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Block 6 - Week 5
Parasites
105
Biology
Graduate
09/04/2009

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Term
Name this species - eukaryote, cell walls made of complex polysaccharides like chitin/chitosan/glucans/mannans, and plasma membrane contains ergosterols.
Definition
Fungi
Term
What is the difference between yeast and molds?
Definition
Yeast are unicellular, reproduce by budding, and form colonies; Molds are multicellular, form cotton colony by extension of their septate or aseptate hyphae
Term
Describe fungal asexual reproduction with and without propagules.
Definition
Without propagules hyphae grow and extend to form a new mycelium; with them, they use either conidia which develop from fertile hyphae or sporangia that come from non-septate hyphae
Term
What is fungal dimorphism?
Definition
They normally exist as mold in the environment and yeast in the body
Term
Ergot alkaloids that cause vasoconstriction and necrosis, aflatoxins that cause liver disease in animals, and psychotropics like psilocin are all what type of fungi pathogenesis?
Definition
Mycotoxicoses
Term
There are four categories of fungal colonization - superficial, cutaneous, subcut, and systemic- describe the types of tissue that are invaded in each one.
Definition
Superficial: outermost layer of skin and hair, colonization of mucosa; Cutaneous: extend into epidermis, invade hair and nail; Subcutaneous: invade dermis, subcutaneous tissue, muscle, fascia; Systemic: originate in lung, may spread to other organs
Term
Tinea versicolor creates hyper/hypopigmented macules, Tinea nigra produces melanin in macules, and White/Black piedra puts granules on the hair shaft, but what type of colonization are all three of these fungal infections?
Definition
Superficial; Tinea Versicolor is the spaghetti and meatballs on KOH
Term
Dermatophytes are cutaneous mycoses, like Microsporum or Trichophyton or Epidermophyton, and are diagnosed by scraping tissue and using alkali treatments to lyse epidermal cells, but what is there nutrional substrate?
Definition
Keratin, they produce keratinases
Term
Subcutaneous mycoses are commonly found in the soil, chronic and insidious in fections, and are rare except which organism?
Definition
Sporotrichosis
Term
Name this fungi - subcutaneous, tracks up lymphatics from site of inoculation, ulcerating lesions, nodules, adenitis, rarely pulmonary and disseminated when complicated, with rose thorns being a classic exposure.
Definition
Lymphocutaneous sporotrichosis
Term
Black molds, chromoblastomycosis, phaeohyphomycosis that causes allergic sinusitis, and eumycotic mycetoma that causes madura foot are all what type of subcutaneous mycoses?
Definition
Dematiaceous fungi
Term
What colonization type of mycoses are all of the following - histoplasma, blastomyces, coccidiodes, paracoccidioides, and Cryptococcus?
Definition
Systemic, which involves inhalation of spores
Term
Name this fungal infection - inhaled arthroconidia from soil, dust, in the arid SW US, mild respiratory infection, Valley Fever, 5-10% will have residual pulmonary problems, dissemination in skin bones or CNS may occur, erythema nodosum with non-infectious arthritis.
Definition
Coccidioidomycosis
Term
Which of the following are diagnostic tests for Coccidioidomycosis - wet prep with saline or KOH shows spherules, stains in tissue, culture, or serology for tube precipitin IgM, complement fixation of IgG to chitinase, or immunodiffusion.
Definition
All of them
Term
Name this fungal infection - from ohio and Mississippi river valleys and Africa, unknown reservoir, causes pulmonary infection, and mays disseminate to skin and bones, thick yeast wall resists phagocytosis.
Definition
Blastomycosis
Term
Which of the following are true regarding the diagnosis of blastomycosis - growth in culture, thick walled yeast seen on biopsy, seroglogy does not indicate treatment, negative serology does not preclude disease in disseminated disease.
Definition
All of them
Term
Name this fungal infection - called south American blastomycosis, lid pulmonary infection, central and south America, oral and nasal lesions, fungal protease is a virulence factor for tissue invasion.
Definition
Paracoccidioidomycosis
Term
Dimorphic, also has sexual phase as a powdery mildew, Grows in soil with high nitrogen content, e.g. contaminated with bird or bat excreta (chicken coops, caves), Only 5% with acute mild pneumonia, Dissemination in immunocompromised hosts affecting Liver, spleen, bone marrow, lymph nodes, skin.
