PARASITE Trichuris trichiura A.K.A. EGG INFECTIVE Whip worm Embryonated Egg in soil/feces Barrel-S, 2 plugs unembryo Enterobius Vermicularis ADULT M – curved 360 F – blunt; stichocytes Seat Worm D-shape, football spindle-S, cephalic ala, corpus, isthmus, bulb M – curved tail F – pointd tail Trichinella Spiralis DFS Unembryo eggs in feces Encysted larvae in Inad cooked pork HOST LOC. LI, Whip inserted into wall no migration phase to lungs embryonated in soil Embryonated ova Pin worm DIAGNOSTIC Scotch tape Swab Ileum of SI, Cecum,LI man Embryonated Eggs Gravid female Migrates to Perianal area Tissue biopsy Muscle tissue of man, pigs Xenodiagnosis larva – w/ spearlike burrowing tip Bachman Intradermal test thread-like ; F – blunt; M – curved w/ 2 lobular appendages; A-end- non-papillated Capillaria Philippinensis Larva in raw fish Eggs embryonate in Fresh water peanut shape Ascaris Lumbricoides Most common Intestinal nematode Ancyclostoma Duodenale DFS -eggs (E) -larva (L) -adults (A) embryonated eggs in F typical F – 8 in 1 row atypical F – 40 in 2 M – w/ chitin spicule Giant Round Worm Embryonated Egg DFS of eggs SI (jejunum ) of fish, man larvae in gastric mucosa and intestines SI of man (not attach) Decorticated, Unembryo egg tri-radiate xs F-3 lips; M–2 spicules larvae, corticated 3rd stage filariform Old World Hook worm Adults in SI Gall bladder, Liver, nares, appendix DFS EIA -ELA Liver-lung Migration (larv swallowed) SI Lung migration teeth Necator Americanus New World Hook worm pointed tail, short esophagus 8-cell stage DFS EIA INT HOST 2NDINT HOST PATHOLOGY -Prolapse of Anus -IDA, Alb, D -Sometimes appendicitis -symptoms due to unique mode of attachment 1) site - ulceration 2) eggs - prupritus 3) migration -vulvuvag & salphingitis -Rheumatic pain (intestinal flu) - M eosin -swollen eyelids -3 stages of inf: intest,larval,encap -Stage of conval - death due to Myocard or enceph -int mal-ab -Borborygmi -Ab Pain -Diarrhea -Villus flat -Atrophy COL -death MOT F-O-R (fecaloral route) H-M (handmouth) PHIL Albendazole 80-90% Mebendazole warm, tropical regions Yup (F>M) OxantelPyrantel Mebendazole Pyrantel pamoate inhalation Retro infection Ingestion of encysted larvae in pork yup Thiabendazole Corticosteroid (for allergic rxn) Mebendazole? Ref (5F 20d, 20F10d, 20F 6d) Ingestion Of larva In raw fish Yup (M>F) I. Norte (N.Luzon) Mebendazole Albendazole THA,JPN, EGY,TAI, IRAN Lung mig –Asthma; Capil penetration –Pneumonia; Ab Pain due to adult Migration; Int Obst; eosin Ingestion Yup Burrowing of Sin of foot Most Common In world Ground itch; <500 eggs in feces = light worm, >500 eggs = heavy worm; Hookworm anemia due to suction of blood/ bleeding Oral percutaneous Yes Microcytic Hypochromic Tx Yup Tropics, subT Peperazine Citrate Albendazole Mebendzaole Pyrantel Pam Pyrantel Pamoate Mebendazole Iron replacement Skin Penetration -ELA cutting plates Strongyloides Stercoralis Thread Worm filarifor m; no F M Long eso, Prominent 3rd stage filariform Rhab in stool short buc cav SI man; Lung Migr aftr skin Penet; repro parthogenesis Eggs hatch SI Larval migration – Lobular pneu w/ hem; like PUD, Hyper Infection, Peripheral Eosinophilia, malab syndrome - Skin Penetration of FL - Free-living - auto infection Yes Albendazole Tropics, SubT Thiabendazole Genital primordium, notched tail PARASITE