Bacterial GIT IV: Session 51 (Melu) 1.

Describe the conditions leading to antibiotic associated colitis and the antibiotics that may cause this state. Pseudomembranous colitis (PMC) classic example of an antibiotic treatment-induced disease.

ass w/ antibiotic use

o!ergrowth of normal flora

ex. clindamycin" cephalosporins" ampicillin" some anti#neoplastics

$$ Clostridium Difficile %(&) rod' (naerobe' )P*+, former (subterminal)

-hen things go wrong. (!arying degrees of pathology)

a) b) c)

Diarrhea w/ lower ab cramping / no systemic symptoms )e!ere colitis w/o pseudomembrane / profuse diarrhea" pain Classic pseudomembranous colitis system symptoms / fe!er" malaise" dehydration

o o o

symptoms same as se!ere elevated yellowish plaques 1-10 mm over inflamed regions of mucosa psudomembrane 0 fibrin mesh of necrotic cells" PM1s" monocytes" +2)

3. *utline the disease process of pseudomembranous colitis

Ma4or predisposing factor 0 D5)+6P75*1 *8 1*+M(9 %67 89*+(

o o o o o o o

coloni:ation/o!ergrowth of C difficile release of toxins ;1<= ppl ha!e C. difficile in 1ormal 8lora w/o problems

l 518(17) harbor m/o w/o effect 1osocomial outbrea>s

(symptomatic carrier ,5( most reliable / detection of toxin of specific proteins in feces is best tool for disease etiology (#) tests do 1*7 rule out PMC dx admin 1,- antibiotic

D?. of T !I" best

7?. fluid/electrolytes

l l l

#ancom$cin (superior)" metronida:ole

Complications.

spores +,)5)7(17 to antiobiotics' some pts will relapse" some multiple times )tory. if you isolate bacteria (w/ clindomycin) and infection not going away /or getting worse... logically thin> Clostridium built a resistance to Clindo... actually" they are all sensiti!e to clindo" but )*M,7@51% ,9), is in the mix... could be another player" or the toxin still causing symptoms

*1, resistant strain can protect the rest of the Clostridiums... or doesnAt ha!e to be Clostridium remember they donAt li!e in isolation...

B C. %i!e the is the mec%anism(s) e&idemiolo'ical features of food poisoning caused by )taphylococcus" 2. cereus" and Clostridium perfringens and the conditions under which each is most li>ely to occur. %eneral Common cause of acute food borne diarr%ea (()S) Clostridium perfringens 7ype ( %(&) rod )pore 8ormer 1*1motile (naerobe 1ood borne illness %(&) rod )pore former Motile (erobic 2acillus cereus 3.-iarr%eal form 9g F of cells ingested ab pain" profuse watery diarrhea 1#1J hrs after ingestion 3nd common (ne/t to Salmonella) of food borne d4 (cute emetic diarrheal d: T5: -4 w/o coloni4ation - pt may ne!er ha!e been coloni:ed or in!aded by ). aureus )taphylococcal S%ort incubatAn (1#L hrs after eating) "ausea2 #omitin'2 diarr%ea2 6ram&s2 %$&ersali#ation *a&id reco#er$ Clinical Manifestations S%ort incubation *+,I- onset Se#ere watery diarrhea (b cramping 7E. " fe#er " #omitin' *+,I- reco!ery ;1 day 3 forms. 1) .metic form *+,I- onset # upper %5 symp w/in 1#H hours Vomit2 cram&s2 diarr%ea Dirulence 8actors .nteroto/in (ileum) # s$n durin' s&orulation (defense against engulfment) ,pidemiology Common gut flora (ppl animals) #contaminated meat" poultry" gra!y / not coo>ed enough to destroy spores s&ores 'erminate if food is left out 0IG0 dose m/o 1. ,metic d:. Poorly coo>ed +5C,/!eggies/grains D? 1o fe!er DetectAn of 9(+%, Fs in food/feces. G1<H cells# food G1<C cells# feces 9atex agglutinatAn 7?/Pre!ention Pre!ent. #7oxin. Destroy by re#heating foodI #+efrigeration of coo>ed food )upporti!e 7x' fluid replacemnt Pre!ention. Prompt fridge of all grains after coo>ing 7x symptoms' disease course is fast' may not e!en ha!e to relie!e (bacteria dies in stomach acid## no more toxins produced / symp lasts as long as toxin is present) Pre!ention. 8ood handlers w/ staph infectAn (H<= no trace) 7x. self limiting / rapid course since toxins preformed )ome strains produce enterocolitis w/ water diarrhea" fe!er" cramps put on 9ong term antibiotics where guy flora has been disrupted.

