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Micro Chart Test 4

Micro Chart Test 4

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Published by: api-26938624 on Oct 19, 2008
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Class Mollucutes, family Mycoplasmataceae, genera Mycoplasma and Ureaplasma

No true cell wall (but Gram -) - highly pleomorphic (many shapes). ABC's will not work because they target the cell wall Highly developed outer membrane. Contains sterols (cholesterol-like) Smallest known organisms (filterable) that are capable of autonomous growth fastidious nutritional growth faculative anaerobes produce hydrogen peroxide Small like viruses, replicate like bacteria

Role in disease is "not clearly defined" No seasonality Spread via nasal secretions/ aerosolized droplets. Close contact. STD??

Virulence Factors
Attachment: adhesin P (base of cilia and epithelial and RBC surface) cause ciliostasis --> persistant caugh Also binds to neuramic acid Is a superantigen Produces hydrogen peroxide and inhibits host catalase (which breaks down h2o2) incomplete immunity

MILD URI/pharyngitis Acute tracheobronchitis "Walking pneumonia", "Eaton's agent" pneumona Erythema multiforme Stevens-Johnson Syndrome OM Hemolytic anemia Meningitis, pericarditis KI stones Urethritis Urethritis

Prevention/ Treatment
No cell wall therefore, resistant to penicillins, cephalosporins, vancomycin

Mycoplasma and Ureaplasma

3 types: 1) Influenzae A: epidemics, pandemics, bird reservoirs (ducks, chickens) 2) Influenzae B: stomach flue Orthomyxoviridae 3) Influenzae C

Enveloped virus - wash your hands! Destroyed with soaps ssRNA genome in 8 segments: facilitates rearrangement

Epidemic --> antigenic drift. Small mutations. Will re-infect every 2-3 years


Influenzae A Influenzae B Secondary Bacterial pneumonia Encephalopathy Reye Syndrome

Never give aspirin! Reduce contact with infected individuals wash hands! Natural immunity is longer than vaccine Vitamin D

Pandemic --> antigenic shift. Only in influenzae Neuramidase - allows spread through A, major recombinations. Every 10 years. mucous membranes Also zoonoses - a new strain is formed that can first strain known to cross species be spread to humans barrier from chicken to human - H5N1 Limited viremia - very rarely spread Transmission - respiratory droplets beyond lung Ab mediated response (anti HA Abs) Flu season: winder months Oct-Dec, only 4-6 protect against re-infection from that weeks particular strain only. Th1 response and INF are key Sx's depend on T cell response, IFN (interferon) response (liberated from Vitamin D and epidemic influenza damaged cells, responsible for classic flu symptoms) Damage is direct to viral pytopathology NOT immunopathology


One of the largest families: Includes enteroviruses (HAV, Coxsackie virus, Naked capsid virus polio virus, echo virus) and rhinovirus Enterovirus - stable at pH3-9. Rhinovirus --> labile at acidic pH, optimal growth is 33C (nose is cooler) Rarely cause GI disease but fecal-oral spread Range from cold-like symptoms to paralytic disease Coxsackie and echo virus --> also respiratory spread

Echo/Coxsackie viruses --> relatively wide tropism Polio virus --> narrow tissue tropism. Anterior horn cells of spinal cord. 1st Replication tonsils/pharynzx of PP Second replication - iff tissues carry specific receptors Stomach acid, protease and bile do NOT kill virus Immune protection is from Abs

Asymptomatic Abortive Non-paralytic poliomyelitis Paralytic Post polio syndrome (PPS)


Coxsackie A --> usually vesicular lesions Coxsackie B --> myocarditis, pleurodynia Coxsackie/ Echovirus

Herpangina Hand-foot-mouth disease

two types of polio vaccine: 1) IPV: (Jonas Salk - 1956) -> inactivated virus (safer but parenteral so no mucosal immunity) 2) OPV (Albert Sabin -1962) -> live attenuated virues (oral polio vaccine)

Type of enterovirus

Acute hemorrhagic conjunctivitis Pleurodynia (Bornholm's disease) Myocarditis/ Pericarditis IDDM Aseptic meningitis

over 100 serotypes - can get common cold more than once!

MC common cause (>50%) of the common cold Gradual antigenic drift (like influenza A) Spread via aerosolized nasal droplets, fomites, Infection by as little as 1 infectious hands (#1) particle Can't grow in acid of stomach (unlike enteroviruses) and also grows best at 33 C (cooler in nasal mucosa)

Common cold - coryza


bing ICAM-1

"deliberate exposure of "volunteers" to wet and only transient immunity cold does not cause colds - VIT D!

