Parasitic and Spirochetal Disease - ID Quiz #2- Spring 2022

Mosquito-borne red blood cell disease caused by
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How do you diagnose malaria?Giemsa stain blood smear. Repeat the smear between 8-24 hours.What will a malaria serologic test tell you?It indicates history of the disease. It tells you if you've ever had malaria.What is the treatment for Malaria?ChloroquineWhat is the LIFE THREATENING treatment for malaria?IV Quinidine gluconateWhat parasite or infection may cause nocturnal perinatal pruritis?Pinworms (Enterobiasis vermicularis)What is the most common helminthic infection in the US?Pinworms (Enterobiasis vermicularis)_____ is a common cause of intestinal infection worldwide with maximum prevalence in school-aged childrenPinworms (Enterobiasis vermicularis)How is pinworms transmitted?Transmitted by fecal-oral route directly, indirectly inadvertently by contaminated hands or shared toys bedding, toilet seatsWhere do the eggs of the pinworms hatch? And where do the larvae migrate to?They hatch in the duodenum and travel down to the cecum then anus to deposit large numbers of eggs.What are some signs and symptoms of pinworms?Nocturnal perinatal itching, insomniaHow do you diagnose pinworms?Cellophane tape test or pinworm paddle test (apply clear tape on anus in the morning)What is the treatment for pinworms?-Albendazole or Mebendazole. -If pregnant, treat with Pyrantel *P and P* -Treat everyone in the house to reduce reinfectionIngestion of undercook pork can lead to?TrichinosisWhat are the main signs and symptoms of Trichinosis?-Transient intestinal symptoms followed by fever, myalgias, and peri orbital edema. - *Eosinophilia* and elevated serum muscle enzymes (CPK)Where do the larvae of trichinosis go? AND Where do the adults go?-Larvae goes to the duodenum and jejunum to replicate -Adults are excreted in the stool and larvae penetrate intestinal wall and encapsulate in striated muscle tissue.What are some signs and symptoms of Trichinosis?-GI Phase: abd pain, N/V, diarrhea -Muscle phase: Myositis (muscle pain, tenderness, swelling, weakness + high fever) -Eye: Swelling of the eye and redness -Macular rash -Cardiac: myocarditis (due to eosinophilia)How is Trichinosis diagnosed?Confirmed with serology -Consider in patients with "MEP" Myositis, Eosinophilia, Periorbital edemaWhat is the hallmark for Trichinosis?EosinophiliaEosinophils are a type of disease-fighting WBCs associated with what 3 things?1) Parasitic Infection 2) Allergic Reaction 3) CancerHow do you treat Trichinosis?"MAC" M: Mebendazole or A: Albendazole + C: Corticosteroids *Contraindicated in children 2 years or younger and pregnancy*What is the species name of Trichinosis?T. SpiralisWhat is the most common CNS infection in patients with AIDS who are not receiving appropriate prophylaxis?ToxoplasmosisHow is toxoplasmosis transmitted?Undercooked meat and cat fecesWhat is the definitive host for toxoplasmosis?CatsWhat are the signs and symptoms of toxoplasmosis?Primary Infection: Asymptomatic, or develop a mono-like infection Encephalitis: H/A, fever, neurological deficits. Seen with CD4 count <100 Chorioretintis: Posterior uveitis - eye pain and decreased visual acuity PneumonitisHow do you diagnose Toxoplasmosis?Serology (Anti-toxoplasma IgG or antibodies via ELISA) MRI: shows multiple ring enhancing lesions CSFWhat is the treatment for Toxoplasmosis?"FAPS" Folinic Acid* Pyrimethamines Sulfadiazine* *: to prevent bone marrow suppression *Pregnant: Spiramycin*What is the neumonic used for congenital infections?"TORCH" T: Toxoplasmosis O: Other (syphillus) R: Rubella C: CMV H: HSVHow do you diagnose Congential toxoplasmosis?Serology: Anti-toxoplasma IgM antibodies is the BEST INITIAL TEST PCR: for toxoplasmosis MOST ACCURATEWhat is the treatment for congenital toxoplasmosis?Sulfadiazine + PyrimethamineWhat is the most common intestinal helminth worldwide?AscariasisHow is Ascariasis transmitted?Oral ingestion of fertilized eggs from contaminated soil or surfacesWhat is the pathophysiology of ascariasis?1) Ingestion 