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Fungi Cutaneous/ Etiology Epidemiology Pathogenesis Disseminated infections & Lab Evaluation/ superficial infection:...

Fungi Cutaneous/ Etiology Epidemiology Pathogenesis Disseminated infections & Lab Evaluation/ superficial infection: symptoms Imaging/Diagnosis skin head and nails Tinea pedis Trichophyton rubrum, T. -natural habitats like -transmitted mostly from -interdigital: itching, red Skin scraping Athlete’s foot interdigitale, & anthropophilic (resides on anthropophilic and zoophilic erosions/scales between toes KOH prep Epidermophyton human skin), zoophilic (reside sources -hyperkeratotic: thick skin on soles *consider a gram stain if erosions, floccosum on skin of domestic and farm *only pathogenic fungi are and medial/lateral surfaces with ulcers, or odor is present animals), geophilic (reside in capable of human-to-human varying redness soil) spread* -vesiculobullous: itching, sometimes Diagnosed as either: Interdigital, painful, vesicular bullous eruption with hyperkeratotic, or vesiculobullous underlying redness DDX’s: bacterial infection, atopic dermatitis, contact dermatitis, psoriasis, scabies Treatment: topical therapies (mostly) or oral therapies Tinea corporis T. rubrum (most -natural habitats like -transmitted mostly from -itching, is circular/ oval, scaling patch Skin scraping Ringworm common) & E. anthropophilic (resides on anthropophilic and zoophilic or plaque that spreads centrifugally KOH prep floccosum human skin), zoophilic (reside sources -outisde of ring is usually inflamed *consider a gram stain if concerned on skin of domestic and farm *only pathogenic fungi are and vesiculated about secondary infection animals), geophilic (reside in capable of human-to-human soil) spread* DDX’s: systemic lupus erythematosus, granuloma annulare, nummular eczema, psoriasis Treatment: topical Tinea capitis Trichophyton and -natural habitats like -transmitted mostly from -single or multiple scaly patches with Dermoscopy Scalp ringworm microsporum species anthropophilic (resides on anthropophilic and zoophilic alopecia (black dots at spots of hair KOH prep of proximal hairs human skin), zoophilic (reside sources loss) on skin of domestic and farm *only pathogenic fungi are DDX’s: alopecia areata, seborrheic animals), geophilic (reside in capable of human-to-human folliculitis soil) spread* Treatment: oral antifungal therapy -primarily affects children Tinea versicolor Malassezia species -natural habitats like -transmitted mostly from -Changes in cutaneous pigmentation: KOH prep (both hyphae and yeast -dimorphic fungi anthropophilic (resides on anthropophilic and zoophilic hypopigmented (bleached), cells are evident- spaghetti and human skin), zoophilic (reside sources hyperpigmented (darker), and meatballs) on skin of domestic and farm *only pathogenic fungi are erythema (red) animals), geophilic (reside in capable of human-to-human -macules (flat), patches, and thin DDX’s: seborrheic dermatitis, soil) spread* plaques (raised) vitiligo, & pityriasis rosea -occurs in hot/humid weather, Treatment: topical or oral antifungal hyperhidrosis, and topical skin oils Subcutaneous mycoses Sporotrichosis Sporothrix schenckii -almost always spread -causative organisms reside in -dissemination can occur in Culture (gold standard) (thru -dimorphic through traumatic lacerations the soil and on vegetation immunocompromised pts (alcoholism, aspiration, LP) -activities that increase or puncture wounds DM, COPD, HIV/AIDS) risk: rose gardening, landscaping, and other -lymphocutaneous sporotrichosis: activities in soil papule that develops at site of inoculation days to weeks after, primary lesion usually becomes ulcer, more lesions will occur along lymphatic channels -pulmonary sporotrichosis: results from inhalation of S. schenckii conidia, symptoms may be mimicking of TB (fever, night sweats, weight loss, fatigue, dyspnea, cough), find through xray (upper lobe cavities) -osteoarticular sporotrichosis: bone/joint infection may occur thru direct inoculation, affects middle aged men with alcoholism a lot, symptoms are joint redness, pain and swelling -meningeal sporotrichosis: rare manifestation Chromomycosis Phialophora and -almost always spread -causative organisms reside in -symptoms: indolent, granulomatous KOH prep (aka cladosporium species through traumatic lacerations the soil and on vegetation fungal disease chromoblastomycosis) or puncture wounds -caused by melanized fungi -early