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Parasitic Infestations By Tonagaya, Sarah

Parasitic Infestations

By Tonagaya, Sarah

Schistosomiasis

Schistosoma japonicum is an important parasite and one of the major infectious agents of schistosomiasis

Geog. Distribution:

Confined to Far East (Japan, China, Formosa, Thailand and Philippines)

Schistosomiasis  Schistosoma japonicum is an important parasite and one of the major infectious agents of

Schistosomiasis

Disease: Schistosomiasis/ Belharziasis/ Snail Fever

present in many countries and affect some 200 million people with whom 120 million are symptomatic and 80 million suffer from severe disease

infection is transmitted in association with implementation of water source project in most developi ng countries can be acquired during activities like: bathi ng, swimming,planting rice, fishing and doing laundry

involves contact with water infected with intermediate snail host of the parasite free swimming cercaria attach es to a vertebrate host and penetrate intact skin

Schistosomiasis

Schistosome Cercarial Dermatitis

Cercarial dermatitis, also called Swimmer's itch, is a skin rash caused by an allergic reaction to infection with certain parasites of birds and mammals.

These microscopic parasites are released from infected snails who swim in fresh and salt water, suc h as lakes, ponds, and oceans used for swimming an d wading.

Infection is found throughout the world. Swimmer's itch generally occurs during summer months.

Schistosomiasis

signs and symptoms of swimmer's itch:

Within minutes to days after swimming in contaminated water, yo u may experience tingling, burning, or itching of the skin. Small reddish

appear within 12 hours. Pimples ma y develop into small blisters. Itching

may last up to a week or more

but w

Schistosomiasis

If you have a rash, you may try the following for relief:

corticosteroid cream

cool compresses bath with baking soda baking soda paste to the rash anti-itch lotion Calamine* lotion colloidal oatmeal baths, such as Aveeno

Try not to scratch. Scratching may cause the rash to become infected. If itching is severe, your health care provider may p rescribe lotion or creams to lessen your symptoms

Schistosomiasis

Schistosomiasis Swimmer's itch
Schistosomiasis Swimmer's itch

Swimmer's itch

Schistosomiasis

Schistosomiasis Papular dermatitis
Schistosomiasis Papular dermatitis

Papular dermatitis

Schistosomiasis

Visceral Schistosomiasis (Bilharziasis)

The cutaneous manifestation bilhaniasis may begin with mild itching and a papular dermatitis of the feet and other parts after swimming in polluted stre ams containing Cercanae

After an asymptomatic incubation period, there may be a sudden illness with fever and chills,pneumonitis, and eosinophilia. Petechial hemo rrhages may occur

Cutaneous schistosomal granulomas most frequentiy involve the genitalia, perineum, and butt ocks

Schistosomiasis

Treatment: Praziquantel

Ancylostomiasis

Ancylostomiasis (also anchylostomiasis or ankylostomiasis) is the condition of infection by Ancylostoma hookworms

Ancylostomiasis is caused when hookworms, present in large numbers, produce an iron deficiency anemia

by sucking blood from the host's intestinal walls.

They commonly infect the skin, eyes, and viscera in humans.

Ancylostomiasis

CAUSE:

The infection is usually contracted by persons walking barefoot over contaminated soil.

In penetrating the skin, the larvae may cause an allergic reaction. It is from the itchy patch at the site of entry that the early infection gets its nickname "ground itch".

Once larvae have broken through the skin, they enter the bloodstream and are carried to the lungs (unlike ascarids, however, hookworms do n ot usually cause pneumonia).

The larvae migrate from the lungs up the windpipe to be swallowed and carried back down to the intestine. If humans come into contact with larvae of the dog hookworm or the cat hookworm, or of certain other ho okworms that do not infect humans, the larvae may penetrate the skin.

Sometimes, the larvae are unable to complete their migratory cycle in humans. Instead, the larvae migrate just below the skin producing snake-like markings. This is referred to as a creeping eruption or cutane ous larva migrans.

