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  1. Which parasite can travel up the portal vein and form abscesses in the liver?
    • Entamoeba histolytica.
    • (heptatomegaly in 50% of cases)
  2. How is entamoeba histolytica spread?
    fecal-orally, contaminated food/H20
  3. Which cells do entamoeba histolytica lyse?
    Polys (neutrophils)
  4. What diagnostic tests do you use to detect entamoeba histolytica?
    • 1)Fecal antigen tests or
    • 2) PCR
  5. What is the tx for entamoeba histolytica?
    metronidazole 750 mg TID X 10 days
  6. How many entamoeba histolytica cysts need to be ingested to cause disease?
    Just one.
  7. Which 3 populations are most prone to entamoeba histolytica infection?
    • 1) institutionalized ppl
    • 2) promiscous homosexuals
    • 3) travelers.
  8. What other condition can amiebiasis be mistaken for?
    Ulcerative colitis.
  9. What do stool smears show for entamoeba histolytica?
    some PMNs (but less than seen w/ Shigella)
  10. What is this?
    Image Upload 1
    • Giardia Lamblia.
    • (Eyes w/ smile).
  11. How many cysts are required to cause infection w/ Giardia lamblia
    10-25 minimum
  12. Which parasite is often associated w/ camping/drinking stream water?
    Giardia lamblia.
  13. What are some symptoms of Giardiasis?
    • Diarrhea (sudden onset; initially may be watery) -90%
    • Malaise — 85 %
    • Foul-smelling and fatty stools (steatorrhea) — 70%
    • Abdominal cramps and bloating — 70%
    • Flatulence — 75 %
    • Nausea — 70 %
    • Weight loss — 65 %
    • Vomiting/fever < 30%
  14. Which parasite can cause a secondary lactose deficiency?
    Giardia lamblia.
  15. How long does the diarrhea last from Giardia?
    4-6 weeks, so suspect if diarrhea > 2 weeks.
  16. How diagnose Giardiasis?
    • 1) Microscopy
    • 2) ELISA/ immunoflorescence antigen test
  17. What are 2 drugs to treat Giardia?
    Metronidazole, Tinidazole.
  18. How many min. oocysts of Cryptosporidium can cause disease?
  19. What species of Cryptosporidium most commonly affects humans?
    Cryptosporidium hominis
  20. Which population is most likely to get affected with Cryptosporidium?
    Immunocompromised, like AIDS pts.
  21. How do you diagnose Cryptosporidium?
    Stool smear: Acid-fast stain.
  22. What is the main drug effective for Cryptosporidium?
  23. What is the string test used to detect?

    (Sensitive and cheap, but rarely done in the US)
  24. How is the string test done for Giardia?
    • One swallows a gelatin capsule attached to a long
    • string. The end of the string remains outside the mouth and is taped to the cheek. The capsule dissolves in the stomach and the string passes into the
    • duodenum. The string is left in place for 4-6 hours or overnight. Then it is withdrawn and the end is examined under the microscope for parasites that
    • are attached to it.
  25. How is Cryptosporidium spread?
    contaminated water, even in swimming pools.
  26. What are the different ways Giardia is spread?
    • 1) contaminated water
    • 2) person to person in daycare center/institutionalized places (fecal-oral)
    • 3) homosexuals (rare)
  27. Why is Entamoeba no longer diagnosed by stool analysis?
    Can't be differentiated from 2 other Entamoeba species.
  28. What's another name for Whipworm? How is it acquired?
    Trichuris. Acquired by ingestion.
  29. What is this? AKA ___worm. How is it spread?
    Image Upload 2
    Tricuris trichiura. (whip worm). Spread fecal-orally.
  30. What are clinical findings of whipworm?
    • Most asymptomatic.
    • Serious: Fe deficiency, nocturnal stooling.
    • loose stools
    • Rectal prolapse =often seen
  31. How do you diagnose Trichuruis?
    • Fecal smear.
    • Tx: MAIN
    • Mabendazole & Albendazole --> main ones
    • Ivermectin --> not as effective
    • Nitazoxanide --> good
  32. How many ppl does Ascaris affect worldwide? How does it access the GI?
    Over 1.2 billion. when swallowed, embryos enter venous bloodstream, to lungs, into alveoli, up bronchi & trachea, swallowed.
  33. S&S of Ascaris?
    • Most asymptomatic
    • If symptomatic: vomting (worms out--mostly in kids 1-5), abdominal pain.
    • Heavy: malabsorption, steatthroa, wt loss, if block common bile duct = cholecystitis
  34. What syndrome is associated w/ Ascaris? what is it?
    Loeffler's syndrome. It's a condition in which eosinophils accumulates in the lung in response to a parasitic infection.
  35. What type of egg is this? What conditions does this parasite like?

