1. what are 2 other names for trematode?
    • flatworm
    • flukes
  2. what are the 2 main types of flukes and give eg of both
    • tissue flukes - in bile ducts/lungs or liver eg clonorchis sinesis and fasciola hepatica
    • blood flukes eg schistosoma
  3. what are the worlds 2 most important parasitic disease?
    • malaria
    • schistosomiasis
  4. how can you tell which type of schistosoma?
    Terminal spine from a Terminal urine sample = haemaTobium
  5. which parts of the world do you find schistosoma haematobium?
    • africa eg lake malawi!
    • middle east
    • egypt
  6. which organ does schistosoma haematobium affect?
    • bladder
    • can cause inflammation and fibrosis and ureteric obstruction
    • hydronephrosis
  7. what are symptoms of schistosoma haematobium?
    • freq
    • dysuria
    • haematuria
  8. how do you diagnose schistosoma haematobium?
    • urine microscopy for eggs (midday collection)
    • USS renal tract for morbidity
    • bladder biopsy - as can lead to SCC of bladder
  9. what is first symptom of schistosoma usually?
    swimmers itch - local dermatitis at site of invasion
  10. what is katayama fever? what see on FBC?
    • after incubation period of 1-3 WEEKS
    • get fever malaise and myalgia
    • eosinophilis on FBC
  11. what is main difference between s.haematobium and mansion?
    • mansoni is in bowel
    • diagnosed by faecal microscopy for eggs
  12. what is treatment for schistosomiasis?
    • praziquantel
    • one dose for haematobium
    • 2 doses for mansoni and japonicum
  13. what is the main TYPE of complication with schistosomiasis and why?
    • fibrotic as get inflammatory reaction which heals with fibrosis
    • portal hypertension with mansoni and japonicum
    • hydronephrosis, pyeloneph, CRF with haematobium
  14. why may you see pulm HTN in schisto?
    eggs are shunted to lungs by bypass fibrotic liver
  15. how can schisto be prevented?
    • avoid freshwater contact in endemic area
    • note - chlorination of water kills schistosomes so swimming pools should be ok
  16. why would you want to do both non contarst and contrast XR of KUB in schist?
    • non contrast: see calcification due to chronic inflame and fibrosis
    • contast: obstrustive uropathy, hydroureter and hydronephrosis
  17. what is correct term for worms?
  18. what are the 3 main types of worms?
    • nematodes: roundworm
    • trematodes: flatworm/flukes
    • cestodes: tapeworms
  19. what are nematodes?
  20. what are 2 classes of nematodes? and 4 eg of each
    • soil transmitted: ascaris, trichuris, strongyloides, hookworm
    • filaria: bancroftian filariasis, onchocerca, loa loa
  21. what are 2 main types of trematodes and give eg for both
    • tissue flukes eg clonorchis liver, fasciola hepatica liver
    • blood flukes eg schistosoma
  22. what are 2 main cestodes?
    • taenia
    • hydatid (echinococcus)
  23. what do cestodes look like?
  24. how would you describe larva currens?
    • faint rash
    • serpigenous - spread quickly
    • currens = running
  25. what does question mark shape worm look like?
  26. what type of roundworm is strongyloides?
    soil transmitted
  27. what are 3 main tests for worms?
    • FBC: eosinophilia
    • stool microscopy: ova cysts parasites
    • serology: ELISA positive
  28. what would 3 investigations for strongyloides show?
    • FBC: eosinophilia
    • stool microscopy: larvae of strongyloides
    • serology: strongyloides ELISA strongly positive
  29. what is Rx of strongyloides?
    albendazole 400mg for 4 days
  30. if symptoms of strongyloides persist, what is Rx?
    ivermectin 200 micrograms/kg stat
  31. what is full name of organism that causes strongyloidiasis?
    strongyloides stercoralis
  32. which parts of world do you get strongyloidiasis?
  33. how is strongyloidiasis transmitted?
  34. which 2 main organs does strongyloidiasis affect and how?
    • migrates to upper airways - wheeze and cough
    • coughed up and swallowed into GI tract - where colonise - abdo pain
    • (remember infected via skin so that is affected too)
  35. where in GI tract does strongyloidiasis affect?
    small bowel
  36. name 4 symptoms of strongyloidiasis?
    • skin: larva currens
    • lung: dyspnoea cough
    • GI: nausea, anorexia then heavy GI infection
  37. what are 2 main complications of strongyloidiasis?
    • malabsorption (remember small bowel) and weight loss
    • 2ndry G-ve sepsis
  38. which 3 Ix do you do if suspect strongyloidiasis?
    • FBC: eosinophilia
    • serology: ELISA +
    • stool microscopie or duodenal aspirate
  39. how do you prevent strongyloidiasis?
    wear shoes on feet
  40. what 4 potential outcomes of strongyloidiasis in immunosuppressed?
    • lung: necrotising pneumonia
    • GI: severe diarrhoea
    • G-ve sepsis
    • meningitis
  41. which is the other percutaneous soil transmitted helminth?
  42. how is hookworm commonly acquired? and what do you subsequently see?
    • beach holidays eg caribbean
    • dogs poo on beach and human foot on beach
    • cutaneous larva migrans
  43. what is main 2 symptoms of hookworm?
    • itching at site of larval entry
    • ulcer like abdo pain
  44. what is main complication of hookworm and how?
    • anaemia
    • up to 100mls blood loss/day as hookworm has teeth to attack to GI mucosa and draw blood
  45. what do you see in Ix of hookworm?
    • stool microscopy: ova - number=severity
    • eosinophilia
  46. what can hookworm be assoc with in children?
    stunting and cognitive development
  47. what do travellers get who go to area where hookworm and why?