A.K.A. Brugia Malayi EGG ADULT kinky, overlapping nuclei, nuclei reach tail end (terminal, subterminal n.) giemsa – sheath unstained smooth, single row of nuclei, no term nuc, >L than BM giemsa – pink stain Wuchereria Bancrofti Loa Loa INFECTIVE Larvae In Arthropod Vector Bites at Night Enters Bite wound Bioincub - 1 year Larvae crawl into wound DIAGNOSTIC Blood smear (thick And Knott Conc) HOST LOC. Lymphatics Bloodstream Peripheral Blood Microfilaria In blood at Night CARD Test – Antigen det DNA probes Thin blood Smear Subcutaneous tissue INT HOST mosquitos W.B. – Culex Quinque Fasciatus RuralAnoph; UrbanFatigans; Pacificaedes VectorDipteran (chrysops) 2ND INT HOST PATHOLOGY Acute – Hypersensitizatn Chronic – (poor prog), elephantiasis (blocks lymphs) Weingarten’s Syndrome – Hyper-eosin of Peripheral blood MOT PHIL Skin Yup Larva Enter bite wound Warm regions Tx Diethylcarbamazine (not effective on adult worms) Ivermectin Mosquito Bites at night corticosteroids supportive – pressure bandaging surgery Calabar swelling Skin No Diethylcarbamazine Adult in eye Larva Enter bite wound Africa Corticosteroids Ingestion Of Infective copepods NO Metronidazole Middle East, Africa Thiabendazole Skin NO Diethylcarbamazine Larva Enter bite wound Ingestion Of larva In snails Africa C. and S. America NO Corticosteriods TAI, THAI, CAM, VIET, Hawaii, Tahiti Dead parasite Could exacerbate Tissue reaction biopsy hypersensitivity surgery shedding of sheath, Dracunculus Medinensis Fiery Serpent Israelites Guinea worm Larvae in copepods larva migrates to lower ext. Oncocerca Volvulus Angiostrongylus Cantonensis Larvae Crawl into Bite wound 3rd stage larva in snails and slugs or rats ingested by man Rat Lung worm adult emale “Barber pole” dark red intestinal tract Angiostrongylus costaricensis snails – paratenic hosts 3rd stage larva in snails/ slugs ingested by man nd cotton rat Local lesion Worm/Larvae Mesenteric Tissues Calcifiqed Worms by x-ray Biopsy Larva migrate To lower ext Subcutaneous tissue Copepods Ingest Larva in water Blister w/ Serous exudates VectorBlack fly -River Blindness -Eye lesions - Skin lesions - Scrotum enlargement Eosinophilic Meningoencephalitis Mazzotti Slit lamp History -eating, travel Brain Spinal cord leukocytosis & eosinophilia Skin test needs evaluation ManAccidental hosts Intestines (gut wall) Mollusks, Snails: Achantina, Pila Planaria, Slugs, prawns Mollusks Snails, slugs (Sigmodon hispidus) Anisakis Herring disease Terranova sp – juveniles Pseudoterranova sp – not penetrate Eustrongylides sp – perforates large bowel 3rd stage larva in flesh of raw fish; larva migrate from viscera to muscle after death of fish Edoscopy Immunologic Tests under Study Marine Crustaceans And fish Pseudoperitoneal syndromes + eosins in CSF, CN involve, diplopia and strabismus CSF >= 500 cells/ml w/ 10-90% eosins “acute abdomen” - inflamm of ileocecal region; Ab pain loc to right lower quad + palpable tumor-like m Pseudoterranova spp – Not penetr8 stom, Throat irrit, coughed Anisakis simplex (USA) Stom, int, inflamm Rxn surrounding larva Anisakiasis – local Tissue response; (Eustrongylides spp) Perforation of L bowel Surgery None recommended Surgical if ncessary Ingestion Of raw Marine Food w/ Alcohol, “green” herring, sashimi NO JPN, Netherlands Remove larvae By biopsy Forceps Surgical