Types Class Mollucutes, family Mycoplasmataceae, genera Mycoplasma and Ureaplasma
Mycoplasma and Ureaplasma
Morphology No true cell wall (but Gram -) - highly pleomorphic (many shapes). ABC's will not work because they target the cell wall Highly developed outer membrane. Contains sterols (cholesterol-like) Smallest known organisms (filterable) that are capable of autonomous growth fastidious nutritional growth
Epidemiology
Virulence Factors
Diseases
Role in disease is "not clearly defined"
Attachment: adhesin P (base of cilia and epithelial and RBC surface)
MILD URI/pharyngitis
No seasonality
cause ciliostasis --> persistant caugh
Acute tracheobronchitis
Spread via nasal secretions/ aerosolized droplets. Close contact.
Also binds to neuramic acid
STD??
faculative anaerobes produce hydrogen peroxide Small like viruses, replicate like bacteria
Is a superantigen Produces hydrogen peroxide and inhibits host catalase (which breaks down h2o2) incomplete immunity
Prevention/ Treatment No cell wall therefore, resistant to penicillins, cephalosporins, vancomycin
"Walking pneumonia", "Eaton's agent" pneumona Erythema multiforme Stevens-Johnson Syndrome OM Hemolytic anemia Meningitis, pericarditis KI stones Urethritis Urethritis
3 types:
Enveloped virus - wash your hands! Destroyed with soaps
Epidemic --> antigenic drift. Small mutations. Will re-infect every 2-3 years
1) Influenzae A: epidemics, pandemics, bird reservoirs (ducks, chickens)
ssRNA genome in 8 segments: facilitates rearrangement
Pandemic --> antigenic shift. Only in influenzae Neuramidase - allows spread through A, major recombinations. Every 10 years. mucous membranes Also zoonoses - a new strain is formed that can first strain known to cross species be spread to humans barrier from chicken to human - H5N1 Limited viremia - very rarely spread Transmission - respiratory droplets beyond lung Ab mediated response (anti HA Abs) Flu season: winder months Oct-Dec, only 4-6 protect against re-infection from that weeks particular strain only. Th1 response and INF are key Sx's depend on T cell response, IFN (interferon) response (liberated from Vitamin D and epidemic influenza damaged cells, responsible for classic flu symptoms)
2) Influenzae B: stomach flue Orthomyxoviridae
Picornaviridae
Haemagglutinin
3) Influenzae C
One of the largest families: Includes enteroviruses (HAV, Coxsackie virus, Naked capsid virus polio virus, echo virus) and rhinovirus Enterovirus - stable at pH3-9.
Influenzae A
Never give aspirin!
Influenzae B
Reduce contact with infected individuals
Secondary Bacterial pneumonia
Natural immunity is longer than vaccine
Reye Syndrome
Vitamin D
Damage is direct to viral pytopathology NOT immunopathology
Rhinovirus --> labile at acidic pH, optimal growth is 33C (nose is cooler) Rarely cause GI disease but fecal-oral spread
Enterovirus
Range from cold-like symptoms to paralytic disease Coxsackie and echo virus --> also respiratory spread
Echo/Coxsackie viruses --> relatively wide tropism Polio virus --> narrow tissue tropism. Anterior horn cells of spinal cord. 1st Replication tonsils/pharynzx of PP Second replication - iff tissues carry specific receptors Stomach acid, protease and bile do NOT kill virus Immune protection is from Abs
wash hands!
Encephalopathy
Asymptomatic Abortive Non-paralytic poliomyelitis Paralytic Post polio syndrome (PPS)
Coxsackie A --> usually vesicular lesions
Herpangina
Coxsackie B --> myocarditis, pleurodynia Coxsackie/ Echovirus
Hand-foot-mouth disease
Type of enterovirus
Acute hemorrhagic conjunctivitis
two types of polio vaccine: 1) IPV: (Jonas Salk - 1956) -> inactivated virus (safer but parenteral so no mucosal immunity) 2) OPV (Albert Sabin -1962) -> live attenuated virues (oral polio vaccine)
Pleurodynia (Bornholm's disease) Myocarditis/ Pericarditis IDDM Aseptic meningitis over 100 serotypes - can get common cold more than once!
