Paragonimus, House Dust Mites & Loeffler’s Syndrome

Question 1

Mention limitations of serodiagnosis of p

Answer 1

Cross-reaction with other trematode infections

Can be avoided by excretory secretory antigens

Question 2

Imaging modalities used for Paragnimus diagnosis & findings

Answer 2

X-ray: nodular or ring shadows, patchy infiltation & cavities, sometimes calcified cyst.
CT: worm cysts, soap bubble appearance in cerebral lesions

Question 3

Drug of choice for Paragonimus treatment

Answer 3

Praziquantel (Biltricide)

Question 4

Breeding site of house dust mites is

Answer 4

Beds

Question 5

Conditions which favour house dust mites growth

Answer 5

Warm, damp & inadequately aired

Question 6

Main food of house dust mites is

Answer 6

Human skin scales, organic debris

Question 7

Describe moulting of house dust mites

Answer 7

Incomplete metamorphosis egg to larvae to nymph to adult

Question 8

Mention reactions caused by house dust mites & their feces

Answer 8

Bronchial asthma & allergic rhinitis & atopic dermatitis

Question 9

Describe control measures of house dust mites

Answer 9

Vacuum cleaning, washing sheets & blankets, airing of rooms, applying benzyl benzoate to mattresses and carpets

Question 10

Mention parasites causing Loeffler’s syndrome

Answer 10

HAS

Question 11

GR: Strogyloidiasis causes most severe Loeffler’s

Answer 11

Due to increase larvae load caused by autoinfection

Question 12

DD of Loeffler’s syndrome

Answer 12

1. VLM characterized by long-term illness (many months)
2. Katamaya syndrome characterised by splenomegaly & long-term illness (2-3 months)
3. Tropical pulmonary eosinophilia, responds to DEC

Question 13

What is detected in sputum in Loeffler’s syndrome

Answer 13

Larvae, abdundant eosinophils, Charcot Leyden crystals

Question 14

X-ray of Loeffler’s syndrome shows …..

Answer 14

Ground glass appearance

Question 15

Duration of Loeffler’s syndrome

Answer 15

3 weeks

Question 16

Manifestations of patent phase of P.w.

Answer 16

T.B.

Question 17

Site of P.w lesions in lung commonly is ….

Answer 17

Upper right quadrant

Question 18

Content & strcture of lung cysts of Paragonimus

Answer 18

Granuloma with formation of thick fibrous cysts which may become sclerotic surrounding adults which can live in pairs/triplets contaning numerous eggs & Charcot Leyden crystals.

Question 19

When does chronic phase of P.W. occur?

Answer 19

3-4 months post-infection

Question 20

Mention the events of life cycle corresponding to acute pulmonary phase

Answer 20

It occurs during migration of immature flukes through the lung and accompanied by high eosinophilia can cause acute pneumonitis.

Question 21

Epidemiology of Paragonimus

Answer 21

Not in Egypt but in Far East, West Africa, South & central America

Question 22

MOT of Paragonimus

Answer 22

Ingestion of encysted metacercaria in improperly cooked or prepared crab or crayfish.

Question 23

Definitive & reversoir hosts of Paragonimus

Answer 23

Human - D

Dogs, cats, pigs, wolf & fox - R

Question 24

1st intermediate host, stage penetrating it & 2nd intermediate host

Answer 24

1st: Semisulcospira libertina
Penetrating: microcercus cercaria
2nd: crustaceans, crabs & caryfish

Question 25

Mention the infective & diagnostic stages of Paragonimus

Answer 25

I:encysted metacercaria D: immature operculated eggs

Question 26

Adult has .... suckers, the tegument is provided with ……., it is a ….., having 2…..testes & ovary. …… are formed of fine follicles olt paragonimus is ….. in colour, has …….. n lateral sides.

Answer 26

Reddish-brown, 2 (oral & ventral), spines, hermaphrodite, lobed, vittelaria.

Question 27

Mention advatages of serology in Paragonimus

Answer 27

1. Early diagnosis 2. Diagnosis of acute & extrapulmonary p. 3. Diagnosis of chronic p. 4. Follow-up of treatment as Ab decline 6-12 months

Question 28

Limitations of sputum examination

Answer 28

Not present in prepatent period, very scarce in patent period

Question 29

Mention specimens in which egg of Paragonimus can be recovered

Answer 29

Sputum, stool, gastric lavage, pleural effusion fluid, fine needle aspiration

Question 30

Describe shape & shell of egg of Paragonimus

Answer 30

Oval with wide top & narrow bottom | Thick shell & operculated

Question 31

DD of Paragnimiasis

Answer 31

1. Other causes of pneumonia with eosinophilia, Loeffler’s (HAS) 2. Tuberculosis 3. Cerebral p. should be differentiated from other cerebral lesions (S.japonicum, E.granulosus, T.solium)

Question 32

Mention complications of P.westermani

Answer 32

Bronchopneumonia, lung abscess, empyema, pneumothorax, pyothorax, fulminating abdominal cavity & cerebral lesions, 2ry bac inf.

Question 33

Write a short note on cerebral paragnimiasis

Answer 33

Behaviour of parasite is similar to that in lung with cyst formation, it causes eosinophilic meningitis & sometimes calcification. Affects occipital and/or temopral lobes C/P: Headaches, epileptic fits, hemiplegia.