Intervention For obstruction Manage conservatively PARASITE A.K.A. EGG Schistosoma Hematobium ADULT INFECTIVE S. Japonicum Freeswimming Cercaria DIAGNOSTIC Eggs, miracidia in urine Platyhelminthes terminal spine Schistosoma Mansoni Freeswimming Cercaria HOST LOC. Adults Bladder, liver larva – Venous Plexuses Ova in feces (blood, mucus) Rectal biopsy Liver Ova in feces, Rectal biopsy, COPT test, ELISA Liver, Mesenteric Venules, SI, heart, Spleen, CNS Unembryo ova in feces, duodenal aspirates Bile duct of Sheep Metacercaria Encysted On aquatic vegetation Unembryo ova Metacercaria Encysted On Fresh Water fish Embryo ova In feces or Biliary duodenal aspiratesBDA Embryo ova In feces or BDA Giant AnimalsCattle Biliary tract (BT) Man Platyhelminthes Mesenteric venules, SC, lungs INT HOST Bulinus Snail (Miracidia to cercaria) Biomphalaria Snail lateral spine Schistosoma Japonicum Cercaria in copula, males have gynecophoric canals Platyhelminthes Schistosoma Intercalatum Schistosoma Mekongi Fasciola Hepatica Fasciolidae Fasciola Gigantica lateral knob (smallest) Like Schistosoma Mansoni in terms of life cycle, pathology and clinical features Intermediate host – Biomphalaria snail Lide Schistosoma Japonicum in terms of life cycle, pathology and clinical features Intermediate host – Lithoglyphopsis aperta Sheep Metacercaria Liver Encysted Fluke On aquatic vegetation leaf S, w/ shoulders cephalic cone, “popping spinous, dendritic testes operculum” Giant Liver Fluke Larger than F. hepatica Fasciolidae Clonorchis Sinensis no shoulders Chinese Liver Fluke branched testes; spatulate Opistorchidae Opistorchis Felineus Cat Liver Fluke lancet S reddishbile color Opistorchidae Opistorchis Viverrini Opistorchidae knob at abopercular end lobed testes like O. felineus Metacercaria Encysted On fresh Water fish Metacercaria Embryo ova In feces Or BDA Herbivore animals BT Small AnimalsCats, dogs, etc (BT SI) Civet cat, Dog, fisheating Oncomelania Quadrasi, Formosa SnailsLymnea Philippinensis, Lymnea swinhoe (TAI) (sporocystredia-cercaria) Snail Operculate Snails (Alocinma, Parafossarulus, Bithynia) Snails Bithynia Funiculate Snails Bithynia Goniomphalus, Funiculate, laevis 2ND INT HOST PATHOLOGY Calcified Bladder (dead eggs= “sandy patches”); Painful urination; Kala-azar; adults coated w/ RBC An and not detected; trapped egg cause clinical symptoms; Terminal Hematuria; infection linked To S. typhi and paratyphi carriers Claypipe-stem Fibrosis = Thickening of portal vessels due to rxn w/ eggs; Hepatosplenomegaly Portal HTN, ascites, eggs sometimes Deposited in SC, lungs liver enzy,serum alb, glob(prot) Katayama rxn/ fever, reaction to Eggs in tissue = CNS damage, Hepatosplenomegaly, Portal HTN, Ascites; mucus/blood in feces, liver enzy,serum alb, glob(prot) Aquatic vegetation Halzoun – ingestion Raw sheep, goat livers (dyspnea, deafness, asphyxiation, death) fibrotic vs. traumatic/ necrotic lesions; obs; False vs true (no eggs) Aquatic vegetation Fresh water Fish (FWF) : Cyprinidae, Ctenopharyngodon FWF Cyprinus Carpio (Taiwan) FWF Punteus Orphoides, Hampala dispar MOT PHIL Skin Penetration Thru Infected water Wala Siguro… Cercaria Penetrate Skin thru Infected water Nope Cercaria Penetrate Skin thru Infected water Yup Ingestion of Infected Vegetation; Infected Liver (false) Cosmo Ingestion of Infected