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Senior - ID 3 > 16 - Protozoal Infections > Flashcards

16 - Protozoal Infections Flashcards

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1
Q

What are protoza?

A 
Highly motile
Unicellular eukaryotes
Predatory/parasitic
Move by cilia, flagella or ameboid motion
Aquatic or terrestrial
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2
Q

Protozoal infections?

A
  • Amebiasis
  • Giardiasis
  • Leishmaniasis
  • Cryptosporidiosis
  • Babesiosis
  • Malaria
  • Toxoplasmosis
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3
Q

Enatomebia histolytica causes?

A

Intestinal and extraintestinal infections

  • Amebic liver abscess
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4
Q

Who gets amebic liver abscess?

A

Men: 7-12x more likely

10% of the world’s pop

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5
Q

Pathyphysiology of amebiasis?

A

Lytic effect on tissue
- histo”lytic”a

Induces self-destruction
- trophozoite colonizes the colon
- invades the intestinal mucosal barrier
- gains access to the circulation
(Commonly infects liver and lung)
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6
Q

Amebic colitis s/s?

A

Weeks of

  • abd pain
  • diarrhea
  • blood stools
Fever (uncommon)
Wt loss w volume depletion
Fulminant colitis
Rectovaginal fistulas
Fulminant or necrotizing colitis
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7
Q

Fulminant or nectorizing colitis mortality?

A

0.5% of pts w amebic colitis

But 40% mortality

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8
Q

Who is more prone to amebic colitis?

A

Poor nutrition
Corticosteroids
Pregnancy
Very young

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9
Q

S/s of amebiac liver abscess?

A

1-2 week hx

  • fever (unlike colitis)
  • RUQ (abdominal pain)

Single abscess - subacute presentation

  • prominent wt loss
  • usually no fever
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10
Q

Amebic liver pts usually have a hx of?

A

Dysentery in the last yr

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11
Q

amebic colitis PE

A

Fever (30%)
Wt loss (40%)
Diffuse abd tenderness
Heme pos stools

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12
Q

Amebic liver abscess PE

A 
Fever (90%)
RUQ tenderness (90%)
Wt loss (50%)
Hepatomegaly (50%)
Jaundice (10%)
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13
Q

Test of choice for amebiasis?

A

PCR

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14
Q

Other labs and imaging for amebiasis?

A 
Stool exam (traditional method)
Stool antigen detection (EIA)
Stool O and P
US - homogenous hypoechoic round lesion
CT scan
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15
Q

Ddx for amebiasis?

A 
Abdominal abscess
Campylobacter
Diverticulitis
IBD
Salmonellosis
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16
Q

Tx for amebiasis?

A

Metronidazol
Tinidazole
Iodoquinol (yodoxin) luminal agent
Paromomycin (humatin) luminal agent

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17
Q

Surgery for amebiasis?

A

Used for fulminant amebic colitis

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18
Q

MC parasite identified in stool specimens in the US?

A

G. Lamblia

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19
Q

Asymptomatic carriage with giardiasis?

A

Asymptomatic carriage rate 3-7%

Can persist for months

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20
Q

What badness does giardiasis cause?

A

Malabsorption

  • alters epithelial structure/function
  • villous atrophy
  • distorted microvilli at attachment site
  • releases cytopathic substances

*mechanism not fully understood

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21
Q

S/s of giardiasis

A 
– Vomiting 
– Low-grade fever (infrequent) 
– Various neurologic Sx
• Irritability
• Sleep disorder
• Mental depression
• Neuroasthenia – Urticaria
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22
Q

S/s of giardiasis in children?

A 
– SX in children -- 40-80%
• Diarrhea 
• Malaise/weakness 
• Abdominal distention 
• Flatulence 
• Abdominal cramps 
• Nausea 
• Malodorous greasy
stools 
• Anorexia 
• Weight loss
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23
Q

PE for giardiasis?

A

Usually nothing

Kids have generalized abd tenderness sometimes

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24
Q

tests for giardiasis?

A

PCR - test of choice
- can also do Enteric parasite panel (EPP)

Stool exam (trophozites/cysts)
Stool EIA
Entero-test/duodenal biopsy (alternate test)
X-ray (non-diagnostic)

