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Clinical Medicine Lecture - Professor Kramer > Infectious Disease - Helminth Infestations 2 > Flashcards

Infectious Disease - Helminth Infestations 2 Flashcards

(75 cards)

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1
Q

Amebiasis patho?

A

Cysts of Entamoeba are viable in the soil and water for weeks to months

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2
Q

Most pathogenic organism for Entamoeba?

A

Entamoeba histolytica most pathogenic

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3
Q

Entamoeba transmission to humans via?

A

fecally contaminated food or water

fly droppings

human-to-human contact

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4
Q

Amebiasis: once ingest, cysts pass through the investing where they _____?

A

hatch

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5
Q

Amebiasis: ______________ invade mucosa and induce ________.

A

Trophozoites

necrosis

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6
Q

Amebic ulcers typically are _____ shaped and occur anywhere in the _____ bowel or ________ _____.

A

flask shaped

large bowel

terminal ileum

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7
Q

Amebic ulcers are usually limited to the __________ layer, and if the penetrate they ______ the can cause what three things?

A

muscularis layer

if they penetrate the serosa it can cause Perforation, Abscess, Peritonitis

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8
Q

Amebiasis demographic?

A

Mostly tropical and subtropical

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9
Q

Hx of mild Amebiasis?

A

Cramps
Fatigue
Weight loss
Increased flatulence

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10
Q

Hx of severe Amebiasis ?

A

Fever
n/v

*sometimes you can be asymptomatic **

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11
Q

PE of mild Amebiasis?

A

Abd Distention

Hyperperistalsis ( active bowel sounds )

generalized abdominal tenderness

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12
Q

PE of severe Amebiasis ?

A

Prostrate

toxic with fever

Tenesmus ( pressure on the rectum that makes you feel like you need to have a bowel movement ; but you don’t have anything there it is just the pressure )

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13
Q

Diagnostic lab for Amebiasis? Results?

A

Stool O&P - cysts or

trophozoites

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14
Q

If severe: diagnostic lab for Amebiasis? Results?

A

Colonoscopy / Sigmoidoscopy - flask shaped ulcerations

Biopsy- Ulcers, trophozoites

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15
Q

If concern for abscess, especially liver, lab for Amebiasis? Results?

A

CT, MRI, ultrasound = Identify size and location of hepatic abscesses

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16
Q

Labs to consider for Amebiasis ? Results?

A

CBC - WBC count = Elevated, no eosinophilia

LFT - minimal changes

Serum antibodies - up to 10 years after infection, cannot be used to differentiate

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17
Q

Amebiasis CBC results?

A

WBC count is moderately elevated
but without eosinophilia

  • you don’t get the eosinophilia like most of the parasites we have ( because it is walled off so much)- more abscesses not like a diffuse infection -“more of an isolated thing”**
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18
Q

Amebiasis complications?

A

Cycles of remission and recurrence typical

Hepatic or pulmonary abscess
Rupture may be fatal

Ameboma– Localized ulcerative lesions of the colon and localized granulomatous lesions of the colon

Additional GI complications - Appendicitis, bowel perforation, fulminant colitis, massive mucosal sloughing, hemorrhage, bacterial infection, bleeding, and peritoneal spillage.

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19
Q

Amebiasis prognosis ?

A

good w/ tx

high mortality w/o tx

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20
Q

Amebiasis tx: all?

A

Luminal amebicide

  • (diloxanide furoate, iodoquinol, or paromomycin)**
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21
Q

Amebiasis mild infection tx?

A

luminal amebicide

Plus tinidazole or metronidazole ( Flagyl)

  • Tetracycline followed by chloroquine**
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22
Q

Severe Amebiasis tx?

A

IV hydration , electrolyte replacement

Plus Chloroquine

if not better in 3 days the I/D

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23
Q

Opoids decrease _____ motility and lower risk of _____ _________.

A

bowel motility

lower risk of toxic megacolon

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24
Q

Amebiasis Hepatic abscess tx?