Definition
Histoplamsmosis
Term
In diagnosing histoplasmosis what options are available which are similar for other fungi?
Definition
Yeast seen in biopsy, culture, antigen test, serology of complement fixation and immunodiffusion
Term
Name this organism - Monomorphic yeast, Thick capsule acts as virulence factor, Resists phagocytosis, Found in pigeon excreta, Inhaled, pulmonary infection usually mild, May result in pulmonary nodule, Dissemination to skin, central nervous system, Most common cause of fungal meningitis, More severe in immunocompromised host.
Definition
Cryptococcosis
Term
Which of these unique tests is usable for cryptococcosis - stain yeast capsule, India ink stain of CSF, culture, crytococcal serum CSF antigen.
Definition
All of them
Term
Candida species of fungus form yeast with psuedohyphae and blastoconidia, but how do the subspecies of albicans and non-albicans differ in serum blood culture?
Definition
Albicans form germ tubes, others do not
Term
Name this species of fungi - normal flora in oropharynx, GI, vagina, can cause localized disease of skin and mucosal membranes, possible dissemination to blood liver spleen CNS, may mimic dermatophytes causing rash or thrush on mucosal surfaces.
Definition
Candida
Term
T or F: Diseminated candidiasis usually occurs in immunocomps and as it progresses increases more organ involvement such as liver, spleen, retina, or any organ but pneumonia is rare.
Definition
True
Term
How do you diagnose candidiasis?
Definition
KOH prep for vaginitis, culture, or clinical presentation of skin, muc membranes, or endoscopy
Term
What categories of treatment are used for candidiasis versus invasive candidiasis?
Definition
Azoles and nystatin in regular disease, azoles and ampho B for invasive
Term
Name this fungus - not normal flora, found in soil and decaying vegetation, septate hyphae branching 45 degrees, and the spectrum of disease includes allergic reactions, mycotoxicoses from aflatoxin, pulmonary, or invasive which can go to skin, GI, rhino, pulmonary, CNS.
Definition
Aspergillus
Term
Which of the following are diagnostic tests for aspergillus - appearance on imaging such as CT, culture, biopsy shows septate hyphae with 45 degree braching, galactomannan assay.
Definition
All of them
Term
What is the treatment of invasive aspergillus?
Definition
Ampho b, Triazoles (itra/vori/posa), echinocandins
Term
Name this fungus you bastard - non-septate hyphae, sporangiospores, ubiquitous in environment, affects rhinocerebral pulmonary skin GI, normally in immunocomps only, can see necrotic tissue in infected peeps.
Definition
Zygomycosis
Term
What is the diagnosis and treatment of zygomycosis?
Definition
Diagnose via clinical appearance like necrotic tissue, imaging, and histopath; treatment is sugery for necrotic tissue and meds of ampho b and rifampin.
Term
Fusarium, scedosporium, and pencicillium are all what type of organism and how are they treated?
Definition
Opportunistic fungi, treated with triazoles because ampho b resistant; note fusarium is banana shaped
Term
Name this fungi - either protozoa or fungus, infect immuno comps only, causes interstitial pulmonary infiltrates, dry cough, fever, dyspnea.
Definition
Pnuemocytis
Term
T or F: To diagnose pneumocytis you can check for elevated blood lactate dehydrogenase, beta-D-glucan, or through silver staining of sputum or bronchial lavage.
Definition
True, treatment with bactrin which is atypical for fungi
Term
Which of the following fungi are endemic and which are ubiquitous - candida, histoplasma, coccidiodes, blastomycosis, aspergillus, Cryptococcus?
Definition
First and last two are ubiquitous, rest are endemic
Term
What is the one feature in common about all of the following drugs - Polyenes: Amphotericin, Nysatin; Azoles: ketoconazole, butoconazole, clotrimazole, econazole, miconazole; Allylamine: terbinafine, naftifine; Antimetabolites Ciclopirox, tolnaftate.
Definition
They are all topical anti-fungals which can aid in the treatment of dermatophyte (tinea) infections, except tinea capita and onychomycosis.
