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ID Board Review > Parasites > Flashcards

Parasites Flashcards

1
Q

how fast does classic cutaneous larve migrans migrate?

A

2cm/day

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2
Q

56M hx of asthma p/w epigastric discomfort x 3 weeks. Also has intermittent nausea and loose stools. Recently returned from Peru and also notes dry cough and wheezing when symptoms started.

Dx?

Rx?

How long should you follow after treatment?

A

Strongy

Ab+

Ivermectin

serial stool eams or ant-Strongy Ab x 1-2 years. Because parasite can autoinfect. Eggs hatch and larve mature in intestinal lumen.

Treat all patients with strongy regardless of symptoms.

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3
Q

Patient with recractory asthma from cambodia. Will start long-term systemic steroids.

What should you check?

A

strongy

can precipitate hyperinfection syndrome

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4
Q

fever, gram negative sepsis and cough in a patient who recently started steroids

A

strongy hyperinfection syndrome

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5
Q
A

strongy

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6
Q
A

ascaris lumbricoides

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7
Q
A

schisto mansoni

(mesenteric veins)

(its a fluke)

praziquantel

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8
Q

28F with crampy abdominal pain

colonoscopy reveals white papules

biopsy reveals egg with granulomatous inflammation

A

schistosoma

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9
Q

praziquantal treats all…..

A

trematodes (flukes)

(except fasciola - liver fluke rx with tricalbendazole)

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10
Q

fever, myalgias, headache and urticaria

eosionphilia, increased LFT

How to confirm Dx?

A

This is Katayama Fever (acute schisto)

really, you can’t

serology and stool O/P frequently negative

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11
Q

clonorchi and opisthorchis both can live 50 years and cause

A

chinese and southeast asian liver flukes

biliary obstruction

cholangiocarcinoma

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12
Q

nodules, pruritic papular eruptions, orange peel skin, keratitis

how to dx?

Rx?

A

onchacerciasis/river blindness

Dx: Skin Snip

Rx: multiple rounds of ivermectin

Doxy also works

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13
Q

cough and eosinophilia after eating raw crayfish

A

paragoniums westermanii

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14
Q

Patient with neurocystercosis has 3 viable (non calcified) cysts. No evidence of increased ICP. What is treatment?

A

albendazole AND praziquantel

+steroids

(1-2 cysts albendazole only, increased ICP - steroids and surgery)

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15
Q

what exam should you always perform in a neurocysticercosis patient?

A

ophtho

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16
Q

50F develops anaphylaxis after sustaining a hard ground level fall

confirm dx?

A

echinococcus - fall caused liver cyst to rupture

liver us

IgG 85% sensitive for liver cysts

50% sensitive for pulmonary cysts

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17
Q

skin-lungs-gut

gut-liver-lungs-gut

A

strongyloides and hookworms

ascaris

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18
Q

what is the most common nematode that causes loeffer’s syndrome?

A

ascaris

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19
Q

picture (barium) sillhouette of a worm

Rx?

A

ascaris

albendazole

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21
Q

mild abdominal pain and anemia

A

ancylostoma, necator (hookworms)

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22
Q

50m from ecuador just diagnosed with COPD and needs steroids- what should you do?

A

treat empirically with ivermectin

or, check strongy Ab and stool

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23
Q

A 6 yo boy from Indiana who has a pet dog and likes to play in a
sandbox presents with fever, hepatosplenomegaly, wheezing, and
eosinophilia. He has never travelled outside the continental U.S.

A

Toxocara canis

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24
Q

Dx?

Rx?

A

lymphatic filariasis

Dx: biopsy/blood smear circulating antigen

Rx: DEC

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25
Q

southwestern US patient 3 deep nodules near cervical spinal cord

A

onchacerca lupi

Onchocerca lupi  an infection of wolves

  • as with O. volvulus, is transmitted by blackflies
  • 6 human cases reported to date
  • 3 with deep nodules near cervical spinal cord
  • Southwestern U.S.(Arizona, New Mexico, Texas)
26
Q

skin nodules, pruritic papules, keratitis

A

onchacerciasis

Dx: serology or skin snip

Rx: ivermectini or doxy

27
Q

Hunter with muscle pain and periorbital edema

A

trichinella

Dx: biopsy/serology

Rx: albendazole/steroids

28
Q

eosinophili meningitis in hawaii

A

angiostrongylus

supportive - steroids? antihelminthic therapy controversial

29
Q

stomch pain after sushi

A

anisakis

the reason we freeze sushi

endoscopizcally removed

30
Q

ceviche

frogs, reptiles

cutaneous larve migrans

A

gnathostoma

rx with 3 weeks of albendazole

31
Q
A
  • Vivax or Ovale - RBC is larger than surrounding suggesting reticulocyte.
  • Favor vivax over ovale given no fimrbiation of the cell
32
Q
A
  • More than 12 merozoites in the schizont favors Vivax
  • Ovale usually not more than 8
  • Falciparum schizonts are ‘sequestered’
    *
33
Q
A