MC common cause (>50%) of the common cold Gradual antigenic drift (like influenza A)
Common cold - coryza
Spread via aerosolized nasal droplets, fomites, Infection by as little as 1 infectious hands (#1) particle Can't grow in acid of stomach (unlike enteroviruses) and also grows best at 33 C (cooler in nasal mucosa)
Rhinovirus
bing ICAM-1
"deliberate exposure of "volunteers" to wet and only transient immunity cold does not cause colds - VIT D!
Alphaviruses -> arboviruses Enveloped, linear ssrnA (arthropod borne), similar antigenicity Pestivirus and Arterivirus --> no human pathogens Togavirus and Flaviviruses
Rubivirus --> german measles Flavivirus -> Hep B, Hep C
Ab in subsequent infections
Togavirus: replicate in cytoplasm, bud CMI - DTH (class IV), ab/ag complexes female mosquitoe bites another vertebrate host at plasma membrane can affect vasculature Fc receptor (phagocytes) - internalizes zoonoses virus more vectors -> mosquitoes
similar pathogenesis and epidemiology
Reservoirs -> "immunologically naïve" birds
cause lytic infections in vertebrate hosts
Humans - dead end hosts
enveloped
one of the most deadly viral diseases - 100% mortality
Flu-like syndromes
No vaccine for Dengue fever
Meningitis/ encephalitis Hepatitis, hemorrhagic fever, shock, viral arthritis Yellow Fever Dengue (break bone) Fever Dengue hemorrhagic shock syndrome
puddles, ditches, artificial ponds, toys, trash cans In infected areas only <1% of mosquitoes are infected and <1% of people bitten by infected mosquito get serious health effects Vector is culex pipens - larvae can overwinter No person to person transmission - possibly breast feeding, blood products, organ transplants, prenatal main reservoir is corvid birds - sparrows? Immunity - not sure
West Nile Virus
Rhabdovirus
Female mosquitoe takes blood meal from vertebrate host
Hand washing/ disinfect contaminated surfaces Chicken soup - "the jewish penicillin" Zinc: important for immune systen (IFN), decrease inflamm, decrease virual attachment to nasal mucosa, inhibit viral replication, Zn fingers and Ab sysnthesis and many other fxns works better if Zn deficient - zinc talley test ABCs - useless in primary infection. Flu and cold are caused by viruses NOT bacteria.
West Nile
Supportive only regular mosquito protection Remove outside water containers
Attach to nicotinic Ach ganglioside recetors at muscle/…
Rabies
Aggressive post-exposure prophylaxis is only hope for overturning clinical illness
zoonoses. MC bite of rabid dog (also cats, foxes, raccoons, coyotes, skinks, bats). Body fluids
wound management
Does not penetrate intact mucosal membranes
immunization
Respiratory Enteric Orphan Viruses Reoviridae
Antigenic shift like Influenza A
Includes: Orbiviruses, Coltiviruses (Colorado Tick fever), Orthoreoviruses Non-enveloped (asymptomatic infections) Rotavirus - #1 cause of infant diarrhea Enveloped virus-like properties worldwide
Rotavirus
spread is fecal-oral. Respiratory?
very contageous
Abs from mothers colostrum/milk (IgGs) --> only prevents infection for 6 months
Like cholera toxin (NSP4 protein)
furniture, fomites, toys, hands
Antigenic shift (like influenza)
MC tick borne viral disease in the USA (compare to Lyme disease and RMSF) vector --> wood tick (Dermacenter andersoni); reservoir --> squirrels/ chipmunks. Hosts are humans. Western/NW USA and Canada - sping/ summer/ autumn unlike other tick diseases, coltivirus must enter the bloodstream quickly - must remove ticks quick!