    • migratory phase
    • Loefllers pneumonia: allergic pneumonitis with wheeze - eosinophilia in lung in response to parasitic infection
  48. what are the 2 faeco-oral transmitted soil-transmitted helminths?
    • ascaris=roundworm
    • trichuris=whipworm
  49. what parts of world go you get ascaris especially?
    • asia
    • poor areas
  50. which part of body does ascaris affect?
    • small bowel
    • biliary tract
    • lungs
  51. what are symptoms of ascaris?
    • abode pain and distension as bowel obstruction
    • anorexia nausea vomit
    • cough dyspnoea as lung
  52. what are 2 main complications of ascaris?
    • bowel obstruction
    • biliary tract obstruction
    • pulmonary eosinophilia
  53. what do you see on Ix of ascaria?
    • ova from stools
    • worms on Ba studies
    • eosino
  54. what is Rx of ascaris?
  55. where do you get trichuris?
    tropical climates
  56. what is route of transmission of trichuris?
  57. which part of bowel does trichuris affect? think of symptoms
    large bowel
  58. what are symptoms of trichuris?
    • bloody diarrhoea
    • abdo pain
    • anorexia,
  59. what are complcitioans of trichuris?
    • dysentery
    • rectal prolapse
  60. what is the name of pinworm/threadworm?
    enterobius vermicularis
  61. which part of world get pinworm?
    more in temperate climates even UK!
  62. how is pinworm transmitted?
  63. what time do female pinworms lay eggs and why important?
    • lay eggs at night at anus
    • so can do Ix at night?
  64. what is main symptom of enterobius vermicularis/pinworm
    perianal ITCHING!!
  65. what is name of test done to detect pinworm?
    • sellotape test
    • sticky tape to perianal area to get ova for microscopy
    • also see ova in stool
  66. what is important about treatment of pinworm?
    treat all family to prevent spread
  67. what are the 3 main filaria?
    • bancrofti
    • onchocerca
    • loa loa
  68. what is lymphatic filariasis caused by?
    wuchereria bancrofti/brugia malayi
  69. how do you get bancrofti?
    anopheles mosquito bite at night
  70. which part of body does bancrofti affect?
  71. what are clinical features of lymphatic filariasis?
    • lymphedema
    • hydrocele
    • elephantiasis
  72. when should you do blood test for lymphatic filariasis and why?
    • at night
    • as worms know mosquitoes come out at night so they swim around blood at night
  73. what is treatment of lymphatic filarisis?
  74. what is the main problem with onchocerciasis?
    river blindness
  75. how do you get onchocerciasis?
    female blackly bite during day
  76. which part of body does onchocerciasis affect?
    • subcut tissues - so think about Ix...
    • skin
    • lymph
    • eyes
  77. what are clinical features of onchocer?
    • skin: hypopigmentation
    • lymphadenopathy
    • eye: uveitis, keratitis, cataract, optic neuritis, atrophy, blindness
  78. name 2 Ix for onchocerciasis?
    • skin/eye snips kept in saline - think of where it affects subcut tissue!
    • slit lamp examination of eye shows microfilariae
  79. what is first and second line treatment for all filarial infections
    • 1st: ivermectin
    • 2nd: DEC = di ethyl carbamazine
  80. which part of world do you get loa loa?
  81. which 2 tissues does loa loa affect?
    • subcutanous
    • periorbital
  82. what are 3 main clinical features of loa loa?
    • skin: urticaria, pruritis
    • joints: calabar swelling, arthritis
    • eyes: chorioretinitis, worms migrate across conjunctiva
  83. which Ix do for loa loa?
    • daytime blood film - microscopy
    • see worm in subcut tissue or conjunctiva
    • serology
  84. why does swelling move around in loa loa?
    worm moves around and intermittently blocks different lymphatics!
  85. what are 2 main types of tapeworms?
    • taenia
    • hydatid - echinococcus
  86. what are 2 main types of taenia and how do you get each?
    • beef tapeworm: taenia saginata
    • pork tapeworm: taenia solium
    • eat meat contaminated with larvae
  87. what are complications of taenia?
    • pancreatitis
    • appendicitis
    • cysticercosis
  88. how do you treat taenia infection?
  89. what is cysicercosis?
    • pt infected with intermediate larval forms of taenia solium
    • most common symptom ie epilepsy
    • also causes focal neurology
  90. what does CT of cysticercosis look like?
  91. what are the role of dog and sheep in hydatid disease?
    • sheep dies as it eats dog faeces which has eggs
    • dog eats sheep which has hydatid cysts in it
    • cycle
    • human eats meat and cysts made in humans
  92. which countries do you get hydatid disease?
    • turkey
    • iran
    • kenya
    • wales
  93. what 3 investigations would you do in suspected hydatid disease?
    • FBC: eosinophilia
    • CT liver: see cyst
    • hydatid serology +ve
  94. what is the organism causing hydatid disease?
    • dog tapeworm
    • echinococcus granulosus
  95. which 2 organs in body can hydatid cysts commonly form?
    • liver
    • lung
  96. how can hydatid disease present?
    • jaundice
    • slowly RUQ swelling and pain due to hepatomegaly form cysts
    • PUO
    • chest symptoms
  97. how do you treat asymptomatic cysts?
    no treatment especially once outer layer has calcified
  98. if symptomatic cysts how to treat?
    • combo: albendazole and praziquantel
    • puncture, aspirate cysts
    • may need surgical resection for symptom relief
  99. how may hydatic cysts present?
    anaphylactic reaction from contamination with released cyst contents
  100. what do you need to do first before aspirating hydatid cyst and why?
    • use scolicidal agent eg alcohol or hypertonic saline into cyst under image guidance
    • to prevent bursting and anaphylaxis
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