Hand washing/ disinfect contaminated surfaces Chicken soup - "the jewish penicillin" Zinc: important for immune systen (IFN), decrease inflamm, decrease virual attachment to nasal mucosa, inhibit viral replication, Zn fingers and Ab sysnthesis and many other fxns works better if Zn deficient - zinc talley test ABCs - useless in primary infection. Flu and cold are caused by viruses NOT bacteria. No vaccine for Dengue fever

Alphaviruses -> arboviruses Enveloped, linear ssrnA (arthropod borne), similar antigenicity Pestivirus and Arterivirus --> no human pathogens Togavirus and Flaviviruses Rubivirus --> german measles Flavivirus -> Hep B, Hep C similar pathogenesis and epidemiology cause lytic infections in vertebrate hosts

Female mosquitoe takes blood meal from vertebrate host

Ab in subsequent infections

Flu-like syndromes Meningitis/ encephalitis Hepatitis, hemorrhagic fever, shock, viral arthritis Yellow Fever Dengue (break bone) Fever Dengue hemorrhagic shock syndrome

Togavirus: replicate in cytoplasm, bud CMI - DTH (class IV), ab/ag complexes female mosquitoe bites another vertebrate host at plasma membrane can affect vasculature Fc receptor (phagocytes) - internalizes zoonoses virus more vectors -> mosquitoes Reservoirs -> "immunologically naïve" birds Humans - dead end hosts puddles, ditches, artificial ponds, toys, trash cans In infected areas only <1% of mosquitoes are infected and <1% of people bitten by infected mosquito get serious health effects Vector is culex pipens - larvae can overwinter No person to person transmission - possibly breast feeding, blood products, organ transplants, prenatal main reservoir is corvid birds - sparrows? Immunity - not sure enveloped one of the most deadly viral diseases - 100% mortality zoonoses. MC bite of rabid dog (also cats, foxes, raccoons, coyotes, skinks, bats). Body fluids Does not penetrate intact mucosal membranes Attach to nicotinic Ach ganglioside recetors at muscle/…

West Nile

Supportive only regular mosquito protection Remove outside water containers

West Nile Virus


Aggressive post-exposure prophylaxis is only hope for overturning clinical illness wound management immunization


Respiratory Enteric Orphan Viruses Reoviridae

Antigenic shift like Influenza A

Includes: Orbiviruses, Coltiviruses (Colorado Tick fever), Orthoreoviruses Non-enveloped (asymptomatic infections) Rotavirus - #1 cause of infant diarrhea Enveloped virus-like properties worldwide spread is fecal-oral. Respiratory? very contageous furniture, fomites, toys, hands Abs from mothers colostrum/milk (IgGs) --> only prevents infection for 6 months Antigenic shift (like influenza) Gastroenteritis Supportive treatment only. There is a vaccine. Bovine colostrum Probiotics MC tick borne viral disease in the USA (compare to Lyme disease and RMSF) vector --> wood tick (Dermacenter andersoni); reservoir --> squirrels/ chipmunks. Hosts are humans. Western/NW USA and Canada - sping/ summer/ autumn unlike other tick diseases, coltivirus must enter the bloodstream quickly - must remove ticks quick! Orthopoxvirus: Variola (smallpox) Mollscipoxvirus: Molluscum contagiosum one of the largest, most complex viruses double layered envelope Last reported case --> Oct 1977 in Merca, Southern Somalia considered bioterrist threat Infects RBC precursors. Survives in mature RBCs leakage --> hemorrhage --> hypotension --> shock Colorado Tick fever No treatment. Prevention - same as for other tick borne diseases


Like cholera toxin (NSP4 protein) watery diarrhea --> severe dehydration


Smallpox Ecthyma contagiousum (Orf) Molluscum contagiousum

Smallpox Vaccine: live vaccinia (modified copox). Side effects: vaccinia necrosum.