2) Eggs hatch in small intestine, organisms travels via blood/circulation to lungs (where they mature) 3) Larvae migrate to the trachea and then swallowed 4) Mature, mate and produce eggs that pass into stoolHigh load of ascariasis produces?Intestinal obstructionHow do you diagnose ascariasis?Stool *Eosinophilia* presence Obstruction: CT Neurological symptoms: CT of Brain Gallbladder symptoms: EndoscopyWhat will radiographic imaging show for ascariasis?"Four Lines Sign"How do you treat for ascariasis?Albendazole or Mebendazole Pyrantel if pregnantWhere are hookworms most commonly found?Tropic or sub tropic areasHow are hookworms transmitted?Penetration of skin by larvae found in the soilWhat is the pathophysiology of Hookworms?-Larvae penetrate the skin and migrate to the pulmonary capillaries. -Carried to the mouth via the mucociliary escalator and swallowed -once swallowed it enters the small bowel and starts sucking blood -entire cycle is 4 weeksHow many phases are there in Hookworms?4What is phase 1 of Hookworms?Skin, pruritic erythematous maculopapular dermatitis @ site of larvae entry, which is typically the feet and ankles.What is phase 2 of Hookworms?-Transpulmonary, usually asymptomatic but can have a mild cough. -Loeffler syndrome which is (low grade fever, sputum, wheezing, cough). -We will see increased IgE + eosinophiliaWhat is phase 3 of Hookworms?GI -N/V, diarrhea, epigastric pain, GI BleedingWhat is phase 4 of Hookworms?Chronic nutritional impairment -Major impact of hookworms infection -Hookworms cause blood loss by lacerating capillaries and ingesting blood, leading to daily loss of blood, iron and albumin.How do you diagnose Hookworms?-Hookworm eggs can be found in the feces -Eosinophilia, IgEHow do you treat Hookworms?-Albendazole or Mebendazole -If pregnant, Pyrantel -Supportive care like iron supplements, multivitamins, dewarmingWhat is the name for tapeworms?CestodesWhere does the tapeworm attach itself?Intestinal mucosa via suckling cups or hooks located on the scolexWhat is the best host for Taenia Saginata and Taenia asiatica?HumansWhat is the name of the beef tapeworm?Taenia saginataWhat is the name of the swine tapeworm?Taenia asiaticaHow are these tapeworms (beef and swine) transmitted?-Eggs are excreted in feces and ingested by cattle or other herbivores -larvae encyst (cysticerci) in the striated muscles of these animals -When humans ingest raw or undercooked meat, the cysticerci mature into adult worms in about 2 monthsWhat are some signs and symptoms of the beef and swine tapeworm?Perianal discomfort Abd pain Nausea change in appetite weakness *Weight loss* Patient becomes aware of the infection by noting passage of motile proglottids in their feces.How do you diagnose beef and swine tapeworms?Seeing eggs in the feces, Tape Test, Eosinophilia and elevated IgEThis is: -part of the normal GI and GU flora -Most common opportunistic pathogen -Mucosal disease, particularly vaginitis and esophagitisCandidiasisSigns and symptoms of Candidiasis EsophagitisSubsternal odynophagia (painful swallowing) Gastroesophageal reflux pain N/VHow is candidiasis esophagitis diagnosed?-Endoscopy with biopsy and culture. You will see white linear plaques/erosions -KOH smear: budding yeast and pseudohyphaeWhat is the treatment for Candidiasis esophagitis?Oral fluconazole is the 1st line treatmentWhat are some signs and symptoms of Candidiasis oropharyngealFriable white plaques (leave erythema if scraped) Common side effect from oral steroid asthma medicationHow is Candidiasis oropharyngeal diagnosed?-Clinical findings -Culture of Mouth Swab -KOH Smear: budding yeast & pseudohyphaeWhat is the treatment for Candidiasis oropharyngeal?Nystatin swish and swallow or Clotrimazole trochesSigns and symptoms of vulvovaginal candidiasis?-Vulvar pruritus -burning vagina discharge white thick curd likephysical examination of vulvovaginal candidiasis?-Erythema of the vulva and vaginal mucosa and vulvar edema -Cervix usually appears normalHow is vulvovaginal candidiasis diagnosed?