Parasites Flashcards
Some characteristics of parasitic diseases
-high prevalence in developing countries; in lower socioeconomic population -low morality and morbidity -limited drug-development -no vaccines
Why Don’t North Americans suffer from parasites
- high standards of education- better housing, higher standard of living -general good health- poor health=more susceptible to disease
- nutrition= adequate diet
- sanitation- sewers and septic systems keep raw sewage out of streams
- temperate climate- parasites do better in the warmth of the tropics
- absence of certain vectors
- intermediate hosts such as the tsetse fly, certain snails, etc
Ectoparasite
-Parasite which lives on the outside of the host (infestation)
Endoparasite
-parasite which lives within the body of the host
Direct Life Cycle
-only humans are host -infective stage like ovum, cyst, larva passed out of the body that infects another healthy person -example: E. histolytica, Giardia, Ascaris lumbricoides
Indirect Life Cycle
-multiple hosts or involvement of vector - definitive host, intermediate host -example: Taenia solium (pork tapeworm), Malaria
Importance of Vectors in Parasitic Diseases
-the geographic distribution and occurrence of many parasitic disease is directly related to the distribution of various vectors that are responsible for the transmission of the parasite and the distribution of secondary or intermediate hosts -Mosquito, Sand-fly, Tick-bone
Parasite Classification
- 3200 varieties of parasites in two major categories
- Parasitic Protozoa- Unicellular: Ameba- like Entamoeba Flagellates- like Giardia, Leishmania Ciliates
- Balantidium Sporozoa- like Plasmodium, Cryptosporidium
- Parasitic Helminths- Multicellular Nematodes (roundworms)- like Ascaris, Pinworm
Cestodes (flatworms/tapeworms)- like Taenia solium (pork), Taenia saginata (beef) Trematodes (flukes)
Blood borne parasites
-malaria -babesia -trypanosomes -leishmania -filarial infections
Global impact of malaria
-50 million cases per year -1-3 million deaths per year -reasons: increased global travel, drug resistance by the parasite, Plasmodium falciparum has replaced P. vivax as the main type of malaria in much of Africa -Malaria control efforts have decayed- India had a few as 700,000 cases of malaria at its low point a couple of decades ago, Recently about 50 million cases occurred per year
Causes of Malaria
- the single cell protozoan that causes malaria derives from the genus Plasmodium
- human malaria is caused by either: P. falciparum, P. vivax, P. ovale, and P. malaria
- P. falciparum is by far the most lethal of the strains, causes the most deaths
- P. vivax is the most common strain, cause of large percentage of cases in the US
- malaria parasites are transmitted to humans through the bite of an infected female mosquito of the genus Anopheles
Distribution of Plasmodium Species
- 104 malaria-endemic countries
- P. vivax: all malarious areas except sub- Saharan Africa
- P. malariae: all malarious areas, but spotty
- P. ovale: tropical areas of western Africa; occasionally, western Pacific and Southeast Asia
- P. falciparum: predominates in sub-Saharan Africa, but also occurs in Southeast Asia, Southeast Asia, South
Genetic and Immunological Protection
- the absence of Duffy antigen in RBC, predominates in West Africans, prevents P. vivax malaria -patients with hereditary elliptocytosis, in those with glycophorin C deficiency (Leach phenotype) as well as in those who are heterozygous for sickle cell disease are less susceptible to infection
- certain thalassaemias or glucose-6-phosphate dehydrogenase deficiency offer a degree of protection
- untreaated infected patients eventually develop curative immunity against the parasitizing strain
Hemoglobin Variants
-a number of genes, including those for sickle hemoglobin S and C, the thalassemias provide protection against malaria infection -Hemoglobin C (HbC) is one of the commonest structural hemoglobin variants in human populations
Duffy Antigen Negativity
- duffy antigen is the erythrocyte receptor for P. vivax merozoite invasion
- erythrocytes lacking Duffy antigen are resistant to P. vivax invasion, which accounts for the extremely low incidence of vivax malaria in West Africa, where Duffy antigen negativity is highly prevalent
