-
what are 2 other names for trematode?
-
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
-
what are the worlds 2 most important parasitic disease?
-
how can you tell which type of schistosoma?
Terminal spine from a Terminal urine sample = haemaTobium
-
which parts of the world do you find schistosoma haematobium?
- africa eg lake malawi!
- middle east
- egypt
-
which organ does schistosoma haematobium affect?
- bladder
- can cause inflammation and fibrosis and ureteric obstruction
- hydronephrosis
-
what are symptoms of schistosoma haematobium?
-
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
-
what is first symptom of schistosoma usually?
swimmers itch - local dermatitis at site of invasion
-
what is katayama fever? what see on FBC?
- after incubation period of 1-3 WEEKS
- get fever malaise and myalgia
- eosinophilis on FBC
-
what is main difference between s.haematobium and mansion?
- mansoni is in bowel
- diagnosed by faecal microscopy for eggs
-
what is treatment for schistosomiasis?
- praziquantel
- one dose for haematobium
- 2 doses for mansoni and japonicum
-
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
-
why may you see pulm HTN in schisto?
eggs are shunted to lungs by bypass fibrotic liver
-
how can schisto be prevented?
- avoid freshwater contact in endemic area
- note - chlorination of water kills schistosomes so swimming pools should be ok
-
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
-
what is correct term for worms?
helminth
-
what are the 3 main types of worms?
- nematodes: roundworm
- trematodes: flatworm/flukes
- cestodes: tapeworms
-
what are nematodes?
roundworms
-
what are 2 classes of nematodes? and 4 eg of each
- soil transmitted: ascaris, trichuris, strongyloides, hookworm
- filaria: bancroftian filariasis, onchocerca, loa loa
-
what are 2 main types of trematodes and give eg for both
- tissue flukes eg clonorchis liver, fasciola hepatica liver
- blood flukes eg schistosoma
-
what are 2 main cestodes?
- taenia
- hydatid (echinococcus)
-
what do cestodes look like?
segmented
-
how would you describe larva currens?
- faint rash
- serpigenous - spread quickly
- currens = running
-
what does question mark shape worm look like?
strongyloides
-
what type of roundworm is strongyloides?
soil transmitted
-
what are 3 main tests for worms?
- FBC: eosinophilia
- stool microscopy: ova cysts parasites
- serology: ELISA positive
-
what would 3 investigations for strongyloides show?
- FBC: eosinophilia
- stool microscopy: larvae of strongyloides
- serology: strongyloides ELISA strongly positive
-
what is Rx of strongyloides?
albendazole 400mg for 4 days
-
if symptoms of strongyloides persist, what is Rx?
ivermectin 200 micrograms/kg stat
-
what is full name of organism that causes strongyloidiasis?
strongyloides stercoralis
-
which parts of world do you get strongyloidiasis?
TROPICS
-
how is strongyloidiasis transmitted?
percutaneously
-
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)
-
where in GI tract does strongyloidiasis affect?
small bowel
-
name 4 symptoms of strongyloidiasis?
- skin: larva currens
- lung: dyspnoea cough
- GI: nausea, anorexia then heavy GI infection
-
what are 2 main complications of strongyloidiasis?
- malabsorption (remember small bowel) and weight loss
- 2ndry G-ve sepsis
-
which 3 Ix do you do if suspect strongyloidiasis?
- FBC: eosinophilia
- serology: ELISA +
- stool microscopie or duodenal aspirate
-
how do you prevent strongyloidiasis?
wear shoes on feet
-
what 4 potential outcomes of strongyloidiasis in immunosuppressed?
- lung: necrotising pneumonia
- GI: severe diarrhoea
- G-ve sepsis
- meningitis
-
which is the other percutaneous soil transmitted helminth?
hookworm
-
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
-
what is main 2 symptoms of hookworm?
- itching at site of larval entry
- ulcer like abdo pain
-
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
-
what do you see in Ix of hookworm?
- stool microscopy: ova - number=severity
- eosinophilia
-
what can hookworm be assoc with in children?
stunting and cognitive development
-
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
-
what are the 2 faeco-oral transmitted soil-transmitted helminths?