Term
The _______________ inhibit beta glucan synthetase activity, interfering with the synthesis of this cell wall component of fungi, examples are caspofungin, anidulafungin, micafungin.
Definition
Echinocandins
Term
Name two polyene class antifungals and what their mechanism of action is.
Definition
Amphotericin B and nystatin, they directly bind ergosterol in the fungal membrane and allow ion channels to form.
Term
Amphotericin B has an extremely broad range of use in fungi (not aspergillus) and has a lipid form of it used to reduce toxicity, what are the two major adverse reactions?
Definition
Infusion reaction and nephrotoxicity.
Term
These drugs - keto/itra/posa/vori/fluconazole - are from what category of drugs and what is their mechanism of action?
Definition
Azole class, inhibits sterol synthesis in fungal memebrane via lanosterol 14a demethylase
Term
Azole antifungals have variable absorption and distribution and interfere with CYP450 metab but have a wide spectrum of use, but what is the azole of choice for invasive aspergillosis?
Definition
Triazoles
Term
T or F: Aspergillus species are resistant to fluconazole.
Definition
True
Term
What is the mechanism of action for 5-flucytosine?
Definition
Inhibits thymidylate kinase and functions as a pyrimidien analogue disrupting nucleotide metab
Term
T or F: Griseofulvin is a microtubule assembly inbitor for fungi.
Definition
True
Term
Terbinafine is used for tinea capitus and onychomycosis by interfering with ergosterol synthesis, what class of drug is it and what enzyme does it interfere with?
Definition
Allylamine, inhibits squalene epoxidase
Term
What is the pathogenesis of Kartagener’s syndrome that causes chronic sinusitis, bronchiectasis, possible hearing loss and infertility.
Definition
Auto recessive disorder of cilia motility proteins called dyneins
Term
Why is CF so common in people of European descent?
Definition
CF chloride transport gene may have given people greater survival from cholera toxin during pandemics
Term
In regards to immune deficiency disorders of phagocytes, complement, and splenectomy cause problems with extracellular bacteria, but deficiencies in ___________ cause problems with intracellular, viruses, fungi, and parasites.
Definition
B cells
Term
Chronic granulomatous disease is a heterogenous disorder causing mutations in NADPH oxidase which makes neutrophils less effective in creating an oxidative burst of peroxide, so which type of organism are these patients subject to?
Definition
Catalase positive organisms because they use that enzyme to inactivate peroxide; bugs like, Staph, Aspergillus, Nocardia; treatment involves preventative bactrin and interferon gamma, with possible stem cell transplant from sibling
Term
T or F: the most common granulocyte defect is neutropenia due to bone marrow injury, antibodies to neutros, or hereditary defects.
Definition
True
Term
How does diabetes increase susceptibility to infection increasing incidence of pneumonia, flu, UTI, foot infections, invasive otitis externa, and rhinocerebral mucormycosis?
Definition
Hyperglycemia impairs leukocyte function
Term
T or F: In patients with fever and neutropenia gram positive bacteria are the main concern due to indwelling catheters.
Definition
True
Term
In regards to complement deficiency, if a person is deficient in the ________ and _________ pathway they have a higher susceptibility to collagen vascular disease, H. flu, S. pneumo.
Definition
Classical, junction C3
Term
In regards to complement deficiency, if a person is deficient in the ________ and _________ pathway they have a higher susceptibility to N. meningitides.
Definition
Membrane attack complex, alternate
Term
T or F: The spleen has two major anti-infective roles: clearing the blood stream of bacteria and antibody production.
Definition
True
Term
While the liver is effective at removing _________ bacteria, the spleen is more efficient in removing ________ bacteria.
Definition
Opsonized, nonopsonized
Term
What type of patients are at greater risk of infection from encapsulated bacteria like h. flu, N. meningitides, malaria, and babesiosis, as well as overwhelming pneumococcal sepsis syndrome?
Definition
People without spleens or non-functional ones; people should be given the pneumo vaccine 2 weeks before transplant
Term
The following problems are associated with what type of immunodeficiency - X-linked agammaglobulinemia (XLA, Bruton’s Syndrome), Hyper-IgM syndrome (usually X-linked), IgA deficiency, Common variable immunodeficiency (CVID).
