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Pediatric Primary Care Exam 4 > Pediatric Parasites > Flashcards

Flashcards in Pediatric Parasites Deck (65):
1

Types of parasites (6)

1. Parasitic infection can occur in children of all ages.

2. Infants, toddlers, and very young children in day care settings are at risk for the parasitic disease called giardiasis that causes diarrhea and is spread through contaminated feces.

3. Pinworm infection (enterobiasis) also occurs among preschool and young school-age children.

4. Preschool and school-age children can become infested with head lice (pediculosis) or scabies, both of which are spread by close person-to- person contact as is common during childhood play.

5. Children of all ages can develop
cryptosporidiosis from swallowing contaminated water during swimming, playing, and other activities in contaminated recreational water (e.g. pools, fountains, lakes, rivers and streams, etc.)

6. Parasites can live for a very long time so if you don’t catch and get rid of them they can cause significant long-term health concerns

2

Pinworms Description (5)

1. Also called THREADWORMS
2. Intestinal nematode or roundworm
3. Live in the intestines of humans hosts only
4. Tiny, narrow, white worms, 2-13mm in length; the size of a staple
5. Females have long, pointy tail

3

Pinworms Prevalence

Prevalence: Highest in preschool and school-aged, daycare centers, caregivers of

4

Pinworms Transmission (6)

1. Fecal-oral route
2. Direct transfer of infected eggs by hand, anus, mouth 3. Females die after depositing up to 10,000 eggs / 24 hr
4. Eggs can live for 2 WEEKS off humans on surfaces
*Very resilient
5. Are infective within hours of being deposited
6. Indirect transmission - from bedding, clothing, in the air

5

Pinworms incubation period

1-2 months from ingestion until adults migrate to anal area

6

Pinworms Clinical Manifestations (8)

1. One-third are asymptomatic
2. Pruritus ani (around and in the anus)
*Itching occurs mainly at night- females migrate to lay eggs around the anus
3. Both the migrating females and eggs are irritating
4. Intensity of itching varies- (tickling, crawling, pain)
5. Disturbed sleep
6. Irritability
7. Pruritus vulvae
8. If they tell you they see something is moving, immediately suspect parasite

7

Pinworms Complications (2)

1. Itching leads to continuously scratching → skin tears → secondary infections (bacterial), dermatitis & folliculitis

2. Vulvovaginitis

8

Vulvovaginitis (4)

Complication from pinworm

1. Inflammation
2. Migration from the anus – can move to the ovaries, liver and lung (rare)
3. Pelvic pain, granuloma in the peritoneal cavity
4. 20% of females with pinworm (EV) infestation will have vulvovaginitis.

9

Pinworms Diagnosis

Pinworm paddle test & sticky (cellophane) tape test
– At night or first thing in the morning before bath or bathroom
– Press sticky side against anus to collect eggs
– 1x = 50% detected…3x = 90% detected
– microscopic eggs will stick to the sticky part

10

Pinworm Pharmacological Treatments (3)

ANTIEMETICS

1. Albendazole

2. Pyrantol panomate (OTC)
*FIRST LINE TX

3. Mebendazole (ENVERM)

11

Albendazole dosing

400mg PO once - repeat in 2 weeks and take with food

12

Pyrantol Pamoate dosing

First line treatment!

Dosing is by weight; 11mg/kg PO once - max 1g per dose
*Repeat in two weeks

13

Mebendazole (Enverm) dosing

100mg - since dose tablet - repeat in 3 weeks if not cured

14

Pinworms Treatment Method (7)

1. Work by paralyzing the worms so they can not migrate and/or lay eggs

2. Works on adult worms NOT the eggs

3. Expel them with stool

4. TREAT THE ENTIRE

5. VERY CONTAGIOUS and EASILY RE-INFECTED

6. Treat again after 2 weeks–to make sure!

7. Continue to check and clean for 2 weeks after last treatment

15

Pinworms Patient Teaching for Treatment and Prevention (8)

1. Shower in the morning to wash away eggs
*Baths are not a good idea b/c can continue to re-contaminate
*No co-bathing

2. Change underwear, bed clothes, bedding daily during treatment

3. Change bedding weekly regular basis
*Do not shake blankets out – eggs can release into the air → swallowed → cycle restarted

4. Vacuum regularly, clean all surfaces especially the toilet and bathroom frequently

5. Wash hands before you eat!

6. Keep nails short

7. Need to be washed every single day!! Excessive amount of laundry

8. Thoroughly wipe down and clean house

16

Soil Transmitted Helminths (2)

1. Soil-transmitted helminth (STH) diseases ("helminth" means parasitic worm) are of major importance in developing countries.

