Eosinophilia
-eosinophils > 5%
-tissue invasion with larvae
-Th2 response: Il4, Il5, Il13
cestoda—tapeworms
-no free living
-no separate sexes
-segmented
-tegument
-no cavity
-no GI tract
-ribbon or band shaped
scolex- the “head”
rostellum
hooks
4 suckers
-strobila—string of proglottids (segments)
d. latum
taneia saginata- 4 suckers
taenia solium -suckers w. hooks
-ADULTS in intestine—NO clinical effect
PATHO- damage caused by larve penetrating through intestinal wall
DIAG- eggs or proglottids in feces
Flukes
-no free living
-tegument
-no body cavity
-GI tract with no anus
diphyllobothrium latum
-fish tapeworm
sx-
· epigastric pain
· nausea
· vomiting
· occasional intestinal obstruction
· diarrhea
· abdominal pain
· megaloblastic anemia
o impairs absorption of B12
intermediate hosts: water fleasà fish
def host- human, fish eating mammals
transmit- eat fish (larvae)
-passed in human feces
geo: north america, europe, soviet union, asia, chile
ADULTS in intestine—NO clinical effect
PATHO- damage caused by larve penetrating through intestinal wall
DIAG- eggs or proglottids in feces
· Operculated/flat eggs with knob on the bottom of the shell
Trt
· Niclosamide
· Prazyquantel
Double pore tape worm
definitive host: pet owners and children
-cats and dogs
intermediate host: flea (larvae)
Tramsit: ingestion of fleas with larvae
-passed in human and pet feces
-emerge from perianal area
sx
· abdominal discomfort
· anal puritis
· diarrhea
geo: world wide
DIAG- eggs or proglottids in feces
Trt: niclosamide
-prazyquantel
-ADULTS in intestine—NO clinical effect
PATHO- damage caused by larve penetrating through intestinal wall
Definitive host: humans and rodents
-dimunata
-nana
Intermediate host: fleas/beatles and humans
-nana
Transmit:
-eat fleas with larvaeà definitive human host
-eat feces with eggs à intermediate human host
-resevoir host: dogs, rodents
sx
-abdominal discomfort
-diarrhea
-abdominal pain
-restlessness
-irritability
-restless sleep
-anal purtitis
-nasal puritits
geo
hymenolepsis nana- worldwide
· Temperature regions: children and institutionalized groups
Hymenolepsis diminuta
· Southeast USA
DIAG- eggs in feces
Trt- prazyquantel
Definitive: human only
Intermediate: beef larvae in muscle
Cattle – eat grass with human feces
transmit: humans eat larvae in beef meat
SX
· abdominal discomfort**
o passage of proglottids through the intestinal tract
à appedicitis or cholangitis from migrating proglottid
geo: worldwide
diag: eggs in feces
adults are distinguishable
· beef – 4 suckers
· proglottids- MORE uterine branches
trt- prazyquantel
-pork/ham/bacon—SO SALTY! Like sodium
definitive host: human only
intermediate: pigs and HUMANS
transmit:
· eat pig meat with larvae
· eat our human feces
(pigs and humans)
geo: worldwide
-prevalent in poorer communities
SX
· abdominal discomfort**
o passage of proglottids through the intestinal tract
à appedicitis or cholangitis from migrating proglottid
-less frequently symptomatic than T saginata
diag: eggs in feces
adults are distinguishable
· pork– 4 suckers, hooks
· proglottids- thicker and less uterine branches in proglottids
trt: prozyquantel
tissue infection!
