Sketchy Parasites
Leishmania braziliensis and donovani
Desert Mania protozoa of the blood mediterranean, middle east, and africa zombie: host is vertebrates, especially humans Brazil flag on belt: cutaenous leishmaniasis, caused by braziliensis flesh eating zombie: consume flesh, causes ulcers flies: sand flies are vector goat in cage: transmission promastigote (infective form of parasite), becomes amastigote in macrophage spots on goats: diagnosis: aspirates from marrow, spleen, lymph nodes, or skin lesions donavan: visceral leishmaniasis caused by donovani black spots: black fever, kala-azar offerings of partially eaten meat: pancytopenia, deficiency of RBC, WBC, and platelets cow spots: liver and spleen, hepatospenomegaly fever, weakness t bone steak: stibugluconate treatment for cutaneous frogs: visceral treated with amphotericin b
Entamoeba histolytica
Entering the Historical Dig GI protozoa Do not ENTer HISTorical site: entamoeba histolytica bubbles: cyst form archeologist drinking contaminated water: infectious when ingested from contaminated water two guys holding hands: associated with men who have sex with men, anal oral transmission cyst form in GI tract differentiate into trophozoites which invade colon and spread via portal circulation to the liver shape of dig: liver, right lobe is most common site for amoebic liver abscesses man touching quadrant: right upper quadrant pain, large and tender livers anchovy paste truck: abscess consistency and smell of anchovy paste drainage pipe with rust: ulcerations in colon, erlenmeyer flask shaped red stool: invasive, bloody diarrhea OP on pipe: stool O&P puddle: presence of trophozoite with endocytosed RBC's ELISA antigen test on stool or serum treatment: metro: metronidazole eliminate cysts, luminal agents: pair of mice: paramycin Queen Iodos Tomb: iodoquinol do not operate on liver abscess, don't need to surgically drain it
Giardia lamblia
Giardia Jungle Ride bubbles: drink unfiltered water that has cysts poop: fecal oral transmission, poorly purified drinking water backpacks: association with campers and hikers campers holding noses: flatulence, foul smelling diarrhea, bloating man on yellow stool: steatorrhea life rafts: differentiates into trophozoite form, ventral sucking discs and flagella attach but do not invade the intestinal wall some life rafts in water: finding trophozoites in stool is diagnostic OP shirt: Stool O&P is diagnostic test ELISA boat: ELISA stool antigen test treatment: monorail: metranidazole
toxoplasma gondii
OH HI, IZ MAKIN SUM TOXO prtozoa of cns pregnant woman: important to pregnant and immunocompromised intracellular parasitic protozoan, 30% of world's population carries it transmitted by consumption of raw or undercooked meat that contains toxo tissue cysts water or vegetables with oocysts shed in feces of infected animals through placenta from mother to fetus, TORCH lady changing litter box: pregnant woman should not change kitty litter boxes, cat feces cat with cane: immunocompromised multi lens glasses: brain abscesses, ring enhancing lesions on CT or MRI red turban: encephalitis pin: brain biopsy to differentiate from CNS lymphoma pushing bowl of bubbly meat: cysts in undercooked meat flu like symptoms in healthy people, usually asymptomatic statue of liberty cat: congenital toxoplasmosis kittens drinking milk: congenital disease milk on the head: intracranial calcifications bowl on head: hydrocephalus, seizures camera bulb: chorioretinitis, HIV patients also get this beethoven cat: deafness serology or biopsy looking for intramuscular cysts positive serology does not indicate active infection treatment of active: dyed rotten eggs: sulfadiazine pyramid shapes: pyrimethamine benjamin franklin on 100 dollar bill: CD4 counts less than 100, IgG positive for toxo key to kite: key is IgG, kite has positive sign sulfur egg: prophylaxis is TMP-SMX (trimethoprim, sulfamethoxazole)
trypanosoma brucei
Prince Bruce to the Rescue gambiense rhodesiense sleeping princess: sleeping sickness, coma fly in tea: Tsetse fly is the vector africa map: wester and southeastern africa pearls and ruffles: parasites move from blood to lymph nodes, cervical and axillary lymphadenopathy rolling hills: undulating, recurrent fever trickle of blood from finger with goat: trypomastigotes seen in blood smear multicolored tent: variable surface glycoproteins, antigenic variation, evade immune system and enabling chronic infection single pink ribbon: motile with single flagella bar of soap: melarsoprol treatment, CNS infection serum: suramin treatment, peripheral blood infection
