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217 Cards in this Set
- Front
- Back
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How do people get Giardia lamblia? |
Unfiltered or unpurified drinking water contaminated byhuman/animal feces with Giardia cysts |
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How is Giardia lamblia transmitted? |
Fecal/oral transmission via cysts |
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What is Giardia lamblia associated with? |
Campers/hikers |
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Symptoms of Giardia lamblia (3) |
1. Foul smelling diarrhea
2. Steattorhea 3. Vitamin DEAK malabsorption |
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Pathogenesis of Giardia lamblia |
Trophozoite attach but does not invade intestinal wall,which means doesn’t cause bloody diarrhea |
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How do you diagnose Giardia lamblia? (3) |
1. Trophozoites in stool is diagnostic
2. Stool O&P is diagnostic test 3. ELISA stool antigen test is also diagnostic |
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How do you treat Giardia lamblia? |
Metronidazole |
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How is Entamoeba histolytica transmitted? |
Cyst form is infectious, ingested in contaminated waters |
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What is associated with Entamoeba histolytica? |
Associated with men who have sex with men via anal oraltransmission |
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Pathogenesis of Entamoeba histolytica? |
In GI tract, differentiates into trophozoites which invadescolon and spreads via portal circulation to liver |
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Where is the most common site of Entamoeba histolytica abscesses |
Right lobe of liver |
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Symptoms of Entamoeba histolytica (3) |
1. RUQ pain
2. Hepatomegaly 3. Bloody diarrhea |
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Describe the Entamoeba histolytica liver abscess |
consistencyof anchovy paste |
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How does the colon look in Entamoeba histolytica infections? |
Intestinal amebiasis: flask shaped ulcerations in colon |
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Is Entamoeba histolytica invasive? |
Yes |
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How do you diagnose Entamoeba histolytica? (3) |
1.
Diagnosis with Stool O&P – trophozoites with endocytosedRBCs under microscope 2. Elisa stool antigen test 3. Intestinal biopsy may show flask shaped lesions |
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How do you treat Entamoeba histolytica? (4) |
1. Metronidazole treatment
2. Paramycin – luminal agent to eliminate cysts 3. Iodoquinol – luminal agent to eliminate cysts 4. Treat medically NOT surgically |
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Do you treat Entamoeba histolytica medically, surgically or both? |
Medically only |
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How do you treat Entamoeba histolytica in the lumen to eliminate cysts? |
1. Paramycin
2. Iodoquinol |
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How does Cryptosporidium in the immunocompromised compared to the immunocompetent? |
1. Severe watery diarrhea in HIV patients
2. Mild watery diarrhea in immunocompetent |
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Describe the life cycle of Cryptosporidium |
Complete life cycle in single host |
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What is the only acid fast parasite? |
Cryptosporidium |
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How is Cryptosporidium transmitted? |
Fecal-oral transmission |
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How does a person acquire Cryptosporidium? |
Infectious cysts passed through spores ingested in infected water |
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What is unique about the cysts of Cryptosporidium? |
Each cyst is composed of 4 motile sporozoites |
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Pathgenesis of Cryptosporidium |
Sporozoites attached to intestinal wall, cause diarrhea andsmall intestine damage |
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What is the most common location in the body for Cryptosporidium? |
Small intestine |
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How do you diagnose Cryptosporidium? |
Diagnose with Stool O&P |
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How do you treat Cryptosporidium? (2) |
1. Nitazoxanide treatment – antiprotoza that can be usedexclusively in immunocompromised
2. Spiramycin (outside the US) |
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How do you prevent Cryptosporidium infection? |
Filtration can remove oocysts from infected water (resistantto chlorination) |
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Can you treat Cryptosporidium infected water with chlorine? |
No-resistant, must filter |
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What is a buzz word for Toxoplasmosis gondii? |