produce 3 toxins. 1. @eat )table Preformed enterotoxin / (emetic d:) 3. @eat 9abile enterotoxin &roduced w/in bod$ / (diarrheal d:) ## stim (C Kc(MP in intestinal cells @eat stable" preformed" Protease resistant ,nterotoxin M types. + most common in 6.). -ater soluble (can w/stand B<min boiling) ##)uperantigenI ,metic response / absorbed in guy" stimulus in C1) impulse to !omiting center

1* fe!er )uspicion if upper %5 illness 1#H hrs after eating or 9ower %5 illness H# 1J hours after eating 5solate G1<H cells for both food feces 1* fe!er 6ustard filled ba7ed 'oods" canned foods (high salt)" processed meats (high salt)" potato salad / ideal en!iron for staph since adapted to human s>in high osmotic stress en!irons.

3. diarrheal d:. Meats" stews" gra!y $often confused w/ staph or clostridial food poisoning.

@6M(1) 0 source -4 w/o coloni4ation 7oxin undetectable in food / no taste" odor" color 7oxin produced Nuic>ly in warm conditions

Common between all three.

antibiotics not useful intoxications # 1*7 directly transmissible P3P 1o fe!er (or minimal) inadeNuate coo>ing" reheating" or refridgeration of foods

)tool Cultures indicated if. immunocompromised febrile bloody diarrhea se!ere ab pain se!er or persistant illness many fecal leu>ocytes are present

Intro to ,arasites: Session 53 (Melu) 1. 9ist the parasitic diseases and respecti!e causati!e agents (scientific names).

*bstruction

(scaris (intestinal bloc>age)

o o o o o
%iardia

bile duct (only ta>es 1 worm) %5 (multiple worms) destroys +2Cs reNuires ;H<<< cal/day ta>es B<= of , of host is wasted absorbs massi!e amts of 213 tapeworm pernicious anemia

Plasmodium (malaria)

7issue Destruction

Competition for nutrients Malabsorption

Diphyllobothrium latum

Diarrhea interferes w/ nutritional status

o o o

forms cobblestone#li>e co!ering on duodenum mucosa

whipworms blood loss in 9g intestine microcytic anemia hydatid disease (cyst) grows in sensiti!e organ (C1)) hoo>worms ,chinococcus granulosus

5ron deficiency

Pressure @ost immune response /

o
eosinophilia" tissue destruction hypersensiti!ity granuloma rxn

wuchereria bancrofti

3. Disually identify the agents from their microscopic structures (eg" cyst" tropho:oites" eggs" etc). see each lecture for pictures in charts... B. 9ist the infecti!e stages (ie" how the person contracts the parasitic infections). 5ngestion Direct )>in Penetration Direct P3P (rbobone ,ggs/cysts 9ar!al )tage sporo:oites 8eces contaminate water 5n!ades thru s>in )exual contact 2ite from arthropod food hoo>worm" schistosomes 7richomonas MosNuito in4ecting sporo:oites into human

C. Describe the pathogenicity" !irulence factors" and clinical presentation of each disease. see each lecture chart for description H. Describe the treatment options for each disease. Euinolines (rsenic (ntimonial Cmpds Euinine" chloroNuine" primaNuine" mefloNuine )odium stibogluconate 7rimethoprim" sulfonamides Metronida:ole Mebenda:ole" abenda:ole 7hiabenda:ole / cattle Pyrantel pamoate" pipera:ine" i!ermectin Pra:iNuantel 5nterfere w/ D1( replication in parasite 2ind to sulfhydryl grps on proteins en:s 7arget the synthesis of folic acid for purine biosyn 5nhibit D1( syn thy D1( al>ylation 5nhibits tubulin polymeri:ation microtubule formation )tim neuromm paralysis (lter balance of intracell Ca3& which causes titanic mm contraction alterations in tegument / increase >illing by host immunity 5nterferes w/ protein syn Prophylactic for malaria Plasmodium 9eishmania Cyclospora %iardia" trichomonad ()7D)" amoebas (scarid @oo>worms (scarid/roundworms (Kexcretion/>illing) 5ntestinal tapeworm (gi!en to dogs)

