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    Hemoflagellates PDF

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    Machlery Kun

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    © All Rights Reserved
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    Hemoflagellates PDF

    Uploaded by

    Machlery Kun
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    hemoflagellates.pdf

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    322 views69 pages

    Hemoflagellates PDF

    Uploaded by

    Machlery Kun

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    © All Rights Reserved
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    of 69

    BLOOD AND TISSUE PROTOZOA

    (Haemoflagellates)
    Leishmaniasis & Trypanosomiasis

    D:\Pict and Vid\Video\Hemoflagellata\Death


    by Tsetse Fly.mp4

    INTRODUCTION
    The family Trypanosomatidae contains only two
    genera that parasitize humans:
    1. Genus Trypanosoma
    Found either in the circulating blood or intracellularly
    (in cardiac muscle)
    African - blood; American - blood & cardiac muscle.

    2. Genus Leishmania
    Always intracellular, principally in cells of the
    reticuloendothelial system.

    INTRODUCTION
    Insects are roled as intermediate host
    Trypanosomiasis:
    American trypanosomiasis - transmitted by reduviid
    bugs (Triatoma).
    African trypanosomiasis - transmitted by Glossina
    spp (Tsetse flies).

    Leishmaniasis:
    "Old World leishmaniasis - transmitted Phlebotomus
    spp (sandflies).
    American leishmaniasis - transmitted by Lutzomyia
    spp. sandflies.

    STAGES OF LIFE
    Generally, there
    hemoflagellata:

    are

    1. Amastigote/ Leishmania
    2. Promastigote/ Leptomonade
    3. Epimastigote/ Chritidia
    4. Trypomastigote/ Trypanosoma

    stadium

    in

    Different stages of Haemoflagellates

    TRYPANOSOMIASIS

    SPECIES
    Three species caused disease in human:
    1. T. rhodesiense
    2. T. gambiense
    3. T. cruzi

    African Trypanosomiasis
    American Trypanosomiasis

    T. rhodesiense & T. gambiense


    T. rhodesiense: East Africa, wild animal
    reservoirs, primarily an animal pathogen,
    transmitted to humans by Glossina morsitans.
    T. gambiense: West and Central Africa, domestic
    animal reservoirs, mainly human infection,
    transmitted by Glossina palpalis group of tsetse
    fly.
    Disease: African trypanosomiasis or sleeping
    sickness from Africa

    EPIDEMIOLOGY

    MORPHOLOGY
    Both have identical morphology
    Two stage:
    1. Trypomastigote:
    Found in human and flies.
    Infective stage
    Two forms: long shape (32 ) and short
    unflagellated (16 )

    2. Epimastigote:
    Developmental form in flies

    African Trypanosomiasis

    Life cycle of Trypanosoma


    brucei gambiense & T. b. rhodesiense

    Tsetse fly

    CLINICAL SIGN & PATHOLOGY

    Three clinical stages:


    1. Skin stage: 48 hours after bite, chancre, febrile episodes,
    night sweats, malaise, headache.
    2. Haematolymphatic stage: 3 weeks after bite, generalized
    lymphadenopathy, anaemia, generalized organ
    involvement (Winterbottoms sign)
    3. Central nervous system stage (CNS):
    Meningoencephalitis, convulsion, motoric and sensoric
    disorders, uncontrolled desire to sleep

    Development of the disease more rapid in T.


    rhodesiense.

    chancre

    Winterbottoms stage

    rd
    3

    stage CNS

    HOW TO DIAGNOSE
    1. Examine wet mounts of aspirates from
    sight of insect bite, lymph node or CSF
    aspirate.
    2. Fluorescence test

    Lymph node aspirate

    CSF

    T. cruzi
    Disease: American trypanosomiasis, Chagas
    disease.
    Transmission: trypomastigote in reduviid bug
    feces is introduced through the skin following the
    bug's bite.
    Reservoar host: domestic animals (cat, dog) or
    wild (monkey, squirrel)
    Found in South America, USA

    MORPHOLOGY
    4 stages:
    1. Trypomastigote: extracelluler in human (blood
    stage), in faeces of Triatomide bug, exhibits a
    characteristic "C" shape with an undulating
    membrane and anteriorly extending flagellum.
    2. Amastigote: intracelluler in macrophage (tissue
    stage), oval, averages 3 to 5 microns in
    diameter and contains a nucleus and rod-shaped
    kinetoplast.
    3. Promastigote: transitional stage only.
    4. Epimastigote: developmental stage in the bug

    C-shape

    AMERICAN TRYPANOSOMIASIS

    LIFE CYCLE OF Trypanosoma cruzi

    D:\Pict
    and
    Vid\Video\Hemoflagellata\Animated
    life
    cycle of T. cruzi in the human host..mp4

    Reduviid (Triatomine) bug

    CLINICAL SIGN & PATHOLOGY

    Acute stage:
    1.
    2.
    3.
    4.
    5.

