Why does this lady have a headache? Should you treat her?
Neurocysticercosis caused by teniae solium. Treatment with albendazole and steroids results in less likelihood of long-term seizures, hydrocephalus, headaches and focal neurologic deficits.
Can a vegetarian get neurocysticercosis?
Yes, if your chef did not wash his hands and he has teniae solium he is pooping out eggs. If you ingest the eggs they can travel to the CNS and encyst in the brain.
What other imaging findings would you have in a patient with neurocysticercosis besides the cystic lesions?
Perilesional edema around dying cysts and old calcifications.
A 29 year old nurse presents with a headache that is worst when he bends over. He just got back from Cote D’Ivore. RDT comes back positive for P. falciparum. Physical exam reveals a fever of 103.2 and he becomes shaky, clammy and has the worst headache of his life. How do you want to treat him?
IV coartam, because he is vomiting and cannot tolerate oral medications.
What test do you use for malaria follow-up?
Blood smear. RDT will still be positive for weeks after the infection has resolved.
An 18 year old man presents with hepatomegaly and a palpable RUQ mass. He is from northwestern China and works as a sheep farmer. Abdominal CT is shown below. What should you absolutely not do next?
Stick a needle in the lesion. He has echinococcus granulosus (e. multilocularis does not form nice cysts)1 and allowing leakage of the hydatid cyst can cause anaphylaxis, peritoneal irritation and death.
Mammals involved in the life cycle of echinococcus?
Dogs and sheep
Special considerations with strongyloides infection
Treating with steroids can cause hyper infection syndrome, the worm can undergo its entire life cycle in humans, O&P may be negative because egg shedding is intermittent
Which type of malaria is this?
P. vivax or P. ovale, note the larger red blood cell.
Why might someone have re-infection of P. vivax after taking primaquine?
#1) Noncompliance 2) Malabsorption of meds 3) Resistant parasites
A 28 year old female presents with tender, warm periorbital swelling. She has a travel history to Cameroon. Labs show 27% eosinophils and elevated ESR. Physical exam reveals the eye exam shown below. What is causing her condition?
Loiasis presents with calabar swellings on hand/arm, periorbital edema and a worm in the eye.
A patient presents with fever of 102, stiff neck and joint pain. Labs show WBC 26,000 and 26% eosinophils. He recently came back from Uganda where he was building bridges. He didn’t eat prawns or snails (not angiostrongylus cantonensis). He hasn’t been swimming (not schistosomiasis). What does he most likely have?
He actually does have schistosomiasis, from exposure to water while building bridges and it entered through the skin. His initial presentation is due to initial production of eggs that begin traversing the gastric mucosa and causes Katayama fever (terrible abdominal pain, high fevers, diarrhea and high eosinophilia).
Treatment for schistosomiasis