WEBVTT

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Welcome.

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In today's lecture, we're going to be
doing an overview of parasitology

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with a particular focus on those parasites
that infect

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the body
outside of the gastrointestinal tract.

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Today, the speakers are myself,

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Mark Toria, and medical director
of parasitology at air U.P.

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and a professor of pathology
at the University of Utah.

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Joining me is Blaine Mathison,
who is an R&D scientist and parasitology

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specialist at RTP and also an adjunct
instructor at the University of Utah.

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Our objectives for today's talk

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are to understand
the parasite diversity and taxonomy.

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We are going to review
the relevant parasites that we find

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in humans, as well as conventional ways
to test for them.

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And we're going to understand the impact
and role

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that parasites
play in human health worldwide.

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So the structure of this talk
is going to be systems based.

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So we're going to oversee the broad range

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of areas in the human body
that we can find parasites.

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We're going to start with the brain
and central nervous system.

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Move into skin and soft tissue.

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Combine lungs and liver in one section.

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A brief section on genital urinary.

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And then there's actually a separate video

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where we'll cover the conventional blood
parasites found in humans.

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I'm going to start with covering

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basically basic concepts of parasitology,

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including some of the lifecycle terms that
we're going to use throughout this talk.

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And so essentially what is a parasite
in in medical science is a parasite

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is essentially an organism

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that derives a survival benefit
from a host at the expense of the host.

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Specifically, clinical parasitology
focuses on the non fungal

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eukaryotic parasites.

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And we're going to go into

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some of the major taxonomic groups
here in just a second as well.

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So some of the terms we're going to be
using throughout this talk,

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especially with regards
to life cycles in biology, definitive

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host in a host with an excuse me,
an a parasite with multiple hosts.

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The definitive host
is essentially where the adult occurs

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or sexual maturity and reproduction
takes place.

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For example, the Anopheles
mosquito is the definitive host

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for Plasmodium, which causes malaria.

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The intermediate host.

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This is a this is the host where asexual

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or developmental stages occur.

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For example, as worms,
it'll be larval stages.

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And the intermediate host development
does occur in the immediate host,

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but the intermediate host
is not competent for development.

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The final life cycle stages a parrot host,

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is sometimes confused
with an intermediate host, a pair of ten.

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The host harbors an immature stage,
but there's no further development.

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It's used mainly for transmission,
usually to get from an intermediate host

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to the definitive host.

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A reservoir host is a host that maintains

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the parasite in nature
in the absence of a human.

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So, for example, in North America,
pigs are a reservoir host for asterisk.

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Asterisk continue its life cycle in pigs
without any human involvement.

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Dead end and accidental hosts.

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We use this term, usually

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with human parasitology

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for parasites that the humans
not normally part of the life cycle.

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Humans get the parasite
and it doesn't develop in us,

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or at least doesn't develop
to the definitive host in US.

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Technically, intermediate hosts and Paris
ten hosts

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can also be considered
dead end or accidental hosts.

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But when talking about human
parasitology, it's

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usually zoonotic
things that humans acquire,

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and the parasite cannot fulfill its life
cycle in the human host.

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Next, I'm going to cover some of the broad

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medical classifications of parasites,
starting with the worms.

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Helminth is by definition
a parasitic worm.

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There's two broad groups
the flatworms and the roundworms.

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The flatworms are broken into two
major groups the stones,

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which are your tapeworms,
such as tenia di palladium.

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And then your tremor toads,
which are your flukes, such as Fashola,

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Fousey lops as paragon nymphs
and the schistosomiasis.

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The other major broad group are
the roundworms, which are your nematodes.

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So that's asterisk whip worm. Pin worm.

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The floral nematode such as Will Karia.

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The other major group are the protozoans.

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Or I should say, a second
major group are the protozoans.

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These are essentially
and clinical parasitology.

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These are your unicellular cellular
and non fungal,

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eukaryotic free
living and parasitic organisms.

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And they're broken into several

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major groups such as the amoebas
the cock citizens, the flagella.

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It's ciliates instrumental piles.

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Medically toxicity
often includes Cryptosporidium,

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although that's now considered a I'm
not a true cock citizen.

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Also, we're going
to put the micro esperti in here.

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It should be noted the micro esperti
a taxonomically are true fungi,

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but they're still treated in parasitology
because diagnosis is usually done

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in the parasitology lab,

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and most expertise are still maintained
by clinical parasitologist.

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And the last major group
are the arthropods.

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These are insects and arachnids,
and related and organisms.

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Most of them function
as ecto parasites in the human host.

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So these are your mites.

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Like the causative agent of scabies, lice,
like the head lice and pubic

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lice, fleas, ticks, fly larvae
that cause meiosis,

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and true bugs such as the kissing bugs,
which vector

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Trypanosoma cruzi,
the agent of Chagas disease.

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So when it comes to diagnosing parasites,
one of the most important parts

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besides social application
history is selecting the correct tests.

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And for many parasites, there's

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multiple tests that can be used to get
to the final answer and understanding how

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these tests are used and what scenarios
is actually quite important.

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So within each of the body systems,
we'll talk about different parasites

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and we'll dive into some of these specific
utilizations a little bit more.

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But broadly speaking we can do
stool parasite exams, which again

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I mentioned we're not going to focus
so much on the stool parasites today.

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But stool exams,

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body fluids and aspirates analysis,

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is the path of tissue.

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Those three are all used up
under microscopy.

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So classical microscopy
to look at a specimen,

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to try to visualize the presence
of one of the parasites.

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There's also antigen detection.

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And this can be done as a lateral flow
rapid test

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that can be a plate based Eliza,
where you're trying to detect

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an antigenic component
of a pathogen indirectly.

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Antibody detection is even more indirect.

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So that's looking at, IGA antibodies

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that the body produces
against a specific parasite.

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Nat testing and nucleic acid
amplification tests.

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Admittedly,
probably one of the newer methods

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to clinical parasitology,
not as broadly used as some of the others,

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but very valuable in many, discrete
situations.

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We'll talk about some of those in this,
in this content and then culture.

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There is a very few indications
for still doing

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culture for parasites,
but we will mention 1 or 2 in this talk.

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So a little bit more on the microscopy.

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So stool exams are really the parasite

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a logical interrogation
that most labs are familiar with.

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This is our classical exam.

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And this, consists of a wet mount

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and a permanent stain trigram slide.

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There are other special stains
that can be used,

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to set different organisms,
such as the Cork city.

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But, again, this is
not going to be the focus on this topic.

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I really want to dive
into all the other areas

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of parasitology
that sometimes get, minimalist.

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So body fluid examinations,
we can ask aspirates

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where we can see things like it
kind of caucus if there is fluid

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taken from a cyst
during a surgical procedure tissue.

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So we can see amoebas and tissue,
if we're sampling things

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such as, intestinal liver, etc..

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So I previously mentioned
antigen detection is an indirect way

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of detecting the presence
of a parasite in a specimen.

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So the antigen is is the immuno
stimulatory component of the parasite.

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It could be a carbohydrate.
It could be a protein.

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Doesn't really matter.

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It's just something that that is produced
in a high amount

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that can be captured by an antibody
in an antigen test.

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How to indirectly detect
the presence of that parasite.

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These tests are available primarily
for blood and stool

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parasites, and the performance
of different commercial tests

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is actually quite variable.

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Some can be highly sensitive
with, lower sense, specificity.

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Some can be very specific
and maybe have lower sensitivity.

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And knowing the characteristics of that
test is important for how you interpret

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it. These tests do offer an advantage
of being reasonably fast

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to perform, and that's useful
for getting a diagnosis quickly.

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Antibody detection, conversely,
does have a bit of a time delay.

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Now, the test is no less time to perform
than an instant test.

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But biologically, we need to make sure
that the patient has had adequate time

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for the parasite to have been in the body
and elicit an immune response

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in order to detect those complementary
antibodies to the to that parasite.

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And again, the performance is variable.

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And it depends on what specimen
you're testing,

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what stage of disease
and the location of the parasite.

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And we'll talk about some examples
of this.

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Typically serum and CSF are the two

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most commonly used specimens
for Nap testing.

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This is more of a direct,

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reporting of the presence of a parasite.

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If you're detecting the nucleic acid
and you are mostly detecting

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the exact location of the parasite
when you're sampling.

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So, for instance, a stool specimen,

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for GI parasite,
it should be in the stool.

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If you have,

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PCR, these two are not usual.

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Two from a CSF specimen.

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Then that's that parasite is in the CSF,
possibly the brain.

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That again specimen types are very broad.

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It depends.

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Every test is specific
to a specific clinical

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presentation
and biological location on the body.

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So that sensitivity
is going to depend on those variables.

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Which organism is it, what stage
of its life cycle and where is it located.

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For some of these tests they're very
esoteric, so they're only available at

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you know, CDC or select,
specialized reference laboratories.

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So you don't really get an immediate
result with some of these factors

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just because you have transport
to that specialized lab.

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And then the time that it takes
to start a run to do the testing.

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And then for culture, again,
very limited utility for the most part.

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Some of that still maintain
for the living amoeba

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culture, for things
like a Kent amoeba or a nickel area.

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In general, these culture

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methods are not exquisitely sensitive,

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and most routine
labs are not performing them.

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And there's also a biosafety risk
that goes into maintaining

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some of these organisms in culture.

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So we're going to jump
into the organ systems at this point.

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Now that we have a basic overview
of the diagnostics.

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And we'll start with the brain
and central nervous system okay.

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For the first parasite
we're going to cover in the CNS.

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We're going to talk about Toxoplasma
gondii the causative

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agent of toxoplasmosis.

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It's it's a it's a field parasite.

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Its natural hosts are cats
in other fields.

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It has a complex life cycle.

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And I'll show you the life
cycle in the next slide.

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Has a complex,

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one host life cycle,
but other animals can serve as parasitic

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hosts, and humans are essentially
a dead end host for this parasite.

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There's multiple routes of
infection for the human host.

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The classic one, of course,

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is the ingestion of the OSA stage
in something contaminated with cat feces.

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Now, there's a little caveat to that,

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because not all cats are at risk
for harboring Toxoplasma.

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Your greatest risk are going to be feral
kittens

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and cats, especially young cats
that have access to the outdoors.

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So if you have a cat that's indoors,
all the time, there's very low risk

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that it's going to be shedding
Toxoplasma and a risk to the homeowners.

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Also eating undercooked meat of animals
that harbor tissue cysts

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for example, deer grazing in a field
in just osis where a cat defecated.

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The deer gets the tissue cysts,
the hunter shoots the deer, doesn't cook

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it properly, can get infected
by eating that deer meat.

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Also blood transfusion and solid organ
transplantation.

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And then, parents can personally,

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transfer the parasite,
to their developing fetus.

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So here's the life cycle on the right
that kind of highlights

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those those different elements
that I just discussed.

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The life cycle shows

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host as part of the natural life cycle.

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But cats can be infected
by direct ingestion of O cysts.

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Those intermediate host,
those pyrotechnic hosts

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are not really required
for for parasite development.

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But a lot of cats are going to get this
from eating infected rodents and birds.

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Again, humans are a dead end stage
for this parasite.

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Cannot develop
the sexual maturity in the human host.

