Theme 1- interpreting test results, fungal pathogens, parasites Flashcards
(137 cards)
1
Q
What are ideal tests? What is the correlation between sesnitivity and speicificity?
A
Rarely available in routine practice
High sensitivity and specificity rarely coexist
Increased sensitivity traded for decreased specificity and vice versa
2
Q
What are strategies to improve tests?
A
Select a more appropriate ‘Normal’ population- compare heart attacks to group of elderly- more normal
Use a combination of tests - e.g. LFT profiles
Combine tests to achieve a diagnostic goal, e.g. neonatal screening for PKU and hypothyroidism
- Sensitive first line test (low cost)
- Specific test for screen positives (higher cost)
3
Q
What are appropiate ‘normal’ populations to test?
A
Patients with similar presenting symptoms
e.g. chest pain
Same age
Same gender
Hospitalised ‘normals’
Same underlying disease
4
Q
Why do we set cut offs for sensitive screening tests?
A
Sensitive screening test- pick up all the abnormal
5
Q
What is cut off for specific second-line tests?
A
Readjusting and taking through second line removing the false positives by adjusting the limit
6
Q
What are factors that affect the reference range?
A
- Age
- Gender
- Diet
- Pregnancy
- Time of month- menstruation cycle
- Time of day- cortisol
- Time of year- Calcium/Vit D
- Weight- can dilute yourself with water
- Stimulus- glucose can change the reference range
7
Q
What is the diurnal rhythm of cortisol?
A
Cortisol at time of day different- normally taken at 9am or 12am
Reference range is tight- when asleep, during day reference range widens, midnight it narrows again. Gone up at mid-morning- stressed. 8pm- exercise
8
Q
What is the glucose tolerance test?
A
- Give someone glucose- fasting ref range is 3-5
- Glucose intolerance- goes up- normally when diabetic when given glucose
9
Q
What are substances that can’t use reference ranges?
A
Action Limits
- Cholesterol- more interested as a risk factor- cut offs to tell us the risk
- Paracetamol- no normal range as not normally in the body- needed for when poisoned
Therapeutic Ranges - for drugs
- lithium
- digoxin
10
Q
What are the action limits for paracetamol?
A
If patient has overdose, take a measurement and decide whether they get antidote treatment. In the liver it is conjugated with glutathione but when runout liver gets damaged.
Can give treatments to replace glutathione and replace paracetamol into harmless products.
11
Q
How is advanced glycosylated endprodutcs formed (AGE) formed?
A
Protein + Glucose —-> Advanced Glycosylated Endproducts (AGE)
Non-enzymatic process
Rate of formation proportional to
a) glucose concentration
b) time
May explain long-term complications of diabetes
Scientific basis of commonly used monitoring tests
12
Q
What is HbA1c?
A
- HbA1c is stable glycosylated haemoglobin
- Its percentage concentration indicates cumulative glucose exposure
13
Q
What are the types of fungi?
A
–Hypha = moulds
–Yeast cells = yeasts
14
Q
Is fungi eukaryotic or prokaryotic?
A
Eukaryotic microorganisms
Single celled to macroscopic
15
Q
How do fungi reproduce?
A
Reproduce asexually and/or sexually, spore formation
16
Q
What are the type of fungal disease?
A
- Superficial infection
- Subcutaneous infection
- Systemic infection
17
Q
What is a superficial infection? What are the types of fungi?
A
Superficial infection – affecting skin, hair, nails and mucocutaneous tissue
- Dermatophytes
- Malassezia
- Candida
18
Q
What is subcutaneous infection?
A
Subcutaneous infection – affecting subcutaneous tissue, usually following traumatic implantation
19
Q
What is systemic infection? What are examples?
A
- Systemic infection – affecting deep-seated organs
- Candida
- Aspergillus
20
Q
What are dermatophytes? Where do they originate from?
A
- Group of moulds seen as causes of disease in skin, hair and nail
- Originate in soil, other animals or other humans
- Geophilic- soils
- Zoophilic- animals
- Anthropophilic- other humans
21
Q
What are the disease names for dematophtye infections in the foot, nail and groin?
A
Tinea pedis, tinea unguium and tinea cruris
22
Q
What are the disease names for dematophtye infections in the limbs and torso skin and scalp, skin and hair?
A
Tinea corporis and tinea capitis
23
Q
Where are fungal nail infections most common, athletes foot and scalp ringworm?
