Snapshot A 5-year-old boy is brought to his pediatrician for abnormal scratching behavior. His mom reports that he has been scratching his anus for the past few days, causing some concern among his schoolteachers. His bowel movements and appetite have been normal. On physical exam, there is some erythema and excoriations from scratching around his anus. His pediatrician conducts a scotch tape test and identifies eggs on microscopy. He is given the correct anti-helminthic therapy. Introduction Introduction helminths are macroscopic parasitic worms tapeworms (cestodes) flukes (trematodes) roundworms (nematodes) roundworms (nematodes) organism characteristics transmission ingestion of eggs/larvae Enterobius Ascaris Toxocara Trichuris Trichinella invasion of larvae cutaneously Strongyloides Ancylostoma/Necator arthropod bites Loa loa Onchocerca volvulus Wuchereria bancrofti Dracunculus treatment most are treated with bendazoles other options include ivermectin or diethylcarbamazine Roundworms (Nematodes) Organism Clinical Presentation Transmission Treatment Transmission by Ingestion of Eggs Enterobius vermicularis (pinworm) Anal pruritus, especially in children Scotch tape test scotch tape to anal area will show eggs on microscopy Most common helminth parasite in the US Fecal-oral Ingestion of eggs Bendazoles Pyrantel pamoate Ascaris lumbricoides (giant roundworm) Biliary obstruction Intestinal obstruction or perforation May also affect the lungs Oval eggs are seen on stool microscopy Fecal-oral Ingestion of eggs Migrates from the nose/mouth to intestines Bendazoles Toxocara canis Visceral larva migrans Myocarditis, liver damage, ocular damage (visual impairment and blindness), and brain damage (seizures and coma) Granuloma formation causes damage Fecal-oral Ingestion of eggs Migrates from intestinal wall to blood Bendazoles Trichuris trichiura (whipworm) Microcytic anemia Abdominal pain and diarrhea Can cause intestinal/rectal prolapse in children Fecal-oral Ingestion of eggs Bendazoles Transmission by Ingestion of Larvae Trichinella spiralis Trichinosis Fever, vomiting, nausea, periorbital edema, and myalgia Undercooked meat Ingestion of larvae (the only nematode transmitted this way) Migrates from blood to striated muscle, causing inflammation Bendazoles Transmission by Cutaneous Penetration Strongyloides stercoralis (threadworm) Gastrointestinal upset Pneumonitis Loffler syndrome Dermatitis Rhabditiform larvae, not eggs, seen on stool microscopy Penetration from soil into the skin Bendazoles Ivermectin Ancylostoma braziliense Necator americanus (hookworm) Microcytic anemia Cutaneous larva migrans or "creeping eruption" that moves as the larvae moves Pruritic serpiginous rash Penetration into the skin, often from walking barefoot on the beach Nematode sucks blood from the intestinal wall Bendazoles Pyrantel pamoate Transmission by Arthropods (Bite or Ingestion) Wucheria bancrofti Lymphatic filariasis or elephantiasis Lymphedema causing disfiguration of extremities Via female mosquitoes Invades lymph nodes Diethylcarbamazine Loa loa (African eye worm) Calabar swellings in skin Worms in conjunctiva Via deer flies, horse flies, and mango flies Diethylcarbamazine Onchocerca volvulus Hyperpigmented rash, river blindness, and black skin nodules Via female blackflies Ivermectin (Rivermectin) Dracunculus medinensis (Guinea worm) Skin inflammation and ulceration Worm eruption from skin Anaphylactic shock if worm is pulled from skin and breaks, due to release of foreign antigens Ingestion of water contaminated with infested water fleas Niridazole Removal of worm that has emerged from skin, by a few cms each day using a rod