Ancylostomiasis

Ancylostomiasis creeping eruption or cutaneous larva migrans
Ancylostomiasis creeping eruption or cutaneous larva migrans

creeping eruption or cutaneous larva migrans

Ancylostomiasis

Treatment: mebendazole

Parasitic Systemic Infestations

Cutaneous And Mucocutaneous Leishmaniasis

Trypanosomiasis

American Trypanosomiasis (AT) Human African Trypanosomiasis (HAT)

Cutaneous Amebiasis And Acanthamebiasis

Cutaneous Amebiasis Cutaneous Acanthamebiasis

Cutaneous And mucocutaneous Leishmaniasis

Cutaneous And mucocutaneous Leishmaniasis

Cutaneous And mucocutaneous Leishmaniasis  Etiology: Many species of obligate intracellular protozoa Leishmania; predominant species are:

Etiology: Many species of obligate intracellular protozoa Leishmania; predominant species are:

Old World: L.tropica, L.major, L. aethiopica New World: L. Mexican complex, Viannia sub-genus

Cutaneous And mucocutaneous Leishmaniasis

Vector: sandflies

Old World: Plebotomus New World: Luzomyia

Cutaneous And mucocutaneous Leishmaniasis  Vector: sandflies • Old World: Plebotomus • New World: Luzomyia
Cutaneous And mucocutaneous Leishmaniasis  Vector: sandflies • Old World: Plebotomus • New World: Luzomyia

Cutaneous And mucocutaneous Leishmaniasis

Infection of macrophage in skin (dermis), nasooropharyngeal mucosa, and the reticuloendothelial system (viscera)

Diversity of clinical syndromes due to particular parasite, vector, and host species.

Clinical syndromes: Cutaneous, mucosal, visceral

Cutaneous leishmaniasis (CL) characterized by development of single or multiple cutaneous papules at the site of a sandfly bite, often evolvi ng into nodules and ulcers, which heal spontaneous with a depressed s car

Old World cutaneous leishmaniasis (OWCL) New World cutaneous leishmaniasis (NWCL)

Diffuse (anergic)

cutaneous leismaniasis (DCL)

Mucasal leishmaniasis (ML)

Visceral leishmaniasis (VL) ; kala-azar; post- kala- azar dermal leishmaniasis (PKDL)

Cutaneous leishmaniasis

Cutaneous leishmaniasis New World cutaneous leishmaniasis: ulcer on thigh

New World cutaneous leishmaniasis:

ulcer on thigh

Cutaneous leishmaniasis

Cutaneous leishmaniasis New World cutaneous leishmaniasis: chiclero ulcer

New World cutaneous leishmaniasis:

chiclero ulcer

Mucocutaneous

leishmaniasis

Mucocutaneous leishmaniasis Mucocutaneous leishmaniasis, South American. Painful, mutilating ulceration

Mucocutaneous leishmaniasis, South American. Painful, mutilating ulceration

Cutaneous And mucocutaneous Leishmaniasis

Treatment:

Cutaneous leishmaniasis

For certain types of cutaneous leishmaniasis where the potential for mucosal spread is low, t opical paromycin can be used.

For more invasive lesions (eg, those failing to respond to topical treatment; metastatic sprea d to the lymph nodes sodium stibogluconate or pentamidine can be used.

Cutaneous And mucocutaneous Leishmaniasis

Treatment:

Mucosal leishmaniasis

Pentavalent antimony for a course of 4 weeks has been recommended.

Amphotericin B deoxycholate may be first-line therapy for advanced mucosal disease.