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So you would never expect to find,
oh, cysts in human feces when infected.

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Common sites of, common sites of infection
in the human host

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are skeletal muscle,
the myocardium, the brain and the eyes.

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And I should point out,

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this is both an immuno competent
and immunocompromised patients.

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They can get into the brain of someone
who is immuno competent.

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They tend to be dormant as a Zoid stage

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unless that patient becomes
immunocompromised later in life.

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The symptoms are highly variable depending
on the immune status of the patient.

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The age of the patient.

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Is it a pregnant female?

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Is it a newborn?

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They may have congenital, etc..

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Often the disease is asymptomatic.

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You might get some
cervical lymphadenopathy

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and a generalized flu like illness.

00:14:40.133 --> 00:14:41.900
In immunocompromised patients.

00:14:41.900 --> 00:14:45.600
However, they tend to get localized
symptoms based on body sight,

00:14:45.966 --> 00:14:50.100
and some of the more detrimental clinical
presentation takes place in the brain,

00:14:50.600 --> 00:14:53.300
where you can get Toxoplasma encephalitis,

00:14:53.300 --> 00:14:56.100
or in the eyes
where you can get retinal colitis.

00:14:56.100 --> 00:15:00.500
Diagnosis of Toxoplasma is laboratory
diagnosis is serology

00:15:00.900 --> 00:15:04.333
and serologic interpretation
can be kind of complex.

00:15:04.766 --> 00:15:08.533
I would recommend, consulting either
the CDC website

00:15:08.533 --> 00:15:12.600
or the Manual of Clinical Microbiology
for some of these interpretive tables.

00:15:13.300 --> 00:15:17.233
For CNS involvement, it's usually noted

00:15:17.233 --> 00:15:20.633
first on imaging as a ring
enhancing lesion.

00:15:21.000 --> 00:15:23.933
Now that's not specific to Toxoplasma, but

00:15:23.933 --> 00:15:26.933
it could support positive
serologic assays as well.

00:15:27.366 --> 00:15:30.566
The treatment for toxoplasmosis
is going to be highly variable.

00:15:30.566 --> 00:15:34.066
Again, depending on the the,
the demographics

00:15:34.066 --> 00:15:36.000
and the immune status of the patient.

00:15:36.000 --> 00:15:40.066
The next disease, I'm going to discuss
regarding the CNS is Pam

00:15:40.066 --> 00:15:43.066
primary amoebic meningoencephalitis.

00:15:43.166 --> 00:15:48.000
This is caused by the free living amoeba
flatulent Naegleria fowleri.

00:15:48.333 --> 00:15:51.100
Now, I should point out that this organism
in the next couple

00:15:51.100 --> 00:15:54.100
I'm going to talk about
are not technically parasites.

00:15:54.100 --> 00:15:57.966
It did not evolve to use, a host
for nutritive source.

00:15:57.966 --> 00:16:01.066
These are free living organisms
and infections

00:16:01.066 --> 00:16:04.066
in humans or other animals is considered
incidental.

00:16:04.466 --> 00:16:08.533
The root of infection for Naegleria
is through the nasal mucosa.

00:16:08.866 --> 00:16:13.200
Your classic clinical vignette is a child
or a young teenager jumping in the water,

00:16:13.400 --> 00:16:14.500
jumping in like a lake.

00:16:14.500 --> 00:16:17.800
You know, warm, warm water on a warm
summer days.

00:16:18.366 --> 00:16:21.233
It's believed that this disease is most
commonly seen in children

00:16:21.233 --> 00:16:24.233
and teens because once the,

00:16:24.233 --> 00:16:28.033
because these younger individuals
have a less developed crib form plate.

00:16:28.333 --> 00:16:32.200
And when the amoeba enter the nasal
mucosa, they can transcribe that,

00:16:32.800 --> 00:16:36.533
that form plate much easier
and then hitch a ride

00:16:36.533 --> 00:16:39.533
on the on the olfactory
nerve to get to the brain.

00:16:39.766 --> 00:16:42.100
There is a couple other,
routes of infection.

00:16:42.100 --> 00:16:45.133
We should note there's been, a few cases

00:16:45.133 --> 00:16:48.533
associated with the improper
use of nasal irrigation devices.

00:16:49.033 --> 00:16:52.033
And there's also been clusters of cases
in Asia,

00:16:52.233 --> 00:16:55.900
specifically Pakistan,
associated with ritual ablution.

00:16:56.433 --> 00:16:59.866
Symptoms are sudden and severe.

00:16:59.866 --> 00:17:04.000
And unfortunately, most of the time,
by the time the symptoms symptoms set in,

00:17:04.400 --> 00:17:08.900
it's often sadly too late to actually do
anything to help the patient.

00:17:09.400 --> 00:17:12.866
Clinically, it presents as,
necrotizing meningoencephalitis.

00:17:13.266 --> 00:17:18.733
It has a very, very high case
fatality rate with only 2 or 3 successful,

00:17:19.466 --> 00:17:22.466
cases reported in the scientific
literature that I'm aware of.

00:17:23.166 --> 00:17:24.733
Here's the life cycle again.

00:17:24.733 --> 00:17:27.066
The organism cycles between a cyst,

00:17:28.033 --> 00:17:29.333
a related trough, desire

00:17:29.333 --> 00:17:33.300
for motility and the trough reside
for feeding in the environment.

00:17:33.300 --> 00:17:35.900
Swarm wet soil, warm water.

00:17:35.900 --> 00:17:40.200
And then infection occurs
through entry into the nasal mucosa via

00:17:40.233 --> 00:17:41.900
a fresh water source.

00:17:41.900 --> 00:17:46.500
The picture on the right shows, trophies,
hides in the CSF stained with games.

00:17:46.766 --> 00:17:50.800
So diagnosis sadly, is most
most of the time is made on autopsy.

00:17:51.200 --> 00:17:56.000
If a patient comes into a clinic or an ER
or they're presenting with symptoms

00:17:56.000 --> 00:17:59.433
that sound like Pam, they've had a recent,
exposure to fresh water.

00:17:59.833 --> 00:18:04.066
And this is suspected the the first
best thing you can do is do a fresh wet

00:18:04.133 --> 00:18:08.233
mount of the CSF before it's refrigerated
and look for the live modal trough.

00:18:08.233 --> 00:18:09.666
Associates.

00:18:09.666 --> 00:18:14.500
The CSF can also be, stained with games
and try chrome to, to enhance detection.

00:18:14.966 --> 00:18:16.600
The next step is to get that CSF

00:18:16.600 --> 00:18:19.600
to a reference lab
that does PCR as quickly as possible,

00:18:19.766 --> 00:18:22.766
such as the CDC
or maybe some other large reference labs.

00:18:23.166 --> 00:18:26.133
This organism is cultural,
but there are delay issues.

00:18:26.133 --> 00:18:29.200
You're probably not going to see results
for 24 to 48 hours,

00:18:29.600 --> 00:18:31.833
and by then
it could be too late for the patient

00:18:31.833 --> 00:18:35.933
for the few patients that have survived
this disease, the treatment has included

00:18:35.933 --> 00:18:39.700
chemotherapeutic treatments,
such as not seen in combination

00:18:39.700 --> 00:18:44.866
with medically controlled hypothermia,
related to Pam, or clinically.

00:18:45.400 --> 00:18:48.300
The clinical differential for Pam,
I should say, is GI

00:18:48.300 --> 00:18:51.266
granulomatous amoebic encephalitis.

00:18:51.266 --> 00:18:53.166
This is caused by a couple more free
living

00:18:53.166 --> 00:18:56.900
amoeba ballets, museums and galleries
and account amoeba species.

00:18:57.000 --> 00:18:59.433
Just like Naegleria.
These are not true parasites.

00:18:59.433 --> 00:19:00.500
There are normal component

00:19:00.500 --> 00:19:03.800
of the soil and water fauna,
and humans are just accidental hosts.

00:19:04.433 --> 00:19:07.900
The root of exposure is believed to be
to the lower respiratory

00:19:07.900 --> 00:19:12.733
tract after inhalation
or through ulcerated, broken and cut skin.

00:19:13.100 --> 00:19:16.466
I should point out that a camp
amoeba can also enter the eye,

00:19:16.700 --> 00:19:20.300
usually from some kind of corneal
abrasion, and causes amoebic keratitis.

00:19:20.666 --> 00:19:24.233
Amoebic keratitis and gar
are not precursors for one another.

00:19:24.600 --> 00:19:26.166
In other words, if someone has a count,

00:19:26.166 --> 00:19:30.066
they may be keratitis that does not
make them predisposed for developing.

00:19:30.066 --> 00:19:34.033
GI symptoms include meningioma,
cellulitis, and encephalitis.

00:19:34.266 --> 00:19:38.800
It does tend to be more chronic and Pam,
but again, typically once CNS involvement

00:19:38.800 --> 00:19:42.833
sets in CNS symptoms set in, it's often
too late for the patient.

00:19:43.100 --> 00:19:44.833
Here's the life cycle.

00:19:44.833 --> 00:19:50.400
Very similar to, to Naegleria fowleri, but
just with different routes of exposure.

00:19:50.600 --> 00:19:54.200
Notice the image on the left shows,
those are amoebic

00:19:54.200 --> 00:19:58.100
troughs and cysts in a brain specimen
seen with H.

00:19:58.100 --> 00:20:01.066
And he notice in the inset
there's two cysts.

00:20:01.066 --> 00:20:04.200
You you don't see cysts with Naegleria
fowleri and histo

00:20:04.200 --> 00:20:07.200
past specimens,
but you do with Belarusian account amoeba.

00:20:07.400 --> 00:20:10.633
So the presence of cysts in a biopsy
or autopsy specimen

00:20:10.933 --> 00:20:13.433
is supportive of GA over Pam.

00:20:14.666 --> 00:20:16.133
This disease, I'd like,

00:20:16.133 --> 00:20:19.500
Naegleria fowleri, which is most
commonly seen in young, healthy people.

00:20:20.300 --> 00:20:23.500
G is predominantly seen in people
who are immunocompromised

00:20:23.500 --> 00:20:27.400
and that could be immunocompromised
through some kind of chemotherapy, through

00:20:27.400 --> 00:20:31.600
steroid use, through infectious agent
or through an autoimmune disorder.

00:20:32.500 --> 00:20:35.500
Again,
diagnosis is usually made on autopsy.

00:20:36.066 --> 00:20:38.500
If you have clinical specimens,
it could be stained

00:20:38.500 --> 00:20:41.966
with games or sometimes calico for white
to pick up the cysts.

00:20:41.966 --> 00:20:45.033
But you don't often get cyst and CSF.

00:20:45.433 --> 00:20:49.100
You can culture account the amoeba,
but you cannot a culture blameworthy,

00:20:49.200 --> 00:20:52.200
at least not in the typical

00:20:52.300 --> 00:20:55.300
non-nutritive
auger plate overlaid with the bacteria.

00:20:56.566 --> 00:20:58.400
If you,

00:20:58.400 --> 00:21:00.433
culture is recommended
for a counter mature

00:21:00.433 --> 00:21:03.766
keratitis where
there's not such an urgency about it.

00:21:03.800 --> 00:21:08.266
But again, with CNS involvement,
you really want to get that CSF to a PCR.

