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Clinical Parasitology Prt2-10

Clinical Parasitology Prt2-10 - Parasitic Infections...

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Parasitic Infections: Clinical Manifestations, Diagnosis and Treatment Part II Lennox K. Archibald, MD, PhD, FRCP, DTM&H Hospital Epidemiologist University of Florida
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Case 1 A 24-year-old white male army officer Referred to the VA ID clinic with a 3-month history of a lesion on his right leg, developing approximately 2 weeks after returning from Iraq Recent travel history: 1 month in Kuwait and 2 months traveling between Kuwait and Iraq Recalled being bitten numerous times by small flying insects and other nasty “bugs”
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Case 1 Physical examination essentially normal except for: Non-tender (20 × 15 mm) scaly erythematous plaque with a moist central erosion of the left popliteal area. There was no lymphadenopathy and no mucosal lesions were noted
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An intact macrophage practically filled with amastigotes (arrows),
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Leishmaniasis Tropical areas where phlebotomine sandfly is common: South America, India, Bangladesh, Middle East, East Africa Sandfly introduces flagellated promastigote into human ingested by macrophages develops into nonflagellated amastigote
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Leishmaniasis Cutaneous Most common among farmers, settlers, troops and tourists in Mid East (L. major and tropica), Central and South America (L. mexicana, braziliensis, amazonensis, and panamensis) L. mexicana reported in Texas Visceral (kala azar) Anemia, leukopenia, thrombocytopenia, hypergammaglobulinemia common
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Visceral Leishmaniasis Dissemination of amastigotes throughout the reticulendothelial system of the body Spleen Bone marrow Lymph nodes Opportunistic infection in AIDS patients Ineffective humeral response
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Hepatosplenomegaly
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Splenic aspirate Most satisfactory method Spleen must be at least 3cm below LCM Aspirate stained with Giemsa
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Leishmaniasis: treatment Only drug approved in US is Amphotericin B Treatment of cutaneous disease depends on anatomic location Many spontaneously heal and do not require treatment
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Remember.. The factors determining the form of leishmaniasis: Leishmanial species Geographic location Immune response of the host
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Case 2 6-yr-old boy recently arrived from Brazil Swelling around the eye Conjunctivitis Fever Enlarged lymph nodes Hepatosplenomegaly Had stayed in a hotel—adobe style with thatched roof
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Blood smear
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Reduviid bug (assassin bug)
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Chagas disease: Clinical manifestations Local edema is followed by fever, malaise, anorexia More rarely: myocarditis, encephalitis Years later: chronic Chagas Disease (10-30%) Heart: primary target Cardiomyopathy associated with CHF, emboli, arrythmias GI tract: mega-esophagus, megacolon
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