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Sexual Intestine >> Liver Lungs Brain Heart Site Morphology Motile trophozoits Bulls eye shaped nucleus (sharp central karyosome & radial chromatin spokes) with RBC in cytoplasm Microscopic Diagnosis Trophozoits and/or cysts in feces Abdominal CT for abscesses Pathology Disease Worldwide prevalence with 90% asymptomatic Amebiasis Bloody dysentery Inverted flask-shaped lesions in LI Liver abscesses Giardia lambia G. intestinalis G. duodenalis Fecal-oral Contaminated water from streams, food with oocysts Intestine: Duodenum Jejunum Falling leaf motility Happy face Fecal antigen test (string test) abdominal gassy distension Malabsorption Trophozoits and/or cysts in feces Traveler's diarrhea foul smelly & greasy (high fat content) Metronidazole Treatment Metronidazole (10 days) followed by Iodoquinol (20 days)
Horseshoe shaped nucleus Macronucleus is long and sausage-shaped, and the spherical micronucleus is nested next to it
Cysts in feces
Tetracycline Metronidazole
Oocyst in water
Intestine (epithelium)
Acid fast spherical oocysts that fluorescence under UV light in feces 2 sporocysts with 2 sporozoites each
Watery diarrhea + nausea/vomiting Self-limiting diarrhea in normal host Severe/prolonged diarrhea in AIDS Linked to imported raspberries & strawberries Cryptosporidiosis Self-limiting watery diarrhea, vomiting, abdominal pain in healthy Severe to life threatening diarrhea in immunocompromised Diarrhea in AIDS patients mimicking Giardia infection Malabsorption syndrome
Trimethoprim Sulfamethoxazole
Acid fast oocysts in stool 4 sporozoites Obligate intracellular parasite Biopsy of intestinal epithelium shows dots on the intestinal glands Acid fast oocysts in stool 2 sporocysts with 4 sporozoits each Obligate intracellular parasite Biopsy shows eosinophilia G+, acid fast spores in stool
Isospora belli
Fecal oral
Trimethoprim Sulfamethoxazole
Microsporidia
Spores ingested
No effective therapy
GU, vagina
Motile trophozoites Corkscrew motility Cant live outside body because no cysts stage
Trichomoniasis Yellow green frothy vaginal discharge Fish odor, strawberry vagina Burning on urination Painful vaginal itching Amebic meningoencephalitis Severe prefrontal headache, nausea, fever, altered sense of smell Rapidly fatal within days
Naegleria fowleri
water shoots up the Motile trophozoites nose > Cribriform plate > CNS Trails left on agar when coculture with G- bacteria
Amoeboflagellates
Acanthamoeba culbertsoni
Fresh water lakes Contaminated contact lens solution (airborne) Respiratory tract, ulcerated skin Vector transmission via tsetse fly Vector transmission via reduviid/kissing/ triatomine bug Vector transmission via Phlebotomine sand fly Reservoirs: rodents Vector transmission via Anopheles(female) mosquito 2 life cycles: Sporogny (sexual) in definitive host (mosquito) Schizogony (asexual) in intermediate host (vertebrates)
CNS via hematologic spread CNS via hematologic spread Saliva of tsetse fly
Granulomatous amoebic encephalitis Corneal keratitis Fatal within an year Granulomatous amoebic encephalitis Fatal
GAE: ketoconazole Keratitis: propamdine isothionate, imidazole Ketoconazole Rarely successful Suramin (no CNS effect) Melarsoprol (treat CNS) Acute: Nitrofurtimox Benzimidazole Stibogluconate sodium
Blood smear Serology (high IgM) Blood smear Xenodiagnosis Amastigote inside macrophages in liver, bone marrow, spleen
Chagas disease
Hemoflagellates
Cutaneous: ulcer -> depigmented scar Mucocutaneous: nasal septum erosion Visceral (kala-azar): fatal Malaria Periodic episodes of high fever and chills followed by episodes of profuse sweating +/Anemia Hepatomegaly Splenomegaly Irregular fever spikes Brain, lung, kidney damage Recrudescence Tertian: 48 hr fever spikes Latent in liver, relapses Tertian: 48 hr fever spikes Latent in liver, relapse Quartan: 72 hr fever spikes Recrudescence Toxoplasmosis Healthy: flu-like + lymphadenopathy Congenitally acquired (TORCH)::: Early: still birth, chorioretinitis, convulsions, retardation, microcephaly Late: progressive blindness from chorioretinitis by teens AIDS: MCC focal CNS disease
Plasmodium vivax Plasmodium ovale Plasmodium malariae Sporozoa / Apicomplexa (Blood/Tissue) Toxoplasma gondii
Bite > exoerythrocytic sporozoites > invasion of Liver (parenchymal cells), hypnozoites > trophozoite in RBC (erythrocytic) > sexual & asexual cycles after RBC lysis (merozoites) Asexual cycle determines febrile episodes
Oval, jagged, infected RBC Bar and band forms, Rosette schizonts Cysts in muscle tissue, nervous tissue, motile tachyzoites in blood obligate intracellular parasite IgM or IgG serology CT scan shows ring/contrast enhanced lesions in brain
Raw pork meat Contact with cat feces Vertical transmission if mothers primary infection Cat is definitive host
Tissue, CNS
Babesia spp.
RBC
Babesiosis Clindamycin + Malaria like disease, hemolytic Quinine Coinfection with Borrelia (lyme disease)