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PARAGONIMUS WESTERMANI aka Oriental Lung Fluke Classification: Kingdom: Animalia Phylum: Platyhelminthes Class: Trematoda Order: Plagiorchiida Family: Troglotrematidae Morphology Adult L: 7.5mm to 12mm W: 4mm to 6mm covered with single-spaced spines; hermaphroditic Egg L: 80 to 120 g long; W: 45 to 70 g operculum Pathogenesis

Clinical Features Acute Phase Diarrhea, abdominal pain, fever, urticaria, eosinophilia after 1 - 2 weeks: pleuritic chest pain, cough and/or dyspnea Chronic Phase Cough, hemoptysis, fatigue, myalgia, chest radiographic abnormalities CXR: nodular shadows, calcifications, or patchy infiltrates Diagnosis Microscopy Sputum (egg) Feces (egg) Biopsy (egg and adult) Serology For light and extrapulmonary infections Epidemiology P. westermani - asia including China, Philippines, Japan, Vietnam, South Korea, Taiwan and Thailand P. africanus - Africa P. mexicanus - Central and South America P. kellicotti - United States Treatment PRAZIQUANTEL Bithionol Prevention Avoid ingestion of RAW freshwater crabs/crayfish Cook crabs/crayfish adequately to at least 145 degress F (63 degrees C) ____________________________________________________ PNEUMOCYSTIS JIROVECI Unicellular fungi MC opportunistic infection in HIV patients Habitat: respiratory tracts of mammals and humans Transmission: AIRBORNE Found in 3 distinct morphologic stages: trophozoite (trophic form), exists in clusters sporozoite (precystic form) cyst, contains several intracystic bodies (spores) Classification: Kingdom: fungi Phylum: Ascomycota Class: Taphrinomycotina Order: Pneumocystidomyecetes Family: Pneumocystidaceae Pathogenesis

Larval Activity Penetrate intestinal wall Localize in the peritoneal cavity (wanders around) Migrate to chest cavity through diaphragm Penetrate pleural activity Infects lung parenchyma

Pathogenesis Inflammatory reaction: abdominal pain, diarrhea, fever

Approximately 20 days after infection. Causes inflammatory reaction in diaphragm. Turbid or hemmorhagic exudation. Acute exudative pneumonitis and hemorrhage. Eggs produce granulomatous reaction. Found in pairs, inside bronchial lumen lined with bronchial epithelia (squamous metaplasia). Produces zones of collagenous fibrous tissue and of active inflammation with exudate. Jacksonian epilepsy, cerebral hemorrhage, brain edema, visual disturbances, meningitis

Gradually mature and encyst

May penetrate other organs: brain

Physiologic changes include the ff: Hypoxemia Respiratory Alkalosis Impaired diffusing capacity Changes in total lung capacity and vital capacity

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____________________________________________________ ASCARIS LUMBRICOIDES Soil-transmitted helminth LARGEST NEMATODE parasitizing the human intestine Adult females: 20 - 35 cm Adult male: 15 to 30 cm Classification: Kingdom: Animalia Phylum: Nematoda Class: Rhabditea Order: Ascaridida Family: Ascarididae Morphology: Underfertilized egg elongated and larger thin shelled shell ranges from irregular mammillations to a relatively smooth layer internal contents: a mass of disorganized, highly refractive granules 85-95 mm by 43-47 mm Fertilized egg bile strained mammillated thick external layer unembryonated 55-75 mm by 35-50 mm

Clinical Features Risk Factors: Persons with HIV infection whose CD4+ cells fall below 200/L Persons with primary immune deficiencies Persons receiving long-term immunosuppressive regimens Persons with hematologic and nonhematologic malignancies Persons with severe malnutrition Symptoms: Progressive exertional dyspnea Fever Nonproductive cough Chest discomfort weight loss Chills Hemoptysis (rare) Complication: Acute Respiratory Distress Syndrome (ARDS) Diagnosis Histopathologic Diagnosis Microscopy Immunofluorescence Microscopy Quantitative PCR Sputum BAL Biopsy LDH Levels are elevated (>200 U/L) Reflect the degree of lung injury CXR Diffuse bilateral infiltrates extending from the perihilar region CT scan Classic patchy areas of ground-glass attenuation Treatment Trimethoprimsulfamethoxazole Pentamidine Adjunctive corticosteroid (severe PCP) Prevention Smoking cessation Chemoprophylaxis TMP-SMX Dapsone Atovaquone Aerosolized pentamidine

Clinical Features Intestinal parasitism Abdominal discomfort Intestinal Obstruction Lofflers Syndrome a transient respiratory illness associated with blood eosinophilia and radiographic shadowing Symptoms appear 10-16 days after ingestion of Ascaris eggs Fever malaise cough wheezing dyspnea Diagnosis CBC Eosinophils 5 - 20 % Microscopy Stool exam Sputum exam Serum IgE level Chest Radiograph

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Treatment Antihelminthic Prednisone (severe) Albendazole Mebendazole 400mg orally once 100 mg orally BID for 3 days or 500 mg orally once 150 - 200 mcg/kg orally once


____________________________________________________ BRUGIA MALAYI Nematode Classification: Kingdom: Animalia Phylum: Nematoda Class: Secementea Order: Spirurida Family: Onchocercidae Habitat: Lymphatic tissue Vector: Anopheles sinensis White and thread-like worms female: 5 - 10 cm Male: 2.5 - 4 cm Microfilariae 177 - 296 mm in length encased in a sheath contains large number of body nuclei A nerve ring with no nuclei can be seen at the anterior 1/5 of the body 2 terminal nuclei Microfilaria Comparison
Brugia Malayi Appearance Size Cephalic Space irregular, stiff curves smaller, 177 - 230 x 6 longer, length:width = 2:1 equal sized, clearly defined, countable two Anopheles sinensis Anopheles anthopophagus Asia Wuchereria bancrofti graceful, sweeping curves larger, 244 - 296 x 7 shorter, length:width = 1:1 unequal sized, coalescing, uncountable none Culex pipiens pallens Culex fatigans Worldwide

Pathogenesis Acute Stage Allergic reaction filarial fever, lymphangitis and lymphadenitis Chronic Phase elephantiasis Tropical Pulmonary Eosinophilia Intense eosinophilic alveolities Symptoms: cough dyspnea nocturnal wheezing fever, anorexia and weight loss Similarly between gamma glutaryl transpeptidase of L3 stage larvae and pulmonary epithelium Microfilariae released from lymphatics to circulation Trapped microfilariae in the lungs degenerate and release their antigenic constituents that trigger local inflammatory and immune process Lung parenchyma inflammation (Intense alveoliti

Nuclei Terminal Nuclei Vector Distribution

Epidemiology Infects 13 million people in south and southeast asia Responsible for nearly 10% of the worlds total cases of lymphatic filiariasis Endemic in 16 countries, where it is most common in: southern China India Indonesia Thailand Vietnam Malaysia Philippines South Korea

Diagnosis Chest X-ray: Diffuse reticulonodular infiltrates Pulmonary Function Tests: restrictive defects with mild obstruction Marked Peripheral blood eosinophils High serum concentrations of IgE and filarial - specific IgG and IgE antibodies Definitive: thick blood smear (10PM to 2AM) Treatment DIETHYLCARBAMAZINE Ivermectin Prevention Vector Control DEC table salt ______

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