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Where is an Entamoeba histolytica infection acquired?
Tainted water, often in a foreign country
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Where is a cryptosporidium parvum infection infection acquired?
Tainted drinking water, often in another country
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Which protozoa is particularly resistant to chlorination?
Cryptosporidium parvum
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Where is a Giardia Lamblia infection acquired?
Tainted water
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What is the lifecycle of toxoplasma gondii?
Mice, to cats, where sexual reproduction of the organism occurs, to feces, to mice
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Which fungus can only be treated with anti-protozoal drugs?
Pneumocystis jiroveci
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What parasite causes Pneumocystis Pneumonia?
Pneumocytis jiroveci
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What patient population is primarily at risk for Pneumocytis Jirovechi?
Immunosupressed
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What are the main clinically relevant protozoal parasites?
Entamoeba histolytica, Cryptosporidium parvu, Giardia lamblia, Trichonomias vaginalis and Toxoplasma gondii
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Which protozoa is an STD?
Trichonomas vaginalis
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Which clinically relevant protozoal parasites cause intestinal infections?
Entamoeba histolytica, Cryptosporidium parvu and Giardia lamblia
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Which clinically relevant protozoal parasites cause EXTRAintestinal infections?
Trichonomias vaginalis and Toxoplasma gondii
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What is the MOA of Nitroimidazoles (metronidazole and tinidazole)?
Enter cell and are reduced by pyruvate-ferredoxin oxidoeductase (not in mammal cells) to free radicals that destroy the DNA and proteins
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By what route is metronidazole given?
Orally
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What percent of metronidazole is absorbed orally?
100%
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What is the half-life of metronidazole?
8-10 hours
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Which clinically relevant parasites can be treated with metrinidazole?
E. histolytics, G. lambia, Trichonomiasis vaginalis
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Why is Metronidazole not efficient at treating intestinal protozoal infections?
Because it is well absorbed, so does not stay in the gut long
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What are the side effects of metronidazoles?
Urine discoloration (not as common as in past), GI issues, metallic taste, neuropathy, disulfarin-like effect and neutropenia
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Can you use metronidazole during pregnancy?
Not during the first trimester
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What is the spectrum of tinidazole?
E. histolytics, G. lambia, Trichonomiasis vaginalis (same as metronidazole)
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How does tinidazole compare to metronidazole?
Better tolerated and longer half-life, with fewer daily doses
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What is the hal-life for tinidazole?
12-14 hours
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Can you use tinidazole during pregnany?
Not during the first trimester
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How many doses a day do you need to take with tiidazole?
1
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How many doses a day do you need to take with metronidazole?
2
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How does Diloxanide furoate compare to diloxanide?
Diloxanide furoate is a prodrug of diloxanide
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What is the spectrum for diloxanide?
E. histolytica (for acute treatment must be used in combo w/ metronidazole or tinidazole)
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What are the side effects of diloxanide?
Minor GI effects
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What patient population is less likely to have side effect when using diloxanide?
Children
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Is diloxanide good for luminal or tissue treatment?
Only luminal, it is degraded before reaching the tissues
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What is the MOA for Iodoquinol?
Unknown, oral metal chelator (Zn)
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Iodoquinol only ills Trophozoites, in what part of the body?
Colon
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Iodoquinol is used with what other anti-parasitic drug to treat parasites of the colon?
Metronidazole
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Is Iodoquinol well absorbed?
No, little absorption
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What are the side effects of Iodoquinol?
Optic atrophy (high prolonged doses), GI effects
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Is Iodoquinol generally poorly or well tolerated?
Well
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What patient population is Iodoquinol contraindicated in?
Those with a Quinolone or Iodine hypersensitivity
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What is the MOA for paromomycin?
Protein synthesis inhibitor, aminoglycoside antibiotic
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Is paromomycin well absorbed?
No
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How is paromomycin administered?
Orally or IM
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What is the spectrum for paromomycin?
E. Histolytica, giardiasis and visceral leishmanias
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What are the side effects of paromomycin?
GI, ototoxicity and nephrotoxicity (later 2 at high doses and rare)
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How would you administered paromomycin for a visceral leishmanias treatment?
IM (all other parasites administer orally)
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What is the route of administration or Nitazoxanide?
Oral
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What is the spectrum fro Nitazoxanide?
Cyryptosporidium parvum and giardia lamblia
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What is the MOA of Nitazoxanide?
Competitive inhibitor of pyruvate-ferredoxin oxidoreductase
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Is Nitazoxanide and active or prodrug?
Prodrug
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What are the side effects of Nitazoxanide?
GI side effects
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What parasites can be treated with Amphotericin B?
Visceral and cutaneous leishmanias
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