Unlike other viruses - pox viruses Kills only 30%. Is very infectious. Aerosol contain all the necessary information stable, small infectious dose. Immunologically for their own DNA and RNA synthesis naïve population. No effective treatment

Scrapies-like agent


Molluscum contagiosum and other pox viruses are zoonoses - STD, fomites, wrestling, rugby Orf - occupational hazard for sheep/ goat farmers. prions (proteinaceous infectious Transmissible neruogenerative disease to a very closely associated with normal sporadic Creutzfeld-Jakob disease, particles) variety of mammals human protein PrPc variant CJD filterable (size of viruses) but no DNA Some variation of PrPc that might be Sporatic Creutzfeld Jakob disease or RNA actual infective agent get aggregates of protease resistant Creutzfeld-Jacob disease - variant very resistant hydrophobic glycoproteins in plaques/ form fibrils in CNS bind same glycoprotein Ig family naked capsid virus = stable isolated from himan edenoid cell culture Pharyngitis receptor as Coxsackie B virus Spread fecal-oral, poorly chlorinated swimming Used as a vector for gene therapy Atypical pneumonia pools help stimulate bone growth Cause: lutic infections, latent infections, only human to human spread conjunctivitis transforming infections Most infections are asymptomatic Gastroenteritis Genus: papilloma a) cutaneous: verucca (warts) b) mucosa: genital, Naked capsid virus oral, conjunctival papillomas, cervical CA Through breaks in skin and mucosa cause lytic, chronic, latent or transforming infections Common glat wart (verruca plana or verucca vulgaris)

Gene replacement therapy vectors for treating CF…

Human papilloma virus (HPV)

transformation occurs bc proteins transferred by fomites - direct contact into small bound by HPV16&18 bind tumor breaks in skin/ mucosa suppressor molecules Also infected birth canal (STD transmission)

Oral papillomas Laryngeal papillomas Condyloma acuminata (anogenital warts) Cervical dysplasia and cervical CA

PARASITIC INFECTIONS Protozoans: ameoba (= change). 2 stage lifecycle: 1) trophozoite (Active/infectious stage) 2) cyst stage. MC fecal-oral transmission. Sanitation KEY. LAB DX: culture is not important (unlike bacteria). Need to know lifecycles - know where and when to sample. Stool samples. Difficult because eukaryotes (like fungi). Multiple develepmental stages

Usually organisms are acquired over time chronic infections

Not highly virulent

Repeated exposure

Immunopathology - can cause all 4 types of hypersensitivity Exposure/entry: MC'ly exogenous. Compromised skin integrity. Exception is toxoplasma - can enter transplacentally Large inoculum size. Exception is malaria. Adherence: non-specific (e.g. Giardia). Specific (e.g. E. histolytica) Temperature specific replication toxins: not nearly as toxic as bacterial toxins Helminths: damage is due solely to size, movement and longevity/ persistence Evade host immune system for disease process to be maintained ST acid induces change to pathogenic trophozoite Destroyed by ambient O2 levels infect blood/ tissues

Entaemoeba histolytica

MSM - men having sex with men Endemic in the US


killed by oxygen in the environment - ozone treatment?

•microbe present in cat feces
Toxoplasma gondii fecal-oral spread 1) improperly cooked contaminated meat/ meat juices 2) contaminated soil 3) contaminated cat feces Worldwide zoonotic Cryptosporidium parvum Waterborne- resistant to usual water purification (MC) Fecal- oral Oral-anal: MSM (Flagship in AIDS) Worldwide sylvatic (wilderness): Beavers and muskrats are local reservoirs contaminated water: resist chlorination (unlike Entamoeba but like Cryptosporidia) person to person spread via fecal-oral or oralanal practices Urogenital protozoan Monomorphic- no cyst stage MC protozoal disease in developed nations Worldwide STD M/C helminthic infection worldwide Eggs are very hardy Ingested infected egg - develops into larval worm that penetrates duodenal wall hatch in SI to become infective Characteristic egg shape: flattened on one side proliferates and then is coughed up and swallowed bite from infected mosquitoe: migrate to lymphatics chronic symptoms are due to: physical blockage of lymphatic vessels

Pregnant women: avoid undercooked meat, wear heterophile negative mononucleosis gloves when gardening, avoid like syndrome exposure to cat feces chorioretinitis

congenital disease


Prevention: Concentrated chlorine/ filtration

Flagellated protozoa: unlike amoeba, move by flagella Giardia lamblia

ST acid induces changes to trophozoites Very rarely spread beyond the GIT no tissue necrosis

"beaver fever"

safe water practices when wilderness travelling

Trichomonas vaginalis Roundworms! Ascaris lumbricoides Nematodes pinworms Enterobius vermicularis Hookworm Necator americanus Wucheria bancrofti Filariasis


Trichomonas Bowel obstruction/appendicitis Pneumonitis Pinworm clinical disease tx. Ascaris first