A
Fungal nail infection, common in the general adult population, probably 5-25% rate, increasing incidence in elderly people
Athlete’s foot more common than onychomycosis, more common in adults (not younger people) and sportsmen.
Scalp ringworm most common among prepubertal children. Recent US survey, tinea capitis found in 6% of children. Estimated global prevalence of 200 million cases.
24
Q
What are the symptoms of tinea pedis?
A
- Uni- or bilateral,
- Itching, flaking, fissuring of skin
- Plantar: Soles of feet dry and scaly, if skin of whole of foot affected “Moccasin foot”
- Hyperhidrosis, secondary to infection may increase severity
- May spread to infect toe nails
- Typical cause Trichophyton rubrum
25
What is tinea unguium? What are the symptoms?
Thickening, discolouring, dystrophy, four main types
i) Lateral/distal subungual
Ii) Superficial white – usually
in immunocompromised
iii) Proximal
iv) Total nail dystrophy
Typical causes
Trichophyton rubrum and
T. interdigitale
26
What is tinea curis? What are the symptoms?
* More prevalent in men than women
* Itching, scaling, erythematous plaques with distinct edges
* Satellite lesions sometimes present
* May extend to buttocks, back and lower abdomen
* Typical cause T. rubrum
27
What is tinea capitis? What are symptoms?
* Mainly seen in pre-pubescent children
* Signs range from: slight inflammation, scaly patches, with alopecia, “black dots”, “grey patches” to severe inflammation
* Kerion celsi: boggy, inflamed lesions, usually from zoophilic dermatophytes
28
What is tinea corporis? What are the symptoms?
* Circular, single or multiple erythematous plaques
* May extend from e.g. scalp or groin
* Invasion of follicle “Majocci’s granuloma”
* Typical cause , wide range of dermatophytes, anthropophilic or zoophilic
29
What is the investigation and treatment of dermatophyte infection?
* Investigation: Microscopy and culture
* Treatment:
* Topical antifungal therapy: mild disease (self-diagnosis and treatment)
* Terbinafine, clotrimazole,miconazole
* Systemic antifungal therapy: severe disease
* Treat ALL cases of tinea capitis with systemic **oral** antifungals
* Griseofulvin, terbinafine, itraconazole (depends on causal species)
* Topical therapy will NOT be curative (role in reducing spread)
30
What is malassezia? What are examples?
Genus of yeasts
E.g. M. sympodialis, M. restricta and M globosa
31
Where is malassezia found?
* Part or normal skin flora in all humans from shortly after birth
* Highest levels on head and trunk
32
What is the cause of pityriasis versicolor?
Malassezia
33
What is pityriasis versicolor?
Hyper- or hypopigmented lesions
Upper trunk
Between puberty and middle age
More common in tropics
Relapsing
34
What is the diagnosis and treatment of pityriasis veriscolor?
Microscopy
* Yeast cells and hyphal segments “Spaghetti and meatballs”
* Culture difficult and not interpretable
Treatment
* Topical antifungals eg. clotrimazole, if fails oral fluconazole or itraconazole
35
What are candida?
•Large genus of yeasts
36
Where do candida colonise?
Often colonises the mucosal sufaces and GI tract in healthy people
37
What does candida do?
* Cause of superficial mucosal (oral and vaginal) disease “thrush”, also occasionally skin disease and keratitis
* Cause of systemic disease, once present in circulatory system, can infect almost any organ in the body
38
What does oral candidosis do?
Angular cheilitis- inflammation in the corners of the mouth
Chronic hypoplastic (oral leukoplakia)- white spots (top pic)
Chronic atrophic erythema- red lesion on tongue (bottom pic)
39
What is the epidemiology of oral candidosis?
* HIV/AIDS – sometimes even with Anti-retroviral therapy, T-cell immunity important to prevent mucosal candidosis
* Antibiotic use – suppresses normal bacterial flora, less competition for yeasts
* Head and Neck cancer – radiotherapy and chemotherapy affect salivary secretions
* General debilitation in hospitalised patients e.g. in ICU – increases colonisation and risk of oral disease
40
What is candida vulvovaginitis? Who does if effect? What are the symptoms?
* Affects 70-80% all women at least once during child-bearing years
* Inflammation of vaginal epithelium, may extend to labia majora
* Pruritis, burning sensation, +/- discharge
41
How do you diagnose superficial candiosis?
