OTHER SIGNIFICANT BLOOD PARASITES Flashcards
African
trypanosomiasis
(sleeping sickness) parasites
- Trypanosoma brucei brucei,
- Trypanosoma brucei gambiense
- Trypanosoma brucei rhodesiense
African
trypanosomiasis
(sleeping sickness) vector
Glossina spp.
(Tsetse fly)
Chagas disease and American
trypanosomiasis parasite
Trypanosoma cruzi
Chagas disease and American
trypanosomiasis vector
Triatoma
(“kissing”) bugs
Leishmaniasis parasite
Leishmania spp.
Leishmaniasis vector
Phlebotomine
sand flies
Malaria parasite
Plasmodium spp.
Malaria vector
Anopheles
mosquitoes
Babesiosis parasite
Babesia spp.
Babesiosis vector
Ticks
4 morphological forms of Hemoflagellates
- Amastigote
- Promastigote
- Epimastigote
- Trypomastigote
non-flagellated
oval form
4 morphological forms of Hemoflagellates
Amastigote
Flagellated stage found
in the vector, rarely seen
in the blood
4 morphological forms of Hemoflagellates
Promastigote
Long, slender
flagellated form
Found in arthropod
vectors
4 morphological forms of Hemoflagellates
Epimastigote
has undulating membrane running the length of the
body Found in the vector
and bloodstream of human
4 morphological forms of Hemoflagellates
Trypomastigote
All morphological forms of Hemoflagellates are found in ________
infections
Trypanosoma cruzi
morphological forms of Hemoflagellates seen in Trypanosoma brucei infections
epimastigote and trypomastigote
morphological forms of Hemoflagellates seen
in Leishmania infections
amastigote and promastigote
morphological forms of Hemoflagellates in Diagnostic Stages (found in humans)
amastigote and or trypomastigote
How does Trypanosoma multiply
binary fission
Where can you find Trypanosoma
blood
Diagnosis is made by microscopic examination of blood,CSF, lymph node aspirate, chancre aspirate, microhematocrit centrifugation, serologic testing
Trypanosoma
Trypanosomiasis occurs mainly in
Africa and South
America
T. brucei causes _____________
African trypanosomiasis or african sleeping
sickness
Infection of Trypanosoma brucei
affects the:
- lymphatic system
- CNS
Cause swollen lymph nodes at the posterior base of the neck
Trypanosoma brucei
Subspecies of Trypanosoma brucei
- gambiense
- rhodesiense
Subspecies gambiense and rhodesiense are named according to their _________
geographic location
Trypanosoma cruzi causes ____________
Chagas disease or American Trypanosomiasis
Characterized by lesion formation, conjunctivitis, edema of the face and legs, and heart muscle involvement leading to myocarditis
Trypanosoma cruzi
“African Sleeping Sickness”
Transmission
- via vector: bite from the Tse tse fly (Glossina spp.)
- Mother to child infection
- Blood transfusion
- Sexual contact
- Mechanical transmission – blood sucking insects
Primary reservoirs of Trypanosoma brucei rhodesiense
Animals (wild and domestic)
Trypanosoma brucei rhodesiense Illness
Acute (early CNS invasion), <9 mos
Trypanosoma brucei rhodesiense level of Lymphadenopathy
minimal
Trypanosoma brucei rhodesiense Parasitemia level
High
Trypanosoma brucei rhodesiense Epidemiology
Anthropozoonosis
Trypanosoma brucei rhodesiense Diagnostic stage
Trypomastigote
Trypanosoma brucei rhodesiense Recommended specimens
- Chancre aspirate
- lymph node aspirate
- blood
- CSF
Areas of high endemicity are:
Western Africa
Northeastern Africa
Ethiopia (endemicity unknown)
Central Africa
Democratic Republic of the Congo (epidemics)
United Republic of Tanzania
Uganda
Rwanda (endemicity unknown)
Southern Africa Angola (epidemics) Namibia
(unknown) Mozambique
Trypanosoma brucei rhodesiense
Trypanosoma brucei rhodesiense Vector
Tsetse fly, Glossina morsitans group
Trypanosoma brucei gambiense Vector
Tsetse fly, Glossina palpalis group
Trypanosoma brucei gambiense Primary reservoirs
