Rishi Desai, MD, MPH

Onchocerca volvulus (River blindness)

First Aid 

Chapter 82 Nematodes (Roundworms)  DIAGNOSIS LAB RESULTS ▪ ▪ ▪ ▪  Hypergammaglobulinemia ↑ IgE level Worm’s presence (blood smear) Serology ▫ IgG antibodies against L. loa antigens  OTHER DIAGNOSTICS  ▪ History, physical examination ▫ Worm detection in subcutaneous tissue, conjunctiva  ▫ Onchocerciasis co-infection contraindicated (DEC provokes severe inﬂammatory skin, eye response; Mazzotti reaction) ▫ Eradication may require multiple treatment rounds ▪ Albendazole ▫ Sterilizes mature worms without microﬁlarial activity ▪ Antihistamine/corticosteroids ▫ Limits post-treatment immune reactions (e.g. Calabar swelling)  SURGERY  ▪ Large worm removal  TREATMENT MEDICATIONS  ▪ Diethylcarbamazine (DEC) ▫ Active against L. loa microﬁlariae, microﬁlariae (adult worms)  OTHER INTERVENTIONS Prevention ▪ Weekly DEC prophylaxis ▪ Only considered for long-term endemicarea exposure  ONCHOCERCA VOLVULUS (RIVER BLINDNESS) osms.it/onchocerca-volvulus PATHOLOGY & CAUSES ▪ Filarial nematode transmitted by blackﬂies ▪ Leading preventable blindness cause in sub-Saharan Africa Life cycle/transmission ▪ Simulium blackﬂy human bite → larvae skin deposited → adult parasite maturation (microﬁlariae) → subcutaneous/deeper intramuscular tissue migration → ﬁbrous capsule/nodule development → reproduction → microﬁlarial (immature worm) production, subcutaneous tissue migration → human blackﬂy bite → microﬁlarial development into infective larvae (in blackﬂy)  Ocular onchocerciasis ▪ Common manifestation: West African savanna ▪ Commonly affects anterior eye chamber ▫ Iridocyclitis, glaucoma, uveitis ▪ Posterior chamber may also be affected ▫ Onchochorioretinits, optic atrophy ▪ Ocular involvement degree correlates with symbiotic Wolbachia bacteria quantity Onchocercal skin disease ▪ AKA Leopard/lizard/elephant skin (especially when depigmentation present); common manifestation in African forest areas ▪ Classiﬁed by chronicity ▫ Acute/chronic papular onchodermatitis  OSMOSIS.ORG 447   

Bacterial structure and functions

Introduction to bacteria

Bacillus anthracis (Anthrax)

Bacillus cereus (Food poisoning)

Corynebacterium diphtheriae (Diphtheria)

Listeria monocytogenes

Clostridium botulinum (Botulism)

Clostridium difficile (Pseudomembranous colitis)

Clostridium perfringens

Clostridium tetani (Tetanus)

Actinomyces israelii

Nocardia

Staphylococcus aureus

Staphylococcus epidermidis

Staphylococcus saprophyticus

Streptococcus agalactiae (Group B Strep)

Streptococcus pneumoniae

Streptococcus pyogenes (Group A Strep)

Streptococcus viridans

Enterococcus

Gram positive bacteria

Bacteroides fragilis

Bartonella henselae (Cat-scratch disease and Bacillary angiomatosis)

Enterobacter

Escherichia coli

Klebsiella pneumoniae

Legionella pneumophila (Legionnaires disease and Pontiac fever)

Proteus mirabilis

Pseudomonas aeruginosa

Salmonella (non-typhoidal)

Salmonella typhi (typhoid fever)

Serratia marcescens

Shigella

Yersinia enterocolitica

Yersinia pestis (Plague)

Campylobacter jejuni

Helicobacter pylori

Vibrio cholerae (Cholera)

Moraxella catarrhalis

Neisseria gonorrhoeae

Neisseria meningitidis

Bordetella pertussis (Pertussis/Whooping cough)

Brucella

Francisella tularensis (Tularemia)

Haemophilus ducreyi (Chancroid)

Haemophilus influenzae

Pasteurella multocida

Gram negative bacteria

Mycobacterium tuberculosis (Tuberculosis)

Mycobacterium avium complex (NORD)

Mycobacterium leprae

Mycobacteria

Chlamydia pneumoniae

Chlamydia trachomatis

Gardnerella vaginalis (Bacterial vaginosis)