Clinical diagnosis and empiric therapy
Culture with identification and antifungal sensitivity testing where appropriate eg. Recurrent disease
42
What is the treatment for superficial candidosis?
* Usually oral azoles, fluconazole highly effective
* Resistance in normally sensitive species (e.g. Candida albicans) or naturally resistant species (Candida krusei) can be problem
* Do NOT use oral fluconazole or other azoles in pregnant women, this increases risk of teratologies (e.g. heart defects), use topical azoles eg clotrimazole
43
What is systemic candidosis? Where does it infect?
* Candida sp can infect almost any organ in the body
* Defined by site of infection
* Usually acquired from colonised skin or mucosal sites, or from GI tract
* Usually seen in the compromised host
* Candida albicans still most common, other species also occur
* Disseminated disease may be identified from blood culture
44
What are candida oesophagitis symptoms? Caused by what?
* Candida oesophagitis in 10-20% patients with oropharyngeal disease
* Pain/difficulty on eating/swallowing
* Mainly in HIV
* Diagnosed by endoscopy with biopsy
45
What is candidaemia?
Candida in blood culture
46
How do you treat candidaemia?
* Remove lines (where possible)
* Start antifungal therapy
* Check eyes and heart
47
What is candida chorioretinitis?
Chorioretinitis is an inflammation of the choroid (thin pigmented vascular coat of the eye) and retina of the eye
48
What is candida endophthalmitis?
Endophthalmitis is inflammation of the interior cavity of the eye, usually caused by infection.
49
What disease can be caused due to candidaemia?
Risk of occular candidosis (OC) following candidaemia 3-25%. Of those patients:
Chorioretinis c. 75% OC
Endophthalmitis- white balls seen on fundoscopy c. 25% OC, requires intravitreal antifungals
50
What is candida endocarditis?
Vegetations seen on heart valves
51
Candidaemia can cause candida endocarditis. What are the symptoms and what causes it?
* Vegetations seen on heart valves
* Fever, weight loss, fatigue, heart murmur
* IV drug abusers, valve surgery
* Difficult to treat without valve replacement
52
Where is urinary tract candida infection found?
Ascending from genital tract infection/colonisation or from catheterisation
53
Who is likely to have urinary tract candida infection?
More common in women, diabetics, damaged/abnormal urinary tracts, ICU patients
54
What is candiduria?
Candiduria (isolation of Candida from urine) common, may or may not be significant
55
What is candida peritonitis?
Complication of peritoneal dialysis
Perforation of bowl during surgery (mixed bacterial/yeast infection)
56
Symptoms of candida peritonitis?
Fever, abdominal pain, nausea, vomiting
57
What is diagnosis and treatment of candida peritonitis?
Diagnosis by culture of Candida from peritoneal fluid
Treatment by source control/drainage and antifungals
58
What is the diagnosis and treatment of systemic candidosis?
Diagnosis:
Culture, ideally from sterile site, blood, peritoneal fluid etc
Imaging results
Treatment:
Depends on Candida sp. sensitivity, severity, need for oral agent
Echinocandins, e.g. Anidulafungin (IV)- for systemic infections
Azoles, e.g. Fluconazole (oral)- could be followed up for systemic infections
Liposomal Amphotericin B (IV)
59
What are aspergillus?
Genus of moulds – filamentous fungi
Producing airborne spores
60
How are you exposed to aspergillus?
Exposure to Aspergillus spores universal by inhalation- everyone breathes it in
Airways may be colonised by Aspergillus sp.
61
What is aspergillosis?
Reaction to inhaled Aspergillus,
Space occupying/non invasive – lung cavity
62
What does aspergillosis cause?
Allergic reaction – Asthma, cystic fibrosis (CF)
-Allergic bronchopulmonary aspergillosis, allergic sinus disease
Chronic infection – Chronic lung disease
-Chronic pulmonary aspergillosis
Invasive infection – immunocompromised (leukaemia)
-Invasive pulmonary aspergillosis, invasive aspergillus sinusitis
Aspergillus sinusitis
63
What is aspergilloma?
* Patients with cavities in lungs derived from previous tuberculosis, sarcoid, surgery
* Form solid balls of fungus
* Aspergillomas are often indolent (cause little pain), but may break up causing haemoptysis and are potentially fatal
64
What occurs when you have allergic forms of aspergillosis?
