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Pathology And Pharamcology > Hemoflagellates - Micro > Flashcards

Hemoflagellates - Micro Flashcards

1
Q

What are hemoflagellates ?

A

Eukaryotic Parasitic Flagellates that live in the blood stream or tissue of man and animals and reproduce by binary fission

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2
Q

Morphological forms of hemoflagellates?
“Mastigtotes”

A

Amastigote
Promastigote
Epimastigote
Trypomastigote

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3
Q

The primary Diagnostic form in Leishmania is the?

A

Amastigote

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4
Q

The primary diagnostic form of Trypanosoma is the ? Exception of ?

A

Trypomastigote
Exception of T. Cruzi in which amastigotes can also be found

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5
Q

Amastigote can be found

A

Primarily in the tissue and muscle, CNS ………..within macrophages ”where they multiply

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6
Q

Trypomastigotes are found where?

A

They reproduce and are visible in the peripheral blood, Lymphatics and CSF

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7
Q

Promastigotes may be seen where?

A

In the blood if the sample is collected immediately after transmission into a healthy host
Also be seen if the appropriate sample is cultured

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8
Q

Epimastogotes are found primarily in the?

A

Arthropod vectors

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9
Q

Trypanosoma and leishmania belong the what phylum, subphylum, class and order ???

A

Phylum -sarcomastigophora
Subphylum - mastigophora
Class - Kinetoplastidae
Order - Tripanosomatidae

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10
Q

Two forms of Trypanosomes ?

A

African Trypanosomiasis
American Trypanosomiasis

They live in blood and tissue of their host

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11
Q

African Tripanosomiasis is also called?
Aetiology??

A

Sleeping sickness

Caused by
Trypanosoma brucei gambiense
Tryoanosoma brucei rhodesiense

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12
Q

T.b gambiense is seen in ??? And TB rhodeisiense occurs in ??
Vector is??

A

Gambiense - West Africa and central Africa
Rhodeisiense - East Africa and central Africa

Vector; Tsetse-fly

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13
Q

Some Facts about tsetsefly and it’s infectivity

A
  • Trypanosomiasis develops after the bite from an infected tsetsefly
  • Both male and female tsetsefly transmit infection
  • Bite occurs early in the morning and evening
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14
Q

The tsetsefly injects what morphological form into man?

A

Tryptomastigotes are injected into the subcutaneous tissue after a bite?

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15
Q

What happens when Tryptomastigotes enters into the subcutaneous tissue ?

A
  • They form a local chancre that’s hard and painful.
  • Chancre resolves spontaneously 1-2weeks later

Some may enter into the blood and spread to the entire body

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16
Q

Course of Tryptomastigotes ?

A

They move and multiply in the blood and lymphatic vessels

When the posterior cervical lymph node is involved, a lesion called “WINTER-BOTTOM SIGN” is formed

Untreated infection can spread to the CNS, they infiltrate the Subarachnoid space and brain tissue

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17
Q

Course of Tryptomastigotes (symptoms) ?

A

Early symptoms include ; Hepatosplenomegaly
CNS involvement include; Headache, and behavioral changes (aggressive, sleep-like state)

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18
Q

Clinical stages of Tripanosomiasis

A
  • Skin stage: Reaction occurs at the site of inoculation of trypomastigotes, Chancre is formed which resolves in 2-3weeks
  • Hemato-lymphatic stage
  • CNS stage
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19
Q

Symptoms of the hemato-lymphatic stage of Trypanosomiasis

A

intermittent fever, headache, generalized lymphadenopathy mainly in the Cervical and sub-occipital region (Winterbottom sign), and anemia

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20
Q

Symptoms of CNS stage of Trypanosomiasis ?

A

Trypomastigotes cross BBB into the spinal fluid and CNS causing;

  • change in behavior, confusion, poor coordination,
  • disturbance of sleep (sleep during the day and insomnia at night)
  • meningoencephalitis
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21
Q

Life cycle of trypanosomiasis in flies?

A

• Metacyclic Trypomastigotes are ingested from an infected man
• In the Midgut of fly, It transforms into Procyclic Trypomastigotes
• It leaves the midgut and transforms into epimastigotes
• In the salivary gland of fly, epimastigotes multiply and transform back into metacyclic Trypomastigotes
• Man is then injected by fly during another blood meal

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22
Q

Differences between Gambiense and rhodesiense

1) Course of disease?
2) Lymph node enlargement?
3) Profound somnolence and other Marked nervous symptoms?
4) Febrile paroxysms

A

1) G - chronic course
1) R. -Acute course
2) G- more pronounced LN enlargement
2) R - less pronounced LN enlargement
3) G - Less common (CNS symptoms)
3) R - More common (CNS symptoms)
4) G - Less frequent febrile paroxysms
4) R - More frequent febrile paroxysms

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23
Q

Differences between Gambiense and rhodesiense

1) Geographical location ?
2) Main tsetsefly vector ?
3) Reservoir hosts ?
4) Virulence?
5) Number of Trypomastigotes in the blood?