-Clinical findings -asses vaginal pH -Culture of discharge *KOH Smear: budding yeast and pseudohyphaeWhat is the treatment for vulvovaginal candidiasis?Fluconazole 150mg oral dose x1, however, if patient comes back and isn't getting better then: -Miconazole 200mg-vaginal tablet OR Clotrimazole 100mg vaginal tabletHow do you diagnose candida endocarditis?-Established definitively by culturing Candida from emboli or from vegetations at the time of valve replacement -KOH Smear: budding yeast and pseudohyphaeHow do you treat candida endocarditis?IV Amphotericin B, or caspofungin if severeWhat are the 3 types of Invasive Candidiasis?1) Candidemia (bloodstream infection) without deep-seated infection 2) Candidemia with deep-seated infection (Eyes, Kidneys or abdomen) 3) Deep-seated candidiasis in the absence of bloodstream infectionSigns and symptoms of Invasive Candidiasis?Can be from fever to septic shock that can resemble a severe bacterial infection. Symptoms also depend on what area of the body is mainly affected.How do you diagnose Invasive Candidiasis?Consecutively positive (1,3)-beta-D-glucan results may be used to guide empiric therapy in high-risk patients even in the absence of positive blood culturesMost common cause of fungal meningitis?Cryptococcus neoformans or C.gattihow is cryptococcus neoformans transmittedThrough inhalation of fungus (bird and pigeon droppings) into lungsSigns and symptoms of meningoencephalitis (cryptococcosis)?H/A, Neck stiffness, N/V, photophobiaSigns and symptoms of pulmonary (cryptococcosis)Cough, Pleuritic CP, dyspnea, nodules in lungs, abscesses in lungs, Pleural effusion in lungsHow do you diagnose Cryptococcosis?-Lumbar Puncture -increased WBC -decreased glucose -increased protein -India Ink shows encapsulated yeast *MRI more sensitive than CT in finding CNS abnormalities*Treatment from cryptococcosis?Amphotericin B IV for 14 days + Fluconazole CORTICOSTEROIDS NOT USEDIs Cryptococcus considered an AIDS defining illness?yesIs Histoplasmosis considered an AIDS defining illness?Yes, especially with CD4 count of <150 cellsSigns and symptoms for Histoplasmosis?Mild: Flu like symptoms moderate: Atypical Pneumonia (fever, nonproductive cough, myalgia, chest pain) This can mimic TBWhat are the 4 clinical forms of histoplasmosis?1) Acute Pulmonary histoplasmosis 2) Progressive disseminated histoplasmosis 3) Chronic pulmonary histoplasmosis 4) Complications of histoplasmosisClinical manifestation are similar to flu-like symptoms or severe pneumonia. Rarely fatal. What clinical form of histoplasmosis is this?1; Acute Pulmonary histoplasmosisSeen in patients with HIV, CD4 cell count <100. Fever and multi-organ dysfunction Can mimic septic shock and needs to be treated FAST or can lead to death -Poor prognosis. What clinical form of histoplasmosis is this?2; Progressive disseminated histoplasmosisMainly seen in older patients with chronic lung disease -CXR shows: various lesions including complex apical cavities, infiltrates, nodules what clinical form of histoplasmosis is this?3; chronic pulmonary histoplasmosis-Granulomatous mediastinitis -Enlarged mediastinal lymph nodes and fibrosis mediastinitis -Poor prognosis What clinical form of histoplasmosis is this?4; Complications of pulmonary histoplasmosisDiagnosis of histoplasmosis?Antigen testing via sputum (PCR) or urine highly specificWhat is the most specific test for histoplasmosis?Culturestreatment for Histoplasmosis?*Asymptomatic: No treatment *Mild-Moderate: Itraconazole orally. -AIDS patients with histoplasmosis have to be on lifelong suppressive therapy with itraconazle *Severe: IV Amphotericin BHow is PCP transmitted?airborneWhat is the most common opportunistic disease in AIDS patients and is considered an AIDS defining illness?PCPWhat does the CXR and CT show for PCP?CXR: Diffuse bilateral interstitial infiltrates CT: Ground glassDiagnostic Tests for PCP?-ABGs (Shows hypoxia and hypocapnia) -PCR with BAL -STAIN WITH DIRECT FLUORESCENT Antibody staining -Bronchoscopy if induced sputum is (-)treatment for PCP?Bactrim and to prevent PCP we give patients prophylaxis for remainder of life.