Asthma and CF
* Allergic Bronchopulmonary aspergillosis
* Wheezing, breathlessness, loss of lung function, bronchiectasis
* Airways inflammation
* Raised total IgE
* IgE and G reaction to Aspergillus
* Responds to steroids sometimes antifungal therapy added
65
What does Chronic pulmonary aspergillosis (CPA) worsen?
Chronic obstructive pulmonary disease
66
Symptoms of Chronic pulmonary aspergillosis (CPA)
Chronic respiratory symptoms, cough, wheezing, breathlessness, chest pain
67
Diagnosis of CPA?
Consolidation, cavitation on chest computerised tomography (CT)
Positive culture of Aspergillus from sputum and BAL
Positive for Aspergillus IgG
68
What is invasive aspergillosis?
Haematological malignancy, stem cell and solid organ transplant
69
What does invasive aspergillosis cause?
* Low neutrophil counts
* Angioinvasion of lung tissue
* Dissemination in c. 25% of cases to extrapulmonary sites
* Halo and air crescent signs on chest CT
* Moderate to poor prognosis, even with aggressive antifungal therapy
70
Diagnosis of aspergillosis?
Diagnosis:
Culture
Serology (study of serum and other bodily fluids)
Imaging
71
Treatment of aspergillosis?
Treatment
* Aspergilloma try to resect the balls
* Allergic aspergillosis treat with steroids +/- antifungals
* CPA and invasive aspergillosis treat with antifungals, itraconazole and voriconazole, amphotercin B
72
Summary of fungal pathogens
Dermatophytes
* Infect skin hair and nails
* Low morbidity, high incidence
Malassezia
* Yeasts part of normal flora, cause of pityriasis versicolor
Candida
* Causes both superficial and systemic disease
* Can infect any organ in the body
* Infection usually from patients own colonised mucosa
Aspergillus
* Causing pulmonary or sinus disease
* Inhalation of Aspergillus spores
* Effect depends on host reaction, or lack of reaction, from allergy to invasive disease
73
What is a parasite?
An organism which lives in or on another organism (its host) and benefits by deriving nutrients at the other's expense.
The parasite derives all benefits from the association and the host may either be harmed or may suffer the consequences of this association (a parasitic disease)
74
Host definition
Host = an organisms which harbours the parasite
75
Symbiosis definition
Symbiosis = living together; close, long term interaction between two different species
76
Mutualism defintion
Mutualism = an association in which both species benefit from the interaction eg Egyptian plover and crocodile
77
Parasitism defintion
Parasitism = an association in which the parasite derives benefit and the host gets nothing in return but always suffers some injury eg Tick feeds on animals blood – can also pass on infections to host such as Lyme disease
78
Commensalism definition
Commensalism = an association in which the parasite only is deriving benefit without causing injury to the host eg Remora fish – attach themselves to whales or shark and eat their left overs
79
What is a definitve host?
Definitive host
Either harbours the adult stage of the parasite or where the parasite utilizes the sexual method of reproduction
In the majority of human parasitic infections, man is the definitive host
80
What is a reservoir host?
Reservoir host- infects into cattle before host
An animal or species infected by a parasite which serves as a source of infection for humans or other species
81
What is an intermediate host?
Intermediate host
Harbours the larval or asexual stages of the parasite
Some parasites require two intermediate hosts in which to complete their life cycle
82
What is a paratenic host?
Paratenic host
Host where the parasite remains viable without further development
83
Types of parasite
* Protozoa
* Helminths
* Arthropods
84
What is a protozoa?
Protozoa:
Single celled organisms- can be free-living or parasitic in nature and multiply in humans
Microparasite
85
What are protozoa normally transmitted by?
GI parasites typically transmitted by faecal –oral route
Blood parasites transmitted by arthropod vector (insects)
86
What are the subdivisons of protozoa?
* Flagellates
* Amoeboids
* Sporozoans
* Trypanosomes
87
What are helminths?
Helminths:
large multicellular organisms adults generally visible by eye.
Adults cannot multiply in humans
88
What are types of helminths?
* Platyhelminths (flatworms)
* Nemastodes (round worms)
Macroparasites
89
Types of platyhelminths (flatworms)?
* Cestodes- tapeworms
* Trematodes- flukes
90
What are types of nematodes (round worms)?
* Intestinal nematodes
* Tissue nematodes
91
What is the subdivion of arthropods?
Ectoparasites
92
What are ectoparasites?
Ectoparasites:
broadly include blood sucking arthropods and those that burrow into skin.
