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(C) CM 1B: ID/EENT > Lecture 9: Parasitic Diseases > Flashcards

Lecture 9: Parasitic Diseases Flashcards

1
Q

What is the main cause of amebic dysentery?

A

Entamoeba histolytica

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2
Q

What is the transmission of amebic dysentery?

A

Fecal-oral, ingestion of cyst form.

Worldwide, mainly in subtropical/tropical

Crowding, poor sanitation, poor nutrition

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3
Q

What are the main hosts for amebic dysentery?

A

Humans

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4
Q

How does mild-moderate amebic dysentery present?

A

Gradual onset diarrhea, abd pain, bloating, AFEBRILE.

PE: Abd distension & tenderness, hyperperistalsis, hepatomegaly

Microscopic hematochezia common

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5
Q

How does moderate-severe amebic dysentery present?

A

Colitis, dysentery with 10-20 bloody stools/day
FEVER, prostration, abd pain, vomiting
PE: abd distension & tenderness, hepatomegaly, hypotension.

Hematochezia common.

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6
Q

Who is severe amebic dysentery MC in?

A

Young children
pregnant pts
malnourished
steroids

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7
Q

What are intestinal complications common in amebic dysentery?

A

Necrotizing colitis, intestinal perforation, mucosal sloughing, hemorrhage, death

Chronic diarrhea with weight loss, bowel ulcerations, amebic appy

Amebomas: localized granulomatous lesions.

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8
Q

What is the extraintestinal complication in amebic dysentery?

A

Amebic liver abscess.

MC in men, causes wt loss and anorexia.

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9
Q

What are the tests for checking for intestinal amebic dysentery?

A

Stool microscopy/O&P - E. histolytica

Preferred:
Stool antigen
Stool PCR

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10
Q

What are the tests for checking hepatic abscess?

A

Anti-amebic antibodies: almost always +

Stool O&P: usually -

Imaging: US or CT liver

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11
Q

What is the treatment for amebic dysentery?

A

Metronidazole (10d) or tinidazole (3d) for trophozoites

Paromomycin (7d) for cysts (PO aminoglycoside)

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12
Q

What causes giardiasis?

A

Giardia lamblia (smiley face protozoa)

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13
Q

How is giardia transmitted?

A

Fecal-oral
MC intestinal protozoan in the US.

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14
Q

What are the risk factors for giardia transmission?

A

Endemic areas: tropical regions
Swallowing dirty water
MSM
Immunocomped

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15
Q

What is giardiasis sometimes called? Why?

A

Beaver fever

Humans, dogs, cats, numerous wild animals are all hosts.

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16
Q

What does symptomatic giardiasis look like?

A

Acute diarrheal syndrome with no vomiting and afebrile. Watery diarrhea only.

Chronic diarrheal syndrome with greasy/frothy diarrhea . No fever or vomiting.

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17
Q

How is giardiasis diagnosed?

A

Stool O&P for cysts and trophozoites without blood/leukocytes.

Preferred:
Stool antigen assay
Stool PCR

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18
Q

How is giardiasis treated?

A

Main: Tinidazole x1 dose

Nitazoxanide for pts 1-3

Metro for infants < 1

TNM

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19
Q

What is nitazoxanide used for? Main SE?

A

Cryptosporidium and giardia.

Only for young pts
Can cause yellow green urine

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20
Q

What two protozoa cause cryptosporidiosis?

A

Cryptospodirium parvum
Cryptosporidium hominis

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21
Q

How is crypto transmitted?

A

Ingestion of oocyst

Swimming pool outbreaks are MC.
MC in HIV+

swimming in crypto

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22
Q

What is unique about crypto survival?

A

Can survive in chlorinated water

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23
Q

How does acute crypto infection present?

A

Watery diarrhea
low-grade fever

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24
Q

How does chronic crypto infection present?

A

chronic diarrhea in AIDS pts.

Foul-smelling stool
Malabsorption and weight loss
Extraintestinal disease

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25
Q

What two things appear in extraintestinal disease in a crypto infection?

