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Kat's Pathology > Parasitology > Flashcards

Parasitology Flashcards

1
Q

4 year old white British girl. Systemically well, but waking at night for past month. Grabbing at underwear, perianal scratching.
No foreign travel. Recently started at a new pre-school.
Stools - ova, cysts and parasites negative x 3.

What parasite is causing her symptoms?

A

Enterobius vermicularis - threadworm.

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2
Q

What is enterobius vermicularis (threadworm)

A

A roundworm (nematode)

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3
Q

What is the route of transmission of enterobius vermicularis.

A

Faeco-oral

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4
Q

Who is most often affected by enterbius vermicularis.

A

Young children (and their families)

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5
Q

What are the most common signs of enterobius vermicularis infection. (2)

A

Itching.

Sleep disturbances.

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6
Q

Why is enterobius vermicularis hard to get rid of.

A

Auto-infection occurs frequently - infection can continue for a while.

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7
Q

How do you diagnose enterobius vermicularis?

A

Sellotape slide test for eggs.

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8
Q

What is the treatment for enterobius vermicularis. (2)

A

Hygiene measures.

Mebendazole x 2.

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9
Q

17 year old student - white British male. Blue light call - collapsed during a rugby match. Tachycardic, hypotensive and flushed. Wheezy, urticarial rash.
No foreign travel, grew up in rural Wales.

What is the most likely parasite responsible?

A

Echinococcus granulosus (cestode)

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10
Q

What are the principle carriers of echinococcus granulosus? (2)

A

Tapeworm in dogs.

Cysts in sheep.

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11
Q

What is characteristic of hydatid disease.

A

Usually liver cysts, but can also be elsewhere in the body.

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12
Q

What are the usual symptoms of hydatid disease (2).

A

Abdominal discomfort.

Biliary obstruction.

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13
Q

When is hydatid disease usually diagnosed?

A

Usually incidentally.

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14
Q

What causes an acute presentation for hydatid disease.

A

Rupture of the cysts - potentially causes anaphylaxis.

Contact sports make rupture more likely.

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15
Q

What are the treatment options for hydatid disease. (3)

A

Long term - albendazole/praziquantel.
Aspirate and inject cysts.
Surgical removal of cysts.

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16
Q

32 year old white Births woman. Claims she found a worm in the toilet. Panicked and flushed - no pictures.
No symptoms, examination is normal.
routine bloods including eosinophils are normal.
Stool - first sample negative for ova, cysts and parasites.
Foreign travel - spent the previous summer volunteering for an aid agency in Timor-Leste.

What is the most likely causative parasite?

A

Ascaris lumbricoides.

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17
Q

What type of parasite is ascaris lumbricoides?

A

A roundworm (nematode)

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18
Q

What is the route of transmission of ascaris lumbricoides.

A

Faeco-oral transmission.

However, also needs time in soil.

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19
Q

How many people are infected with ascaris lumbricoides worldwide.

A

1 billion.

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20
Q

When do symptoms develop in a patient infected with ascaris lumbricoides.

A

When the worm burden is high.

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21
Q

What is the treatment for ascaris lumbricoides? (2)

A

Medical therapy is usually fine.

Surgery may be required if worm burden is high or causing intestinal obstruction.

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22
Q

27 year old female. Normally fit and well. Itchy and painful rash on her foot. Just come back from a Caribbean holiday.

What is this condition?

A

Cutaneous larva migrans

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23
Q

What is cutaneous larva migrans usually caused by.

A

Animal hookworm (e.g. ancyclostoma braziliense)

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24
Q

What is the life cycle of animal hookworm infection?

A

Worm cannot go beyond the subcutaneous tissues - will die there.

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25
Q

What is the treatment for cutaneous larva migrans.

A

Ivermectin speeds up death of worm.

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26
Q

44 year old Somali male - UK resident for 15 years. Last travelled to Somalia 8 years ago. Referral from Dermatology. Long history of severe eczema. Chronic eosinophilia (0.7), otherwise well.

What is the most likely causative parasite?

A

Strongyloides stercoralis.

27
Q

55 year old Indian male - UK resident for 25 years. Last travelled to India 5 years previously. Relapsed AML following stem cell allograft. Graft versus host disease - high dose steroids given.
In extremis.
Intubated and ventilated - high oxygen requirement.
Patchy consolidation in both lung fields. Pancytopaenia (including eosinophils)
Blood culture shows: E.coli, VRE.
CSF shows E.coli.

What is the most likely causative parasite?

A

Strongyloides stercoralis.

28
Q

What is strongyloides stercoralis?

A

A roundworm (nematode)

29
Q

What is the route of infection of stronglyloides stercoralis.

A

Invades through the skin like hookworm.

30
Q

How is stronglyloides stercoralis diagnosed (2)

A

Stool or serology.

31
Q

Why is strongyloides stercoralis difficult to treat.

A

Auto-infection common - can last a lifetime.

32
Q

What are the symptoms of stronglyoides stercoralis? (4)

A

Asymptomatic often.
Milk GI symptoms.
Skin rash due to larva current.
Stronglyloids hyper infestation syndrome.