Vegetation Most Probably Cholangiocarcinoma of liver, liver function Impaired but SGPT and SGOT are normal Ingestion of Uncooked fish Periportal fibrosis, Invasion of pancreas, Form bile stones Ingestion of Infective fish Hyperplastic biliary Epithelium (Stim by Nitrosamines); assos. w/ cholangiocarcinoma Ingestion of Infective fish Tx Praziquantrel Tropics Subtropics Praziquantrel Africa Brazil Praziquantrel Mindanao, Visayas Bithionol In sheep Raising countries Africa, Asia Rare CHI, JPN, SK, Vietnam Nope USSR, poland Nope Thailand Udorn Bithionol Chloroquine Diphosphate Praziquantel Praziquantel Praziquantel Dicrocoelium Dendriticum Lancet fluke Dicrocoellidae PARASITE Paragonimus Westermani deep golden-brown A.K.A. EGG 2 large testes lancet, flat, transparent, aspiny Metacercaria ADULT INFECTIVE Oriental Lung Fluke branched testes side by side; coffee operculum at broad end, thick aboper 2 dendritic testes in tandem Heterophyes Heterophyes H. Metagonimus yokogawai M. eggs no aboper protub; same hard to distinguish adults; scale-like spines, w/ genital sucker, globular testes Echinostoma Ilocanum oral sucker with collar of spines; 2 lobed testes in tandem, reddish-grey Pork Tapeworm Longest Tapeworm MC are Sensitive to Dryness Metacercaria In fish Miracidium present in The egg once Deposited by adult Beef tapeworm No sporocyst stage Cysticercous Cellulosae rostellum w/ hooks 4 suckers; ripe proglottid <13 lateral branches; 3m Taenia Saginata Cercaria w/ spines Metacercaria indisting.from fasciolas Taenia Solium Metacercaria In crustacean Metacercaria In water Plants indistinguish from F. hep, F. gigantica indistinguish from each other and from E. granulosus; hexacanth (6 hooklets); radially striated shell eggs – cause cysticercosis Cysticercous bovis DIAGNOSTIC Unembryo eggs in feces or sputum complement fixation Unmebryo Eggs in feces Snails- Abida, Cochilcopa, Helicella, Zeb HOST LOC. INT HOST Encapsulated in Parenchyma of lung; in fibrotic capsules Snail Miracidia (M) Cercaria (C) Antemelania Asperta; Antemelania Dactylus Snails – MC Reservoir – Cats & dogs Duodenum of Man or pigs Segmentina, Hippeutis Unembryo Eggs in stool Using Kato-Katz method Small Intestines Reservoir – Fish eating mammals Snails : Freshwater, Brackish or Marine Formica Fusca (ants) Unembryo Eggs in feces Small Intestines 2ND INT HOST Crabs – Sundathelphusa Philippina Reservoirrats Ripe or gravid Proglottid Small intestines of man formaldehyde soln cysticercosis in muscles eggs cysticercous cellulosae Scolex after therapy Ripe or gravid Proglottid Man SI (accidental) Cattle, llama, Giraffe, Carabao eggs cysticercous bovis Ingestion of ants Wala siguro Praziquantel PATHOLOGY MOT Granulomatous rxn in lungs; rustcolored sputum, w/ Foul fish Odor Ingestion Of Infected crustaceans PHIL Tx Yes Praziquantel Asia Bithionol Triclabendazole C meta-C Aquatic Vegetation C meta-C Water caltrop, Water chestnut, Water morning Glory, lotus Many fish in the Phil. (30 Species); in muscles at base of the fin MC Snails: -Gyralus Convexlusculus -Hippeutis Umbilicalis MC Hogs, wild Boars, sheep, Deer, dogs, Monkeys, rats, cats Same as F. hepatica Portal cirrhosis, Periductal fibrosis C meta-C Scolex after therapy no rostellum, hooklets ripe >15 branches; 5m; tree-like dicho branching sheep w/ fully dev miracidium