Trasmit: eat eggs in human feces
Sx-
-cysts = nodules
· calcified nodules in brain and mm
· subcutaneous nodules (MC)
· calcified nodules in mm (MC)
· ocular
· cardiac
· spinal lesions
· brain
o neurocysticercosis
o seizures
o mental disturbances
o focal neurologic deficits
o space occupying intracerebral lesions
Geo: california
Diag:
· antibody detect
o immunoblot (western blot)
· biopsy
· CT scan
· Eosinophilia
Trt
· Surgery : removal of the cysts
· Albendazole or mebendazole + steroids
· Anticonvulsant drugs when needed
If asymptomatic- will subside 2-5 yrs
· Do not treat
Hyatid worm
[HUMANS not the defininitive HOST]
definitive host: dogs
intermediate host: human and livestock
transmit: eat dog poop – feces
· vegetables and fruits with feces on it
sx
· LATENCY ~ silence for years
· [Cysts in organs]
· Hepatic- abdominal pain, mass in hepatic area, biliary duct obstruction
· Pulmonary- chest pain, cough, hemoptysis
· CYST RUPTURE- fever, hives, eosinophilia, anaphylactic shock, cyst dissemination
Geo- worldwide (sheep farms, grazing lands where dogs run free and eat sheep viscer)
-e multilocularis in the Northern hemisphere
· definitive host: fox, intermediate host: rodent
diag
-antibody detection
-ultrasound or other imaging and serology
-seronegative and biopsy
treat
· surgery
o danger: ruptured cyst
§ release of antigen to cause shock
§ release of protoscolicesà new cysts
· albendazole or mebendazole
o to keep cyst from reoccurring
· dogs - prazy
Flukes
-no free living
-tegument
-no body cavity
-GI tract with no anus
fluke life style
water
1) eggs in feces/urine/sputum hatch in water
à motile micracidum
snails (obligate host)
2) motile micracidum infect snails
à sporocyst/ redia (amplification)
released from snail à motile cercaria
water
3) motile cercaria ---INFECTIVE
àhuman à Adult
(schistoà waterà adult)
OR
àvegetation or secondary intermediate hostà meta cercaria ----INFECTIVE
(lung flukeàshellfishà human)
(liver flukeà vegetation àhuman)
à humanà adult
Shistosomiasis—BLOOD FLUKES
Schistosome life cycle
à penetrates skin
à loses tail and becomes a shistosomulae
à circulation à portal blood à liver à matures into adult/ mates
à lay eggs in mesenteric vein/ bladder veins
s. mansonià mesenteric veins
s. japonicumà mesenteric veins
s. haematobiumà veins of bladder
à NOT in the US
- Separate sexes
in Human
-adults life 20-30 years
-eggs migrate into intestinal lumen or bladder (feces/urine)
· produce proteases for tissue migration
-pathology: autoimmune response to eggs trying to get out of host
· 50% of eggs die within host and also trigger IS
· eggs leave thru feces, urine, sputum in water
transmission: water born motile cercaria
-DIRECT skin penetration (via HA)
-tegement takes up host components of RBC antigens, HLA, Ig
· cercariaà schistosomulum (in human ~2d)
· after enters skin searches for blood vessels and antigen coating
· immature schistosomes feed on plasma
· migrates through vessels of lungs to liver where ADULTS MATE
Patho
-release halo of NO, PG, LT to vasodilate and so it can move through vv
-inhibits phagocytosis
-molecular mimicry
-covers themselves in ABO Ag/ RBC membrane
Eggs that die in tissuesà
-egg induced granuloma
Liver migration and drug
· Noxious stimuli à out of vasculature àLIVER MIGRATION and surrounds itself with cytochrome p450 so liver detoxifies the drug
-they mate for years
SX
-live for 20 years
-eggs produced for over 10 years
-see clinical symptoms years later when eggs have been built up and died AND also by eggs that are trying to get out
Schistosoma mansoni and S. japonicum
· liver fibrosis
o symmer’s clay pipestem fibrosis- fibrosis of all large vv of liver
· portal hypertension with collateral circulatoin
· ascities
· esophageal varices
· vomiting blood
shistosoma haematobium (bladder fluke)
· hematuria in early disease
· fibrosis of bladder
· obstructive uropathy (granulomas)
· renal failure and hydronephrosis
· bladder carcinoma
-egg in urine/feces
Diag
Eggs in feces or urine
Immunodiagnosis: ELISA, IFAT, RIA, IHA (indirect hemoagglutination)
spike on side spine on end
trt
-praziquantel (PZQ) and oxaminiquine
Vaccine
· target the schistosomulum
· enzymes to penetrate the skin
-low worm load may give minimal disease
-concomitant immunity- worms caused TH2 response were supressing pathology of malarial infection
· maybe use to suppress crohn’s disease?
-macrophages, eosinophils, neutrophils all involved **
-cercarial dermatitis
-speices in ducks that do not use ppl as host
-fail to form functional schistosomulum and die
-inflammatory reaction in skin
· small red spots in 30 min
· inc in size 24-30 hr
· resolves 4-7d
Lung Fluke –paragonimus westermani
-cercaria releasted from snailsà raw undercooked shell fish, crap, shrimp (metacecarae) à humans
à tissue invasion à lung cavities (adults mature)
-eggs in sputum may be swallowed and then shed through feces
geo: korea, japan, taiwan, central china, phillipines
SX:
Acute (invasion and migration):
-diarrhea (shed through feces)
-abdominal pain
-fever, cough
-pulmonary abnormalities
-eosinophilia (DIAGNOSTIC)**
[acute liver: : diarrhea, abdominal pain, fever, vomiting, enlarged liver]
Chronic:
-pulmonary manifestations
· cough, discolored sputum--expectorated clusters of reddish brown eggs, not blood
-radiographic abnormalities (pseudeotubercules)
-may persist for 20 yrs
· patho related to inflam response and how many flukes
Diagnosis: eggs in stool / sputum (not present until 2-3 months after infection)
-persist for 20 years
Treatment: Praziquantel
Liver Fluke- fasciola
Transmission: consumption of raw/undercooked water vegetables; pig feces
Symptoms:
· Acute: diarrhea, abdominal pain, fever, vomiting, enlarged liver
· Chronic: intermittent blockage of the bile duct and inflammation
o MOST DIAGNOSTIC
Diagnosis: eggs in stool
Treatment: Praziquantel