Humans
Trypanosoma brucei gambiense Lymphadenopathy level
Prominent
Trypanosoma brucei gambiense Illness
Chronic (late CNS invasion), months to years
Trypanosoma brucei gambiense Parasitemia
Low
Trypanosoma brucei gambiense Epidemiology
Anthroponosis, rural populations
Trypanosoma brucei gambiense Diagnostic stage
Trypomastigote
Trypanosoma brucei gambiense Recommended specimens
- Chancre aspirate
- lymph node aspirate
- blood
- CSF
Areas of high endemicity:
Western Africa
Côte d’Ivoire, Guinea, Northeastern Africa
Chad, Sudan (epidemics), Central Africa Democratic Republic of the Congo (epidemics)
United Republic of Tanzania
Rwanda (endemicity unknown)
Cameroon, Central African Republic Congo, Southern Africa, Angola (epidemics)
Namibia (unknown)
Trypanosoma brucei gambiense
African Trypanosomiasis Initial lesion
local, painful, pruritic, erythematous
Stages of African Trypanosomiasis
Stage 1: Early HAT (Haemolymphatic Stage)
Stage 2: Late HAT (Meningoencephalitic stage)
Most patients do not notice this stage
Stages of African Trypanosomiasis
Stage 1: Early HAT (Haemolymphatic Stage)
Small papule - local inflammation
Stages of African Trypanosomiasis
Stage 1: Early HAT (Haemolymphatic Stage)
Stage 1: Early HAT (Haemolymphatic Stage) occurs when trypomastigotes enter the hemolymphatic system to
undergo _______________
Stages of African Trypanosomiasis
asexual reproduction
Fever
Stages of African Trypanosomiasis
Stage 1: Early HAT (Haemolymphatic Stage)
Headache
Stages of African Trypanosomiasis
Stage 1: Early HAT (Haemolymphatic Stage)
Joint pain
Stages of African Trypanosomiasis
Stage 1: Early HAT (Haemolymphatic Stage)
Malaise
Stages of African Trypanosomiasis
Stage 1: Early HAT (Haemolymphatic Stage)
Winter bottom’s sign
Stages of African Trypanosomiasis
Stage 1: Early HAT (Haemolymphatic Stage)
Sleeping sickness
Stages of African Trypanosomiasis
Stage 2: Late HAT (Meningoencephalitic stage)
Neurologic symptoms
Stages of African Trypanosomiasis
Stage 2: Late HAT (Meningoencephalitic stage)
Nocturnal
Stages of African Trypanosomiasis
Stage 2: Late HAT (Meningoencephalitic stage)
Personality changes, headaches, and withdrawal from the
environment
Stages of African Trypanosomiasis
Stage 2: Late HAT (Meningoencephalitic stage)
Insomnia
Stages of African Trypanosomiasis
Stage 2: Late HAT (Meningoencephalitic stage)
Daytime lethargy
Stages of African Trypanosomiasis
Stage 2: Late HAT (Meningoencephalitic stage)
Secondary infections = pneumonia
Stages of African Trypanosomiasis
Stage 2: Late HAT (Meningoencephalitic stage)
Treatment for Stage 1: Early HAT (Haemolymphatic Stage)
- Pentamidine
- Suramin
How many Pentamidine injections for T.b gambiense infection
7-10
Pentamidine Side effects:
- hypotension and shock
- pancreatic, renal, or hepatic dysfunction
- BM suppression
Multiple doses on varying days
Treatment for Stage 1: Early HAT (Haemolymphatic Stage)
Suramin
For T.b. rhodesiense infection
Treatment for Stage 1: Early HAT (Haemolymphatic Stage)
Suramin
Suramin Side effects:
- Renal impairment
- peripheral neuropathy
- BM suppression
for T.b gambiense infection
Treatment for Stage 1: Early HAT (Haemolymphatic Stage)
Pentamidine
Treatment for Stage 2: Late HAT (Meningoencephalitic stage)
- Melarsoprol
- Eflornithine
- Nifurtimox
Effective for both hemolymphatic and neural stages
Treatment for Stage 2: Late HAT (Meningoencephalitic stage)
Melarsoprol
Slow intravenous infusion
Treatment for Stage 2: Late HAT (Meningoencephalitic stage)
Melarsoprol
IV infusion for 2 weeks for every 6 hrs
Treatment for Stage 2: Late HAT (Meningoencephalitic stage)
Eflornithine
Melarsoprol side effect
encephalopathy
how will you know if African Trypanosomiasis is in second stage?
