Parasitic Diseases PDF

Parasitic Diseases DONE BY: HANA HOSSAM, FAYROUZ,ASMAA ASHRAF,HANA OSSAMA, AYA SHERIF Parasitic Infection Parasitic infections often cause Parasitic infections are any illnesses intestinal illness, with symptoms...

Parasitic Diseases DONE BY: HANA HOSSAM, FAYROUZ,ASMAA ASHRAF,HANA OSSAMA, AYA SHERIF Parasitic Infection Parasitic infections often cause Parasitic infections are any illnesses intestinal illness, with symptoms or conditions caused by parasites like diarrhea and vomiting. But living and reproducing in your they can also give you itchy skin body. Parasites are organisms that rashes or infect other parts of need another living thing (a host) your body, like your brain or to get the nutrients they need to lungs. survive.  What are the symptoms of parasitic infections? Symptoms of parasitic infections depend on where in your body you’re infected. Some common symptoms include: Fever. Muscle aches. Fatigue. Nausea. Vomiting. Diarrhea.  Common types of parasitic diseases 1) Protozoal Infections Examples: Malaria, Giardiasis, Toxoplasmosis 2) Helminth Infections Examples: Ascariasis, Schistosomiasis, Hookworm 3) Ectoparasitic Infection Examples: Scabies, Lice, Myiasis  Helminthic diseases Helminths - worms - are some of the world's commonest parasites. They belong to two major groups of animals, the flatworms or Platyhelminthes (flukes and tapeworms) and the roundworms or Nematoda. All are relatively large, and some are very large, exceeding one meter in length. Their bodies have well-developed organ systems, especially reproductive organs, and most helminths are active feeders. The bodies of flatworms are flattened and covered by a plasma membrane, whereas roundworms are cylindrical and covered by a tough cuticle. Flatworms are usually hermaphroditic whereas roundworms have separate sexes.  Helminthic diseases Epidemiology Helminths are worldwide in distribution; infection is most common and most serious in poor countries. The distribution of these diseases is determined by climate, hygiene, diet, and exposure to vectors. Poor Sanitation and Hygiene: Inadequate sanitation is a major risk factor for helminthic infections. Open defecation, unclean drinking water, and inadequate sewage systems allow for the fecal-oral transmission of helminths. Environmental Conditions: Helminths thrive in warm, humid climates. Poorly managed agricultural practices, such as the use of untreated human feces as fertilizer, also contribute to the spread of soil-transmitted helminths.  Helminthic diseases Etiology The etiology of helminthic diseases refers to the specific parasitic worms (helminths) responsible for causing the diseases. These helminths are multicellular, eukaryotic organisms that can live inside the human body and cause a range of diseases, from mild symptoms to severe, chronic conditions. They are generally classified into three main groups: nematodes (roundworms), cest odes (tapeworms), and trematodes (flukes).  You can get parasitic infections from: Drinking contaminated water or getting it in your mouth. Eating undercooked meats. Helminthic Eating contaminated foods (like food washed with diseases contaminated water). Mosquito bites, tick bites, fly bites or other bites from Etiology insects that carry parasites. Contaminated surfaces. Contaminated dirt (soil). Some parasitic infections can pass from a pregnant person to the fetus.  Helminthic disease Pathophysilogy 1. Mechanical Damage Helminths can directly damage tissues through physical mechanisms such as penetration, migration, or attachment to various organs. This can result in obstruction, organ dysfunction, and potential secondary infections. 2. Inflammatory and Immune Reactions The immune system reacts to the presence of helminths, triggering inflammation and immune responses that can contribute to tissue damage. 3. Nutrient Depletion Many helminths feed on nutrients in the host’s digestive system, leading to malnutrition and deficiencies, which can severely impact the host, especially in children. 4. Immune Evasion Helminths have evolved strategies to avoid the host's immune defenses, allowing them to persist in the host over long periods and cause chronic infections. Helminthic diseases pharmacotherapeutic management Table 1: Nematodes, Trematodes, and Cestodes (Part 1) Helminthic diseases pharmacotherapeutic management Helminthic diseases pharmacotherapeutic management  Aka Trypanosomaisis “sleeping disease” Trypanosomiasis is a parasitic infection that spreads through the bites of tsetse flies in equatorial Africa. Trypanosoma brucei gambiense. In 2009 the World This causes over Health 90% of all Organization trypanosomiasis (WHO) indicated cases. that the number of new African Trypanosoma trypanosomiasis brucei cases dropped rhodesiense. This below 10 000 for causes less than 10% of all the first time in 50 trypanosomiasis years cases.  