Cough from the Tropics Flashcards Preview

Respiratory 2 > Cough from the Tropics > Flashcards

Flashcards in Cough from the Tropics Deck (16):
1

Best test for parasites

CBC looking for eosinophilia

WBC will also be pretty high

IgE modestly elevated

2

Esosinophilia causes

Allergy and asthma

Vasculitis

Certain infections (fungi (coccy), parasites

Malginancy (lymphoid, Hodgkins)

Adrenal insufficiency

Cholesterol embolism sx

3

PIE syndromes

Pulmonary infiltrates and eosinophilia

Speific infection including parasites

Drug-induced lung dz but NOT HS pneumonitis***


4

TB support and against

Primary sx include cough, dyspnea, and WL...may or may not have hemoptysis

CAN be trnasmitted to others

Chronic

Radiographic variation

NO fever, wheezing, or eosinophilia

5

Histoplasmosis and coccidio and eosinophilia

NOT a fature unless adrenal involvement with hypoadenalism present

Yes, coccidio...most common fungal but exposure not expected in KY

6

Milirary patterns

Histo, blasto, TB

Do NOT just assume they have TB

7

Allergic asthma

Hodgkins

Churg-Strauss

Lower degree of esoinio...NO miliary pattern

Radiography shows thoracic adenopathy and NOT miliary pattern

Think sinus problems....Multisys vasculitis...will have extr-pulmonary dz...fever and weight loss common...most have asthma

8

TB
Ascaris
Paragonimus
Filariasis

Slowly progressive

Acquiring a GI parasite by fecal oral route that is benign and self-limited

Acquiring a pulm parasite by ingesting contaminated sushi that is chronic

Lymphatic pathogen by insect bite..large scrotum

9

Ascaris

Most 1 billion

Acquireed through ingestion of eggs

Migration of larvae through lungs may produce transient pulm sx...radiographic opacitis and eosinophilia (Loeffler's)

Worms die and unless re-infected, pulm findings disappear

Hookworm similar except route is dermal penetratioon

10

Strongyloidea

Helminth through dermal penetration by larva

Can survive in chronic state of parasitism due to autoinfection...eosinophilia and a lifelong frined

COmpromised immunity can lead to hyperinfection where they migrate and can cause polymicrobial bacterial sepsis

Eosinophilia may be absent with steroids

Present throughout tropics, subtropics, and endemic to appalachia

Dx via ELISA

11

Echinococcosis

LIvestock and canines

Acquired via ingestion of eggs

Cysts that have mass effect (liver more than any other)

Contain multiple protoscolices

Cyst rupture can produce anaphylaxis and other acute manifestation (massive effusions or biliary obstruction)

Alveolar echinoccocis is often fatal if untreated

12

Paragonimiasis

Acquired via ingestion of raw or undercooked shellfish

Adults get cysts, producing pneumonic infiltrates, cavities, and pleural efusions

Hemoptysis - mimics TB

Differences is eosionophilia

13

Lymphatic filariasis

Most in INdia, Nigeria, Bangladesh and indonesia

Mosquito bite transmission

Adult worms in lymphatic vessels, large parasite burdens may produce obstruction and elephantiasis of geninal and lower extremities

Microfilariae migrate at night in blood stream to coincide with peak mosquito feeding

NOT pitting edema, but "doughy"

14

TPE

Think south asians

HS response ot migrating microfilariae due to Wuchereria bancroft and brugai malagy

.5% of infected pts

Sx begin as wheezing, cough and dyspnea worse at night (like asthma)

Fever, malaise and WL uncommon

Profound blood eosionphilia

Reticulonodular or miliary opactics in mid and lower lung zones

May lead to pulm HTN with granulomatous vasculitis becoming fribortic (and fatal) if untreated)

15

TPE dx and tx

Eosinophilia above 3,000 cells?mm^3

Appropriate exposure (mos in endmic area)

High anti-filarial ABs

Paradoxial lack of microfilariae in blood (cleared quick)

Response to tx

Diethylcarbamazine for 21 days

16

Toxocara canis

Fecal-oral route from infected dogs

Eggs hatch and migrate through lungs

Impressively high eosinophilia and IgE levels

Most often children 1-5

Tissue biopsy or ELISA...never by stool studies