Infects RBC precursors. Survives in mature RBCs
Gastroenteritis
Bovine colostrum
watery diarrhea --> severe dehydration
Coltivirus
Poxviridae
Scrapies-like agent
Adenovirus
Human papilloma virus (HPV)
Probiotics
Orthopoxvirus: Variola (smallpox)
one of the largest, most complex viruses
Last reported case --> Oct 1977 in Merca, Southern Somalia
Mollscipoxvirus: Molluscum contagiosum
double layered envelope
considered bioterrist threat
Colorado Tick fever
No treatment. Prevention - same as for other tick borne diseases
Smallpox
Smallpox Vaccine: live vaccinia (modified copox). Side effects: vaccinia necrosum.
leakage --> hemorrhage --> hypotension --> shock
Ecthyma contagiousum (Orf)
Unlike other viruses - pox viruses Kills only 30%. Is very infectious. Aerosol contain all the necessary information stable, small infectious dose. Immunologically for their own DNA and RNA synthesis naïve population. No effective treatment
Molluscum contagiousum
Molluscum contagiosum and other pox viruses are zoonoses - STD, fomites, wrestling, rugby Orf - occupational hazard for sheep/ goat farmers. prions (proteinaceous infectious Transmissible neruogenerative disease to a very closely associated with normal sporadic Creutzfeld-Jakob disease, particles) variety of mammals human protein PrPc variant CJD filterable (size of viruses) but no DNA Some variation of PrPc that might be Sporatic Creutzfeld Jakob disease or RNA actual infective agent get aggregates of protease resistant Creutzfeld-Jacob disease - variant very resistant hydrophobic glycoproteins in plaques/ form fibrils in CNS bind same glycoprotein Ig family naked capsid virus = stable isolated from himan edenoid cell culture Pharyngitis receptor as Coxsackie B virus Spread fecal-oral, poorly chlorinated swimming Used as a vector for gene therapy Atypical pneumonia pools help stimulate bone growth Cause: lutic infections, latent infections, only human to human spread conjunctivitis transforming infections Most infections are asymptomatic Gastroenteritis Genus: papilloma a) cutaneous: verucca (warts) b) mucosa: genital, Naked capsid virus oral, conjunctival papillomas, cervical CA
Supportive treatment only. There is a vaccine.
Through breaks in skin and mucosa
cause lytic, chronic, latent or transforming infections
transformation occurs bc proteins transferred by fomites - direct contact into small bound by HPV16&18 bind tumor breaks in skin/ mucosa suppressor molecules Also infected birth canal (STD transmission)
Common glat wart (verruca plana or verucca vulgaris)
Oral papillomas Laryngeal papillomas Condyloma acuminata (anogenital warts) Cervical dysplasia and cervical CA
Gene replacement therapy vectors for treating CF…
PARASITIC INFECTIONS Protozoans: ameoba (= change). 2 stage lifecycle: 1) trophozoite (Active/infectious stage) 2) cyst stage. MC fecal-oral transmission. Sanitation KEY.
LAB DX: culture is not important (unlike bacteria). Need to know lifecycles - know where and when to sample. Stool samples.
Usually organisms are acquired over time chronic infections
Repeated exposure
Difficult because eukaryotes (like fungi). Multiple develepmental stages
Not highly virulent
Immunopathology - can cause all 4 types of hypersensitivity Exposure/entry: MC'ly exogenous. Compromised skin integrity. Exception is toxoplasma - can enter transplacentally Large inoculum size. Exception is malaria. Adherence: non-specific (e.g. Giardia). Specific (e.g. E. histolytica)
MSM - men having sex with men
Entaemoeba histolytica
Endemic in the US
Temperature specific replication toxins: not nearly as toxic as bacterial toxins Helminths: damage is due solely to size, movement and longevity/ persistence Evade host immune system for disease process to be maintained ST acid induces change to pathogenic trophozoite Destroyed by ambient O2 levels infect blood/ tissues
•microbe present in cat feces fecal-oral spread 1) improperly cooked contaminated meat/ meat juices 2) contaminated soil 3) contaminated cat feces
Toxoplasma gondii
Waterborne- resistant to usual water purification (MC) Fecal- oral Oral-anal: MSM (Flagship in AIDS) Worldwide sylvatic (wilderness): Beavers and muskrats are local reservoirs contaminated water: resist chlorination (unlike Entamoeba but like Cryptosporidia) person to person spread via fecal-oral or oralanal practices
Flagellated protozoa: unlike amoeba, move by flagella Giardia lamblia
Trichomonas vaginalis Roundworms!