A

Biliary tract infection
Sclerosing cholangitis

CBS

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26
Q

How is crypto diagnosed?

A

Stool O&P with acid fast stain.

Stool antigen assay
Stool PCR

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27
Q

How is crypto treated?

A

Acute is supportive and self-limiting.

Can use nitazoxanide or paromomycin.

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28
Q

What causes cyclosporiasis?

A

Cyclospora cayetanensis

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29
Q

What is the MC transmission of cyclosporiasis?

A

Foodborne outbreaks in the US from imported produce.

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30
Q

How does symptomatic cyclosporiasis present?

A

Flu-like prodrome phase
Watery diarrhea
Fever only 1/4 of pts.
2+ weeks

Note:
Cyclo = cycles, Prodrome and then diarrhea

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31
Q

How does cyclosporiasis present in immunocomped pts?

A

Severe and prolonged
Chronic and fulminant watery diarrhea

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32
Q

How is cyclosporiasis diagnosed?

A

Preferred:
Stool microscopy/O&P with acid-fast stain

Colonoscopy with biopsy.

No rapid antigen test!

cycle fast

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33
Q

What is the first-line treatment for cyclosporiasis?

A

Bactrim x10 days. Also used as prophylaxis in AIDS.

Cycle back

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34
Q

What are the second-line treatments for cyclosporiasis?

A

Cipro
Nitazoxanide (not as well studied) (good for sulfa allergy pts)

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35
Q

What causes trichomoniasis?

A

Trichomoniasis vaginalis

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36
Q

How is trichomoniasis transmitted?

A

STI
Very common cause of GU infections

MC in women, esp. non-hispanic black females.

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37
Q

Who is recommended to get annual screenings for trichomoniasis?

A

HIV+ and high-risk females

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38
Q

How does symptomatic trichomoniasis present in females?

A

Frothy, green, yellow non-malodorous vaginal discharge.
Vulvovaginal pain/discomfort
Dysuria, dyspareunia, pruritis
Strawberry cervix

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39
Q

How does symptomatic trichomoniasis present in males?

A

Dysuria
Scant, thin urethral discharge

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40
Q

How do you diagnose trichomoniasis?

A

Wet prep of vaginal or urethral secretions:
Presence of motile, flagellated organisms.

Rapid antigen testing
Nucleic acid assay (PCR)

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41
Q

How do you treat trichomoniasis?

A

Tinidazole or secnidazole x1 dose
Metronidazole x 1week possibly
Must treat sexual partners

TSM are letters in trichomoniasis and not trichinosis

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42
Q

What causes toxoplasmosis?

A

Toxoplasma gondii

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43
Q

How is toxoplasmosis transmitted?

A

Fecal-oral
Cats, cat litter, undercooked pork/meat

One of the leading causes death from foodborne illness in US.

Usually only immunosuppressed or pregnant ppl get severe s/s.

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44
Q

What is the definitive host for toxoplasmosis?

A

Cats

45
Q

How does toxoplasmosis present in immunocompetent people?

A

GI tract => lymphatics => disseminated

Symptomatic: mono-like.

Rare: hepatitis, meningoencephalitis, polymyositis, retinochoroiditis

46
Q

How does toxoplasmosis present in immunocompromised people?

A

Reactivated in AIDS pts, pts on immunosuppressive rx, cancer pts.

MC: encephalitis with necrotizing brain lesions.

47
Q

How does a congenital toxoplasmosis infection present?

A

Early: still birth, spontaneous abortion

Neuro: seizures, psychmotor retardation, deafness, hydrocephalus.

Other s/s: fever, jaundice, HSM, V/D, pneumonitis, myocarditis, retinochoroiditis

Mild: Normal at birth, but later development of LAD, HSM, CNS, or eye disease.

Late: Retinochoroiditis

Eye and brain symptoms

48
Q

What is the general recommendation for pregnant women regarding toxoplasmosis?

A

Stay away from cats and cat litter.

