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 A group of teenage tourists visit Egypt and go swiming in the Nile. They notice that there are snails on the river bank. 5 weeks later one of they gets a fever, chills and his liver is enlarged (had he gone to the DR-eosinophilia was also present). Throughout the year he developed abdominal pain and portal vein HTN. Parasite? Intermediate host? Site of infection? What is required in order to produce pathogenic eggs? What major complication are you worried about? |
 Schistosoma Mansoni (slide: granuloma around egg) IH: Snail Site: mesenteric venules Must have a male and female worm present to produce eggs Rupture of collateral veins due to portal HTN, transverse myelitis (eggs in spinal cord) |
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Pt is in China (Hong KONG?) and goes swimming in a lake. 5 weeks later she get fever, chills, dysentery, headache, cough, eosinophilia, lymphadenopathy and hepatosplenomegaly. You examine her feces and see eggs. Ten years later she had cerebritis and cor pulmole cauing R-sided heart failure.
Parasite? What is the name of the pts initial syndrome? What major complications are you worried about? |
 Schistosoma Japonicum Initial syndromes: Katayama Complications: Right heart failure (due to cor pulmole), cerebritis |
 Pt in sub-Saharan Africa with hematuria, dysuria and calcification obstruction her bladder. She often washed clothes in the river. You do a fecal smear that shows the lancet egg below. To confirm you do and ultrasound. Parasite? Is this a common sp of the parasite? Complications? |
 Schistosoma Haematobium More of this infection that the other two schistosomes combine (all in Africa) Complications: Squamous cell carcinoma of the bladder, UTI, renal failure |
 Pt in Thailand eating undercooked fish. 3 weeks later he had fever and abdominal pain that went away. He had GI issues ever since. 30 years later he developed bile duct cancer. What is the group of parisites? |
 Clonorichis, Opisthorchis viverrini and felineus (Oriental river fluke) Oriental river fish in thailand stuffed with Opi-um will let you Live (r) with c(l)on man Richis |
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Pt is in china eating crab/crayfish. Later develops chest pain, hemoptysis, cough and TB-like pulmonary infiltrates.
What is the fluke? |
Paragonimus (lung fluke)
China's cray Crab will create para TB lung symptoms |
 Pt was recently in Peru and eat watercress and other freshwater vegetation. Developes RUQ pain and eosinophilia. What is the parasite? What damage does chronic infection cause? |
Fasciola Hepatica (western liver fluke (S america))
Chronic infection causes liver cirhosis. Infects liver. vector: lymaeid snail. ( all flukes use snal) |
 Family goes down to Mexico to get pork tacos. Everyone feel fine but then years later one of the family members develops severe muscle pains and a giant bump on his tounge followed by epilepsy and seizure. What is the parasite (CT shows?)? What was different about the one family member that developed muscle and neuro symptoms? If you HAD TO pick a species of this worm to ingest, which would you pick and why (I swear it’s a good question)? |
 Taneia Solium (Pork Tapeworm)- CT shows ring-enhances lesoin Cysticercosis and Neurocysticercosis only develop with human ingest the eggs of Solium. The rest of the family ingested encysted cysticerci and have asymptomatic tapeworm infections still, 25 yrs later. I would pick Teania Saginata (beef tapeworm) b/c it is asymptomatic (too bad I don’t like meat or Ethiopian food) |
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Sol goes fishing with the Inuits in Alaska. They catch fish and eat them raw. A year later Sol has pernicious, megaloblastic anemia and feel "something moving inside me."
What does sol have? Why the anemia? |
 Diphyllonothrium latum (Fish Tape worm) Anemia: worms use 80% of the B12 2 (di) phlly fishers in Alaska |
 This summer in Morocco you saw surgery on the liver of a sheep farmer. What was the parasite? Where stage infects humans and where does it migrate to? How do you diagnose? |
 Echinococcus granulosis Larval oncosheres migrate to the lung, liver and brain and form hydatid cysts Dx: with CT and serology Tx: surgury if cyst may rupture (causes anaphylactic shock) Other sp: Multilocularis: alveolar mutlilocular cyst Vogeli/oligarthus: polycystic |
