Clinical Parasitology Prt1-10

Clinical Parasitology Prt1-10 - Parasitic Infections:...

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Parasitic Infections: Clinical Manifestations,  Diagnosis and Treatment Part I Hospital Epidemiologist University of Florida
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The Reality 1.3 billion persons infected with  1.3 billion persons infected with  Ascaris (1: 4 persons on earth) Ascaris (1: 4 persons on earth) 300 million with schistosomiasis 300 million with schistosomiasis 100 million new malaria cases/yr 100 million new malaria cases/yr At UCLA, 38% of pediatric and  At UCLA, 38% of pediatric and  dental clinic children  harbored  dental clinic children  harbored  intestinal parasites  intestinal parasites 
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Chronic Diarrhea
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Case1   42-yr-old previously healthy, UF professor 6-week history of intermittent diarrhea, flatus  and abdominal cramps Diarrhea: x8/day; pale; no blood or  mucus No tenesmus Illness began slowly during camping trip to  Colorado with loose stools Spontaneously remission for 5-6 days at a  time, then recur
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Case 1 His 8-yr-old son had had a mild  course of watery diarrhea—ascribed  to viral gastroenteritis by general  practitioner Stool smear—no pus cells However, wet preps showed…
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Giardiasis ( G. lamblia ) Should be suspected in prolonged diarrhea Contaminated water often implicated— outbreaks Campers who fail to sterilize mountain  stream water Person-person in day care centers MSM  Symptoms usually resolve spontaneously in  4-6 weeks
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Giardiasis  Tests of choice Examination of concentrated stools for  cysts (90% yield after 3 samples) Usually no PMNs Stool ELISA, IF Antigen (up to 98%  sensitive/90-100% specific) Consider aspiration of duodenal  contents--trophozoites Treatment: Metronidazole for 5-7 days
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Case 2 40 y/o male vicar returned from 2 years of  missionary work in South Africa Excellent health throughout stay there 3 months after returning to U.S.  Suddenly ill with abdominal distension Fever Periumbilical pain Vomiting Blood-tinged diarrheal stools Denied arthritis /known exposure to parasites Family history of “inflammatory bowel  disease”
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Case 2 Physical examination: Acutely ill Distended abdomen No hepatomegaly or splenomegaly Decreased bowel sounds Stool exam Gross blood present No pus cells  Negative for O&P, one negative C&S
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Sigmoidoscopy revealed… Multiple punctate bleeding sites  at 7 to 15 cm with normal   appearing mucosa between sites This mucosa easily denuded  when pressure applied to it,  leaving large areas of bleeding  submucosa
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Diagnosed with ulcerative colitis Started on corticosteroids Temperature rose to 40°C
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This note was uploaded on 07/02/2011 for the course MMC 6500 taught by Professor Gulig during the Spring '11 term at University of Florida.

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Clinical Parasitology Prt1-10 - Parasitic Infections:...

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