Dracunculus medinensis, wuchereria bancrofti, onchocerca volvulus, toxocara canis, loa loa
Screamatodes III: Return of the Flesh Eaters dracula: dracunculus medinesis -drinking: drinking contaminated water that has copepods with larvae -paper cups: copepods are intermediate host -red shoelace: parasitic larvae penetrate intestinal wall when copepods die, mature, females migrate to surface of skin, lower extremities, and you get a painful skin ulcer -shoelace around water cooler: slowly extract worm with small stick over period of days -metronidazole will make process go faster -eosinophil boy: peripheral eosinophilia fly man: onchocerca volvulus -black flies found around rivers in africa, central and south america -deposits larvae into skin, mature into adults -adults produce microfilaria, migrate throughout body -stains on pants: scattered puritic papules, later become hyper or hypopigmented -human hand covering eyes: microfilaria in eyeball=blindness, river blindness -eosinophilia -microscope: diagnosis is microfilaria in skin biopsy under microscope -river: ivermectin Witch: wuchereria bancrofti -baggy pants: elephantiasis: long standing lymphedema -ruffled shirt: lymphadenopathy -coughing: microfilariae in lungs -mosquitoes: mosquito is intermediate host, deposit larvae on skin -blood on hat: thick blood smear to see organisms -eosinophilia -diet carb magazine: diethylcarbamazine Wolf man: toxocara canis -poop bag: contamination of food with dog or cat feces or wolf feces -parasitic larvae in human, never mature out of larvae, circulate in body for years, visceral larvae migrans -sleeping eye mask: ocular larvae migrans (blindness) -eosinophilia -bending wires: albendazole swamp creature from loa loa lagoon: loa loa -transient angioedema -lumps on arms and legs: local subcutaneous swellings -adult worm can migrate to eye, see beneath the conjunctiva, African eye worm -blood on face: diagnosis is blood smear with microfilariae -flies: transmitted by deer flies -eosinophilia -diet carb magazine: diethylcarbamazine -bending chair: albendazole
enterobius vermicularis, ancylostoma duodenale, necator americanus, ascaris lumbricoides, strongyloides stercoralis, trichinella spiralis
Super Worms! helminths roundworms nematodes vermin lady: enterobius vermicularis, pinworm -hole and rocks: anus, at night the female worms -migrate here and lay their eggs -baby rats: fecal oral route -really really itchy, will infect themselves over and over again, common in children -long cape with rocks: diagnose: scotch tape on -anus in morning, eggs will stick to it treatment: -PAM superhero: pyrantel pamoate -metal bent bars: albendazole American Dude ankle and neck: ancyclostoma duodenale and necator americanus -hook: hookworms found in rural southern united states -boots: walk barefoot, larvae penetrate skin of soles of feet, in bloodstream go to lungs and ascend bronchiole tree, get coughed up and swallowed, mature into adults in small intestine -iron dangling: attach to gut wall and feed from capillaries in intestinal villi, develop severe iron deficiency anemia -grenades in water: eggs in the stool -Eosinoboy: eosinophilia, pink granules and bilobed nuclei -treatment: pyrantel pamoate and albendazole Tree man: ascaris lumbricoides, giant round worm -eating eggs in contaminated food or water, hatch in small intestines, larvae goes into gut wall and blood stream, goes to lungs into capillaries and alveoli, ascend into bronchus and then swallowed back down again, mature into adults in intestine -no boots: doesn't enter through feet -leaf on chest: malnutrion, most likely to cause respiratory symptoms -blocking tunnel: intestinal obstruction at ileocecal valve -acorns in puddle: eggs in feces, high eosinophil count -treatment: -bent bars: albendzole, cause microtubule disfunction making worms immobile -don't give microtubule inhibitors to pregnant women Strong Guy: strongyloides stercoralis -boots: penetrate through skin on soles of feet -same mechanism as American Dude -kicking wall: auto infects host: lays eggs into intestinal wall -worms out of wall: diagnosis: eggs laid into intestinal wall, won't be in stool, only larvae will be in the stool -treatment: albendazole -river: ivermectin spiral Porky Trickster: trichinella spiralis -pig: find in undercooked meat such as pork or bear -glasses and green drool: ever, vomiting, paraorbital edema -red pipes and lined wall: ingest cysts, develop into larvae, enter bloodstream and form cysts within striated muscle cells -explosion in wall: muscle inflammation, severe myalgia -treatment: albendazole
Cryptosporidium spp.