8olic (cid 5nhibitors 1itroimida:oles Ben:imida:oles Paralytic (gents Pyra:inoisoNuiniolines

7etracyclines

7racycline" doxycycline

Plasmodium" 2alantidium

L. Contrast how a parasitic disease is diagnosed bacterial disease. see each lecture for DX. J. *utline control measures" pre!entati!e steps" and the epidemiology of each disease. see each lecture for these...

HB"HC or'anism Giardia lamblia Protozoan single cell flexible! cyst. o!al" hyaline/chitin wall" 8 nuclei 1 cyst 0 3 trophs Trophozoite: bilobed teardrop adhesi!e disc M flagella" 3 nuclei disease %iardiasis. water$ diarr%ea (intermittent) cyst does not cause illness dose not in!ade or destroy +2Cs cysts (feces)Cyst ingested troph (duodenum) fecal/oral $$ ;3 wee> inoculatory period 5nfecti!e dose ;1<< cysts Pathogenic )tage. Tro&%o4oite. feeding/!egetati!e stage duodenum/ 4e4unum GS+ 0 giardia specific ag Dx 0 both stages in feces * &at%o&%$s infecti!e stage. c$st en!iron resistant ingested in water -ia'nosis (&ic) e&idemiolo'$ worldwide" 6) children" distended abdomen transmission. human animal feces 9ater :oonotic i.e. bea#ers @3* e!erywhere surface parasite " 51D()5*1 0i'%l$ conta'ious: Treatment D*C. Metronida:ole (benda:ole Control. drin> clean water only; Boil; iodine 5nnate acNuired immunity control infectAn Breastmil7 is 'iardicidal: I'+ Intestine: metronida:ole lodoNuinol combo li#er: 7inida:ole & iodoNuinol Control. drin> clean water only; Boil; iodine

%)( positi!e stool sample

Entamoeba hisolytica Protozoan c$st. round" 8 nuceli Tro&%. 1 nucleus central endosome

6olitis' (moebic dysentery blood$ diarrhea *(5 &ain 0 li#er abcess <%e&atic amoebiasis= low grade fe!er 8las> shaped ulcer

5nfecti!e stage.6$st Pathogenic )tage. Tro&%o4oite multiplies in l' intestine I"V+-.S::> ulcers (deat%Ocommon' peritonitis" gut perfusion" @8" exhaustion)

college student who goes to %uatemala Troph Cyst worldwide' Kin tropical areas fecal contam water and food borne

Troph

Dirulence 8actors. 6$steine &roteinases" phospholipases" amebrapore Cryptosporidium parvum C hominis oc$st. 8 sporo4iotes " sporoc$sts 6r$&tos&oridiosis self limiting diarr%ea (cholera li>e) / lasts ; 3 wee7s fe!er" malaise De!elopment. brush border of sm) int) +esides. &arasiti&%orous #acuole (extracytoplasmic)

.ats *B6s (PhematophagousQ) 5nfecti!e stage. ooc$st infects %5 micro!illi Dx. oocyte in feces. :inc sulfate centrifugal flotation' cholecystits/pancreatiti s

Dx. troph or cyst in stool

DX:

6%ildren/ immunosuppressed (+I-S) :oonotic. manure contaminated drin7in' water ,ndemic. ,3,