Gametocyte of vivax (falciparum is falciform or banana)

Ovale usually more fimbriation

34
Q

23F develops severe abdominal pain and vomiting several hours after eating sushi of wild caught Pacific salmon. Endoscopy reveals 2cm nematode in gastric mucosa

A

Anisakis simplex

Must be removed endoscopically

can cause anaphylaxis

35
Q

58F from japan presents with cough productive of dark brown sputum with specks of blood. WBC 15 20% eos. CT showing cavitary lesions.

A

Paragonimus Westermanii

endemic in asia

fluke that travels to the lungs after being ingested with raw fish.

*often does NOT cause fever

*treat with praziquantel

*Paragonimus kellicotti in US from crayfish

36
Q

what mosquito carries yellow fever?

A
37
Q

47 yo sheep farmer from bolivia presents with fevers, abdominal pain and diarrhea. Admits to eating his own sheep and watercress by nearby lake.

Dx?

Rx?

A

Fascioloa Hepatica

(endemic to bolivia/peru)

Unlike other flukes, requires triclabendazole

38
Q

What does ivermectin treat?

A

strongyloides and Onchocerca volvulus

39
Q

What does praziquantel treat?

A

Flat worms: cysticerci, clonorchis, schistosoma

40
Q

What does DEC treat?

A

Filarial worms: loa loa, wucheria

41
Q

how

A
42
Q

how does albendazole work?

A

Inhibits microtubule formation in worms - impairs ability to absorb nutrients

43
Q

38M from Africa with keratitis.

Dx/Rx?

A

Onchocerca volvulus (nematode)

Ivermectin

44
Q

severe disease BAND trophozoite

A

Knowlesi

45
Q

schuffner dots

A

vivax or ovale (think oval for ovale)

46
Q

basil, raspberries, cilantro

Latin America

Dx/Rx?

A

Cyclospora!

8-10 um on mAF stain of stool

Bactrim

47
Q

CD4<100

Diarrhea

Dx/Rx?

A

Cryptosporidium

Resistant to chlorine! (swimming pools)

5um

No proven therapy - reduced IS, nitazoxanide?

48
Q
A

Ancylostoma or Necator (hookworm)

(Larvae penetrate human skin)

Rx: albendazole

49
Q

abdominal discomfort, generalized pain.

B12 deficiency

Rx?

A

D. latum

Praziquantel

50
Q
A

Katayama Fever (schisto)

Dx sero (often absent in poop at this stage)

Rx with prednisone+praziqunatal - then retreat in1 month to kill mature worms

51
Q

Treatment of paragonimiasis

A

Praziquantal

52
Q

keratitis from tap water washing of glasses

A

acanthamoeba

53
Q

treatment for entoaemeba histolytica

A

metronidazole PLUS luminal agent (paramomycin)

54
Q

How big is cryptosporidium?

What is the treatment for cryptosporidium?

A

4-6um

nitazoxanide (but in HIV they really just need ART)

55
Q
A

8-10uM

bactrim

56
Q

What parasites cause biliary disesase?

A

fasciola hepatica

clonorchi/opisthorcis

Ascaris (can migrate to biliary tree and cause cholangitis)

schistosoma mansoni and japonicun can cause granulomatous hepatitis

57
Q

Parasitic causes of HSM

A

schistosomiasis, Visceral Leishmaniasis

also toxocara (think kids)

58
Q

cutaneous leish treatment

A

Uncomplicatated: topical paramomycin

Complicated: azoles, miltefosine (UNK MOA)

59
Q

species of visceral leish

A

donovani, infatum, chagasi (new world)

60
Q

Treatment of Toxo for Sulfa-allergic patient

A

Pyramethamine + Clindamycin

ID Board Review (11 decks)

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