    Image Upload 3
    Ascaris lumbricoides. Likes warm & moist.
  36. How do you diagnose Ascaris lumbricoides? What's the down side of the testing?
    Stool smear, but eggs don't appear until >40 days of infection. Also if male worms only, no eggs.
  37. What's the treatment for Ascaris? Similar drugs to treating what other worm?
    • MAPN
    • Mabendazole & Albendazole
    • Pyrantel pamoate, nitazoxanide
    • (similar to whipworm and pinworm)
  38. What is Enterobius vermicularis AKA? What's the clinical manisfestation?
    Pinworm. Nocturnal perianal itching, interfering w/ sleep.
  39. How do you diangose Enterobius?
    Cellophane/Scotch tape test.
  40. Which 2 parasite drugs are contraindicated in pregnancy? What is used instead?
    • Mabendazole and Abendazole are contraindicated.
    • Use pyrantel pamoate instead.
  41. Which 2 nematodes (roundworms) are acquired through the skin?
    Strongyloides and Hookworm.
  42. Which parasite is associated with hyperinfection syndrome? What are symptoms?
    Strongyloides stercoralis.

    Fever. N/V/D, Anorexia, Ab pain. Pulm: Dyspnea, Wheezing, Hemoptysis, Cough
  43. Which parasite is it possible to autoinfect oneself again?
  44. What are S&S of Strongyloides? What is pathognomonic for Strongyloides?
    • Upon entrance:
    • inflammation, edema, petechiae, serpiginous or urticarial tracts, and severe pruritus
    • Chronic infection: urticaria or pruritis can develop.
    • Pathognomonic: larva currens ("running" larva)
  45. What is the Tx for Strongyloidiasis?
    Ivermectin w/ Albendazole as an alternative.
  46. How to diagnose Strongyloides?
    • Feces or aspiration of duodenal fluid.
    • ELISA is good, but can't differentiate past/present infection.
  47. Which population is susceptible to Strongyloides? What meds do you avoid giving?
    • Those w/ congenital immunodeficiency, underlying malignancy, malnutrition, alcoholism, hematopoietic stem cell transplantation (HSCT), or the
    • administration of corticosteroids or cytotoxic drugs
  48. Which parasite is known to be transmitted from stepping in human feces?
  49. This is what?
    Image Upload 4
  50. What are the 3 parasites associated w/ Loeffler's syndrome?
    • ASH:
    • Ascaris, Strongyloides, Hookworm
  51. S&S of hookworm?
    • "ground itch" assoc/ w/ local erythema and papular rash at penetration site.
    • Sometimes N/V & flatulence.
  52. TX for hookworm?
    • MAP
    • mabendazole (choice), albendazole, pyrantel pamoate
    • (ivermectin not effective)
  53. What are the biggest complications w/ hookworm?
    • 1) Fe deficiency anemia
    • 2) protein malnutrition
  54. How to diagnose hookworm?
    • 1) Stool smear (but only after 2 months infection)
    • 2) High eosinophils
  55. What parasite produces the condition Visceral larva migrans?
    What population does it usually affect?
    • Toxacara.
    • Usually affects kids, esp. those having geographous pica.
  56. How is toxacara transmitted?
    Ingest egss in animal feces or from undercooked meat of intermediate host (chicken, cattle swine)
  57. What's the Tx for Toxacara?
    • Noen usually, if really needed Albendazole/Mabendazole
    • Steroids often help for severe cases, for inflammation
  58. What are S&S of Toxacara? In the visceral form? Ocular form?
    • Visceral form: Hepatosplenomegaly, skin rash
    • Ocular: retinitis resembling retinoblastoma
  59. How to diagnose Toxacara?
    • Biopsy (but impractical often)
    • ELISA
  60. How does one get Trichinosis?
    • Usually from consuming cysts in undercooked pork
    • (Trichinella spiralis)
  61. What are S&S of trichinella ingestion?
    • Gut: mild cramps
    • Cysts in muscle: pain, arthralgia,edema, fever, myocarditis
    • Classic: subungual splinter hemorrhages, conjunctival and retinal hemorrhages, periorbital edema and chemosis, disturbed vision, and ocular pain
  62. Tx for trichinella?
    Mosty none. Mabendazole/albendazole PRN.
  63. Taenia solius causes what condition?
  64. What are clinical S&S of cysticercosis?
    CNS: cysts in brain and spinal cord --> seizures
  65. How do you diagnose cysticercosis?
    • CT scan,
    • x-ray for cysts,
    • biopsy
  66. Tx of cysticercosis? What should be screened before initiating steroid therapy?
    • Seizure control.
    • Albendazole or praziquantel, often w/ steroids.
    • Surgery as needed.

    Before steroids: Screen for latent TB, strongyloides
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