Term
| what does WASH stand for? |
|
Definition
| Water sanitation and hygiene |
|
|
Term
define diarrhoea
when is it chronic? |
|
Definition
3 loose stools in 24 hours
chronic if >1 month |
|
|
Term
|
Definition
|
|
Term
| 2 most common presentations of amoebiasis are |
|
Definition
Amoebic dysentry
amoebic liver abscess |
|
|
Term
entamoeba dispar is how many times more common than E histolytica?
Is it pathogenic?
What does it look like on microscopy? |
|
Definition
3x more common than e histolyca
Not pathogenic
Looks identical to e histolytica on microscopy. |
|
|
Term
| symptoms of intestinal amoebiasis? |
|
Definition
|
|
Term
| How is amoebiasis caught? |
|
Definition
Faecal oral route.
Trophozoites reside in colon feeding on bacteria. |
|
|
Term
| How are E histolytica cysts killed? |
|
Definition
Temps > 50 and <5
standard rx of water supplies kills them |
|
|
Term
| where do amoebomas usually occur? |
|
Definition
|
|
Term
| Complications of amoebiasis infection? |
|
Definition
Amoebic liver abscess
Amoebomas
GI haemorrhage
Colitis |
|
|
Term
|
Definition
| Fresh stool sample with trophozoites that have ingested RBCs are diagnostic. |
|
|
Term
| what might you see in amoebic trophozoite in a stool sample |
|
Definition
|
|
Term
| In amoebiais stool Ag testing is sensitive/specific but what must we remember about this? |
|
Definition
| It remains positive for life long. |
|
|
Term
| how to differentiate amoebic liver abscess and hydatid cyst |
|
Definition
Amoebic liver abscess patients are toxic
Hydatid cysts are slow growing and patient typically presents with distended abdomen. |
|
|
Term
|
Definition
|
|
Term
| Amoebic liver cyst may present as what on CXR? |
|
Definition
| Right pleural effusion and raised hemi diaphragm. |
|
|
Term
|
Definition
| Vibrio cholerae 01 and 0139 |
|
|
Term
| what kind of bacteria is cholera? |
|
Definition
| Gram negtaive comma shaped bacillus. |
|
|
Term
| how is cholera transmitted? |
|
Definition
Faecal oral route.
Incubation 1-5 days. |
|
|
Term
| who definition of cholera |
|
Definition
| in an area where there is a cholera epidemic a patient >5 develops acute watery diarrhoea. |
|
|
Term
|
Definition
Rapid dipstick stool Ag
Lab confirmation of dx and serotype: shooting star darting motility |
|
|
Term
|
Definition
Isolate
Rehydrate: replace and maintain fluids
stat doxy or Azithromycin (reduces stool output) |
|
|
Term
| How to control and prevent cholera? |
|
Definition
Detect > isolate > rx > Vaccine > Zinc to < 5
Improve WASH >public eduction > train personnel |
|
|
Term
| what is the most common chronic diarrhoea illnes sin hiv + Pts? |
|
Definition
|
|
Term
| what cant cryptospiridium be killed by? |
|
Definition
| Chlorination. They are also small enough to pass through filtration systems. |
|
|
Term
| How to diagnose cryptosporidium on microscopy? |
|
Definition
| acid fast oocyst measuring 5um |
|
|
Term
| Ways to dx cryptosporidium |
|
Definition
Ag assays
Faecal microscopy for acid fast oocysts |
|
|
Term
| treatment for cryptosporidium |
|
Definition
supportive rx as pts with intact immunity usually recover.
in HIV + start ART. |
|
|
Term
Cyclospora.
Spread
Oocyst size
Rx |
|
Definition
Faecal oral spread
Oocysts larger 10um than cryptosporidum 5um
Rx: co-trimoxazole.
Stains with acid fast |
|
|
Term
Cytoisopora belli.
Oocyst size
Rx |
|
Definition
largest oocyst 25um
also stains with acid fast
Rx: co-trimoxazole |
|
|
Term
| giardia cysts are resistant to chlorination. how to kill it? |
|
Definition
| filtering or boiling is key |
|
|
Term
|
Definition
| Metronidazole or albendazole |
|
|
Term
|
Definition
Never bloody
can be water-greasy |
|
|
Term
|
Definition
Stool microscopy
Stool Ag testing
stool PCR assays
Duodenal fluid aspirate testing. |
|
|
Term
| Ballantidium coli occurs where humans live in close proximity with? |
|
Definition
|
|
Term
| Describe ballantidium colli trophozoites |
|
Definition
Large size 40-200um
They have cillia on their surface and a bean shaped nucleus. |
|
|
Term
Rx for E coli diarrhoea?
