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NTD Flashcards

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1
Q

Schistosomiasis - definition/organisms

A

Water-borne parasitic infection with an intermediate host of freshwater snails. Two primary syndromes including intestinal (S.mansoni, S. japonicum) and urogenital (S.haematobium)

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2
Q

Schistosomiasis - geographical distribution

A

Mansoni - Sub-Saharan Africa and Brazil

Japonicum - China, Philippines, Indonesia

Haematobium - Sub Saharan Africa

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3
Q

Intestinal schistosomiasis clinical features

A

Diarrhoea, abdominal pain, blood in stool
Chronic inflammation can lead to intestinal strictures and obstruction, as well as liver fibrosis and portal hypertension

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4
Q

Urogenital schistosomiasis clinical features

A

Haematuria, dysuria. Chronic inflammation leading to contractures, hydronephrosis and squamous cell carcinoma of the bladder

Male/female genital schistosomiasis can cause STI symptoms like vaginal/bloody discharge and itch, pain during sex, infertility, increased risk of HIV

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5
Q

Acute (Katayama fever)

A

4-6 weeks later fever, urticaria, cough, abdominal pain

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6
Q

Schistosomiasis non-specific clinical features

A

Anaemia, growth faltering, reduced educational performance, cecariae dermatitis

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7
Q

Ectopic presentations of schistosomiasis

A

Transverse myelitis, pulmonary HTN and cerebral schistosomiasis

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8
Q

Schistosomiasis diagnostics - parasitological methods

A
  1. Stool microscopy - Kato-Katz (thick faecal smear)
  2. Urine microscopy - egg count, urine filtration and centrifugation
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9
Q

Intestinal schistosomiasis - diagnostics

A
  1. Stool microscopy
  2. Faecal occult blood/calprotectin
  3. Eosinophils + Hb
  4. Colonoscopy
  5. US liver
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10
Q

Urogenital schistosomiasis - diagnostics

A
  1. Urine microscopy
  2. Urine dip (haematuria)
  3. Urine antigen detection CAA (cannot speciate)
  4. Ultrasound and cystocopy
  5. Eosinophilia
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11
Q

Schistosomiasis - returning traveller approach to diagnostics

A
  1. Asymptomatic – wait for 3 months after last freshwater contact.
    - Serology for schisto antibodies
    - Blood count (Hb, eosinophilia)
    - 3 x MSU for RBCs/ova
    - 3 x stool for ova
  2. Febrile presentation
    - Exclude other life threatening illnesses
    - Will need repeat PZQ if diagnosis confirmed
    - Unclear whether steroids might be worth giving
  3. Symptoms e.g. haematuria/change in ejaculate
    Same as 1. and refer to Urology/Gastro/Gynae depending on symptom
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12
Q

Schistosomiasis - returning from an endemic area - approach to diagnostics

A
  1. Asymptomatic
    - Blood count (eosinophilia)
    - 3 x MSU RBCs/ova
    - 3 x stool for ova
    - Urine antigen detection CAA (most sensitive and can be used for all types, CCA for S mansoni)
  2. Symptoms or signs (e.g. haematuria, splenomegaly)
    Same as 1 and include onward referral to Urology/Gastro/Gynae
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13
Q

Schistosomiasis treatment

A

Praziquantel
Needs repeat as not effective against non-adult forms

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14
Q

Praziquantel in schistosomiasis - pros and cons

A

Pros:
- Safe
- Effective against all species

Cons:
- Only effective against adults
- Global shortage
- Requires second dose a month later
- Taste is horrible

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15
Q

Prevention measures in schistosomiasis

A
  1. MDA annually in endemic regions
  2. Improved sanitation (open defecation and urination)
  3. Snail control - mulluscicides, habitat modification
  4. Safe water provisions
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16
Q

Onchocerciasis - organism

A

Onchocerca volvulus parasite

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17
Q

Onchocerciasis - transmission

A

Transmitted by blackflies (Simulium damnosum and Simulium ochraceum). Females bite outdoors in the daytime