A

luminal amebicide

tinidazole or metronidazole
followed by chloroquine

If no response within 3 days of initial treatment, incision and drainage

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25
Parasite of Malaria?
Parasite is Plasmodium Vivax Malariae Ovale Falciparum - good prognosis , except for cases involving P. falciparum ( more severe case when it comes to exposure- more neurologic componet to it and anemic type symptoms more)
26
Malaria transmission is through the bite of the ________ mosquito?
Anopheles mosquito
27
Malaria incubation period ranges between _ and __ days
8-60 days
28
Malaria: once passed to humans ___________ invade hepatocytes and mature as tissue _________
sporozoites schizonts
29
_________ escape the liver and invade ____, where they multiply and cause rupture of the RBC within __ hrs
Schizonts RBCs 48 hrs * cycle of invasion, multiplication, and red blood cell rupture continues **
30
Hx of Malaria stages?
Stages: 1. shaking chills (the cold stage) 2. fever (the hot stage) 3. diaphoresis (the sweating stage) Patients are fatigued between attacks.
31
If you have malaria is there a release of Tissue necrosis factor?
Yes there is a release of TNF because of ``` Fatigue Headache Dizziness GI complaints Myalgias Arthralgias Backache dry cough ```
32
Malaria PE?
fever rigors hepatosplenomegaly *best clinical indication = hepatomegaly for the entire process of the disease - even through the symptomatic an asymptomatic stages **
33
Malaria screening? Results?
CBC - anemia, reticulocytosis, thrombocytopenia, leukocytosis or luekopenia LFT - Elevated Bilirubin, elevated enzymes
34
Malaria diagnostic lab?
Blood smear with Giemsa stain (or Wright stain) - diagnostic test of choice Giemsa or Wright stain examined at 8-hour intervals for 3 days during and between attacks infected red blood cells ranges from 5% to 20%
35
Malaria labs to consider?
Plasmodium abs appear 8 to 10 days later too late for diagnostic benefit in most cases persist for 10 years, making the distinction between old and new infection difficult
36
Malaria complications?
Infection with P. falciparum can be much more severe and can manifest as : cerebral malaria hemolytic anemia ``` hyperpyrexia noncardiogenic pulmonary edema acute tubular necrosis adrenal insufficiency, cardiac dysrhythmias ( heart blocks ) ```
37
Malaria: uncomplicated initial tx?
Chloroquine - it lyses the parasite itself used prophylaxtly if traveling to endemic areas if chloroquine resistant... then use mefloquine
38
Malaria: severely ill patients tx?
chloroquine, quinine, or quinidine IV PLUS doxycycline OR clindamycin
39
malaria alternative tx drugs?
atovaquone and proguanil (Malarone) Mefloquine Hydroxychloroquine atovaquone/doxycycline
40
Toxo organism?
T gondii
41
what is T gondii?
an obligate intracellular protozoan
42
What is the most common host of toxo?
cats
43
Humans are infected with toxo after ingestion of a _____ usually from undercooked ____ or contaminated by cats.
cyst meat
44
Toxo incubation period?
1-2 weeks
45
Types of toxo?
Immunocompetent Immunocompromised Congenital
46
Toxo Hx immunocompetent?
mild fever malaise
47
Toxo Hx immunocompromised?
encephalitis chorioretinitis Pneumonitis
48
Toxo Hx congenital?
``` Neurologic : Seizures psychomotor retardation ( simple tasks - opening up a can or cap off the milk) Deafness Hydrocephalus ``` Retinochoroiditis
49
Toxo PE immunocompetent?
Generalized tender lymphadenopathy
50
Toxo PE immunocompromised?
Encephalitis-- meningismus Chorioretinitis visual disturbance Necrosis of retina Pneumonitis– adventitious lung sounds
51
Toxo PE congenital?
Neurologic eye
52
Toxo diagnostic labs? Results?
tissue culture: +
53
Toxo screening during pregnancy lab?
IgG or IgM toxoplasmosis
54
Toxo labs to consider?
Sabin-Feldman dye test ELISA indirect fluorescent antibody test agglutination tests *all these tests will be positive if the is a current Toxoplasmosis infection**
55
Toxoplasmosis diagnostic criteria?
Exposure Chorioretinitis Tissue culture-- + Optional serologic tests (will be +)
56
Toxoplasmosis complications?
Encephalitis Retinochoroiditis Congenital transmission
57
Toxo tx if immunocompetent or uncomplicated?
no Tx necessary
58
Toxo Tx if immunocompetent but significant symptoms?
pyrimethamine oral PLUS | sulfadiazine 2-4 weeks
59
Toxo Tx if immunocompromised?
pyrimethamine oral PLUS sulfadiazine 4-6 weeks the sulfa component is just for a longer period
60
Toxo Tx if pregnant and not transmitted to fetus?
Spiramycin - reduces frequency of transmission (does not cross the placenta)
61
What pharmacologic agent do you want to add to you Toxoplasmosis Tx to prevent bone marrow suppression?
Folinic Acid
62
Toxo Tx if pregnant and transmitted to fetus?
take complete regimen
63
Patho of FUO?
Most cases represent unusual manifestations of common diseases Usually not rare or exotic diseases
64
Causes of FUO to consider?
Tuberculosis Endocarditis gallbladder disease HIV
65
what percent of fevers will relapse with no dx?
75%
66
what percent of persistent fevers are unexplained?
15%
67
Patho of FUO: most causes of FUO in adults?
Infections (25–40%) Cancer (25–40%) - isolate cancers Autoimmune (10–20%) *PE is least common ( 20%)- 20% PE patients have fever **
68
Patho of FUO: most causes of FUO in children?
Infections (30–50% of cases) Autoimmune (10–20%) Cancer rare (5–10% of cases)
69
Hx and PE of FUO?
Fever rest of exam is unremarkable
70
FUO screening labs?
CBC CMP UA
71
FUO if indicated labs to run?
``` TSH CXR CSF- LP PCR Cultures of blood or urine ```
72
Diagnostic criteria for FUO?
Fever over 38.3°C (100.9F)on several occasions Illness of at least 3 weeks Diagnosis has not been made after three outpatient visits or 3 days of hospitalization
73
FUO Tx?
monitor closely AVOID - steroids - b/c they suppress the immune system
74
When to refer with FUO?
progressive weight loss immunocompromised
75
When to admit with FUO?
rapidly declining with weight loss Neutropenic fever - 1500 neutropenic, 500 ( neutropenia)

Clinical Medicine Lecture - Professor Kramer (28 decks)

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