00:21:08.366 --> 00:21:11.366
I'm sorry, to a lab
that does PCR as quickly as possible.

00:21:11.833 --> 00:21:14.833
There's really no most cases are fatal.

00:21:15.066 --> 00:21:18.733
There haven't been enough successful cases
to really spell out

00:21:18.733 --> 00:21:22.400
an appropriate, treatment
plan for this, for this condition.

00:21:22.733 --> 00:21:24.800
I put this slide in there.

00:21:24.800 --> 00:21:26.100
Just kind of as a review,

00:21:27.066 --> 00:21:29.733
giving you the differences between
Pam and GA.

00:21:29.733 --> 00:21:32.433
I'm not going to rattle off this table
in every aspect of it.

00:21:32.433 --> 00:21:35.433
This is more for your for your, personal,

00:21:35.766 --> 00:21:39.200
education and studying,
but compares the root of infection.

00:21:39.266 --> 00:21:42.100
Excuse me? The source of infection,
the root to the brain.

00:21:42.100 --> 00:21:45.066
Primary risk groups, primary diagnosis.

00:21:45.066 --> 00:21:48.066
What stages are seen in human tissue
and treatment.

00:21:48.100 --> 00:21:51.100
The next disease
I'm going to cover is neurocysticercosis.

00:21:51.466 --> 00:21:54.600
This is caused by the larval stage
of tinea solium,

00:21:54.800 --> 00:21:57.566
which is commonly called the pork
tapeworm.

00:21:57.566 --> 00:22:00.466
Essentially, it can occur anywhere
in the world where pigs are raised

00:22:00.466 --> 00:22:04.033
because pigs are needed
to maintain the parasite's life cycle.

00:22:04.433 --> 00:22:09.300
But most, most cases come out of Latin
America and Southeast Asia.

00:22:10.033 --> 00:22:13.966
Now, acquisition of this disease
and this is a common trip up.

00:22:13.966 --> 00:22:16.966
And for those of you
that might go on to take board exams

00:22:17.066 --> 00:22:20.066
or medical school exams,
they love to test over this,

00:22:20.633 --> 00:22:24.466
acquisition of this disease
is from eating the tenia solium eggs

00:22:24.833 --> 00:22:29.466
in food or fomites or some other reservoir
contaminated with human stool.

00:22:29.866 --> 00:22:31.233
It's not from eating pork.

00:22:31.233 --> 00:22:33.200
It's not from eating pig feces.

00:22:33.200 --> 00:22:34.100
It's human stool.

00:22:34.100 --> 00:22:36.533
Because humans are the only definitive
host.

00:22:36.533 --> 00:22:37.866
It's a very common trip up.

00:22:37.866 --> 00:22:40.866
But, but it likes to be tested over.

00:22:41.566 --> 00:22:44.900
In academia, the clinical manifestations
are going to vary

00:22:44.900 --> 00:22:48.800
based on the size, the number,
and the state of the sister Circe.

00:22:48.900 --> 00:22:51.500
Often,
if you've got 1 or 2 and they're small

00:22:51.500 --> 00:22:53.000
and they're not in the part of the brain,

00:22:54.266 --> 00:22:54.566
where

00:22:54.566 --> 00:22:57.666
they're they're not causing much, damage,

00:22:57.666 --> 00:23:00.766
symptoms can actually be quite mild
when there are symptoms.

00:23:00.766 --> 00:23:04.966
Epilepsy is the most common clinical
manifestation, followed by intracranial

00:23:04.966 --> 00:23:09.133
hypertension, hydrocephalus,
meningitis, and nerve abnormalities.

00:23:09.800 --> 00:23:11.033
Here's a life cycle on the right.

00:23:11.033 --> 00:23:12.800
There's
kind of two aspects of the life cycle.

00:23:12.800 --> 00:23:14.300
The large red circle.

00:23:14.300 --> 00:23:16.000
This is for intestinal tinnitus.

00:23:16.000 --> 00:23:19.000
This is how you get the tenia solium
in your intestinal tract

00:23:19.033 --> 00:23:20.600
from eating undercooked pork.

00:23:20.600 --> 00:23:23.300
Sister psychosis,
if you notice the blue arrow going from

00:23:23.300 --> 00:23:26.433
the egg to the human,
that's from ingesting the egg.

00:23:26.533 --> 00:23:28.433
Think of it
this way. And similar psychosis.

00:23:28.433 --> 00:23:30.700
The human is assuming the role of the pig.

00:23:30.700 --> 00:23:33.700
The human is essentially becoming
the intermediate host.

00:23:34.000 --> 00:23:38.233
Now, if someone has tinea solium in their
GI tract, they can give themselves

00:23:38.600 --> 00:23:42.633
sister psychosis, but they can also
give it to other household contacts.

00:23:43.166 --> 00:23:46.966
Diagnosis is primarily by imaging,
followed by antibody detection.

00:23:47.300 --> 00:23:51.000
Historically,
the the antibody testing when as follows.

00:23:51.266 --> 00:23:55.300
You have an idea for initial screening,
which has a higher sensitivity,

00:23:55.300 --> 00:23:59.066
but lower specificity, and
then you confirm it with an immuno blot.

00:23:59.466 --> 00:24:00.466
The eyes are

00:24:00.466 --> 00:24:04.166
becoming a little more specific
and as such are losing some sensitivity.

00:24:04.566 --> 00:24:07.833
So some people are recommending,
depending on the clinical presentation

00:24:07.833 --> 00:24:08.833
of the patient,

00:24:08.833 --> 00:24:09.800
sometimes going straight

00:24:09.800 --> 00:24:13.633
to the immuno blot, you can see
larval worms and biopsy specimens,

00:24:13.633 --> 00:24:16.000
but the brain isn't a part of the body
we normally like to go.

00:24:16.000 --> 00:24:19.000
Digging around in treatment
is highly variable.

00:24:19.000 --> 00:24:21.466
Often you don't treat it again
if the patients are.

00:24:21.466 --> 00:24:25.200
If the symptoms aren't severe,
sometimes you just leave it alone because,

00:24:26.200 --> 00:24:27.833
the CIS will eventually

00:24:27.833 --> 00:24:32.166
die and calcify when it is treated,
you're usually treated the symptoms rather

00:24:32.166 --> 00:24:37.033
than targeting the actual parasite itself,
such as the use of corticosteroids.

00:24:37.400 --> 00:24:40.233
If you do feel if it is felt that the

00:24:40.233 --> 00:24:43.233
that the that the parasite itself
needs to be targeted.

00:24:43.500 --> 00:24:46.533
Albendazole is the drug of choice
rather than Prozac.

00:24:46.600 --> 00:24:48.500
Quantal,
which is what's used for targeting

00:24:48.500 --> 00:24:51.466
the intestinal stage of the adult worm.

00:24:51.466 --> 00:24:54.933
Next is andro strange, Elias's
specifically cerebral energy,

00:24:54.933 --> 00:24:55.966
a strange Eleusis

00:24:55.966 --> 00:24:59.900
which is caused by the rat lungworm
and just through Angeles, countenances

00:25:00.400 --> 00:25:02.966
the parasite that pretty much occurs
circum tropical.

00:25:02.966 --> 00:25:05.966
Most cases are in Southeast Asia
and the South Pacific,

00:25:06.400 --> 00:25:09.033
Africa, Latin America and the Caribbean.

00:25:09.033 --> 00:25:11.900
In the United States, where this disease
has become most problematic.

00:25:11.900 --> 00:25:14.833
In Hawaii,
where rats in the intermediate hosts,

00:25:14.833 --> 00:25:19.300
which are terrestrial snails, slugs
and semi slugs, have become pests.

00:25:19.833 --> 00:25:23.366
So the rate of infection
is eating undercooked snails, slugs,

00:25:23.366 --> 00:25:26.633
or sometimes pyrotechnic hosts
with the infectious larva.

00:25:26.866 --> 00:25:28.866
So you can imagine someone
with an organic garden.

00:25:28.866 --> 00:25:32.000
In Hawaii, there's snails that they bring
in some lettuce

00:25:32.000 --> 00:25:35.000
to make a salad, so
they bring in the lettuce to chop it up.

00:25:35.100 --> 00:25:38.000
Unbeknownst to them,
there's some small young snails

00:25:38.000 --> 00:25:41.000
and slugs in the produce harboring,

00:25:42.200 --> 00:25:43.366
so the L-3

00:25:43.366 --> 00:25:46.833
larvae,
those larvae are ingested in the produce.

00:25:47.300 --> 00:25:49.033
And that's how you get the disease.

00:25:49.033 --> 00:25:53.566
Again, the symptoms are going to be varied
based on the number of worms consumed

00:25:53.800 --> 00:25:56.800
and the number of worms
that make it to the brain.

00:25:56.800 --> 00:26:00.166
It can be anywhere from asymptomatic
to a mild bi temporal headache,

00:26:00.500 --> 00:26:03.933
nausea, vomiting, and stiff
neck all the way to coma and death.

00:26:04.400 --> 00:26:07.066
A clinical aspect of this disease
is an SNF.

00:26:07.066 --> 00:26:10.066
Eosinophilic plays the doses of the CSF

00:26:11.300 --> 00:26:12.933
and again, the symptoms are related

00:26:12.933 --> 00:26:15.966
to the inflammatory response
to the dying worms.

00:26:16.266 --> 00:26:20.000
So when the inflammatory response kicks
in, the worms are dead and dying.

00:26:20.300 --> 00:26:23.200
So there's really no anti helminth
treatment for it.

00:26:23.200 --> 00:26:25.166
This is a life cycle on the left.

00:26:25.166 --> 00:26:26.033
Excuse me. On the right.

00:26:26.033 --> 00:26:31.066
It's kind of complex but essentially
I'm going to focus on the human aspect.

00:26:31.900 --> 00:26:34.900
Humans get it from ingesting the L3 larva
in the snail.

00:26:35.300 --> 00:26:37.100
They're liberated in the small intestine.

00:26:37.100 --> 00:26:39.733
They enter the bloodstream
and they're carried to the brain.

00:26:39.733 --> 00:26:43.200
Where they usually die
is either L4 larvae or sub adults.

00:26:43.466 --> 00:26:46.100
And that initiates
the inflammatory response.

00:26:46.100 --> 00:26:49.666
The same thing happens in the rat, but
in the rat they eventually leave the brain

00:26:49.666 --> 00:26:52.666
and then go to the pulmonary vessels
where they become an adult.

00:26:52.800 --> 00:26:53.800
Diagnosis.

00:26:53.800 --> 00:26:56.233
If you suspect this disease,
you've got a patient with the

00:26:56.233 --> 00:26:59.466
with the appropriate symptoms,
appropriate epidemiologic

00:26:59.466 --> 00:27:02.466
or travel history,
and you suspect NGO strangles

00:27:02.833 --> 00:27:06.400
the the main diagnosis
really is PCR of the CSF.

00:27:06.400 --> 00:27:10.166
And that can be done at the CDC as
well as the Hawaii Department of Health.

00:27:10.466 --> 00:27:13.900
You can
sometimes see L4 larvae in CSF for brain

00:27:13.900 --> 00:27:17.000
biopsy specimens,
but those assays are not very sensitive.