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18
Q

Onchocerciasis - life cycle

A
  1. Blackflybites host and delivers 3rd stage larvae into the skin
  2. Larvae mature into adult worms in the subcutaneous tissue (itching)
  3. Adult worms produce microfilariae which migrate through the skin and eyes. They die, leading to inflammation and pathology
  4. When a blackfly bites a human it ingests the microfilariae which move into the midgut then to flight muscles before moving on to the mouthparts
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19
Q

Onchocerciasis - clinical features

A
  1. Skin - itching and firm/painless subcutaneous nodules in the acute stage followed by skin atrophy and patchy depigmentation (leopard skin) chronically
  2. Eye symptoms including keratitis, anterior uveitis, secondary cataracts, optic atrophy and chorioretinitis.
  3. Neurological - epilepsy, nodding phenomenen
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20
Q

Ochocerciasis - diagnostics

A
  1. Skin snips with microscopy to see the microfilariae
  2. Ov16 ELISA test
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21
Q

Onchocerciasis - treatment

A
  1. Ivermectin - does not kill adult worms so often needs prolonged/recurrent treatment
  2. Doxycycline - kills the Wolbachia bacteria which is needed for worm fertility. Give a 4 week course for definitive treatment.
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22
Q

Prevention strategies in onchocerciasis (5)

A
  1. Community directed treatment with ivermectin (MDA)
  2. Vector control - insecticide and environmental management
  3. Health education
  4. Surveillance and mapping
  5. Cross-border collaboration
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23
Q

Challenges in eliminating onchocerciasis (7)

A
  1. Cross border re-invasion
  2. Treatment limitations (ivermectin does not kill adult worms)
  3. Co-infection with Loa Loa endemicity as ivermectin can be life-threatening
  4. Sustaining public interest and funding in the longterm
  5. Conflict zones
  6. Competing public health concerns
  7. Capacity building of expertise - public health, entomologists, laboratories
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24
Q

Baylisascaris procynosis - definition

A

A racoon round worm infection from old poo (not fresh).
Found in Europe, N.America, Japan