D*C. nita:oxanide Paromomycin Difficult w/ @5D/(5D) (!oid public swimming pools

Arrow -parasitiphorous vacuole common parasite of cattle' human accident Cyclospora cayetanensis Protozoan incubation ~1 week 6$clos&oriasis e/&losi#e water$ diarr%ea cramps" low grade fe!er larger (3?) oocyst than cryptosporidium autofluorescent ooc$st / lar'e *esistant to 6%lorine: fecal/oral 7ra!elerAs diarrhea *Acid Fast berries from ?atin +merica basil &esto &asta salad B#BH?/day diarrhea Balantidium coli ,IGS: 2alantidiasis / diarr%ea' rural regions in de!eloping countries' ,nteritis" can be in!asi!e Dirulence 0 proteolytic en: 5nfecti!e stage 0 c$st ciliated largeI * Pig 7roph cyst. macronucleus# >idney bean shaped oral/fecal !ia contaminated water tetracycline or metronida:ole DOC: Tri ethopri sulf etho!a"ole # day course

Blastoc$stosis. Distractor answerI

9%i&worm and +scarids: Session 55 (Melu) -- nemotodes 1. 9ist characteristics of nematodes. sessions HH and HL roundworms

1emotodes 0 roundworms

o o o

1*7 all parasitic long" cylindrical" tapered" unsegmented 7ube w/in a tube l uter tube > cuticle" hypodermins" mm" nn" ,) (secretory) system l Inner tube > complete digesti!e reproducti!e system l In between > pseudocoelomic space filled w/ noncompressible fluid hydrostatic s>eletom

o
" ?.GS:: eggs adult

PcirculatoryQ system

L1

L4 L3

L2

9ife Cycle. egg" C 9ar!al stages" adult l stages loo> the sameOseparated by Moltin'I (i.e. li>e a sna>e)

Caenorhabditis elegans is popular model system

1*7,). (scaris suum. large roundworm of pig intestines

similar to (. lumbricoides

but many differences

humans can be infected / accidental host

9ower Rield. 7richuris

other helminthes tend to stimulate 7h3 response 5lC" 5lH" eosinophils suppress 7h1 o can affect susceptibility to other infections induce 7 reg populations 0$'iene 0$&ot%esis early exposure to helminthes reNuired for proper tuning of immune system to a!oid damaging 7h1 responses seen in autoimmune disorders o Correlation between what youAre exposed to early in life can determine how your immune system de!elops.

%eneral/ 7ransmission Direct life cycle w/o intermed host/!ector 1ecal/oral route ,ggs de!elop in soil ;B wee>s #warm" moist soil promotes de!elopment Mature females. BH#H< mm Mature males. B<#CH mm ... pretty small

5nfecti!e/diagnostic stages

,pidemiology

7ypical eggs

Clinical Manifestations *ften asymp. ## low worm F

7?/Pre!ention/Con trol

7richuris truchuria 0uman 9%i&worm

Infectious Sta'e > .'' @ 9ar!e hatch in small intestine @ Molt C times S Mi'rate to ?' Inst. and )7(R) 7ime 0 ; B months ?ifes&an> se#eral $ears

#Brd most common roundworm #worldwide #)outhern 6.). #inadeNuate sanitation #%uman feces used as fertili4er )ee adult worms !ia protoscopy or !ia prolaspe... Tnobs on ends / Pbipolar plugsQ 5f males females are present" fertili:ed eggs (up to 1<<<< eggs/day) / passed in feces. .''s in feces are -ia'nostic

$(dult worms do not multiply w/in host burden depends on F e''s digestedI #tissue damage due to anterior end embedded in mucosa (b pain" loss of appetite !omit" diarrhea (bloody)" anemia" 3 infectAns" *ectal &rola&se A common w/ 7ids Pre!ention/Control. # 5mpro!e sanitatAn # S use of feces as fertili:er

(scaris lumbricoides

Direct life cycle w/o intermed host/!ector 1ecal/oral route *ften ingestion of food contaminated w/ &arasite e''s Mature females. 3<#C< cm (;1 ft long) Mature males. 13#3H cm ?ifes&an> 1-3 $ears

Infectious Sta'e > .'' @ 9ar!e hatch in small intestine @ ,nter portal !enous system tra!el to the li#er S Cont. to pulm circulation to lun's S .nter al!eolar spaces S Molt T9I6. @ Mi'rates up trac%ea coughed up swallowedI S 1inal Molt in sm) intestine S Maturation into adult worm # Most found in BeBunum 7ime 0 1M#C3 days 7ime til presence of eggs in feces GB months