00:27:17.000 --> 00:27:18.133
And again,

00:27:18.133 --> 00:27:21.366
you know, the brain is not an organ
you really want to be digging around in.

00:27:21.733 --> 00:27:25.533
There is antibody detection
available in endemic areas,

00:27:25.800 --> 00:27:28.000
but it's not available in the US.

00:27:28.000 --> 00:27:31.000
There's just too much cross-reactivity
with other nematodes.

00:27:31.233 --> 00:27:35.233
And again treatment is usually limited
to analgesics and corticosteroids

00:27:35.533 --> 00:27:38.600
for pain and inflammation
rather than targeting the worm itself.

00:27:39.433 --> 00:27:42.800
For our next organ system, we're
going to actually talk about the parasites

00:27:42.800 --> 00:27:45.800
that can infest the skin and soft tissue.

00:27:46.000 --> 00:27:49.000
And this, first picture,
which is show up again in,

00:27:49.533 --> 00:27:52.866
subsequent sites
as an example of cutaneous Leishmania,

00:27:53.700 --> 00:27:55.800
in presenting as a pizza lesion,

00:27:55.800 --> 00:27:59.100
the first parasite we'll talk about
is unleash mania.

00:27:59.633 --> 00:28:01.400
The cause of leishmaniasis.

00:28:01.400 --> 00:28:03.200
This is the hemo flagella. Protozoa.

00:28:03.200 --> 00:28:06.200
It's found in, various parts of the world,
multiple continents.

00:28:07.100 --> 00:28:12.500
It infects a multitude of million hosts,
and there are 30 known species.

00:28:12.800 --> 00:28:17.533
And of those, 21 are,
at least documented as infecting humans.

00:28:18.033 --> 00:28:20.733
This is vectored by the phloem.

00:28:20.733 --> 00:28:22.333
And sandfly is a very small,

00:28:23.766 --> 00:28:26.566
bloodsucking flies that live in the soil
and come out

00:28:26.566 --> 00:28:29.766
during the day when there's disturbances
and, they dissect hosts.

00:28:30.366 --> 00:28:33.800
They are dispersed across
multiple parts of the world.

00:28:33.800 --> 00:28:36.200
So you can see on this map,

00:28:36.200 --> 00:28:40.300
there's endemic regions
even in the Mediterranean countries.

00:28:41.166 --> 00:28:44.233
But we're really the hardest
hit areas are places

00:28:44.233 --> 00:28:48.300
where there is a low
socioeconomic, conditions.

00:28:48.566 --> 00:28:54.166
And that that's mainly because it's
the cases can be identified early.

00:28:54.166 --> 00:28:55.733
There's,

00:28:55.733 --> 00:28:58.900
chemotherapeutic interventions that
can stop the progression of the disease.

00:28:59.333 --> 00:29:02.333
But in places such as the Amazonian

00:29:02.900 --> 00:29:05.166
basin, parts of sub-Saharan

00:29:05.166 --> 00:29:08.400
Africa,
the Middle East and parts of India,

00:29:08.900 --> 00:29:12.266
these cases can go, undiagnosed,

00:29:13.000 --> 00:29:16.200
with with pretty
severe outcomes over time.

00:29:16.466 --> 00:29:20.533
So the clinical manifestations
of which many are variable and it depends

00:29:20.533 --> 00:29:24.966
on, which species is infecting the host

00:29:25.400 --> 00:29:28.400
for what the clinical outcomes may be.

00:29:28.400 --> 00:29:32.766
So the cutaneous form this was that pizza
lesion that I showed you,

00:29:33.966 --> 00:29:36.133
described as a painless,

00:29:36.133 --> 00:29:41.400
progressively to painful,
continuous lesion at the site of where

00:29:41.766 --> 00:29:44.766
the food bottom and fly bites and,

00:29:44.900 --> 00:29:47.433
the parasites migrate through the tissue.

00:29:47.433 --> 00:29:52.033
The micro cutaneous form,
is the disseminated form of continuous

00:29:52.033 --> 00:29:56.233
into the soft tissue surrounding,
the continuous layers.

00:29:56.566 --> 00:29:59.566
The visceral form, also known as callus,

00:30:00.233 --> 00:30:02.400
is the most dramatic form.

00:30:02.400 --> 00:30:03.966
And this is,

00:30:03.966 --> 00:30:07.900
again, specific to certain, species
of Leishmania.

00:30:08.633 --> 00:30:11.633
It's characterized by fever, weight loss,

00:30:11.800 --> 00:30:15.200
about a span of Magali
patients can be profoundly anemic,

00:30:16.100 --> 00:30:19.100
short of thrombocytopenia
as well as the Wikipedia.

00:30:19.600 --> 00:30:22.600
So the life cycle for this is,

00:30:23.533 --> 00:30:26.533
very complicated in the sense that,

00:30:26.900 --> 00:30:30.700
there is the sandfly vector,
which has multiple stages

00:30:30.700 --> 00:30:34.166
of development that go on within it,
but within the human host

00:30:34.700 --> 00:30:37.700
for goats, essentially are,

00:30:38.033 --> 00:30:41.033
phagocytes by the host immune system,
they become

00:30:41.833 --> 00:30:44.000
basically ingested into those cells.

00:30:44.000 --> 00:30:47.733
They can then transport through the body,
almost hijacking,

00:30:48.400 --> 00:30:51.400
those macrophages and, other phagocytes.

00:30:51.933 --> 00:30:53.866
And then there's
multiplication and then they,

00:30:54.933 --> 00:30:55.400
lice and

00:30:55.400 --> 00:30:59.466
rupture and then move to other, tissues
within the body.

00:30:59.600 --> 00:31:03.666
So the diagnosis of leishmaniasis,
again, depends on

00:31:04.300 --> 00:31:07.600
what type
of, of manifestations are being seen.

00:31:08.000 --> 00:31:11.900
So for cutaneous we have a visible lesion.

00:31:12.800 --> 00:31:16.100
This can be identified
by a histopathological exam.

00:31:17.000 --> 00:31:20.000
Some special stains, such as acne,

00:31:20.233 --> 00:31:21.500
perhaps.

00:31:21.500 --> 00:31:25.000
And you can visualize the parasite
in, biopsy

00:31:25.000 --> 00:31:29.866
or even aspirate for the, visceral form.

00:31:30.333 --> 00:31:35.533
We often are using serology because
you're not really having a society.

00:31:35.533 --> 00:31:38.066
You can directly,

00:31:38.066 --> 00:31:40.200
sample for testing.

00:31:40.200 --> 00:31:44.966
And PCR is also available for,
multiple stages.

00:31:44.966 --> 00:31:48.200
It can be done from, basically
any direct tissue

00:31:48.500 --> 00:31:51.700
or fluid
that can be, acquired from the host.

00:31:52.166 --> 00:31:56.000
The treatment is, variable
depending on the stage axis.

00:31:56.566 --> 00:31:59.266
So if there's a drug called Pennsylvanian
antimony

00:31:59.266 --> 00:32:02.666
that is, under investigation
or compassionate use from the CDC,

00:32:03.433 --> 00:32:06.666
liposomal amphotericin
B, which has been used for decades

00:32:06.666 --> 00:32:10.400
for visceral leishmaniasis
and melts at the scene,

00:32:10.900 --> 00:32:14.800
which, plane mentioned can be used for
malaria.

00:32:14.800 --> 00:32:19.700
Fowleri was actually developed
initially as an anti Leishmania drug

00:32:20.000 --> 00:32:24.833
and can be used for all three stages
of, different which media presentation.

00:32:24.966 --> 00:32:29.200
The next tissue parasite is trick
and which causes trick and allows us,

00:32:30.033 --> 00:32:32.933
this is a roundworm that is acquired

00:32:32.933 --> 00:32:36.066
from eating undercooked meat specifically,

00:32:37.000 --> 00:32:41.833
we think about pigs and, bears especially,

00:32:42.400 --> 00:32:47.166
and the muscles of either
the pig or the bear

00:32:47.500 --> 00:32:50.166
will actually have an assisted larvae

00:32:50.166 --> 00:32:53.166
of, the nematode inside of it.

00:32:53.300 --> 00:32:55.233
And when it's undercooked or raw,

00:32:56.700 --> 00:32:59.766
the larva,
when they get into the intestinal tract,

00:32:59.766 --> 00:33:04.500
the human will release,
maturing to adults in the small intestine.

00:33:04.933 --> 00:33:08.666
And then, larval mucosa
and then circulate,

00:33:09.866 --> 00:33:15.133
in, throughout the body and, and
get into our muscle and become insistent.

00:33:15.500 --> 00:33:20.133
And it's those insisted larvae
that cause the clinical manifestations.

00:33:20.133 --> 00:33:23.133
So we'll talk about in the next slide.

00:33:23.200 --> 00:33:26.200
This is really found anywhere

00:33:26.300 --> 00:33:28.733
that you have ingestion

00:33:28.733 --> 00:33:31.733
of pork and bare meat,

00:33:31.866 --> 00:33:35.800
specifically where there's,
not good screening of the meat.

00:33:35.800 --> 00:33:40.900
So pork up until maybe the 1970s in
the United States was a major risk.

00:33:40.900 --> 00:33:43.900
But there's been a much there push to,

00:33:43.900 --> 00:33:47.800
to screen pork products through, USDA.

00:33:48.166 --> 00:33:50.566
So that rate is actually
probably much lower.

00:33:50.566 --> 00:33:54.866
That association with pigs is probably
more so with, game hunters and bear meat.

00:33:55.700 --> 00:33:56.233
We see,

00:33:57.166 --> 00:33:58.366
a bit of a skewed toward

00:33:58.366 --> 00:34:02.000
Europe and North America for cases of,
chicken illnesses.

00:34:02.533 --> 00:34:05.533
So the symptoms of having these,

00:34:06.066 --> 00:34:08.800
larvae insistent in your muscle,

00:34:08.800 --> 00:34:11.466
can be as variable as asymptomatic.

00:34:11.466 --> 00:34:14.466
So people can have these
and just have no symptoms at all.

00:34:15.233 --> 00:34:17.600
You can have a, acute stage

00:34:17.600 --> 00:34:21.500
which is characterized
as a GI manifestation, including diarrhea,

00:34:21.500 --> 00:34:25.966
cramping, vomiting after the first week
is when you get,

00:34:26.833 --> 00:34:29.833
the dispersion to the muscles
and different parts of the body.

00:34:30.200 --> 00:34:32.866
And this can present itself
in different ways.

00:34:32.866 --> 00:34:34.500
You can have,

00:34:34.500 --> 00:34:37.000
carrier orbital and facial edema.

00:34:37.000 --> 00:34:39.533
You can get fever, myalgia,

00:34:39.533 --> 00:34:40.900
and you get dispersed rashes

00:34:40.900 --> 00:34:43.566
in different parts of the body,
especially the limbs.

00:34:43.566 --> 00:34:49.000
And one hallmark of this, from a laboratory perspective, that you can use as a,

00:34:50.033 --> 00:34:52.033
a good marker for,

00:34:52.033 --> 00:34:56.833
for this with the companion
symptoms is peripheral eosinophilia.

