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Reservoirs and Mode of Infected humans serve as Infected humans serve as Reservoirs include soil
Transmission reservoirs for typhoid and reservoirs. Transmission contaminated with human,
paratyphoid occurs via direct mucous horse, or other animal feces.
membrane-to-mucous Person-to-person transmission
membrane contact, usually does not occur.
sexual contact; adult-to-
child (may indicate sexual
abuse); and mother-to-
neonate during birth.
Patient Care: Use Standard Precautions for Use Standard Precautions for Use Standard Precautions for
hospitalized patients hospitalized patients. hospitalized patients.
Skin Dermatophytoses
⎯ Dermatophytoses are also known as tinea (ringworm) infections and dermatomycoses.
⎯ Some of the dermatomycoses cause only limited irritation, scaling, and redness. Others cause itching,
swelling, blisters, and severe scaling.
Pathogens: Dermatomycoses are caused by various filamentous fungi (moulds), collectively referred to as
dermatophytes. Examples include species of Microsporum, Epidermophyton, and Trichophyton.
Reservoirs and Mode of Transmission: Infected humans and animals and soil serve as reservoirs. Transmission is by
direct or indirect contact with lesions of humans or animals; or contact with contaminated floors, shower stalls, or locker
room benches; barbers’ clippers, combs, and hairbrushes; or clothing.
Patient Care: Use Standard Precautions.
Parasitism is a symbiotic relationship that is of benefit to one party or symbiont (the parasite) at the expense of the
other party (the host).
Parasites are defined as organisms that live on or in other living organisms (hosts), at whose expense they gain some
advantage. Parasites that live outside the host’s body are ectoparasites; those that live inside the host are
endoparasites.
The definitive host harbors the adult or sexual stage of the parasite or the sexual phase of the parasite’s life cycle. The
intermediate host harbors the larval or asexual stage of the parasite or the asexual phase of its life cycle. Facultative
parasites are organisms that can be parasitic but are also capable of a free-living existence. Obligate parasites have no
choice; to survive, they must be parasitic.
In general, parasitic infections are diagnosed by observing and recognizing various parasite life cycle stages in clinical
specimens.
Protozoa
⎯ Protozoa are classified taxonomically by their mode of locomotion. Some move by pseudopodia, others by
flagella, others by cilia, and some are nonmotile.
⎯ The trophozoite is the motile, feeding, dividing stage in the protozoal life cycle, and the cyst, oocyst, and spore
are dormant stages. Protozoal infections are most often acquired by ingestion or inhalation of dormant stages.
Leishmaniasis
⎯ There are three forms of leishmaniasis: cutaneous, mucocutaneous (or mucosal), and visceral.
⎯ The cutaneous form starts with a papule that enlarges into a craterlike ulcer
⎯ Individual ulcers may coalesce, causing severe tissue destruction and disfigurement.
⎯ Visceral leishmaniasis, also known as kala-azar, is characterized by fever, enlarged liver and
spleen, lymphadenopathy, anemia, leukopenia, and progressive emaciation and weakness.
⎯ Death may result in untreated cases
Parasite: Leishmaniasis is caused by various species of flagellated protozoa in the genus Leishmania. The nonmotile,
intracellular form of the parasite is called an amastigote. The motile, extracellular form of the parasite is called a
promastigote.
Reservoirs and Mode of Transmission: Reservoirs include infected humans, domestic dogs, and various wild animals.
Leishmaniasis is principally a zoonosis and is usually transmitted via the bite of an infected sand fly. Transmission by
blood transfusion and person-to-person contact have been reported.
Reservoirs and Mode of Transmission: The amoebas enter the eye from ameba-contaminated waters. Infections have
occurred primarily in people who wear soft contact lenses and have used nonsterile, homemade cleaning or wetting
solutions, or have become infected in ameba-contaminated spas or hot tubs.
Patient Care: Use Standard Precautions for hospitalized patients.
Toxoplasmosis
⎯ Toxoplasmosis is a systemic sporozoan infection that, in immunocompetent persons, may be asymptomatic
or resemble infectious mononucleosis.
⎯ However, serious disease, even death, may occur in immunodeficient persons.
⎯ Disease typically involves the central nervous system, eyes (chorioretinitis), lungs, muscles, or heart.
Cerebral toxoplasmosis is common in AIDS patients.
⎯ Infection during early pregnancy may lead to fetal infection, causing death of the fetus or serious birth defects
(e.g., brain damage).
Parasite: Toxoplasmosis is caused by Toxoplasma gondii, an intracellular sporozoan.