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25
Baylisascaris - clinical features
Human infections often asymptomatic but can cause visceral larva migrans, neural larva migrans and ocular larva migrans
26
Baylisascaris - treatment
Zap the eye with laser Albendazole Steroids in neurological diseases
27
Diffuse unilateral subacute neuroretinitis - definition and causes (5)
DUSN is caused by a live, motile nematode infecting the retina It primarily affects one eye and leads to inflammation, vision loss, and retinal damage if untreated - Gnathatoma - Thailand - eating raw fish/frog (drill head) - Angiostrongylus - America, Vietnam, Thailand, Hawaii - Toxocara canis, ancylostoma caninum (dog poo) - Strongyloides - Baylisascaris
28
Ciguatera poisoning - symptoms
Diarrhoea and vomiting within hours of ingestion Neurological symptoms 3-72 hours after ingestion (paraesthesia, metallic taste, hot/cold allodynia, reversible cerebellar dysfunction) Cardiovascular: Bradycardia, heart block, hypotension
29
Ciguatera poisoning - definition
Non-bacterial fish poisoning which can occur worldwide - especially Asia and Caribbean
30
Ciguatera poisoning - differentials
GBS, MS, organophosphate poisoning, botulism, scombroid, shellfish and pufferfish poisoning
31
Scombroid - symptoms
ALLERGY - Rash, palpitations, tachycardia
32
Shellfish poisoning - symptoms
GI upset, rapid onset pararesthesia and paralysis
33
Pufferfish poisoning - symptoms
Weakness (Na channel blockage)
34
Botulism - symptoms
GI upset, CN dysfunction, descending paralysis
35
Sea urchin injury - definition and treatment
Painful, visible puncture wounds Causes granulomatous inflammation 1. Hot water soak 2. Remove visible spines where possible 3. Cover with antibiotics (staph, strep, mycobacterium marinarum, aeromonas hydrophilia) and topical steroids
36
Phytophotodermatosis - definition
Contact dermatitis on the skin when certain compounds are exposed to sunlight. This reaction results in skin inflammation and can cause blistering, redness, and hyperpigmentation.
37
Cutaneous leishmaniasis (diagnostics)
Slit skin smear (Giemsa stain) and biopsy
38
Cutaneous leishmaniasis (types)
American (more aggressive) - L.brasiliensis/viannia, L.Mexicana Non-American - L.tropica, L.major, L.aethiopica
39
Leishmaniasis - treatment
Local 1. Intra-lesional antimony 2. Heating/freezing Systemic: 1. PO/IV miltefosine 2. IV liposomal amphotericin B
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Migratory rashes differentials
Gnathastoma spinigerum Sparganosis Cutaenous larva migrans Strongyloides sterocoralis Loa loa Eczema Phytophotodermatosis Trichinosis (raw pig)
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Gnathostomiasis - organism, geographical distribution and exposure risk
Gnathastoma spinigerum SE Asia, increasingly in Mexico Eating undercooked/raw freshwater fish which is the intermediate host
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Gnathostomiasis - symptoms
Acute Fever, urticaria, GI symptoms Chronic Migratory swelling, visceral (lung, GI, meningitis)
43
Gnathostomiasis - Treatment
Albendazole 3 weeks
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Gnathostomiasis - Diagnosis
Clinical Eosinophilia Serology
45
Leptospirosis
46
GBS infectious causes
Campylobacter, shigella, influenza, mycoplasma, HIV, covid
47
Visceral leishmaniasis case definition
Fever (>2 weeks) + splenomegaly + positive RDT
48
Visceral leishmaniasis - geographical distribution
South Asia, East Africa, Latin America
49
Visceral leishmaniasis - transmission
Vector: Sandfly - night biting females, can feel the bite. Reservoirs: Humans, dogs
50
Visceral leishmaniasis - clinical features and labs
Fever, splenomegaly, hepatomegaly, anaemia Weight loss, anorexia, cough, diarrhoea Labs: Hypergammaglobulinaemia, anaemia, leucopenia, thrombocytopenia, proteinuria and haematuria
51
What is PKDL?
Post Kala Dermal Leishmaniasis Non-fatal skin considition post visceral leishmaniasis
52
Diagnostics in visceral leishmaniasis
1. Gold standard: Microscopy of LD bodies in Giemsa-stained smears from spleen, lymphoid tissue and bone marrow 2. Slit skin smear in PKLD 3. HIV screen 4. PCR (more often used in research setting, can speciate) 5. Serology (rk39 antigen test)
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What is rk39 antigen test used for?
Serology for visceral leishmaniasis in Asia
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How do you diagnose PKDL?
Slit skin smear
55
Treatment in visceral leishmaniasis
1. Liposomal amphotericin B 2. Miltefosine 3. Paromomycin HIV: Combination L-AMB + miltefosine
56
Cutaneous leishmaniasis - epidemiology
Old world (Non-American) - Phlebotomus sandfly New world (Americas) - Lutzomyia sandfly (also think viannia)
57
Cutaenous leishmaniasis clinical features
Localised: Wide range of skin lesions including ulcers, nodules, keratotic plaques on exposed areas Systemic (more common in HIV/immunsuppression) Mucosal involvement (nose, throat and mouth) Disseminated, nodular lymphangitis
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Cutaneous leishmaniasis - diagnostics