The parasite enters the bloodstream, evades the immune system through antigenic variation (changing surface proteins), and spreads to tissues, including the central nervous system (CNS).  Pharmacologic Therapy Medications Type of Trypanosomiasis Stage 1 (Early or Hemolymphatic Stage) Stage 2 (Late or Neurologic Stage) Suramin 4-5 mg/kg IV test dose, then 20 East African trypanosomiasis (caused Melarsoprol 2.2 mg/kg/day (maximum by Trypanosoma brucei rhodesiense) mg/kg (maximum 1 g/dose) IV on Days 1, 180-200 mg) IV for 10 days 3, 7, 14, 21 Pentamidine isethionate 4 mg/kg/day IM for 10 days Nifurtimox-Eflornithine Combination or Therapy (NECT): Nifurtimox 5 mg/kg PO Suramin 4-5 mg/kg IV test dose, then 20 q8h for 10 days AND mg/kg (maximum 1 g/dose) IV on Days 1, Eflornithine 200 mg/kg IV q12h for 7 days West African trypanosomiasis 3, 7, 14, 21 or (caused by Trypanosoma brucei or Eflornithine 400 mg/kg/day IV in 2 divided gambiense) Fexinidazole 20 to < 35 kg: 1200 mg PO qd doses for 14 days on Days 1-4, then 600 mg qd on Days 5- or 10 Melarsoprol IV for 10 days Fexinidazole 35 kg or greater: 1800 mg PO or qd on Days 1-4, then 1200 mg qd on Days Fexinidazole PO for 10 days 5-10  Ectoparasite a parasite that lives on the exterior of its host, they infest the skin of humans and animals, causing skin lesions visible to the naked eye and intense itching, for example fleas, ticks and lice. They are caused by organisms like fleas, ticks, The prevalence of lice, and mites, which lice in buffaloes can infest animals or ranged between 0 humans. These parasites and 92%. The louse are typically spread prevalence in through direct contact cattle was in the with an infected host, range of 0– environmental exposure, 38.3%. In 2015, or by vectors such as 1,489 camels were other animals and can examined for a cause various health mite infestation, problems, including skin recording an irritation, allergic infestation rate of reactions, and 11.28% transmission of diseases.  Pathophysiology Pharmacologic Therapy Initial bites in a person who is not permethrin is the treatment sensitized may cause little to no of choice for lice and reaction, but repeated bites lead to scabies in the US and in raised, itchy lesions (papular Great Britain, whereas urticaria) that typically appear lindane is still within 24–48 hours. Over time, recommended for scabies increased sensitization can cause in most other European more immediate and pronounced countries with malathoin reactions, including larger areas of which is used for treatment edema or wheals. In hypersensitive failures. individuals, these reactions may be severe, while repeated exposure Topical corticosteroids (e.g., may eventually diminish the hydrocortisone) may be response. Papular urticaria lesions used to reduce often persist for several days and inflammation, redness, and are associated with intense swelling caused by the skin inflammatory responses. reaction to bites or infestation.  Giardiasis Giardiasis is a common parasitic infection worldwide caused by Giardia lamblia. Giardia infection is an intestinal infection It can be asymptomatic, self-resolving, or cause symptoms like fatigue, bloating, and acute diarrhea, sometimes leading to chronic gastrointestinal symptoms. Infection usually happens by swallowing cysts in contaminated water (such as Drinking or swimming in unfiltered water) or food. Person-to-person transmission can also occur, Touching a surface that an infected person touched  Epidemiology Giardiasis is common worldwide, especially in areas with poor sanitation. especially prevalent in developing countries, where contaminated water is a major issue often affects children in daycare centers, travelers to endemic areas, and people who drink untreated water. People with weakened immune systems are more likely to get infected.  Pathophysiology Giardia infection occurs when a person ingests Giardia cysts, typically from contaminated water or food. Once swallowed, the cysts pass through the stomach and reach the small intestine, where they "hatch" into active trophozoites. Trophozoites multiply and create a barrier between the cells, causing further intestinal damage. Giardia releases harmful substances that contribute to this damage, but the infection generally stays in the intestines without spreading to other parts of the body.  