disease: macules or papules -seen most commonly in -direct inoculation that are verrucous (wart like) or tropics hyperkeratotic -w/out treatment: infection slowly progresses to larger areas and is nodular, verrucous, tumoral, plaque, scar like -severe: associated with tissue fibrosis and lymphedema Mycetoma Madurella grisea, -almost always spread -causative organisms reside in -symptoms: tumor, sinus tracts, and KOH prep exophiala jeanselmei through traumatic lacerations the soil and on vegetation macroscopic grains (black, white, red, Histopathology (most common) or puncture wounds or yellow) -41 species causes -skin and soft tissue affected, -different based on most often foot, leg, hands region Systemic mycoses General Facts Grow as mold in solid, bird or bat droppings, spores are inhaled and disseminated to other areas, NO person to person transmission coccidioidomycosis ”Valley fever” in arid Inhalation: can remain -Arthoconidia are inhaled and Valley Fever is primary pulmonary ESR - often elevated Southwestern US (San suspended for long periods of then change into spherical infection  Joaquin valley) - 60% time structures -usually no symptoms or minimally CXR AZ -Enlarge and produce internal symptomatic septation -Similar to community acquired ELISA for IgM and IgG Caused by dimorphic -Develop endospores in these pneumonia with chest pain, cough, fungi: C immitis and C -Rupture and release more fever Diagnosis “Valley fever”: When a posadasii endospores patient presents with pulmonary Extrapulmonary: symptoms AND fails to respond to **important to acquire -drenching night sweats, weight loss, appropriate antibiotic therapy about travel history rheumatologic and cutaneous symptoms Coccidiocal meningitis: CSF studies Disseminates by blood to skin, skeleton, meninges Skin or soft tissue infections: -cutaneous granulomatous lesions -Subcutaneous soft tissue abscesses Coccidiodal meningitis: High mortality if untreated -persistent headache and worsening -N/V Histoplasmosis Most prevalent in Central North America: Ohio and Mississippi River valley Blastomycosis South central and South Eastern US Opportunistic mycotic Candidiasis -dimorphicthat exist as -most common occurring in -pts with recent antibiotic -affect HIV pts and KOH prep (if area is easily a yeast on/in body fungal nosocomial infection exposure are susceptible immunocompromised (cancer, organ accessible) for candida albicans in US -invades: thru GI tract mucosal transplant, rheumatologic conditions) - part of normal skin, mouth, barrier, via an intravascular Blood cultures (gold standard), vagina, intestine flora catheter, or from a localized - oropharyngeal candidiasis biopsy of infected area, -candida albicans most focus of infection (thrush): occurs in infants, adults w/ T2Candida panel, and common dentures, inhaled corticosteroid use, Beta-D-glucan assay for HIV, abx candidiasis -esophagitis: is an AIDS defining condition and is rare -vulvovaginitis: abx, glucocorticoids, diabetes mellitus, HIV, IUDs -balanitis: of glans penis -Candidemia: presence of candida in the blood stream (yeast) -chorioretinitis: inflammation of choroid, lining of the retina deep in the eye that causes pain and visual changes and excessive tearing - can cause painless pustules on an  red base -can also affect kidneys, heart, liver, spleen, lungs, and brain -symptoms: range from minimal fever to full blown sepsis Cryptococcosis -cryptococcosis: invsive -infection begins by inhaling C. -affect HIV pts and -capsule is observed with India ink fungal infection due to neoformans spores or yeast immunocompromised (cancer, organ -C. Meningitis: CD4 count under 100 C. neoformans (more (pigeons) transplant, rheumatologic conditions) cells/microL, serum C. antigen, predominant) or C. gatti -in immunocompromised, pts ar lumbar puncture esubclinical primary infections -cryptococcosis and most are asymptomatic -symptoms: AIDS, chronic glucocorticoids usage, organ transplant, malignancy, liver disease, sarcoidosis -clinical manifestations may develop: cough, sputum, hemoptysis, dyspnea, chest pain, fever, night sweats, malaise, weight loss -cryptococcal meningoencephalitis: meningitis is most frequently encountered in pts that are immunocompromised, symptoms are fever, malaise, headache and sometimes stiff neck, photophobia, and vomiting; ddx could be toxoplasmosis, TB meningitis, lymphoma, syphilis Aspergillosis -occur everywhere in nature (A. -affect HIV pts and -X-ray (pulm aspergillus)- fungus