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next Lab Values Blood Hematologic Cerebrospinal Sweat, Urine, and BMI Blood, Plasma, Serum Reference Range ALT 8-20 U/L Amylase, serum 25-125 U/L AST 8-20 U/L Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL Calcium, serum (Ca2+) 8.4-10.2 mg/dL Cholesterol, serum Rec: < 200 mg/dL Cortisol, serum 0800 h: 5-23 μg/dL //1600 h: 3-15 μg/dL 2000 h: ≤ 50% of 0800 h Creatine kinase, serum Male: 25-90 U/LFemale: 10-70 U/L Creatinine, serum 0.6-1.2 mg/dL Electrolytes, serum Sodium (Na+) 136-145 mEq/L Chloride (Cl-) 95-105 mEq/L Potassium (K+) 3.5-5.0 mEq/L Bicarbonate (HCO3-) 22-28 mEq/L Magnesium (Mg2+) 1.5-2.0 mEq/L Estriol, total, serum (in pregnancy) 24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL 28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL Ferritin, serum Male: 15-200 ng/mLFemale: 12-150 ng/mL Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL Female: premenopause: 4-30 mIU/mL midcycle peak: 10-90 mIU/mL postmenopause: 40-250 pH 7.35-7.45 PCO2 33-45 mmHg PO2 75-105 mmHg Glucose, serum Fasting: 70-110 mg/dL2-h postprandial:<120 mg/dL Growth hormone - arginine stimulation Fasting: <5 ng/mLProvocative stimuli: > 7ng/mL Immunoglobulins, serum IgA 76-390 mg/dL IgE 0-380 IU/mL IgG 650-1500 mg/dL IgM 40-345 mg/dL Iron 50-170 μg/dL Lactate dehydrogenase, serum 45-90 U/L Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL Female: follicular phase: 5-30 mIU/mL midcycle: 75-150 mIU/mL postmenopause 30-200 mIU/mL Osmolality, serum 275-295 mOsmol/kd H2O Parathyroid hormone, serume, N-terminal 230-630 pg/mL Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L Phosphorus (inorganic), serum 3.0-4.5 mg/dL Prolactin, serum (hPRL) < 20 ng/mL Proteins, serum Total (recumbent) 6.0-7.8 g/dL Albumin 3.5-5.5 g/dL Globulin 2.3-3.5 g/dL Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h Thyroxine (T4), serum 5-12 μg/dL Triglycerides, serum 35-160 mg/dL Triiodothyronine (T3), serum (RIA) 115-190 ng/dL Triiodothyronine (T3) resin uptake 25%-35% Urea nitrogen, serum 7-18 mg/dL Uric acid, serum 3.0-8.2 mg/dL Hematologic Reference Range Bleeding time 2-7 minutes Erythrocyte count Male: 4.3-5.9 million/mm3Female: 3.5-5.5 million mm3 Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/hFemale: 0-20 mm/h Hematocrit Male: 41%-53%Female: 36%-46% Hemoglobin A1c ≤ 6 % Hemoglobin, blood Male: 13.5-17.5 g/dLFemale: 12.0-16.0 g/dL Hemoglobin, plasma 1-4 mg/dL Leukocyte count and differential Leukocyte count 4,500-11,000/mm3 Segmented neutrophils 54%-62% Bands 3%-5% Eosinophils 1%-3% Basophils 0%-0.75% Lymphocytes 25%-33% Monocytes 3%-7% Mean corpuscular hemoglobin 25.4-34.6 pg/cell Mean corpuscular hemoglobin concentration 31%-36% Hb/cell Mean corpuscular volume 80-100 μm3 Partial thromboplastin time (activated) 25-40 seconds Platelet count 150,000-400,000/mm3 Prothrombin time 11-15 seconds Reticulocyte count 0.5%-1.5% of red cells Thrombin time < 2 seconds deviation from control Volume Plasma Male: 25-43 mL/kgFemale: 28-45 mL/kg Red cell Male: 20-36 mL/kgFemale: 19-31 mL/kg Cerebrospinal Fluid Reference Range Cell count 0-5/mm3 Chloride 118-132 mEq/L Gamma globulin 3%-12% total proteins Glucose 40-70 mg/dL Pressure 70-180 mm H2O Proteins, total < 40 mg/dL Sweat Reference Range Chloride 0-35 mmol/L Urine Calcium 100-300 mg/24 h Chloride Varies with intake Creatinine clearance Male: 97-137 mL/minFemale: 88-128 mL/min Estriol, total (in pregnancy) 30 wks 6-18 mg/24 h 35 wks 9-28 mg/24 h 40 wks 13-42 mg/24 h 17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 hFemale: 2.0-8.0 mg/24 h 17-Ketosteroids, total Male: 8-20 mg/24 hFemale: 6-15 mg/24 h Osmolality 50-1400 mOsmol/kg H2O Oxalate 8-40 μg/mL Potassium Varies with diet Proteins, total < 150 mg/24 h Sodium Varies with diet Uric acid Varies with diet Body Mass Index (BMI) Adult: 19-25 kg/m2 Calculator ( ) xy AC 7 8 9 ÷ 4 5 6 × 1 2 3 - 0 . = + Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.MC.4817) A 32-year-old woman presents to your office with abdominal pain and bloating over the last month. She also complains of intermittent, copious, non-bloody diarrhea over the same time. Last month, she had a cough that has since improved but has not completely resolved. She has no sick contacts and has not left the country recently. She denies any myalgias, itching, or rashes. Physical and laboratory evaluations are unremarkable. Examination of her stool reveals the causative organism. This organism is most likely transmitted to the human host through which of the following routes? Review Topic QID: 109392 1 Inhalation 16% (15/96) 2 Penetration of skin 52% (50/96) 3 Animal bite 24% (23/96) 4 Insect bite 0% (0/96) 5 Sexual contact 6% (6/96) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 2 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
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