Etiology 1. Contaminated Water: Drinking water that has been contaminated with Giardia cysts, often from untreated or improperly treated water sources like lakes, rivers, or wells. 2. Contaminated Food: Eating food that has been contaminated with Giardia, typically due to improper handling or washing with contaminated water. 3. Poor Hygiene: Poor handwashing practices, especially after using the bathroom or handling animals, can spread Giardia cysts. 4. Person-to-Person Transmission: Direct contact with an infected person, such as through sexual contact or sharing food or drink, can transmit the parasite. 5. Contaminated Surfaces: Touching surfaces contaminated with Giardia cysts (such as doorknobs or toys) and then touching the mouth or face. 6. Travel to Endemic Areas: Traveling to areas with poor sanitation, where Giardia infection is more common due to contaminated water and food sources. 7. Close Contact with Infected Animals: Handling animals, especially pets like dogs or cats that may carry Giardia, can lead to infection if hygiene is not maintained.  Treatment Medication Adult Dose Pediatric Dose Notes Most commonly used. 15 mg/kg/day divided into 250 mg three times daily Side effects: nausea, Metronidazole (Flagyl) 3 doses for 5–7 days (max: for 5–7 days metallic taste. Avoid 750 mg/day) alcohol during treatment. Single-dose treatment. 50 mg/kg (max 2000 mg) Similar side effects to Tinidazole (Tindamax) Single 2 g dose as a single dose metronidazole. Avoid alcohol. Age-based dosing: 1–3 years: 100 mg twice Liquid form available, daily 500 mg twice daily for 3 easier for children. Side Nitazoxanide (Alinia) 4–11 years: 200 mg twice days effects: nausea, yellow daily urine/eyes. >12 years: 500 mg twice daily For refractory cases. Not 100 mg three times daily 2 mg/kg three times daily FDA-approved for Quinacrine for 5–7 days for 5–7 days giardiasis in the U.S. Limited availability. Pregnancy Considerations: No consistently recommended medications due to potential harm to the fetus. Treatment may be delayed until after the first trimester if symptoms are mild.  Amebiasis Entamoeba histolytica amebas in a person's small intestine. Amebiasis Amebiasis is a parasitic intestinal infection caused by any of the amoebas of the Entamoeba group. More common in people living in tropical areas with poor sanitary conditions or people traveling to these areas. Amoebiasis may present with no symptoms(80-90%) or mild to severe symptoms(10-20%), including abdominal pain, diarrhea, or bloody diarrhea. Severe complications may occur. Etiology: caused by the protozoal organism E histolytica. can give rise both to intestinal disease (eg, colitis) and to various extraintestinal manifestations, including liver abscess (most common) and pleuropulmonary, cardiac, and cerebral dissemination. E histolytica is transmitted primarily through the fecal-oral route. Sexual transmission is possible. Epidemiology: International statistics: Worldwide, approximately 50 million cases of invasive E histolytica disease occur each year, resulting in as many as 100,000 deaths. The incidence of amebiasis is higher in developing countries. Amebiasis is the second leading cause of death due to parasitic diseases, killing about 40,000-100,000 people per year globally. In Egypt, 38% of individuals presenting with acute diarrhea to an outpatient clinic were found to have amebic colitis. All age groups, both sexes equally, However, invasive amebiasis is much more common in adult males than in females,  Pathophysiology: E histolytica causes proteolysis and tissue lysis and can induce host-cell apoptosis (amebapores : forming pores in lipid bilayers) Ingestion of E histolytica cysts from the environment is followed by excystation in the terminal ileum or colon to form highly motile trophozoites. Upon colonization of the colonic mucosa,the trophozoite may : encyst and is then excreted in the feces, reach the environment to complete the cycle. or it may invade the intestinal mucosal barrier and gain access to the bloodstream, whereby it is disseminated to the liver, lung, and other sites. Amebiasis Treatment & Management Most : outpatient basis. Some clinical scenarios :may favor inpatient care, as follows: Severe colitis and hypovolemia requiring intravenous (IV) volume replacement Liver abscess that is of uncertain etiology or is not responding to empiric therapy Fulminant colitis requiring surgical evaluation Peritonitis and suspected amebic liver abscess rupture In endemic areas, asymptomatic infections are not treated. In nonendemic areas, asymptomatic infection should be treated.  