Flagellated
Urogenital protozoan
MC protozoal disease in developed nations
Monomorphic- no cyst stage
Worldwide STD M/C helminthic infection worldwide
Ascaris lumbricoides Nematodes pinworms Enterobius vermicularis Hookworm
Pregnant women: avoid undercooked meat, wear heterophile negative mononucleosis gloves when gardening, avoid like syndrome exposure to cat feces
congenital disease
Cryptosporidosis
ST acid induces changes to trophozoites
"beaver fever"
Prevention: Concentrated chlorine/ filtration
safe water practices when wilderness travelling
Very rarely spread beyond the GIT no tissue necrosis Trichomonas Eggs are very hardy Ingested infected egg - develops into larval worm that penetrates duodenal wall
Fecal-oral
hatch in SI to become infective
auto-inoculation
Characteristic egg shape: flattened on one side proliferates and then is coughed up and swallowed
Transmission is direct contact with contaminated soil or ingestion
killed by oxygen in the environment - ozone treatment?
chorioretinitis
Worldwide zoonotic Cryptosporidium parvum
Amebiasis
Bowel obstruction/appendicitis
tx. Ascaris first
Pneumonitis Pinworm clinical disease
Hookworm clinical disease
Necator americanus Wucheria bancrofti Filariasis
bite from infected mosquitoe: migrate to lymphatics
Lymphatenitis
chronic symptoms are due to: physical blockage of lymphatic vessels
Elephantiasis
mosquitoe control
Can live in pork Trichinella spiralis
rarely symptomatic - M/C’ly only aware of infection when seen in feces Insufficiently cooked pork - characteristic proglottid structure Cestodes (Tapeworms)
Larvae (infectious); live in striated muscle Ingest infected meat (encysted larvae, 2 day incubation --> enter many different new muscle sites infectious when ingested by new host
T. spirales clinical syndrome
cook pork/ polar bear until interior is gray
cook pork/ polar bear until interior is gray
suckers and crown of hooklets All are hermaphroditic No digestive system ingests pork muscle containing a larval worm (cystericercus)
Human infection with larval stage of T. appearance of calcified cysticerci in solium soft tissue
fecal-oral transmission
Cisterocercosis
Iff viable larvae: host reaction is minimal Iff death of larvae: release increased Ag material. marked inflammatory reaction
M/C’ ly fecal- oral transmission but also autoinfection cook beef fully control disposal of human feces
insufficiently cooked beef Will not cause Cisterocercosis (unlike T. solium)
Taenia sanginata
one the M/C cestode infections in the USA Adult tapeworms are ingested by humans in rare/ insufficiently cooked beef Diphyllobothrum latum
Fish tapeworm
raw, undercooked, fresh water fish containing ribbon-like larval worm (sporganum) in flesh
one of the longest tapeworms
Increased risk with dumping raw sewage in to fresh water lakes obligate intravascular parasites
Schistosomes
skin penetrating cercariae liberated from snails
Clinical disease
develop in intrahepatic portal system or in vesical, prostatic, rectal and uterine plexuses and veins Host response to eggs: intense, inflammatory reaction Larvae inside eggs produce enzymes; aide in tissue destruction
Shitstomiasis
avoid ingestion of insufficiently cooked fish
Microbe
System
1
Mycoplasma pneumonia
Respiratory
2
Mycoplasma pneumonia
Respiratory
3
Mycoplasma pneumonia
Respiratory
4
Mycoplasma pneumonia
Skin
5 6 7 8 9 10
Mycoplasma pneumonia Mycoplasma pneumonia Mycoplasma pneumonia Mycoplasma pneumonia Ureaplasm urealyticum Ureaplasm urealyticum
Skin Ear Hematopoetic Systemic Urinary Urinary
11
