Tutorial Problem Questions Human Parasitology __________________________________________________________________ Q.

1: A young child presented with an enlarging head, left sided microphthalmia (Abnormal smallness of the eye), seizures and brain calcifications.

a. What parasitic organism is likely to cause such pathology? b. What caused the microphthalmia? c. How did this child become infected? d. What signs and/or symptoms might the mother demonstrate? Q.2: An indigent Mexican mother presented a two and one-half year old child to an Emergency Room after a 6 week illness characterized by fever, irritability, anorexia and weight loss. Physical examination revealed fever, wasting and a huge tender liver. A chest X-ray demonstrated an elevated right hemidiaphragm, CAT scan of the patients liver. a. What is the diagnosis? b. What can you conclude from the CAT scan? c. What is the drug of choice? d. Do such patients always show intestinal parasites when they present with liver abscesses?

Q.3 A young Honduran female patient presented with a huge cutaneous ulcer involving the right shoulder. She had been involved in an agricultural clearance project in the interior of the country.

a. What parasite/s might cause such a lesion? b. How is the infection usually acquired? c. How might the parasite reach the skin?

Q.4 A 32 year old Brazilian immigrant male with a long history of cardiac arrhythmia died suddenly. Autopsy revealed an apical left ventricular aneurysm and severe cardiac inflammatory reaction around nests of very small organisms.

a. What is the diagnosis? b. How is this disease usually acquired? c. What other organ systems may be involved? d. Are other mammals susceptible? How is this important to the human condition?

Q.5 A 25 year old, white male presented to the Emergency Room with classical signs and symptoms of appendicitis, which had become progressively worse over a period of 48 hours. An appendectomy was performed with removal of a severely necrotic appendix.

Organism removed from the appendix (~12 um diameter). a. What is the diagnosis? b. How is infection acquired? c. What complication commonly follows such surgery assuming the patient has had no appropriate medication? d. What is appropriate medical therapy?

Q.6 A middle aged female patent presented with flatulence and intermittent diarrhoea. She also complained of frequent bouts of tiredness. A stool analysis revealed 1000s of 15um long cysts:

Photomicrograph of cyst

What is the parasite involved?

How was the infection acquired?

What epidemiological intervention is indicated?

How are infections treated?

Q.7 A barely conscious 6 year old Ugandan male was presented by his mother with intermittent fever (every day or so), significant weight loss, severe anaemia. A thick blood file revealed the following parasitological result.

What is your diagnosis?

Why do fevers occur every day rather than every 2-3 days (as expected?)

What is the main chemotherapeutic agent?

What are the main obstacles to control?

Q.8 A 54 year old Puerto Rican male presented to Emergency Room short of breath, feverish and coughing. Examinations revealed right-sided cardiac enlargement and reticular-nodular markings in the lung. He was admitted but died within the week. Autopsy showed an unusual liver. Multiple pseudotubercles were present in the liver (photograph) and lungs. Right-sided cardiac enlargement was confirmed.

What pathogenic sign does the liver show?

What caused this patients pulmonary and cardiac problems?

What simple test might have been performed that would have suggested the right diagnosis?

What therapy might have saved the patients life had it been prescribed earlier?

Q.9 A 7 year old Italian-born female fell down, unconscious, but recovered quickly. This was followed by a week of vomiting. One month later she developed headaches, intermittent drowsiness, and convulsions. She presented to an Emergency Room, where physical examination showed neck stiffness, hyperactive knee jerks, a positive Kernig sign and a Babinski reflex. The patient went into a deep coma with occasional involuntary motions. She died two days later. At autopsy, a 250 gram, 5 by 10 cm white-walled cyst (arrow) bulged out of the cerebrum....

a.

Diagnosis please?

b.

In what organs are these cysts usually found?

c.

How is the infection acquired?

d.

What therapy is appropriate?

Q.10 A four year old child was brought to the medical clinic with signs and symptoms of acute small bowel obstruction. The child was transported to hospital, but died the following day. An autopsy was performed, this revealed...

What parasitic infection may induce small bowel obstruction

How is this infection acquired?

What therapies are appropriate?

Why do children suffer the greatest morbidity. Q.11

A Jamaica man was brought to the Emergency Room because of an alarming serpiginous track on his arm. The lesions itched continuously, and were painful to touch. He had just returned from holiday where he spent considerable period relaxing on public beaches, and had observed stray dogs on the beach.

Diagnosis please

How is this infection acquired?

What therapy is appropriate?

Why are dogs and cats not permitted on beaches in resort areas?

Q.12 A 22 year old Italian born male was pronounced DOA at the Emergency Room. He had been in perfect health until he married two days earlier. He expired suddenly during intercourse. Photograph shows a transacted cyst which has separated from the surrounding kidney parenchyme.

Diagnosis please

How is this infection acquired?

What are the two mechanisms most likely to kill patients infected with this parasite?

Q.13

An adult male presented with complaints of multiple seizures. Physical examination was remarkable for the presence of multiple, pearl-like subcutaneous nodules.

What larval parasite is pearl-like in size and induces seizures when appropriately placed in the brain?

How is infection acquired?

What imaging modalities are useful in suggesting the right diagnosis?

What is the drug of choice?

Q.14 A five year old child presented to the Emergency Room suffering a prolapsed rectum. Multiple worms were seen on the mucosa.

Diagnosis please?

How was infection acquired?

What therapy is indicated?

Name 3 other clinical signs of this infection.

Q.15 A 30 plus year old Black African presented to the Emergency Room complaining of a moving vein in his scrotum. Physical examination was almost compatible with a diagnosis of a varicocele. The correct diagnosis was established after minor surgery of the scrotum and limb.

Diagnosis please?

How is the infection acquired?

What is the most common presentation of this parasite?

What is the current public health status of this parasite?

Q.16 A routine chest X-ray revealed a single 2 cm, non-calcified nodule in the right lower love of a 45-year old hunter. This was removed surgically. Biopsy examination revealed cross sections through adolescent parasites in the nodule. No larvae were observed in the blood.

What type of parasite is present here?

What is the most likely candidate re. diagnosis?

What are the normal hosts of this candidates?

How is this parasite transmitted?

Q.17 A JDF airman temporarily stationed in the Far East complained of a painless, fluctuant, moving, subcutaneous mass in his thigh. A CT scan revealed a low-density subcutaneous round area surrounded by a thin inflammatory reaction. The photograph shows a parasite that was surgically removed from the cutaneous mass. The anterior end is thicker than the posterior.

Diagnosis please?

How is this infection acquired?

How does the inflammatory host reaction change if the parasite dies?

Q.18 A 30 year old woman presented with complaints of dyspareunia, dysmenorrhea, and lower abdominal discomfort. Physical examination revealed a pelvic mass, which was excised. A section through the necrotic mass showed multiple eggs that were flattened on one side...

Questions: Diagnosis please

What sample would you send to the laboratory for diagnosis

How did this infection get to this unusual location?

What is the normal location for infections?

How is this infection usually acquired?