if cns is involved
First line drugs for early stage of west african Trypanosomiasis
Pentamidine
First line drugs for CNS involvement stage of west african Trypanosomiasis
Eflornithine
First line drugs for early stage of east african Trypanosomiasis
Suramin
Alternative drugs for early stage of west african Trypanosomiasis
Suramin, eflornithine
First line drugs for CNS involvement stage of east african Trypanosomiasis
Melarsoprol
Alternative line drugs for CNS involvement stage of west african Trypanosomiasis
Melarsoprol,1
eflornithine-nifurtimox1
Alternative drugs for early stage of east african Trypanosomiasis
Pentamidine
Prevention for African Trypanosomiasis
- Control in the reservoir like livestock
- Remove scrub
- Education
- Public awareness
- Hygiene
Diagnosis are:
* Demonstration of trypomastigote in chancre, lymph node aspirate, CSF
* Thick and thin blood smear (Giemsa)
* Buffy coat concentration
* Lymph node aspirates
* ELISA
* IFA
* Indirect hemagglutination
* Mini-anion exchange centrifugation technique
* Card agglutination test for trypanosmiasis (CATT)
* Card indirect agglutination test for trypanosomiasis (CIATT)
* PCR
African Trypanosomiasis
Chagas Disease or South American trypanosomiasis
American Trypanosomiasis
Transmission of American Trypanosomiasis
- Mediated via vectors = Kissing Bugs
- Ingestion of food contaminated with parasites
- Blood transfusions
- Fetal transfusion
- T. cruzi = by Carlos Chagas
American Trypanosomiasis Trypomastigotes location
bloodstream
American Trypanosomiasis Amastigotes location
tissue cells
Phases of American Trypanosomiasis Pathogenesis
- Acute phase
- Intermediate Phase
- Chronic Phase
1 week after infection
Phases of American Trypanosomiasis Pathogenesis
Acute phase
Fever, lymph node enlargement,
unilateral swelling of eyelids
Phases of American Trypanosomiasis Pathogenesis
Acute phase
Damaged muscle cells and edema
Phases of American Trypanosomiasis Pathogenesis
Acute phase
Asymptomatic
Phases of American Trypanosomiasis Pathogenesis
Intermediate Phase
Cardiac manifestation
Phases of American Trypanosomiasis Pathogenesis
Chronic Phase
Arrhythmia, cardiac failure, thromboembolism, atrioventricular
fibrillation, ventricular hypertrophy
Phases of American Trypanosomiasis Pathogenesis
Chronic Phase
Gastrointestinal manifestation
Phases of American Trypanosomiasis Pathogenesis
Chronic Phase
Lesions in the intestinal organs
Phases of American Trypanosomiasis Pathogenesis
Chronic Phase
Difficulty in swallowing, regurgitations, constipations, fecal
compacting
Phases of American Trypanosomiasis Pathogenesis
Chronic Phase
Diagnosis:
* Wet smear – blood, CSF = examination for motile
trypomastigote
* Thick and Thin Smear (Stain = Giemsa)
* CSF, tissue samples, lymph examination
* Concentration methods
* Blood culture
* PCR
* Xenodiagnosis
Phases of American Trypanosomiasis Pathogenesis
Acute phase
Leishmaniasis
Divided into:
- Old World
- New World
Diagnosis:
* Serological testing
* IFAT
* CATT
* ELISA
* IHA
Phases of American Trypanosomiasis Pathogenesis
Chronic Phase
L. tropica, L. aethiopica, L. major
Division
Leishmaniasis
Old World
Most common in the Middle East. PKDL is seen in India and East Africa (Kenya and the Sudan)
Old World
L. mexicana, L. amazonensis, L.
guyanensis, L. braziliensis, L. chagasi
New World
Found in the Americas from southern Texas to
northern Argentina.
