Trypanosomiasis and Leishmania Flashcards
What organism causes Chagas diseae?
Trypanosoma cruzi
What is the vector for Trypanosoma?
Triatomine bugs
“kissing bugs”
Reduviid bugs
Endemic to Mexico, Central, South america
What is the timeframe of an acute Chagas infection?
Week-months after infection
When the patient has a high parasitic load
What are the symptoms of acute chagas?
Romana’s sign
Chagoma
Fever, myalgias, hepatomegaly, encephalitis, myocarditis
What organisms cause chronic chagas infection and where?
Amastigotes - live in gut and heart
Trypomastigotes - can infect new sites like the brain
What are the cardiac manifestations of chronic chagas infection?
Conduction - RBBB, LAFB
Arrhythmias
Dialted cardiomyopathy
CHF
Apical aneurysm
Stroke
What are the GI manifestations of a chronic chagas infection:?
Megaesophagus - dysphagia, odynophagia, weight loss, regurgitation, aspiration
Megacolon - prolonged constipation, abdominal pain, risk of volvulus and bowel ischemia
How is acute chagas diagnosed?
Parasites in blood or PCR
EKG/Echo
GI studies if symptomatic
How is Chronic chagas diagnosed?
Antibodies
Muscle biopsy
How is chagas transmitted congenitally?
1-10% transmissionr ate
Cord blood or peripheral blood
What is the danger of chagas in immunocompromised patients?
Can reactivate
Parasitemia
CSF
What is the treatment for chagas?
Benznidazole
Nifurtimox
Both effective in early acute phase
What patients get treated?
Acute/congenital infection
Chronic <50 w/o cardiomyopathy
What conditions is chagas treatment contraindicated for?
Hepatic/Renal insufficiency
Pregnancy
What condition does do trypanosoma brucei gambiense and Trypansoma b. rhodesiense cause?
African trypanosomiasis or
African sleeping sickness
What is the vector for african sleeping sickness?
Tsetse fly
What occurs during the early infection with african trypanosomiasis?
Chancre at site of bite
Intermittent fever
Invasion of lymph nodes - Winterbottom sign
Myalgias/Arthralgias
What occurs during the late infection with african trypanosomiasis?
Progression to CNS
Personality changes, psychosis, tremors, altered circadian rhythm
How is african trypanosomiasis diagnosed?
Microscopy
Lymph node biopsy
Serology
CSF - stage determination
What is the treatment for T.b. Rhodesiense?
Suramin - hemolyphatic
Melarsoprol - CNS involvement
What is the treatment for T.b. Gambiense?
Pentamidine - hemolyphatic
Eflornithine - CNS involvement
What is the vector of leishmaniasis?
Sand fly
Promastigote - transmitted through saliva
Amstigote - infects macrophages
How does cutaneous leishmaniasis present?
Red papule at site of bite taht becomes pruritic and enlarges
Painless Ulcer formation - will heal without treatment
How is cutaneous leishmaniasis diagnosed?
Amastigotes in smear or biopsy
What are the treatments for cutaneous leishmaniasis?
Cryotherapy/heat/surgical excision
Paromycin
-azoles
Sodium Stibogluconate - from CDC
What is mucocutaneous leishmaniasis?
Similar to cutaneous, but also involves mucous membranes
Nose/mouth/nasal spetum
How does visceral leishmaniasis present?
Fevers/Chills/Vomiting
Anemia leading to greating of skin color
Low WBC
Can be rapidly fatal
What is Post-kala-azar Eishmanial dermatitis?
Macular/maculopapular/nodular rash after visceral leishmaniasis
Reservoir for parasites
How is visceral leishmaniasis diagnosed?
Travel history
Microscopay
Serologic testing
How is visceral leishmaniasis treated?
Amphotericin B
Miltefosine
Sodium stibogluconate