Definition
B cell defects; CVID causes low production of IgG, IgA is most common inherited immunodeficiency, Hyper IgM is due to Tcells not inducing class switching in B cells, Brutons is due to deficient enzyme for B cell maturation
Term
The following problems are associated with what type of immunodeficiency - Severe combined immunodeficiency (SCID), Ataxia telangiectasia.
Definition
T and B cell defects requiring hemato stem cell transplant; ataxia is a progressive disorder with cerebellar ataxia and sinus/respiratory infections.
Term
The following problems are associated with what type of immunodeficiency - X-linked lymphoproliferative disease (XLP, Duncan’s syndrome), Thymic aplasia(DiGeorge syndrome).
Definition
T cell defects; XLP is a failure to control CD8 due to EBV causing mono
Term
T or F: In hematopoietic stem cell transplant there are 3 phases that correlate with immune dysfunction starting with neutropenia, then impaired cellular immunity, and finally impaired cellular and humoral immunity.
Definition
True
Term
In parasitology what is the difference between a definitive host and an intermediate host?
Definition
Definitive has mature parasite with sexual reproduction, intermed is immature parasite with asexual reproduction
Term
Name this parasite - fecal oral transmission via ingestion of bad water, worldwide distribution with poor sanitation, cysts inactivated by boiling/filtering/chems, disease presents as ab pain, colitis, diarrhea or dysentery and you factor in travel history.
Definition
Entamoeba histolytica; E. dispar is nonpathogenic form of amoeba.
Term
What is the diagnostic test for enteric parasites?
Definition
Ova and parasite test via a stool sample and is 80% effective
Term
What is the difference between the cyst and trophozoite stage of amoebas?
Definition
Cysts are the infectious, rigid cell wall, nondividing stage that survives in water and can be killed via boiling/chems; trophozoites are lumen dwelling disease stage that divide by binary fission, with fluid cell walls, and disintegration of the host.
Term
In determining whether a dystentery is bacterial or amoebic there is a PMN test or Charcot-Leyden crystal test, how are they used?
Definition
PMNs reveal bacterial infection, the crystal test reveals eosinophil breakdown from parasites
Term
T or F: infection with Entamoeba histolytica can become invasice disease causing flask shaped colonic ulceration, primary abcess in the right lobe of the liver, and a secondary abcess in the brain.
Definition
True
Term
What is the treatment of choice for Entamoeba histolytica?
Definition
Metronidazole
Term
Name this parasite - oval 4 nuclei cysts and 2 nuclei pear-shaped trophozoite found in small intestine, transmission via poor santiation/day care/sierra stream water, causes ab pain, mild to severe diarrhea, flatulence, with possible lactose intolerance and malabsorption.
Definition
Giardia lamblia
Term
When diagnosing giardia an O&P test is used, but if it is negative and it is still suspected what is then used as a test and what is the treatment?
Definition
Enteric string test which samples the duodenum, treated with metronidazole
Term
Name this parasite - free living amoeba, all forms found in fresh warm water, enters through olfactory epithelium, causes primary amebic meningoencephalitis inducing nausea vomting fever headache and coma.
Definition
Naegleria fowleri, whose diagnosis is via trophos found in CSF and treatment is amphotericin B.
Term
Name this parasite - apicomplexan, replicates in the brush border of intestinal epi, trophozoite sacs contain merozoites which reproduce sex or asex, worldwide via sanitation and fecal-oral, mild to severe diarrhea, resovles 2 weeks.
Definition
Cryptosporidium
Term
Diagnosing cryptosporidium is based on diarrhea and recent travel, but when testing stool with acid-fast technique and the biopsy what is looked for in each case and what is the treatment?
Definition
Stool is oocytes 4-6um, biopsy is trophozoites, there is no treatment except to stay hydrated
Term
Name this parasite - apicomplexan, cyanobacteria-like bodies, fecal-oral via contaminated water worldwide, diarrhea that may last up to six weeks until infection is resolved, seen in fruit contamination.
Definition
Cyclospora
Term
Diagnosing cyclospora infection is with presentation of diarrhea, travel, and acid fast stool sample looking for oocytes from 8-10um, what is the other test used?