fumigatus, A. flavus, and A. immunocompromised (cancer, organ balls in the lung terrerus) transplant, rheumatologic conditions) -inhalation of infections conidia -Imaging is frequent -pulmonary aspergillus: most -Positive Aspergillus IgG -tissue invasion usually only commonly involved site, classic triad antibody test occurs in immunocomp of fever/pleuritic chest pain/ -culture -Rarely pathogenic in immune hemoptysis, may have SOB/ cough Histopathology competent pt except for if on -Galactomannan antigen abx -tracheobronchitis aspergillus: detection most commonly seen in lung -Beta-d-glucan assay transplant, caused by focal invasions or tracheobronchial mucosa/cartilage, may present as dyspnea, cough or wheezing -rhinosinusitis -CNS infection -endocarditis Pneaumocystis jiroveci -looked at a cause of -primary mode is by airborne -affect HIV pts and -microscopic exam of lung tissue pneumonia in premature and immunocompromised (cancer, organ -beta-d-glucan malnourished infants in -fungus may enter a latent transplant, rheumatologic conditions) europe after WWII phase -some difficulties with dx: cannot be -PCP (pneumocystis pneumonia): cultured and 100% of individuals -60s and 70s: mostly diagnose -pt may be cleared and cough, dyspnea, hypoxemia, resp have antibodies in pts with hematologic reinfectected thru person to failure malignancies person -prevalence increased in 80s -nearly all fatal if untreated bc of HIV epidemic -75% of humans infeted by age 4 (can be asymptomatic) Protozoa Intestinal Protozoa Etiology/Cause or origin Epidemiology/Transmission Pathogenesis/Mechanism Clinically significant disorders & Lab Evaluation/ symptoms Imaging/Diagnosis Amebic dysentery Caused by Entamoeba India, Africa, Mexico, and parts Cysts: infective form ingested from Dysentry: infection of the intestines Stool testing: stool histolytica, E. dispar,a E. of Central and South America contaminated food or water to form that causes bloody diarrhea antigen detection only moshkovskii, and E. trophozoites with severe diarrhea due bangladeshi May be passed to Travelers or Symptomatic Factors: Age and strain to expense immigrants Trophozoites: active protozoa invading of E histolytica epithelium and penetrating through GI muscle layer -Mild to severe dysentry -injure post cell by secreting -abdominal pain proteinases, lysis of cells, amoebapores and kill with apoptosis -change intestinal permeability -Can cause abscesses in liver -Consume intestinal bacteria -Form cyst and pass out in feces Giardiasis Caused by Giardia Occurs worldwide Can cause sporadic or epidemic 50% are asymptomatic Antigen detect assay duodenalis diarrheal illness **Most commonly diagnosed Acute Symptoms: parasitic intestinal disease in Life Cycle: cyst and bind leave -Diarrhea the US trophozoite with flagella -malaise/uneasy/fatigued -Foul smelling steatorrhea (fatty **MOUNTAIN STREAMS: Small intestine is major site foamy stool) beaver sources of cysts -villous atrophy -microvilli shortening Chronic: occurs in half untreated -increased permeability sympamatic individuals -breaks down lactose -loose stools -Steatorrhea -profound weight loss -stunted growth (in children) *symptoms may wax and wane over months Crytosporidiosis Caused by C parvum in Every continent except Inhabits the epithelial cells of lower small Diarrhea: transient, intermittent or Microscopy: look for  humans Antarctica intestine continuous diarrhea oocysts in stool specimens Often from domestic Can be passed person to Life Cycle: Single host Long term: abdominal pain Enzyme Immunoassay animals esp. cattle person Lives and reproduces in the GI tract of animals and humans Usually resolves in 10-14 days Slightly more common in without treatment undeveloped countries Ingested through contaminated drinking water or recreational water -chlorine resistant Trichomoniasis Caused by Trichomonas One of three most common Infects squamous epithelium of the Urethritis in men Microscopy: flagellated vaginalis infectious vaginal complaints urogenital tract protozoans appreciated Women: Humans are only natural Most common non viral STI -asymptomatic carrier state NAAT is gold standard host in the world -purulent, malodorous thin vaginal discharge -burning **Can cause cervical neoplasia, PIC and infertility in nonpregnant **Increased risk of HIV **Pregnant women can have premature membrane rupture, preterm delivery, or low birth weight **Can pass to child Men: -most are asymptomatic up to months -usually spontaneous resolution -dysuria **can cause infertility, prostate cancer Blood and tissue Protozoa Malaria Caused by Plasmodium Transmission: female Infection into RBCs uses Hgb as Uncomplicated Malaria: Diagnoses: species anopheline mosquito nutrient, infected RBCs rupture releasing -fever, chills, N/V/D, abdo pain, HA, -Light microscopy of thick -P. falciparum = majority of more merozoites, leads to anemia, fever diaphoresis… or thin smears cases-deaths, Africa LIfe cycle: bite from infected dominate mesquite, Sporozoites travel Infected RBCs also bind to capillaries Complicated malaria: Rapid diagnosis testing: from salivary glands of and venules, leads to partial blood flow -Altered consciousness w/ or w/o -Antigen detection Occurs most tropical mosquito to our liver, cell obstruction seizures (depends on species) regions of world divides many times, rupture -Respiratory distress (Histidine-rich protein only allows invasion of RBCs, infect -Circulatory collapse effective for P. Falciparum more RBCs, a few differentiate -Metabolic acidosis species) into male/female gametocytes, -Hypoglycemia circulate into bloodstream to be picked up by feeding female PE findings: anopheline mosquito -anemia -tachycardia -tachypnea -palpable spleen -Jaundice Toxoplasmosis Toxoplasma gondii Transmission: Cats excrete Two kinds of Toxoplasma trophozoites: -Healthy people asymptomatic Diagnoses: infectious oocysts in feces, 1)Tachyzoites: rapid growing, destroy usually with primary infection -Serologic testing (ELISA)  Cats are the only animal in humans become infected by cells -Histopathologic exam of which T. Gondii can ingesting oocysts 2)Bradyzoites: slow growing, contained Congenital infections =severe: lymph nodes completes its reproductive in cysts in muscle, brain, eye -Stillbirth, brain lesions, cycle i hydrocephalus, blindness in newborns *Pregnant women discouraged from cleaning litter box* General sxs: -Fever/chills, HA, rash, pharyngitis, enlarged liver/spleen Uncommon findings: -Pneumo/respiratory distress -myocarditis/pericarditis -encephalitis -hepatitis Trypanosomiasis Two chronic, potentially 1)Transmission: bite of an 1)bite from fly, produces chancre, 1)Early infection (stage 1): DIagnoses: fatal diseases: infected tsetse fly parasite spreads to lymph tissue and -intermittent HA, fever, chancre, 1)-Blood smear 1) Human African eventually invades the CNS causing lymphadenitis -Tissue aspirate Trypanosomiasis (HAT) 2)Transmission: bite from inflammation Late infection (stage 2): -CSF AKA African sleeping triatomine bug (major trans -fatality 100% in untreated, -Molecular tests sickness route), oral (ingestion of 2)bite from bug, takes blood meal, progressive meningoencephalitis can 2) American contaminated food/drink), blood defecates near bite wound containing develop, coma 2)-Light microscopy Trypanosomiasis AKA transfusion, organ transplant, trypomastigotes , then those get into T. b. Gambiense: slow infection looking for motile Chagas disease lab accident open sore or conjunctiva T. b. Rhodesiense: rapid infection trypomastigotes on blood smear Have flagella 2)-incubation 1-2wks -PCR -Acute phase lasts 8-12wks -inflammation/swelling at site -Severe acute disease can cause myocarditis, meningoencephalitis, pericardial effusion Leishmaniasis Infection caused by Transmission: bite of female 2)parasite attacks the tissue of mucosa 1)-Ulcerating skin sore Diagnoses: flagellated protozoan sand fly dermal junction of mount and nose, -Ulcers heal spontaneously but with -Histologic visualization on erosion occurs bad scarring Giemsa-stained tissue 3 clinical variations of (need tissue or fluid leishmaniasis:: 3)parasite initially infects macrophages, 2)-Nasal stiffness/blockage sample) 1)cutaneous migrate to spleen, liver, and bone -bleeding/increased secretions -PCR 2)mucocutaneous marrow, multiples rapidly -sloughing of dead tissue 3)visceral *Diagnoses the same 3)-Fever, weight loss, enlargement of regardless of location* liver/spleen Helminths Cestodes Etiology Epidemiology Pathogenesis Clinical Significant disorders & Lab Evaluation/ “Tapeworm” symptoms Imaging/Diagnosis General facts Segmented body: each segment is called a proglottid, distal segments (gonads) contain eggs, can separate and be expelled in feces, when doing a stool test proglottids can  help determine the species Taenia saginata: Life cycle: eggs or Transmission: ingest Grows in small intestine Taeniasis Stool test Beef tapeworm proglottids in human stool raw/undercooked beef or pork Lack digestive