- ascaris=roundworm
- trichuris=whipworm
-
what parts of world go you get ascaris especially?
-
which part of body does ascaris affect?
- small bowel
- biliary tract
- lungs
-
what are symptoms of ascaris?
- abode pain and distension as bowel obstruction
- anorexia nausea vomit
- cough dyspnoea as lung
-
what are 2 main complications of ascaris?
- bowel obstruction
- biliary tract obstruction
- pulmonary eosinophilia
-
what do you see on Ix of ascaria?
- ova from stools
- worms on Ba studies
- eosino
-
what is Rx of ascaris?
mebendazole
-
where do you get trichuris?
tropical climates
-
what is route of transmission of trichuris?
faeco-oral
-
which part of bowel does trichuris affect? think of symptoms
large bowel
-
what are symptoms of trichuris?
- bloody diarrhoea
- abdo pain
- anorexia,
- TENESMUS
-
what are complcitioans of trichuris?
-
what is the name of pinworm/threadworm?
enterobius vermicularis
-
which part of world get pinworm?
more in temperate climates even UK!
-
how is pinworm transmitted?
faeco-oral
-
what time do female pinworms lay eggs and why important?
- lay eggs at night at anus
- so can do Ix at night?
-
what is main symptom of enterobius vermicularis/pinworm
perianal ITCHING!!
-
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
-
what is important about treatment of pinworm?
treat all family to prevent spread
-
what are the 3 main filaria?
- bancrofti
- onchocerca
- loa loa
-
what is lymphatic filariasis caused by?
wuchereria bancrofti/brugia malayi
-
how do you get bancrofti?
anopheles mosquito bite at night
-
which part of body does bancrofti affect?
lymphatics!!
-
what are clinical features of lymphatic filariasis?
- lymphedema
- hydrocele
- elephantiasis
-
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
-
what is treatment of lymphatic filarisis?
ivermectin
-
what is the main problem with onchocerciasis?
river blindness
-
how do you get onchocerciasis?
female blackly bite during day
-
which part of body does onchocerciasis affect?
- subcut tissues - so think about Ix...
- skin
- lymph
- eyes
-
what are clinical features of onchocer?
- skin: hypopigmentation
- lymphadenopathy
- eye: uveitis, keratitis, cataract, optic neuritis, atrophy, blindness
-
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
-
what is first and second line treatment for all filarial infections
- 1st: ivermectin
- 2nd: DEC = di ethyl carbamazine
-
which part of world do you get loa loa?
africa
-
which 2 tissues does loa loa affect?
-
what are 3 main clinical features of loa loa?
- skin: urticaria, pruritis
- joints: calabar swelling, arthritis
- eyes: chorioretinitis, worms migrate across conjunctiva
-
which Ix do for loa loa?
- daytime blood film - microscopy
- see worm in subcut tissue or conjunctiva
- serology
-
why does swelling move around in loa loa?
worm moves around and intermittently blocks different lymphatics!
-
what are 2 main types of tapeworms?
- taenia
- hydatid - echinococcus
-
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
-
what are complications of taenia?
- pancreatitis
- appendicitis
- cysticercosis
-
how do you treat taenia infection?
praziquantel
-
what is cysicercosis?
- pt infected with intermediate larval forms of taenia solium
- most common symptom ie epilepsy
- also causes focal neurology
-
what does CT of cysticercosis look like?
calcification
-
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
-
which countries do you get hydatid disease?
-
what 3 investigations would you do in suspected hydatid disease?
- FBC: eosinophilia
- CT liver: see cyst
- hydatid serology +ve
-
what is the organism causing hydatid disease?
- dog tapeworm
- echinococcus granulosus
-
which 2 organs in body can hydatid cysts commonly form?
-
how can hydatid disease present?
- jaundice
- slowly RUQ swelling and pain due to hepatomegaly form cysts
- PUO
- chest symptoms
-
how do you treat asymptomatic cysts?
no treatment especially once outer layer has calcified
-
if symptomatic cysts how to treat?
- combo: albendazole and praziquantel
- puncture, aspirate cysts
- may need surgical resection for symptom relief
-
how may hydatic cysts present?
anaphylactic reaction from contamination with released cyst contents
-
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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