00:34:57.533 --> 00:35:01.033
When the larval stage is in the muscle,

00:35:01.500 --> 00:35:05.533
one of the more severe manifestations
can be profound

00:35:06.000 --> 00:35:09.033
myalgia, physical weakness.

00:35:09.533 --> 00:35:10.700
And then it progresses.

00:35:10.700 --> 00:35:14.633
And then eventually those symptoms
should subside because,

00:35:15.500 --> 00:35:18.933
these sets
essentially become walled off dead worms.

00:35:19.400 --> 00:35:23.400
And, eventually the inflammatory response

00:35:23.400 --> 00:35:27.700
will, set
and the symptoms will, will resolve.

00:35:28.400 --> 00:35:32.733
The diagnosis can be best achieved
by thorough social history

00:35:33.133 --> 00:35:35.833
and finding out what the dietary habits

00:35:35.833 --> 00:35:38.833
of the host are of the patient.

00:35:38.900 --> 00:35:43.700
I g serology, is very useful
for supporting the diagnosis

00:35:43.700 --> 00:35:47.266
of chicken analysis and if indicated,

00:35:47.966 --> 00:35:51.133
doing biopsy of muscle and doing,

00:35:52.533 --> 00:35:55.900
stain and,
and microscopically identifying these,

00:35:57.266 --> 00:35:59.433
traditionally, spiral

00:35:59.433 --> 00:36:03.700
shaped looking insistent worms in tissue,
which is where this names,

00:36:04.433 --> 00:36:07.166
spirals comes from in the species
name as it was described

00:36:07.166 --> 00:36:08.300
when it was seen in tissue.

00:36:08.300 --> 00:36:11.600
The next nematode that infects tissue
that we're going to talk about

00:36:12.166 --> 00:36:14.066
is ankle circle volvulus.

00:36:15.900 --> 00:36:18.166
This is a,

00:36:18.166 --> 00:36:21.933
worm that is acquired
by the simile and blackfly bite.

00:36:22.600 --> 00:36:26.600
And this has a much more focal
distribution

00:36:27.000 --> 00:36:30.000
as opposed to, the previous,

00:36:30.833 --> 00:36:33.300
tissue parasites that I've just discussed.

00:36:33.300 --> 00:36:36.300
So for this thing sub-Saharan Africa,

00:36:36.900 --> 00:36:39.166
very focal spots in Latin

00:36:39.166 --> 00:36:42.200
America and Yemen, in the Middle East.

00:36:42.500 --> 00:36:45.966
So this again, has, developmental stage

00:36:46.466 --> 00:36:49.066
within the blackfly

00:36:49.066 --> 00:36:52.233
where a micro area
are picked up by the fly.

00:36:52.766 --> 00:36:56.333
They mature two and L three larvae,

00:36:56.900 --> 00:36:59.900
and then they migrate to the feeding,

00:37:00.766 --> 00:37:01.666
parts of the flies.

00:37:01.666 --> 00:37:05.600
So the mouthparts
and then when the blackfly takes a blood

00:37:05.600 --> 00:37:08.933
meal of the adult, the L three larva

00:37:09.366 --> 00:37:12.200
will enter the bite wound.

00:37:12.200 --> 00:37:13.733
Once they're in the human,

00:37:13.733 --> 00:37:17.233
they go to the subcutaneous tissue,
and then they become adults.

00:37:17.233 --> 00:37:22.233
And these subcutaneous nodules
and these nodules are quite painful.

00:37:22.233 --> 00:37:23.700
And this is actually,

00:37:23.700 --> 00:37:27.566
one of the main clinical manifestations
that people have with ankle circle.

00:37:28.233 --> 00:37:32.666
And then these adults produce, progeny
microphone area

00:37:33.200 --> 00:37:37.166
that, then get taken up by the blackfly
and the cycle continues.

00:37:37.533 --> 00:37:39.200
So anchor sky assess,

00:37:40.233 --> 00:37:40.966
symptoms, as

00:37:40.966 --> 00:37:44.000
I mentioned, there's a it's
an inflammatory response

00:37:44.000 --> 00:37:47.766
to the dead or dying worms
in the subcutaneous tissues.

00:37:48.233 --> 00:37:50.600
So you can get an acute rash.

00:37:50.600 --> 00:37:53.533
You can get a painful nodules over time.

00:37:53.533 --> 00:37:56.966
If you have chronic infection,
multiple reinfections.

00:37:57.533 --> 00:38:00.533
This can, lead to vision changes.

00:38:01.400 --> 00:38:04.400
And this is due to a just
as chronic inflammatory process

00:38:04.566 --> 00:38:09.566
due to an overwhelming reinfection
and constant exposure to the worms.

00:38:09.966 --> 00:38:15.666
And this is due to the inflammation
surrounding the cornea and optic nerves.

00:38:15.666 --> 00:38:18.700
And this causes
eventually a chronic scarring,

00:38:18.700 --> 00:38:21.966
which results in blindness,
which has been termed river blindness

00:38:22.566 --> 00:38:26.466
due to the clustered incidence of this in,

00:38:27.600 --> 00:38:30.600
river basins in Africa,
where this was mostly described,

00:38:30.966 --> 00:38:34.666
the diagnosis is typically done
by a skin snip

00:38:35.200 --> 00:38:39.700
of those subcutaneous nodules,
and during histological exams

00:38:40.100 --> 00:38:43.533
using these stains,
the treatment is quite effective.

00:38:43.533 --> 00:38:45.933
And it's ivermectin in its tissue.

00:38:45.933 --> 00:38:47.900
Parasite we'll talk about is scabies.

00:38:48.900 --> 00:38:51.800
The causative agent is SARS-CoV-2 escapee.

00:38:51.800 --> 00:38:54.200
And this is known as the hitch mite.

00:38:54.200 --> 00:38:57.200
This is acquired from direct contact

00:38:57.200 --> 00:39:00.200
with surfaces that have been infected and,

00:39:01.233 --> 00:39:03.266
contaminated with the mites.

00:39:03.266 --> 00:39:06.266
So we often think about these as,
like, things you can get in, like,

00:39:06.266 --> 00:39:09.733
long term care facilities,
hospitals, institutionalized settings.

00:39:10.166 --> 00:39:13.900
The symptoms, can be severe pruritus,

00:39:14.700 --> 00:39:20.166
at the site of these burrows that often
are found between, digits and behind large

00:39:20.166 --> 00:39:26.000
joints, such as the back of the knees,
the folds of the elbows and the armpits.

00:39:26.433 --> 00:39:30.533
We can find this pretty much everywhere
in the world where there's humans.

00:39:31.400 --> 00:39:34.400
This is a a very human linked,

00:39:34.400 --> 00:39:38.000
active parasite,
and it's, associated again,

00:39:38.000 --> 00:39:42.333
as I mentioned, low socioeconomic status,
crowding, institutionalized settings.

00:39:42.966 --> 00:39:47.966
The diagnosis is made by the microscopic
identification of these mites.

00:39:49.333 --> 00:39:49.800
In some

00:39:49.800 --> 00:39:53.000
scenarios
as well, you can detect the eggs,

00:39:54.000 --> 00:39:56.600
but that's much less out
or the, the phases

00:39:56.600 --> 00:39:59.600
of the mite, from skin scrapings.

00:39:59.766 --> 00:40:02.500
If you don't see the mite itself,
you might see its remnants.

00:40:02.500 --> 00:40:04.600
And the
the treatment is actually complicated.

00:40:04.600 --> 00:40:09.566
So you're treating the human host
and you're also treating the environment.

00:40:10.000 --> 00:40:13.433
So permethrin is, treatment

00:40:13.433 --> 00:40:17.233
for human and, articles of clothing.

00:40:17.600 --> 00:40:20.200
But then you also have to treat
the surrounding environment.

00:40:20.200 --> 00:40:23.200
So that's hot water laundering of,

00:40:23.666 --> 00:40:26.866
bedsheets of any kind of,

00:40:27.700 --> 00:40:31.266
of natural materials
like cottons and such,

00:40:32.466 --> 00:40:35.066
steam cleaning of carpets.

00:40:35.066 --> 00:40:38.000
It's it's,
you know, we're talking more of a,

00:40:38.000 --> 00:40:41.833
a broad ecology at this point
rather than just the human ecology.

00:40:41.933 --> 00:40:43.233
And then, related.

00:40:43.233 --> 00:40:46.833
We'll talk about lice shares
a lot of the same features as far as,

00:40:48.366 --> 00:40:50.033
how we get rid of it.

00:40:50.033 --> 00:40:53.866
So this can be caused by
particular segments, which is the a head

00:40:53.866 --> 00:40:55.266
and body louse.

00:40:55.266 --> 00:40:58.433
And here is pubis,
which is the pubic louse.

00:40:59.000 --> 00:41:02.000
Now the symptoms of these are itching.

00:41:02.100 --> 00:41:03.100
At the site of infection.

00:41:03.100 --> 00:41:06.333
We don't really think about these
as causing, you know, any actual

00:41:06.333 --> 00:41:09.866
pathology to the skin
like we see with the burrows with scabies.

00:41:10.400 --> 00:41:13.000
But the bigger risk
is what they can transmit.

00:41:13.000 --> 00:41:16.200
So, for instance, body lice can transmit

00:41:16.500 --> 00:41:21.533
serious diseases such as epidemic
typhus, relapsing fever and trench fever.

00:41:21.833 --> 00:41:24.833
Diagnosis of this is really by,

00:41:24.866 --> 00:41:29.566
harvesting the mouse
and the eggs off of the hair

00:41:30.066 --> 00:41:32.800
and looking at them
under the microscope treatment.

00:41:32.800 --> 00:41:36.300
Again,
like I said, with stark optics, it's more,

00:41:37.100 --> 00:41:39.800
environmental biology aspect.

00:41:39.800 --> 00:41:44.866
You have to think about so we can use
a ivermectin lotion on the host.

00:41:45.400 --> 00:41:48.166
We can physically remove, nets

00:41:48.166 --> 00:41:52.466
by combing them out of the hair
and then killing them in alcohol or,

00:41:53.033 --> 00:41:56.300
hydrogen peroxide
and then environmental cleaning.

00:41:56.300 --> 00:42:00.200
So once you get it off the human, you've
got to make sure the environment is clean.

00:42:00.200 --> 00:42:04.566
So that includes hot water
laundering of bedsheets,

00:42:04.566 --> 00:42:07.566
clothes, steam cleaning carpets.

00:42:08.233 --> 00:42:11.200
In some cases for kids, you have to

00:42:12.166 --> 00:42:13.766
you got,

00:42:13.766 --> 00:42:17.633
stuffed animals in a hot environment,
or maybe just throw them out completely

00:42:18.100 --> 00:42:21.366
to make sure that you've gotten
rid of virus reinfection is possible.

00:42:21.733 --> 00:42:22.766
Next target and systems

00:42:22.766 --> 00:42:26.900
we'll look at are the respiratory tract
and the biliary tract.

00:42:26.900 --> 00:42:31.133
So lung and liver
we're going to start with paragon emesis

00:42:31.133 --> 00:42:34.266
which is caused by the lung flukes
in the genus Paragon amus.

00:42:34.700 --> 00:42:36.966
There's a handful of species
that cause the disease.

