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Chapter 78. Parasitic Diseases

Student Questions

AR is a 23-year-old US Marine who was evacuated from Liberia after he developed nausea and vomiting, abdominal pain, and high fever and chills. It was reported that he had thrombocytopenia and an enlarged spleen. He was admitted to Walter Reed Hospital and treated with IV chloroquine. However, on the third day, he became delirious and his fever spiked at 41oC. This patient is most probably infected with which of the following?

A. P. vivax malaria

B. Yellow fever

C. P. falciparum malaria

D. Amebiasis

Answer: C

Option A: Incorrect. These symptoms are not characteristic of P. vivax malaria.

Option B: Incorrect. These symptoms are not characteristic of yellow fever.

Option C: Correct. Complications of P. falciparum include hypoglycemia, acute renal failure, pulmonary edema, severe anemia, thrombocytopenia, heart failure, cerebral congestion, seizures, coma, and respiratory distress syndrome. Additionally, P. falciparum has high rates of chloroquine resistance, and therefore the patient would not have been treated adequately with chloroquine.

Option D: Incorrect. These symptoms are not characteristic of amebiasis.

Complications of falciparum malaria include which of the following?

A. Hypoglycemia and acute renal failure

B. Hepatorenal syndrome

C. Agranulocytosis

D. Peritonitis

Answer: A

Option A: Correct. P. falciparum complications include hypoglycemia, acute renal failure, pulmonary edema, severe anemia, thrombocytopenia, heart failure, cerebral congestion, seizures, coma, and respiratory distress syndrome.

Option B: Incorrect. P. falciparum complications do not include hepatorenal syndrome.

Option C: Incorrect. P. falciparum complications do not include agranulocytosis.

Option D: Incorrect. P. falciparum complications do not include peritonitis.

Which of the following is true about amebic liver abscess (ALA)?

A. Should be treated with diloxanide furoate alone.

B. Should be routinely aspirated.

C. Usually affects the right lobe of the liver.

D. Is associated with eosinophilia.

Answer: C

Option A: Incorrect. These cases should not be treated with diloxanide furoate alone because it is a nonabsorbed luminal agent which would not effectively treat liver abscesses.

Option B: Incorrect. Needle aspiration should only be done in select cases.

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