bloody stools? |
|
Definition
Supportive rx
Yes bloody stools. |
|
|
Term
campylobacter rx
complication of campylobacter? |
|
Definition
|
|
Term
| Type of bacteria is shigella? |
|
Definition
|
|
Term
|
Definition
| Humans are the only important resevoir |
|
|
Term
| transmission of shigella? |
|
Definition
Faecal-oral
P2P
food
water
flies |
|
|
Term
| which vitamin and mineral reduce mortality in shigella infection? |
|
Definition
|
|
Term
|
Definition
bloody mucoid diarrhoea
Red currant jelly. |
|
|
Term
| how many types of shigella are there |
|
Definition
4 types
infection confers serotype immunity |
|
|
Term
|
Definition
Ciprofloaxacin
but note that resistance is common. |
|
|
Term
| what supplement shoudl you give to children < 5 in cholera and shigella outbreaks? |
|
Definition
|
|
Term
| how many nuclei do mature giardia cysts contain? |
|
Definition
|
|
Term
| how many nuclei in immature giardia cysts? |
|
Definition
|
|
Term
mature amoeba cysts have how many nuclei?
Immature cysts contain how many nuclei? |
|
Definition
4 nuclei in mature
1 nucleus in immature |
|
|
Term
| what is the most common presentation of amoebiasis? |
|
Definition
|
|
Term
describe the next step in amoebiaiss infection
1. 4 nucleated cyst ingested in food/water contaminated by human faeces |
|
Definition
| 2 Cysts are digested in the gut releasing 8 amoebic trophozoites. they live in the colon on the mucosal surface feeding on bacteria and food. |
|
|
Term
| when might you see. 'flask shaped ulcers'? |
|
Definition
|
|
Term
|
Definition
Tenderness in intercostal spaces.
Sign of amoebic liver abscess |
|
|
Term
| why are finding amoeba cysts little significance for dx? |
|
Definition
They resemble e dispar cysts which are non pathogenic.
Dx depends on finding e histolityca trophozoites containing rbc in a fresh stool sample. non pathogenic amoeba do not ingest rbc. |
|
|
Term
| rx option for amoebiasis cyst eradication |
|
Definition
Diloxanide
Paromycin
Iodoquinol
Quinfamide
Tetracycline |
|
|
Term
| giardia cysts are relatively resistant to... |
|
Definition
|
|
Term
| belching in giardiasis a/w with what smell? |
|
Definition
|
|
Term
| as giardia cysts are resistant to chlorination what methods are important ? |
|
Definition
Flocculation
Sedimentation and filtration are important.
cysts are killed if water is boiled |
|
|
Term
| rx of HIV related cryptosporidium? |
|
Definition
|
|
Term
| how can cryptosporidium parasite be removed? |
|
Definition
boiling water
ozone rx
filtration |
|
|
Term
| t/f Giardia can cuase liver abscess? |
|
Definition
False
E histolityca can cause liver abscess |
|
|
Term
| t/f Giardia cysts can survive several months in cold water? |
|
Definition
True
they are indeed hardy and can survive several months in cold water. |
|
|
Term
| Rx options for giardia infection? |
|
Definition
Metronidazole
Tinidazole
Nitozoxanide |
|
|
Term
|
Definition
Fasciola hepatica
Fasciola gigantica |
|
|
Term
| name 2 oriental liver flukes |
|
Definition
Opisthorcis species
Clonorchis species |
|
|
Term
|
Definition
|
|
Term
|
Definition
Schistosoma Mansoni
S Japonicum
S Haematobium |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Which drug can cause mazzoti reaction if co-morbid onchocerciasis is involved? |
|
Definition
|
|
Term
| what cause lymphatic filariasis? |
|
Definition
Wucheria bancrofti
spread by any type of mosquito. |
|
|
Term
| how is lymphatic filariasis dx? |
|
Definition
Midnight sampling of thick blood film for microfilariae
Ag for W bancrofti |
|
|
Term
| Rx for lymphatic filariasis |
|
Definition
DEC and albendazole or
ivermectin and Albendazole
Doxycycline effective at killing microfilariae and adult worms. |
|
|
Term
| if co-mormid loa loa which drug should be avoided and why? |
|
Definition
| Avoid ivermectin can cause encephalopathy |
|
|
Term
| WHOs 3 point strategy to eliminate LFilariasis |
|
Definition
Large scale mda for 5 years
Recommended basic care for chronic LF
Vector control |
|
|
Term
where is loa loa found
what transmits the disease? |
|
Definition
Found in west/central africa especially cameroon
Transmitted by deer fly aka Chrysops fly |
|
|
Term
| what are calabar swellings and which condition are they found? |
|
Definition
Found in loa loa
where adult worms migrate across eye |
|
|
Term
|
Definition
MF in midday bloods
PCR is best diagnostic method
Eye worms are diagnostic |
|
|
Term
| best diagnostic method for Loa Loa? |
|
Definition
PCR
although eye worms are diagnostic |
|
|
Term
| when is best to sample for mf in loa loa and lymphatic filariasis? |
|
Definition
Loa loa = midday
Lymphatic filariasis = midnight |
|
|
Term
|
Definition
Risk of encephalopathy with ivermectin so avoid.
