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GI 3 > Protozoal infections > Flashcards

Protozoal infections Flashcards

1
Q

protozoa causing bloody diarrhea

A
  • Entamoeba

- Balantidium

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2
Q

symptoms caused by entamoeba histolytic

A
  • bloody diarrhea
  • ulcers
  • liver abscesses
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3
Q

epidemiology of entamoeba

A
  • associated with camping/hikers

- fecal oral transmission - cysts are passed in stool

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4
Q

lifecycle of entamoeba

A
  • only cyst form is infectious
  • ingest cyst, stomach acid erodes cyst leading to growth and invasion
  • trophozoites are the actively replicating form and indicates parasitic infection
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5
Q

pathogenesis of entamoeba

A
  • gastric acid stimulates excystation
  • local necrosis of large intestine
  • destruction of epithelial cells
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6
Q

clinical disease of entamoeba

A
  • ab pain and cramps, colitis, bloody diarrhea
  • weight loss and anorexia
  • liver abscess - flask shaped ulcer, fever, RUQ pain, tenderness
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7
Q

treatment of entamoeba

A
  • non-invasive: paramomycin

- invasive: metronidazole followed by paramomycin

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8
Q

MOA of metronidazole

A
  • destabilizes DNA
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9
Q

epidemiology of balantidium coli

A
  • ciliate: only spp that infects humans
  • fecal oral transmission
  • pigs are reservoirs
  • infection from ingested cysts
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10
Q

clinical disease of balantidium coli

A
  • watery diarrhea WITH blood and pus
  • ab pain, nausea, anorexia
  • secondary bacterial infections of GI mucosa
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11
Q

treatment for balantidium coli

A
  • tetracycline

- metronidazole and iodoquinol are alternatives

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12
Q

epidemiology of giardia

A
  • fecal oral via cysts
  • beavers and muskrats are reservoirs
  • more common in campers and hikers and also in daycares
  • most often transmitted from contaminated water
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13
Q

clinical disease of giardia

A
  • explosive watery diarrhea
  • foul smelling stools
  • ab cramps
  • can progress to malabsorption syndrome - steatorrhea (foul smelling (malodorous), mushy, greasy stool)
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14
Q

diagnosis of giardia

A
  • microscopic examination of stool
  • bilobed nuclei, looks like a horseshoe crab
  • has flagellum
  • falling leaf motility
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15
Q

treatment and prevention of giardia

A
  • treat with metronidazole
  • boil water and treat carriers
  • cysts can survive in chlorinated water
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16
Q

epidemiology of cryptosporidium

A
  • mainly affects children (peak age around 5)

- can be severe in IC patients - lethal in AIDS, #1 cause of AIDS associated diarrhea

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17
Q

pathogenesis of cryptosporidium

A
  • oocyst is infectious form
  • stains acid fast
  • resistant to chlorination
  • water born disease
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18
Q

lifecycle of cryptosporidium

A
  • infects intestinal epithelial cells

- oocyst is infectious and diagnostic form

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19
Q

clinical disease of cryptosporidium

A
  • asymptomatic to severe disease
  • self limited (1-2 wk) enterocolitis
  • watery diarrhea, dehydration, weight loss, ab pain, fever, N/V
  • in AIDS pts, can shit up to 50 times a day
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20
Q

diagnosis of cryptosporidium

A
  • acid fast staining

- pink is positive and green is negative

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21
Q

treatment of cryptosporidium

A
  • replace fluids and electrolytes
  • nitazoxanide for immunoCOMPETENT patients
  • HAART therapy for AIDS patients
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22
Q

epidemiology of isospora belli

A
  • humans are only known reservoir
  • more prevalent in AIDS pts
  • outbreaks are commonly seen in day cares and mental institutions
  • fecal oral: mature oocysts ingested and reside in epithelium
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23
Q

clinical disease of isospora belli

A
  • mimics giardiasis with malabsorption syndrome

- steatorrhea

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24
Q

diagnosis of isospora belli

A
  • oocyst found in feces is elliptical
  • cryptosporidium is round
  • microscopic examination of iodine-stained stool smears
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25
Q

triad for isospora belli diagnosis

A
  • acid fast staining
  • malabsorption
  • watery diarrhea
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26
Q