Definition
UV fluorescence looking for the oocyte cysts
Term
Malaria is primarily an infection of _______ and the initial infection by ___________ parasite requires one round of replication in the __________.
Definition
RBC, plasmodium, liver
Term
_______________ ______________ is the most important of the species of malaria causing organism to identify quickly and accurately because infection may be rapidly lethal, and because drug-resistant strains must be considered in selecting a treatment.
Definition
Plasmodium falciparum is the most common
Term
____________ inhibits heme polymerase in the food vacuoles of plasmodium infected RBCs disrupting the parasites food supply.
Definition
Cholorquine, which has developed a resistance among P. falciparum due to changes in the CG2 gene in the food vacuole membrane
Term
There is a ________ incidence of “duffy” red cell antigen due to P. vivax induced mutations in humans, and there is a _________ incidence of malaria due to P. falciparum.
Definition
Decrease, increased
Term
Characteristic intracellular stages, or lack or stages, and RBC perturbations can be used to identify the species of plasmodium: Band-form trophozoite for _____________; Schuffner’s dots on enlarged RBC, for __________; and crescent gametocytes (extracellular), multiple ring stages in RBC, and lack of trophozoite stages in RBC for ___________.
Definition
P. malariae, P. vivax, P. falciparum.
Term
All of the following are anti-malarial schizonticides but which are blood and which are for the liver - Atovaquone/proguanil, chloroquine, mefloquine, Pyrimethamine, primaquine.
Definition
Primaquine is the only liver schizonticide
Term
Infection of plasmodium comes from the sporozoite form from mosquitos, what is the clinical presentation of malaria?
Definition
Malaria paroxysms of chills, fever, and sweats during the replication cycle of the plasmodium, as well as hepatosplenomegaly; as a note -Plasmodium malariae has a 3-day cycle; Plamodium vivax and Plasmodium falciparum have a 2-day cycle
Term
T or F: Of the anti-malarial drugs quinine is the most effective and reserved for extreme cases and chloroquine is the choice for P. vivax, with primaquine effective against relapse.
Definition
True.
Term
T or F: Complications of malaria include cerebral malaria due to P. vivax causing adhesion of RBCs to brain capillaries.
Definition
False, P. falciparum is the cause
Term
In malarial infections, what is the difference between recrudescence caused by P. falciparum and relapse due to P. vivax?
Definition
Recrudescence is an emergence of symptoms after a supposedly successful treatment due to low levels of infected cells remaining, versus relapse of P. vivax due to a dormant phase in the liver.
Term
Name this parasite - animals are the normal host, worldwide and in US NE/NW states with tick transmission, mice reservoir, causes malaise fever headache chills, malaria like bugs on blood smear.
Definition
Babesia
Term
Name this parasite - infects all cells, tachyzoite during infection and dormant cyst after resolution, worldwide associations with bradyzoite cyst in raw/undercooked meat and oocyst in cat feces, causes flu-like symptoms or infectious mono syndrome.
Definition
Toxoplasma gondii
Term
To diagnose toxoplasmosis requires serology or white blood cell smear, and most cases are self resolving, but what are the complications and treatment if it doesn’t resolve in immunocomps?
Definition
complications are death in immunocomps and abortion in 1st tri preggers with 2nd and 3rd tri preggers getting hydrocephalus or chorioretinitis.
Term
Name this parasite - trypomastigotes found in giemsa-stained blood, African sleeping sickness in chronic cases, tse-tse fly vector, causes lethargy relapsing fever CNS personality changes, treated with pentamidine in the blood stage and melarsoprol in the CNS stage.
Definition
Trypanosome brucei gambiense
Term
Why is African trypanosomiasis so effective initially at evading the hosts immune defenses?
Definition
Because of antigenic variation due many genes for the VSG, variant surface glycoprotein.
Term
Name this parasite - intracellular flagellate, chagas disease, bloodstream trypomastigote, intracellular found in the muscle of the heart and intestine, most common from reduviid bug bite, acutely causes fever malaise lymphadeno heptospleno myocarditis, in chronic disease years later amastigotes causing cardiomyopathies and enlarged organs, found in central and south America.