*ften asymp. ## low worm F - Most common helminthic infection in humans # worldwide #7ropical # )outheast 6.). #inadeNuate sanitation #%uman feces used as fertili4er +dult worms can mi'rate. out of mouth/nose/etc #induce migration !ia anesthesia" medications" spicy food" diarrhea" high fe!er .''s in feces are -ia'nostic # Peripheral ,osinophilia # ?ray. w%irl&ool ima'e 6ltrasound. @epatobiliary pancreatic ascariasis / more common in females/ adults 9ar!ae / deposited in other organs inflam" granulomas 9ar!ae can die during migration inflam" necrosis" abscess $(dult worms do not multiply w/in host burden depends on F e''s digestedI %5. (b pain" loss of appetite" Intestinal bstruction / common w/ 7ids' pain" !omit" constipation Complications. !ol!ulus" intususseption" gangrene" perforation 9ung. cough" pneumonitis" 9oefflerAs synd. eosin pneumonia' +scaris aller'enic I'. A twd lar#al sta'es *einfection common 7?. acti!e against adult worms 8R5. albenda:ole or mebenda:ole Corticosteroids for pulm symptoms Pre!ention/Control. # 5mpro!e sanitatAn # S use of feces as fertili:er

(nisa>i simplex P@erring -orm diseaseQ P(nisa>iasisQ

(lso" Pseudoterrano!a decipiens / cod worm disease 0 anisa7iasis @umans accidental %ost 6sually mature in marine animals @umans become infected by eating raw/undercoo>ed fish

Complex lifecycle w/ T9 intermed hosts. crustacean fish/sNuid 5nfectious )tage 0 lar#ae ?ar#ae in stomac%/intestine are dia'nostic )ee graph for complete life cycle of time parasite...

#worldwide #higher incidence in areas of raw or pic>led fish (Uapan" Pacific coast of ). (meri" 1etherlands) donAt forget about importsI

,gg stage w/in fish" not human

w/in @*6+) of ingestion. ab pain" nausea" !omiting 9ar!ae get coughed up 5f lar!ae get into intestine. .osino&%ilic 'ranulomatous response lasts ;1#3 wee>s A similar to CrohnAs d:

8R5. gastoscopic examination' 7issue remo!al/ remo!al of lar!ae (surgical) Pre!ention (8R5) 8ree:e for 1 wee> or 8lash 8ree:e G1H hrs

Tric%uria:

+scarites:

+nisa7is

Medicall$ Im&ortant *oundworms: Session 5C (Melu) -- nemotodes

1emotodes 0 roundworms

o o

1*7 all parasitic long" cylindrical" tapered"

unsegmented

1. %i!e the scientific names and their corresponding diseases. )trongyloides stercoarlis asthma" s>in infections 1ecator americanus/(ncylostoma duodenale pneumonitis" hypochromatic anemia" s>in infections (ncylostoma bra:iliense/(ncylostoma caninum Pruritic" erythematous" serpignious lesion ,nterobius !ermicucularis Pruritis (ni / worms in perianal folds

1*7,. 7hin> ,(7 roundworms. ,nterobius (scaris 7richuris ##G we eat/ingest the infecti!e stage (embryonated egg)

5D/5E Ta&eworms )trobila 0 flat body/ribbon li>e Proglottis 0 segments

,(C@ segment/proglottis contains eggsI )colex 0 mainly for attatchment / bothria" suc>ers" hoo>s" or spines 7egument

contain reproducti!e organs (hermaphroditic) %ra!id proglottis fully de!eloped eggs

li!ing tissue w/ high metabolic acti!ity Microtric%es A K absorpti!e areaOsimilar to micro!illi in gut (worm turned inside out) Muscular system / circular (T.*/lon'itudinal I"".* "o digesti!e system / nutrients are absorbed

9ife Cycle. ,gg found in feces of definiti!e host (adult worm releases eggs) Metacestode0 lar!a found in intermediate host

o o o o

Plerocercoid ( sparganum) 0 solid body

l Diphyllobothrium Cysticercoid 0 solid body but lac>s bladder l Hymenoplepsis Cysticercus l bladderworm 0 taenia @ydatid cyst / contains protoscolices

