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Parasitology
USMLE parasitology
| Question | Answer |
|---|---|
| Entamoeba hystolytica | Amoebae-ingestion of cysts from water or sexual intercourse -> intestinal symptoms or extraintestinal such as liver abscess or pericardial disease. Dx with cysts in feces. Tx metronidazol+iodoquinol; diloxanide, furoate, tinidazole, paromycin. |
| Giardia Lamblia | flagellate-ingestion of cysts in water->intestinal infection only->steatorrhea smell stools with diarrhea. Dx-cysts in feces. Tx-metronidazole or tinidazole |
| trichomonas vaginalis | flagellate-transmitted sexually to infect the vagina and urethra causing pruritis, strawbery mucosa, greenish discharge, corkscrew motility on wet mount. Dx-trophozoites on wet mount. Tx- metronidazole+tinidazole |
| Naegleria fowleri | Flagellate- infects nasal passage from diving in water. causes amoebic meningoencephalitis. Dx-trophozoites in CSF. |
| Acanthamoeba culbertsoni | Flagellate- Infects skin, eyes, lungs, and other tissues; especially in immunocompromised persons that may cause granulomatous encephalitis. |
| Trypanosoma gambiense and trypanosoma rhodesiense | Haemoflagellates- African Sleeping sickness w/ amastigotes (w/in cells) and trypomastigotes (w/in plasma) that may affect the CNS. vector-tsetse fly. Tx- suramin, melarsoprol (if encephalitis). |
| Trypanosoma cruzi | haemoflagellate- chagas' disease w/ megacolon, dilated cardiomyopathy, megaesophagus. vector reduviid bug (kissing bug). dx-amastigotes in cells and trypomastigotes in plasma. Tx-nifurtimox(non-chronic), suramin |
| Leishmania brasiliensis | Haemoflagellate- musculocutaneous form that causes ulcers on skin and necrosis of nasal mucosa. Vector- phlebotomine sandfly. Dx-amastigotes in cells and trypomastigotes in plasma. Tx- miltefosine, topical paromomycin. |
| Leishmania donovanii | Haemoflagellate-visceral= Kala Azar w/ pancytopenia, high output HF/myocarditis/pericarditis/irregular fever, weight loss/ hepatosplenomegaly/high aminotransferases/hypoalbuminemia. Dx-amastigotes in cells. Tx-pentosan/glucantine/allopurinol/ miltefosine |
| intestinal parasites associated with myocarditis, percarditis, pericardial effusions or cardiac tamponade. | trichonella spiralis (trichinosis), Echinococcus granulosus (hydatid cyst), Taenia solium (cystocercosis) |
| Hookworm or tapeworm associated with anemia that may also cause cardiac pathology. | Necator americanus (Fe), Acylostoma duodenale (Fe), Dyphyllobothrium latum (Vit B12) |
| endomyocardial fibrosis | Helminth-associated chronic eosinophilia may lead to restrictive cardiomyopathy. |
| Babesia sporozoa | Vector-Ixodes tick. Found in blood as schizogony (asexual cycle) in the intermediate host w/ maltese cross in RBCs. Presents w/ fever and hemolytic anemia. co-infection with borrelia burgdorferi |
| Toxoplasma gondii | undercooked meat, fecal-oral cat feces, organ transplant are vectors. transplancental TORCH. Presents w/ flu like signs w/ latency. HIV encephalitis/chorioretinitis /myocarditis/pericarditis/CHF. schizogony in tissue. Tx- pyrimethonine/sulfadiazine |
| Wuchereria bancrofti & Brugia malayi | vector-mosquitto. adult in lymphatics->produce microfilariae-> travel in blood & lymph->inflammatory Rx=elaphantitis. Dx-PBS, high eosinophils/IgE/antifilarial ab/IgG4/microfilariae, ELISA. co-infect wolbachia bacteria. Tx- DEC/albendazole/ivermectin |
| Loa Loa | W. Africa. Vector-deer fly (chrysops). larva infect subdermal CT->mature->migrating worm RX->across eye. Rx to migrating and dead worms. chronic abcess-> granuloma-> fibrosis. Tx-Ivermectin/Albendazole |
| Onchocerca Volvulus | Africa/S.America. largest cause of blindness. Vector-Black fly. Larvae infect subcutaneous CT-> nodules-> microfilariae cause skin dermititis and blindness. Dx-nodulectomy. Tx-DEC/ivermectin, suramin |
| Dracunculus medinensis | Vector-Water flea (cyclops). larvae infect from contaminated water-> larvae develop to adults in subcutaneous CT-> skin eruptions. Dx-radiology or PE. Tx-metronidazole and/or thiabendazole. |
| Mansonella Ozzardi | S. America/caribbean. Vector-Simulium black fly/culicoides midges. mild/asymptomatic headache, joint pains, pruritis, inguinal adenitis. No sheath. |
| Mansonella Perstans | Africa/S America/Caribbea. Vector Culcoides midges. Mild/asymptomatic abdominal pain or transient skin swellings. No sheath. |
| Plasmodium Vivax | Vector F. anopholes mosquito. 48 hr relapsing fever with relapsing latent infections due to hypnozoites. requires duffy antigen (FyaFyb). Dx-PBS, HRP2 detection, parasite LDH. Tx-quinine, artemisinin |
| Plasmodium Ovale | Vector F. anopholes mosquito. 48 hr relapsing fever with relapsing latent infection due to hypnozoite. Dx-PBS (schizonts), HRP2 detection, parasite LDH. Tx-quinine, artemisinin |
