babesiosis, balantidiasis and pseudomonas

8/8/2019 Babesiosis, Balantidiasis and Pseudomonas

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BABESIOSISBabesiosis is a rare, severe and sometimes fatal tick-borne disease caused by various types of Babesia, amicroscopic parasite that infects red blood cells.

is a malaria-like parasitic disease caused by Babesia

, agenus ofprotozoal piroplasms. After trypanosomes

,Babesia are thought to be the second most commonblood parasites of mammals and they can have a major

impact on health of domestic animals in areas withoutsevere winters. Human babesiosis is uncommon, butreported cases have risen recently because of expandedmedical awareness.


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Who gets babesiosis?

Babesiosis is seen most frequently in the elderly orin immunocompromised individuals. Cases of thisdisease have been primarily reported during spring,summer and fall in coastal areas. Babesiosis can bemore severe in people who have had their spleenremoved.

How is babesiosis transmitted?

Babesiosis is transmitted by the bite of an infecteddeer tick, Ixodes scapularis. Transmission can alsooccur via transfusion of contaminated blood.


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Symptoms of babesiosis Generalized weakness Fatigue Depression

Fever Anorexia and weight loss CNS - Headache, photophobia, neck stiffness,

altered sensorium Pulmonary - Cough, shortness of breath GI - Nausea, vomiting, abdominal pain Musculoskeletal - Arthralgia and myalgia Renal - Dark urine

Chills And sweating


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Symptoms appear when

It may take from one to eight weeks,sometimes longer, for symptoms to appear.

LIFE CYCLE


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To prevent babesiosis?

When in tick-infested habitat - wooded and grassyareas - take special precautions to prevent tickbites, such as wearing light-colored clothing (foreasy tick discovery) and tucking pants into socksand shirt into pants. Check after every two to threehours of outdoor activity for ticks on clothing orskin. Brush off any ticks on clothing before skinattachment occurs. A thorough check of bodysurfaces for attached ticks should be done at theend of the day. If removal of attached ticks occurswithin 36 hours, the risk of tick-borne infection isminimal.


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Babesiosis

Classification andexternal resources

The disease is named for the genus of thecausative organism, which was in turn namedafter the bacteriologist Victor Babe. Equinebabesiosis is also known as piroplasmosis.


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Epidemiology

Babesiosis is a vector-borne illness usually transmitted byIxodid ticks. Babesia microtiuses the same tick vector, Ixodesscapularis, as Lyme disease and ehrlichiosis, and may occurin conjunction with these other diseases. In endemic areas,the organism can also be transmitted by blood transfusion.

Most cases of babesia infection are asymptomatic or includemild fevers and anemia and go unnoticed. In more severecases, there are symptoms similar to malaria, with fevers upto 105F / 40C, shaking chills, and severe anemia (hemolyticanemia). Organ failure may follow including adult respiratorydistress syndrome. Severe cases occur mostly in people who

have had their spleen removed surgically. Severe cases arealso more likely to occur in the very young, very old, andpersons with immunodeficiency, such as HIV/AIDS patients.Some people with babesiosis have additional tick-borneillnesses, such as Lyme disease.


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Babesia life cycle


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Diagnosis Other laboratory findings include decreased numbers ofred

blood cells and platelets on complete blood count.

Babesia parasites in red blood cells on a stained blood smear.

In symptomatic people, babesiosis usually is diagnosed byexamining blood specimens under a microscope and seeingBabesia parasites inside red blood cells.

If babesiosis is being considered, examination of blood smearsshould be specifically requested. Multiple smears may need tobe examined to detect low levels of parasites.


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Treatment

Most cases of babesiosis resolve without anyspecific treatment. For ill patients, treatment isusually a two-drug regimen. The regimen ofquinine and clindamycin has been used, but isoften poorly tolerated; recent evidence suggeststhat a regimen ofatovaquone and azithromycin

can be equally effective.I

n life-threatening casesexchange transfusion is performed. In thisprocedure the infected red blood cells areremoved and replaced with fresh ones.