Fecal-oral auto-inoculation Transmission is direct contact with contaminated soil or ingestion

Hookworm clinical disease

Lymphatenitis Elephantiasis

mosquitoe control

Can live in pork Trichinella spiralis

Larvae (infectious); live in striated muscle Ingest infected meat (encysted larvae, 2 day incubation --> enter many different new muscle sites infectious when ingested by new host suckers and crown of hooklets All are hermaphroditic No digestive system ingests pork muscle containing a larval worm (cystericercus)

T. spirales clinical syndrome

cook pork/ polar bear until interior is gray

rarely symptomatic - M/C’ly only aware of infection when seen in feces Insufficiently cooked pork - characteristic proglottid structure Cestodes (Tapeworms)

cook pork/ polar bear until interior is gray

Human infection with larval stage of T. appearance of calcified cysticerci in solium soft tissue Cisterocercosis

fecal-oral transmission

Iff viable larvae: host reaction is minimal Iff death of larvae: release increased Ag material. marked inflammatory reaction

M/C’ ly fecal- oral transmission but also autoinfection insufficiently cooked beef Taenia sanginata Will not cause Cisterocercosis (unlike T. solium) one the M/C cestode infections in the USA Adult tapeworms are ingested by humans in rare/ insufficiently cooked beef Diphyllobothrum latum Fish tapeworm one of the longest tapeworms raw, undercooked, fresh water fish containing ribbon-like larval worm (sporganum) in flesh Increased risk with dumping raw sewage in to fresh water lakes obligate intravascular parasites Schistosomes develop in intrahepatic portal system or in vesical, prostatic, rectal and uterine plexuses and veins Host response to eggs: intense, inflammatory reaction Larvae inside eggs produce enzymes; aide in tissue destruction Shitstomiasis Clinical disease avoid ingestion of insufficiently cooked fish cook beef fully control disposal of human feces

skin penetrating cercariae liberated from snails

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 West Nile Virus Mycoplasma pneumonia Mycoplasma pneumonia Mycoplasma pneumonia Mycoplasma pneumonia Mycoplasma pneumonia Mycoplasma pneumonia Mycoplasma pneumonia Mycoplasma pneumonia Ureaplasm urealyticum Ureaplasm urealyticum Mycoplasma hominis Orthomyxoviridae Orthomyxoviridae Orthomyxoviridae Orthomyxoviridae Orthomyxoviridae Polio Polio Polio Polio Polio Coxsackie A Coxsackie A Coxsackie A Coxsackie B Coxsackie B Coxsackie B Coxsackie B (echo and entero) Rhinovirus Alpha/Flavivirus Alpha/Flavivirus Alpha/Flavivirus Alpha/Flavivirus

Respiratory Respiratory Respiratory Skin Skin Ear Hematopoetic Systemic Urinary Urinary Urinary Respiratory Respiratory Respiratory Systemic Systemic Systemic Systemic Muscular / Neural Muscular Mouth Skin Eye Respiratory Cardiac

MILD URI/pharyngitis

Signs and Symptoms
Symptoms similar to RSV, group A strep

DDX and Lab Dx
Most difficult pathogenic organisms to grow (fastidious growth). "Fried egg colonies". Cold agglytination