A

1) G- WA
1) R- EA
2) G - G.palpalis & G.Fuscipes
2) R - G. Morsitans & G Pallidipes
3) G - mainly humans
3) R - mainly animals
4) G - less virulence
4) R - more virulent
5) G - Less trypomastigotes in the blood
5) R - more trypomastigotes in the blood

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24
Q

American Trypanosomiasis is also known as ??

A

Chaga’s Disease

  • Found in both central and South America
  • DX occur in two stages (acute and chronic stage)
  • Incubation period; 2weeks to several moths
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25
Vector for American Trypanosomiasis?
**ReduVid** bug / **Kissing** Bug/ **Triatomine** bug
26
Course of American Trypanosomiasis
Bug **defecates** after taking a blood meal, the feces contains **Metacyclic tryptomastigotes** (infective form) The saliva of the bug contains **irritant** which makes the **bite area itchy** and thus, the person rubs in the infective form
27
Clinical pathophysiology 1
Subcutaneous inflammatory nodule is formed at the site of entry (**Chagoma**) If the entry point is the conjunctiva, a painless, swollen, unilateral conjunctivitis called **ROMANIA SIGN** is seen The metacyclic tryptomastigote introduced can spread to regional lymph nodes causing **lymphadenitisi It **transforms** into **Amastigotes in the RES** and other tissues like muscles/nervous tissue
28
Clinical pathophysiology 2
When the cell ruptured, amastigotes are released which then **transforms to tryptomastigotes** in the **blood** **Triatomine bug** picks this up during another blood meal leading to the beginning of another cycle
29
Clinical features of Acute illness of Chaga’s disease?
**Early stage**; Asymptomatic or mild symptoms that include; Fever, swollen lymph nodes, headaches, Chagoma (local swelling at the site of the bite) **Romania’s sign**; involves the **swelling of the eyelids** on the side of the face near the bite wound. or where the bugs feces were deposited/accidentally rubbed into the eyes
30
The most **recognized marker** of acute Chaga’s disease is ??
The Romania Sign
31
Features of Chronic Chaga’s disease ?
2/3 of people with chronic symptoms have **Dilated cardiomyopathy** - which causes **heart rhythm abnormalities**, and may result in **sudden cardiac death** T. Cruzi - chronic illness with **progressive myocardial damage** leading to **cardiac arrythmias** and **cardiac dilatation** Gastrointestinal involvement; leads to **Megaesophagus** and **megacolon** Intracellular **amastigotes** destroy the intramural neurons of the ANS in the intestine and heart ——> **Megaintestine** and **heart aneurysms** Main causes of death is due to **heart muscle damage**
32
For the laboratory diagnosis of Trypanosomiasis ?
**Sample**; Blood, Lymph node aspirate, CSF, BM, Fluid aspirated from chancre **Direct microscopy;** stained (with **giemsa**) and unstained specimens. **Serology**; - indirect fluorescent antibody tests - Indirect haemagglutination test - Elisa
33
In the Laboratory diagnosis of Trypanosomiasis, if parasites cannot be detected in both stained and unstained films .. what to do??
**Concentration Methods** can be used; - Haematocrit Centrifugation - Allow blood to coagulate and search for tryptomastigotes in the serum
34
Treatment of African Trypanosomiasis
**Suramin** and **pentamidine isethionate** - Drug of choice *They don’t cross the BBB* **Melarsoprol** - CNS involvement ***Resistance** is seen in advanced stage of the T.b Rhodesiense infection*
35
Drug of choice for treating **American trypanosomiasis**
**Nifurtimox** and **Benznidazole**
36
Three known forms of leishmaniasis are ?
**Cutaneous** Leishmaniasis **Mucocutaneous** leishmaniasis **Visceral** leishmaniasis or Kala-azar
37
Leishmania species that cause **cutaneous Leishmaniasis** ?
Leishmania **Tropica** Leishmania **Major** Leishmania **aethiopica** Leishmania **Mexicans**
38
Leishmania species that cause **visceral leishmaniasis** ?
Leishmania **Donovani** Leishmania **infantum** leishmania **Chagasi**
39
Leishmania species that cause **Muco-cutaneous leishmaniasis**
Leishmania **braziliensis**
40
Leishmania species causing disease in man are classified into?
Old world and new world
41
Old world leishmania species , vector is ?