bean; integument w/ spines Fasciolopsis Buski Embryo ova Snails: -Pila luzonica “kuhol” and -Vivipara Angularis“suso” C meta-C Misdiagnosed For PTB Worms cause Traumatic, Obstructive and toxic effects; ulceration and mucus prod. Ingestion Of Infected Water Plants Nope Inflamm, Sloughing off Of layers, xs Mucus prod Ingestion of MC Encysted in fish Yes Ingestion Of encysted MC in snails Of course Praziquantel N. Luzon, Samar, Leyte, Mindanao yes Praziquantel Misdiagnosed For acid Peptic ds (APD), consistent w/ PUD Inflamm, Ulceration, Diarrhea, intoxiacation Inflamm, Eosinophilia, leukopenia Dev Cisticercosis (ingestion of eggs), larva in brain, muscle, eye Epigastric Pain, vertigo, Nervousness, eosinophilia Ingestestion Of inadeq. Cooked Pork Praziquantel SEA, CHN, India, indonesia Praziquantel EGY, Greece, CHN, JPN, KOR, TWN, Phil cosmo Accidental Ingestion of eggs Ingestion Of cysts in beef Niclosamide -damage to point of dissolution Echinococcus Granulosus Parasite Of dog Eggs – man Hydatid sand smallest Tapeworm In man PARASITE Diphyllobothrium Latum one long gravid proglottid A.K.A. Fish/ Broad t-worm EGG yellow-brown knob like thickening Dipylidium Caninum egg packets (8-15 eggs) oncosphere w/ 6 hooklets retractile, conical scolex; rose-thorn shape hooklets mature proglottid – with 2 lateral genital pores Embryo Eggs in Contam food and Water like D. caninum scolex but with less hooklets; ripe segment Rat T-worm Sparganosis Mansoni, Erinacei, Ranarum Spirometra Sheep, man (accidental, intermediate– in liver and lungs) HOST LOC. SI in man Reservoir Host: Dogs, cats,Bears Paratenic host: Carnivore fish Cysticercoid Larva in Arthropod Host when ingested Dwarf t-worm w/o filaments bile-stained; fan-like DIAGNOSTIC Operculated Eggs; Proglottids Kato tech with filaments Hymenolepsis Diminuta INFECTIVE Plerocercoid Larva Encyted In fish SI of Dog -Cysts Ingested and Release scolices spatulate, rosette uterus 2 bothria = sucking grooves Dog T-worm Double Pored T-worm Hymenolepsis Nana ADULT dogs x-ray to detect hydatid ds; immunologic tests Cyticerci Can complete Cycle in single Host (autoinf) Gravid Proglottids That are passed out/ Crawl out, Egg packets, Melon-shaped Proglottids in Chains (Not stool bec proGlot disint in environment Embryo Eggs in feces SI of dog or cat ProC PleroC Coracidia (CO) Procercoid (ProC) Ctenocephalides canis (dog flea) rare Ingestion Of eggs in feces Sugery Prev spillage of eggs) Albendazole PATHOLOGY Anemia (misdiag for pernicious type Vit B12 def); hyperchromic megaloblastic; examine for HCl in gastric juice (+ infection) MOT Ingestion PHIL Rare Tx Praziquantel Minimal symptoms Ingestion yup Praziquantel Enteritis due to Necrosis and Desquamation Of intestinal Epithelial cells FOR yup Praziquantel Ingestion Of Infected insects yes Praziquantel Ingestion Of Infected interM hosts Not sure Only 7 cases temperate zone Pulex irritans (human flea) SI of man Trichodectes canis (dog louse) Insects, rice And flour beetles Proglottids not Recovered bec They degenerate Auto Infection Direct/indirect pathways Eggs in stool (more circular, larger, lack bipolar thickening vs H. nana SI of man Plerocercoid In toads, frogs, snakes, White larvae In lesion Adult – Intestines of Cat/man paratenic hosts - pigs 2ND INT HOST (fish) perch, trout, salmon, pike FOR Ctenocephalides