Respiratory Tract Infections (Parasites)

Dr. Tulika Mishra (Ph.D)

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 Parasitic infections of lung
 Ascaris (Transient pneumonitis)
 Schistosoma (Mild respiratory symptoms)
 Wuchereria, Brugia (Tropical Pulmonary Eosinophilia)
 Ascaris, Strongyloides (Pulmonary eosinophilia)
 Echinococcus granulosus (Pulmonary hydatid cyst)
 Paragonimus westermani (Chest pain, breathing difficulty,
bronchopneumonia)
 Entamoeba histolyitca (Rarely involve lung)
 Ascariasis

• Causative agent: Ascaris lumbricoides (Roundworms)

• Infection can occur : accidentally ingesting the eggs of the A. lumbricoides roundworm.

Coughed Out whole mount of

• Intestine-----blood stream----lungs------throat eggs from Ascaris lumbricoides

Swallowed

• Who is at risk? Poor Hygine

• Symptoms: Coughing, Shrtness of breath, Aspiration pneumonia, blood in mucus, Chest discomforet, Fever

• Diagnosis: X-ray, Ultrasound

• Treatment: Albendazole, Ivermectin, Mebendazole

 Schistosomiasis
Causative agent: cercariae (Develop in freshwater snails), Contaminate water around them

Skin exposure to fresh water infected with parasitic worms-----Schistosomiasis

Africa, South America, parts of Asia and the Caribbean

Eggs----Skin-----worms----residence in human blood-----lung, liver

Egg with terminal spine

Symptoms: fever, chills, muscle aches, dry cough, enlarged liver or spleen, dry cough, wheezing, shortness of breath, myalgia,
abdominal tenderness and headaches
Parasitic load higher ------granuloma formation and fibrosis around the schistosome eggs
(Lungs)
Katayama fever is a Acute clinical manifestation 
Acute Eosinophilic Pneumonia- severe clinical  manifestation

Diagnosis: Microscopic examination (Blood, urine), CT Scan (Sever)---small nodular lesions

ELISA- TNF, IL-1,IL6)

Treatment: Praziquantel
 Pulmonary amebia
sis

 Causative agent :Entamoeba histolytica

 Trophozoites can cross the intestinal mucosa and through the bloodstream reach liver, brain and lungs
 Fever, RUQ/chest pain, cough and hemoptysis , pleural effusion and basal pulmonary involvement
 “anchovy sauce-like” pus
 Pulmonary amoebiasis can be diagnosed by the presence of trophozoites in the sputum or pleural fluid
 Serum antigen or antibody detection (IHA) are highly sensitive
 DOC : metronidazole or tinidazole, paromomycin
 Toxoplasmosis
 Causative agent: Toxoplasma gondii
 Pneumonia, with or without fever, is also frequently reported as a manifestation of toxoplasmosis in liver transplant patients

 Cough, dyspnea, hypoxia, and diffuse bilateral or localized infiltrates

• Weak Immune system- Fever, Swollen lymph nodes, headache

muscle aches and pains, sore throat
Pulmonary infection- Dry cough, fever, shortness of breath
Others -----encephalitis and eye infection
Congenital toxoplasmosis may appear normal at birth
Later Mental disability, hearing loss, blindness
 Serologic testing :presence of T. gondii–specific IgM antibodies by ELISA

 PCR in Bronchoalveolar lavage or peripheral blood

 Histological examination with Wright Giemsa stain of sputum or BAL

 DOC : pyrimethamine/sulfadiazine/folinic acid

MILD CASE : Self-limiting

Hydatidosis/ Pulmonary echinococcosis

 Causative Agent: Echinococcus granulosus

 E. granulosus and E. multilocularis
 cough, fever, dyspnea, chest pain compression of adjacent tissue by the HYDATID cyst.
 Rupture of the cysts into a bronchus may result in hemoptysis
 Expectoration of cystic fluid containing parasite membrane and can cause anaphylactic shock,
respiratory distress, asthma-like symptoms, persistent pneumonia
 Sepsis rupture into the pleural space results in pneumothorax, pleural effusion and empyema
 Antibody detection remains as the only supportive diagnostic method

Hemoptysis: coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs.
 Strongyloidiasis

 Causative agent: Strongyloides stercoralis

 Strongyloides stercoralis has worldwide distribution but more common in South America,
South-East Asia, sub-Saharan Africa and the Appalachian region of the United States
 Pulmonary symptoms include cough, shortness of breath, wheezing and hemoptysis
 In patients with disseminated strongyloidiasis, Gram negative septicemia, pneumonia, and
meningitis
 Pneumonitis is common, with cough, respiratory failure, and diffuse interstitial infiltrates or
consolidation on radiographs
 The parasite can be visualized in respiratory secretions
 Ivermectin : DOC
• Tropical Pulmonary Eosinophilia (TPE)
 Syndrome that results from an immunologic hyperresponsiveness to filarial parasites,
Wuchereria bancrofti and Brugia malayi
 Characterized by cough, dyspnoea and nocturnal wheezing, diffuse reticulonodular
infiltrates and marked peripheral blood eosinophilia
 Sputum is usually scanty, viscous and mucoid, often shows clumps of eosinophils, Charcot-
Leyden crystals are rarely observed Hallmark of TPE is leucocytosis with an absolute
eosinophillia

• Loffler’s syndrome
 Unilateral or bilateral, transient, migratory, nonsegmental opacities of various sizes in the
setting of parasitic infections usually described in patients with pulmonary Ascaris
infection
 Leucocytosis, particularly eosinophilia, is an important laboratory finding
 Larvae can sometimes be demonstrated in respiratory or gastric secretion
 Nematodes such as Ascaris, Strongyloides and the hookworms (Ancylostoma duodenale and
necator americanus) which migrate through the lungs as they move to the small intestine.
 Break out of the capillaries around the alveoli to enter the bronchioles.
 The damage caused by this process, and the development of inflammatory responses, can
lead to a transient pneumonitis with cough, wheeze, dyspnea and pulmonary infiltrates.

 Schistosome larvae, which may cause mild respiratory symptoms as they migrate through the
lungs

  P. westermani (the oriental lung fluke)

  after eating an infected raw or undercooked crab or crayfish
 Pulmonary symptoms begin approximately 6 months after infection and are often mistaken
for symptoms of tuberculosis