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Lecture 6

Parasitology/Intestinal Protozoa - Giardia and Others

What are two other names for Giardia lamblia? Giardia duodenalis or G. intestinalis
What is the transmissible form of Giardia lamblia? Cyst
Which form of Giardia lamblia causes disease? Trophozoites
Compare the size of the cyst and trophozoites forms of Giardia lamblia. Cysts: 10um Trophozoites: 20um
Name some mammals that can cause zoonotic transmission of Giardia lamblia to humans. Livestock, cats, dogs, beavers
Which patients are probably at risk for developing worse Giardia infections? agammaglobulinemic patients
What are the epidemiologic exposures that should make one consider Giardia lamblia as part of the differential diagnosis in the US? Day care, waterborne outbreaks, hikers, foreign travel
True/False: Giardia lamblia can cause symptomatic and asymptomatic infection. True
What is are the symptoms of active Giardia lamblia infection? Foul-smelling diarrhea, abdominal cramping, bloating lasting weeks and often resulting in weight loss.
How does Giardia lamblia cause symptoms? Trophozoites multiply and attach to small bowel epithelium by a sucking disk which leads to malabsorption.
True/False: During asymptomatic infection with Giardia lamblia people can pass trophozoites. False: They are “cyst passers”.
How is diagnosis of Giardia lamblia made? 1.Antigen detection: ELISA/IF 2. Stool microscopy to visualize cysts on a stained smear or motile trohphozoites on a saline wet mount. 3. Duodenal sampling (rare)
What are the drugs of choice for treating Giardia lamblia? Tinidazole or metronidazole
How is infection with Giardia lamblia prevented? Fecal-oral hygiene, boiling, filtering, iodine works on water
How are people infected by Cryptosporidium spp.? Ingestion of oocysts.
What is the leading cause of diarrhea in AIDS? Cryptosporidium spp.
What is the normal course of infection with Cryptosporidium spp. in immunocompetent pts? self-limited diarrhea, abd pain for 2 wks. Fever is rare
What are the complications with AIDS and Cryptosporidium spp. infection? Severe, chronic debilitating diarrhea and dissemination (cholangitis, other sites)
How do you diagnose infection with Cryptosporidium spp.? Antigen detection (ELISA/IF), Stool microscopy (staining of oocysts with acid-fast stain), Endoscopy with biopsy.
What is the treatment for Cryptosporidium spp.? Cryptosporidium is generally highly resistant to chemotherapy. Can use nitazoxanide and for AIDS HAART should be started.
What are the strategies for preventing infection with Cryptosporidium spp.? 1.Fecal-oral hygiene 2. Screen pets of AIDS pts. 3. Boiling and <1um filters
Does chlorine or iodine kill Cryptosporidium spp.? no
What organism causes disseminated diarrhea and keratitis in AIDS pts? Microsporidia spp.
What is the treatment for Microsporidia spp? Albendazole or fumagillin
What are the two organisms which cause diarrhea in AIDS pts and are treated with TMP/SMX? Isospora belli and Cyclospora cayetanesis.
True/False: Cyclospora cayetanesis is foodborne and can be found in raspberries and mesclun. True
What is the only life cycle form of Trichomonas vaginalis? Trophozoite
How is Trichomonas vaginalis transmitted? Human to human sexual transmission
What are the possible increased risks with Trichomonas vaginitis? Pre-term delivery and may increase HIV transmissibility
What are the clinical features of Trichomonas vaginitis? Vaginal discharge and irritation (similar to candida vaginitis or bacterial vaginosis) asymptomatic in men.
How is the diagnosis of Trichomonas vaginitis made? On exam: copious yellow bubbly discharge, elevated pH (>5), on wet mount of d/c: WBCs and motile trophozoites
What is the treatment for Trichomonas vaginalis infection? Metronidazole single dose to pt and partner
How is Trichomonas vaginalis transmission prevented? Condoms
Created by: UVAPATH4