Trypanosomiasis

American Trypanosomiasis (AT) Human African Trypanosomiasis (HAT)

Trypanosomiasis

Trypanosomiasis  Zoonosis  Parasitic protozoa disease caused by three species o f Trypanosoma

Zoonosis

Trypanosomiasis  Zoonosis  Parasitic protozoa disease caused by three species o f Trypanosoma

Parasitic protozoa disease caused by three species o f Trypanosoma

Trypanosomiasis

Vector: reduviid bugs

Trypanosomiasis  Vector: reduviid bugs  Epidermiology • Central and South America: T.cruzi • Africa: T.brucei

Epidermiology

Central and South America: T.cruzi Africa: T.brucei gambiense, T.brucei rhodesiense

Trypanosomiasis

Clinical findings:

Acute: Inoculation site nodule Chronic: Cardiac, gastrointer, and central nervous system involvment

Course: most infected persons remain so far life. Heart, GI, and CNS involvement associated with serious morbidity

Trypanosomiasis

Treatment:

American trypanosomiasis is currently treated with a variety of antifungal agents, including

. Melarsoprol is another drug which is used for the treatment of T. b. gambi ensie.

American Trypanosomiasis (AT)

American Trypanosomiasis (AT)

Synnonym: Chaga disease Etiology: T.cruzi

Transmission: T.cruzi deposited in feces of reduviid bugs onto the skin; enters host via breaks in skin, mucous membranes, or con junctivae. Chagoma can occur at inoculatio n site. Can also be transmitted by transfusi on of blood from infected persons, by orga n transplantation, from mother to fetus

American Trypanosomiasis (AT)

Dissemination: Via lymphatics and bloodstream to muscles. Geography: Central and South America Clinical findings:

Acute AT Chronic AT

American Trypanosomiasis (AT)

Acute AT 1. Inoculation chagoma

An indurated area of erythma and sweeling (chagoma), at the portal of entry, occuring 7-14 days after inoculation.May be accomp anied by local lymphadenopathy. Parasites l ocated within leukocytes and cells of subcut aneous tissue. These initial local signs are f ollowed by malaise, fever, anorexia, and ed ema of the face and lower extremities

American Trypanosomiasis (AT)

American Trypanosomiasis (AT) An indurated area of erythma and sweeling (chagoma)

An indurated area of erythma and sweeling (chagoma)

American Trypanosomiasis (AT)

2.Romana sign

Unilateral painless edema of palpebrae and periocular tissue – classic finding in acute AT

American Trypanosomiasis (AT) 2.Romana sign • Unilateral painless edema of palpebrae and periocular tissue – classic

American Trypanosomiasis (AT)

3.Edema of face and lower extremities

American Trypanosomiasis (AT) 3. Edema of face and lower extremities

American Trypanosomiasis (AT)

4.Trypanosomides

Morbilliform, urticariform, or erythematopolymorphic eruptions

American Trypanosomiasis (AT) 4. Trypanosomides • Morbilliform, urticariform, or erythematopolymorphic eruptions

American Trypanosomiasis (AT)

5.Hematogenic or metastatic chagomas

Nodule(s) caused by dissemination of infection. Hard, painful, wine-colored nodules; rarely soften or ulcerate

American Trypanosomiasis (AT) 5.Hematogenic or metastatic chagomas • Nodule(s) caused by dissemination of infection. Hard, painful,

American Trypanosomiasis (AT)

Chronic AT: In the immunocompromised host (HIV/AIDS disease, organ transplant r ecipient)

Reactivation chagoma Nodule at inoculation site

A cellulitis-mimicking plaque

Diagnosis

Acute AT : Detect parasites in blood Chronic AT : Detect specific antibodies

Human African Trypanosomiasis (HAT)

Human African Trypanosomiasis (HAT)

Synonym: Sleeping sickness

Etiology: complex of T.brucei

T.brucei gambiense causes West African sleeping sickness

T.brucei rhodesiense cause East African sleeping sickness

Human African Trypanosomiasis (HAT)  Synonym: Sleeping sickness  Etiology: complex of T.brucei • T.brucei gambiense

Transmission

Vector: tsetse flies Transmission during human Blood meal from infected saliva

Human African Trypanosomiasis (HAT)