00:42:36.966 --> 00:42:40.833
Most people tend to think of Paragon
as West ammonia, which is a common

00:42:40.833 --> 00:42:44.566
species in Southeast Asia, as well
as paragon of mass hetero treatments.

00:42:44.833 --> 00:42:47.366
But, you know, here in North America,
we have an endemic paragon.

00:42:47.366 --> 00:42:48.600
It's called Paragon miskelly.

00:42:48.600 --> 00:42:52.600
Cody, which occurs in the Ohio
and Missouri River valleys,

00:42:53.133 --> 00:42:54.666
infection with Paragon.

00:42:54.666 --> 00:42:58.033
And this occurs after the ingestion of raw
or undercooked freshwater

00:42:58.033 --> 00:43:01.433
crustaceans,
such as freshwater crabs and crayfish.

00:43:01.733 --> 00:43:06.800
Here in the U.S., crayfish are the vehicle
for color coded infection.

00:43:07.300 --> 00:43:09.200
Symptoms are going to be highly variable.

00:43:09.200 --> 00:43:11.633
There's there's kind of two parts to it.

00:43:11.633 --> 00:43:15.800
You've got the
initial acute phase, which is

00:43:16.833 --> 00:43:19.966
associated
with the migration of the larval worms

00:43:19.966 --> 00:43:23.900
from the intestinal tract
after ingestion to the lungs.

00:43:24.133 --> 00:43:26.200
So you're going to get diarrhea,
abdominal pain,

00:43:26.200 --> 00:43:29.500
fever, cough, urticaria,
and increased eosinophilia.

00:43:29.966 --> 00:43:34.166
Once it gets to the lungs,
you have the chronic phase, which is cough

00:43:34.600 --> 00:43:38.433
and, and discolored sputum
and hematopoiesis.

00:43:38.666 --> 00:43:40.400
You might have heard the term iron
fillings.

00:43:40.400 --> 00:43:43.333
This was from dried
flaked blood in the sputum.

00:43:43.333 --> 00:43:46.233
So if you ever see like
the iron fillings is a buzzword

00:43:46.233 --> 00:43:49.233
that should direct
you towards paragon in meiosis.

00:43:49.400 --> 00:43:52.400
Clinically this is kind of a
the differential for

00:43:52.466 --> 00:43:55.866
tuberculosis in a couple of the cases
I've seen in my career,

00:43:56.100 --> 00:44:00.666
the eggs of the worm are actually found on
smears prepped for, for TB.

00:44:00.666 --> 00:44:03.666
You know, the, the admin stains for TB.

00:44:03.733 --> 00:44:05.033
So here's a life cycle.

00:44:05.033 --> 00:44:07.633
It has a multi host life cycle.

00:44:07.633 --> 00:44:09.633
All flukes do for all flukes.

00:44:09.633 --> 00:44:12.300
The first intermediate
host is always a snail.

00:44:12.300 --> 00:44:18.066
So the human either spits out eggs
or coughs up and swallows the eggs.

00:44:18.066 --> 00:44:20.400
And then they're then shed in feces.

00:44:20.400 --> 00:44:22.266
You can get the eggs in the feces,

00:44:22.266 --> 00:44:25.100
but they are primarily
in respiratory secretions.

00:44:25.100 --> 00:44:27.800
They hatch in fresh water
and infect the snail.

00:44:27.800 --> 00:44:30.000
Out of the snail comes the sakariya.

00:44:30.000 --> 00:44:34.100
The cycle consists in the freshwater
crustacean forms a medicine carrier,

00:44:34.400 --> 00:44:37.933
so infection occurs from the ingestion
of that medicine burial stage

00:44:38.366 --> 00:44:41.066
in undercooked
and raw freshwater crustaceans.

00:44:42.266 --> 00:44:44.100
Diagnosis is primarily

00:44:44.100 --> 00:44:48.233
microscopy, and that's eggs
in your respiratory specimens or stool.

00:44:48.233 --> 00:44:50.433
If you suspected paragon animals,

00:44:50.433 --> 00:44:53.633
you're going to want to collect bells
and bronk washes or sputum.

00:44:53.900 --> 00:44:56.900
You can see the eggs and stool,
but it's much less sensitive.

00:44:57.166 --> 00:45:00.366
There is also serology available
at large reference labs.

00:45:00.766 --> 00:45:05.866
The treatment for Paragon, like most
visceral flukes, is going to be quantal.

00:45:06.333 --> 00:45:08.466
The next disease is the kind of carcasses

00:45:08.466 --> 00:45:11.800
caused by, tapeworms in the genus,
a kind of carcass.

00:45:12.266 --> 00:45:12.933
Clinically.

00:45:12.933 --> 00:45:14.866
There's three main presentations.

00:45:14.866 --> 00:45:15.933
The two,

00:45:15.933 --> 00:45:20.800
then the two, more familiar and more
common ones are cystic, a kind of carcass.

00:45:20.800 --> 00:45:24.466
So this is caused by members
of a kind of carcass granulomas complex.

00:45:25.033 --> 00:45:27.266
And then you've got alveolar
a kind of carcasses

00:45:27.266 --> 00:45:30.266
which is caused by kind of carcass motor
like Hillary's

00:45:30.466 --> 00:45:33.600
the definitive host for a kind of carcass
are dogs and other canids.

00:45:33.600 --> 00:45:36.966
So infection occurs
from eating the tapeworm eggs and food

00:45:36.966 --> 00:45:40.666
and fomites, etc.,
contaminated with dog feces.

00:45:40.666 --> 00:45:44.800
Again, humans are a dead end host
for this, so we harbor the larval stage.

00:45:45.033 --> 00:45:46.266
So we kind of assume the role

00:45:46.266 --> 00:45:49.266
of the intermediate host,
which you'll see in the next slide.

00:45:49.366 --> 00:45:49.966
Symptoms.

00:45:49.966 --> 00:45:53.166
Again, symptoms are going to vary
based on the size of the cysts,

00:45:53.166 --> 00:45:55.866
the number of system,
the location of the cysts.

00:45:57.666 --> 00:45:58.400
The most

00:45:58.400 --> 00:46:01.966
common side of infection is the liver
followed by the lung and then the brain.

00:46:02.266 --> 00:46:04.200
So if you have a large cyst

00:46:04.200 --> 00:46:07.766
that's calcified and walled off
and isn't putting physical pressure

00:46:08.233 --> 00:46:12.700
on major parts of the liver,
your patient can be totally asymptomatic.

00:46:12.900 --> 00:46:16.400
Now, if the older is much
more detrimental, it starts.

00:46:16.400 --> 00:46:19.400
Essentially, the parasite almost functions
like a tumor.

00:46:19.533 --> 00:46:23.000
It starts off as a is a is a sterile cyst,

00:46:23.366 --> 00:46:26.433
and it starts
growing and undulating and expanding.

00:46:26.433 --> 00:46:31.533
It will eventually leave the liver and
start to infect the neighboring organs.

00:46:32.133 --> 00:46:34.700
It really functions more like,
metastatic disease

00:46:34.700 --> 00:46:37.700
rather than, than a typical helminth
infection.

00:46:37.766 --> 00:46:41.066
The life cycle here on the right
and talking specifically

00:46:41.066 --> 00:46:44.100
about cystic a kind of carcasses,
which is your kind of carcass.

00:46:44.100 --> 00:46:48.666
Granulosa is complex, in nature,
typically cycles between the dog

00:46:49.166 --> 00:46:51.700
definitive host and livestock intermediate

00:46:51.700 --> 00:46:54.700
hosts such as sheep and goats.

00:46:54.966 --> 00:46:58.866
Here where we're Doctor
Kataria and I are in the Mountain West.

00:46:59.600 --> 00:47:02.400
Our facility actually sees this disease
a couple times a year

00:47:02.400 --> 00:47:05.400
because there's a lot of sheep
herding and goat herding communities.

00:47:05.800 --> 00:47:09.333
And so, this is a disease
that our labs actually see with,

00:47:10.666 --> 00:47:13.033
probably a couple times a year.

00:47:13.033 --> 00:47:16.066
Again, humans are a dead end stage
for this parasite.

00:47:16.366 --> 00:47:19.233
And again,
the most the primary organ of involvement

00:47:19.233 --> 00:47:22.433
is the liver, followed by the lungs
and then the brain.

00:47:22.433 --> 00:47:26.166
And then less commonly, other parts,
such as such as skin and bone.

00:47:26.866 --> 00:47:27.733
Diagnosis.

00:47:27.733 --> 00:47:30.100
Diagnosis
almost always starts with imaging,

00:47:30.100 --> 00:47:33.933
followed by antibody detection,
which is usually an EIA.

00:47:34.500 --> 00:47:35.733
You can identify this disease

00:47:35.733 --> 00:47:39.700
microscopically, for example,
seeing proto skull kisses

00:47:40.100 --> 00:47:43.400
and fried hook slits and stuff
that's referred to as high end stand.

00:47:43.700 --> 00:47:46.700
Seeing the height of that sand,
for example, in the liver aspirate.

00:47:47.000 --> 00:47:50.733
Although you don't often want to go
poking around in those in the in the cysts

00:47:50.733 --> 00:47:55.500
because you run the risk
of seeing the body, or seeing other organs

00:47:55.500 --> 00:47:58.866
with with the parasite
and causing disseminated infection.

00:47:59.466 --> 00:48:01.733
Treatment is going to be highly variable.

00:48:01.733 --> 00:48:06.200
Again, if there's if the symptoms aren't
severe and it's a single walled off,

00:48:06.200 --> 00:48:10.166
calcified cyst, leave alone
treatment may not be warranted.

00:48:10.666 --> 00:48:15.866
If you feel the parasite does need to be
treated with, anti helminth tech drugs,

00:48:16.033 --> 00:48:21.200
our benzoyl is the drug of choice
with quantal, preoperative,

00:48:21.966 --> 00:48:26.133
surgical removal of the cyst as indicated
and of course

00:48:26.133 --> 00:48:29.466
there's pair which is percutaneous
aspiration injection.

00:48:29.466 --> 00:48:30.833
Re aspiration.

00:48:30.833 --> 00:48:32.766
This method is kind of falling
out of favor.

00:48:32.766 --> 00:48:35.000
But essentially you're rinsing the cyst

00:48:35.000 --> 00:48:38.900
out with the formalized saline or alcohol
to kill the parasite.

00:48:39.500 --> 00:48:40.933
Visceral larval migrants.

00:48:40.933 --> 00:48:42.833
This is caused by the larvae

00:48:42.833 --> 00:48:46.433
of Asker and nematodes of other animals,
primarily carnivores.

00:48:46.433 --> 00:48:50.166
So you think humans have asters, lumber,
coyotes, toxic

00:48:50.200 --> 00:48:53.566
cars, kind of like the Oscars of dogs
and cats and bellies.

00:48:53.600 --> 00:48:54.700
Asker is Procyon.

00:48:54.700 --> 00:48:57.233
This is kind of the outskirts of raccoons.

00:48:57.233 --> 00:49:00.333
So humans just like with ask or us humans
who get this disease

00:49:00.333 --> 00:49:04.633
by eating fully and bringing eggs
in something contaminated with soil,

00:49:04.633 --> 00:49:09.666
that that itself has been contaminated
with the feces of these various animals.