(dult worm found in definiti!e host

5nfecti!e )tage either ,gg or Metacestode (species dependent) 7x. PraiNuantel / (dissol!es the scolex) same tx for dogs cats" so if need immediate" 4ust got to petsmartI

Metacestode pics

)ession HL

%eneral/ 7ransmission

5nfecti!e/diagnostic stages Infecti#e sta'e > filariform lar#a S Penetrate intact s7in @ ,nter !enous or lymph S Passi!ely transported to lun's S 2rea> into al!eoli @ Migrate to trachea/swallowed S (attaches molts) (dult reside in small intestine

,pidemiology #)>in penetrance or ingestion of lar#a #transmammary possible (ss. w/ T5F com&romised/+I-S rd B world countries (dults produce eggs hatch r%abditiform lar#a &assed in feces > dia'nostic T5 @

Pathophysiology

Clinical Manifestations

7?/Pre!ention/ Control

1ecal/oral Stron'$loides stercoralis (Infecti#e sta'e) 9ife cycle is facultati#e / can complete its life cycle in soil/en!iron *r w/in host (dul t 0 small worm Voonotic d:

6utaneous: #5n!asion !ia s>in ,ulmonar$: #migrates thru lung / damage tissue GI ,nteritis/eosinophilia 0$&erinfectGn autoinfectAn in compromised pts

6utaneous: # )light hemorrhage swelling # Pruritic lesion (6ree&in' eru&tion W site of entry) ,ulmonar$: # produces intense burnin' in c%est #hea!y infectAn #G &neumonitis -- ass w/ ast%ma T5F GI: ,nteritis/eosinophilia

#Pre!ent fecal contamination #,ducation D*C i!ermectin *r 72V 0 thiobenda:ole / mostly used in cattle / induces lots of emesis (DonAt respond well to albenda:ole or mebenda:ole)

"ecator americanus 1ecal/ ral +nc$lostoma duodenale 0 H9 *M )tout worm 2uccal Capsule. 1. americanus 0 cuttin' &lates (. duodenale 0 lar'e teet% Infecti#e sta'e > filariform lar#a S S7inlun'GI route (see abo!e) $$IeBunum$$ 7ime. 1 w> 9i!e ;1#H yrs

7ropical/)ubtropical -arm" Moist )oil Se'mented .'' embryonatAn ;1#3 days rhabditiform lar!a feeds on feces > dia'nostic > .GG

6utaneous: #Creeping eruption/ ground itch / pruritic lesion) ## anemia ,ulmonar$: #migrates thru lung / damage tissue GI: blood loss !ia feeding on mucosal tissue (lacerations)

6utaneous: ,ulmonar$: ,neumonitis GI: 0$&oc%romic anemia *ther )ymptoms. # protein deficiency #pot belly #dry s>in/ dry hair #mental dullness #heart failure #death #,osinophilia possible Cutaneous. Creeping eruptions 7hiabenda:ole (72V) / topically 5!ermectin D*%) (1D C(7) (!oid barefoot Pre!ent fecal contamination ,ducation Mebenda:ole Pyrantel pamoate or D*C. albenda:ole

(ncylostoma bra:iliense (ncylostoma caninum

6utaneous lar#a mi'rans @ igrates thru s!in @umans accidental hosts - GS/cats

Infecti#e sta'e > filariform lar#a S S7in mi'ration

Puerto +ico" 8lorida )outhern 6.). 1ecal contamination &er&etuates life c$cle

Pruritic" erythematous" serpignious lesion

,I"9 *M )mall worm ,3, transmission @ all members of household should be tx. 8ecal contamination Can be airborne

,nterobius !ermicucularis

Infecti#e sta'e > .GG S 5nfecti!e in L hrs S )wallowed hatches in duodenum S Molts twice S Matures in BeBunum/ileum 7ime. 1H#CB days S (ttach to ileocecal but can wander