felis (cat flea) Cysticercoid Larvae in insects gravid segment; rudimentary, unarmed rostellum INT HOST copepods (Cyclops & Diaptomus) Obstruction – Growing cysts; Anaphylactic Shock when Cyst ruptures Larvae – any part, eye, subQT, Fleas, beetles, cockroaches, mealworms & earwigs Cyclops, copepods Minimal and Non-specific Frogs, Snakes, Toads, rats Painful edema Due to migrating Larvae Eosinophilia, Edema and erythema In rats <8% surgical mistaken for D. latum; pseudosegmentation w/ slit-like invagination PARASITE Entamoeba Histolytica Naegleria fowleri A.K.A. CYST TROPHOZOITE Ameba greenish-yellow quadrinucleate, thick, rodlike chromatoidal bodies CB, central karyosome (K), w/ chromatin dots No cyst only Flagellated form Large, usually Central K muscles INFECTIVE DIAGNOSTIC HOST LOC. Qudri cysts -Trophozoites In liquid stools -Cysts in Formed stools Large Intestines (cecal and sigmoidorectal) active, progressive, directional; pseudopod PSD: finger-shape, hyaline; w/ ingested RBC Culture, serology to detect invasive Amebiasis (IHAT) Trophozoite trophozoite large central K; double cell wall sluggish; PSD: spine-like No peripheral chrom Entamoeba coli yellow-brown; 1-8 nuclei, K eccentric; CB : splinter-like Entamoeba Gingivalis Endolimax nana pale green; 1-4 nuc; K irreg CB : bacilliform sluggish, rarely prog and dir; PSD: short, blunt; Bacteria/ debris Inclusions Mod active, prog PSD : blunt, hyalin sluggish prog; PSD:blunt /hyaline; K – L, cent Iodamoeba butschlii 1 nuc yellow green; K surr slug, prog; PSD : Blunt/Hyaline Brain Flagellate form in CSF slug-like; PSD: blunt; Acanthamoeba ELISA most Sensitive indicator Trophozoites In CSF and tissue liver in extraint amebiasis Cysts and Trophs inTissue Giemsa or PAS of Scrapings or Cornial biopsy CNS cornea INT HOST 2ND INT HOST PATHOLOGY Flasklike Primary ulcer; Histo changes: Histolysis, Thrombosis, Petechiae, Round Cell Infiltration, Necrosis MOT Ingestion Of Infective cysts PHIL Yes Most Common Are Asympto carriers Bacilliary vs Amebic dysentery Tx Supportive, Chemotherapy Asympto – Diiodohydroxyquin Mod severe Metronidazole Meningoencephalitis Severe frontal Headache,Blocked nose, Altered taste and smell EntersThru Nose rare Severe – D + M Hepatic – M + emetine Amphotericin Penetrate Cribriform Plate all types of soil Amp + miconazole and rifampicin Kernig’s sign; Leukocytosis w/ neuts, prot, glu Amebic Encephalitis (immunocompromised) Multiply in brain Thru Lower respi Tract or Thru ulcerated, Broken skin Rare Propamidine, Miconazole, neomycin Amebic Keratitis (assoc w/ use of contam contact lenses) All types Of soil Corneal grafting w/ granules; endosome Entamoeba hartmanii A.K.A. 1-4 nuc; K small/Central; Diffuse glyco mass non prog; PSD : fingerlike CYST TROPHOZOITE INFECTIVE DIAGNOSTIC HOST LOC. INT HOST 2ND INT HOST PATHOLOGY MOT PHIL Tx PARASITE Balantidium Coli Largest prot parasite Only ciliate Giardia Lamblia cyst bean-shaped nuc cytostome; cytopyge; “gay bowel syn” Quadri cysts young – 2 nuc; mature – 4 nuc; flagella retracted into axonemes No cyst stage Trichomonas vaginalis pyriform/tear-drop; bi-symm; erratic tumbling motion; 8 flag Troph No known cystic stage Sigmoidoscopy DFS Cysts and Trophs Biopsy, Entero-test, IF and antigen detection pyriform; jerky movements; 4 free flag +1 undulating; axos Dientamoeba