33
Q

What is Stronglyoides hyper infestation syndrome (4)

A

Bowel breakdown - gut bacteria spread everywhere.
Meningitis/encephalitis.
Lung disease.
Death.

34
Q

Who is prone to stronglyoides hyper infestation syndrome. (3)

A

HTLV-1.
Steroids.
Biologics - infliximab, entancercept.

35
Q

What is the treatment for strongyloides hyper infestation syndrome.

A

Ivermectin x 2.

36
Q

When does stronglyloides hyperinfestation syndrome occur.

A

When the immune system fails.

37
Q

44 year old Egyptian male - recently moved to the UK. Normally fit and well. Several months of terminal haematuria. Otherwise well, nil on examination.
Eosinophils 0.6.

What is the most likely causative parasite?

A

Schistosomiasis.

38
Q

22 year old white British medical student. Acutely unwell. Cough, wheeze, fevers, abdominal pain, uriticarial rash. No history of allergies or asthma. Raised inflammatory markers. Eosinophils 0.8.
Came back from an elective in Malawi a months ago.

What is the most likely causative parasite?

A

Schistosomiasis.

39
Q

What is schistosomiasis/

A

A fluke (trematode)

40
Q

Where is schistosomiasis found (geographically).

A

All over the tropics.

Now also in Corsica.

41
Q

What are some species of schistosomiasis. (3)

A

S.mansoni.
S.japanicum.
S.haematobium.

42
Q

Where does schistosomiasis live outside humans.

A

Water snails.

43
Q

How does schistosomiasis infect humans.

A

Invades through the skin.

44
Q

Where does schistosomiasis live in humans. (3)

A

Majority of species set up in the colon and liver.

S.haematobium sets up in the bladder.

45
Q

Why does schistosomiasis cause respiratory symptoms.

A

Adult worms migrate via lungs.

Katayama fever - cough, wheeze, urticaria, eosinophilia.

46
Q

How is schistosomiasis diagnosed? (2)

A

Eggs in stool sample.
Serology.

Diagnosis is subject to window period.

47
Q

What is the treatment for schistosomiasis infection.

A

Praziquantel (window period)

48
Q

How can you avoid catching schistosomiasis. (3)

A

Don’t go in the water!
Wellies.
Boats.

Eradication is possible.

49
Q

8 year old Indian boy. Unwell for several months: fatigue, fevers, weight loss, abdominal swelling.
Pancytopaenia (including eosinophilia)
Stool - ova, cysts and parasites negative x 3.

What is the most likely parasite?

A

Leishmaniasis.

50
Q

What is leishmaniasis.

A

Prokaryotic parasite.

51
Q

How does leishmaniasis spread.

A

Sandflies.

52
Q

What are the two main ways that leishmaniasis presents.

A

Cutaneous.

Visceral (‘kala azar’)

53
Q

32 year old white Births male. Normally fit and well.
Several day history: unwell, fevers, headache, red rash on arms.
Wildlife cameraman. Recently filming in southern Tanzania.

What is the most likely parasite?

A

Trypanasomiasis.

54
Q

Where is trypanosomiasis found. (2)

A

East Africa.

West Africa.

55
Q

What are the two different aetiologies of trypanosomiasis infection? (2)

A

East Africa - aggressive, fulminant infection with a mortality of 100% if left untreated.

West Africa - known as ‘sleeping sickness’ and presents months to years later.

56
Q

19 year old black Births female. Referred by GP - ‘something moved across my eye’.
Complains of flitting swellings at her wrists and elbows.
Eosinophilia 0.4.
First stool negative for ova, cysts, and parasites.
Spent the summer with her family in rural Camaroon.

What is the most likely parasite?

A

Loa loa.

57
Q

How is loa loa diagnosed? (3)

A

Calabar swellings - indicate worm migration.
Blood film for microfilariae.
You may actually see the worm in a patients eye.

58
Q

45 year old white British female. Long history of symptoms - assiduously documented. Itchy skin.
Worms coming out through skin - notices them in the bath.
Examination of skin and clothing normal.
Esinophils 0.2.
Stool - negative for ova, cysts and parasites x 3.
Further stool sample brought to clinic.

What parasite is causing her symptoms?

A

Delusional parasitosis.

59
Q

What is delusional parasitosis.

A

When you do not have a parasitic infection, but strongly believe that you do, regardless of negative tests.

60
Q

What are the telltale signs of delusional parasitosis. (4)

A

Documentation.
Unsolicited samples.
Matchbox sign (or never producing evidence)
Extreme measures to get rid of infection.

61
Q

What is the treatment for delusions parasitosis.

A

Referral to psychiatry.

62
Q

19 year old white Births male. Small painful lump on the right side of his abdomen. Feels well, but creeped out…because he’s sure he’s seen it move.
Recently returned from his ‘gap yah dahling’
Backpacking around South America.

What is under his skin?

A

Tumbu and Bot flies.

63
Q

How are bot flies picked up? (3)

A

Eggs are laid on clothing.
Larvae hatch from eggs.
Larvae find somewhere warm to live (i.e. burrow into your skin).

64
Q

How are bot flies removed?

A

A pair of tweezers certainly help.

Kat's Pathology (105 decks)

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