Cats |
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What patients are at risk for Toxoplasmosis gondii? |
Pregnant and immunocompromised, especially HIV at risk |
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How is Toxoplasmosis gondii transmitted? (3) |
1. Raw or undercooked meat containing cysts
2. water/vegetablescontaining oocytes shed in the feces of infected animals transmission 3. Pregnant women at risk of transplacental transmission(TORCHES) |
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What do you find on imaging with Toxoplasmosis gondii? |
Ring enhancing lesions on CT or MRI in immunocompromised,usually multiple lesions |
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Major symptom of Toxoplasmosis |
Encephalitis |
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What do you have to differentiate Toxoplasmosis from? |
CNS lymphoma |
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How do you differentiate Toxoplasmosis from CNS lymphoma? |
Brain biopsy to differentiate from CNS lymphoma (also CNSlymphoma usually only one lesion) |
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Congenital Toxoplasmosis Features (5) |
1. Intracranial calcifications
2. Hydrocephalus 3. Seizures 4. Chorioretinitis 5. Deafness |
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How do you diagnose Toxoplasmosis? |
Diagnosis made by serology or biopsy, but positive serologydoesn’t indicate active infection given a large portion of the population hastoxoplasmosis exposure but asymptomatic |
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Does positive serology indicate active Toxoplasmosis infection? |
No because a large portion of the population has toxoplasmosis but asymptomatic |
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How do you treat Toxoplasmosis? (2) |
1. sulfadiazine
2. pyrimethamine |
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When do you need to prophylactically treat for Toxoplasmosis? (2) |
1. Prophylaxisfor CD4 count < 100 AND MUST HAVE
2. seropositive for IgG against Toxoplasmosis |
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What do you give for prophylaxis against Toxoplasmosis |
TMP-SMX |
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Disease caused by Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense? |
African sleeping sickness |
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Location of Trypanosoma brucei gambiense |
West Africa |
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Location of Trypanosoma brucei rhodesiense |
Southeast Africa |
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How is African sleeping sickness transmitted? |
Tsete fly vector |
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Symptoms of African sleeping sickness (3) |
1. Coma (penetrates CNS)
2. Cervical/Axillary lymphadenopathy 3. Recurrent fevers |
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Pathogenesis of African sleeping sickness |
After biting moves from blood to lymph nodes(cervical/axillary lymphadenopathy) |
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How do you diagnose African sleeping sickness? |
Trypomastigotes seen on blood smear |
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What is a major reason for Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense's ability to avoid the immune system? |
Variable surface glycoprotein coats, undergoing constantantigenic variation |
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How would you describe how Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense? |
Motile with single flagella |
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How do you treat African sleeping sickness? (2) |
1. Melarsoprol treatment – CNS infection
2. Suramin treatment – Peripheral blood infection |
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What is Naegleria fowleri associated with? (5) |
1. Freshwater
2. Water sports 3. Hot springs 4. Nasal irrigation symptoms 5. Contact lens symptoms |
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How would you describe the form of Naegleria fowleri? |
Amoeba |
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What is the prognosis of Naegleria fowleri? |
High mortality rate, rapidly fatal with poor prognosis |
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What disease does Naegleria fowleri cause? |
Primary amoebic meningoencephalitis |
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How does Naegleria fowleri cause its symptoms? |
Trophozoite enters CNS via cribiform plate |
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How do you diagnose Naegleria fowleri? |
Lumbar puncture you see amoebas |
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How do you treat Naegleria fowler? |
Amphoterocin B |
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Where do you find Trypanosoma cruzi regionally? |
South America and Central America |
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What disease does Trypanosoma cruzi cause? |
Chagas disease |