Tales from the Crypt GI protozoa severe diarrhea, most commonly identified in HIV patients with diarrhea cane: HIV brown water: watery diarrhea unicellular, partially acid fast organisms, complete entire life cycle in one organism, create oocyst that are released in feces cowboy hat: acid-fast campers, people who work with animals, at risk, fecal oral route bubbles: infectious cysts passed through stool amethyst: purple gems floating histology look, cyst composed of 4 motile sporozoites small pipe: attach to intestinal wall, usually associated with small intestine treatment: knitted sock: nitazoxanide water dripping from sock: filtration can remove oocysts from infected water spirit crows: spiramycin/ not FDA approved in the US
cestodes
cestode county carnival tapeworm tents: taenia genus undercooked meat, GI problems Sun and sold tent: T. solium pig: get from undercooked pork meat hooks: hooks on proglottid heads seen on O&P sagging tent: T. saginata cattle: intermediate host is undercooked beef circus carousel: neurocysticercosis all cows and pigs: people ingest taenia eggs in water contaminated by animal feces cheese stand girl: taenia eggs go to brain and form cystic brain lesions, hydrocephalis, looks like swiss cheese on head CT, seizures immigrant or farmer ingesting cysts or larvae gives you taenisis, GI problems, malabsorption ingesting eggs: cysticercosis pretzel stand: treat with praziquantel bending bar: albendazole for neurocysticercosis bathroom: diphyllobothrium guy running to bathroom with fish: fish tape worm, eating undercooked fish must b 12 to buy fireworks: B12 deficiency, megaloblastic anemia cobalt blue: another name for B12 is cobalamin red fireworks: megaloblastic anemia toilet paper on shoe: largest tapeworm, can be 10 meters long toilet paper in mud: proglottid segments seen in stool O&P pretzel: praziquantel coin box, nickel: niclosamide cocker spaniel: echinococcus granulosus sheep dog: dogs are definitive hosts, sheep are intermediate host humans are incidental host poop: eggs in dog feces cup with broken egg in it, blue place ribbon: hydatid cysts, slow growing tumor, egg shell calcifications on CT ruptured cyst: anaphylactic reaction and acute abdomen taking ribbon off second place: inject cyst with ethanol or hypertonic saline to kill cells before removal eosinophilia
Trypanosoma cruzi
cruzin' through che's gas protozoa of blood parasitic protozoan located in central and south america Che's gas: chagas disease feeds on blood and lymph kissing girlfriend: kissing bug, vector's feces get into open wound, bites often found around the mouth bugs: reduviid, kissing bug 10 to 20 years after inoculation you get chagas large intestine line: megacolon, extreme constipation, acute abdomen from already perforated colon backpack: dilated cardiomyopathy snake recently fed: mega-esophagus leaking gas: diagnosed by blood smear bug on heart: trypanosomes may be seen within cardiac mycocytes on a heart biopsy mole: burrows into endocardium furry moccasins: nifurtimox treatment no treatment for chronic chagas
Naegleria fowleri
naegleria falls protozoa of cns freshwater lakes cribs: enters CNS via cribiform plate neck brace and red turban: causes meningoencephalitis, nuchal rigidity and fever, altered mental status primary amoebic meningoencephalitis dead man: rapidly fatal windsurfing dude: association with water sports water bottles, can contaminate water supplies, nasal irrigation solutions and contact solutions champagne bottle with corkscrew: diagnosed by lumbar puncture, look at CSF you will see amoebas champagne tap: no red blood cells in CSF tap fluid treatment: frogs: amphotericin
trematodes
san franschisto ocean park helminths flatworms shistosoma free living cercariae that penetrate skin in aquatic environment and enter bloodstream mature in liver adults lay eggs in humans, we poop and pee in water snails are intermediate host swimmers at risk red fish going opposite direction: adult worms migrate against portal flow to venous destination merman: shistosoma mansoni long red fish: large lateral spine swimmer's itch: larvae penetrate the skin crack port hole: portal hypertension, GI hemorrhage, cirrhosis, abdominal pain yellow coat: jaundice japanese tourists: schistosoma japonicum round fish: small round spine swimmer's itch: larvae penetrate the skin crack port hole: portal hypertension, GI hemorrhage, cirrhosis, abdominal pain yellow coat: jaundice schistosoma haematobium swimmer's itch: larvae penetrate the skin red