Reservoirs and Mode of Transmission: Definitive hosts include cats and other felines that usually acquire infection by
eating infected rodents or birds. Intermediate hosts include rodents, birds, sheep, goats, swine, and cattle. Humans
usually become infected by eating infected raw or undercooked meat (usually pork or mutton) containing the cyst form of
the parasite or by ingesting oocysts that have been shed in the feces of infected cats. Oocysts may be present in food or
water contaminated by feline feces. Children may ingest oocysts from sand boxes containing cat feces. Infection can also
be acquired transplacentally, by blood transfusion, or by organ transplantation.
Patient Care: Use Standard Precautions for hospitalized patients.
Cyclosporiasis
⎯ Cyclosporiasis is a coccidial gastrointestinal infection, causing watery diarrhea (6 or more stools per day),
nausea, anorexia, abdominal cramping, fatigue, and weight loss.
⎯ The diarrhea lasts between 9 and 43 days in immunocompetent patients, and months in
immunocompromised patients.
Parasite: Cyclosporiasis results from ingestion of oocysts of Cyclospora cayetanensis, a coccidian.
Reservoirs and Mode of Transmission: Reservoirs include fecally contaminated water sources and produce that has
been rinsed with fecally contaminated water. Transmission is primarily waterborne, but outbreaks have involved
contaminated raspberries, basil, and lettuce
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Course Title
Module #23 Student Activity Sheet
Patient Care: Use Standard Precautions for hospitalized patients.
Giardiasis
⎯ Giardiasis is a protozoal infection of the duodenum (the uppermost portion of the small intestine) and may
be asymptomatic, mild, or severe.
⎯ Patients experience diarrhea, steatorrhea (loose, pale, malodorous, fatty stools), abdominal cramps,
bloating, abdominal gas, fatigue, and possibly weight loss.
Pathogen: Giardiasis is caused by Giardia lamblia (also called Giardia intestinalis), a flagellated protozoan). Trophozoites
attach by means of a ventral sucker to the mucosal lining of the duodenum. Trophozoites and/or cysts are expelled in
feces.
Reservoirs and Mode of Transmission: Reservoirs include infected humans, possibly beavers and other wild and
domestic animals that have consumed water containing Giardia cysts; and fecally contaminated drinking water and
recreational water. The disease commonly occurs in day care centers. Transmission occurs via the fecal–oral route,
usually by ingestion of cysts in fecally contaminated water or foods, or from person to person by soiled hands to mouth
(as occurs in day care centers). Large community outbreaks have resulted from drinking treated but unfiltered water.
Smaller outbreaks have involved contaminated food, person-to-person transmission in day care centers, and fecally
contaminated recreational water (e.g., swimming and wading pools).
Patient Care: Use Standard Precautions for hospitalized patients. Add Contact Precautions for diapered or incontinent
patients.
Sickness)
⎯ African trypanosomiasis is a systemic disease caused by flagellated protozoa in the bloodstream, known as
hemoflagellates.
⎯ Early stages of the disease include a painful chancre at the site of a tsetse fly bite, fever, intense headache,
insomnia, lymphadenitis, anemia, local edema, and rash.
⎯ Later stages of the disease include body wasting, falling asleep, coma, and death if untreated.
⎯ The latter stages of the disease have given rise to the name African sleeping sickness or simply sleeping sickness.
Pathogens: Two subspecies of Trypanosoma brucei cause African trypanosomiasis. T. brucei ssp. gambiense, in
western and central Africa, causes most cases of sleeping sickness; the disease may last several years. T. brucei ssp.
rhodesiense, in eastern Africa, causes a more rapidly fatal form of African trypanosomiasis, usually lethal within weeks or
a few months without treatment.
Reservoirs and Mode of Transmission: Infected humans serve as reservoirs of T. brucei ssp. gambiense, whereas wild
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Course Title
Module #23 Student Activity Sheet
animals and domestic cattle are the primary reservoirs of T. brucei ssp. rhodesiense. Tsetse flies become infected when
they ingest blood that contains the trypanosomes. The parasites then multiply and mature within the infected tsetse flies.
Humans become infected when mature trypanosomes (trypomastigotes) are injected into the bloodstream as the infected
tsetse flies take blood meals.
Patient Care: Use Standard Precautions for hospitalized patients.
Malaria
⎯ Malaria is a systemic sporozoan infection with malaise, fever, chills, sweating, headache, and nausea.
⎯ The frequency with which the cycle of chills, fever, and sweating is repeated is referred to as periodicity,
which depends on the particular species of malarial parasite that is causing the infection.
⎯ The intermittent bouts of chills and fever are sometimes referred to as paroxysms.