00:49:10.000 --> 00:49:13.900
Now, the embryo nation period of the eggs
takes at least a couple of weeks.

00:49:14.233 --> 00:49:18.200
So you go out on your your deck right now
and you see raccoon poop on your deck,

00:49:18.333 --> 00:49:19.766
fresh raccoon poop.

00:49:19.766 --> 00:49:22.633
That's
probably not a risk for Bailey's aspirus,

00:49:22.633 --> 00:49:26.233
but if raccoons are defecating
in your yard and raccoons

00:49:26.233 --> 00:49:29.233
do like to return to the same site,
they're called latrines.

00:49:29.233 --> 00:49:31.166
They like to poop in the same place.

00:49:31.166 --> 00:49:33.566
The soil in your yard
might be contaminated.

00:49:33.566 --> 00:49:37.500
So risks would be, for example, gardening
or children playing with soil,

00:49:37.500 --> 00:49:40.900
especially children that have a habit
of putting dirt in their mouths.

00:49:41.300 --> 00:49:44.300
Again, humans are dead in host
for all these parasites.

00:49:44.766 --> 00:49:48.266
Symptoms vary based on the location.

00:49:48.533 --> 00:49:51.500
Toxic horror tends to have a predilection
for the liver below.

00:49:51.500 --> 00:49:54.466
Sassafras tends
to have a predilection for the brain,

00:49:54.466 --> 00:49:57.500
so symptoms can be fever,
myalgia, weight loss.

00:49:58.133 --> 00:50:02.433
Paddle battles
split on for liver involvement

00:50:02.833 --> 00:50:06.100
and eosinophilic meningitis
for CNS involvement,

00:50:06.566 --> 00:50:09.600
and in the case of toxic
or ocular involvement, as well.

00:50:10.166 --> 00:50:11.800
Here's the life cycle.

00:50:11.800 --> 00:50:14.966
It's in nature
typically has a one host life cycle.

00:50:14.966 --> 00:50:19.000
Cats, dogs, and raccoons can get infected
by ingesting the eggs,

00:50:19.000 --> 00:50:21.700
but they can also get it from paired
tannic hosts.

00:50:21.700 --> 00:50:24.500
Humans primarily
get the disease from the eggs in the soil,

00:50:24.500 --> 00:50:27.133
but we can get it from
pair tannic hosts as well.

00:50:28.133 --> 00:50:28.933
Within the dog.

00:50:28.933 --> 00:50:31.133
In the
cat, you can get vertical transmission

00:50:31.133 --> 00:50:35.300
from from dogs and cats
to their developing puppies and kittens.

00:50:35.666 --> 00:50:38.666
But you don't see this phenomenon
in the human host.

00:50:39.433 --> 00:50:42.166
Diagnosis is antibody detection.

00:50:42.166 --> 00:50:46.600
Usually in combination
with, with appropriate epi link treatment.

00:50:46.833 --> 00:50:49.700
Visceral is going to be albendazole or

00:50:49.700 --> 00:50:52.633
diesel in combination
with steroids for symptoms.

00:50:52.633 --> 00:50:55.700
And an ocular is going to be all benders
all or benders all

00:50:55.700 --> 00:50:59.366
but topical steroids apply
this drops directly to the eye.

00:50:59.866 --> 00:51:03.966
Next is, liver fluke
disease caused by clean orcas.

00:51:04.766 --> 00:51:09.133
And opah stalks primarily clean orca
sinensis, which is the Chinese liver fluke

00:51:09.500 --> 00:51:11.600
or orcas viver ENE,

00:51:11.600 --> 00:51:15.000
which occurs in Southeast Asia,
especially Thailand and Laos,

00:51:15.266 --> 00:51:18.800
and opus orcas for Linnaeus,
which occurs in Eastern Europe

00:51:18.800 --> 00:51:22.666
and Russia, infection of all
these diseases is pretty much the same.

00:51:22.666 --> 00:51:26.200
It occurs
from the ingestion of the vicarious stage

00:51:26.200 --> 00:51:29.200
and undercooked or raw freshwater fish.

00:51:29.300 --> 00:51:31.333
So on the right
we're looking at the life cycle.

00:51:31.333 --> 00:51:32.700
It's kind of similar to Paragon.

00:51:32.700 --> 00:51:34.500
Famous humans poop out eggs.

00:51:35.533 --> 00:51:38.600
The eggs are ingested by the snail
intermediate host.

00:51:38.600 --> 00:51:40.866
Out of the snail comes the sakariya.

00:51:40.866 --> 00:51:45.433
The sakariya infects and and cysts
in the flesh of a freshwater fish.

00:51:45.966 --> 00:51:48.633
And then humans get infected
by eating that metal sakariya

00:51:48.633 --> 00:51:51.633
from eating undercooked and raw,
freshwater fish.

00:51:51.866 --> 00:51:54.366
The eggs of orcas and opus
orcas are very similar.

00:51:54.366 --> 00:51:55.800
Labs tend to call them.

00:51:55.800 --> 00:51:59.500
So you can't really separate
the two genera based on egg morphology,

00:51:59.833 --> 00:52:01.166
but clinically it's the same.

00:52:01.166 --> 00:52:02.966
So they're going to be treated the same.

00:52:02.966 --> 00:52:05.366
Symptoms are related to worm burden.

00:52:05.366 --> 00:52:09.533
So early in the infection you might get
inflammation and intermittent obstruction

00:52:09.533 --> 00:52:14.433
of the biliary ducts and abdominal pain
especially in the right upper quadrant.

00:52:14.900 --> 00:52:19.433
Eventually you could get toxicity,
both the metabolic byproducts of worms

00:52:19.766 --> 00:52:22.766
and possible
secondary bacterial infections.

00:52:22.900 --> 00:52:25.766
These organisms, especially orca sinensis,

00:52:25.766 --> 00:52:28.933
are the leading cause
of cholangiocarcinoma worldwide.

00:52:29.366 --> 00:52:34.733
So again, you ever you ever see some of
those clinical board exam buzz terms.

00:52:34.733 --> 00:52:37.933
If you if you hear or see
cholangiocarcinoma, clonal orca

00:52:37.933 --> 00:52:41.033
should be at the top
of your differential zebra as well as,

00:52:41.900 --> 00:52:45.066
chill and dryness of cystitis
and pancreatitis.

00:52:45.733 --> 00:52:48.166
Diagnosis, as shown in the previous slide,

00:52:48.166 --> 00:52:51.300
is made by the detection of eggs
and feces and again, like most,

00:52:52.033 --> 00:52:56.233
most, the visceral flukes, the treatment
is going to be proxy quantal.

00:52:56.900 --> 00:52:59.333
And next we're going to talk about
the general urinary tract.

00:52:59.333 --> 00:53:02.766
And thankfully there are not
many parasites that will infect this area.

00:53:03.300 --> 00:53:06.800
But the one we're going to talk about
is actually very prevalent worldwide.

00:53:07.400 --> 00:53:08.733
And this is the protozoa trick.

00:53:08.733 --> 00:53:10.833
Homeowners phage analysis.

00:53:10.833 --> 00:53:15.866
This is, one of the leading
sexually transmitted diseases worldwide.

00:53:15.866 --> 00:53:20.000
But we can really appreciate that until,

00:53:20.766 --> 00:53:25.200
recent developments of better testing,
this is acquired directly

00:53:25.633 --> 00:53:28.633
through genital contact
and sexual contact.

00:53:29.100 --> 00:53:33.633
And anywhere there's humans
there is to that.

00:53:34.133 --> 00:53:39.100
And the more sexually active
a population is, the more promiscuous

00:53:39.100 --> 00:53:43.033
the population, the higher the probability
of having to have an infection.

00:53:43.333 --> 00:53:45.466
Now, chicken monas is interesting.

00:53:46.466 --> 00:53:48.266
It's kind of an insidious little pathogen.

00:53:48.266 --> 00:53:51.800
In fact, almost well evolved

00:53:52.366 --> 00:53:55.100
to its human host.

00:53:55.100 --> 00:53:58.000
To the point
where you might almost wonder if,

00:53:58.000 --> 00:54:00.333
you know, hundreds of years ago,

00:54:00.333 --> 00:54:03.300
this could have almost been commensal
to a certain extent.

00:54:03.300 --> 00:54:06.033
So in women, it can cause a vagina.

00:54:06.033 --> 00:54:09.033
That is where they purulent discharge,

00:54:09.500 --> 00:54:12.500
in severe complications,

00:54:12.566 --> 00:54:15.966
can occur when you have a woman
who's pregnant gets infected.

00:54:16.366 --> 00:54:19.600
And this can cause,
spontaneous abortion and,

00:54:20.266 --> 00:54:22.866
premature rupture of membranes

00:54:22.866 --> 00:54:25.866
just due to the complications,
the inflammation and such.

00:54:26.666 --> 00:54:29.600
But very rarely
does it do anything long term

00:54:29.600 --> 00:54:33.033
destructive, such as, like,
cervical lesions or sterility.

00:54:33.033 --> 00:54:36.033
It's, it's almost not associated with that
at all.

00:54:37.166 --> 00:54:40.166
It can cause abdominal pain,
but not like pelvic ulcer disease.

00:54:40.466 --> 00:54:43.766
It's in this area,
but not to the point of,

00:54:43.766 --> 00:54:47.533
like a really bad
urinary tract infection. So.

00:54:47.900 --> 00:54:51.900
So it's got this kind of in
between symptomology now and then.

00:54:51.900 --> 00:54:56.000
It's very interesting
because the majority of men

00:54:56.000 --> 00:54:59.600
who are infected
are completely asymptomatic hosts.

00:55:00.166 --> 00:55:01.433
In a way.

00:55:01.433 --> 00:55:04.933
You can almost think that trick harmonious
has adapted

00:55:05.333 --> 00:55:09.633
to be transmitted by men,
because men don't show symptoms.

00:55:09.633 --> 00:55:10.066
And the more,

00:55:11.100 --> 00:55:13.600
sexual
partners they have, they could spread it,

00:55:13.600 --> 00:55:17.133
whereas a woman who's symptomatic
could potentially get treated

00:55:17.466 --> 00:55:20.466
and it stops,
you know, further spread of the infection.

00:55:21.366 --> 00:55:26.033
Very rare complications with men
have included urethra as prostatitis,

00:55:26.033 --> 00:55:26.900
an epidemic.

00:55:26.900 --> 00:55:30.900
But like I said, the vast
majority and surveillance data has shown

00:55:31.400 --> 00:55:34.400
that men have absolutely no idea
that they're infected.

00:55:34.600 --> 00:55:38.100
The diagnosis is now preferred by Matt.

00:55:38.100 --> 00:55:39.900
So I mentioned the last slide.

00:55:39.900 --> 00:55:44.866
Modernized, better techniques of really,
lifted the curtain on the true

00:55:44.866 --> 00:55:49.666
prevalence of, trachoma
analysis in the United States, especially,

00:55:50.366 --> 00:55:53.666
we used to rely on physician's office
Westmount

00:55:53.666 --> 00:55:56.666
exams of,

00:55:56.900 --> 00:55:58.966
national smears and urethral swabs,

00:55:58.966 --> 00:56:01.966
but that's often extremely insensitive

00:56:02.066 --> 00:56:04.766
and not maintained very much anymore.