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How does a person get infected with Trypanosoma cruzi? |
“Kissing Bug” bites around victim’s mouth and depositsinfected feces which can later be introduced by scratching area |
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How is Chagas disease transmitted? |
Transmitted by Reduviid aka Kissing bug |
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Symptoms of Chagas disease (3)
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1. Megacolon
2. Dilated cardiomyopathy 3. Mega-esophagus |
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How do you diagnose Chagas disease? |
1. Diagnosed by blood smear in active infection – motiletrypanosomes
2. Trypanosomes may be seen within cardiac myocytes on heartbiopsy |
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How do you diagnose chronic Chagas disease? |
diagnosedvia serology and clinical |
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How does Trypanosoma cruzi reach the heart? |
Burrows into endocardium from blood stream |
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How do you treat Chagas disease? |
Nifurtimox actuely |
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How do you treat chronic Chagas disease? |
No treatment |
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How is Babesia transmitted? |
Tick borne illness – Ixodes/Deer Tick – Northeast America(often coinfection with Borrelia) |
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What coinfection can occur with Babesia? |
Borrelia |
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Symptoms of Babesia (5) |
1. Blood-related symptoms: hemolytic anemia, hemoglobinuria,jaundice
2. Sweat 3. Irregularly cycling fever |
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How is Babesia diagnosed? (2) |
1. Thick blood smear
2. Maltese cross appearance in RBC (tetrad of trophozoites) |
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Who is at higher risk of severe disease of Babesia? |
Sickle cell disease/asplenia |
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How do you treat Babesia? (2) |
1. Atovaquone
2. Azithromycin |
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Can healthy people recover from Babesia spontaneously? |
Yes |
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How do you diagnose Plasmodium? |
Blood stain and Giemsa stain to see parasites in RBCs |
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Describe the fever in Plasmodium malariae? |
Quartan fever schedule – every 72 hours (4 days) |
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Describe the fever in Plasmodium vivax |
Tertian fever cycles (48 hours, every third day) |
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Describe the fever in Plasmodium ovale |
Tertian fever cycles (48 hours, every third day) |
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Plasmodium vivax produces _______ ________ in _______ |
Produce dormant hypnozoites in hepatocytes |
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Plasmodium ovale produces _______ ________ in _______ |
Produce dormant hypnozoites in hepatocytes |
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Symptoms of Plasmodium falciparum (3) |
1.
Irregular fever patterns 2. Cerebral malaria 3. Parasitized RBC’s occlude vessels to lungs and kidneys |
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What does Plasmodium falciparum look like on peripheral blood smear? |
Banana shaped |
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Chloroquine mechanism (2) |
1. blocksPlasmodium heme polymerase
2. high resistance against this drug already |
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Primaquine 1. Uses 2. Mechanism/Side effect |
1. Treats P. ovale or P. vivax
2. Destroyshypnozoites in liver (must check for G6PD deficiency or else risk anemia) |
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Mefloquine (2) |
1. goodagainst resistance species of all Plasmodium species
2. also good for prophylaxis for travelers tochloroquine resistant countries |
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Atovaquone and Proguanil combined |
goodfor prophylaxis and treatment for travelers in chloroquine resistant areas for P. vivax and P. ovale |
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How do you treat P. falciparum? (2+) |
artemisins OR Atovaquone/Proguanilcombo |
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How do you severe malaria infections? |
IV artesunate |
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How do you treat super resistant malaria? (Any side effects) |
1. IV Quinidine
2. Cinchonism-whichincludes headaches, tinnitus |
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Pathogenesis of malaria |
Transmitted via anopheles mosquitoes carrying sporozoites insaliva => mature to trophozoites in liver => Schizont divides intomerozoites which burst from hepatocyte and infect RBCs => inside RBC becomestrophozoite => Schizont => Ruptured RBC releasing merozoites => infectother RBC |
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What does malaria look like in RBC?