2. They are caused by infection with roundworm, hookworm or whipworm, and can include diarrhea, abdominal pain, intestinal obstruction, anemia, and retarded growth and cognitive development.

17

Hookworms Etiology (4)

1. Caused by nematode parasites

2. Only 2 target humans Ancylostoma duodenale and Necator americanus 


3. A soil-transmitted helminth (STH)
*Roundworm- one of the most common in humans 


4. Live in the small intestine 


18

Necator americanus (5)

Type of hookworm

1. Gray-pink in color, 0.5 mm thick

2. Male: 5–9 mm long

3. Female 10 mm long

4. Lifespan: up to 15 years

5. Reproduction: females lay up to 10,000 eggs/day

19

Ancylostomaduodenale (5)

Type of hookworm

1. 0.5mmthick

2. Males: 5–10 mm long

3. Females: 10 mm or more in length

4. Lifespan: 6 months

5. Reproduction: 30,000 eggs/day

20

Hookworms Transmission (8)

1. Human feces contaminates soil with eggs

2. Burrow in the feet of people washing barefoot
*Itchy, may have some rash or redness but nothing obvious

3. Eggs hatch into larvae and live in the soil

4. Larvae burrow into feet from walking barefoot in contaminated soil.
*Infection in skin is intensely itchy

5. Travel within the body to the mouth and are swallowed

6. Larval attachment to tissue occurs in the intestine and lungs
*Suck blood once attached in intestines

7. Blood suckers

8. Can also become infected by consuming improperly washed vegetables. Humans can have a hookworm intestinal infection, but it is easy to treat.

21

Hookworm Clinical Manifestations (6)

1. Itchy rash at site of entrance

2. Diarrhea (as hookworms grow in intestines) – Nausea

3. Abdominal pain (colic in infants!) and cramping – Decreased appetite

4. Fever

5. Can have blood stool

6. Progressive anemia (“blood-suckers”)
*May be presenting tired; ask where they’ve been recently, etc.

22

Hookworm Complications (4)

1. Anemia over time – hookworms can live in your intestine for 1year before passing in stool

2. Nutritional deficiency (lack of protein and Fe)

3. Failure to thrive

4. Delayed development

23

Hookworm Risk Factors (3)

1. Poor hygiene and sanitation

2. Poor sewage systems

3. Outside in areas of contaminated soil

24

Hookworm Prevention

Wear shoes!
*Improve sanitation/sewage removal systems/reduce outside defecation

25

Hookworm Diagnostic Tests (3)

1. CBC – anemia and follow up after Fe started

2. Stool sample – to look for eggs

3. Soil sample – for larva

26

Hookworm Treatment Goals (3)

1. Rid of parasites and treat anemia

2. Improve nutrition and growth

3. Based on complications
*Hydration – as needed
*Admission – as needed

27

Hookworm Pharmacological Treatments (3)

1. Albendazole

2. Pyrantel Panomate

3. Fe Supplements (dosing is based on age); use to increase protein intake

28

Albendazole dosing for hookworms

*not FDA approved for hook worm

400mg PO once
*Take with food
*May take up to 3 days

29

Pyrantel Panomate hookworm dosing

11mg/kg PO once a day for 3 days

30

Hookworm Safety for Treatment (3)

1. Albendazole
- Safety not certain < 6y of age

2. Pyrantel pamoate
- Label reads “not for under 2 years of age”
- WHO has used in “mass campaigns” and approves use in <1y of age
- Few studies under 1 year of age – safety?

3. Pregnancy Category C for both drugs

31

Whipworm Etiology (4)

1. Found in southern USA

2. Soil transmitted helminth (STH)

3. Trichuris trichiura

4. Tail looks like a ‘whip’

32

Whipworm Life Cycle and Transmission (4)

1. Contaminated soil with human feces and whipworm eggs

2. Eggs mature and become infective in the soil

3. Ingestion of contaminated unwashed, unpeeled or undercooked fruits/veggies OR contaminated hands-to-mouth

4. Whipworms live in the large intestine

33

Whipworm Clinical Manifestations (4)

1. Can be asymptomatic

2. Frequent passage of painful stool → blood and mucous

3. Poor growth

4. Pale, tired (anemia)

34

Whipworm Diagnosis

Stool sample - ID eggs

35

Whipworm Treatments (4)

1. Follow stool samples – 3 times in 3 months following treatment

2. Albendazole

3. Mebendazole

4. Ivermectin (Stromectol)

36

Albendazole dosing for whipworm

400mg once a day PO for 3 days; take with food

37

Mebendazole dosing for whipworm

100mg PO BID for 3 days

38

Ivermectin (Stromectol) dosing for whipworm (2)

