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    Haemoflagellates: Leishmaniasis & Trypanosomiasis

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    Follow up treatment is important to prevent reinfection.

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    Haemoflagellates: Leishmaniasis & Trypanosomiasis

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    heni aris
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    Follow up treatment is important to prevent reinfection.

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    hemoflagellates

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    Follow up treatment is important to prevent reinfection.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    50 views69 pages

    Haemoflagellates: Leishmaniasis & Trypanosomiasis

    Uploaded by

    heni aris
    Follow up treatment is important to prevent reinfection.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 69

    Haemoflagellates

    Leishmaniasis & Trypanosomiasis


    Protozoan Groups

    Apicomplexans

    Amebas
    Ciliates

    Flagellates
    Protozoan Taxonomy
    • Morphological taxonomy • Molecular taxonomy
    – Phylum sarcomastigophora – Indicate that morphological
    • Subphylum mastigophora relationships are tenuous
    – Flagellates – Divergence between phyla
    » Phytoflagellates of protozoa as great as
    » Zooflagellates between kingdoms (ie
    • Subphylum sarcodinia animalia, fungi and plantae)
    – Amoebas – Revisions are continuously
    – Foramiferans occurring
    – Radiolarians
    – Phylum Ciliophora
    • Ciliates
    – Phylum Apicomplexa
    • parasitic protozoa
    • Spore forming protozoans
    Intracellular Parasitic Flagellates
    Parasitic Kinetoplastids
    • Phylum Euglenozoa
    – Subphylum Kinetoplasta
    • Class Trypanosomatidea
    – Trypanosoma spp
    – Leishmania spp
    Trypanosomiasis
    • African sleeping sickness – Eastern hemisphere
    – Trypanosoma brucei
    – Vector – Tsetse Fly - Glossina spp

    Immages from links at http://www.biosci.ohio-state.edu/~parasite


    Trypanosomiasis
    • Chaga’s disease – Western hemisphere
    – Trypanosoma cruzi
    – Vector – assassin bug – Rhodnius spp, Panstrongylus spp and
    Triatoma spp
    Leishmaniasis
    • Leishmania spp
    • Vector – sandfly – OW Phlebotomus spp,
    NW Lutzomyia, Brumptomyia
    • Similar protozoan to Trypanosoma sp
    • Cutaneous and visceral forms of disease
    Life Cycle of Leishmania
    Different stages of Haemoflagellates
    The life cycle of Leishmania
    Leishmania Parasites and Diseases
    SPECIES Disease
    *Leishmania tropica
    *Leishmania major Cutaneous leishmaniasis
    Leishmania aethiopica
    Leishmania mexicana
    Leishmania braziliensis Mucocutaneous leishmaniasis

    *Leishmania donovani
    *Leishmania infantum Visceral leishmaniasis
    Leishmania chagasi

    Endemic in Saudi Arabia *


    Sand fly
    amastigotes
    promastigotes
    promastigotes
    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 self-


    limited ulcer
    Uncommon types
    • Diffuse cutaneous leishmaniasis (DCL):
    Caused by L. aethiopica, diffuse nodular non-
    ulcerating 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
    cutaneous leishmaniasis

    Diagnosis:

    • Smear: Giemsa stain – microscopy for LD


    bodies (amastigotes)

    • Biopsy: microscopy for LD bodies or


    culture in NNN medium for promastigotes
    NNN medium
    Treatment

    • No treatment – self-healing lesions


    • Medical:
    o Pentavalent antimony (Pentostam), Amphotericin B
    o +/- Antibiotics for secondary bacterial infection.

    • Surgical:
    o Cryosurgery
    o Excision
    o Curettage
    Visceral leishmaniasis

    • There are geographical variations.


    • The diseases is called kala-azar
    • Leishmania infantum mainly affect children
    • Leishmania donovani mainly affects adults
    Presentation
    • Fever
    • Splenomegaly, hepatomegaly,
    hepatosplenomegaly
    • Weight loss
    • Anaemia
    • Epistaxis
    • Cough
    • Diarrhoea
    Untreated disease can be fatal

    After recovery it might produce a condition


    called post kala-azar dermal leishmaniasis
    (PKDL)
    Fever 2 times a day due to kala-azar
    hepatosplenomegaly
    mucocutaneous
    PKDL
    Visceral leishmaniasis

    Diagnosis
    (1) Parasitological diagnosis: METHOD

    Bone marrow aspirate 1. microscopy


    Splenic aspirate 2. culture in NNN medium

    Lymph node
    Tissue biopsy
    Bone marrow aspiration

    Bone marrow amastigotes


    :Immunological Diagnosis )2(

    • 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
    Formol-gel
    Treatment:
    • Pentavalent antimony (Pentostam)
    • Amphotericin B
    Treatment of complications:
    • Anaemia
    • Bleeding
    • Infections etc.
    Trypanosomiasis
    African Trypanosomiasis

    Life cycle of Trypanosoma


    brucei gambiense & T. b. rhodesiense
    African sleeping sickness

    Trypanosoma brucei rhodesiense: East


    Africa, wild and domestic animal reservoirs

    Trypanosoma brucei gambiense: West and


    Central Africa, mainly human infection
    Tsetse fly
    Pathology and clinical picture
    1. Skin stage: chancre.
    2. Haematolymphatic stage: generalized
    lymphadenopathy, anaemia, generalized
    organ involvement.
    3. Central nervous system stage (CNS):
    Meningoencephalitis.
    (Development of the disease more rapid in
    Trypanosoma brucei rhodesiense)
    chancre
    Winterbottom’s stage
    3rd stage CNS
    Lymph node aspirate
    trypanosoma
    CSF
    AMERICAN TRYPANOSOMIASIS

    LIFE CYCLE OF Trypanosoma cruzi


    Reduviid (Triatomine) bug
    Diagnosis
    • Blood film
    • Serology: IFAT
    • Xenodiagnosis: feeding bugs on a suspected
    cases.
    T. cruzi causes cutaneous stage (chagoma)
    Ocular (Romana’ sign)
    C-shape
    TREATMENT
    African trypanosomiasis
    For early infection
    • pentamidine
    • suramin
    For late infection
    • eflornithine (Diflouromethylornithine- DFMO)

    American trypanosomiasis (Chaga’s disease)


    • benznidazole
    • nifurtimox
    Trichomonas vaginalis
    Transmission:

    • sexual intercourse
    • contact with contaminated objects.
    Pathology

    Female:
    vaginitis, profuse thin yellowish discharge with
    bad smell

    Male:
    invasion of urethra, prostate and seminal vesicles,
    causing urethritis but mostly asymptomatic.
    trophozoites
    Diagnosis

    • Identification of parasite by microscopy of


    discharge.
    • Examination of vaginal or urethral
    discharge for T. vaginalis
    Treatment:
    metronidazole (flagyl).

    Note:
    Treat sexual partner because infection is
    mostly asymptomatic in males.

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