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Ring form of immature schizont shape in RBC |
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How does malaria spread from one person to another? |
Merozoites can also form gametocytes in RBC to spreadinfection via mosquito bite to other |
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Host of Leishmaniasisbraziliensis |
Vertebrates |
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What disease is caused by Leishmaniasisbraziliensis? |
Cutaneous leishmaniasis |
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Cutaneous leishmaniasis type of disease |
Flesh eating |
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Pathogenesis of Cutaneous leishmaniasis |
sandflyvector carrying promastagote (infective form) => becomes amastogote-intracellular form in macrophages |
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Is Leishmaniasis braziliensis intracellular form? |
Yes |
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What is the vector for Leishmaniasis braziliensis? |
Sandfly |
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How do you treat cutaneousleishmaniasis? |
Stibugluconate |
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What disease is caused by Leishmaniasisdonovani? |
Visceral leishmaniasis |
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Where do you find Leishmaniasis donovani regionally? |
Mediterranean Middle East Africa |
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Features of Leishmaniasis donovani
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1. Black fever, or kala-azar
2. Pancytopenia when bone marrow affectedHepatosplenomegaly |
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How do you treat visceral leishmaniasis? |
Amphotericin B |
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What does Trichomonas vaginalis cause? (2) |
1. Vaginitis
2. Cervicitis |
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Describe the cervix in Trichomonas vaginalis |
Strawberry cervix |
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Symptoms of Trichomonas vaginalis (2) |
1. Burning/itching
2. malodorous Yellow green vaginal discharge |
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How do you diagnose Trichomonas vaginalis? |
Wet-Mount showing motile trophozoites |
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What pH is required for Trichomonas vaginalis? |
Vaginal fluid pH > 4.5 |
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How is Trichomonas vaginalis transmitted? |
STD |
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How do you treat Trichomonas vaginalis? |
Metronidazole |
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What type of parasite is Enterobius vermicularis? |
1. Intestinal nematode
2. Pinworm |
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Pathogenesis/Transmission of Enterobius vermicularis? (3) |
1. Female worms at night lay eggs at the anus
2. Fecal/oral route transmission 3. Repeat infection- itchy, scratch butt, touch mouth |
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How do you test for Enterobius vermicularis?
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Scotch tape test shows eggs under microscope (tape to anusin the morning) |
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How do you treat Enterobius vermicularis? |
1. Pyrantelpamoate or
2. Albendazole |
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What group of people often gets Enterobius vermicularis? |
Children |
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What type of parasite is Ancyclostomaduodenale? |
1. Intestinal nematode
2. Hookworm |
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Where do you find Ancyclostomaduodenale regionally? |
Rural southern US |
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Pathogenesis of Ancyclostomaduodenale |
Hookwormlarvae penetrate skin of soles of feet => blood stream => lungs =>coughed up and swallowed => Small intestines |
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Features of Ancyclostoma duodenale (3) |
1. Iron deficiency anemia
2. Eggs in stool 3. High eosinophil count |
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How do you treat Ancyclostoma duodenale? (2) |
1. Pyrantelpamoate or
2. Albendazole |
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What is Necator americanus similar to? |
Ancyclostoma duodenale |
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What is Ancyclostoma duodenale most similar to? |
Nectar americanus |
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What type of parasite is Ascaroslumbricoides? |
1. Intestinal nematode
2. Giant round worm |
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How is Ascaros lumbricoides transmitted? |
Eatingeggs in contaminated food or water |
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Pathogenesis of Ascaros lumbricoides |
GItract => blood stream => lungs => coughed up => swallowed => GItract (small intestine) |
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Ascaros lumbricoides features (4) |
1. Respiratory symptoms
2. intestinal obstruction at Ileocecal valve 3. Eggs in stool 4. Eosinophilia |
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How do you treat Ascaros lumbricoides? (2) |
1. Treatwith Albendazole (microtubule dysfunction => immotile)
2. don’t give topregnant women instead give Pyrantel pamoate |
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How do you treat Ascaros lumbricoides in pregnant women? |
Pyrantel pamoate |
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How do you contract Strongyloides stercoralis?