system -proglottids to distinguish species - consumed by cattle or Absorb nutrients through its Most carriers asymptomatic Taenia solium: pigs - oncospheres hatch Asia outer body surface directly from Pork tapeworm in animal intestine - host intestine General symptoms: nausea, migrate to animal muscle epigastric pain, anorexia - develop into cysticerci - human consumes animal *May see worm segments in stool or muscle infected with the feel movements in anus cysticerci (larval form) Taenia solium Life cycle: human ingests Transmission: ingest human Invades CNS Cysticercosis CT, MRI, biopsy eggs or proglottids - feces Cysticerci usually develop in oncospheres hatch in eyes and brain NCC: neurocysticercosis human intestine - migrate Latin America, Sub-Saharan -Intraparenchymal to human musculature - Africa, India neurocysticercosis: 3-5yr post develop into cysticerci in infection, seizure most common organs symptom - Extraparenchymal neurocysticercosis Dibothriocephalus latus: Life cycle: human fecal Transmission: ingest Grows in small intestine Diphyllobothriasis Stool test Fish tapeworm matter into water - eggs in raw/undercooked freshwater Absorbs vit B12 water - ingested by fish Gut inflammation and increased Most carriers asymptomatic crustaceans - ingested by permeability small fish - develops into Japan General symptoms: anemia due to larvae - ingested by larger B12 deficiency, diarrhea, signs of fish - human eats fish allergy, etc. Dipylidium caninum: Life cycle: proglottids in Transmission: ingest infected Grows in small intestine Dipylidiasis Stool test Dog tapeworm human or animal feces or flea from dog or cat perianal region - eggs Most carriers asymptomatic released - eggs Children consumed by flea larva - General symptoms: abdominal pain, develops into infected diarrhea, itchy butthole, urticaria adult flea - human/animal host ingests flea Echinococcus granulosis: Life cycle: dog is definitive Transmission: ingest eggs in Penetrates intestine and moves Echinococcosis US, CT, MRI Dog tapeworm host - sheep is feces through blood/lymph circulation intermediate host - to invade liver, lungs, and other Initial phase asymptomatic, ELISA test, but many are infection through ingestion Children internal organs symptoms not seen until adulthood seronegative of eggs in feces Develop into hydatid cysts Symptoms: liver involvement is asymptomatic, lung involvement causes cough, chest pain, dyspnea, hemoptysis Cyst rupture: fever, anaphylaxis Trematodes “Fluke” Disease process General facts 2 groups: hermaphroditic and sexual, all species use freshwater snails as intermediate host Schistosomiasis Schistosoma species in Transmission: skin contact Penetrate skin and move Swimmer’s itch due to repeated Not on slides the host freshwater snail with contaminated water through circulation and into skin exposure reproduce and shed into portal blood the water Sub-Sarah Africa Mating takes place in the liver Pathogenesis depends on Acute general manifestation: Acute schistosomiasis syndrome Not on slides what species Hypersensitivity reaction to (Katayama fever): sudden fever, antigens urticaria, angioedema, etc. GI manifestation: Intestinal chronic infection: Stool test Primary site of infection is the Ulcerations lead to bleeding and iron intestines deficiency Eggs deposit in bowel wall, Abdominal pain, diarrhea, loss of inflammatory response to eggs appetite Liver/spleen manifestation: Hepatosplenic chronic infection: Not on slides Acute: liver inflammation Portal hypertension, splenomegaly, Chronic: periportal fibrosis hepatomegaly, occlusion portal veins, portacaval shunting Lung manifestation: Pulmonary chronic infection: Not on slides Eggs lodge in pulmonary artery Pulmonary hypertension GU manifestation: Genitourinary chronic infection: Urine test Infection of veins of urinary Hematuria, dysuria bladder Neuro manifestation: Neuroschistosomiasis: Imaging: brain MRI Worms enter spinal cord or Seizures, motor/sensory impairment, Serology: ELISA test CSF cerebral circulation and release cerebellar syndrome eggs Paragonimiasis Paragonimus westermani: Transmission: Penetrates duodenum and Early: fever, diarrhea, etc upon Eggs in sputum or stool Lung fluke raw/undercooked crab or migrates to lungs, causes invasion of duoenum. crayfish inflammatory response Late: cough, hemoptysis upon invasion of lungs Clonorchiasis Clonorchis sinensis: Transmission: Mature in biliary tract RUQ pain, diarrhea, etc. Stool test Oriental liver fluke