10 Parasites
Giardia
- backpack: Associated with campers
- poop in water: Fecal oral transmission
- cysts downstream: Transmitted by cysts
- water bottle: Transmitted through poorly filtered drinking water
- metro train: Metronidazole treatment
- Distinct trophozoite form seen on stool O&P
- ELISA boat: ELISA may be used for diagnosis
- yellow stool: Causes steatorrhea, or fatty stool (lactose intolerance due to border enzyme deficiency)
Entameoba Histolytica
- Do not enter, historical site: Entameoba histolytica
2 life cycles:
- cyst in water: Cyst form
- guy drinking: Cyst form infectious, ingested in contaminated waters
- holding hands: Associated with men who have sex with men. Found to be related to anal oral transmission
- Red cups in amoeba: trophozoites, invade colon and spread elsewhere
- liver map and tomb on right: Right lobe of liver is most common involved site of amoebic liver abscess
- guy with stomach pain: Right upper quadrant pain
- anchovy paste truck: Abscess described as having "anchovy past" consistency
- stains on wall: Intestinal amebiasis: ulcerations in colon
- red stool: Intestinal amebiasis: bloody diarrhea
- O&P: Diagnosis with stool O&P
- red cups: Trophozoites with endocytosed red blood cells under microscope, pseudopods looking
- flask: Intestinal biopsy may show flask-shaped lesions
- Metronidazole drug of choice treatment
- pair of mice: Paramycin - luminal agent to eliminate cysts
- queen iodus: Iodoquinol - luminal agent to eliminate cysts
Cryptosporidium
- cane: Severe diarrhea in HIV patients
- Cryptosporidium outbreaks have been associated with drinking water supplies, swimming pools, and recreational water facilities.
- bubbles: Infectious cysts passed through stool
- pipe: Sporozoites attach to intestinal wall, cause diarrhea and small intestine damage
- crystals: Cysts composed of 4 motile trophozoites
- cape: Stains acid fast
- knit a sock: Nitazoxanide treatment
- sock: Filtration can remove oocysts from water
- spirit bird: Spiramycin treatment
Protozoa of the CNS
Toxoplasmosis
- cane: Immunocompromised at risk; immunocompetent asymptomatic
- pregnant lady: Pregnant women at risk of transplacental transfer
- bowl of meat: Cysts in undercooked meat
- litter box and poop: T. gondii can be transmitted by cat feces
- bird eggs in poops: Oocysts in feces
- extra lenses: Brain abscesses. Multiple ring enhancing lesions on CT or MRI
- red: turban: Encephalitis
- ping sticking out turban: Brain biopsy to differentiate from CNS lymphoma
- cat dressed as statue of liberty: ToRCHeS infection
- milk on head: Congenital Toxoplasmosis: intracranial calcifications
- bowl stuck on head, shaking: Congenital Toxoplasmosis: hydrocephalus and seizures
- flash bulb looking like retina: Congenital Toxoplasmosis: Chorioretinitis
- beethoven: Congenital Toxoplasmosis: Deafness
- dyed sulfa eggs: Sulfadiazine
- pyramid on eggs: Pyrimethamine
- $100 with cane: Prophylaxis for CD4 count <100
- IgG key with positive kite: Prophylaxis for CD4 count <100 and seropositive for IgG
- egg without pyramid: TMP-SMX for prophylaxis
Trypanosoma brucei
- multi colored tent: Variable surface glycoprotein coats, undergoing constant antigenic variation, thus recurrent fevers
- single ribbon: Motile with flagella
- Sleeping beauty: African sleeping sickness
- Tea fly: Tsetse fly vector, bite
- map with pins: Gambiense, Rhodesiense
- sleeping: Coma
- necklace: Cervical lymphadenopathy
- cloth: Axillary lymphadenopathy
- undulating hills: Recurrent fevers
- blood on finger and goat: Trypomastigotes seen on blood smear
- bar of mela soap: Melarsoprol treatment - CNS infection
- bottle of serum: Suramin treatment for serum - Peripheral blood infection
Naegleria fowleri
- brain eating amoeba disease: primary amoebic meningoencephalitis
- Nigeria fall: Naegleria fowleri
- scene: Associated with freshwater
- wind surfing dude: Associated with patients involved in water-sports