treatment for isospora belli

A
  • TMP-SMX
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27
Q

characteristics of cyclospora cayetanensis

A
  • resembles cryptosporidium excepts infects immunoCOMPETENT patients
  • explosive watery diarrhea
  • fecal contaminated water or food (raspberries or basil)
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28
Q

clinical disease of cyclospora cayetanensis

A
  • low grade fever, fatigue, anorexia, abdominal pain, N/V
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29
Q

diagnosis of cyclospora cayetanensis

A
  • stains acid-fast

- fluoresces blue under UV light

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30
Q

treatment of cyclospora cayetanensis

A
  • TMP-SMX
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31
Q

latin name for pinworms

A
  • enterobius vermicularis
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32
Q

common name for enterobius vermicularis

A
  • pinworm
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33
Q

transmission of enterobius vermicularis (pinworm)

A
  • fecal oral
  • eggs are “sticky”
  • eggs can be transmitted on fomites
  • autoinfection occurs
  • common in children 5-9 years old
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34
Q

clinical disease of enterobius vermicularis (pinworm)

A
  • intense perianal itching at night
  • prickling pain
  • diarrhea during acute infection
  • migrating worms may get lost: vaginal itching and granuloma formation
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35
Q

diagnosis of enterobius vermicularis (pinworm)

A
  • cellophane (scotch) tape method

- only used for this type of worm

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36
Q

treatment for enterobius vermicularis (pinworm)

A
  • mebendazole
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37
Q

latin name for roundworms

A
  • ascaris lumbricoides
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38
Q

common name for ascaris lumbricoides

A
  • roundworm
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39
Q

transmission of ascaris lumbricoides (roundworm)

A
  • fecal oral
  • contaminated food or water
  • eggs can survive for months
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40
Q

lifecycle of ascaris lumbricoides (roundworm)

A
  • ingest egg

- egg hatches and travels to liver, heart, lungs, etc.

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41
Q

clinical disease for ascaris lumbricoides (roundworm)

A
  • dependent on number of eggs
  • few eggs - asymptomatic
  • early phase: large migrate to lungs producing fever, nonproductive cough, dyspnea, wheezing
  • late phase: diffuse or epigastric pain, N/V, bolus can obstruct and perforate bowel
  • can be lethal
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42
Q

diagnosis of ascaris lumbricoides (roundworm)

A
  • CBC may show eosinophilia
  • sputum may show larvae
  • eggs in stool: knobby coated, oval shaped, bile stained
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43
Q

treatment for ascaris lumbricoides (roundworm)

A
  • albendazole

- if pregnant then use pyrantel pamoate

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44
Q

toxocariasis (roundworm)

A
  • dog and cat roundworms
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45
Q

symptoms of toxocariasis (roundworm)

A
  • larvae can penetrate any tissue: lungs, heart, liver, kidney, skeletal muscle, eyes, CNS is most common
  • bleeding, necrosis, eosinophilic granulomas
46
Q

diagnosis of toxocariasis

A
  • eggs found in pet feces

- eggs NOT found in human feces

47
Q

treatment for toxocariasis

A
  • albendazole
48
Q

latin name for whipworm

A
  • trichuris trichiura
49
Q
  • transmission of trichuris trichiura (whipworm)
A
  • fecal oral

- prevalent in southern appalachian range and gulf coast states

50
Q

clinical disease of trichuris trichiura (whipworm)

A
  • light infections (100): ab pain, vomiting, anorexia, weight loss, diarrhea (can be bloody), tenesmus, rectal prolapse
51
Q

diagnosis of trichuris trichiura

A
  • barrel (football) shaped eggs, plugged ends

- RBC and WBC present

52
Q

treatment of trichuris trichiura

A
  • albendazole
53
Q

latin name for hookworms

A
  • ancylostoma duodenale

- necator americanus

54
Q

epidemiology of hookworms (N. americanus)

A
  • penetrate into feet

- go to lymphatics, blood, heart, lungs, cough them up and then swallow into GI tract

55
Q

early symptoms of hookworms (N. americanus)

A
  • itching, localized maculopapular eruption on foot
  • low grade fever
  • mild cough, wheezing when worm in lungs
56
Q

late symptoms of hookworms (N. americanus)

