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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
Q

Vector for American Trypanosomiasis?

A

ReduVid bug / Kissing Bug/ Triatomine bug

26
Q

Course of American Trypanosomiasis

A

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
Q

Clinical pathophysiology 1

A

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
Q

Clinical pathophysiology 2

A

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
Q

Clinical features of Acute illness of Chaga’s disease?

A

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
Q

The most recognized marker of acute Chaga’s disease is ??

A

The Romania Sign

31
Q

Features of Chronic Chaga’s disease ?

A

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
Q

For the laboratory diagnosis of Trypanosomiasis ?

A

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
Q

In the Laboratory diagnosis of Trypanosomiasis, if parasites cannot be detected in both stained and unstained films .. what to do??

A

Concentration Methods can be used;
- Haematocrit Centrifugation
- Allow blood to coagulate and search for tryptomastigotes in the serum

34
Q

Treatment of African Trypanosomiasis

A

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
Q

Drug of choice for treating American trypanosomiasis

A

Nifurtimox and Benznidazole

36
Q

Three known forms of leishmaniasis are ?

A

Cutaneous Leishmaniasis
Mucocutaneous leishmaniasis
Visceral leishmaniasis or Kala-azar

37
Q

Leishmania species that cause cutaneous Leishmaniasis ?

A

Leishmania Tropica
Leishmania Major
Leishmania aethiopica
Leishmania Mexicans

38
Q

Leishmania species that cause visceral leishmaniasis ?

A

Leishmania Donovani
Leishmania infantum
leishmania Chagasi

39
Q

Leishmania species that cause Muco-cutaneous leishmaniasis

A

Leishmania braziliensis

40
Q

Leishmania species causing disease in man are classified into?

A

Old world and new world

41
Q

Old world leishmania species , vector is ?

A

L. donovani
L. tropica
L. major
L. Infantum
L. aeithopica

Vector - SAND FLY (Genus Phlebotomus)

42
Q

Leishmaniasis is endemic in ———? countries and ——- of which are ?

A

Endemic in 88 countries and 72 of which are developing countries

43
Q

90% of all Visceral leishmaniasis occur in?

A

Brazil, India, Nepal, Sudan, Bangladesh

44
Q

90% of all mucocutaneous leishmaniasis occurs in?

A

Brazil, Bolivia, and Peru

45
Q

90% of all Cutaneous leishmaniasis cases occur in?

A

Afghanistan, Brazil, Iran, Peru, Saudi Arabia and Syria

46
Q

Pathogenesis of leishmaniasis in hosts ?

A
  • 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
Q

Life cycle of leishmaniasis in the sandfly ?

A
  • 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
Q

Most severe form of leishmaniasis is the ?

A

Visceral leishmaniasis. Incubation period ranges between 10days to 2years

49
Q

Symptoms of visceral leishmaniasis?

A

Fever, hepatomegaly, splenomegaly, weight loss
Anemia, epistaxis , cough, post kalaazar dermal leishmaniasis (PKDL) may develop after recovery

50
Q

Most common form of leishmaniasis is ?

A

Cutaneous leishmaniasis

51
Q

Cutaneous leishmaniasis clinical features ?

A
  • 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
Q

Peculiar features of cutaneous Leishmaniaisis ?

A
  • 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
Q

L. tropica infection spreads to the?

A

Contiguous mucous membranes (upper lip to nose)

54
Q

Features of Mucocutaneous leishmaniasis?

A
  • 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
Q

Hoarseness in Mucocutaneous leishmaniasis is a sign of ?

A

Laryngeal involvement

56
Q

Non specific tests for diagnosing Leishmaniaisis includes?

A

FBC
Leucopaenia with Granulocytopaenia
PCV - Anaemia

57
Q

Parasitological diagnosis of Leishmaniaisis includes?

A

Peripheral blood film (Amastigotes in blood)
Sample;
- BM aspirate
- Tissue biopsy smear stained with giemsa - Amastigotes
- splenic aspirate
- Lymph node

58
Q

Diagnosis of leishmania (Molecular and serology) ?

A

1) Molecular
- Skin probes
- PCR
- Monoclonal antibodies
2) Serology (specific immunological tests)
- Direct agglutination tests
- indirect Heamagglutination tests
- Indirect fluorescence antibody test
- Elisa

59
Q

Treatment of leishmaniasis includes?

A

Pentavalent antimonials
- Sodium stibogluconate
- Meglumine antimoniate
Aromatic diamidines
- Pentamidine
Others
- Monomycins, paromycins
- Amphotericin B, Allopurinol
- Aminosidine

60
Q

Pentavalent antimonials In treatment of Leishmaniasis include?

A

Sodium stibo-gluconate
Meglumine antimoniate

61
Q

Culture of Leishmaniasis involves?

A
  • Samples:
    Blood or biopsy material
  • medium;
    Inoculated on NNN medium for 2 weeks
  • Temp:
    22-25•Celsius
  • form produced: Promastigotes
62
Q

Name of the medium for growing leishmaniasis?

A

NNN medium
Novy-MacNeal-Nicolle Medium

Pathology And Pharamcology (7 decks)

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