Risk of encephalopathy with DEC if high MF load.
If <2500 use DEC tds 21/7
If >2500 Albendazole for 21 days |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what parasite causes onchocerciasis/river blindnesS? |
|
Definition
| Onchocerca volvulus filarial worm. |
|
|
Term
| which vector transmits onchocerciasis? |
|
Definition
The simulium black fly
typically near rivers/flowing waters |
|
|
Term
| features of river blindness? |
|
Definition
many asymptomatic
dermatological and opthalmological |
|
|
Term
| skin manifestations of onchocerciasis |
|
Definition
s/c fibrous nodules of adult worms
skin loose elasticity giving elephant skin appearance.
Depigmentaion - giving leapord skin appearance. |
|
|
Term
| in which condition might you see elephant skin and leapord skin appearance? |
|
Definition
|
|
Term
| in onchocerciasis what leads to progressive corneal opacity? |
|
Definition
Keratitis
Also get iritis/anterior uveitis |
|
|
Term
how to diagnose onchocerciasis?
gold standard |
|
Definition
MF in skin snips remains gold standard
NOT IN BLOOD |
|
|
Term
| all the ways to dx onchocerciais |
|
Definition
skin snip for MF
Adult worms in biopsy specimens of skin nodules.
Slit lamp may show MF in anterior chamber of eye. |
|
|
Term
|
Definition
ivermectin bi annually for 10 years
First map loaloa to est endemicity of loa loa. If high loaloa then Ivermectin is contraindicated.
Doxycycline 6/52 kills both MF and adult worms
DEC c/i as causes mazzoti reaction and accerlates blindness |
|
|
Term
| Onchocerciasis. which drug is c/i and why? |
|
Definition
DEC
because it cause mazzoti reaction and accelerates blindness. |
|
|
Term
| before starting treatment for onchocerciasis with ivermectin what must we map? |
|
Definition
| endemicity of loa loa as ivermectin c/i if loa loa co-endemic then alternative is doxycycline. |
|
|
Term
| control of onchocerciasis |
|
Definition
free provision and delivery of ivermectin
Mapping onchocerciasis: if >20% have skin nodules the area qualifies for MDA.
Insecticide spraying of simulian blackfly territories. |
|
|
Term
| how to treat guinea worm? |
|
Definition
| Wind out the worm slowly over several days. |
|
|
Term
| which microfilariae would you see on the skin and not in the blood? |
|
Definition
|
|
Term
| is there a serological Ag test for circulaing W bancrofti? |
|
Definition
Yes there is
you can also use non specific clinical signs like high eosinophillia, high ige, ig4 |
|
|
Term
| if mf is sparse in a blood film what concentration method can be used? |
|
Definition
|
|
Term
|
Definition
| Form of onchocerciasis that leads to skin depigmentation |
|
|
Term
| what is nodding disease associated with? |
|
Definition
onchocerca volvulus infection
may be an AI reaction to the parasitic worm. |
|
|
Term
| which filarial worm does not have wolbachia endosymbionts? |
|
Definition
|
|
Term
| unsheathed mf with hook shaped tail with nuclei extending to tip of tail? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Ivermectin or moxidectin
Also doxycycline |
|
|
Term
| DEC provocation test can be used to diagnose lymphatic filariasis. Explain this test |
|
Definition
Give single dose of DEC. This will induce parasitaemia during the day.
then collect 30-60ml of peripheral blood for staining |
|
|
Term
DEC can precipitate...... reaction in ochocoerciais
DEC can precipitate ..... in loiasis |
|
Definition
|
|
Term
LF rx?
Loiasis rx?
Onchocerciasis rx? |
|
Definition
LF: albendazole with Ivermectin or DEC
Loiasis: DEC
Onchocerciasis: ivermectin/moxidectin |
|
|
Term
DEC rx for which 2 filarial disease?
remember D 2 the L |
|
Definition
|
|