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Larvae penetrate skin of soles of feet |
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Type of parasite Strongyloides stercoralis |
1. Intestinal nematode
2. Hookworm |
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Pathogenesis of Strongyloides stercoralis (2) |
1. Hookwormlarvae penetrate skin of soles of feet => blood stream => lungs =>coughed up and swallowed => Small intestines
2. autoinfectionand repeat cycle by repenetrating intestinal wall |
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What is the problem with Strongyloides stercoralis in immunocompromised? |
immunocompromisedcan lead to hyperinfection and dissemination |
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What do you find in the stool in Strongyloides stercoralis and why? |
Eggs layed into intestinal wall so only find larvae instool NOT eggs |
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Do you see eosinophilia with Strongyloides stercoralis infection? |
Yes |
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How do you treat Strongyloides stercoralis? |
1. Albendazole or
2. Ivermerctin |
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How is Trichinella spiralis transmitted? |
Uncooked pork or bear containing cysts |
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Features of Trichinella spiralis (5) |
1. periorbital edema
2. vomiting 3. fever 4. myalgias 5. eosinophilia |
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Pathogenesis of Trichinella spiralis |
Larvaeenter blood stream => striated muscle => larvae form cysts within striatedmuscle => muscle inflammation |
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How do you treat Trichinella spiralis? |
Albendazole |
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How is Dracunulus medinensis transmitted? |
transmittedvia drinking contaminated water with copepods (tiny crustaceans infreshwater/sea-intermediate hosts) containing larvae |
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Pathogenesis of Dracunulus medinensis |
Drink copepods => copepods die => larvae released=> maturation in abdominal cavity => migrate to skin => skin ulcers |
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Dracunulus medinensis Features |
1. Adultfemales emerge from painful ulcer in skin
2. Slowly over days use small stick to ease worm out of skin,sometimes metronidazole can speed up process 3. Eosinophilia |
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How is Onchocerca volvulus transmitted? |
Black flies found around rivers of Africa, Central America, South America |
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Pathogenesis of Onchocerca volvulus |
blackfly deposits larvae via bite into skin => mature into adults => producemicrofilariae |
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Features of Onchocerca volvulus (3) |
1.
Hyper/hypo-pigmented spots occur with onchodermatitis(hypopigmented normally on shins of older patients) 2. Can sometimes float into eye and Microfilariae causeblindness => river blindness 3. Eosinophilia |
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How do you diagnose Onchocerca volvulus? |
Diagnosed by microfilariae seen in skin biopsy undermicroscope |
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How do you treat Onchocerca volvulus? |
Ivermectin |
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Features of Wuchereria bancrofti (3) |
1. elephantiasis – long standing lower extremity lymphedema
2. cough from microfilariae in lungs (hypersensitivityreaction) 3. Eosinophilia |
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How is Wuchereria bancrofti transmitted? |
Mosquitos deposit larvae on skin |
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How do you diagnose Wuchereria bancrofti? |
Thick blood smear |
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How do you treat Wuchereria bancrofti? |
Diethylcarbamazine |
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How is Toxocara canis transmitted? |
Transmitted via food contaminated with dog/cat feces |
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Features of Toxcara canis (3) |
1. circulate in body larva form indefinitely
2. ocular larva migrans => lead to blindness 3. eosinophilia |
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How do you treat Toxocara canis? |
Albendazole |
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Pathogenesis of Loa loa |
Worm migrates through subcutaneous tissue causing transientangioedema called Calibar swellings |
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Features of Loa loa (3) |
1. local subcutaneous swellings
2. Adult worms can migrate across conjunctiva – African eyeworm another name 3. Eosinophilia |
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How is Loa loa diagnosed? |
Blood smear can see Microfilariare |
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How is Loa loa treated? (2) |
1. Diethycarbamazine
2. Albendazole |
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How is Taenia transmitted and what is the general symptom? |
undercookedmeat => GI problems |
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What is the intermediate host for Taenia saginata? |
Cattle |
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What is the intermediate host for Taenia solium? |
Pigs |
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What is the difference between T. saginata and T. solium in appearance? |
Hooks on proglottid heads of T. solium seen on O&P |
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What is the name of the disease caused by Taenia?
