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Tissue protozoans (including leish) Flashcards

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1
Q

Leish vector: New world v. old world

A

Lutzomyia -new, phlebotomus -old

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2
Q

DCL v. DSL

A

Diffuse (no use) cutaneous leish: L amazonensis, mexicana, aethiopca; massive/abundant in smear, negative skin test, NEVER ulcerates, lepromatous lesions, very chronic, NO mucosal involvement

DSL: DISSEMinated: L braziliensis, L mexicana, Scanty/rare in the smear, strongly positive, frequent ulceration, acneiform, frequent mucosal involvement

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3
Q

Leishmania infective stage

A

promastigote

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4
Q
A

leish, promastigote

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5
Q
A

amastigote of leish (diagnostic stage)

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6
Q

Difference between T Cruzi and T brucei

A
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7
Q

Trypanosoma Cruzi Life cycle

A

Triatomine bug takes a blood meal–>metacyclic trypomastigotes penetrate the various cells at bite wound site and transform to amastigotes–>amastigotes multiply in infected tissues–>transform into trypomastigotes–>triatomine bug takes the blood meal–epimastigotes in the midgut–>multiply in midgut–>metacyclic trypomastigotes in hindgut

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8
Q

Toxoplasma gondii Infective stage, diagnostic stage, modes of transmission

A

Infective: Bradyzoites, mature oocysts with sporozoites, tachyzoites;
Diagnostic stage: tissue cysts with bradyzoites, tachyzoites
Modes of transmission: undercooked meat, contaminated food/water with cat, blood transfusion, organ transplant, transplacenta

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9
Q
A

Toxoplasma gondii tachyzoite

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10
Q
A

toxoplasma gondii bradyzoite (usually spherical in the brain, more elongated in cardiac/skeletal muscles)

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11
Q

Naegleria Fowleri infective and diagnostic stage

A

Infective: trophozoites
Diagnostic: trophozoites

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12
Q

primary amebic meningoencephalitis

A

naegleria fowleri

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13
Q
A

Naegleria Fowleri-large single nucleus with large dense karyosome

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14
Q

Acanthamoeba infective and diagnostic stage

A

I: Trophozoites
D: Trophozoites, cysts

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15
Q

granulomatous amebic encephalitis, keratitis

A

acanthomoeba

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16
Q
A

acanthamoeba trophozoite

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17
Q
A

acanthamoeba cyst

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18
Q

Granulomatous amebic encephalitis

A

Balamuthia Mandrillaris

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19
Q
A

Balamuthia Mandrillaris (pleomorphic, long/slender pseudopodia, large single nucleus)

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20
Q
A

balamuthia mandrillaris cyst

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21
Q

starts as pink colored papule, enlarges and develops into a nodule or plaque with central softening, painless ulceration with indurated border

A

localized cutaneous leishmaniasis

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22
Q
A

leish

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23
Q

Disseminated cutaneous leishmaniasis caused by

A

braziliensis, guyanensis, mexicana-several lesions

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24
Q

diffuse cutaneous leish

A

caused by aethiopica, mexicana, amazonensis; localized lesion, does not ulcerate; they have a low immune response

