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Case 3

Case 3. 報告人:胡鴻祥 時間:94071 3 指導老師 : 盧章智主任. Previously healthy 32-year-old woman, diarrhea , alternating with constipation, abdominal discomfort, vomiting, anorexia, intense fatigue, myalgia, and other "flu-like" symptoms for several weeks ,went to her internist for treatment

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Case 3

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  1. Case 3 報告人:胡鴻祥 時間:940713 指導老師:盧章智主任

  2. Previously healthy 32-year-old woman,diarrhea, alternating with constipation, abdominal discomfort, vomiting, anorexia, intense fatigue, myalgia, and other "flu-like" symptoms for several weeks ,went to her internist for treatment • No traveling history but remarked that her symptoms had developed a few days after she attended a June wedding in Florida • several other guests at the wedding had developed similar symptoms

  3. Routine tests for enteric pathogens were reported as being negative • Modified acid-fast-stained smear revealed spherical structures approximately 8 to 10 μm in diameter, showing a range of intensity from colorless to dark red • The spherical structures showed auto-fluorescence when viewed using a UV microscope.

  4. Q1.Which intestinal protozoan parasite might becausing this patient's symptoms? Explain youranswer based on the results of laboratory tests.

  5. Ans: 1.Cyclospora cayetanensis 2.因為在modified acid-fast stain中卵囊會被染成紅色而且在uv microscope下會自己發光,再加上oocyst大小8-10μm

  6. Q2:List two other protozoan parasites which might be confused with this parasite.How may these three parasites be distinguished from each other?

  7. Ans: • Cryptosporidium Parvum • Isopora bellui

  8. Cyclospora cayetanensis的oocyst通常很少存在,若存在的話,會8-10μm,且有些會含granules or have a bubbly appearance(wrinkled cellphone), auto-fluorescence when viewed using a UV microscope.

  9. Cryptosporidium Parvum 不會有auto-fluorescence when viewed using a UV microscope而他的oocyst大小約4-5μm

  10. Isopora bellui的oocyst會auto-fluorescence when viewed using a UV microscope且形狀為oblong而且較其他兩者為大

  11. Q3:How does this patient's history correlate with this diagnosis?

  12. Ans: 1.Diarrhea 2.Abdominal discomfort, vomiting, anorexia, intense fatigue, myalgia, and other "flu-like" symptoms 3.Several other guests at the wedding had developed similar symptom 4.The routine tests for enteric pathogens were reported as being negative

  13. Q4:Where have outbreaks of this infection occurred?

  14. Ans: Since 1990, at least 11 foodborne outbreaks of cyclosporiasis, affecting approximately 3600 persons, have been documented in the United States and Canada.

  15. Q5:Does this parasite cause more serious illness in immunocompromisedindividuals?

  16. Ans: In an immunocompromised host, onset is more insidious, and the condition becomes chronic

  17. Q6:Should the patient be treated? If so, how?

  18. Ans: This disease can be self-limited and we can give supportive treatmrnt first but if the symptom became severe,we can prescribe Trimethoprim-sulfamethoxazole(Immunocompetent host: 160 mg TMP/800 mg SMZ PO bid for 7 dImmunocompromised host: 160 mg TMP/800 mg SMZ PO qid for 10 d, followed by prophylaxis with 160 mg TMP/800 mg SMZ 3 times/wk)

  19. Q7:How can this infection be controlled and prevented?

  20. Ans: 1. Practice good hygiene. 2. Avoid water that might be contaminated. 3. Avoid food that might be contaminated. 4. Take extra care when traveling.

  21. When freshly passed in stools, the oocyst is not infective (thus, direct fecal-oral transmission cannot occur; this differentiates Cyclospora from another important coccidian parasite, Cryptosporidium).  In the environment , sporulation occurs after days or weeks at temperatures between 22°C to 32°C, resulting in division of the sporont into two sporocysts, each containing two elongate sporozoites .  Fresh produce and water can serve as vehicles for transmission and the sporulated oocysts are ingested (in contaminated food or water) .  The oocysts excyst in the gastrointestinal tract, freeing the sporozoites which invade the epithelial cells of the small intestine .  Inside the cells they undergo asexual multiplication and sexual development to mature into oocysts, which will be shed in stools .  The potential mechanisms of contamination of food and water are still under investigation.

  22. Thanks for your attention

  23. 參考資料: 1.Medical parasitology,7th 2.The 10-minute Diagnosis Manual 3.Home page:Division of parasitic disease 4.Home page:E-medicine

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