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25
Ddx for giardiasis?
- Crohns disease - Cryptosporidosis - IBS - Malabsorption - Sprue
26
Tx of giardiasis
Tinidazole Metronidazol * may resolve spontaneously
27
Where is leishmaniasis found?
88 countries - tropics/subtropics - rainforest - C. And S. America - W. Asia
28
90% of visceral leishmaniasis is found in?
``` India Nepal Bangladesh Sudan Brazi; ```
29
Leishmaniasis is divided into?
Cutaneous form Mucocutaneous Visceral Viscerotropic
30
Leishmaniasis cutaneous includes?
- localized - diffuse - leishmaniasis recidivans - post-kala-azar dermal leishmaniasis
31
How is leishmaniasis spread?
Vector-borne disease Zoonosis - sandflys
32
Leishmaniasis is a?
Obligate intracellular protozoa | - leishmania
33
2 main forms of leishmaniasis?
Cutaneous leishmaniasis Visceral leishmaniasis (kala-azar)
34
What factors determine the form of the disease?
Leishmania species Geographic location Immune response of the host
35
Cutaneous leishmaniasis s/s?
``` Lesions at feeding site 1+ sores Change in size/appearance over time Raised edge and central crater Possible crust/scab Painless (normally) Painful (2ndary infection) Regional lymphadenopathy ```
36
Visceral (kala-azar or black fever) s/s?
``` Systemic infection (liver/spleen/bone marrow) - recurrent high fevers - wt loss - splenomegaly/hepatomegaly - post kala-azar dermal leishmaniasis - opportunistic (HIV) ```
37
Splenomegaly with leishmaniasis?
Spleen can be bigger than lier
38
PE for cutaneous leishmaniasis?
``` Systemic signs absent Small red papule (2cm) - ulcerates - found on exposed areas of skin Regional adenopathy Satellite lesions Subq nodule (possible) ```
39
Visceral leishmaniasis physical exam
- bouts of fever - hepatosplenomegaly - wasting/weakness - darkening of skin - diarrhea - pancytopenia
40
Characteristic finding of visceral leishmaniasis?
Darkening of the skin
41
Labs and imaging of leishmaniasis?
Isolation form tissue Serology - (not cutaneous) ELISA Culture Cutaneous made by appearance
42
MC leishmaniasis diagnostic tool?
Isolation of organism from tissue | - giemsa-stained slides of the relevant tissue
43
Ddx for leishmaniasis?
Basal cell carcinoma Impetigo Malaria
44
Definition of mild leishmoniasis?
<4 lesions None are - > 5cm - cosmetically sensitive areas - not in joints
45
Mild disease tx?
Paromomycin ung (investigational drug) LN2 (consultation w ID services) May spontaneous resolve in 6 mo Slide 48 (doesnt make sense)
46
Who gets aggressive therapy (leishmoniasis)
- Face lesion - not healing (months) - joint involvement - hand and feet (secondary infection likely) - local dissemination - immunocompromised host - 5-10 lesions - >4-5cm
47
Tx of leishmaniasis?
``` Sodium stibogluconate (pentostam U.K.) - hard to get/not FDA approved (CDC) Meglumine antimoniate (glucantime France) - not in US Liposomal amphotericin B (AmBisome) Impavido (miltefosine) p.o. Fluconazole (cutaneous) ThermoMed Radio freq heat ```
48
Who is most likely to get cryptosporidiosis?
Kids 1-5 yrs | HIV/AIDS
49
Mortality rate for cryptosporidiosis?
Usually its aids pts (50%)
50
Cryptosporidiosis is?
Cryptosporidium parvum, hominis
51
Infection rate with cryptosporidiosis?
Highly infections - oocysts are very resistant - only need a small dose
52
Cryptosporidiosis is found?
Water | - even chlorinated water
53
Where in the body does cryptosporidiosis infect?
Healthy pax: - jejunum AIDS: - whole gi tract
54
Why does cryptosporidiosis cause diarrhea?
We dont know Malabsorption maybe
55
S/s of cryptosporidiosis (besides asymptomatic)
``` Watery diarrhea Occasional pancreatic involvement Wt loss Abd pain Fever (low grade) N/V ``` Short lived in healthy Not so in CD4 <200
56
Cryptosporidiosis PE?
Non-specific GI findings - abd tenderness - - RUQ - - Epigastric tenderness - hyperactive bowel sounds - icterus (rare) - ascites (rare)
57
Labs for cryptosporidiosis?
EPP, PCR (preferred) - GI biopsy - EIA available New tests are able to ID species
58
___ is not indicated with cryptosporidiosis?
Imaging studies
59
Ddx for crypto?
- amebiasis - campy - choledocholithiasis - cholelithiasis - giardiasis
60
Tx for crypto?
Immunocompetent - no therapy req - nitazoxanide (maybe) - symptomatic care Immunocompromised - HAART therapy (Abx and antimicrobials are not effective)
61
What causes babesiosis?
B. Divergens | B. Microti
62
Where is babesiosis found?
US: - long island NY - nantucket/marthas vineyard MA World - europe and asia
63
Babesiosis is aka?
Tick-borne “malarialike” illness
64
Clinical sx form babesiosis is?
2/2 parasitism of RBCs Capillary blockage/microvascular stasis RBC fragments involve - spleen - kidney - CNS - Liver
65
Babesiosis S/S
``` Fatigue - hemolytic anemia Fever Same symptoms as malaria - chills -> fever -> diaphoresis -> prostration - malarial paroxysm ``` S/s are related to the degree of RBC parasitemia
66
S/s of babesiosis are more sever if?
``` Hx of splenectomy - more fulminany - prolonged clinical course - overwheliming infection - fatal outcome Elderly/immunospuuressed Transmitted in utero ```
67
Which is of the babesiosis is more severe?
B. Divergens >> B. Microti
68
PE for babesiosis?
Few Minority get - jaundice - spelnomegaly
69
Babesiosis labs and imaging
``` Wright or giemsa stain Serology CBC ESR elevated LFTs mild elevation ```
70
Ddx for babesiosis?
Malaria Lyme disease Rocky mountain spotted fever
71
Tx for babesiosis
- Atovaquone (Mepron) + azithromycin (Zithromax) – Clindamycin (Cleocin) + quinine (Formula Q) • Preferred regimen for severe babesiosis – Supportive therapy – Severe patients • Hospitalization – Exchange transfusion may be considered
72
In wine there is wisdom, in beer there is freedom in water there is bacteria
- banjamin franklin

Senior - ID 3 (11 decks)

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