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Multisystem Part 2 > Trypanosomes > Flashcards

Trypanosomes Flashcards

1
Q

two diseases caused by trypanosoma?

A

chagas disease and african sleeping sickness

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2
Q

once kinetoplastids infect you (trypanosoma/leishmania)….

A

you are infected for life

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3
Q

kinetoplastids are found

A

in the blood (different forms w flagella or no flagella)

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4
Q

the kinetoplast structure? function?

A

contains DNA organized into minicircles and maxicircles similar to mitochondrial DNA function and need for etensive posttranslational editing is unknown in close association with the basal body in the base of the flagellum

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5
Q

trypanosoma cruzi vector? parasite form in vector? parasite form in blood? parasite form in tissue? distribution?

A

triatomine bugs epimastigote, metacyclic tryp trypomastigote amastigote americas

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6
Q

trypanosoma brucei vector? parasite form in vector? parasite form in blood? parasite form in tissue? distribution?

A

tsetse fly epimastigote, metacyclic tryp trypomastigote extracellular sub-saharan africa

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7
Q

leishmania vector? parasite form in vector? parasite form in blood? parasite form in tissue? distribution?

A

sand fly promastigote - (blood) amastigote global except australia

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8
Q

trypanosoma lifecycle

A
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9
Q

remale reduviids prefer to lay eggs…

A

in cracks crevices

high in rural/poor housing

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10
Q

transmission of trypanosomes

A

animal reservoir for trypanosomes/reduviids = rats,, racoons, skunks, dogs

human-human via blood transfusion/organ transplant

sugarcane juice, guava juice, acai juice

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11
Q

in chagas disease, what kills you?

A

heart disease

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12
Q

how many people in US infected w chagas disease?

A

300,000 with T cruzi

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13
Q

phases of T cruzi infection

A
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14
Q

romana sign

A

eye infection

T cruzi acute phase infection

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15
Q

acute chagas disease

A

febrile; can cause myocarditis and meningoencephalitis

romanas sign = unilateral painless periorbital edema

indurated lesion at site of parasite entry = chagoma

1-2 weeks incubation

**amastigotes in heart muscle

After a stage of initial parasitemia, trypomastigotes pass to the cardiac muscle and smooth muscle lining the intestinal tract. Here they transform into the amastigote

stage. In the heart, this causes myocarditis in the early stages.

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16
Q

amastigote vs trypomastigotes

A

Amastigotes are intracellular form with short/no flagella

trypomastigotes travel in blood and have long flagella

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17
Q

t cruzi strains 1 vs 2

A

type 1 strains are LESS pathogenic than type 2

type 2 occur in southern south america and are human/peridomestic types

type 1 are sylvatic

18
Q

congenital chagas

A

1-10% of + mothers will past to baby

–severe respiratory distress, meningoencephalitis, hepatosplenomegaly, or myocarditis

19
Q

ekg findings from chagas

A

conduction issues!

-widened QRS

RBBB (right bundle branch block)

20
Q

chronic chagasic cardiopathy

A

80% of chronic chagas disease causes heart disease!

conduction issues, arrhythmias, sudden cardiac death, heart failure, thromboembolism, aneurysms

21
Q

chagas GI disease

A

mega-esophagus or mega-colon (chagasic colopathy) / distended belly

severe constipation and difficulty swallowing

(disrupted autonomic fx)

22
Q

reactivated chagas disease

A

in immunocompromised host

CNS abscess-like lesions (ring enhanced)

meningoencephalitis

acute myocarditis

febrile episodes + transplant rejection

panniculitis

23
Q

diagnosis of acute chagas

A

blood smear

peripheral blood will show C shaped trypomastigote with prominent kinetoplast

24
Q

diagnosis of chronic chagas

A

T cruzi specific antibody (IgG)

–use 2 different serologic test with 2 different antigens

25
Q

chagas treatment

A

benznidazole (1st line) and nifurtimox

*not FDA approved; get from CDC

very effective for acute phase! less for chronic

26
Q

sleeping sickness - other name?

A

african trypanosomiasis

27
Q

african sleeping sickness outlook

A

300-500K infected in africa–> FATAL infection (death in 2 years)

very toxic drugs with increasing resistance

28
Q

HAT = human african trypanosomiasis

epidemiology?

A

subsaharan Africa

T.b. gambiense (west coast)

T.b. rhodesiense (east coast)

east african trypanosmiasis (rhodes) is more common in travelers; BUT west (gambi) is more common in endemic populations

29
Q

what do tourists do in east africa to get HAT?

A

safari!!!!

it is a zoonosis

very aggressive biting fly! (tsetse)

30
Q

vector for HAT

A

tse tse fly (glossina species)

G.palpalis breeds along rivers, streams, lakes (West Africa)

G.morsitans breeds in wooded savannah (East Africa)

*charateristic cleaver wing

31
Q

what explains the persistence and resistance of trypanosomiasis

A

antigenic variation/change!

it changes its dense coat of variant surface glycoproteins (VSG)

-variant clones that express an alternate VSG gene lacks antigenic cross-reactivity and persists!

32
Q

east and west HAT comparison

A
33
Q

presentation and progression of HAT

A

fatal if untreated

infected tsetse fly bite –> parasites injected and replicate into blood (haemo-lymphatic stage) -> fever, itching, headahces, myalgias, hepatomegaly, anemia

winterbottoms sign = posterior cervical adenopathy

–> meningoencephalitic stage

34
Q

winterbottoms sign

A

posterior cervical adenopathy

sign of HAT

35
Q

rhodesiense (east) vs gambiense (west) prognosis

A

Rhodes –> death in weeks to months, fulminant illness, shock–> death may occur before CNS invasion occurs

Gambiense –> early stage unrecognized, CNS invasion after 1-2 years –> death due to coma/malnutrition

36
Q

what do you see in CSF when sleeping sickness is being diagnosed?

A

lymphocytes!

37
Q

PSG syndrome of sleeping sickness

A

(PSG = polysomnography)

An alteration of the normal distribution of sleep and wakefulness, proportional to the severity of symptoms.

An alteration of the structure of sleep episodes, with the abnormal occurrence of REM sleep.

38
Q

travelers with sleeping sickness do not present with

A

sleeping issues

usually just an acute febrile illness

39
Q

lumbar puncture for HAT/sleeping sickness will show…

A

CSF with elvated wBC, IgM, total protein, ICP

and

MOTT cells = large eosinophilic plasma cells that have failed to secrete their antibodies

40
Q

MOTT cells in CSF indicate

A

afircan sleeping sickness

41
Q

HAT/sleeping sickness treatment

early gambiense?

late gambiense?

early rhodes?

late rhodes?

A

EG = pentamidine

LG = eflornithine + nifurtimox

ER = suramin (doesnt cross BBB)

LR = melarsoprol (arsenical = very toxic)

Multisystem Part 2 (20 decks)

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