole or KI
Systemic Mycosis
1. Histoplasmosis (bird/bat droppings) 2. Blastomycosis (Broad-base budding/Saboraud's agar)
3. Coccidiodomycosis (inflammatory lung disease)
4. Paracoccidioidomycosis (captain's wheel appearance)

All except for COCCIDIOIDOMYCOSIS are found in the dimorphic form (cold = mold, heat = yeast) and can cause pneumonia when disseminated

Tx: Fluconazole or ketoconazole for local disease; Amphotericin B for systemic infection