93
What are subdivions of ectoparasites?
* Insects
* Lice
* Mites
* Arachnid (ticks)
94
What are the types of life cycles?
* Direct
* Simple indirect
* Complex indirect
95
What is a direct life cycle?
Direct life cycle. (Science: epidemiology) a life cycle in which a parasite is transmitted directly from one host to the next without an intermediate host or vector of another species.
Infective eggs eaten by bird
Bird sheds parasite eggs into environment
Eggs mature in the environment and become infective
Start cycle again
96
What is an indirect cycle?
An indirect life cycle is a type of a life cycle wherein a parasite is transmitted from one host to another by using a vector or by an intermediate host of another species.
Bird sheds parasite eggs into the environment in faeces
Different parasite eats the eggs
Eggs then develop in the parasite and the bird then eats it
97
What is a complex indirect lifecycle?
Those that must infect more than one host species to complete their life cycles.
* Bird excretes in water
* Frogs eat it
* Fish eat the frog
* Bird eats the fish
98
What is an ascariasis?
Macroparasite: Intestinal nematode
Peak prevalence in 3-8 year olds
Areas of poor hygiene
99
Life cycle of ascariasis?
Ingested into the mouth into the cut, excreted then goes back in from eating the eggs
Acquired by ingestion of eggs
100
What are the symptoms of ascariasis?
Lung Migration:
Loefflers syndrome- dry cough, dyspnoea, wheeze, haemoptysis, eosinophilic pneumonitis
Intestinal Phase:
Malnutrition
Malabsorption
Migration – into hepatobiliary tree and pancreas
Intestinal obstruction
Worm burden
101
What is the treatment for Ascariasis?
Treatment: Albendazole
Prevents glucose absorption by worm
Worm starves-detaches-passed PR
102
What is schistosomuasis sp.?
Macro-parasite (Helminth- Platyhelminth- Trematode/Fluke)
Also known as “Bilharzia” – in Africa
103
Schistosomiasis- Life Cycle?
* Live for about 10 years
* Defecate in water
* Eggs hatch
* Infects snails
* Snails release cercariae
* Skin penetration
* Into liver
Snails as intermediate host
104
Incubation period? Symptoms?
Initial infection Incubation period 14- 84 days
Often asymptomatic
Symptomatic acute infection /Katayama syndrome
rash, fever, headache, myalgia, and respiratory symptoms.
Often with eosinophilia and hepato- and/or splenomegaly.
* Swimmers itch
* Katayama fever
* Chronic Schistosomiasis (can persist for years)
* Effects of eggs in distant sites: spine, lung
105
What are the public health risks of schistosomiasis?
* Undernutrition, ? via the suppression of appetite and inflammation-mediated cachexia.
* Anaemia
* Hepatic fibrosis and associated increased risk of oesophageal varices
* Renal failure
* Bladder tumours
* Increased risk of transmission of HIV: Serodiscordant heterosexual couples in Zambia. Increased risk of HIV or acquisition, and all-cause death
106
How do you diagnose schistomiasis?
Urinary
Terminal Stream Microscopy
Serology
Hepatic/Intestinal
Stool Microscopy
Rectal Snip Microscopy
Serology
107
Treatment for schistosomiasis?
Praziquantel (parazinoisoquinoline derivative)
108
How do you control schistomiasis?
* Chemical treatment to kill snail intermediate hosts
* Chemoprophylaxis
* Avoidance of snail infested waters
* Community targeted treatment, education and improved sanitation
109
What is hydatid disease? Who is the normal host?
* Macro-parasite (Platyhelminth- Cestode-Tapeworm)
* Human is accidental host
* Usual hosts are sheep and dogs
* Found all over the world wherever sheep are farmed
* Caused by Echinococcus sp.
110
Life cycle of Hydatid disease?
* Sheep ingest the eggs in their faeces
* Dog eat sheep
* Get infected
* We get infected from foecal matter by accident
111
What are the clinical problems of Hydatid disease?
* Cysts: 70% liver, 20% lungs
* May remain asymptomatic for years
* Mass effect
* Secondary bacterial infection
* Cyst rupture- hypersensitivity
112
Treatment for Hydatid disease?
Treatment:
Albendazole + praziqantel for daughter cysts ( E granulosus)
113
What is malaria?