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25
mucosal leishmaniasis caused by
LV Braziliensis, LV Guyanensis, LV Panamensis, LL Amoazonensis
26
how to diagnose leish
immunological test with the skin test; elisa or direct smear
27
How to treat LCL
Antimony for 20 days, Amph B, Miltefosine
28
what are the 3 evolutive forms of t cruzi
amastigote: ONLY in tissues, Epimastigote: ONLY in intestine of the vector, trypomastigote: posterior intestine of the vector and in the blood of the reservoirs
29
3 types of vector
rhodnius prolixus, triatoma infestans, panstrongylus megistus
30
how to transmit t cruzi
vectors Blood transfusion, mother to child, oral route (Acai) lab accident
31
What are the phases of T cruzi infection and how can you measure for it
1-2 weeks: Acute phase-romana sign, chagoma: Positive smear, culture, PCR 4-8 weeks: Chronic phase: negative smear but positive PCR/serology Indeterminate form: asymptomatic-->can progress ot the determinate form over the next several years
32
RBBB in a person from endemic region of Tcruzi
Chagas cardiomyopathy
33
how to treat pregnant women for chagas
You don't-its all about detecting congenital chagas first, then treating baby with beznidazole or nifurtimox
34
in acute chagas, can you breast feed
trypomastigotes have been detected in milk in this stage-so recommend against
35
Treatment of chagas
Beznidazole and Nifurtimox
36
3 ways to control chagas disease
insecticides, housing improvement, sanitary education
37
Trypanosoma brucei gambiense Trypanosoma brucei rhodesiensee
38
Vector of aftrican sleeping sickness
glossina spp: tsetse fly
39
What is the life cycle of glossina
tsetse flies suck blood q3-4 days; some of hte parasites (1%) transform in procyclic (midgut) and then metacyclic trypomastigotes (salivary gland). TseTse become infectious 2-3 weeks after blood meal
40
TB Gambiense epidemic mostly where
Central and West AFrica
41
painful, erysepilas presentation
Tb Rhodesiense
42
37year old man with fever, Hepatosplenomegaly and cutaneous foot lesion after a trip to africa
T. B. Rhodesiense (trypanosomal chancre)
43
low grade fever, winterbottom sign, edema (face), malnutrition, pruriritis (rash)
Tb Gambiense
44
Winterbottom sign
posterior cervical LAD-Tb Gambiense
45
Acute high fever, LAD, edema, rash, petechiae, multiorgan failure
Tb rhodesiense
46
patient from Africa
Winterbottom sign-Tb gambiense
47
What are the late states of African Sleep sickness
Both Tb gambiense and Tb rhodesiense can go to meningoencephalitic stage (gambiense is usuallly more frequent)
48
How to diagnose T b gambiense and T b rhodensience
LP: Presence of Tryps in CSF AND PResence of 5 leukocytpes
49
what is the big difference between trypanasoma brucei gambiense and trypanosoma brucei rhodesiense
TB Grambiense: Slow progressing neurological disease TB Rhodesiense is mainly an acute systemic febrile illness
50
How to diagnose Tb Gambiense:
screening with serology; confirm with parasitological blood smeaer, lymph node aspiration, CSF
51
how to diagnose Tb Rhodesiense
blood smear
52
What are the screening tools of gambiense int he field
-card agglutination trypanasoma test -CATT -Lateral flow immunochromatographic assay
53
What is the best diagnostic test of gambiense?
Mini-Anion exchange centrifugation-concentration methods (85%) Microhematocrit centrifugation concentration method (60%) LN Aspiration (40%) Blood smeear (25-30%)
54
Who (in non endemic settings) gets Tb Rhodesiense?
Almost exclusively toursists-from tanzania, malawi, zambia
55
Who (in non endemic populations) gets tb gambiense
mostly migrants (from DRC, Gabon, Angola)
56
What are the available treatments for african sleeping sickness
pentamidine, or suramin, or melarsoprol, or eflornithine + fexinidazole
57
What can we treat with Pentamidine-what are the side effects
Efficacious in Tb Gambiense HAT No good CNS penetration SEs: Painful intramuscular administration, hypoglycemia, hypotension, cardiac arrythmia
58
What is NECT
nifurtimox-eflornithine combination tehrapy0good for second stage african trypanosoma brucei gambiense
59
WHO guideline to treat patients with first stage gambiense HAT:
Fexinidazole
60
Patients with 2nd stage gambiense HAT if CSF <100 WBC
fexinidazole
61
Patients with second stage gambiense HAT if CSF >100 WBC
Nifurtimox-eflomithine combination therapy
62
What is the follow up for gambiense-HAT
Minimal 2 years; LP every 6 months for second stage; cure if WBC<5, Relapse if tryp or WBC>50
63
How to treat rhodesiense first stage HAT treatment? What are the side effects?
Suramin-proteinuria, exfoliative dermatitis, mazotti (if onchocerciasis)
64
second stage of rhodesiense treatment? Side effects?
suramin + melarsoprol + prednisolone ; very toxic (encephalitis)
65
types of visceral leish
L dovanni, L Archibaldi, L Chagasi, L Donovani, L Infantum
66
What is the difference between L infantum/chagasi and L donovani
Infantum/chagasi: Animal reservoir (dogs) -latin america, asia, mediterranean L Donovani: Human reservoir (indian subcontinent, east africa)
67
Clinical manifestations of Visceral Leish
Fever, slenomegaly, hepatomegaly, LAD, cachexia, hyperpigmentation
68
Complications of visceral leish
malnutrition, symptomatic anemia, superinfections, petechial rash *if untreated, lethal
69
Description of Post-Kala Azar Dermal Leishmaniasis
pale spots, painless nodules on the face, thorax, arms, legs, and then genitals (very common in Africa, not as much in India)
70
fever >2 weeks, splenomegaly or weight loss with pnacytopenia. What is your clinical suspicion?
Visceral Leishmaniasia
71
How to diagnose VL
parasitological diagnosis, Serology, Urine antigen, Molecular
72
What ist he highest sensitivity for parasite detection in VL?
Spleen Then bone marrow Then LN (Low sensitivity)
73
From spleen aspirate
extracellular amastigotes
74
what is the specific RDT for visceral leish
rK38 RDT (especially in INdia)
75
What is the treatment of VL?
Pentavalent antimonials x 30 days Paromomycin 21 days Amphotericin B Miltefosine
76
What is toxicity of pentavalent antimonials
cardiac, pancreatitis, liver, renal *Resistant in India
77
PKDL Treatment
Antimonials /liposomal amphotericin in E Africa Amph B/Miltefosine (India)-same tx but longer
78
how to prevent relapse in VL + HIV patients
secondary ppx with pentamidine

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