New World
Agent of Leishmaniasis (old world)
Phlebotomus sp.
Agent of Leishmaniasis (New world)
Lutzomyia
Obligate intracellular parasite
Leishmaniasis
Primarily a zoonotic disease
Leishmaniasis
4 categories of Leishmaniasis
- Cutaneous Leishmaniasis (CL)
- Mucosal/Mucocutaneous Leishmaniasis (ML)
- Diffuse or disseminated CL (DCL)
- Visceral Leismaniasis (VL)
The most common form of leishmaniasis
4 categories of Leishmaniasis
Cutaneous Leishmaniasis (CL)
Usually with one or more painless ulcers
4 categories of Leishmaniasis
Cutaneous Leishmaniasis (CL)
Freq caused aused by L. major and L. tropica in the Old World and L. braziliensis,
L. mexicana, and related species in the New World.
4 categories of Leishmaniasis
Cutaneous Leishmaniasis (CL)
Usually occurs months or years after healing of primary CL, most commonly due to L. braziliensis.
4 categories of Leishmaniasis
Mucosal/Mucocutaneous Leishmaniasis (ML)
It can cause destruction of the nasal septum, palate, and other mucosal structures, leading to devastating facial mutilation and, rarely, death from airway
involvement.
4 categories of Leishmaniasis
Mucosal/Mucocutaneous Leishmaniasis (ML)
Lesions confused with lepromatous leprosy
4 categories of Leishmaniasis
Diffuse or disseminated CL (DCL)
The nodules are often described as soft and fleshy, while those of leprosy are
generally more indurated.
4 categories of Leishmaniasis
Diffuse or disseminated CL (DCL)
Can lead to anemia, bleeding and infections with other microorganisms
4 categories of Leishmaniasis
Visceral Leismaniasis (VL)
A febrile illness with weight loss, enlargement of the spleen and liver, and
decreases in the production of blood cells
4 categories of Leishmaniasis
Visceral Leismaniasis (VL)
It is usually caused by L. donovani and L. infantum
4 categories of Leishmaniasis
Visceral Leismaniasis (VL)
Characterized by progressive fever, weight loss, splenomegaly, hepatomegaly,
hypergammaglobulinemia, and pancytopenia.
4 categories of Leishmaniasis
Visceral Leismaniasis (VL)
Leishmania donovani is the agent of:
- Agent of visceral fever
- Dum-dum fever
- Donovani Kala-azar fever (VL)
Leishmania tropica is the agent of:
cutaneous oriental sore
Leishmania braziliensis is the agent of
- mucocutaneous lesion/mucocutaneous Leishmaniasis
- Espundia
- Chiclero ulcer
- Taper nose
cartilage of the nose
Espundia
pina of the ear
Chiclero ulcer
American mucocutaneous lesion
Taper nose
Specimens for diagnosis of Leishmaniasis
- Tissue biopsy
- skin
- spleen
- lymph nodes
Diagnosis:
Stained smears
* Culture (NNN medium; Schneider’s medium)
* Montenegro skin test - Intradermal Testing
* Animal inoculation (hamster)
* Formol gel test
* TPAG
* Flow cytometry
* PCR
* Serological test = CFT, IFAT, ELISA
* Other Immunologic assays:
* rk39 Ag test (for VL)
* Direct agglutination
* Urine Ag test
Leishmaniasis
Treatment for Leishmaniasis
- Amphotericin B
- Pentamidine
- Nifurtimox
Antimony compounds for Leishmaniasis
IM or IV for up to 4 weeks; primary treatment
Epidemiology for Leishmaniasis
- Primarily a disease of poverty
- VL is an important opportunistic infection in AIDS
Early diagnosis and effective treatment
Vector control:
Use of insect repellant
ITNs
Fine-mesh bed nets
Screens and sprays in houses
Effective disease surveillance
Control of animal reservoir hosts
Social mobilization and strengthening partnerships
Leishmaniasis