TOPICS
Opportunistic parasite Parasite causing allergy
OPPORTUNISTIC PARASITE
Definition
Parasite that pathogenic on immunocompromise host
Important species:
Toxoplasma gondii
Toxoplasma gondii
MAMALIA, BURUNG
MANUSIA
oosista
oosista
KUCING
oosista
KUCING
Morphology
tachyzoite :
crescent form/coma
pseudocyst :
Group of tachyzoite; slinght positive with PAS
tissue cyst :
Cyst contain of bradyzoite; strong positive with PAS
oosista :
Double layer wall cyst, contain of 2 sporocyst that each contain of 2 sporozoite
TACHYZOITE
PSEUDOCYST
TISSUE CYST
OOCYST
Pathogenesis
tachyzoite (intracell) multiplication rupture of host cell invasion to other cell through circulation system (blood/lymph) disturbance of host cell/tisue manifestation or no manifestation with formed tissue cyst reactivation of tissue cyst manifestation
Congenital Toxoplasmosis
Diagnosis
Serologic test
antibody antitoxoplasma (IgM, IgG) specimen : serum Kind of test: (dye test,IHA,IFA,ELISA,ect)
Biologic test
inoculation to lab. animal/ tissue culture tachyzoite specimen: tissue fluid, biopsy, blood.
Histologic test
pseudocyst, tachyzoite, tissue cyst. specimen: tissue biopsy/necropsy.
Biomolecular approaches
PCR (polimerase chain reaction)
IgG positive
IgM low positive 1. False positive 2. Infection in past 2 years 3. New infection Second sample 2 weeks later and retest both together
Treatment
spiramycine :
active against tachyzoite & intracellular form, safely for pregnant woman and fetus.
pyrimethamine-sulphonamide :
synergistic action but cause severe side effect and teratogenic not recognized to pregnant woman.
clindamycine :
Good for eye toxoplasmosis, with side effect :
colitis ulcerative, Not safely for children and pregnant woman.
Epidemiology
Infected in man through:
uncooked meat containing tissue cyst swallow oocyst
Prevention
Washing hand before eat avoid ingest of oocyst Cook completely of meat 66oC Cat management
Clean daily the litter pan; Fed on dry, canned or boiled food; Throw away the feces into WC; Children sands boxes should be made cat proof
Miscellaneous
Pneumocystis carinii Cryptosporidium sp
Trigerred by mites
CUTANEOUS FORM
Non human hook worm that infect to man by penetrate the skin cutaneous larva migrans Injurious arthropods : poison of the insects causing dermatitis up to fatal.
Stinging and biting do not affect every person in the same manner (do not suffer local/general allergic manifestation) Flea, Mosquito, Cimex, Tick, Scorpion, Spider, Caterpillar, Fire ants, beetles, etc.
Physical
Cutaneous signs include the following:
Pruritic, erythematous, edematous papules and/or vesicles Serpiginous (snakelike), slightly elevated, erythematous tunnels that are 2- to 3-mm wide and track 3-4 cm from the penetration site Nonspecific dermatitis Vesicles with serous fluid Secondary infection Tract advancement of 1-2 cm/d
Systemic signs: peripheral eosinophilia, migratory pulmonary infiltrates and increased immunoglobulin E (IgE) levels (Loeffler syndrome), but are rarely seen. Lesions are typically : distal lower extremities: dorsa of the feet and the interdigital spaces of the toes, but can also occur in the anogenital region, the buttocks, the hands, and the knees.
Causes
Common etiologies :
Ancylostoma braziliense (hookworm of wild and domestic dogs and cats) is the most common cause. Ancylostoma caninum (dog hookworm) is found in Australia. Uncinaria stenocephala (dog hookworm) is found in Europe. Bunostomum phlebotomum (cattle hookworm).
Rare etiologies:
Ancylostoma ceylonicum Ancylostoma tubaeforme (cat hookworm) Necator americanus (human hookworm) Strongyloides papillosus (parasite of sheep, goats, and cattle) Strongyloides westeri (parasite of horses) Ancylostoma duodenale
Diagnosis
Based on the classic clinical appearance of the eruption. Eosinophilia and increased IgE levels on serum. Biopsy may show a larva Epidermal chronic inflammatory infiltrate with many eosinophils.