A
  • N/V, diarrhea
  • microcytic and hypochromic anemia
  • fatigue and dyspnea
57
Q

chronic disease of hookworms (N. americanus)

A
  • emaciation, physical and mental retardation
58
Q

diagnosis of hookworms (N. americanus)

A
  • early infection: eosinophilia, normal stool
  • patchy infiltrate on chest X-ray (migrating larvae)
  • GI infection: non-bile stained, segmented eggs in stool
  • iron deficiency anemia
59
Q

treatment of hookworms

A
  • abdendazole

- iron therapy for anemia

60
Q

anclyostoma braziliense (hookworm)

A
  • dog and cat hookworm

- humans are accidental hosts

61
Q

clinical disease of anclyostoma braziliense

A
  • cutaneous larval migrans: ground itch, creeping eruption
  • Loeffler syndrome: pulmonary infiltrates with peripheral eosinophilia
  • at risk: children (sandboxes), beaches
62
Q

treatment for anclyostoma braziliense

A
  • thiabendazole
63
Q

worm infections where humans are accidental hosts

A
  • toxocariasis: dog and cat roundworms

- anclyostoma brazilense: dog and cat hookworm

64
Q

latin name for threadworm

A
  • strongyloides stercoralis
65
Q

common name for strongyloides stercoralis

A
  • threadworm
66
Q

clinical disease of strongyloides stercoralis (threadworm)

A
  • pneumonitis similar to hookworm
  • occur in IC patients
  • diarrhea can be bloody, malabsorption
  • symptoms like peptic ulcer, peripheral eosinophilia
67
Q

chronic infection of strongyloides stercoralis (threadworm)

A
  • hyperinfection syndrome: profound diarrhea, malabsorption, electrolyte imbalance, meningitis, secondary bacteremia
  • seen in IC patients
68
Q

diagnosis of strongyloides stercoralis (threadworm)

A
  • Baermann funnel gauze method
69
Q

treatment of strongyloies stercoralis (threadworm)

A
  • ivermectin
70
Q

reservoir of trichinella spiralis

A
  • pork, undercooked bear meat

- larvae form found in striated muscle

71
Q

clinical disease of trichinella spiralis

A
  • acute stage: larvae invade tissue: fever, diffuse myalgias, eosinophilia, periorbital edema
  • late stage: lethal when heart, brain and lungs infected
72
Q

diagnosis of trichinella spiralis

A
  • outbreak traced to infected pork or beat meat
  • encysted larvae in meat or muscle biopsy
  • pt presents with diffuse muscle pain- diffuse myalgias
  • CBC - marked eosinophilia
73
Q

treatment of trichinella spiralis

A
  • albendazole
74
Q

transmission of anisakis simplex

A
  • roundworm of marine fish

- higher incidence where raw fish is eaten

75
Q

clinical disease of anisakis simplex

A
  • within hours after ingested of undercooked (raw) fish
  • violent ab pain, N/V
  • severe eosinophilic granulomatous response if larvae pass into bowel
  • can mimic Crohns
76
Q

hosts for all flukes

A
  • all flukes have clam or snail intermediate hosts
77
Q

characteristics of fluke eggs

A
  • all flukes (and tapeworms) have operculated eggs
78
Q

latin name for giant intestinal fluke

A
  • fasciolopsis buski
79
Q

common name for fasciolopsis buski

A
  • giant intestinal fluke
80
Q

epidemiology of giant intestinal fluke

A
  • ingestion of contaminated water chestnuts
  • look like leeches or tiny tadpoles
  • travelers from china, vietnam, thailand, india, malaysia
81
Q

clinical disease of giant intestinal fluke (fasciolopsis buski)

A
  • diarrhea alternating with constipation

- malabsorption syndrome with malodorous, greasy stools

82
Q

diagnosis of giant intestinal fluke

A
  • large, bile stained, operculated eggs in stool
83
Q

treatment of giant intestinal flukes (fasciolopsis buski)

A
  • praziquantel
84
Q

latin name for sheep liver fluke

A
  • fasciola hepatica
85
Q

transmission of sheep liver fluke

A
  • infection from contaminated water plants
86
Q

clinical disease of sheep liver fluke (fasciola hepatica)