1. Safety in <15kg (33lbs) has not been demonstrated - less than 3 years of age not proven safe

2. 200mcg/kg/day PO for 3 days; take on empty stomach

39

Whipworm Patient Education (4)

1. Medications may cause nausea, cramping, stomach pain

PREVENTION:
2. Improve sanitation
3. Wash hands
4. “Wash it, peel it, cook it or forget it”

40

Protozoa (3)

1. Protozoa are microscopic, one-celled organisms that can be parasitic in nature.

2. They are able to multiply in humans, which contributes to their survival and also permits serious infections to develop from just a single organism. 


3. Transmission of protozoa that live in a human's intestine to another human typically occurs through- fecal-oral route (for example, contaminated food or water or person-to-person contact). 


41

Giardia Epidemiology (2)

1. Most frequently diagnosed intestinal parasitic disease in the US- travelers

2. Child care centers and travelers are common

42

Giardia Etiology (4)

1. Flagellate protozoa: Giardia intestinalis, Giardia lamblia

2. Has a protective shell

3. Can survive outside the body for long periods

4. Makes it tolerant to chlorine disinfection
*Can live in pools

43

Giardia Transmission (3)

1. Found on surfaces or in soil, food, water contaminated with feces from infected humans or animals
*WATER: drinking and swimming = most common mode of transmission

2. Swallowing giardia cysts (hard shells) → cysts are instantly infectious once they leave the host through feces → shed 1-10 billion cysts daily in stool for months → easily passed to others fecal-oral route and oral-anal route

3. They colonize, attach to the epithelium and reproduce in the small intestine

44

Giardia diagnosis - stool samples (3)

1. Used to ID cysts

2. 3 samples on 3 different days

3. Cysts can be excreted intermittently

4. Order Stool for Ova and Parasites(O and P)

45

Giardia diagnosis - ELISA

An ENZYME LINKED IMMUNOSORBENT ASSAY (ELISA) test commercially available and highly sensitive

46

Giardia diagnosis - string test

Swallow a capsule with a string attached → as it passes into the small intestine the trophozites stick to it → string removed and examined
*Can see the cysts when you examine it

47

Giardia diagnosis - CBC

Not helpful because...
1. WBC should be normal
2. Not going to present with anemia because not bloodsuckers

48

Giardia clinical manifestations (9)

1. Begin 1 to 3 weeks after infected

2. Last 1 to 2 weeks
*Always ask where they have been in the last couple of weeks

3. Diarrhea (consider if diarrhea longer than 7 days)

4. Gas

5. Greasy stools that float

6. Stomach pain

7. Nausea /vomiting

8. Symptoms can resolve and return after several weeks (waxes and wanes)

9. Weight loss (failure to absorb fat, Vitamin A and B12)

49

Giardia medications (4)

1. Not all need treatment - may resolve on its own

2. Metronidazole (Flagyl)- FIRST LINE
*5mg/kgpoTIDfor5-7days

3. Tinidazole (Tindamax)
*Older than 3 years of age
*50mg/kg PO once with food

4. Nitazoxanide (Alinia)- liquid form so better for children
*5-11yrs of age=200mg po every 12 hours for 3 days with food
*1-4 yrs of age=100mg po every 12hours for 3 days (with food)

50

Giardia Prevention (2)

1. Handwashing, Avoid swallowing recreational water supplies (pool, lakes), drink bottled water when traveling, disinfect tap water by boiling in an outbreak before using

2. Asking ‘travel’ question is KEY point in history!
*But it’s not just foreign travel; can occur here

51

Preventing Ringworm - healthy swimming (12)

1. Think Healthy. Swim Healthy. Be Healthy!

2. Keep the pee, poop, sweat, and dirt out of the water!

3. Stay out of the water if you have diarrhea.

4. Shower before you get in the water.

5. Don’t pee or poop in the water.

6. Don’t swallow the water.

7. EVERY HOUR EVERYONE OUT

8. Take kids on bathroom breaks.

9. Check diapers, and change them in a bathroom or diaper-changing area–not poolside–to keep germs away from the pool.

10. Reapply sunscreen.

11. Drink plenty of fluids.

12. CHECK THE FREE CHLORINE LEVEL AND PH LEVEL BEFORE GETTING INTO WATER

52

Chlorine levels to prevent ringworm (3)

1. Pools: Proper free chlorine level (1–3 mg/L or parts per million [ppm]) and pH (7.2–7.8) maximize germ- killing power.