Mycoplasma hominis
Urinary
12
Orthomyxoviridae
Respiratory
13 14 15 16 17 18 19
Orthomyxoviridae Orthomyxoviridae Orthomyxoviridae Orthomyxoviridae Polio Polio Polio
Respiratory Respiratory Systemic Systemic
20
Polio
Muscular / Neural
21
Polio
Muscular
22
Coxsackie A
Mouth
23
Coxsackie A
Skin
24
Coxsackie A
Eye
25
Coxsackie B
Respiratory
26
Coxsackie B
Cardiac
27 28
Coxsackie B Coxsackie B (echo and entero)
Condition MILD URI/pharyngitis
Signs and Symptoms Symptoms similar to RSV, group A strep
DDX and Lab Dx Most difficult pathogenic organisms to grow (fastidious growth). "Fried egg colonies". Cold agglytination
34
Acute tracheobronchitis Persistant dry cough that might become paroxysmal "Walking pneumonia", "Eaton's agent" Prolonged, mild form of pneumonia. Initial symptoms "non specific". Increases C XRAY before symptoms felt pneumona in severity over a few days. Hypersensitivity syndrome (vasculitis). Bulls-eye lesions, associated with Erythema multiforme HSV. Stevens-Johnson Syndrome Severe, sometimes fatal, bullous form of erythema multiforme OM Common Hemolytic anemia auto-immune destruction of RBCs Meningitis, pericarditis KI stones Produce urease Urethritis no progression to PID (non gonococcal). Might be asymptomatic can lead to pyelonephritis or to PID. Colonization increases with sexual Urethritis activity Usually symptomology and community Abrupt onset of fever (38-41C for 1-5 days). Non-productive cough, severe Influenzae A history of outbreak is enough for myalgia, rhinorrhea, anorexia diagnosis Influenzae B Milder, more GI symptoms Secondary Bacterial pneumonia In young children Encephalopathy Reye Syndrome Linked to ASA Asymptomatic Most common (90%). Limited to oropharynx and GIT. Abortive non-specific febrile illness. Non-paralytic poliomyelitis Symptoms of abortive poliomyelitis as well as aseptic meningitis Spinal paralytic: asymmetric flaccid paralysis in one or more limbs, no sensory Paralytic loss. Bulbar: affect cranial nerves or medullary respiratory center (75% mortality) Deterioration of affected muscles (or previously non-affected muscles) later in Post polio syndrome (PPS) life (10-40 years later) without presence of virus. Enterovirus lab dx: CPEs on monkey Coxsackie A and echovirus (not Hsv). No external skin lesions --> unlike Herpangina KI tissue culture. RT-PCR in CSF/ hand-foot-mouth disease. Self limiting. White lesions inside mouth other fluids. Caused by Cosdackie A16. Mild febrile disease with vesicular lesions on Hand-foot-mouth disease hands, foot, tongue Acute hemorrhagic conjunctivitis Extremely contagious "devil's grip" --> severe pleuritis chest pain --> unilateral intercostal myalgia -Pleurodynia (Bornholm's disease) > "stich-like pain" MC in adult males. Mistaken for MI. Children - sudden unexplained heart Myocarditis/ Pericarditis failure IDDM possible link if Cosxsackie B infects pancreas Aseptic meningitis # 1 cause is echo virus Lab not necessary. Characteristic rhinorrhead (clear, waterty -> purulent/ mucoid iff secondard bacterial Common cold - coryza CPE in himan diploid fibroblast cells at infection) 33C and acid labile Flu-like syndromes Serology: problem: false +, RT-PCR Meningitis/ encephalitis West nile Hepatitis, hemorrhagic fever, shock, Dengue fever/yellow fever viral arthritis Jungle fever, Aedes aegypti mosquito. Not contagious - no person to person Yellow Fever spread. 3-6 days incubation, then organ pathology. Jaundice, haemorrhage, encephalitis is rare. Dengue (break bone) Fever Aedes aegypti mosquito. Primary infection --> bone pain.