Frgilis DFS of Troph and Cysts in Feces Troph Trophozoites In urine, Urethral sec, Vaginal sec, Cervical sec, Semen, Prostatic sec Binucleate Trophs in fresh Stool samples SI Cysts Troph Ulcer w/ rounded Base and wide Neck (vs flask shape) LI (cecal area) troph SI Duo, jeju, upper il Diarrhea and Dysenter (indisting. from Amebic) Villus flat and crypt Hypertrophy;electrolytes, glu, fluid abs, disacchs; diarrhea most common symptom (89%); spont recovery in 6 wks; chronic – steato, diarr altern w/ constip -Vaginal discharge – Liquid, green to yellow, Irritating -Speculum – Strawberry Cervix (diagnostic) -Vaginitis; urethritis Attaches To int villi Via adhes Disc on ven Female – Vaginal epi Male – Urethra, Epididymis, Prostate g In lumen Of LI -Increase excess mucus -Hypermotility of the bowel Old World Cut Leish w/ ovoid or rounded bodies Pro M promastigote 1 free flagella arising from kinetoplast Leishmania Donovani in skin tissue biopsy Bone marrow, Spleen or Lymph nodes New World Cut Leish Tetracycline Ingestion of Contam Food And water Uncommon In Temperate; Assoc w/ Pigs in tropics siguro Metronidazole FOR Outbreaks Are waterborne Sexual intercourse Passed thru Birth canal Co-infection With E. vermicularis Sand fly Pheobotomus Spp A-Mast Pro M in gut of fly -Mimics IBS (irrit bow syn) Cutaneous leishmaniasis Bite of Sandly vector Lesions resembling Lepromatous leprosy Yes Serology – For supportive diagnosis Smaller and longer than T. vaginalis Troph swabbing Oral Metronidazole Tinidazole Furozolidone Quinacrine paromomycin Oral Metronidazole Acid douches Other groups - 3-8% Siguro Iodoquinol …as long as may infection w/ E. vermic -in pre-schools in Germany, Israel, Holland Wala Tetracycline Metronidazole Antimony Compounds Africa, India South amercia Second line Drugs: Amp B, Pentamidine (Kala-azar), Metronidazole Nifurtimox Visceral Leishmaniasis or Kala-azar Splenomegaly, presence of Parasites in RE cells; Tapir nose Erosion of pinna of forest workers Oral cavity -tartar Iodoquinol Hostpitality Girls – 24% Mucocutaneous or American Leishmaniasis amastigote Trichomonas Tenax Lives Intracellular In Macrophages PMS and Endothelial Cells Pro M A-Mast amastigote Leishmania Braziliensis Siguro -Colicky ab pain; anal Pruritis; Peripheral eosinophilia rosette-shaped nuclei; no peri chromatin; K w/ 4-6 granules; no flag Leishmania Tropica FOR Droplets, kissing yes Chilomastix Mesnili cysts Cysts in Semi-formed Stools; Trophs in Liquid stools Cecal region Of LI INFECTIVE DIAGNOSTIC HOST LOC. T-mastigote Parasite in Blood tissues Or CSF knoblike prod, LemonS FOR Rare <1% spiral forW; 3 antflag + 1 PARASITE Trypanosoma Gambiense Trypanosoma Rhodesiense Trypanosoma Cruzi A.K.A. CYST West African Sleepng Sicknes TROPHOZOITE Trypomastigote Serology for Large scale Screening East African Sleepng Sicknes Chaga’s Disease Epimastigote Trypomastigote T-mastigote Blood smear Toxoplasma gondii (man) bradyzoite, cyst Isospora Belli (cat?) male and female gametocytes Schizont, gametes Inside host pseudocyst and oocyst w/ Sporozoites -Oocyst prod By sexual Cycle in cat; Pseudocystsasexual Serology – IgM detection By ELISA; IFA for IgG And IgM; PCR Of Toxo DNA Mature oocyst w/ sporozoites Immature Cysts in feces -Oocysts/ Sprorcysts in dudenum Surgical open Lung biopsy; BronchoAlLav; Bronchoscopy; Methenamine