Preimary reservoir

West African sleeping sickness: humans East African sleeping sickness: Antelope and cattle

Epidermiology:

Sub-saharan Africa

HAT in travelers: usually East African trypanosomiasis

Human African Trypanosomiasis (HAT)

Clinical findings:

Acute HAT: Stage I Disease Chronic HAT: Stage II Disease

Human African Trypanosomiasis (HAT)

Acute HAT: Stage I Disease 1. Trypanosomal chancre

Painful; 7-14 days after tsetse-fly bite. Occurs more commonly in travelers than i n Africans. Typically 2-5 cm, indurated; m ay ulcerate; resolved in few weeks. Parasi tes can be seen in fluid expressed from ch ancre can buffy coat

Human African Trypanosomiasis (HAT)

Human African Trypanosomiasis (HAT) Trypanosomal chancre

Trypanosomal chancre

Human African Trypanosomiasis (HAT)

  • 2. Hemolymphatic stage

Marked by the onset of fever, arthralgia, malaise, localized facial edema, and moderate splenomegaly. Lymphadenop hthy is prominent in T.brucei gambiense trypanosomiasis

  • 3. Macular-papular rash Occurs on the trunk

  • 4. Pruritus

Human African Trypanosomiasis (HAT)

5. Winterbottom sign

Enlargement of the nodes of the posterior cervical triangle; cervical n ode also enlarged

Human African Trypanosomiasis (HAT) 5. Winterbottom sign Enlargement of the nodes of the posterior cervical triangle;
Human African Trypanosomiasis (HAT) 5. Winterbottom sign Enlargement of the nodes of the posterior cervical triangle;

Human African Trypanosomiasis (HAT)

Chronic HAT: Stage II Disease 1. CNS invasion

Characterized by insidious development of protean neurologic symptoms. Progressive indifference and daytime somnolence develops (“sleeping sickness”)

Human African Trypanosomiasis (HAT)  Chronic HAT: Stage II Disease 1. CNS invasion Characterized by insidious
Human African Trypanosomiasis (HAT)  Chronic HAT: Stage II Disease 1. CNS invasion Characterized by insidious

Human African Trypanosomiasis (HAT)

2. Cardiac disease

East African type may develop arrhythmias and congestive heart failure before CNS disease develops.

Diagnosis

Detection of parasite in chancre, lymp node, blood, bone marrow.

Cutaneous Amebiasis And Acant hamebiasis

Cutaneous Amebiasis

Cutaneous Amebiasis  Cause : • By Entamoeba histolytica , which infects the GI tract and

Cause :

By Entamoeba histolytica, which infects the GI tract and rarely skin

Incidence : 10% of world population infected with Entamoeba Majority of infections caused by noninvasive E. dispar

Cutaneous Amebiasis

More prevalent in tropics and in rural areas: inadequate sanitation and crowding

Skin involement is associated with malnutrition and immunocompromise (HIV/AIDS, solid organ transplantatio

n)

Cutaneous Amebiasis

Clinical finding:

Cutaneous Amebiasis begins as an indurated pustule that evolves to a painful ragged ulcer, fou l-smelling and coverd with pus or necrotic debris

Usually a consequence of an underlying amebic abscess invading the skin

Typical sites are the perianal area (extension of sigmorectal involvement) abdominal wall (draining sinus from liver or colon)

Penis or vulva may become infected during intercourse

Cutaneous Amebiasis

Cutaneous Amebiasis Cutaneous amebiasis: perineum Perineal/perianal ulcer in a patient with rectal amebiasis.

Cutaneous amebiasis: perineum Perineal/perianal ulcer in a patient with rectal amebiasis.

Cutaneous Amebiasis

Cutaneous Amebiasis A male child with multiple ulcers by amebiasis in the diaper area

A male child with multiple ulcers by amebiasis in the diaper area

Cutaneous Amebiasis

Treatment :

The choice of drug depends on the type of clinical presentation and the site of drug a ction (in the intestinal wall versus inside th e intestine itself). Drugs may include

, paromomycin, iodoquinol, or diloxanide f uroate.