Micro-parasite (protozoa- sporozoan)
4 human species of Plasmodium:
P. falciparum
P. vivax
P. ovale
P. malariae
+ Monkey species P. knowlesi (only in monkeys)
114
What is Strongyloidiasis?
Strongyloidiasis is infection by a roundworm, or nematode
Problem is it can autoinfect- reinforcing the disease for many years and spreads via sexual transmission
115
Treatment for strongloids?
Ivermectin 200 µg/kg for 2 days
Or Albendazole 400mg bd for 7 days
116
Control of stronglyloides?
* Wear shoes when you are walking on soil
* Avoid contact with faecal matter or sewage.
* Proper sewage disposal and faecal management
117
What is the vector for malaria?
Anopheles as a vector
118
What are the clinical problems of malaria?
* Parasites rupture red cells, block capillaries and cause inflammatory reaction
* Fever & Rigors (alt. days with falciparum malaria, every 48hrs or 72hrs with benign malaria)
* Cerebral malaria (confusion, headache, coma)
* Renal failure (black water fever)
* Hypoglycaemia
* Pulmonary oedema
* Circulatory collapse
* Anaemia, Bleeding and DIC
119
What is the erythrocytic cycle?
Upon release, the merozoites invade the red blood cells where they undergo another asexual cycle
120
What is the erythrocytic cycle of malaria?
24 hrs
P.knowlesi- monkey malaria
48hrs P.falciparum, P.vivax & P.ovale
72hrs
P.malariae
121
Treatment for Flaciparum malaria?
Antimalarials-
co-artem (artemether/lumefantrine), atovaquone - proguanil
Complicated: IV artesunate – must complete a full oral course when able to stop iv
Supportive therapy
Management of seizures, pulmonary oedema, acute renal failure and lactic acidosis
Exchange transfusion may be helpful in hyperparasitaemia
122
Treatment for non-flaciparum malaria?
Plasmodium vivax, ovale, malariae and knowlesei
Treatment:
Oral chloroquine
Primaquine
123
Control of malaria?
* Insecticide spraying in homes
* Larvicidal spraying on breeding pools
* Filling in of breeding pools- stop spread to other places
* Larvivorous species introduced in to mosquito breeding areas
* Use of insecticide impregnated bed nets
* Chemoprophylaxis
124
What is cryptosporidiosis caused by?
Caused by Cryptosporidium parvum and hominis (micro-parasite, sporozoan)
125
How is Cryptosporidiosis spread?
Human to human spread with animal reservoir (cattle, sheep, goats)
Faecal-oral spread
126
What does cryptosporidiosis cause?
Watery diarrhoea with mucus (no blood)
Bloating, cramps, fever, nausea, vomiting
127
Treatment for cryptosporidiosis?
Symptomatic:
* Rehydration etc.
* Nitazoxanide
For immunocompromised:
* Paromomycin (to kill parasite)
* Nitazoxanide (effectiveness is unclear)
* Octreotide (reduce cramps and frequency)
* HIV patients, HAART should be quickly initiated
* For severe cases may need to use combination therapy parmomycin, nitazoxanide and azithromycin
128
How to control cryptosporidiosis?
Human-Human:
Hand hygiene
* Filter or boil drinking water
* Isolate symptomatic patients in healthcare setting
* Ensure symptomatic children are kept away from school
Animal-Human:
* Pasteurise milk and dairy products
* Boil or filter drinking water if camping
129
What is trichomoniasis caused by? What is it?
* Caused by Trichomonas vaginalis
* Flagellated protozoan
* Sexually transmitted
130
What are the symptoms of trichomoniasis?
* Men = asymptomatic
* Women = smelly vaginal discharge, dyspareunia, dysuria and lower abdominal discomfort, punctuate haemorrhages on cervix (“strawberry cervix”).
131
Treatment for trichomoniasis?
Metronidazole
132
How to prevent trichomonisais?
General advice about prevention of STIs
Use of barrier contraceptive methods if sexually activate
133
What is Giardiasis? How is it transmitted?
Flagellated protozoan
Faecal oral transmission
134
Clinical symptoms of giardiasis?
Spectrum of disease: asymptomatic carriage to severe diarrhoea and malabsorption. Can cause chronic disease
Symptoms: usually last 1-3 weeks
Diarrhoea
Abdominal pain
Bloating
Nausea and vomiting
135
Treatment of giardiasis?
Metronidazole/tinidazole
136
Prevention of giardiasis?
Hygiene measures
Boling water
137