8reN.underrated Minute ulcerations of intestinal mucosa 8lat on one side" round on other " T :oonoticII 8ound. soiled fingers/nails' clothing' bedding" curtains" carpets" dust Children X13 yo Poor hygiene 8emales migrate w/in lg intestine to &erianal s7in :: T5 dia'nostic > .'' S Migration triggered by. lower body temp during sleep (child) S -I. after expelling eggs Males -I. after mating 9ife. C#L w>s ,ruritis +ni 5rritation discomfort b/c female womrs deposit eggs in perianal folds Pt scratches" resulting in bleeding infection ,ggs are !ery adhesi!e fix to tissue Most infections 0 asymptomatic 7x symptoms since worm is self limiting / D?. T56ello&%ane ta&e / eggs stic> to tape (!iew micro) D*C. pyrantel pamoate" mebenda:ole" albenda:ole (eggs 1*7 >illed by drugs / tx for 3#B w>s)

)ession HJ

%eneral/ 7ransmission

1asciolo&sis bus7i Giant intestinal 1lu7e

5nfecti!e/diagnostic stages In'estion: Infecti#e sta'e > Metacercariae (of water c%esnut) @ (dult S (ttaches to small intestine -ia'notic > e''s in feces In'estion: Infecti#e sta'e > Metacercariae (of watercress) @ +dult @ 9i!es in bile duct @ Maturation B#C months -ia'notic > e''s in feces Infecti#e sta'e > Metacercariae (of fresh water fish) S (dult @ 9i!es in sm/med bilar$ ducts @ Maturation 1 month

,pidemiology 1st intermed host0 )1(59 S 6entral/Sout%east +sia China" Dietnam" 7hailand *eser#oir %osts: Pigs" dogs" rabbits w/ water chesnuts

Pathophysiology

Clinical Manifestations

7?/Pre!ention/ Control

light infections / asymptomatic hea!y infections / diarrhea enteritis intestinal obstruction eosinophilia

pre!ent contamination of food/water Control snail pop

,gg 0 Dx

Large/Oval

1ascioloa %e&atic S%ee& ?i#er 1lu7e

Large/leafshaped

1st intermed host0 )1(59 S (9orldwide) ,urope/ middle ,ast" (sia S *eser#oir %osts )heep/Cattle w/ watercress

,gg 0 Dx ,seudofascioliasis /pt recently ingested infected li!er (pt is 1*7 actually infected w/ flu>e)

+cute ,%ase: 1lu7e is mi'ratin': ab pain hepatomegaly 8e!er Domitin Diarrhea 6rticaria ,osinophila 6%ronic: 1lu7e in Bile -uct / periodic biliary obstruction inflammation Se#ere: 8e!er ,pigastric pain @epatomegaly Uaundice In#asion of Gall Bladder: Cholecystitis Cholelithiasis 5mpaired li!er fnx 7E. ass w/ c%olan'iocarcinoma

7riclabenda:ole or bithionol # ma$ not res&onds to &ra4iJuantel 5mpro!ed sanitation' pre!ent contamination of food/water Control snail pop

6lonorc%is sinensis 6%inese ?i#er 1lu7e

Small

-ia'notic > e''s in feces/ duodenal as&irate Infecti#e sta'e > Metacercariae (of fresh/brac>ish water fish) @ (dult S (ttaches to small intestine -ia'notic > e''s in feces Infecti#e sta'e > Metacercariae (of fresh/brac>ish water fish) S (dult S 9i!es in small intestine -ia'notic > e''s in feces Infecti#e sta'e > Metacercariae (of 6rustaceans) ?i#es in ?("G

1st intermed host0 )1(59 S ,ndemic areas of +sia. Torea" China" 7aiwan" Dietnam (1onendemic 0 +sian immi'rants) S *eser#oir %osts dogs" cats" fish# eating mammals in endemic areas 1st intermed host0 )1(59 S ,gypt" Middle ,ast" 8ar ,ast S *eser#oir %osts dogs" cats" fish# eating mammals birds in endemic areas 1st intermed host0 )1(59 S 8ar ,ast" )iberia" Manchuria" 2la>ans" 5sreal" )pain S +eser!oir hosts dogs" cats" fish# eating mammals birds in endemic areas 1st intermed host0 )1(59

Pra:iNuantel 5mpro!ed sanitation' pre!ent contamination of food/water Control snail pop ,ducation w/ raw/uncoo>ed fish Pra:iNuantel 5mpro!ed sanitation' pre!ent contamination of food/water Control snail pop ,ducation w/ raw/uncoo>ed fish Pra:iNuantel 5mpro!ed sanitation' pre!ent contamination of food/water Control snail pop ,ducation w/ raw/uncoo>ed fish