⎯ In addition to these symptoms, falciparum malaria may be accompanied by cough, diarrhea, respiratory
distress, shock, renal and liver failure, pulmonary and cerebral edema, coma, and death.
Parasites: Human malaria is caused by four species in the genus Plasmodium: Plasmodium vivax (the most common
species), P. falciparum (the deadliest), Plasmodium malariae, and Plasmodium ovale. These are intraerythrocytic
sporozoan parasites. Infection with P. vivax and P. ovale results in chills and fever every 48 hours and is referred to as
tertian malaria. P. malariae infection causes chills and fever every 72 hours and is referred to as quartan malaria. P.
falciparum periodicity varies from 36–48 hours. Mixed infections—that is, infections involving more than one Plasmodium
species—occur in certain geographic areas. Drug-resistant strains of P. vivax and P. falciparum are common.
Plasmodium spp. have a complex life cycle involving a female Anopheles mosquito, the liver and erythrocytes of an
infected human, and many life cycles.
Reservoirs and Mode of Transmission: Infected humans and infected mosquitoes serve as reservoirs. Most human
infections occur as a result of injection of sporozoites into the bloodstream by an infected female Anopheles mosquito
while taking a blood meal. Infection may also occur as a result of blood transfusion or the use of blood-contaminated
needles and syringes.
Patient Care: Use Standard Precautions for hospitalized patients
Helminths
⎯ Helminths (parasitic worms) are divided into roundworms (nematodes) and flatworms. Flatworms are further
divided into tapeworms (cestodes) and flukes (trematodes).
⎯ The stages of the typical helminth life cycle are the egg, the larva, and the adult worm.
⎯ Helminth infections are usually diagnosed by observing (a) whole worms or segments of worms in clinical
specimens—most often, fecal specimens, or (b) larvae or eggs in stained or unstained clinical
specimens.
Skin Onchocerciasis (also known as ―river Onchocerca volvulus (N); microfilariae (tiny
blindness‖) prelarval stages of these helminths are found
in the skin
Gastrointestinal Tract Ascariasis infection Ascaris lumbricoides (N); the large intestinal
roundworm of humans
Ancylostoma duodenale (N) or Necator
Hookworm infection americanus (N)
Central Nervous System Cysticercosis Cysts (the larval stage) of the pork tapeworm
(Taenia solium) are found in the brain
3. Which of the following diseases is a synonym for ringworm infection of the nails?
a. tinea barbae
b. tinea cruris
c. tinea nigra
d. tinea unguium
ANSWER: D
RATIO: Tinea unguium is a synonym for ringworm infection of the nails.
4. What do you call an acute-to-subacute pulmonary disease found in malnourished, chronically ill children;
premature infants; and immunosuppressed patients, such as those with AIDS?
a. Cryptococcosis
b. Coccidioidomycosis
c. Histoplasmosis
d. Pneumocystis pneumonia
ANSWER: D
RATIO: PCP is an acute-to-subacute pulmonary disease found in malnourished, chronically ill children; premature infants; and
immunosuppressed patients, such as those with AIDS.
5. A fungal infection characterizes with white, creamy patches occur on the tongue, mucous membranes, and the
corners of the mouth?
a. Cryptococcal meningitis
b. thrush
c. tinea pedis
d. yeast vaginitis
ANSWER: B
RATIO: Thrush is a fungal infection characterized with white, creamy patches occur on the tongue, mucous membranes, and
the corners of the mouth.
6. You are visiting a friend whose parents raise pigs. Which of the following diseases are you most likely to acquire
by drinking well water at their farm?
a. amebiasis
b. balantidiasis
c. cryptosporidiosis
d. giardiasis
ANSWER: B
RATIO: The disease you most likely to acquire by drinking well water at their farm is balantidiasis.
7. You are working on a cattle ranch. Which of the following diseases are you most apt to acquire as you perform
your duties at the ranch?
a. amebiasis
b. balantidiasis
c. cryptosporidiosis
d. giardiasis
ANSWER: C
RATIO: The disease you most likely to acquire as you perform your duties at the ranch is cryptosporidiosis.
8. Which of the following protozoal diseases are you most likely to acquire by eating a rare hamburger?
a. amebiasis
b. balantidiasis
c. giardiasis
d. toxoplasmosis
ANSWER: D
RATIO: Toxoplasmosis is the disease you would most likely to acquire by eating a rare hamburger.
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER:
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Instruction: The instructor will pose and prompt a question and you will have to discuss it with your partner for 2 minutes.
After 2 minutes, you and your partner will be asked to share your thoughts and ideas from your discussion.