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Pinworms
- Found all over the globe
- Eggs are initially swallowed. Worms live in the cecum and females travel through the anus at night in order to lay their eggs
Clinical Presentation
- Few symptoms especially at first
- Itching around the anus
- Restless sleep
- Abdominal Pain
- Nausea
Diagnosis
- Worms may be visible with examination at night or after bowel movement
- Tape test – Worms will get stuck on tape placed over the anus at night.
- Fecal Analysis
- Fecal egg-count method
Treatment
- Medications
- Albendazole
- Mebendazole
- Pyrantel
- All members of the household must be treated
- Decontamination of all sheets and bathrooms
- Hand washing, hand washing, hand washing
Helminth infestation
- Soil transmitted parasitic worms
- Hookworm, Ascaris, whipworm
- Found mostly in warm tropical areas
- Larva enter the body through the feet. The entrance point is itchy.
- Move through the bloodstream to the lungs. Once in the lungs they are carried by cilia to the mouth and swallowed. They attach to the small bowel and lay their eggs.
- Sanitary living environment has played a major role in decreasing cases
Clinical Presentation
- Itching from entry point – bottoms of feet
- Non specific GI complaints
- Pain
- Nausea
- Constipation / diarrhea
- Vomiting
Diagnosis
- CBC – may show anemia
- Microscopic fecal exam for eggs
- Fecal occult blood positive
Treatment
- Mebendazole
- Albendazole
- Pyrantel
Malaria
- Estimates put world wide deaths at over 400,000 per year
- Four species of Plasmodium that infect humans:
- P vivax
- P ovale
- P malariae
- P falciparum
- Mode of transmission
- Through mosquito bite, by an Anopheles Mosquito
- Blood Transfusion from an infected person
- Mother-to-child transmission during pregnancy
- Parasites travel to the liver and reproduce, enter the bloodstream and infect red blood cells, where they break open and affect more blood cells
- Possible complications if left untreated:
- Cerebritis
- Hemolytic Anemia
- Kidney failure
- Liver failure
- Meningitis
- Pulmonary Edema – Respiratory failure from fluid in the lungs
- Hemorrhage – due to rupture of the spleen leading to massive internal bleeding
Clinical Presentation
- Classic symptoms are a cycle of coldness, shivering, fever and sweating occurring every 2-4 days based on the reproductive cycle of the organism
- Flu like symptoms
- Fever
- Headache
- Joint pain
- Vomiting
- Jaundice
- Polyruria
Diagnosis
- Physical exam – enlarged liver and spleen and jaundice
- Malaria blood smear – taken at 6 to 12 hrs interval, diagnostic confirmation
- Complete blood count – to identify anemia
- Recent travel history to places where Malaria exists
Treatment
- Prevent mosquito bites
- Wear protective clothing over the arms and legs
- Use mosquito netting while sleeping
- Use insect repellent
- Antimalarial drugs – drug resistance plays a major role in determining treatment
- Artemether/lumefantrine – commonly the treatment of choice
- Chloroquine -used for treatment and prophylaxis
- Hospital admission – for severe cases
- Fluid replacement and therapy
Toxoplasmosis
- Protozoan Toxoplasma gondii, which forms cysts that can affect almost any part of the body.
- Symptoms can range from none to mild up through life threatening in the immunocompromised
- Mode of transmission:
- Waste from an infected cat
- Fecal oral route with cats as a primary host
- Eating infected undercooked meat
- This is why pregnant women are warned against cleaning the cat litter box
- Infection during pregnancy result in spontanious abortion, stillbirth or birth defects
- Receiving an infected organ transplant or blood transfusion (rare)
- Normally asymptomatic or mild flu like symptoms, but immunosuppressed patients or children may become very ill.
Clinical Presentation
- Fever
- Aching muscles
- Tiredness
- Sore throat
- Blurred vision
- Confusion
- Loss of Coordination
For people with weakened immune system:
- Headache
- Confusion
- Poor coordination
- Seizures
- Lung problems that may resemble tuberculosis or Pneumocystis jiroveci pneumonia – a common opportunistic infection that occurs in people with AIDS
- Blurred vision – due to severe retinal inflammation
In babies who acquired congenital toxoplasmosis:
- Seizure
- Enlarged liver and spleen upon physical examination
- Jaundice – Yellowing of the skin and whites of the eyes
- Severe eye infection
Diagnosis
- Antibody testing for IgG and IgM
- Amniocentesis for pregnant women, to obtain a sample of the amniotic fluid for testing
- CT scan showing ring-enhancing lesions
- Brain Biopsy – Neurosurgeon takes a sample of the brain tissue and sent for laboratory analysis to check for toxoplasma cysts
Treatment
- Medications
- Pyrimethamine + Sulfadiazine
- Cook food to safe temperatures
- Ensure proper hygiene
Trichomonas
- Flagellated protozoan that is sexually transmitted
- Typically causes urethritis or vaginitis
Clinical Presentation
- Females
- Pruritus
- A yellow/green discharge that is malodorous (fishy) and frothy
- Severe vaginal and perineum inflammation
- Dysuria
- Dyspareunia
- Males often have no symptoms, but may have urethral discharge and irritation
Labs and studies
- Females
- Wet mount – motile flagellates
- Nucleic acid amplification tests (NAATs)
- Males
- Urine culture
- Urethral swab
Treatment
- Metronidazole 2 grams one time may be repeated if not cleared
- All partners should be treated