Egg = D

0etero&%$es %etero&%$es Minute intestinal 1lu7e

Intestinal. (b pain Diarrhea M$ocarditis / if eggs reach heart ,ggs can get into circulation to brain.

small

Intestinal: (b pain Diarrhea ,ggs that migrate to @eart or 2rain D* 1*7 usually cause symptoms

Meta'onimus $o7o'awai

Egg = D

Small ,ara'onimus westermani ?un' 1lu7e

-ia'notic > e''s in S&utum

Session 58 and 59: Helminths

General/ Transmission

Infective/Dx Stage Eggs shed in water Fish intermed host Infective Stage = Plerocercoid in raw fish S (dult S small intestine

Epidemiology

Pathophysiology

Clinical

Tx/ Prevention

Scandinava, Baltic States Foodborne= raw fish D ursi most common in U.S.

Ribbon stage= up to 30 ft Scolex= 2 brothria

Mild GI distress: Nausea/Diarrhea Tapeworm pernicious anemia (worm absorbs Vit. B12)

DOC= Praziquantel

Diphyllobothrium latum

broad fish tapeworm **BOARDS**

D!ph"ll#b#thr!as!s $ecal/#ral%% !sh

Dx: Egg (anopercular knob) or proglottid

Taenia saginata beef tapeworm

Infective Stage= Cysticercus undercooked meat S (dult S small intestine Infective Stage= Cysticercus undercooked meat S (dult S small intestine

Africa, Mexico, Argentina Foodborne= beef Most common human taeniid (flatworm)

10-15 ft. --> common up to 75 ft. Scolex= unarmed Key for ID= 20-25 branches/side of central stem in proglottid Dx: egg and proglottid (feces)

Mild GI distress Hunger pains not common Human not suitable interm host

DOC= Praziquantel

Taenia solium pork tapeworm

Worldwide Cysticercosis most common CNS parasitic disease Foodborne= pig Fecalborne= Man (eggs from stool immediately infectious ) Endemic in sheepraising areas Definitive host= dog (most common), coyote, wolf

6-10 ft.--> common Scolex= armed branches in gravid segments < T. saginata Dx: egg and proglottid (feces) Cysticercosis: Xray, MRI, CT, immunoblot assay

Humans also infected w/ Eggs in human feces--> cysticercosis egg develops into bladderworm--> Neurocysticercosis--> seizures & hemiparesis Larval dissemination (cysticerci in retina or vitreous humor)

DOC= Praziquantel for both infections Possibly Sx for cysticercosis Cysticerci may resolve w/out antihelminthTx

Echinococcus granulosus hydatid disease **BOARDS**

Unilocular hydatid cyst: protoscolices and brood capsules dog eats sheep li!er w/ hydatid cyst#G adult worm##G eggs in feces

Infective Stage= egg (dog feces) S (dult S liver (mostly) and lungs

3-5 mm long Scolex= armed Dx: Protoscolex (cyst) Hydatid sand protoscolices in cyst Xray, CT, ELISA Cyst may go undetected for 20 yrs

Mechanical damage, toxicity effects, severe abd pain, necrosis Ruptured Cyst= 1) 2ndary echinococcosis (free protoscolices --> new cysts) 2) Anaphylaxis

Surgery Albendazole (also Sx prophylactic)

Echinococcus multilocularis

Multilocular or alveolar hydatid cyst= liver

Interm host: rodents, humans Definitive host: fox, dog, cat

Cyst metastasis= grave prognosis

Cross your fingers

Hymenolepis nana

Direct P2P dwarf tapeworm

Scolex= unarmed

Mild GI distress

Praziquantel

Hymenolepis diminuta rat tapeworm Dipylidium caninum

Int. host= Fleas & beetles

Infective stage= cysticercoid

Infections can occur in children

Dx: egg (feces)

Praziquantel

2x-pored dog tapeworm

Infective stage= cysticercoid Int. host: Fleas

children who eat fleas

Scolex= armed 2 segments Definitive host= dog, cat, humans

Dx: egg capsule (feces)

Praziquantel Treat dog and fleas