Question

Parasitic surgical diseases . Etiology, clinical presentation, diagnosis , treatment.

Answer 1

• A parasitic infection is an infection caused or transmitted by a parasite.
• Parasite includes various protozoa and worms which may infect humans and cause disease.

Following are the parasitic surgical diseases: ​

Amoebiasisbiasis

• Caused by entamoeba histolytica.
• Majority remains asymptomatic carrier.
• Etiology is faeco oral route.
• Clinical features:
  • Young adult male
  • Non specific symptoms,
  • Abdominal pain, anorexia, fever, night sweat, weight loss
  • Gradually progress to more specific symptoms, pain in upper right abdomen, right shoulder tip, hiccough
  • Bloody diarrhoea/ travel to endemic area
• Diagnosis:
  • Toxic , anemia
  • Skin edema, pleural effusion
  • Yender hepatomegaly
  • Occasionally tinge of jaundice, ascitis present
  • Colonoscopy
  • Biopsy
  • CT
  • ESR
• Treatment
  • Intestinal and early hepatic amoebiasis --+ metronidazole (800mg) TDS for 5-10 days
  • Eliminate luminal cyst--- diloxanide furonate/ Paromomycin (500mg) TDS for 10 days.
  • Secondary infection - other drug treatment
  • Surgical-- ICU, resection of bowel exteriorisation.

Ascaris Lumbricoides

• Roundworm common intestinal nematides to infect human .
• Etiology--- larva leads to pulmonary symptoms, adult worm -. Intetinal symptoms. Faeco oral contamination.
• Clinical features:
  • Larval stage - dry cough, chest pain, dyspnea, fever.
  • Adult worm - malnutrition, failure to thrive, abdominal pain.
  • Obstructive jaundice
  • Acute pancreatitis when worms in pancreatic duct.
• Diagnosis:
  • Eosinophilia
  • Stool examination: ova
  • Sputum or bronchoscopic washing -- Charcot Leyden crystal / larvae
  • USG- worm in CBD, Pancreatic duct.
• Treatment;
  • Pulmonary phase --- self limiting
  • Single dose Albendazole (400mg) or
  • Mebendazole (100mg) BD for 3 days.
  • IV fluid , NG suction, hypertonic saline enema.
  • Surgical --- laparotomy, stricture, gangrenous, perforation-- resection and anastomosis.

Filariasis

• Caused by Wuchereria bancrofti carried by mosquito.
• Etiology --+ mosquito bite
• Clinical features:
  • Episodic fever
  • Lymphadenitis
  • Lymphangitis
  • Massive lower limb deem
  • Skin thickening
  • Secondary streptococcus infection
  • Chylurua
  • Chylous ascites
• Diagnosis :
  • Eosinophilia,
  • Urine, ascites hydrocephali, fluid :: paradite
  • Nocturnal peripheral blood smear: microfilariae
• Treatment:
  • Diethylcarbamazine (2mg/kg) TID for 12 days or
  • Single dose of Albendazole (400mg)
  • Intermittent pneumatics compression
  • Hydrocele : excision or eversion of sac.

Leprosy

• also called Hansen disease
• Etiology .. caused by acid fast bacilli Mycobacterium leprae.
• Clinical features:
  • Slow progressive affecting skin.
  • Upoer respiratory tract, peripheral nerve.
  • Neural involvement: thickening nerves which are tender . Assymetrical well defined anesthetic hypopigmented or erythematous macules with elevated edge and dry rough surface lesion.
  • Deformity: wrinkling of skin, lose eyebrows, destruction of lateral cartilage/ septum of nose. Blindness, claw of the toes .
  • Posterior tibial nerve
  • Trophic ulceration
  • Testis atrophy.
• Diagnosis : skin smear/ skin biopsy
• Treatment:
  • Paucibacillary :: rifampicin (600mg) , Dapson (100mg) for 6 month
  • Multibacillary : Rifampicin (600mg), Clofazimine (300mg) , Dapsone (100mg). For 12 months.