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Balantidiasisis defined as large-intestinal infection with Balantidium coli. B coli areknown to parasitize the colon, and pigs may be its primary reservoir. Mostcases of balantidiasis in individuals are asymptomatic.

Causative agent:

Balantidium coli> is a protozoan parasite responsible for the diseaseBalantidiasis. is the largest protozoan and the only ciliate known toparasitize humans.

infection is most often asymptomatic, but the parasite can invade thelarge intestine leading to diarrhea, dysentery (bloody diarrhea), colitis,and abdominal pain. This collection of symptoms is Balantidiasis, whichcan be treated effectively with antibiotics and can be prevented withproper hand washing practices, water treatment, separation of human andswine habitats, and proper waste disposal.


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Signs and symptoms

Diarrhea - watery, bloody, and mucoid Nausea and vomiting

Abdominal pain/cramps Anorexia Weight loss Headache

Mild colitis Fever Severe and marked fluid loss resulting in

dehydration (resembling amebic dysentery)


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Risk factors for balantidiasis

Contacts with pigs

Handling fertilizer contaminated with pig excrement

Living in areas where the water supply may be contaminated by theexcrement of infected animals.

Poor nutrition Achlorhydria

Alcoholism

Immunosuppression


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Tests and diagnosis Wet smear stool specimens

Chest X-ray may show pulmonary involvement in patients with balantidiasis.

CT- chest reveals reveal pulmonary parenchymal and lymph node involvement.

Complications Perforation of ulcer

Peritonitis

Gastro intestinal bleeding Severe dehydration

Preventive measures Purification of drinking water

Proper handling of food stuffs

Careful disposal of human feces and excreta

Monitoring the contacts of balantidiasis patients

Avoiding contact with pigs and fertilizer that is contaminated with pig excrement candecrease the risk.


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Diagnosis of Balantidiasis >As with other similar diseases, can be

complicated, partly because symptom may or

may not be present. The diagnosis ofbalantidiasis may be considered when a patienthas diarrhea combined with a possible history ofrecent exposure to amebiasis through travel,

contact with infected persons, or analintercourse.


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Transmission

Infection is particularly common in pigs, and are themain source of transmission to man. More than 50% ofhuman cases had contact with pigs. The handling andslaughtering of pigs and the use of pig excrement forfertilizing vegetables favor increase transmission.Person-to-person contact occurs through fecalcontamination. Cysts are the infective stage and mayremain viable for weeks in moist feces. Excystationoccurs in the bowel, and the trophozoites live in thelarge intestine, where they either remain in the lumen

or invade the intestinal mucosa. Encystation occurseither as fecal material being moved down the bowel orafter passage of semi-formed stool.


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TreatmentAntibiotics- Tetracycline 500 mg 4 times a day for 10 daysContact Amebicide- Iodoquinol

(1) Tetracyclines

500 mg four times daily for 10 days

(Contraindicated in pregnant women andchildren younger than 8 years of age)

(2) Metronidazole

750 mg three times daily for 5 days

(3) Iodoquinol

640 mg three times daily for 20 days


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Most cases ofBalantidium coliinfection areasymptomatic. If possible, asymptomatic individualsshould still be treated in order to halt furthertransmission of the disease.

Many people clear the infection spontaneously withouttreatment. Infected individuals usually respond well totreatment using one of the aforementioned regimens.

If left untreated, Balantidiasis can become chronic.Persistent diarrhea can lead to high fluid loss anddehydration. Abdominal bleeding can lead to death.


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Balantidiasis is diagnosed by microscopic

examination of a patients feces. A stool

sample is collected and a wet mount isprepared. Cysts or trophozoites can be

detected in the feces. Balantidium coliis

passed periodically, therefore stool samples

should be collected frequently and examinedimmediately in order to make a definitive

diagnosis.


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Trophozoites can also be detected in tissue. In order to collect a tissuespecimen from the large intestine, a sigmoidoscopy procedure is used. Athin, hollow instrument called a sigmoidoscope is used to visually inspectthe last sections of the large intestine: the rectum and the sigmoid colon.A physician can look for bleeding, ulcers, and inflammation in order todiagnose the cause of diarrhea and other GI complaints, and can take atissue biopsy for inspection.