2. Hot tubs/spas: Proper disinfectant level (chlorine [2–4 parts per million or ppm] or bromine [4–6 ppm] and pH [7.2–7.8]) maximize germ-killing power.

3. Most superstores, hardware stores, and pool-supply stores sell pool test strips.

53

Strongyloidiasis (2)

Type of worm

1. Caused by a worm infection that is of particular danger for children with an impaired immune system.

2. Acquired when larvae (immature worms) in soil contaminated with infected human feces come into contact with and penetrate the skin.

54

Visceral toxocariasis

Type of worm

Spread when children ingest soil contaminated with dog or cat feces containing the eggs of cat or dog roundworms

55

Cutaneous larva migrans,

type of worm

Transmitted when children walk barefoot on soil contaminated with cat or dog hookworm larvae that penetrate their skin.

56

Schistosomiasis (3)

1. Schistosomiasis, another major parasitic disease among children in some developing countries, can also cause impaired growth and development and can lead to severe health problems later in life. It is caused by a STH that spends part of its life cycle in certain types of snail and penetrates the skin of people when they stand or swim in water where the snails live.

2. The STH onchocerciasis ("river blindness") is transmitted by the bite of a type of blackfly that breeds near flowing water. It can cause itching and impaired vision in children, and lead to blindness in adulthood.

3. These 2 STHs are considered Neglected Tropical Diseases (NTDs) because they disproportionately affect impoverished people.

57

Neglected Parasitic Infections in the United States (NPIUS) (5)

1. Chagas
2. Neuro cysticerosis
3. Toxocariasis
4. Toxoplasmosis
5. Trichomoniasis

58

NIPUS Info (5)

1. Chagas disease can cause heart failure and death, most commonly among Latin American immigrants. It is estimated that there are over 300,000 people living in the United States who are infected with the parasite that causes Chagas disease. More than 300 infected babies are born every year in the United States. 


2. Neurocysticercosis is the single most common infectious cause of seizures in some areas of the United States. There are an estimated 1,000 new hospitalizations for neurocysticercosis in the United States each year. 


3. Toxocariasis is a parasitic infection of cats and dogs. Almost 14% of the U.S. population has been exposed to Toxocara. Every year an estimated 70 people, most of them children, are blinded by toxocariasis. The true numbers are believed to be even higher. 


4. Toxoplasmosis is a leading cause of foodborne illness and death. More than 60 million people in the United States are chronically infected. Infections in pregnant women can lead to birth defects in their babies and infections in immunocompromised individuals can be deadly. 


5. Trichomoniasis is a treatable infection that can increase the risk of HIV or serious pregnancy problems such as preterm labor in women and low birthweight in babies. 3.7 million people in the United States are affected.

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Malaria Transmission (5)

Mosquito borne disease caused by a parasite

1. The anopheles mosquito becomes infected with the parasite

2. Mosquito bites human →

3. Parasite invades the bloodstream and enters erythrocytes to hide from immune response and reproduce

4. Erythrocytes burst and parasites move to the liver

5. Can cause uncomplicated or severe disease

60

Malaria incubation period

7-30 days (some will forget they traveled)

61

Malaria Clinical Manifestations (3)

1. Cold stage (cold/shivering)

2. Hot stage (Fever, Headache, Vomiting, Seizures) – Sweating/convalescent stage (sweats- normal temperature, tired)
*Seizures would be very severe

MOST COMMON SYMPTOMS:

3. Fever, Chills, Headache, dry cough, body aches, N/V, malaise
*Very vague symptoms so always ask about recent travel

62

Malaria Diagnosis (2)

1. Blood smear for parasites

2. CBC – mild to severe anemia

63

Malaria Treatment (5)

1. Atovaquone-proguanil (Malarone)- expensive

2. Mefloquine (Coartem)

3. Doxycycline ---cheap but not for children <8yrs

4. Artesunate (Not is US but can get on CDC malaria hotline)

5. Chlorquine (much resistance)

64

Malaria Prophylaxis (4)

1. Avoid outside at dusk
2. Mosquito nets to sleep
3. Repellant
4. Long clothing

65

Malaria Prophylactic Drugs (3)

1. Malarone
- Good for last minute travelers and short trips
- Start 1-2 days before leave and take for 7 days after – Peds tabs available

2. Chlorquine
- Weekly med, areas have high level of resistance
- Not for last minute traveler – need to start 1-2 weeks before travel

3. Doxycycline
- Cheapest, daily med
- Not for children under 8 years old
- Good for last minute travel (start 1-2 days before)
- Side effects → upset stomach/diarrhea