35
Dengue hemorrhagic shock syndrome Hypersensitivity reactions --> weaken, rupture vasculature. No bone pain.
Systemic Systemic
29
Rhinovirus
Respiratory
30 31
Alpha/Flavivirus Alpha/Flavivirus
Respiratory Systemic
32
Alpha/Flavivirus
Systemic
33
Alpha/Flavivirus
Systemic
36
West Nile Virus
West Nile
37
Rhabdovirus
Systemic
Rabies
38
Rotavirus
GI
Gastroenteritis
39
Coltivirus
Systemic
Colorado Tick fever
most infections are mild or sub-clinical. Febrile disease of sudden onset. 1% chance of encephalitis. Long incubation phase: asymptomatic. Delay is important for treatment. Prodrome: retrograde axoplasmic flow and dorstal root ganglia. No detectable Abs. ..................Neurologic phase: travel to infect brain/encephalitis. Hydrophobia, aerophobia, hyperactivity, aggressiveness, "furius rabies" (death in 1 week). "Dumb rabies" - progress to death by cardiac ......Then back down to salivary glands (where is its spread) 48 hr incubation --> sudden onset of severe vomiting (progectile), watery diarrhea, fever, dehydration. Selt limiting. Not distinguishable from other types of gastroenteritis (Norwalk virus, bacterial) by signs and symptoms Fever (biphasic). Maculopapular/petechial rash (like RMSF). Hemorrhage --> hypotension --> shock (like dengue fever)
ELISA anti-WNV Once there is evidence of infection (symptoms or Abs) it is too late for effective intervention. Post mortem Negri bodies. Diagnosis via stool samples - looks like a wheel!
variola is inhaled (4-19 days asymptomatic and not contagious). Prodrome (24 days). Skin rash (most contagious) Think opaque fluid filled center with "belly button-like depression in center". Infectious until all scabs fall off. Unlike chicken pox, in smallpox all the lesions are at the same stage at the same time. Direct contact with sheep/goats, soil? Contagious pustular dermatitis. In immunocompromised. Fleshy, pearl-like umbilicated nodules with central caseous plug. Long incubation (up to 30 years) but rapidly fatal once symptomatic (MC only 1 year). Rapidly progressing dementia. Most common after age 70. Some genetic susceptibility. Young onset --> mean is 27 years of age. Psychiatric/ sensory symptoms. Dementia at final stage only - unlike sporatic CJD. Detect PrPSc in follicular dendritic cells (lymphoid tissue)
40
Poxviridae
Skin
Smallpox
41
Poxviridae
Skin
Ecthyma contagiousum (Orf)
42
Poxviridae
Skin
Molluscum contagiousum
43
Scrapies-like agent
Systemic
Sporatic Creutzfeld Jakob disease
44
Scrapies-like agent
Systemic
Creutzfeld-Jacob disease - variant form
45
Adenovirus
Respiratory
Pharyngitis
46 47 48
Adenovirus Adenovirus Adenovirus
Respiratory Eye GI
49
HPV
Skin
50
HPV
Oral
Atypical pneumonia conjunctivitis Gastroenteritis Common glat wart (verruca plana or verucca vulgaris) Oral papillomas
51
HPV
Oral
Laryngeal papillomas
HPV 6 and 11. STD, vaginal birth, or ?. Rarely regresses spontaneously. 2nd MC canver in women in USA. HPV 16 & 18. Need cofactors to progress to CA
52
HPV
Reproductive
Condyloma acuminata (anogenital warts)
53
HPV
Reproductive
Cervical dysplasia and cervical CA
54
Entaemoeba histolytica
GI
Amebiasis
55
Toxoplasma gondii
Systemic
56
Toxoplasma gondii
Eye
mild URI with fever, rhinorrhea and cough. #4 on viral respiratory diseases. #1: RSV, #2: parainfluenza #3: Rhinovirus
MC clinical only.
