Protozoa: Trypanosomiasis and Leishmania

Question 1

American trypanosomiasis is caused by:

Answer 1

Trypanosoma cruzi.

Question 2

American trypanosomiasis vector:

Answer 2

Triatomine bugs

- Reduvid bugs

Question 3

American trypanosomiasis transmission (5):

Answer 3

• Feces of insect.
• Vertical.
• Oral.
• Transfusion.
• Transplant

Question 4

American trypanosomiasis stages of disease (3):

Answer 4

Acute:
- 6-8 weeks after initial infection.
Chronic:
- Lifelong infection without treatment.
- May not have symptoms until years later.

Question 5

American trypanosomiasis acute symptoms (7):

Answer 5

• Fever
• Myalgias
• Romana’s sign
• Chagoma
• Hepatomegaly
• Encephalitis
• Myocarditis

Question 6

American trypanosomiasis chronic infection in heart (6):

Answer 6

• Conduction abnormalities.
• Arrhythmias.
• Dilated cardiomyopathy.
• CHF.
• Apical aneurysm.
• Stroke.

Question 7

American trypanosomiasis chronic infection of GI (2):

Answer 7

• Megaesophagus.

- Megacolon.

Question 8

American trypanosomiasis diagnosis, acute (4):

Answer 8

• Parasites in blood/cord blood or PCR.
  
  • Must have 2 positive tests.
• EKG with 30 second rhythm strip.
• Echo.
• GI studies.

Question 9

American trypanosomiasis diagnosis, chronic:

Answer 9

Antibodies.

- With confirmation with second test.

Question 10

American trypanosomiasis treatment (2):

Answer 10

• Benznidazole.

- Nifurtimox.

Question 11

African trypanosomiasis is caused by (2):

Answer 11

• Trypanosoma brucei gambiense.

- Tyrpanosoma brucei rhodesiense.

Question 12

Trypanosoma brucei gambiense (3):

Answer 12

• West/central Africa.
• Reservoir: humans.
• Chronic illness.

Question 13

Tyrpanosoma brucei rhodesiense (3):

Answer 13

• East Africa.
• Reservoir: animals.
• Rapidly fatal.

Question 14

African trypanosomiasis vector:

Answer 14

Tsetse fly.

Question 15

African trypanosomiasis early infection symptoms (5):

Answer 15

Hemo-lymphatic:

• Occasionaly painful chancre at bite site.
• Fever, intermittent.
• Invasion of lymph nodes.
  
  • Winterbottom sign.
• Myalgias.
• Arthralgias.

Question 16

African trypanosomiasis late infection symptoms (8):

Answer 16

Crosses BBB:

• Alter circadian rhythm leading to daytime sleepiness.
• Lethargy.
• Headache.
• Personality changes.
• Psychosis.
• Tremors.
• Malnutrition, cachexia, wasting.

Question 17

African trypanosomiasis diagnosis (4):

Answer 17

• Thick and thin smears.
• Lymph node biopsy.
• Serology
  
  • Rapid agglutinating test.
• CSF: stage determination.

Question 18

African trypanosomiasis early infection treatment (2):

Answer 18

• Pentamadine: safe in pregnancy.

- Suramin: better for rhodesiense.

Question 19

African trypanosomiasis late infection treatment (3):

Answer 19

• Eflornathine
• Melarsoprol
• Nifurtimox-eflornathine

Question 20

Three types of leishmaniasis:

Answer 20

• Cutaneous
• Visceral
• Mucocutaneous

Question 21

Leishmaniasis vector:

Answer 21

Sandfly

Question 22

Leishmaniasis transmission:

Answer 22

Saliva as promastigote.

- Lose flagella and become amastigote.

Question 23

Cutaneous Leishmaniasis (3):

Answer 23

• Red papule at bite site.
• Becomes pruritic and enlarges.
• Becomes painless ulcer with rolled margin and crusting.

Question 24

Cutaneous Leishmaniasis diagnosis (2):

Answer 24

• Travel history.

- Amastigotes in smear or biopsy.

Question 25

Cutaneous Leishmaniasis treatment (4):

Answer 25

• Cryotherapy/heat/surgical excision.
• Topical paromycin.
• -azoles topically.
• Sodium stibogluconate.

Question 26

Visceral Leishmaniasis s/s (6):

Answer 26

• Fevers/chills/vomiting.
• Weight loss.
• Hepatosplenomegaly.
• Anemia leading to greying of skin.
• Oral lesions.
• Low WBC count.

Question 27

Visceral Leishmaniasis diagnosis (7):

Answer 27

• Travel history.
• Bone marrow.
• Splenic puncture.
• Lymph node aspirate.
• Liver biopsy.
• Blood.
• Serologic testing available.

Question 28

Visceral Leishmaniasis treatment (3):

Answer 28

• Amphotericin B.
• Miltefosine.
• Sodium stibogluconate.