49
Q

How do you diagnose toxoplasmosis?

A

Serum Ig detection
ID of parasite via tissue biopsy
PCR of amniotic fluids, blood, CSF, etc
Body fluid culture

50
Q

What is not recommended for toxoplasmosis?

A

Routine pregnancy screening NOT RECOMMENDED

51
Q

How is toxoplasmosis treated?

A

Immunocompetents do not require tx in acute disease.

Pregnancy: spiramycin (reduce transmission risk)

Immunodeficiency/fetal infection: pyrimethamine + Sulfadiazine

DO NOT USE pyrimethamine early in pregnancy due to teratogenic effect.

52
Q

What is the MC of malaria?

A

Plasmodium FALCIPARUM

53
Q

How is malaria transmitted?

A

Bite of infected Anopheles FEMALE mosquito.
Highest transmission: Sub-saharan africa

54
Q

How does malaria present acutely?

A

Periodically:
1. cold phase
2. hot phase
3. sweating stage

55
Q

When is malaria risk greatest relative to travel?

A

Within 2 months of exposure (falciparum malaria)

56
Q

What are the complications of severe malaria?

A

Coma (Cerebral malaria)

Severe anemia, DIC, hemolysis
Secondary bacterial infections

57
Q

How is malaria diagnosed?

A

Giemsa-stained blood smears (preferred)

PCR/rapid assays

58
Q

What is malaria treatment dependent on?

A

Depends on species, area and status, etc….

59
Q

What is the treatment for non-falciparum malaria?

A

Chloroquine (resistance increasing)

First-line usually based on region now.

60
Q

What is the treatment for resistant non-falciparum malaria and falciparum malaria?

A

ACTs (artemether-lumefantrine) (Coartem)

61
Q

What is the treatment for severe malaria?

A

IV artesunate from CDC.

62
Q

What do all malaria pts require?

A

Hospitalization and treatment.

63
Q

What drug categories treat selective malaria?

A

Quinoline derivatives
Antifolate (atovaquone-proguanil)
ACT (artemether-lumefantrine or artemether-amodiaquine)

64
Q

What are quinoline derivatives mainly for in regards to malaria?

A

Activity vs erythrocytic stage of infection, since malaria eats hemoglobin.

65
Q

What is the main SE of chloroquine?

A

pruritis

66
Q

When is primaquine used?

A

After tx with chloroquine.

67
Q

What are the CIs of primaquine?

A

G6PD
Pregnancy
Breastfeeding

pregnant primaquine

68
Q

Which antimalarial drugs are dosed weekly for prophylaxis?

A

Mefloquine
Chloroquine

MCW

69
Q

What antimalarial drug has a SE of cinchonism?

A

Quinine/Quinidine

70
Q

When do we use arteminisin derivatives for malaria?

A

Fast parasite clearance in combo regimen.

NOT for prophylaxis due to short half-life.

71
Q

If a patient books a trip to Africa and is leaving in the next 3 days, what antimalarials can they take for prophylaxis?

A

Primaquine
Atovaquone-proguanil
Doxycycline

PAD themselves

72
Q

If a patient is pregnant but is going to an area with high rates of malaria, what antimalarials can they take?

A

Chloroquine
Mefloquine

Weekly & pregnancy same

73
Q

What are the 3 causative organisms for tapeworms/taeniasis?

A

Taenia saginata (beef)

Taenia solium (pork)

Diphyllobothrium latum (fish)

74
Q

Where do tapeworms live?

A

In your intestine, growing up to several feet long.

75
Q

Which tapeworms incubates the fastest?

A

Fish

76
Q

What is the MC finding of intestinal tapeworms?

A

Proglottids in stool

77
Q

What kind of deficiency can a fish tapeworm cause?

A

B12

78
Q

How does invasive tapeworm present?

A

Cystericosis

Altered cognition, psychiatric s/s, seizures, etc.
Known for causing epilepsy in LA and SEA

79
Q

How do you diagnose a tapeworm infection?