The primary therapy for symptomatic amebiasis requires hydration and the use of metronidazole and/or tinidazole. These two agents are dosed as follows: Metronidazole dosing for adults is 500 mg orally every 6 to 8 hours for 7 to 14 days. Tinidazole adult dosing is 2 g orally each day for 3 days. Luminal agents such as paromomycin and diloxanide furoate are also used. An amoebic liver abscess can be managed by aspiration using CT guidance in combination with metronidazole. Surgery is sometimes required to treat massive gastrointestinal bleeding, toxic megacolon, perforated colon, or liver abscesses not amenable to percutaneous drainage. Malaria Etiology Malaria is caused by Plasmodium parasites, with P. falciparum and P. vivax being the most clinically significant species. P. falciparum is responsible for severe and potentially fatal cases The incubation period, and therefore time to symptom development, varies by species The periodicity of the Plasmodium lifecycle creates the classic "malarial paroxysm" of rigors, followed by several hours of fever, followed by diaphoresis, and a drop to normal body temperature. Epidemiology Malaria is a major health problem, especially in sub-Saharan Africa, South Asia, and parts of Latin America. 500 million malaria cases occur annually, with 1.5 to 2.7 million deaths. Of the 125 million travelers who visit endemic locations each year, 10000 to 30000 develop malaria, and 1% of these will die from complications of their disease. The spread of malaria is influenced by factors like : Areas where mosquitoes can breed limited healthcare access the growing resistance to malaria drugs Pathophysiology: Malaria is transmitted when an infected female Anopheles mosquito bites a human and injects sporozoites (the infectious form of the parasite) into the bloodstream. These sporozoites travel to the liver where they mature and reproduce. After leaving the liver, the parasites enter red blood cells. Inside red blood cells, the parasites multiply, causing the cells to rupture, which leads to symptoms like fever, chills, and anemia  Treatment Uncomplicated Malaria: Severe Malaria (All Regions): Treatment in Pregnancy: Chloroquine-sensitive regions: IV Artesunate at 0, 12, 24, and 48 Chloroquine-sensitive hours regions: Chloroquine phosphate Hydroxychloroquine (3 days) Follow with one of those: Chloroquine hydroxychloroquine Chloroquine-resistant or artemether-lumefantrine unknown regions: Chloroquine-resistant atovaquone-proguanil regions: Atovaquone-proguanil 3 days (once daily) Doxycycline Quinine sulfate + Artemether-lumefantrine (3 days clindamycin or mefloquine given as a fixed-dose combination twice daily) mefloquine (any trimester) (7 days) Quinine sulfate combined with doxycycline, tetracycline, or Artemether-lumefantrine clindamycin. (7 days) (second and third trimesters only). Mefloquine Single dose or divided into 2 doses within 24 hours.  Refrences https://my.clevelandclinic.org/health/diseases/24885-parasitic-infection#management-and-treatment https://www.ncbi.nlm.nih.gov/books/NBK8191/#:~:text=Epidemiology,diet%2C%20and%20exposur e%20to%20vectors https://www.cdc.gov/parasites/ https://www.who.int/news-room/fact-sheets/detail/soil-transmitted-helminthiases European Centre for Disease Prevention and Controlhttps://www.ecdc.europa.eu ›...PDFgiardiasis- annual-epidemiological-report-2019_0.pdf https://emedicine.medscape.com/article/176718-treatment Giardia infection (giardiasis) - Diagnosis & treatment - Mayo Clinic https://my.clevelandclinic.org/health/diseases/15238-giardiasis https://altmedrev.com/wp-content/uploads/2019/02/v8-2-129.pdf  Refrences https://www.sciencedirect.com/topics/earth-and-planetary- sciences/ectoparasite#:~:text=An%20ectoparasite%20is%20an%20organism,directly%20cause%20disc omfort%20and%20morbidity. https://www.sciencedirect.com/science/article/pii/S2213224415300237 https://pmc.ncbi.nlm.nih.gov/articles/PMC8716624/ https://www.sciencedirect.com/topics/medicine-and-dentistry/ectoparasite https://link.springer.com/article/10.2165/00003495-200161080-00004 https://emedicine.medscape.com/article/228613-treatment#d7 https://my.clevelandclinic.org/health/diseases/trypanosomiasis#management-and-treatment https://www.ncbi.nlm.nih.gov/ https://reference.medscape.com/?_gl=1*1tujf9f*_gcl_au*MTM0NjEyODE1OC4xNzMxODg5N TU3