Respiratory Respiratory Systemic Systemic Systemic

Acute tracheobronchitis Persistant dry cough that might become paroxysmal "Walking pneumonia", "Eaton's agent" Prolonged, mild form of pneumonia. Initial symptoms "non specific". Increases C XRAY before symptoms felt pneumona in severity over a few days. Hypersensitivity syndrome (vasculitis). Bulls-eye lesions, associated with Erythema multiforme HSV. Stevens-Johnson Syndrome Severe, sometimes fatal, bullous form of erythema multiforme OM Common Hemolytic anemia auto-immune destruction of RBCs Meningitis, pericarditis KI stones Produce urease Urethritis no progression to PID (non gonococcal). Might be asymptomatic can lead to pyelonephritis or to PID. Colonization increases with sexual Urethritis activity Usually symptomology and community Abrupt onset of fever (38-41C for 1-5 days). Non-productive cough, severe Influenzae A history of outbreak is enough for myalgia, rhinorrhea, anorexia diagnosis Influenzae B Milder, more GI symptoms Secondary Bacterial pneumonia In young children Encephalopathy Reye Syndrome Linked to ASA Asymptomatic Most common (90%). Limited to oropharynx and GIT. Abortive non-specific febrile illness. Non-paralytic poliomyelitis Symptoms of abortive poliomyelitis as well as aseptic meningitis Spinal paralytic: asymmetric flaccid paralysis in one or more limbs, no sensory Paralytic loss. Bulbar: affect cranial nerves or medullary respiratory center (75% mortality) Deterioration of affected muscles (or previously non-affected muscles) later in Post polio syndrome (PPS) life (10-40 years later) without presence of virus. Enterovirus lab dx: CPEs on monkey Coxsackie A and echovirus (not Hsv). No external skin lesions --> unlike Herpangina KI tissue culture. RT-PCR in CSF/ hand-foot-mouth disease. Self limiting. White lesions inside mouth other fluids. Caused by Cosdackie A16. Mild febrile disease with vesicular lesions on Hand-foot-mouth disease hands, foot, tongue Acute hemorrhagic conjunctivitis Extremely contagious "devil's grip" --> severe pleuritis chest pain --> unilateral intercostal myalgia -Pleurodynia (Bornholm's disease) > "stich-like pain" MC in adult males. Mistaken for MI. Children - sudden unexplained heart Myocarditis/ Pericarditis failure IDDM possible link if Cosxsackie B infects pancreas Aseptic meningitis # 1 cause is echo virus Lab not necessary. Characteristic rhinorrhead (clear, waterty -> purulent/ mucoid iff secondard bacterial Common cold - coryza CPE in himan diploid fibroblast cells at infection) 33C and acid labile Flu-like syndromes Serology: problem: false +, RT-PCR Meningitis/ encephalitis West nile Hepatitis, hemorrhagic fever, shock, Dengue fever/yellow fever viral arthritis Jungle fever, Aedes aegypti mosquito. Not contagious - no person to person Yellow Fever spread. 3-6 days incubation, then organ pathology. Jaundice, haemorrhage, encephalitis is rare. Dengue (break bone) Fever Aedes aegypti mosquito. Primary infection --> bone pain. Dengue hemorrhagic shock syndrome Hypersensitivity reactions --> weaken, rupture vasculature. No bone pain. West Nile most infections are mild or sub-clinical. Febrile disease of sudden onset. 1% chance of encephalitis. Long incubation phase: asymptomatic. Delay is important for treatment. Prodrome: retrograde axoplasmic flow and dorstal root ganglia. No detectable Abs. ..................Neurologic phase: travel to infect brain/encephalitis. Hydrophobia, aerophobia, hyperactivity, aggressiveness, "furius rabies" (death in 1 week). "Dumb rabies" - progress to death by cardiac ......Then back down to salivary glands (where is its spread) 48 hr incubation --> sudden onset of severe vomiting (progectile), watery diarrhea, fever, dehydration. Selt limiting. Not distinguishable from other types of gastroenteritis (Norwalk virus, bacterial) by signs and symptoms Fever (biphasic). Maculopapular/petechial rash (like RMSF). Hemorrhage --> hypotension --> shock (like dengue fever) ELISA anti-WNV Once there is evidence of infection (symptoms or Abs) it is too late for effective intervention. Post mortem Negri bodies. Diagnosis via stool samples - looks like a wheel!





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Rotavirus Coltivirus

GI Systemic

Gastroenteritis Colorado Tick fever





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Poxviridae Poxviridae Scrapies-like agent Scrapies-like agent Adenovirus Adenovirus Adenovirus Adenovirus HPV HPV HPV HPV HPV Entaemoeba histolytica Toxoplasma gondii Toxoplasma gondii

Skin Skin Systemic Systemic Respiratory Respiratory Eye GI Skin Oral Oral Reproductive Reproductive GI Systemic Eye

Ecthyma contagiousum (Orf) Molluscum contagiousum Sporatic Creutzfeld Jakob disease Creutzfeld-Jacob disease - variant form Pharyngitis Atypical pneumonia conjunctivitis Gastroenteritis Common glat wart (verruca plana or verucca vulgaris) Oral papillomas Laryngeal papillomas Condyloma acuminata (anogenital warts) Cervical dysplasia and cervical CA Amebiasis heterophile negative mononucleosis like syndrome chorioretinitis

