Protozoa Trichomonas Vaginalis Sx Vaginitis foul smelling discharge

Protozoa

Trichomonas Vaginalis • Sx? – Vaginitis: foul smelling discharge, itching, burning – Thin watary frothy discharge on speculum exam – Males asymptomatic • Transmission? – Sexual • Diagnosis? – Trophozoites very motile on wet mount • Treatment? – Metronidazole

Giardia Lamblia • Sx? – Nonblooding diarrhea (does not invade!), Bad smell (fat malabsorption), flatulence, bloating. TROPHOZOITE • Context? CYST – Often camping, hikers drinking natural water sources • Transmission? – Cyst in water • Diagnosis? – Trophozoites or cysts in stool • TX? – Metronidazole

Babesia • Sx? – Fever and Hemolytic Anemia • Geographic Distribution? – NE USA. (Read: Brown University) • Transmission? – Ixodes Tick • Diagnosis? – Blood Smear Maltese Cross and Ring Forms • Treatment? – Quinine, Clindamycin

Trypanosoma Cruzi (American) • Sx? – Chagas’ Disease: dilated cardiomyopathy, megaesophagus and colon. • Transmission? – Reduviid Bug (kissing & pooping bug) • Diagnosis? – See flagyllate on blood smear • Treatment? – Nifurtimox (kills amastigotes on blood—less so in tissue. )

Trypanosoma Gambiense (West African) • Sx? – African sleeping sickness: fever, HA, dizzy, LN swelling, wasting, CNS sx late! • Transmission? – Tsetse Fly • Diagnosis? – Blood smear • Treatment? – Blood disease: • Suramin, – CNS: • Melarsoprol (very toxic!)

Trypanosoma Rhodesiense (East African) • Sx? – African sleeping sickness: fever, HA, dizzy, LN swelling, wasting… same sx but much more sever than west! Death in months • Transmission? – Tsetse Fly • Diagnosis? – Blood smear • Treatment? – Blood disease: • Suramin, – CNS: • Melarsoprol (very toxic!)

Leishmania Donovani • Sx? – Cutaneous • Ulcer at site of bite – Mucocutaneous – Visceral • Spiking fever, crazy HSM, pancytopenia, wt loss, abd pain and distention • Transmission? – Sandfly • Diagnosis? – Amastigotes in Macrophages • Treatment? – Sodium Stibogluconate

Plasmodium (Malaria!) • What are the four types? – Falciparum, Malariae, Vivax, Ovale • Which have dormant liver forms? – Vivax and Ovale (Hypnozoites) • Sx? – Cyclic fever, headache, anemia, splenomegaly • What is CEREBRAL MALARIA? – SX? • Seizures, loss of consciousness, often in kids – Subtype? • Falciparum • Transmission? – Anopheles Mosquito • Diagnosis? – Blood smear • Treatment? – Chloroquine – Vivax and Ovale: PRIMaquine is the PRIME drug to kill liver dormant forms – Sulfadoxine +Pyrimethamine, mefloquine, Quinine

Entamoeba Histolytica • Sx? – Bloody diarrhea (invades mucosa!), Liver abscess (invades portal vasculature), RUQ pain. • Transmission? – Cysts in water—fecal/oral • Diagnosis? – Serology, trophozoites/cysts in stool, RBC’s in cytoplasm of ameoba. • Treatment? – Metronidazole, iodoquinol

Toxoplasma Gondii • Sx? – Brain Abscess with Ring Enhancing Lesion in AIDS pts – Birth Defects (T in TORCH) – Generally toxic to brain and eyes • Transmission? – Cysts in meat or cat poo—pregnant ladies stay away from cats! • Diagnosis? – Serology, biopsy • Treatment? – Sulfadiazine, Pyrimethamine

Cryptosporidium • Sx? – Severe Diarrhea in AIDS, Mild diarrhea in nonimmunocompromised folks • Transmission? – Cysts in water—round oocyst with 4 sporozoites • Diagnosis? – Cysts on acid-fast stain (Acid Fast Stain) • Treatment? – None? Bad news for those with AIDS. Can try nitazoxanide…

Naegleria Fowleri • Sx? – Rapidly (1 week) fatal maningoencephalitis. Fever, HA, stiff neck, N/V • Transmission? – Swimming in freshwater lakes (ameoba enters through cribriform plate) • Diagnosis? – Ameobas in spinal fluid • Treatment? – Two only two people who ever lived got amphotericin B