Life Cycle of the Malarial Parasite
- sporozoites in salivary gland -oocysts in stomach wall
- male and female gametocytes
- liver phase -release of merozoites from liver- these enter red cells where both sexual and asexual cycles continue
Malaria Symptoms
- the time from the initial malaria infection until symptoms appear (incubation period) generally ranges from: 9-14 days for Plasmodium falciparum 12-18 days for P. vivax and P. oval 19 to 40 days for P. malariae 11 to 12 days for P. knowlesi
- symptoms can appear in 7 days. Sometimes, the time between exposure and signs of illness may be as long as 8 to 10 months with P. vivax and P. ovale
- in early stages, malaria symptoms are sometimes simlar to those of many other infections caused by bacteria, viruses, or parasites (fever, chills, headache, sweats, fatigue, nausea and vomiting
Stages of malaria paroxysm
- the malarial paroxysm will usually last 4-8 hrs and begins with a sudden onset of chills in which the pt experiences an intense feeling of cold despite having an elevated temp- cold stage- intense shivering
- immediately following cold stage is the host stage- the pt feels an intense heat accompanied by severe headache. Fatigue, dizziness, anorexia, myalgia, and nausea
- next a period of profuse sweating will ensue and the fever will start to decline. The patient is exhausted, will sleep
- this will cycle
Plasmodium falciparum
- a much more acute and severe than malaria caused by other Plasmodium species
- almost all deaths directly attributable to malaria are caused by severe manifestations of P. falciparum infection, including cerebral malaria,severe anemia, respiratory failure, renal failure, and severe malaria of pregnancy
- an important feature of the pathogenesis of P. falciparum its ability to sequester in the deep venous microvasculature
- P. falciparum is the only one that can infect all cells- young and old- organ damage in kidneys, liver, brain, GI tract
- cerebral malaria in particular can lead to coma and convulsions
Malaria of Pregnancy
- placental colonization by infected RBCs results in maternal morbidity and mortality, intrauterine growths retardation, premature delivery, low birth weight, and increased newborn mortality
- selective accumulation of mature parasites in the placenta appears to involve their interaction with syncytoitrphoblastic chondroitin sulfate A (CSA), hyaluronic acid and immunoglobulins
- this is in contrast to the sequestration of infected erythrocytes in the systemic microvasculature, where CD36 is the major endothelial receptor
Mosquirix Vaccine
- a completely effective vaccine is not yet available for malaria, although several vaccines are under development
- the RTS, S/ASO1 is in phase III clinical trials
- targets an outer membrane protein of the early blood phase of P. falciparium
- initial results found it efficent against severe malaria 6 mon-2 years 34% -initial trial vaccine 50% efficacy in first 3-4 months
Babesia
- world-wide distribution
- multiple species involved with infecting humans
- transmitted by a large variety of ticks
- B. microti most common in US however, additional species- Midwestern US
- Clinical Disease- infections acquired in the Northeast US clinically present with a similar picture of P. vivax
- individuals infected in the Midwest and West coast present with a fulminate, febrile, hemolytic disease
Life cycle of Babesia
- in the mouse there is a sporozoites they then go between Trophozoite and Merozoite and then gamete
- the tick takes a blood meal and sporozoites introduced into host and ingests gametes, there is then fertilization in get, then ookinete enters salivary gland and then sporogony and sporozoties which then transfer into human or dog after blood meal
- then the sporozoites infect RBCs -then trophozoite and merozoite and transmitted from human to human via blood transfusion
Distribution of Lyme Disease and Babesia
- the prevalence and distribution of Lyme disease (Borrelia burgdorferi) and Babesia are the same
- the transmission vector for both diseases are the same
- the blacklegged tick or deer tick spreads the disease in the north eastern, mid-Atlantic, and north-central US, and the western blacklegged tick spreads the disease on the Pacific Coast