variola is inhaled (4-19 days asymptomatic and not contagious). Prodrome (24 days). Skin rash (most contagious) Think opaque fluid filled center with "belly button-like depression in center". Infectious until all scabs fall off. Unlike chicken pox, in smallpox all the lesions are at the same stage at the same time. Direct contact with sheep/goats, soil? Contagious pustular dermatitis. In immunocompromised. Fleshy, pearl-like umbilicated nodules with central caseous plug. Long incubation (up to 30 years) but rapidly fatal once symptomatic (MC only 1 year). Rapidly progressing dementia. Most common after age 70. Some genetic susceptibility. Young onset --> mean is 27 years of age. Psychiatric/ sensory symptoms. Dementia at final stage only - unlike sporatic CJD. Detect PrPSc in follicular dendritic cells (lymphoid tissue) mild URI with fever, rhinorrhea and cough. #4 on viral respiratory diseases. #1: RSV, #2: parainfluenza #3: Rhinovirus pertussis-like illness Associated with swimming pools, dust/ debris. 2nd only to rotaviruses as cause of acute gastroenteritis in children MC on hands and feet. Surface is studded with black dots. Plantar is painful because it grows on pressure points MC epithelial tumor in the larynx. Infected birth cana. Hoarseness or abnormal cry. HPV 6 & 11. HPV 6 and 11. STD, vaginal birth, or ?. Rarely regresses spontaneously. 2nd MC canver in women in USA. HPV 16 & 18. Need cofactors to progress to CA

MC clinical only.

Characteristic skin lesions. Molluscum bodies on biopsy. Not cultivated in lab, no Abs producted, normal CT scan, normal MRI, abnormal EEG Strong lab and epidemiological evidence of link to BSE Similar to owl's eye inclusion body (in CMV). Increased CRP (unique to viruses --> similar to bacteria)

PAP smear - presence of Koilocytes. Topical 5% acetic acid.

Colitis with diarrhea and/ or many bloody stools. LV abscesses. Can have Stool examinations - multiple stool asymptomatic carriers. Failure to thrive in kids. samples (3-5). DDX UC, shigella


Toxoplasma gondii


congenital disease

iff 2nd or 3rd trimester: microencephaly, chorioretinitis +/- blindness, anemia, jaundice, neurological signs (retardation, seizures, microencephaly, hearing loss). Can be asymptomatic at birth and develop disease months to years Microscopy of biopsy sample. later. One of the major cause of encephalitis in AIDS. One of the TORCH agents. three consecutive stool samples: Un-concentrated (HIV/ AIDS) or concentrated (centrifuge, etc.)


Cryptosporidium parvum



Iff immunocompromised (HIV/AIDS) --> Severe diarrhea


Giardia lamblia


"beaver fever"

1) Asymptomatic carriers- 50% 2) Symptomatic: range from mild diarrhea to severe mal-absorption DDX: Isospora belli in HIV/ AIDS syndromes. 1-4 week incubation and then sudden onset of: foul smelling, watery diarrhea, abdominal cramps, flatulence and steatorrhea 1) Females: M/C’ly asymptomatic or profuse frothy vaginal discharge 2) Males: M/C’ly asymptomatic Concentrated stool - knobby coated, bile stained, oval egg Adult worm in feces (20- 35 cm long) Asthma-like attack Iff allergic to worm secretions:Enterobiosis (oxyuriasis): severe pruritis skin reaction/ rash at site of entry. If progress to LU --> pneumonitis. Iff large amount of adult worms: microcytic hypochromic anemia Thickening/enlargement of tissues, esp extremities if many migrating --> splinter hemorrhages, persistent fever, GI distress, periorbital edema. Iff >1000 to 5000 larvae/ gm tissue - Can be lethal. low serum levels of Vitamin B12 --> megaloblastic anemia Immediate and delayed hypersensitivity reactions. Katayama syndrome. Chronic stage: hepatosplenomegaly with portal HT and hematemesis. retained eggs cause extensive inflammation and scarring encysted larvae in implicated meat bile stained, operculated egg with knob-like projection on posterior Characteristic eggs in stool and urine Anal swab/ tape with sticky surface, Rarely see eggs in stool Characteristic eggs in stool Nocturnal periodicity


Trichomonas vaginalis




Ascaris lumbricoides


Bowel obstruction/appendicitis

62 63 64 65 66 67 68

Ascaris lumbricoides Enterobius vermicularis Necator americanus Wucheria bancrofti Wucheria bancrofti Trichinella spiralis Diphyllobothrum latum

Respiratory Skin

Pneumonitis Pinworm clinical disease Hookworm clinical disease Lymphatenitis Elephantiasis T. spirales clinical syndrome Clinical disease

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