A
  • URQ pain, fever, chills, eosinophilia, hepatitis, biliary obstruction
87
Q

treatment of fasciola hepatica

A
  • bithionol
88
Q

latin name for chinese liver fluke

A
  • clonorchis sinensis
89
Q

transmission of chinese liver fluke

A
  • consumption of undercooked freshwater fish
90
Q

clinical disease of clonorchis sinensis

A
  • fever, diarrhea, epigastric pain, hepatomegaly, anorexia, jaundice
91
Q

treatment of clonorchis sinensis

A
  • praziquantel
92
Q

3 main species of schistosomes

A
  • Schistosoma haematobium (bladder): terminal spine
  • S. japonicum (bowel)
  • S. manosin (bowel): lateral spine
93
Q

transmission of schistosomes

A
  • penetrate skin when swimming, burrow in and cause itching (swimmers itch)
94
Q

clinical disease of schistosomes

A
  • acute (Katayama syndrome): swimmers itch, fever, chills, cough, urticaria, ab pain, diarrhea, eosinophilia
  • chronic: granulomatous reactions and fibrosis, bloody diarrhea (S. mansoni mostly), associated with clay pipestem fibrosis around portal vein
95
Q

diagnosis of schistosomes

A
  • leukocytosis, eosinophilia, polyclonal gammopathy
  • S. mansoni: egg larva is oval shape and curved anterior end with lateral spine, found in stool
  • S. japonicum: smallest eggs, oval shaped, spine not distint, found in stool
  • S. haematobium: terminal spine, large egg, found in urine
96
Q

treatment of schistosomes

A
  • praziquantel
97
Q

general characteristics of cestodes (tapeworms)

A
  • flat and ribbon like
  • head has cup shaped suckers and hooks
  • segmented bodies: proglottids
  • eggs in feces are diagnostic
  • all eggs are operculated
98
Q

epidemiology, transmission, and clinical disease of Taenia solium (pork tapeworm)

A
  • undercooked pork
  • in larvae ingested in meat: mostly GI symptoms - ab discomfort, diarrhea, indigestion
  • cystericercosis is dangerous - eggs ingested in contaminated water, vegetables
99
Q

diagnosis of taenia solium

A
  • proglottids and eggs in feces
100
Q
  • treatment of taenia solium
A
  • praziquantel
101
Q

symptoms of neurocystericercosis

A
  • hydroencephalitis, mengitis, nerve damage, seizures, visual defects
102
Q

diagnosis of neurocystericercosis

A
  • imaging studies for calcified cysticeri

- (CT,MRI) - big calcified cysts seen on MRI

103
Q

treatment for neurocystericercosis

A
  • praziquantel, albendazole

- steroids, surgery

104
Q

latin name for beef tapeworm

A
  • taenia saginata
  • does not cause neurocystericercosis in humans
  • diagnosis and treatment identical to T. solium infection
105
Q

latin name for fish tapeworm

A
  • diphyllobothrium latum
106
Q

transmission and reservoir of fish tapeworms

A
  • undercooked freshwater fish

- wild animal reservoirs: bears, minks, walruses, canine

107
Q

clinical disease of fish tapeworms

A
  • most are asymptomatic
  • associated with depleted serum vitamin B12
  • megaloblastic anemia, neurological manifestations: painful tingling, fatigue, weakness, loss of coordination, confusion, weight loss
108
Q

treatment of fish tapeworm

A
  • niclosamide
  • praziquantel alternative
  • vitamin B12 supplementation
109
Q

Echinococcus spp.

A
  • tapeworms of carnivores in sheep-raising areas

- humans are intermediate hosts

110
Q

clinical disease of echinococcus spp.

A
  • hydatid cyst disease
  • liver and lung where cysts develop: ab pain, hepatic mass, bile duct obstruction
  • lungs: chest pain, cough, hemoptysis
  • death from anaphylactic shock after rupture of cysts
111
Q

diagnosis of echinococcus spp.

A
  • CBC- eosinophilia

- X-rays for cysts in lungs, bone and muscle

112
Q

treatment for echinococus

A
  • surgery

- albendazole and mebendazole are DOCs

GI 3 (12 decks)

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