A

Microscopic identification of proglottids in stool

80
Q

How do you treat intestinal taeniasis?

A

Praziquantel x 1 dose.

81
Q

How do you treat neurocysticercosis?

A

Albendazole but may cause massive inflammation in brain.

82
Q

What exactly does albendazole do?

A

Worm detachment, which may cause secondary inflammation when they die.

83
Q

What are the causative organisms for hookworms?

A

Ancylostoma duodenale
Necator americanus

84
Q

How do hookworms transmit?

A

Transcutaneous or ingesting larvae.

MC in tropical/subtropical with 1billion prevalence worldwide.

85
Q

How does a hookworm infection present?

A

Pruritic maculopapular rash at site of infection

Fever, wheezing, dry cough, bloating, abd pain.

86
Q

What is the concern regarding a hookworm infection in children?

A

Cognitive delay and impaired growth

87
Q

How do we diagnose a hookworm infection?

A

Stool microscopy/O&P: eggs in feces
Rapid stool PCR
Anemia, blood in stool and hypoalbuminemia

88
Q

How is hookworm treated?

A

Albendazole x1 dose
Mebendazole x 1-3 days

HAM

89
Q

What should you take with albendazole?

A

High-fat meal or snack

90
Q

Which benzimidazole can cause neutropenia/agranulocytosis?

A

Albendazole in long-term

91
Q

What is the causative organism for pinworm/enterobiasis?

A

Enterobius vermicularis

92
Q

How is enterobiasis transmitted?

A

Fecal-oral
Egg ingestion

MC in school-age children

93
Q

How does enterobiasis typically present?

A

Perianal pruiritis, especially nocturnal.

Secondary impetigo and excoriation

perianal pinworms

94
Q

How is enterobiasis typically diagnosed?

A

Scotch-tape test in the early AM, getting the eggs from the perianal skin.

95
Q

How is enterobiasis treated?

A

Albendazole x1 dose or
Mebendazole x1 dose

Repeat in 2 weeks.

AM treatment, PM symptoms

96
Q

What is the causative organism for trichinosis?

A

Trichinella spiralis

97
Q

How is trichinosis transmitted?

A

Larvae in undercooked pork or meat.

MC for US: ingesting wild game

98
Q

How does normal trichinosis present?

A

V/D, abd pain.

Systemic:
fever, myalgia, periorbital edema, eosinophilia, HA, cough. etc.

99
Q

How does severe trichinosis present?

A

Muscle pain and weakness
Myocarditis, pneumonitis, encephalitis

100
Q

How is trichinosis diagnosed?

A

-Elevated serum muscle enzymes (CK, LDH, AST)
-ELISA assay 2+ weeks after infection (but cross-reacts with other parasites)
-Muscle biopsy

Trichinosis lives in your muscles?

101
Q

How is trichinosis treated?

A

Early: albendazole or mebendazole.
Supportive.
TAM
Full-blown = no specific treatment.

102
Q

What is the causative organism for roundworms/ascariasis?

A

Ascaris lumbricoides

103
Q

How is ascariasis transmitted?

A

Fecal-oral

MC intestinal helminth infection worldwide.

104
Q

Who usually presents with heavy ascariasis?

A

Children

105
Q

How does ascariasis present lung wise?

A

Lung migration:
-fever, eosinophilia
-dry cough, dyspnea, chest pain
-eosinophilic pneumonia sometimes

106
Q

How does ascariasis present intestinal wise?

A

-+/-eosinophilia
-bloating, decreased appetite, obstruction
-pancreatitis, appendicitis, cholangitis
-coughed up, vomited up, passed rectally
-emerging through nose or anus

107
Q

How is ascariasis diagnosed?

A

Stool microscopy/O&P: eggs in feces

Adult worms out of bodily orifices.

108
Q

How is ascariasis treated?

A

Same as hookworm

Albendazole x1 dose
Mebendazole x1 or 3

AAM HAM TAM

(C) CM 1B: ID/EENT (27 decks)

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