Silver stain immature cyst Pneumocystis Carinii cysts GAMETE Plasmodium Vivax SCHIZONT Tsetse Fly Reservor Host: Domestic Animals Tsetse Fly Reservor Host: Game animals ELISA, IF Serology –CF Xenodiag biopsy Plasmodium Falciparum In blood, Lymph and CSF INT HOST Histiocytes RE cells (adipose, myocardial, RE, Neuroglial) In SI of Cat (sexual And asexual Cycle); in Tissues in Asexual cycle Definitive – CAT SI of man Reduviids, Triatomid Bugs Reservoir: Wild mammals Mouse or Rat Man, pigs, Sheep, Accidental Intermediate hosts 2ND INT HOST PATHOLOGY Local Infiltration from bite area to lymph and CNS -Chronic inflammation Of lymphatics -Atrophy of dendrons Of ganglion cells -Winterbottom’s sign, Kerandels sign -Engulfed by histocytes and invade adipose tissue -inflamm response w/ fibrotic encapsulation = chagoma; Romana’s sign Brain lesions; hepatitis; Chorioretinitis; Lymphadenitis Bite of Vector Congenital Transmission possible PHIL Tx NO Supportive West and Central Africa Pentamidine Suramin Melarsopenol Tryparsamide Melarsen NO Uh..east Africa? -Bite of Vector -feces -transplacental -accidental ingestion -blood trans Ingestion, Transplacenetal No Income Groups In Suburban rural Yes FOR 8-amino quinolones Many are Chronic Ill but are asympto Primaquine, Nifurtomax (Bayer 2502) Pyrimethamine (Daraprim), TrisulfapyriMidines; Preg – spiramycin, Clinamycin; AIDS – Atovaquone Not sure Pyrimethamine Cosmo 2 types of postnatal ds 1) mild lymphatic (lide infectious Mononucleosis) 2) acute fulminating Malabsorption syndrome; Shortened villi, hyperTrophied crypts, infilt Of lamina propria, w/ Eosins, polys, rounded cells interstitial pneumonia; fatal pneumonia in infants; hypogammaglobulinemia, leukemia, Hodgkin’s, etc -lungs are gray and airless; death due to asphyxia Definitive – MAN MOT Sulfadiazide or Trimetroprim Droplets, Close contact Yes Bactrim cosmo TROPHOZOITE Mosquito – Gametocytes; Man – Sporozoites Peripheral Blood smears -thick -thin Hypnoxoite – Latent stage, QBC, Para sight F test RBC (Man) Vivax – young Malariae – old Falciparum – all Mosquito : Anopheles Flavirostris Minimus Anopheles -litoralis -Tissue anoxia – basic pathophysio change in malaria -4 mechanisms leading to tissue anox: 1. anemia-hemolysis 2. changes in blood flow 3. changes in capillary endothelium 4. histotoxic shock Bite of female Mosquito Passage of Blood w/ Erythrocytic Parasite by: Yes Malaria Free areas -manila -aklan Vivax and Ova – Chloroquine + Primaquine Falci and Mal -Chloroquine Plasmodium Malariae Plasmodium Ovale Cause relapse Sporogany – Mosquito LC; Schizogony – Human LC - exoerythro (merozoites) - erythro (gametocytes) (dipstick test), IFA 1)Stomach – Gamete form, 2)Stomach wall – oocyst and sporozoite release 3)salivary glands - sporo balabacensis -mangyanus -maculates -parasite virulence factors: 1. multiplication capacity 2. red cell selectivity 3. cytoadherence and resetting ability 4. potential to induce cytokine release 5. antigenicity 6. antimalarial drug resistance Blackwater fever, liver dys, hypogly, Acidosis, GI dys, placenta dys, pulmo edema, renal failure, coagulo and thrombocyto, coma -blood trans -contam syringe -neonatal -congenital -capiz -guimara -siquijor -biliran -iloilo -leyte N -leyte S -N Samar -Camiquin -Cebu -Catand. Chloroquine Resistant – Falc