- water bottles: Associated with nasal irrigation systems and contact lens solution
- cribs: Enters CNS via cribiform plate
- neck brace, red turban: primary amoebic Meningoencephalitis, inflammation of brain/meninges. Fever, neck stiffness, headache
- head on rock: Rapidly fatal, poor prognosis
- needle in bottle: Lumbar puncture for diagnosis
- frogs: Amphoterecin treatment
Protozoa of Blood
Trypanosoma cruzi
- Che Guevara. Che's Gas: Chagas disease, South and Central America, like Che
- "Kissing Bug" bites around victim's mouth, and deposits feces which can later be introduced by scratching area
- bugs, red on heart: Transmitted by Reduviid, or "Kissing bug"
- asympatomatic acutely. Symptoms several years later
- swollen colon: Megacolon with constipation
- Tunneled up mole: Burrows into endocardium
- floppy heart on bike: Dilated cardiomyopathy
- snake with dilated snake: Mega-esophagus
- leaked red gas: Diagnosed by blood smear
- red on heart: Trypanosomes may be seen within cardiac mycocytes on heart biopsy
cardiac biopsy:
- Furry, knee high moccasin boots: Nifurtimox treatment
Babesia
- Vampire babes: Babesiosis
- Blood-related symptoms
- NE cross: NE United States
- Robin of Ixodes: Ixodes tick
- tick shield: tick-borne illness
- deer antlers: Ixodes tick is a deer tick
- sickle: Higher risk of severe disease in sickle cell disease
- hole in robin's shirt: Higher risk of severe disease in asplenia
- cracked blood stained windows: Hemolytic anemia
- yellow babe: Jaundice
- Sweating robin: fever
- torn robin shirt: Irregularly cycling fevers
- thick red floor: Babesioisis diagnosied by thick blood smear
- maltese cross: Maltese cross appearance in red blood cells, tetrad of trophozoites, differentiates from malaria
- crows: ma-crow-lide: azithromycin treatment
- Ato-vampire queen: atovaquone treatment
Plasmodium
- Malaria, especially in Africa
mal area: Plasmodium malariae
- buttons 1 and 4 colored like sun: Quartan fever cycle (72 hrs)
- Only infects mature RBC
oval shield and axe: Plasmodium vivax and ovale
- Only infects immature RBC
- Hypnotist: P. vivax and P. ovale produce dormant hypnozoites, hides in liver
- cow hide and liver spot: Hypnozoites in hepatocytes
- Pendulum: Tertian fever cycle (48 hrs)
False mask: Plasmodium flaciparum
- Infects all RBC
- irregular torn shirt: irregular fever
- red head dress: Cerebral malaria, parasitized RBC occlude capillaries in brain
- banana head dress: RBC banana shaped on blood smear
- gold belt: Parasitized RBC's occlude vessels to kidneys
- gold chest plate: Parasitized RBC's occlude vessels to lungs, pulmonary edema
- sickle: Sickle cell, thalassemia, G6PD deficiency disease is protective against P. falciparum
- "Color queen" - chloroquine, beads join together as polymer, blocking plasmodium heme polymerase. High resistance
- "Primal queen" - primaquine, can cause anemia in G6PD deficiency. Only treats hypnozoites
- "Me-flock queen" - mefloquine, extra strong
- backpack: Mefloquine prophylaxis for travelers to chloroquine resistant areas
- "Ato-vampire queen" - atovaquone, strong
- Iguana: Proguanil
- backpack: Atovaquone/proguanil for travelers to chloroquine resistant areas
Chloroquine is effective in eradicating chloroquine-sensitive plasmodia from the bloodstream, but it has no activity against the latent hepatic infections established by P vivax and P ovale. Primaquine must be added to the regimen to completely eradicate the hypnozoites.
Primaquine has limited therapeutic activity against the erythrocytic forms of plasmodia, including trophozoites. Primaquine is not effective in treating chloroquine-resistant strains, which can be managed with mefloquine or quinine, among others.
No antimalarial agent specifically acts to prevent hemolysis. Primaquine is contraindicated in patients with glucose-6-phosphate dehydrogenase deficiency as the medication can cause hemolysis.
