Updated: 12/12/2019

Visceral Infections: Protozoa

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Snapshot
  • A 50-year-old healthcare worker presents to the emergency room after a month-long trip to India. He reports having fevers, abdominal pain, and a 5-lb weight loss over the past week. He recalls being bit by multiple types of bugs during his summer month in India. His past medical history includes gonorrheal urethritis. His social history includes having several different male sexual partners over the past year often without protection. On physical exam, there is hepatosplenomegaly. He is treated for a presumed parasitic infection, given his clinical risk factors, and tested for HIV. (Visceral leishmaniasis)
Introduction
  • Protozoa
    • single-celled eukaryotes, often parasitic, that feed on organic tissues
Infections of Protozoa
Central Nervous System
Gastrointestinal
Visceral Infections
Hematologic Infections Sexually Transmitted Diseases
  • Toxoplasma gondii
  • Naegleria fowleri
  • Trypanosoma brucei
  • Acanthamoeba
  • Giardia lamblia
  • Entamoeba histolytica
  • Cryptosporidium
  • Trypanosoma cruzi
  • Leishmania donovani
  • Plasmodium
  • Babesia
  • Trichomonas vaginalis

Trypanosoma cruzi
  • Introduction
    • clinical syndrome
      • Chagas disease
    • transmission
      • via triatomine, a type of reduviid bug (“kissing bug”)  
        • painless bite that deposits feces
    • demographics
      • South America
    • risk factors
      • poor sanitation
      • tropical areas
      • immunosuppression
  • Presentation
    • acute infection
      • Romaña sign is a characteristic sign
        • unilateral periorbital swelling
      • chagoma on the skin at the site of inoculation
    • chronic infection
      • dilated cardiomyopathy
        • apical atrophy
      • megacolon
      • megaesophagus
  • Imaging
    • chest radiograph
      • cardiomegaly
    • barium swallow or barium enema
      • dilated esophagus
      • dilated megacolon
  • Studies
    • peripheral blood smear
      • trypomastigotes (motile flagellated form)
    • detection of antibodies via serology
    • detection of DNA via polymerase chain reaction (PCR)
  • Treatment
    • benznidazole or nifurtimox
      • first-line
Leishmania donovani
  • Introduction
    • clinical syndrome
      • visceral leishmaniasis (also known as kala-azar or black fever)
      • cutaneous leishmaniasis
    • transmission
      • via sandfly bites
    • demographics
      • younger children
      • mostly found in India, Bangladesh, Sudan, Ethiopia, and Brazil
    • risk factors
      • HIV/AIDS
    • prognosis
      • visceral leishmaniasis is fatal without treatment
  • Presentation
    • visceral leishmaniasis (kala-azar)
      • spiking fevers
      • weight loss
      • hepatosplenomegaly
      • abdominal pain
    • cutaneous leishmaniasis
      • skin papules that progress to nodule or ulcer
  • Studies
    • pancytopenia
    • biopsy or needle aspiration of bone marrow or skin lesions 
      • macrophages with ingested amastigotes (flagella-lacking form)
    • urine antigen testing
  • Treatment
    • amphotericin B or sodium stibogluconate
      • first-line
    • miltefosine
      • second-line
  • Complications
    • post-kala-azar dermal leishmaniasis
      • chronic skin rash with onset months to years after treatment
      • erythematous or hypopigmented polymorphic lesions throughout the body

 

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