| Plasmodium Malariae | Vecotr F. anopholes mosquito. 72 hr relapzing fever and may cause recrudescence. Dx- PBS (schizonts/gametocytes, HRP2 detection, parasitic LDH. Tx- Quinine, artemisinin |
| Plasmodium falciparum | Vector-F. Anopholes mosquito. Unpatterned relapsing fever w/ recrudescence. severe hemolytic anemia, jaundice, hepatosplenomegaly, pulmonary edema, CHF, hypoglycemia, dyserythropoiesis, blackwater fever, cerebral malaria. Tx-Quinine/artemisinin |
| Proquanil | Prophylaxis and treatment with atovaquone (malarone). MOA-palsmodial dihydrofolate reductase inhbitor. |
| Malarone (atovaquone) | Prophylaxis and treatment with of chloroquine-resistant multidrug resistant strains of P. falciparum and P vivax. |
| Primaquine | Drug of choice for P vivax and P ovale latent infection w/ hypnozoites.exoerythrocytic schizonts, gametocytocidal, hypnozoitocidal (only one). G6PDHase deficiency contraindicated due to acute intravascular hemolysis and methemoglobinemia. |
| Severe P falciparum treatment | Quinidine gluconate+antifolates or antibiotics (doxycyline or clindamycin) |
| Uncomplicated P falciparum treatment | Chloroquine. If resistant than quinine and doxycycline or atovaquone/proguanil. |
| Chloroquine | P vivax, P ovale, P malariae, and uncomplicated P falciparum. prophylaxis safe during pregnancy. MOA-intraerthrocytic forms only by increasing pH in food vacoules, prevents polymeization of heme, inhibits TNF-a. Resistance-transporter, pump |
| Chloroquine Side effects | High doses can lead to hypotension, cardiac arrhythmias, and cardiac arrest. Confusion, convulsions, coma. retinopathy and ototoxicity when high doses are given w/o plasmodium infection. |
| Quinine/Quinidine | alkaloids that concentrate in food vacuoles of plasmodium in RBCs to prevent formation of hemozoin. Resistance- pfmdr1 efflux pump. SE-tinnitus, high tone deafness, visual disturbances, dysphoria, N&V, postural hypotension, hypoglycemia, thrombocytopenia |
| Pyrimethamine | Antifolate prophylaxis antimetabolite parasitic dihydrofolate reductase inhbitor to tx-mildly chloroquine resistant, and uncomplicated multi-drug resistant malaria (w/quinine). Resistance-DHFR target change. |
| sulfadioxine combinations (fansidar) | Antifolate prophylaxis parasitic dihydrofolate reductase inhbitor to tx-mildly chloroquine resistant, and uncomplicated multi-drug resistant malaria (w/quinine). Resistance-DHFR target change. |
| Artemisinin (artesunate, artmether) | standard tx of uncomplicated P falciparum and multi-drug resistant malaria, but not monotherapy. combo w/ amodiaquine, sulfadioxine-pyrimethamine & lumafantrine. Rapid schizonticide. MOA- inhbit Ca++/ATPase. SE- type I hypersensitivity. no pregnancy |
| Metronidazole | Tx-Amebiasis, trichomoniasis, giardiasis, balantiasis, hepatic and extrahepatic amebic infections. diloxanide added 2 increase log-kill. prodrug w/ active metabolite depriving anaerobes of reducing equivalents. resistance-up [O2] or alter [redox molecule] |
| Nifurtimox | Tx-Acute chagas disease, but not chronic disease states. MOA-Produces ROS's intracellularly. AE-common, dose-related and reversible uncluding seizures, polyneuritis, N&V, abdominal pain, and insomnia. |
| Sodium Stibogluconate | heavy metal pentavalent antimonial compound used to treat cutaneous, mucosal and visceral leishmaniasis. SE- Cardiotoxiic |
| Paromomycin sulphate | aminoglycoside antibiotic. luminal amebicide (superior to diloxanide if asymptomatic), cryptosporidiosis in AIDs, Giardia lamblia during pregnancy (metronidazole is usual) |
| Prophylaxis malarial treatment | Chloroquine (not for resistant strains), mefloquine (not for resistant strains), doxycycline, proguanil+atovaquone (malarone), pyrimethamine-sulfadioxine (fansidar) |
| Treatment of Acute attacks of severe malaria | Quinidine gluonate, quinine sulfate (most common), doxycycline, pyrimethamine-sulfadioxide, mefloquine. |
| Treatment of less severe but acute attacks of malaria | Chloroquine (especially P. ovale and P. vivax), tetracycline, clindamycin |
| Treatment of liver staged malaria. | Primaquine (best), proquanil, tafenoquine, tetracycline. |
| hypnozoite stage malarial treatment | Primaquine and tefenoquine |
| Active against trematodes and cestodes. | Praziquantel. |
| Microsporidium (life cycle, | spores are ingested, inject sporoplasm in host cell, develop meronts, multiplies, forms spores, ruptures host cell. pigs/dogs/ chickens/ rabbits/ primats. water-borne. AIDs associated. Giemsa & chromotrope 2R stain. |
| Pinworms enterobius vermicularis | most common helminth in US; Presents in young children w/ perianal itching |
| Ascaris lumbarcoides | 5-12 inches long; fecal-oral transmission; eggs ingested, hatch in intestine; larvae cross bowel-> reach blood; larvae migrate to lung/trachea-> swallowed-> adult worms develop after 14 days in warmer areas; slower in cooler temps; adults live 1-2 yrs |
| Hookworm- Ancylostoma duodenale |
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