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Cysticercosis |
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How does a person acquire Cysticercosis? |
ingestion of taenia eggs contained in contaminated water with animalfeces, lesions anywhere in body |
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What is it called if Taenia infection goes to the brain? |
Neurocysticercosis |
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Cysticercosis symptoms (3) |
1. cystic brain lesions
2. hydrocephalus 3. seizures |
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How does Cysticercosis look like on head CT? |
Swiss cheese on head CT |
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Typical person who gets Cysticercosis (2) |
1. Immigrant
2. Farmer |
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Is it ingestion of eggs, cysts, or larvae that causes Cysticercosis (Taenia)? |
Eggs only |
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What does ingestion of Taenia cysts or lavae cause? |
Taeniasis - usually asymptomatic, but may cause GI problems or malabsorption |
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How do you treat Cysticercosis? |
Treatwith Praziquantel, but add Albendazole if Neurocysticercosis |
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What type of parasite is Diphyllobothriumlatum? |
1. Fish tapeworm
2. Cestodes |
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How do you get Diphyllobothriumlatum? |
Eating undercooked fish |
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Features of Diphyllobothriumlatum (3)
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1. causes diarrhea
2. B12 Cobalamin deficiency 3. Megaloblastic anemia |
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Unique feature of Diphyllobothrium latum
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largesttapeworm that can grow up to 10 m long |
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How do you diagnose Diphyllobothrium latum? |
Proglottid segments seen on stool O&P |
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How do you treat Diphyllobothrium latum? (2) |
1. Treat with Praziquantel or
2. Niclosamide |
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What is the host of Echinococcusgranulosus? 1. Definitive 2. Intermediate |
Dogs are definitive host Sheep are intermediate host |
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How do you get Echinococcusgranulosus? |
Ingest eggs from contaminated food or water with dog feces |
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How does Echinococcusgranulosus appear on CT? |
Egg shell calcifications in cyst on liver |
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What type of cysts do you see on Echinococcusgranulosus? |
Hydatid cysts in liver cyst |
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What is a possible complication of Echinococcusgranulosus? |
Liver Cysts rupture cause an anaphylactic reaction and acute abdomen |
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Do you see Eosinophilia with Echinococcus granulosus? |
Yes |
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What type of parasite is Taenia genus? (2) |
1. Cestodes
2. Tape worm |
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What type of parasite is Echinococcus granulosus? |
1. Cestode
2. Tape worm |
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What type parasite is Schistosoma spp? |
1. Trematode
2. Flukes |
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What type of parasite is Clonorchis sinensis? |
1. Flukes
2. Trematodes |
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What type of parasite is Paragoniumus westermani? |
1. Flukes
2. Trematodes |
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What is another name for Schistosoma infection? |
Swimmer's itch |
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How does Schistosoma enter the person's body? |
Penetrate skin in aquatic environment |
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What is the immediate host of Schistosoma? |
Snails |
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Pathogenesis of Schistosoma |
Blood => mature in liver => migrate against portalblood flow |
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How does Schistosoma mansoni appear on stool O&P? |
Large lateral spine |
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How does Schistosoma japonicum appear on stool O&P? |
small spine on stool O&P (if spine even visible) |
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Schistosoma mansoni symptoms (3) |
1. Portal hypertension
2. Cirrhosis 3. Jaundice |
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Schistosoma japonicum symptoms (3) |
1. Portal hypertension
2. Cirrhosis 3. Jaundice |
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How does Schistosoma haematobium appear on stool O&P? |
Large terminal spine seen on stool O&P |
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Schistosoma haematobium symptoms (2) |
1. Hematuria
2. Bladder cancer |
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Do Schistosomas migrate with or against portal blood flow? |
Against |
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How do you treat Schistosomas? |
Praziquantel |
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Another name for Clonorchis sinesis |
Chinese liver fluke |
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What is the intermediate host of Clonorchis sinensis? |
Snails |
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How do you get Clonorchis sinensis? |
Uncooked fish (sushi) |
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Pathogenesis of Clonorchis sinensis |
Snails => uncooked fish (sushi) => larvae in biliarysystem => biliary tract fibrosis, pigmented gallstones, cholangiocarcinoma |
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Clonorchis sinensis symptoms (3) |
1. Biliary tract fibrosis
2. Pigmented gallstones 3. Cholangiocarcinoma |
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How do you diagnose Clonorchis sinensis? |
Operculated eggs on O&P |
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How do you treat Clonorchis sinensis? |
Praziquantel |
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Paragoniumus westermani is what type of parasite? |
Lung fluke |
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Paragoniumus westermani intermediate host |
snails |
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How do you get Paragoniumus westermani? |
Raw or undercooked crab meet with larvae ingestion |
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How do you diagnose Paragoniumus westermani? |
Operculated eggs on stool O&P |
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How do you treat Paragoniumus westermani? |
Praziquantel |
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Symptom of Paragoniumus westermani |
Chronic cough with bloody sputum |