Medical Care
Even though self-limited the intense pruritus and risk for infection should to be treated. Topical : Soon: 10% thiabendazole susp. or mebendazole cream Thiabendazole agent of choice. Alternatively drug: Mebendazole, Albendazole, Ivermectin
Complications
A secondary bacterial infection, usually with Streptococcus pyogenes, may lead to cellulitis. Allergic reactions may occur.
Prognosis
The prognosis is excellent. This is a self-limiting disease. Humans are accidental, dead-end hosts, with the larva dying and the lesions resolving within 4-8 weeks, as long as 1 year in rare cases.
Patient Education
Persons who travel to tropical regions and pet owners should be aware of this condition.
Scabies
Etiology : Family Sarcoptidae Species Sarcoptes scabiei
Morphology :
- Oval body, dorso-ventrally flat, - Leg : larvae : 3 pairs; adult: 4 pairs - Differentiation - : leg (position of sucker) and size - Mouth: celicera + palpus anteriorly
MP
MP
MP
Nympha
Imatur adult
matur adult
MP : moulting pocket
Special Characteristic:
Location stratum corneum; food: tissue Btn burrowing in superficial layer of skin curve apperence Predelection smooth skin: interdigital, penis, scrotum, axilla, knee, buttock, breast, ect . Children more area can infected
Diagnosis
- characteristic clinical manifestation - Dx. curry on the lesion skin exam microscopically
Teatment
- no resistance to drug - 20-25% benzyl benzoate (emulsion) repeated 3 day later - sulfur : tetmosol : 3x24 hours tetmosol soap : prophylaxis/slow curatif - 1% HCH (cream, lotion) repeated 2-7 days later - 0,5% malathion ; 10% crotamion (cream/lotion) repeated 2-7 days later Important : mass treatment !!!
Home treatment
needed to relieve the symptoms of a mild reaction to common stinging or biting insects and spiders. Some people have more severe reactions to bites or stings. Babies and children may be more affected by bites or stings than adults.
Treatment
Anaphylactic reaction
Epinephrine injection is the main treatment.
Local reactions
wash the area with soap and water. an ice pack or cool compress. a topical steroid cream Calamine lotion. oral antihistamine diphenhydramine (Benadryl), pain medications ibuprofen or acetaminophen.
If becomes infected
Antibiotics
RESPIRATORY FORM
Patogenesis-manifestation
Larvae migration effect
While larvae live in lung inflammation: >> larvae pneumonitis. Manifestation (Loeffler syndrome): dispnea, nonproductive/productive cough, fever (39-40 oC), ronchi, eosinophilia Sputum: charcott leyden chrystal, eosinophil, larvae
Diagnosis
Migratory phase
Loeffler syndrome in highly endemic area Sputum / lavage of gastric material larvae Sometimes eggs found in feces
Treatment
Mebendazole Pyrantel pamoate Piperazine cytrate
Classification: Dust mites are arachnids, the class of arthropods which includes spiders, scorpions and ticks. Live in: cover bed, carpet, dust house, mattres, ect. They live their whole lives in dark corner dust bunnies: hatching, growing, eating, defecating, mating, laying eggs make us itch and wheeze (Many people develop severe allergies: difficulty breathing or even a severe asthma attack). Food: organic debris: dead skin, semen, ect. (and probably potato chips & cookie crumbs).
Antigens stick to the mast cell IgE antibodies, causing granules in the mast cell to fire their contents into the surrounding tissue. This releases inflammatory materials : leukotrienes, TNF, IL-4 and other cytokines. These materials cause fluid to leak from the capillaries and white cells including neutrophils, T cells and eosinophils to leave the circulation. The end result is a "local inflammatory response", a red, itchy welt.
Prevention:
Wash bedding at 55 oC to kill the mites and remove their allergen. Regular washing of clothes and bedding in cool water will remove food for dust mites . Dry cleaning kills the mites (but 20-70 percent of the allergen will remain) . Leaving rugs and blankets in direct sunlight for 3 hours will kill mites (not to allergen) . Use mite allergen-proof mattress covers and pillow covers (vapor impermeable) . Store out-of-season clothes in plastic . Consider using acaracides, which are chemicals that kill dust mites. Benzyl benzoate is considered safe. Use a vacuum cleaner that keeps in all the allergens in breeding place, cover the mattres with plastics material, clean up the cover bed, ect.