Parasitology

E.vermicularis.*Will most likely present with anal pruritis.*Scrape-cotch test*Albendazole/Pyrantel pamoate

*Permetrhin Blocks Na channels thus is neurotoxic for the parasite.*Lindane is also neurotoxic agent but importantly it BLOCKS GABA channels.(Lady GAg(B)A)*Lindane is used only for Non-crusted scabies.

*Think of Hookworm like Ancylostoma duodenale/Necator Americanus in child who has Iron deficiency anemia and who plays outside without his shoes...*Treatment is Albendazole/Mebendazole(they love to test this)

*Well Fever,Anemia,SPLENOMEGALY,Headache are possible symptoms of all 3 causative agents however it is important to differentiate them(For test)*Vivax/Ovale cause fever every 1st and 3rd day-hence tertian with 48 hour cycle(Fever every 2 days), however most commonly tested fact about this species is that their Dormant forms in Liver(HYPNOZOITES) need to be killed by PRIMAQUINE and even more importantly patient should be tested for G6PD(Risk of hemolysis)*P.FALCIPARUM is MOST DEADLY, it causes irregular cycles of fever(Can be continuous,EVERY DAY) and Most importantly you should know that it can modify surface properties of Infected RBCs causing them to Lodge in small capillaries in KIDNEY,Lungs, BRAIN(CEREBRAL MALARIA).*P.malariae causes fever every 3 days(Quatrant fever).

<What form is that?That is SCHIZONT form that contains Meorozoites(Capable of initiating new sexual/asexual cycle of development)P.Vivax/Ovale are characterized by Schuffner Stipling(Basically RED granules) in RBC cytoplasm.

*inhibitor of (Plasmodium)HEME Polymerase known as Chloroquine is the first line.*Chloroquine and Primaquine(Kills liver Hypnozoites) are used for Prophylaxis too-when you travel to areas where you might get it.*For resistant forms you should use MEFLOQUINE, Atovaquone/Proguanil.*For Life-threatening conditions you should you IV QUINIDINE(Class IA antiarrythmic) or ARTESUNATE(Dr.Lionel mentioned that its mechanism has been tested and that is Inhibition of Endoplamic Reticulum ATPase-thus inhibiting metabolism of Falciparum)<VERY Important,testable fact is that before you give these drugs(Esp. artesunate,primaquine)you should test patient for G6PD as you increase risk of Severe hemolysis with those drugs, they love to ask about primaquine.

*HEMOLYTIC anemia and Fever can be due to Babesia which can be transmitted by Ixodes tick which also transmits Spirochette-Borrelia Burgdorferi(Our patient likely has Lyme's disease), so yea BB and Babesia have Same VECTOR.*You should know that ASPLENIC patients are especially susceptible to Babesiosis.*Remember Babesia can have Ring form(Don't confuse with P.ovale),but more characteristically babesia results in "MALTESE CROSS"in infected RBCs, <DIAGNOSTIC, this cross is made by 4 MEROZOITES which are asexually budding but are attached to each other.*PCR can be used for diagnosis too.*TREATMENT:ATOvaquone +AZIthromycinMacrolide) or Quinine +Clindamycin.

*The ability to Form Cysts which can survive harsh environments, that's the reason why Trichomonas Vaginalis can't survive outside the host and is only STD.Remember trichomas is transmitted in in Motile Trophozoite form.

*FOUL-SMELLING, GREEN DISCHARGE is characteristic for vagiNITIS caused by Protozoa-T.Vaginalis(Contrast this with Fish smelling discharge in Vaginosis causes by Gardnerella vaginalis-Gram variable bacteria which is NOT SEXUALLY TRANSMITTED DISEASE while T.Vaginalis IS STD.

*Patient likely KISSED REDUVIID BUG and the kiss is obviously PAINLESS(TESTABLE),at this site of the kiss this reduviid bug basically shitted and infecfted our kisser with T.Cruzzi.MEGAColon,MEGAEsophagus(Both due to destruction of Aurbach's=MYenteric plexus)and Systolic HF due to DILATED cardiomyopathy(important to note that APICAL atrophy is characteristic)*Very important:Trypomastigotes have flaggella and are motile(In the BLOOD) while Amastigotes are immotile forms with No flaggela that grow and divide inside the Tissues.*NIFURTIMOX kills both forms and is often tested as treatment, however pick Benznidazole if it is not present in answer choices.*You diagnose this condition by visualization of TRYPOmastigotes in blood(Pic)

*Leishmenia Donovani is transmitted by SANDFLY and MOST COMMONLY just manifests with HYPERPIGMENTATION of Skin,SELF-HEALING Ulcers-the Cutaneous form is more common.*However Visceral form(Kala-azar) is often tested here you get HEPATOsplenomegaly+Spiking fever and most importantly PANCYTOPENIA.*Treatment:AmphotericinB but more commonly tested one is SODIUM STIBOGLUCONATE.*If they ask about Treatment which can be teratogenic pick Miltefosine.*Remember Sandfly can also transmit Bunyaviridae(Single stranded-,ENVELOPED,Circular RNA virus with helical caspid and 3segments)-can cause fever,myalgia,increased LFT.

*You confirm diagnosis by MUSCLE BIOPSY - TRICHENELLA SPIRALIS (CYSTS) larva migrate to striated muscle and lodge there as cysts, you are likely to find Eosinophilia, but most importantly remember PERIORBITAL EDEMA(Migrating Larvae). *This thing can cause Splinter hemorrhages, so be careful.*Trichinella spiralis is Roundworm(NEMATODE)-Treat with bendazoles.

**Very HY organismthey love to give you patient + for HIV with CD4 count less then 100 and show you MRI with Solitary RING ENHANCING LESIONS.*Another vignette would be about Congetinal TORCH(Can cross placentaLYMPHADENOPATHY, gives birth to a baby who develops CHORIORETINITIS,Hydrocephalus,Mental retardation,Hepatosplenomegaly,DIFFUSE CALCIFICATIONS in white matter,Deafness and BLUEBERRY MUFFIN Rash are possible manifestations too.*Important:MOST COMMON Route of transmission is Trough MEAT by forms of CYSTS.Oocysts in cat feces can be a source and hence pregnant women should avoid them.*Treatment is also HY: COMBO of PYRIMETHAMINE+Sulfadiazine.(Pyrimethamine blocks Dihydrofolate reductase, while Sulfa blocks Dihydropteroate synthase-so we get synergistic sequental block)

*Duffy protein is located on RBC s and is a receptor for various chemokines but also for P.Vivax, so they can ask you mutation in which of the following will render patient RESISTANT to P.vivax and answer would be DUFF PROTEIN.

*CRIBRIFORM PLATE is where NAEGLERIA FOWLERI can sneak in and invade your brain and it is famous for RAPIDLY FATAL MENINGOENCEPHALITIS.Even though Amphotericin B saved some patients, if they ask you about prognosis, they are most likely to DIE.