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Pseudomonas aeruginosa

occur most often in hospitals, where the

organism is frequently found in moist areas

such as sinks, antiseptic solutions, and urinereceptacles. Cross infection transmitted from

patient to patient via the hands of personnel

may occur in outbreaks of urinary tract

infections, on burn units and in neonatalintensive care nurseries.


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Is aGram negative bacteria that is commonly found in theenvironment:

>water

>soil and

>other moist location


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CAUSES oF PSEUDOMONAS AERUGENOSA

Pseudomonas aeruginosa is an opportunistic pathogen. Thebacteria takes advantage of an individual's weakened immunesystem to create an infection and this organism also producestissue-damaging toxins. Pseudomonas aeruginosa causesurinary tract infections, respiratory system infections,

dermatitis, soft tissue infections, bacteremia, bone and jointinfections, gastrointestinal infections and a variety of systemicinfections, particularly in patients with severe burns and incancer and AIDS patients who are immunosuppressed.


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Symptoms of Pseudomonas Aeruginosa

Infection

The symptoms of pseudomonas aeruginosa infection,depends on the part of the body that is infected.Fever, fatigue, muscle and joint pain are symptoms ofpseudomonas bacteremia. The following list gives the

respective symptoms of each infection,Bone infection: Swollen infected part, redness.

Ear infection: Pain in the ear, reduced ability to hear,facial paralysis.

Eye infection: Pain in the eye, reduced vision, swolleneyelids.

Cystic fibrosis: Cough, reduced appetite, fast breathing,enlargement of abdomen.

Skin infections: Ulcer that can result in bleeding.


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Sites of infection;

Respiratory: bronchitis, pneumonia (often recurrent & orchronic), similar to pts w/ CF; lobar, cavitary, diffuseinterstial, bronchiectatic, & empyemas all reported.

Skin: papules, nodules, folliculitis, abscesses, & ecthyma

gangrenosum (usually as a result of systemic infection) ENT: orbital cellulitis; sinusitis (recurrent &/or chronic);

parapharyngeal abscesses, & malignant otitis externa,particularly in diabetic patients.

GU: Complicated UTI, pyelonephritis.

Bone: osteomyelitis. CV: endocarditis mostly in IDU.


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Epidemiology of Pseudomonas

aeruginosa

Pseudomonas aeruginosa is primarily a nosocomialpathogen. According to the CDC, the overall incidenceof P. aeruginosa infections in US hospitals averagesabout 0.4 percent (4 per 1000 discharges), and thebacterium is the fourth most commonly-isolated

nosocomial pathogen accounting for 10.1 percent of allhospital-acquired infections.Within the hospital, P.aeruginosa finds numerous reservoirs: disinfectants,respiratory equipment, food, sinks, taps, and mops. Thisorganism is often reintroduced into the hospital

environment on fruits, plants, vegetables, as well byvisitors and patients transferred from other facilities.Spread occurs from patient to patient on the hands ofhospital personnel, by direct patient contact withcontaminated reservoirs, and by the ingestion ofcontaminated foods and water.


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ncubationPeriod

Usually 24-72 hours.

Diagnosis ofPseudomonas aeruginosa

Diagnosis of P. aeruginosa infection depends upon isolation andlaboratory identification of the bacterium. It grows well onmost laboratory media and commonly is isolated on blood agaror eosin-methylthionine blue agar. It is identified on the basisof itsGram morphology, inability to ferment lactose, a positiveoxidase reaction, its fruity odor, and its ability to grow at 42 C.Fluorescence under ultraviolet light is helpful in earlyidentification of P. aeruginosa colonies and may also helpidentify its presence in wounds.


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Treatment of Pseudomonas

aeruginosa

Pseudomonas aeruginosa is frequently resistant tomany commonly used antibiotics. Although manystrains are susceptible to gentamicin, tobramycin,colistin, and amikacin, resistant forms havedeveloped. The combination of gentamicin andcarbenicillin is frequently used to treat severePseudomonas infections. Several types of vaccines

are being tested, but none is currently available forgeneral use.

babesiosis, balantidiasis and pseudomonas

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