raw/undercooked, salted, pickled, smoked freshwater Parasite of fish eating fish mammals Nematode infection “Roundworm” Intestinal nematodes General facts: Roundworm, complete digestive system, nematodes as a whole can invade Liver, KIdneys, Intestines, Subcutaneous tissue, Eyes. Enterobiasis - pinworm Enterobius Transmission: Eating food Worm lays eggs in the perianal -Pruritus ani (itching anus) -Identifying eggs present around vermicularis: most touched by contaminated fold -White worms visible in the stool or the perianal region common helminthic hands perianal region -Tape test (scotch tape under infection in US, microscope look for eggs) commonly in school aged children Ascariasis - roundworm Ascariasis Transmission: ingestion of Humans consume eggs, the -Most patients are asymptomatic Diagnosing: lumbricoides: 2nd most water or food contaminated eggs hatch in intestine, larvae Early infection: -Imaging - CT, X-ray common only to with Ascaris eggs hematogenously migrate to the -patient may have pulmonary sxs -Eggs in stool Enterobius in US lungs, ascend the bronchial, and (cough, dyspnea, fever) are swallowed Late infection: -intestinal obstruction, malnutrition, hepatobiliary involvement, pancreatitis Trichuriasis - whipworm Trichuris trichiura: Transmission: infection of Eggs pass in stool, embryonate -Majority are asymptomatic Diagnosing: common in tropics, affects contaminate soil in soil, infective in 15-30 days -Stools are often loose and contain -ID of eggs in stool all ages, children are mucus/blood particularly vulnerable -Children who are heavily infected my have impaired growth or cognition Hookworm -Ancylostoma duodenale Transmission: direct skin Attach to the intestinal wall -Anorexia Diagnoses: -Necator americanus contact by larvae found in resulting in blood loss -Ulcer like sxs -ID of eggs in stool soil, larvae migrate into blood -Anemia Common in tropics vessel and carried to lungs, ascends bronchial tree, swallowed Strongylodiasis - -Strongyloides stercoralis Transmission: direct skin Burrow into the duodenum and -Relatively benign in healthy people Diagnoses: threadworm contact by larvae found in jejunum can be fatal in immunocompromised -ID of eggs in stool Relatively uncommon soil, larvae migrate into blood pts Tropical and subtropical vessel and carried to lungs, -May get some irritation in path regions ascends bronchial tree, larvae travel swallowed -Diarrhea -Constipation -Vomiting -Borborygmi (rumbling in intestines) Other Nematodes Ochocerciasis - river Onchocerca volvulus Transmission: bite of blackfly, Adult worms become -Subq nodules Diagnoses: blindness transmits infective larva into encapsulated by fibrous tissue -Pruritic skin rash -Skin biopsy 99% in sub-Saharan human skin and make subq nodules, moves -Ocular lesions - often results in Africa through subq, dermal, ocular blindness tissues, and the lymph system Toxocariasis ) Visceral Toxocara canis/cati: not a Transmission: ingestion of Larvae mature in intestines, Visceral sxs:: Diagnosis: larva migrans) natural human pathogen, eggs from dog/cat feces migrate to liver, brain, eyes -fever, anorexia, respiratory sxs, -H&P, clinical finding dogs/cats carry rash, enlarged liver -Blood test looking for elevated # of *only larvae cause disease WBC Primarily in children Ocular sxs: -unilateral vision impairment Filiarasis (elephantiasis) -Wuchereria bancrofti Transmission: bite from Inhabit the lymphatics and subq Block flow of lymph -> EDEMA Diagnoses: -Brugia malayi (most infected female Anopheles tissues -Detection of larva in blood stream common) and Culex mosquitoes or adult worm in lymphatics -CIrculating antigen detection Trichinellosis 7 species cause human Transmission: consumption of Larva released from cysts in -Severity depends on # of larva Diagnoses: disease encysted larvae in gastric acid, invade small bowel ingested -Serology undercooked pork mucosa and develop into adult -Muscle biopsy worm. Life span in small bowel Intestinal stage: is 4wks, after 1 wk females -abdo pain, N/V/D release larvae that migrate into Muscle stage: striated muscle, larvae encyst -muscle pain, tenderness, swelling, weakness Virology Non-enveloped DNA Etiology Epidemiology Pathogenesis Clinical Significant disorders Lab Evaluation/ Viruses & symptoms Imaging/Diagnosis Human papillomavirus Adenovirus Parvovirus Enveloped DNA viruses Herpesviridae Herpes simplex virus 1 and 2 Varicella-zoster virus Human cytomegalovirus Human herpesvirus type 8 Epstein-Barr virus Poxviridae