ID Exam 3: Guarascio Parasitic Infections and Travel Medicine

Giardiasis

-most common cause of ___ from a parasite in the US (more common in developing countries, summer months, and children)

diarrhea

Giardiasis

-transmission is ___ __ ___ (from contaminated water, swimming, occupational exposure, sexual exposure)

fecal to oral

Giardiasis

-can cause persisting ___ intolerance and ___ deficiency even after parasite is eradicated

lactose, iron

Giardiasis Symptoms

-___ cramping, N/V, light colored/fatty stools dehydration

gastrointesinal

Giardiasis Symptoms

-Chronic symptoms including weight ___, ___ intolerance, vitamin ___ deficiency

loss, lactose, B12

Giardiasis Diagnosis

-more commonly __ stool specimens to check for ova and parasites

-also can perform enzyme immunoassay (___) or nucleic acid amplification testing (___)

3, EIA, NAAT

Giardiasis Treatment

-nonpharm: oral or IV ___ for hydration

fluids

Giardiasis Treatment-DOC

-____ 2g PO once with food

-____ 250mg TID for 5-10 days

tinidazole, metronidazole

Giardiasis Treatment-Alternatives

-____

-____ (use in pregnancy!)

nitazoxanide, paromomycin

Giardiasis Follow Up

-monitor for efficacy- resolution of diarrhea within 3-6 days of effective therapy and resolution of dehydration

-counsel patient to perform hand hygiene and avoid ___ ___ for 2 weeks following diarrhea resolution

swimming pools

Amebiasis

-most common in resource-limited countries (or travel related), at risk immigrants

-transmission is ___ ___ ___ (through tap water, ice, salad, unpeeled fruit, food vendors and open markets)

fecal to oral

Amebiasis

-invades colonic epithelium and causes ulcers in mucosa

-increased risk of ___, mucoid diarrhea

-can gain access to portal circulation and be carried into the ___

bloody, liver

Amebiasis Symptoms

-diarrhea (___-positive), GI cramping

-low-grade ___

-leukocytosis

-colitis or intesinal performation, ___ abcesses possible

heme, fever, liver

Amebiasis Diagnosis

-need ___ or ____

-stool analysis is less sensitive and specific

EIA, NAAT

Amebiasis Diagnosis

-___ or ___ imaging should be performed if liver involvement

CT, MRI

To treat amebiasis, remember you need a systemic drug FOLLOWED by a ___ agent (stays in the lumen of the GI tract rather than being absorbed into the bloodstream)

luminal

luminal agent = ____

paromomycin

Amebiasis Treatment

-preferred is ____ TID for 7-10 days followed by ____

metronidazole, paromomycin

Amebiasis Treatment

-could also use ___ or ___ followed by paromomycin

tinidazole, nitazoxanide

Amebiasis Follow Up

-monitor for efficacy- resolution of symptoms within 3-5 days (7-10 days if liver abcess)

-repeat evaluation and testing at end of therapy and a ___ after therapy

-evaluate __ findings for liver abcess

month, CT

Nematodes include

a) ___

b) ____

c) ____

hookworms, roundworms, pinworms

Hookworms

-Necator americanus in the southeastern US

-Life Cycle: attach to mucosa of small intestine, passed in feces, transmission is ___ ___ ___ in contaminated food or water

fecal to oral

Hookworms can infect humans either via

1. the fecal–oral (___) route

2. through skin penetration after contact with contaminated soil or sand, leading to __ ___ ___

GI, cutaneous larva migrans

Hookworms Symptoms

- ____ pain

-headache

-fatigue

-___

-____ palpular eruption

-erythema

-edema (larva migrans)

epigastric, anemia, cutaneous

Hookworms

-___ is present in 30-60% of cases

eosinophilia

Hookworms Diagnosis

-___ ___ to identify eggs

stool sample

Hookworms Treatment

-____ BID x 3 days

-_____ QD x 3 days

mebendazole, abendazole

Roundworms

-found in areas of poor sanitation, some in southeast appalachia, Ascaris lumbricoides (giant roundworm)

-Life Cycle: ___ __ __ ingestion of eggs from animal/human

fecal to oral

Roundworms Symptoms

-can be asymptomatic

-can have minor symptoms as worm moves through body (____, ___)

pneumonitis, cough

Roundworms

-____ is common

eosinophilia

Roundworms Diagnosis

-___ ___ to identify eggs

stool sample

Roundworms Treatment

-____ BID x 3 days

-_____ QD x 3 days

mebendazole, albendazole

Pinworms

-most __ form of worm infection in US, Enterobius vermicularis

-Lifecycle: ___ __ __ ingestion of eggs

fecal to oral

Pinworms

-Female pinworms lay thousands of eggs in skin surrounding anus during the night while the person ___ (causes itching and transmission to others, can survive for weeks on surfaces)

sleeps

Pinworms Symptoms

-can be asymptomatic

-may be ___ itching of perianal area

cutaneous

Pinworms

-___ common

eosinophilia

Pinworms Diagnosis

-apply adhesive ___ tape to perianal area at night to pick up eggs

scotch

Pinworms Treatment

-___ of bedding, underwear, bathroom rugs, toilet accessories; wash in washing machine on hot cycle/steaming

sterilization

Pinworms Treatment

-_____ PO once, then 2 weeks later

-____ PO once, then 2 weeks later

-____ ____PO once, then 2 weeks later

mebendazole, albendazole, pyrantel pamoate

Cestodiasis (tapeworm)