L. **donovani** L. **tropica** L. **major** L. **Infantum** L. **aeithopica** Vector - **SAND FLY** (Genus **Phlebotomus**)
42
Leishmaniasis is endemic in ———? countries and ——- of which are ?
Endemic in **88 countries** and **72** of which are **developing countries**
43
90% of all Visceral leishmaniasis occur in?
**Brazil, India, Nepal, Sudan, Bangladesh**
44
90% of all mucocutaneous leishmaniasis occurs in?
**Brazil, Bolivia**, and **Peru**
45
90% of all Cutaneous leishmaniasis cases occur in?
**Afghanistan, Brazil, Iran, Peru, Saudi Arabia** and **Syria**
46
Pathogenesis of leishmaniasis in hosts ?
- Sandfly takes a blood meal and injects **promastigotes** into man, which is phagocytized by macrophages - Promastigote transform into **amastigote** in the **RES**/inside the macrophages - They **multiply** in the cells (including macrophages) of various tissues and are present in the blood. - Macrophages infected with amastigotes are taken up during a blood meal by the Sandfly
47
Life cycle of leishmaniasis in the sandfly ?
- In the **midgut of the fly**, Amastigotes transform into **Promastigotes** - This divides to produce enormous amounts that **migrate to the proboscis** - Sandfly takes a blood meal and ingests Promastigotes into the skin of the hosts
48
Most severe form of leishmaniasis is the ?
**Visceral leishmaniasis**. Incubation period ranges between 10days to 2years
49
Symptoms of visceral leishmaniasis?
**Fever**, **hepatomegaly**, **splenomegaly**, **weight loss** **Anemia**, **epistaxis** , **cough**, **post kalaazar dermal leishmaniasis (PKDL)** may develop after recovery
50
Most common form of leishmaniasis is ?
Cutaneous leishmaniasis
51
Cutaneous leishmaniasis clinical features ?
- Localized to the **site in which the sandfly bite** occurs - characterized by one or more **painless** **sores, papules** or **nodules** on the skin - sores described as looking like a **volcano with a raised edge and central crater** - if on face, can leave significant scars and can be **disfiguring**
52
Peculiar features of cutaneous Leishmaniaisis ?
- Amastigotes multiply in the RES system of the skin - sores formed can **change in size and appearance** over time - Sores can **become painful** if secondarily infected - Skin sores **heal on their own** (in months or years) - sores **develop within a few weeks** or sometimes **months** after infection
53
L. tropica infection spreads to the?
**Contiguous mucous membranes** (upper lip to nose)
54
Features of Mucocutaneous leishmaniasis?
- **More serious** (although a subset) than cutaneous leishmaniasis) - Can cause **partial** or **complete destruction** of the mucous memebranes affected - (**mouth, nose, throat, palate, Uvula, lips, pharynx and larynx can be ulcerated**)
55
*Hoarseness* in **Mucocutaneous leishmaniasis** is a sign of ?
**Laryngeal involvement**
56
Non specific tests for diagnosing Leishmaniaisis includes?
FBC **Leucopaenia** with **Granulocytopaenia** PCV - **Anaemia**
57
Parasitological diagnosis of Leishmaniaisis includes?
Peripheral blood film (**Amastigotes in blood**) Sample; - **BM aspirate** - **Tissue biopsy smear stained with giemsa** - **Amastigotes** - **splenic aspirate** - **Lymph node**
58
Diagnosis of leishmania (Molecular and serology) ?
1) Molecular - **Skin probes** - **PCR** - **Monoclonal antibodies** 2) Serology (specific immunological tests) - **Direct agglutination tests** - **indirect Heamagglutination tests** - **Indirect fluorescence antibody test** - **Elisa**
59
Treatment of leishmaniasis includes?
**Pentavalent antimonials** - Sodium stibogluconate - Meglumine antimoniate **Aromatic diamidines** - Pentamidine **Others** - Monomycins, paromycins - Amphotericin B, Allopurinol - Aminosidine
60
Pentavalent antimonials In treatment of Leishmaniasis include?
**Sodium stibo-gluconate** **Meglumine antimoniate**
61
Culture of Leishmaniasis involves?
- Samples: **Blood** or **biopsy material** - medium; Inoculated on **NNN medium** for **2 weeks** - Temp: **22-25•Celsius** - form produced: **Promastigotes**
62
Name of the medium for growing leishmaniasis?
NNN medium **Novy-MacNeal-Nicolle Medium**

Pathology And Pharamcology (7 decks)

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