Mycoplasma pneumoniae

Coxiella burnetii (Q fever)

Ehrlichia and Anaplasma

Rickettsia rickettsii (Rocky Mountain spotted fever) and other Rickettsia species

Borrelia burgdorferi (Lyme disease)

Borrelia species (Relapsing fever)

Leptospira

Treponema pallidum (Syphilis)

Other bacteria

Bacteriology

Malassezia (Tinea versicolor and Seborrhoeic dermatitis)

Cutaneous fungal infections

Aspergillus fumigatus

Candida

Cryptococcus neoformans

Mucormycosis

Pneumocystis jirovecii (Pneumocystis pneumonia)

Sporothrix schenckii

Opportunistic fungal infections

Blastomycosis

Coccidioidomycosis and paracoccidioidomycosis

Histoplasmosis

Systemic fungal infections

Mycology

Pediculus humanus and Phthirus pubis (Lice)

Sarcoptes scabiei (Scabies)

Ectoparasites

Acanthamoeba

Naegleria fowleri (Primary amebic meningoencephalitis)

Toxoplasma gondii (Toxoplasmosis)

Cryptosporidium

Entamoeba histolytica (Amebiasis)

Giardia lamblia

Babesia

Plasmodium species (Malaria)

Leishmania

Trichomonas vaginalis

Trypanosoma brucei

Trypanosoma cruzi (Chagas disease)

Protozoa

Diphyllobothrium latum

Echinococcus granulosus (Hydatid disease)

Ancylostoma duodenale and Necator americanus

Angiostrongylus (Eosinophilic meningitis)

Anisakis

Ascaris lumbricoides

Enterobius vermicularis (Pinworm)

Guinea worm (Dracunculiasis)

Loa loa (Eye worm)

Strongyloides stercoralis

Toxocara canis (Visceral larva migrans)

Trichinella spiralis

Trichuris trichiura (Whipworm)

Wuchereria bancrofti (Lymphatic filariasis)

Clonorchis sinensis

Paragonimus westermani

Schistosomes

Worms

Parasitology

Viral structure and functions

Introduction to viruses

Adenovirus

Hepatitis B and Hepatitis D virus

Cytomegalovirus

Epstein-Barr virus (Infectious mononucleosis)

Herpes simplex virus

Human herpesvirus 6 (Roseola)

Human herpesvirus 8 (Kaposi sarcoma)

Varicella zoster virus

Human papillomavirus

Parvovirus B19

BK virus (Hemorrhagic cystitis)

JC virus (Progressive multifocal leukoencephalopathy)

Poxvirus (Smallpox and Molluscum contagiosum)

DNA viruses

Lymphocytic choriomeningitis virus

Hantavirus

Norovirus

Coronaviruses

Ebola virus

Dengue virus

Hepatitis C virus

West Nile virus

Yellow fever virus

Zika virus

Influenza virus

Human parainfluenza viruses

Measles virus

Mumps virus

Respiratory syncytial virus

Hepatitis A and Hepatitis E virus

Coxsackievirus

Poliovirus

Rhinovirus

Rotavirus

HIV (AIDS)

Human T-lymphotropic virus

Rabies virus

Eastern and Western equine encephalitis virus

Rubella virus

RNA viruses

Prions (Spongiform encephalopathy)

Prions and virioids

Virology

Antimetabolites: Sulfonamides and trimethoprim

Antituberculosis medications

Cell wall synthesis inhibitors: Cephalosporins

Cell wall synthesis inhibitors: Penicillins

DNA synthesis inhibitors: Fluoroquinolones

DNA synthesis inhibitors: Metronidazole

Mechanisms of antibiotic resistance

Miscellaneous cell wall synthesis inhibitors

Miscellaneous protein synthesis inhibitors

Protein synthesis inhibitors: Aminoglycosides

Protein synthesis inhibitors: Tetracyclines

Antibiotics

Azoles

Echinocandins

Miscellaneous antifungal medications

Antifungals

Anthelmintic medications

Anti-mite and louse medications

Antimalarials

Antiparasitics

Hepatitis medications

Herpesvirus medications

Integrase and entry inhibitors

Neuraminidase inhibitors

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Nucleoside reverse transcriptase inhibitors (NRTIs)

Protease inhibitors

Antivirals

Pharmacology

Onchocerca volvulus (River blindness)

Videos

Notes