-pork tapeworm is Taenia solium and beep tapeworm is Taenia saginata

-transmission is via ingestion of poorly cooked __ products

meat

The concern with Cestodiasis (tapeworm) is that Taenia solium is able to enter the ___

CNS

The concern with Cestodiasis (tapeworm) is that Taenia solium is able to enter the CNS and cause ____

neurocyticercosis

Cestodiasis (tapeworm)

-neurocyticercosis can cause new onset ____

seizures

Cestodiasis (tapeworm)

-serum and CSF ____ ____ testing can be used when there is suspected CNS infection

-___ is present

cysticercosis, eosinophilia

Cestodiasis (tapeworm)

-DOC = ___

albendazole

Cestodiasis (tapeworm)

-Alternative = ____

praziquantel

In neurocysticercosis, treatment can include combining albendazole or praziquantel with ____

dexamethasone

Trypanosomiasis

-includes African trypanosomiasis (___ ___) and American trypanosomiasis (___ ___)

sleeping sickness, chagas disease

Trypanosomiasis

-the ____ bug (ie kissing bug) obtains blood from animals, then transfers to humans

reduviid

Trypanosomiasis Symptoms

-Acute symptoms include unilateral ___ ___

orbital edema

Trypanosomiasis acute symptom → unilateral orbital edema

-the bug bites around the human __ for a bloodmeal

-the bug releases fecal tryptomastigotes which enter the human

-periorbital itching and swelling occur

eye

Trypanosomiasis Symptoms

-Chronic symptoms include ___, heart block, ___ of esophagus and/or colon, menigoencephalitis

cardiomyopathy, enlargement

Trypanosomiasis Diagnosis

-___ assay (IHA)

-____ antibody test (IFA)

-___

hemagglutination, immunofluorescence, ELISA

Trypanosomiasis Treatment

-____ 200mg PO BID for ___ days (LONG)

-this treatment rarely fails so alternative not usually needed

benznidazole, 60

Trypanosomiasis Treatment

-during treatment with benznidazole, monitor for ____ dermatitis

allergic

Trypanosomiasis Treatment

-___ testing sometimes performed to assess treatment success or failure

PCR

Ectoparasites: Lice and Scabies

-Pediculus humanus capitis = ___ louse

-Pediculus humanus corporis = ___ louse

-Phthirus = ___ louse (genitals)

-Sarcoptes scabeie = itch ____

head, body, crab, mite

Lice and Scabies

-transmission via close ___

-can cause severe itching, redness, scabs on skin (scabies)

-all close contacts should be checked for infection

contact

Lice Treatment-OTC

-____ 1%

Permethrin

Lice Treatment

-apply the Permethrin 1% to scalp after ___ and drying hair

-wrap towel around head for application of __ minutes, then rinse hair

-use with nit comb to remove eggs

shampooing, 10

Lice Treatment-Prescription for resistant lice

-____ 0.9% lotion

-___ ___ 5% lotion

-___ 5% lotion

spinosad, benzyl alcohol, ivermectin

Scabies Treatment

-____ 5% cream

Permethrin

Scabies Treatment

-first __ body with warm, soapy water to remove scabs from skin

-apply the Permethrin 5% cream to WHOLE BODY (avoiding face, mucous membranes, eyes)

-leave on for __-___ hours before bathing

scrub, 8-14

Scabies Treatment

-repeat application of Permethrin 1 ____ later

week

Scabies Treatment-Prescription for resistant lice

-____ 200mcg/kg PO once

-___ 10% topical application

ivermectin, crotamiton

Malaria is transmitted by mosquitos, particularly the ___ mosquito

Anopheles

Malaria

-____ (4 types are Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae)

-Africa and South America

-___-dependent life cycle

-prevention is antimalarial pre-exposure ___

parasite, temperature, prophylaxis

Malaria Clinical Presentation

-fever, headache, ___ sweats, insomnia, weakness, myalgias

nigh

Malaria Clinical Presentation

-uncomplicated → ___, ___

anemia, jaundice

Malaria Clinical Presentation

-complicated → ___ distress, ___ failure, mental confusion, seizures, coma, death

respiratory, renal

Malaria Prevention Agents

1. ____/____

2. ___

3. ___

4. ____

5. ____

atovaquone/proguanil, chloroquine, mefloquine, doxycycline, primaquine

atovaquone/proguanil advantages -most convenient option

-can start __ minute (1-2 days before)

-taken ___ daily at night

-only need to take __ days after a trip

last, once, 7

chloroquine advantages

-can be taken ___ weekly (useful for long trips)

once

chloroquine disadvantages

-there are areas with ___

-need to take __ weeks after travel

resistance, 4

mefloquine advantages

-can be taken once ___

weekly

mefloquine disadvantages

-there are areas with ___

-need to take __ weeks after travel

resistance, 4

mefloquine disadvantages

-not for patients with a diagnosis of ___, ___, ___ condition

cardiac, psychiatric, seizure

doxycycline advantages

-can start ___ minute (1-2 days before)

last

doxycycline disadvantages

-have to take __ weeks after travel

4

Which Malaria Prevention Agents can be used in pregnancy?

chloroquine, mefloquine

Which Malaria Prevention Agents can be started last minute?

atovaquone/proguanil, doxycycline