00:56:04.766 --> 00:56:07.100
But these tests are readily available.

00:56:07.100 --> 00:56:08.533
They're high throughput.

00:56:08.533 --> 00:56:11.233
They're very sensitive, very specific.

00:56:11.233 --> 00:56:14.333
And the good thing about
this is if you aren't doing mass

00:56:14.333 --> 00:56:17.866
screening, routine screening,
especially for sexually active,

00:56:18.966 --> 00:56:19.700
promiscuous

00:56:19.700 --> 00:56:23.200
patients, a single dose of metronidazole
can be administered

00:56:23.200 --> 00:56:27.266
in the physician's office,
and that's, generally considered curative.

00:56:27.933 --> 00:56:31.433
Blaine mentioned at the beginning
the micro spread has being kind

00:56:31.433 --> 00:56:37.266
of a toxic,
taxonomic scandal in this, subject.

00:56:37.666 --> 00:56:41.833
But we're going to talk about it again,
because the parasitology labs

00:56:42.166 --> 00:56:46.300
still, for the most part, do the majority
of diagnosis from across Prea.

00:56:46.966 --> 00:56:50.533
So these are obligate
intracellular fungal,

00:56:50.866 --> 00:56:53.800
quote unquote parasites,

00:56:53.800 --> 00:56:56.800
and that are found throughout

00:56:57.100 --> 00:56:59.733
the entire zoological world.

00:56:59.733 --> 00:57:02.733
Essentially they are found in

00:57:03.233 --> 00:57:08.433
vast majority of, of ecosystems,
ubiquitously.

00:57:08.433 --> 00:57:11.433
They are in multiple animals.

00:57:11.933 --> 00:57:14.400
But we really think
that this is just an ingestion process

00:57:14.400 --> 00:57:19.433
that's just so, ubiquitously exposed
throughout our environment

00:57:19.733 --> 00:57:24.066
that we just get these, you know,
all the time without even really knowing.

00:57:25.266 --> 00:57:28.366
And so the reason why this came
to the forefront of,

00:57:28.366 --> 00:57:31.366
of human medicine and knowledge was,

00:57:31.833 --> 00:57:35.400
during the early stages of the 1980s

00:57:36.133 --> 00:57:39.433
HIV Aids epidemic,
it was immunocompromised patients.

00:57:39.433 --> 00:57:43.800
We first discovered the presence
of these, fungal parasites.

00:57:44.266 --> 00:57:47.466
And in these hosts, the disease doesn't

00:57:47.733 --> 00:57:50.900
necessarily
just localize just to one source.

00:57:51.300 --> 00:57:54.500
Depending on the genus and species
they can disseminate.

00:57:54.900 --> 00:57:59.633
Others can cause a chronic wasting,
diarrhea that can be debilitating

00:57:59.633 --> 00:58:01.333
and deadly.

00:58:01.333 --> 00:58:04.966
And the treatment for most of the species
is, is all.

00:58:05.366 --> 00:58:08.066
But there are some exceptions
where, treatment

00:58:08.066 --> 00:58:10.166
has not actually been established.

00:58:10.166 --> 00:58:13.300
So in this slide that is to show you
basically just how broad,

00:58:14.466 --> 00:58:16.866
human micro spaghetti uses is.

00:58:16.866 --> 00:58:20.800
So we conventionally think
about the gastrointestinal

00:58:21.100 --> 00:58:23.900
associated, genus and species interest.

00:58:23.900 --> 00:58:27.200
I just want been
UCI and NSF let us go and just analysis

00:58:27.566 --> 00:58:31.466
which both are associated
with, this chronic,

00:58:32.766 --> 00:58:34.300
persistent diarrhea that we

00:58:34.300 --> 00:58:37.300
saw in the HIV Aids epidemic in the 80s.

00:58:37.600 --> 00:58:41.533
But after that discovery,
we found that there's,

00:58:42.633 --> 00:58:45.700
CNS associated, micro spaghetti,

00:58:46.400 --> 00:58:50.333
there's,
cutaneous micro spaghetti, ocular,

00:58:51.166 --> 00:58:53.466
and then some of these species
that are shared

00:58:53.466 --> 00:58:56.500
that actually can disseminate
from multiple parts of the body.

00:58:56.866 --> 00:58:58.700
The diagnosis for micro is pretty.

00:58:58.700 --> 00:59:04.833
Osis is additionally
for the intestinal species, a stool own P.

00:59:05.500 --> 00:59:08.366
But we're not staining
with the traditional tri chrome.

00:59:08.366 --> 00:59:12.666
We're staying with a modified version
of the tri chrome stain.

00:59:13.366 --> 00:59:18.633
These are very small,
very non descript organisms

00:59:19.100 --> 00:59:22.333
that can mimic bacteria yeast.

00:59:22.866 --> 00:59:27.600
It's extremely challenging to read these
these slides in the lab.

00:59:28.000 --> 00:59:30.066
More recently

00:59:30.066 --> 00:59:33.033
PCR tests and DNA

00:59:33.033 --> 00:59:36.333
sequencing have been used specifically

00:59:36.333 --> 00:59:39.466
for more specific identification

00:59:40.000 --> 00:59:42.633
of the causative genus and species.

00:59:42.633 --> 00:59:45.700
And this is not really practical for doing

00:59:46.400 --> 00:59:49.300
routine testing for every single patient.

00:59:49.300 --> 00:59:53.366
But it's a good way of trying to identify,
for instance, if you have a stool

00:59:53.366 --> 00:59:56.833
that's positive by stain
and you want to know

00:59:57.300 --> 01:00:01.766
if it's oral site is owned by ECI
or encephalitis and test analysis,

01:00:02.533 --> 01:00:05.766
there's treatment implications there
because our band is all works

01:00:06.266 --> 01:00:08.800
well for Egon test analysis, but doesn't

01:00:08.800 --> 01:00:11.800
really work effectively for even UCI.

01:00:12.166 --> 01:00:13.666
So knowing

01:00:13.666 --> 01:00:18.200
the molecular test, which genus species
it is, can have prognostic value.

01:00:18.433 --> 01:00:22.766
The direct stains on the left
with the ale stain showing

01:00:24.066 --> 01:00:25.866
in this lower panel

01:00:25.866 --> 01:00:30.766
is tiny pink staining here
spreading spores on the right panel.

01:00:30.766 --> 01:00:33.766
Here you can see the AP stands for

01:00:34.066 --> 01:00:38.366
And second,
someone being UCI and those are very tiny

01:00:38.366 --> 01:00:42.433
one and a half to three micron, organisms

01:00:42.933 --> 01:00:45.933
next to the yeast, which you can see,

01:00:46.000 --> 01:00:49.000
much more like 5 to 6 microns.

01:00:49.100 --> 01:00:51.766
So the stain color is slightly different.

01:00:51.766 --> 01:00:54.833
Once you see enough of these
you can tell the difference in the pink.

01:00:55.566 --> 01:00:56.866
But they're very challenging.

01:00:56.866 --> 01:01:01.000
So in summary, key points
if we take all the organisms

01:01:01.500 --> 01:01:04.500
that we've just, reviewed with you

01:01:04.566 --> 01:01:08.166
Toxoplasma,
think of your bus terms association

01:01:08.166 --> 01:01:11.666
with caps, locations
with congenital infections

01:01:12.166 --> 01:01:15.200
and immunocompromised hosts
and just draw Angeles.

01:01:15.700 --> 01:01:16.733
That is an affiliate.

01:01:16.733 --> 01:01:19.500
Meningitis is a key symptom.

01:01:19.500 --> 01:01:22.733
And then remember the exposure
regions in the US.

01:01:23.133 --> 01:01:28.000
We're thinking about life
or return travelers from tropical

01:01:28.700 --> 01:01:31.900
region South Pacific,
especially for sister psychosis.

01:01:32.866 --> 01:01:33.133
This is

01:01:33.133 --> 01:01:36.500
the pork
tapeworm not acquired from eating pork,

01:01:36.866 --> 01:01:40.366
but actually eating feces
from a human with eggs in it.

01:01:41.133 --> 01:01:44.133
And then think about brain lesions,

01:01:44.600 --> 01:01:47.066
with imaging and serology

01:01:47.066 --> 01:01:50.066
to help support the diagnosis
for neck area,

01:01:50.233 --> 01:01:52.866
we think about diving into warm water

01:01:52.866 --> 01:01:55.666
and rapidly fatal meningoencephalitis.

01:01:55.666 --> 01:02:00.100
I can't remember think about brain
as well as the corneal infections

01:02:00.566 --> 01:02:03.566
with the brain infections
often being fatal.

01:02:04.533 --> 01:02:06.566
Key points for leishmaniasis.

01:02:06.566 --> 01:02:10.833
So think disfiguring lesions on the skin
and the visceral form.

01:02:10.900 --> 01:02:16.466
Carla Azar and as well as the bite
of the sandfly chicken Ella

01:02:17.133 --> 01:02:19.766
undercooked meat, especially

01:02:19.766 --> 01:02:23.566
pork bear L1
larvae are in the muscle cells

01:02:23.800 --> 01:02:28.400
aka circa transmitted by the black fly
causes subcutaneous nodules.

01:02:28.766 --> 01:02:31.766
Endemic areas
may progress to river blindness.

01:02:31.766 --> 01:02:35.533
Paragon amiss from eating undercooked
or raw freshwater crustaceans.

01:02:35.633 --> 01:02:39.066
Think iron fillings and sputum
caused by hematopoiesis.

01:02:39.400 --> 01:02:43.966
A kind of carcass is a dog parasite,
so think sheepdog or other dog exposures.

01:02:44.433 --> 01:02:46.700
Primary site of infection is the liver.

01:02:46.700 --> 01:02:50.500
So think liver cysts
cleanse orcas from eating raw fish.

01:02:51.533 --> 01:02:52.466
Angio carcinoma

01:02:52.466 --> 01:02:55.466
remember clean orca
Snowpiercer orcas world's leading cause

01:02:55.533 --> 01:02:58.600
of cholangiocarcinoma for triggerman, is

01:02:59.033 --> 01:03:03.800
typically asymptomatic in men
and vaginosis with discharge in females.

01:03:03.800 --> 01:03:06.800
One of the few
sexually transmitted parasitic diseases.

01:03:07.866 --> 01:03:11.533
And with that, we like to,
thank you for your attention.

01:03:11.533 --> 01:03:13.300
And hopefully,

01:03:13.300 --> 01:03:15.866
we refreshed and broadened your knowledge

01:03:15.866 --> 01:03:18.866
on some of the conventional parasites

01:03:18.966 --> 01:03:21.966
that exist outside
of the gastrointestinal tract.

01:03:22.733 --> 01:03:25.700
Keep a lookout for a companion lecture.

01:03:25.700 --> 01:03:28.700
Specifically that I alluded to earlier on,

01:03:29.266 --> 01:03:32.033
the conventional blood
parasites of humans.

01:03:32.033 --> 01:03:34.633
We hope you find it
enjoyable and educational.

01:03:34.633 --> 01:03:35.366
Thank you so much.