Definition
Trypanosoma cruzi, American trypanosomiasis
Term
T or F: Diagnosis of chagas disease is trypomastigotes in the blood acutely and detection of amastigotes in tissue and xenodiagnosis in the indeterminant and chronic stages.
Definition
True, xenodiagnosis involves reduviid bugs
Term
Name this parasite - tropics, reservoir is rodents and dogs, promastigote transmitted from the bite of a fly, amastigote thrives via receptor-mediated intrusion via the complement receptor on macros, military and travelers at risk, presents as cutaneous lesions like oriental/chiclero’s ulcer or visceral malaria-like symptoms.
Definition
Leishmaniasis, which is treated via pentavalent antimonials
Term
Diagnosing Leishmaniasis is done via a smear or culture of blood or marrow, but if it is not treated what are the possible complications of L. donovani or L. brasiliensis?
Definition
L. donovani causes visceral disease and can have Post-kala-azar dermal lesions after a supposed cure, L. brasiliensis can cause mucocutaneous lesions of the face
Term
Name this parasite - trophozoite, STD, worldwide, vaginal discharge and itching dysuria, men usually asymptomatic, complications of infertility or HIV, diagnosed via smear or culture.
Definition
Trichomonas vaginalis, treated with metronid
Term
Where do the adult parasites Schistosoma mansoni and S. haematobium reside in the body?
Definition
S. Mansoni is in the upper mesenteric veins and can cause fibosis in liver and intestines around eggs, S. haematobium is in the urinary plexus and has cancer correlation.
Term
Name this parasite - trematode ( blood fluke), lays 300-3000 eggs and causes host response, some infect mesenteric veins or urinary plexus, eggs in feces or urine, mainly in tropics, transmission via water into skin, granulomas in liver intestine or bladder due to trapped eggs.
Definition
Schistosomiasis, treated with praziquantel
Term
Name this parasite - cestode (tapeworm), worldwide, fecal-oral, raw beef or pork meat, one version can result in larval cyst in eye lung muscle brain, species differentiation by uterine count in proglottid, treated by praziquantel.
Definition
Taenia saginata or solium
Term
Humans are refractory to infection if they ingest Taenia saginata eggs, but what happens if they eat T. solium eggs from pork?
Definition
Complications of larval cysts in the brain, eye, organs, or muscle can arise called Cysticercosis which can also cause seizures/CNS problems that is diagnosed by MRI or CT or ova in feces.
Term
Name this parasite - worldwide, school children mostly, ingestion or inhalation of eggs via scratching hand to mouth transfer via perianal area, reinfection common, adults are 1cm long in colon, diagnosed via anal/vaginal intching and scotch tape test.
Definition
Enterobius vermicularis, Pinworm, treated via mebendazole
Term
Name this parasite - worldwide, ingestion of ova from fecal contaminated water/soil, migrates to GI to lungs and back then lives 1 year in small intestine, asymptomatic when parasite burden is low, GI pain and diarrhea, mild eosinophlia, complications of intestinal blockage, eggs in O&P.
Definition
Ascaris lumbricoides, intestinal roundworm, treated with al/mebendazole
Term
This anti-parasitic drug interferes with microtubules synthesis and decreases glucose uptake.
Definition
Al/mebendazole
Term
Name this parasite - worldwide in poor sanitation and high humidity, soil larval infection of unbroken skin migrate to lungs, autoinfection of internal/external epithelium, adults migrate and live in mucosa of duodenum, erythema coughing pulmonary infiltrates, ab pain, diarrhea, and high eosinophilia, can complicate to hyperinfection and dissemination.
Definition
Strongyloides stercoralis, treated with al/mebendazole
Term
Name this parasite - humid areas with poor sanitation via eggs in soil, penetration of unbroken skin by larva, they move to heart/lungs then 1 cm adults in duodenum, entry lesion eosinophilia ab pain diarrhea with ANEMIA but possibly asymptomatic, diagnosed via O&P.
Definition
Hookworms, Ancylstoma duodenale and Necator Americanus treated with albendazole
Term
Name this parasite - human is dead end host, found in raccoons, potential bioterrorism because eggs stable in aerosol, larva migrans is usually asymptomatic but can cause blindess, neuralogic damage and death, with no treatment.
Definition
Raccoon roundworm
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