    Chagoma
    Romana Sign
    fever
    Lymphadenopathy
    Hepatosplenomegaly

    Chronic stage: cardiac sequele

    T. cruzi causes cutaneous stage (chagoma)

    Ocular (Romana sign)

    Diagnosis
    Blood film
    Serology: IFAT
    Xenodiagnosis: feeding bugs on a suspected
    cases.

    TREATMENT
    African trypanosomiasis
    For early infection
    pentamidine
    suramin
    For late infection
    eflornithine (Diflouromethylornithine- DFMO)
    American trypanosomiasis (Chagas disease)
    benznidazole
    nifurtimox

    D:\Pict
    Vid\Video\Hemoflagellata\Sleeping
    sickness by trypanosoma.mp4

    and

    LEISHMANIASIS

    INTRODUCTION
    The leishmanias occur as intracelluler parasite
    in their mamalian hosts.
    The typical leishmanial parasite in the vertebrate is
    a small, oval organism.
    Usually found in macrophage
    mononuclear phagocytes.

    &

    other

    SPECIES
    Three species caused disease in human:
    1.

    L. donovani
    2. L. tropica
    3. L. braziliensis

    Leishmaniasis visceral/ kala azar


    Leishmaniasis kulit/ oriental sore
    Leishmaniasis mukokutis/ Espundia

    The three species have identical morphology.


    Speciation - based on clinical symptoms and
    manifestations.

    The life cycle of Leishmania

    D:\Pict and Vid\Video\Hemoflagellata\Life


    cycle of Leishmania in the human host.mp4

    Sand fly

    amastigotes

    promastigotes

    promastigotes

    L. donovani
    Disease - visceral leishmaniasis, kala-azar
    (black fever).
    Pathogenesis - a viscerotropic form, skin
    lesion seldom noticed; in reticuloendothelial
    system, organisms multiply; extensive
    hyperplasia of parasitized tissue impairs
    function of organs.

    Amastigote
    found
    intracellular
    in
    macrophages: predominantly in liver,
    spleen, bone marrow & lymphnodes.
    Promastigote: in midgut, later in proboscis
    of sand fly

    Untreated disease can be fatal


    After recovery it might produce a condition
    called post kala-azar dermal leishmaniasis
    (PKDL)

    hepatosplenomegaly

    PKDL

    Visceral leishmaniasis
    Diagnosis
    (1) Parasitological diagnosis:
    Bone marrow aspirate
    Splenic aspirate
    Lymph node
    Tissue biopsy

    1. microscopy
    2. culture in NNN medium

    Bone marrow aspiration

    Bone marrow amastigotes

    (2) Immunological Diagnosis:


    Specific serologic tests: Direct Agglutination
    Test (DAT), ELISA, IFAT
    Skin test (leishmanin test) for survey of
    populations and follow-up after treatment.
    Non specific detection of
    hypergammaglobulinaem by formaldehyde
    (formol-gel) test or by electrophoresis.

    DAT test

    ELISA test

    L. tropica
    Distribution - Mediterranean basin, India,
    Middle East, Asia & Africa.
    Disease
    Old
    World
    cutaneous
    leishmaniasis; Baghdad boil, Oriental sore.
    Diagnosis - identification of intracellular
    amastigotes in macrophages from active
    lesions.

    Oriental sore
    Moist ulcers - Incubation period of several weeks to
    months, followed by rapid development of weeping
    ulcers that heal within 6 months.
    Dry ulcers - Incubation period may last for several
    years before appearance of a slowly developing ulcer
    that is covered with a scaly crust. May take years to
    heal.
    Healing of lesions of cutaneous leishmaniasis
    signifies cell-mediated, species-specific, lifelong
    immunity.

    lesion

    lesion

    lesion

    Clinical types of cutaneous leishmaniasis


    Leishmania major: Zoonotic cutaneous
    leishmaniasis: wet lesions with severe reaction

    Leishmania tropica: Anthroponotic cutaneous


    leishmaniasis: Dry lesions with minimal ulceration

    Oriental sore (most common) classical selflimited ulcer

    Uncommon types
    Diffuse cutaneous leishmaniasis (DCL):
    Caused by L. aethiopica, diffuse nodular nonulcerating lesions. Low immunity to Leishmania
    antigens, numerous parasites.

    Leishmaniasis recidiva (lupoid leishmaniasis):


    Severe immunological reaction to leishmania
    antigen leading to persistent dry skin lesions, few
    parasites.

    Diffuse cutaneous leishmaniasis

    Leishmaniasis recidiva

    L. braziliensis
    Disease
    Mucocutaneous
    leishmaniasis, espundia.
    Disfigurement - erosion of oral, nasal
    structures. Affects mainly the mucous
    membranes and cartilaginous areas of
    the nasal and oral structures.

    mucocutaneous

    D:\Pict
    and
    Vid\Video\Hemoflagellata\Leishmaniasis
    Life Cycle.mp4

    C:\Users\dwih\Downloads\leishmaniasis.mp4

    69

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