Occasionally, it may be necessary to drain a liver abscess.

Cutaneous

Acanthamebiasis

Cutaneous Acanthamebiasis  Caused • by free-living Acanthamoeba  Clinical finding • Primary cutaneous Acanthamebiasis •

Caused

by free-living Acanthamoeba

Clinical finding Primary cutaneous Acanthamebiasis Disseminated cutaneous Acanthamebiasis

Cutaneous

Acanthamebiasis

Primary cutaneous Acanthamebiasis

Occurs at site of trauma sustained in adequatic environment.

Cutaneous Acanthamebiasis  Primary cutaneous Acanthamebiasis • Occurs at site of trauma sustained in adequatic environment.

- Keratitis is usually associated with a history of improper cleaning of contact lenses and sw imming in fresh water or a swimming pool, especially while contact lenses are worn

Lesion begin as indurated red/violaceous deep nodules or large pustules that soon ulcerate

Cutaneous

Acanthamebiasis

Granulomatous amebic encephalitis

(GAE) is a subacute diffuse

, usually with an insidious onset. The inc ubation period is unknown but is probabl y weeks to months.

Cutaneous

Acanthamebiasis

Disseminated cutaneous Acanthamebiasis

Occurs in HIV/AIDS disease and solid organ transplant recipients

Disseminates from nasal/sinus colonization.

Present with multiple soft red nodule that ulcerate

Cutaneous

Acanthamebiasis

Cutaneous Acanthamebiasis Ulcerated lesions on the arm of a patient with disseminated Acanthamoeba infection. Skin nodules

Ulcerated lesions on the arm of a patient with disseminated Acanthamoeba infection. Skin nodules with overlying erythema underwent sequence of changes, characterized by central darkening, crusting, and deep ulceration, which left a thin, erythematous, indurated border.

Cutaneous

Acanthamebiasis

Treatment :

Keratitis

Medical treatment consists of topical antimicrobial agents, which can achieve high concentrations at the site of the infection.

Because the cyst form may be highly resistant to therapy, a combination of agents is generally used. Many authorities recommend a combination of

propamidine 0.1%, miconazole nitrate 1%, and neomycin.

combination of a diamide (propamidine isethionate) with a cationic antiseptic (polyhexamethylene biguanide [PHMB] or chlorhexidine).

These topical antimicrobials are administered every hour immediately after corneal debridement. These agents are then continued hourly during waking hours for 3 days (at least 9 times/day is recommended).

The frequency is then reduced to every 3 hours. Two weeks may be required before a response is observed, and the total duration of therapy is a minimum of 3-4 weeks. Some advocate treating for 6-12 months. When t herapy is discontinued, close observation is warranted to rule out recurrent disease.

Cutaneous

Acanthamebiasis

Treatment:

Surgical Care

Keratitis: The abnormal epithelium is débrided. Penetrating keratoplasty may be necessary in cases that do not respo nd to medical therapy.

Cutaneous

Acanthamebiasis

Treatment:

Granulomatous amebic encephalitis

Ketoconazole, miconazole, itraconazole, fluconazole,Pentamidine,Amphotericin Bparomomycin,Polymyxin,Trimethoprim-sulfamethox azole,Sulfadiazine,Flucytosine,Clotrimazole,Rifampin

Disseminated disease:

A case that involved only the skin was treated with intravenous pentamidine, topical chlorhexidine gluconate, and 2% ketoconazole cream, followed by oral itraconazole.

Question

1. What’s the classic finding in acute American Trypanosomiasis (AT)?

Answer ROMANA SIGN

2. What’s sign which is enlargement of the nodes of the posterior cervical triangle in the patient who was bitten by tsetse flies?

Answer Winterbottom sign