1. Microscopy and histology - visualisation of amastigotes in smears or tissue sections 2. Culture 3. PCR NO ROLE FOR SEROLOGY
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Treatment cutaenous leishmaniasis
Key concept: localised vs diffuse infection, is there a risk of mucosal spread (i.e. Americas, viannia, immunosuppressed) 1. Conservative 2. Local - Intralesional antimonials -Cryotherapy -Surgery 3. Systemic - Pentavalent antimonials e.g. meglumine - Miltefosine (PO) 28 days, teratogenic + nausea - Amphotericin B
60
Meglumine
Pentavalent antimonial used in the treatment of leishmaniasis
61
Miltefosine
Used in treatment of leishmaniasis, teratogenic and associated with nausea
62
Viperidae snake features
Vipers, adders, rattlesnakes Short thick body Slow moving, ambush AKI severe local swelling and bruising
63
Elapidae snake features
Cobra, kraits, coral snakes, all Australian venemous snakes Long thin body Fast moving Descending flaccid paralysis. Ptosis --> bulbar/resp paralysis --> necrosis
64
Classic features of a scorpion bite
Autonomic storm - massive release of acetylcholine and catecholamines Cardiorespiratory effects - HTN, shock, pulm odoema Neurotoxic effects - fasiculation, muscle spasm
65
How to manage a snake bite?
Remove from danger Reassure Remove tight clothing from the leg Immbolisation Pressure pad
66
Trachoma - organism and pathophysiology
Chlamydia trachomatis Recurrent infections leads to inflammation, leading to scarring of the eyelid and entropion. This continued trauma leads to corneal scarring.
67
Trachoma - transmission
The 3 F's Fingers, flies and formites (surfaces)
68
Trachoma - clinical features
Stage 1 - Trachomatous inflammation (follicular) TF Stage 2 - Trachomatous inflammation intense (TI) Stage 3 - Trachomatous scarring (TS) Stage 4 - Trachomatous trichiasis (TT) Stage 5 - Corneal opacity (CO)
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Trachoma Stage 1 - Trachomatous inflammation (follicular) TF
5 or more follicles on the conjunctiva Treat with antibiotics - single dose of azithromycin
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Trachoma Stage 2 - Trachomatous inflammation intense (TI)
Tarsal conjunctiva appears red, rough and thickened Treat with antibiotics - single dose azithromycin
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Trachoma Stage 3 - Trachomatous scarring (TS)
C trachomatis not often found, just evidence of the scarring Therefore no treatment suggested
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Trachoma Stage 4 - Trachomatous trichiasis (TT)
C trachomatis not often found Evidence of at least one eyelash rubbing on the eye Needs surgical management - posterior lamellar tarsal rotation surgery
73
Trachoma Stage 5 - Corneal opacity (CO)
Pupil margins blurred due to opacity Past the point of treatment as the damage has already been done
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Which stages of trachoma do not warrant treatment?
Stage 3 - trachomatous scarring Stage 5 - corneal opacity
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Which stages of trachoma warrant antibiotics?
Stage 1 - trachomatous inflammation (follicular) TT Stage 2 - trachomatous inflammation (intense) TI
76
What is the treatment strategy for trachoma?
S - surgery A - antibiotics, including MDA F - facial cleanliness E - environmental (better access to water and sanitation)
77
What makes an NTD suitable for elimination? (4)
1. No animal reservoir 2. Effective intervention 3. Amenable to surveillance 4. Public health importance
78
What is the difference between elimination and eradication?
Elimination is reducing the incidence of a disease to zero in a defined geographical area. Continued interventions are required to prevent re-introduction Eradication is permanently reducing the incidence of a disease to zero worldwide
79
Yaws - organism
Treponema pertenue Gram negative spirochaete
80
Clinical stages of Yaws
Primary: Initial skin lesion at infection site Secondary: Spread to other parts of the body, characterised by more extensive lesions Tertiary: Severe tissue and bone destruction to the face and lower limbs Latent: Can become formant and asymptomatic
81
Yaws - treatment
Azithromycin
82
Noma - definition
Rapidly acting orofacial gangrene most commonly affecting children aged 2-5 years
83
Noma - treatment
Antibiotics Antiseptic mouthwash (e.g. chlorhexidine) Nutritional support Surgical debridement
84
Buruli ulcer - organism
Mycobacterium ulcerans
85
Buruli ulcer - geographical distribution
Africa + Australia
86
Buruli ulcer - diagnosis
PCR is the gold standard Takes months to culture Histopathology can be helpful
87
Buruli ulcer - clinical features
Papules, nodules, plaques and odoema
88
Buruli ulcer - treatment
Rifampicin + clarithromycin for 8 weeks
89
Guinea worm - organism
Dracunculus medinensis
90
Guinea worm - life cycle
Drink unfiltered water with L3 larvae Spend 14 months in the intestine Females migrate to the skin and release larvae into the water which take 14 days to mature
91
Risk factors for crusted scabies
Older age Immunosuppression HIV/HTLV1 Malnutrition
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