- artist: Use artemisins for severe P. falciparum infections
- artist: Use IV artesunate for severe malaria infections; backup
- "Dining queen" - quinidine; backup
- Ivy: Artesunate and quinidine are delivered IV for severe malaria
- tin cans: Side effect of quinidine is cinchonism, including tinnitus/headaches
- mushroom: Anopheles mosquitoes carry sporozoites in saliva. Biting transmission to blood and then liver
- liver spot: Sporozoites mature to trophozoites in liver. Divide and cause RBC to become less flexible = splenomegaly
- RBC and small merozoites: Schizont divides into merozoites which burst from hepatocyte and infect RBCs
- lifecycle continues in RBC: trophozoite -> schizont -> merozoites -> infect RBC
- ring spot: Ring form of immature schizont
- male/female symbol: Merozoite can also form gametocyte, ingested by female mosquitos and stored in saliva
Mosquito bite releases sporozoites into the bloodstream, which are eventually carried to the liver to infect hepatocytes. In hepatocytes, sporozoites divide into merozoites and are eventually released from hepatocytes to infect red blood cells (RBCs)
In RBCs, merozoites develop into trophozoites, which divide and eventually cause infected RBCs to become less flexible. These infected RBCs accumulate and are destroyed in the spleen, leading to splenomegaly.
In addition, trophozoites in infected RBCs can mature into schizonts, which rupture the RBC membrane, releasing merozoites that go on to infect other RBCs.
To complete the cycle, some merozoites turn into gametocytes, which are ingested by female mosquitoes. In the mosquito, gametocytes fuse forming a diploid zygote, which generates haploid sporozoites that are stored in mosquito salivary glands.
- Gems with blood smear: Blood stain and Giemsa stain to see parasites in RBCs
- Schuffner dots: Schüffner dots are unique to P. vivax/ovale and are morphologic changes that occur in infected host erythrocytes. They are visible by light microscopy in blood smears, and appear as multiple brick-red dots.
- ring shaped P. vivax
- schizont
- banana shaped P. falciparum
Leishmaniasis
- undeed brazilian man with brazillian flag: Leishmania Braziliensis - vertebrates are host
- sand flies around zombie: Sandfly vector
- Leishmania braziliensis - cutaneous leishmaniasis, consumes flesh of victim and causes ulcers
- goat inside cages: Amastigote is intracellular form, seen within macrophages
- T bone steak: Stibugluconate treatment for cutaneous leishmaniasi
- amastigote in macrophages:
- Donovin: Visceral leishmaniasis caused by Leishmania Donovani
- black spots and sweating: Black fever, or kala-azar
- empty pan: Bone marrow affected causing pancytopenia
- sweating: Fevers
- cow with spots: Hepatosplenomegaly
- frogs: Amphoterecin B for visceral leishmaniasis
Intestinal nematodes
Enterobius vermicularis
- Vermin lady: Enterobius vermicularis, pin worm
- crawling out of round hole with eggs at bottom: Female pin worms lay eggs at the anus
- rats eating rocks: Fecal oral route. Scratch and put in mouth = auto infect
- long cape with rocks: Scotch tape test shows eggs under the microscope
- PAM: pyrantel pamoate
- bending metal bars: albendazole
- on tape:
Ancyclostoma duodenale and necator
- American dude, Ankle strings: Ancyclostoma duodenale
- American dude: Neck strings: Necator americanus
- hook: hookworm
- red boots: Hookworm larvae penetrate skin of soles of feet (walking bare foot)
- arrow on suit: blood stream —> lungs (coughed and swallowed) —> GI tract
- iron dangling with microcytic and hypochromic holes: iron deficiency anemia
- grenades fallen in water: eggs in stool
- Eo sling shot boy with bilobe sling shot: eosinophilia
- PAM: pyrantel pamoate
- bending metal bars: albendazole. Secondary
- cutaneous larva migrans:
A. Lumbricoides
- lumber man: Ascaris lumbricoides, large round worm
- eating eggs in contaminated food/water
- arrow on suit: blood stream —> lungs (coughed and swallowed) —> GI tract
- bronchial tree on chest: respiratory symptoms
- rocks obstructing: intestinal obstruction at ileocecal valve, malnutrition
- Acorn in puddle: diagnosis by eggs in feces
- Eosinophil granules: eosinophilia
- bending metal bars: albendazole, microtubule inhibitor (avoir in pregnant women)
Strongyloides
- Strong guy: Strongyloides stercoralis
- red boots: larvae penetrate skin of soles of feet
- arrow on suit: blood stream —> lungs (coughed and swallowed) —> GI tract
- round rocks in wall: Autoinfection: Strongyloides larvae hatch from eggs laid in intestinal wall, repenetrate wall, enter blood stream to lungs