Characteristic skin lesions. Molluscum bodies on biopsy. Not cultivated in lab, no Abs producted, normal CT scan, normal MRI, abnormal EEG Strong lab and epidemiological evidence of link to BSE Similar to owl's eye inclusion body (in CMV). Increased CRP (unique to viruses --> similar to bacteria)
pertussis-like illness Associated with swimming pools, dust/ debris. 2nd only to rotaviruses as cause of acute gastroenteritis in children MC on hands and feet. Surface is studded with black dots. Plantar is painful because it grows on pressure points MC epithelial tumor in the larynx. Infected birth cana. Hoarseness or abnormal cry. HPV 6 & 11.
PAP smear - presence of Koilocytes. Topical 5% acetic acid.
Colitis with diarrhea and/ or many bloody stools. LV abscesses. Can have Stool examinations - multiple stool asymptomatic carriers. Failure to thrive in kids. samples (3-5). DDX UC, shigella
heterophile negative mononucleosis like syndrome chorioretinitis iff 2nd or 3rd trimester: microencephaly, chorioretinitis +/- blindness, anemia, jaundice, neurological signs (retardation, seizures, microencephaly, hearing loss). Can be asymptomatic at birth and develop disease months to years Microscopy of biopsy sample. later. One of the major cause of encephalitis in AIDS. One of the TORCH agents.
57
Toxoplasma gondii
Systemic
congenital disease
58
Cryptosporidium parvum
GI
Cryptosporidosis
59
Giardia lamblia
GI
"beaver fever"
1) Asymptomatic carriers- 50% 2) Symptomatic: range from mild diarrhea to severe mal-absorption DDX: Isospora belli in HIV/ AIDS syndromes. 1-4 week incubation and then sudden onset of: foul smelling, watery diarrhea, abdominal cramps, flatulence and steatorrhea
60
Trichomonas vaginalis
Genital
Trichomonas
1) Females: M/C’ly asymptomatic or profuse frothy vaginal discharge 2) Males: M/C’ly asymptomatic
61
Ascaris lumbricoides
GI
Bowel obstruction/appendicitis
62
Ascaris lumbricoides
Respiratory
Pneumonitis
63
Enterobius vermicularis
Skin
Pinworm clinical disease
64
Necator americanus
Hookworm clinical disease
65 66
Wucheria bancrofti Wucheria bancrofti
Lymphatenitis Elephantiasis
67
Trichinella spiralis
T. spirales clinical syndrome
68
Diphyllobothrum latum
Clinical disease
69
Schistosomes
Shitstomiasis
70 71 72 73 74 75 76
Iff immunocompromised (HIV/AIDS) --> Severe diarrhea
three consecutive stool samples: Un-concentrated (HIV/ AIDS) or concentrated (centrifuge, etc.)
Concentrated stool - knobby coated, bile stained, oval egg Adult worm in feces (20- 35 cm long) Asthma-like attack Iff allergic to worm secretions:Enterobiosis (oxyuriasis): severe pruritis skin reaction/ rash at site of entry. If progress to LU --> pneumonitis. Iff large amount of adult worms: microcytic hypochromic anemia
Anal swab/ tape with sticky surface, Rarely see eggs in stool Characteristic eggs in stool Nocturnal periodicity
Thickening/enlargement of tissues, esp extremities if many migrating --> splinter hemorrhages, persistent fever, GI distress, periorbital edema. Iff >1000 to 5000 larvae/ gm tissue - Can be lethal.
encysted larvae in implicated meat
low serum levels of Vitamin B12 --> megaloblastic anemia
bile stained, operculated egg with knob-like projection on posterior
Immediate and delayed hypersensitivity reactions. Katayama syndrome. Chronic stage: hepatosplenomegaly with portal HT and hematemesis. retained eggs cause extensive inflammation and scarring
Characteristic eggs in stool and urine
77 78 79 80