swordfish: large terminal spine migration against portal venous flow piercing jellyfish: hematuria piercing crab: bladder cancer treatment for all trematodes pretzel: praziquantel orcha: clonorchis sinensis snails are intermediate host snail host to fish that we eat uncooked cyst and larvae in uncooked fish will mature and reside in biliary system rope off of sea gull: biliary track fibrosis sea gull on rocks: pigmented gall stones crab on rope: cholangiocarcinoma sea gull cracked eggs in water: operculated eggs on O&P pretzel: praziquantel snail: intermediate host penguins: paragonimus westermani white lung spots: chronic cough with bloody sputum snail: intermediate host crab legs: consumption of raw or undercooked crab meat mature into adults and go to lung cracked penguin eggs: operculated eggs on O&P pretezel: praziquantel treatment
plasmodium malariae, ovale, vivax, and falciparum
the queens and warlords of plasmodium african wilderness plasmodium: malaria fever, headache, splenomegaly, headache box of gems: blood smear and GIMSA stain warlords: 4species plasmodium malariae: top and bottom red buttons: fever occurs on day one and then day 4 plasmodium vivax and ovale: ax: vivax oval shield: ovale pendulum: produce dormant forms in liver called hypnozoites cow hid with spot: hypnozoites in hepatocytes every other red circle of pendulum swing: fever on first day and third day plasmodium falciparum: false mask: most severe torn shirt: irregular fever red head dress, cerebral malaria, neurologic systems gold belt: parasitized RBC's occlud vessels to kidneys gold plate: parasitized RBC's occlude vessels to lungs headress: banana shaped in peripheral blood smear anti-malarial drugs end in quin queens: quin drugs color queen: chloroquine beads: blocking polymerase not much help when hypnotized lots of resistance built up primal queen: primaquine gets hypnozoites be weary of people with G6PD deficiency you can cause severe anemia me fly queen: mefloquine palanquin: extra strong and good against resistant species luggage on palanquin: good prophylactic medication, travelers palaquin: good for resistant strains queen atova: atovaquone used with proguanil is good anti malarial treatment and prophylactic iguana: proguanil luggage: use for travelers, prophylactic artist: use artemisins for severe p. falciparum infections painting queen atova and iguana: can also treat with atovaquone and proguanil sickle: sickle cell disease is protective against p. falciparum other artist facing away: IV artesunate for severe malaria infections dining queen: quinidine palaquin: used against resistant species tin cans: cinchonism, headaches and tinnitis Ivy: IV artesunate and quinidine are IV delivery red mushroom: malaria transmitted by anopheles mosquito that carries sporozoites in saliva cow: sporozoites mature to trophozoites in liver of host burst cow spot: schizont divides into merozoites which burst from hepatocytes and infect RBC's life cycle continues in RBC: trophozoite to schizont to merozoites, infect more RBC's cow spot: immature schizont has ring shape in RBC male and female in cow: merozoite can also form gametocytes in RBC's mosquito picks up gametocytes from host, can go and infect others
babesia spp.
the vampire babes parasitic protozoa 45 to 50% of patients have mild cases severe: malaria like symptoms red stain glass windows cracked: hemolytic anemia hemoglobinuria yellow dress: jaundice shield with antlers: ixodes tick, deer tick: vector 25% of people in Rhode Island are serum positive for babesia Robin of Ixodes meal: ixodes tick, lyme disease robin sweat: fever torn shirt: irregularly cycling fevers vampire queen holding sickle: higher risk of severe disease in sickle cell disease hole in tunic: asplenia, higher risk thick red carpet: diagnose through blood smear cross on carpet: appearance of affected red blood cell, maltese cross NE direction: US northeast with borellia Queen atova: atovaquone crow: azithromycin
trichomonas vaginalis
tricks for money protozoa other tissue strawberry out of hat: cervicitis inflammation, speculum reveals super red inflamed "strawberry cervix" burning fire and homeless lady: burning, itching, malodorus yellow-green discharge green light and water: yellow green discharge moving car: diagnosed from wet mount, motile trophozoites puddles: trophozoites street artist, 4.5 and up: pH of vaginal fluid is 4.5 or higher, more basic, with infection kissing couple: sexually transmitted, treat both partners metro: metronidazole