- larvae in water: diagnosis by larvae in stool, not eggs
- Eosinophil granules: eosinophilia
- bending metal bars: albendazole, microtubule inhibitor (avoir in pregnant women)
- river mectin, no dumping, drain to river sign: ivermectin
Trichinella
- Spiral tricksters: Trichinella spiralis
- pork: undercooked pork/bear
- red pipes: Larvae enter blood stream
- striated brick wall: Larvae travel to striated muscle
- explosives on wall: Larvae form cysts within striated muscle
- red glasses: Periorbital edema
- green drool: Vomiting
- sweat: Fever
- fire: muscle inflammation, myalgia
- Eosinophil granules: eosinophilia
- bending metal bars: albendazole, microtubule inhibitor (avoir in pregnant women)
Tissue Nematodes
Dracunculus Medinensis
- Dracula: Dracunculus medinensis
- water cooler and cupapods cup: D. medinensis transmitted by water contaminated with copepods containing larvae
- Larvae in copepods
- Untied shoe laces: Adult females emerge from painful ulcer in skin
- eo sling shot boy: Eosinophilia
- Shoe lace around water cooler: extract via match stick and twist slowly
Onchocerca Volvulus
- Onchocerca volvulus, river blindness
- black fly bites human host, infiltrates skin, mature to adults, produce microfilariae
- chemical stains: Hyper and hypo-pigmented spots occur with onchodermatitis
- hand cover eyes: Microfilariae in eye cause blindness
- pink granules: Eosinophilia
- microscopes: Microfilariae seen in skin biopsy under microscope
- rivermectin sign: Ivermectin
- in vesicles:
Wuchereria bancrofti
- Witch craft: Wuchereria bancrofti
- mosquitos flying around: W. Bancrofti transmitted by mosquitos
- large pants: Elephantiasis: long standing lymphedema
- ruffled collar and arm pit: Lymphadenopathy
- coughing: Cough from microfilariae in lungs
- thick smear of blood on hat: Organisms seen on thick blood smear
- granules: Eosinophilia
- Diet and carb magazine: Diethylcarbamazine
T. Canis
- wolfman: Toxocara canis
- aka visceral larva migrans
- stinky poop bag: T. canis transmitted by ingesting food contaminated with dog or cat feces
- larva migrans: never mature, circulates body as larva
- sleep mask: Ocular larva migrans leads to blindness
- granules: Eosinophilia
- bending metal chair legs: Albendazole
Loa Loa
- loa loa lagoon
- flies: L. loa transmitted by deer flies
- lumps over arms/legs: Local subcutaneous swellings. Loa loa causes transient subcutaneous areas of localized angioedema and erythema on the extremities and face known as Calabar swellings. Pain or itching may precede the development of these lesions.
- worm in eye ball: Adult worms can migrate across conjunctiva
- thick smear of blood on face: Organisms seen on thick blood smear
- granules: Eosinophilia
- Diet and carb magazine: Diethylcarbamazine
- bending chair: Albendazole
- Intermediate host for T. saginata is cattle
- Intermediate host for T. solium is pigs
- Taenia solium
- Taenia saginata
- Hooks on proglottid heads of T. solium seen on O&P
- Neurocysticercosis - causes seizures. "Swiss cheese" appearance on head CT.
- Ingest egg in stool: neurocysticercosis
- Ingest larvae in meat: intestinal infection
- Taenia eggs transmitted by water contaminated with animal feces
- Praziquantel treatment
- Albendazole treatment
- Diphyllobothrium latum \xe2\x80\x93 fish tapeworm
- B12 deficiency
- Cobalamin deficiency
- Megaloblastic anemia
- Proglottid segments seen on stool O&P
- D. latum is the longest tapeworm
- Praziquantel
- Niclosamide treatment
- Echinococcus granulosus
- Dogs are definitive host, sheep are intermediate host for E. granulosus
- E. granulosus transmitted by dog feces
- Eggshell calcifications in cyst on liver CT
- Hydatid cyst in liver
- Cysts rupture causes an anaphylactic reaction and acute abdomen
- Eosinophilia
- Swimmers at risk of infection
- Snails are intermediate host
- Migrate against portal flow
- Schistosoma mansoni
- Schistosoma japonicum
- S. mansoni - large lateral spine
- Paragonimus westermani
- S. japonicum - small spine
- Portal hypertension
- Jaundice
- S. haematobium - large terminal spine
- Hematuria
- S. haematobium - risk of bladder cancer
- Praziquantel treatment
- Snails are intermediate host
- Snails are intermediate host
- Clonorchis sinensis
- Biliary fibrosis
- Cholangiocarcinoma
- Pigmented gallstones
- Operculated eggs on O&P
- Praziquantel treatment
- Chronic cough with bloody sputum
- Transmitted through consumption of raw or undercooked crab meat with larvae
- Operculated eggs on O&P
- Praziquantel treatment