BABESIA SPECIESBABESIA SPECIES

• ZOONOSISZOONOSIS

• Vector-IXODID tickVector-IXODID tick

• Resorvoir host-mice,voles and other Resorvoir host-mice,voles and other rodentsrodents

• Babesia microti-common cause of Babesia microti-common cause of babesiosis in USbabesiosis in US

Life cycleLife cycle

• Infective stage-pyriform bodiesInfective stage-pyriform bodies

• Diagnostic stage-trophozoiteDiagnostic stage-trophozoite

• In RBC-trophozoites by binary fission In RBC-trophozoites by binary fission forms tetrad-lyse erythrocytes-forms tetrad-lyse erythrocytes-release merozoites-reinfectrelease merozoites-reinfect

• Infected cells-ingested by ticks-Infected cells-ingested by ticks-transovarian transmissiontransovarian transmission

Clinical featuresClinical features

• Incubation period-1-4 weeksIncubation period-1-4 weeks

• Malaise,fever,chills,headache,fatigueMalaise,fever,chills,headache,fatigue

• No periodicityNo periodicity

• Progresses to develop hemolytic Progresses to develop hemolytic anemiaanemia

• Splenomegaly,hepatomegaly,renal Splenomegaly,hepatomegaly,renal failurefailure

Lab diagnosisLab diagnosis

• Microscopic examination of blood Microscopic examination of blood smearssmears

• Resemble the ring forms of Resemble the ring forms of Plasmodium speciesPlasmodium species

• But no pigment or other stages of But no pigment or other stages of growth as in plasmodium growth as in plasmodium

Treatment and controlTreatment and control

• DOC-Clindamycin+quinineDOC-Clindamycin+quinine

• Exchange blood transfusion in pts Exchange blood transfusion in pts who had splenenctomy and severe who had splenenctomy and severe infectionsinfections

• Protective clothing,insect repellentsProtective clothing,insect repellents

TOXOPLASMA GONDIITOXOPLASMA GONDII

• Coccidian parasiteCoccidian parasite

• Reservoir host-house catReservoir host-house cat

• Infective stage-sporulated oocystInfective stage-sporulated oocyst

• Diagnostic stage-immature oocyst in Diagnostic stage-immature oocyst in fecesfeces

• Some trophozoite forms-crescentic Some trophozoite forms-crescentic tachyzoites-responsible for initial tachyzoites-responsible for initial infectioninfection

• Slow growing shorter forms-Slow growing shorter forms-bradyzoites-cysts in chronic infectionbradyzoites-cysts in chronic infection

• More severe CNS disease in More severe CNS disease in immunocompromised individualsimmunocompromised individuals

Clinical featuresClinical features

• Mostly-benign and asymptomaticMostly-benign and asymptomatic

• --headche,myalgia,fatigue,lymphadeniheadche,myalgia,fatigue,lymphadenitistis

• c/c-c/c-lymphadenitis,rash,hepatitis,encephalymphadenitis,rash,hepatitis,encephalopathy,myelitis,myocarditis,choriorelopathy,myelitis,myocarditis,chorioretinitis-blindnesstinitis-blindness

• Congenital infection-Congenital infection-• 11stst trimester-spontaneous trimester-spontaneous

abortion,stillbirthabortion,stillbirth• Afterwards-Afterwards-

epilepsy,encephalitis,microcephaly,inepilepsy,encephalitis,microcephaly,intracranial tracranial calcifications,hydrocephalus,mental calcifications,hydrocephalus,mental retardations,blindness,anemia,jaundiretardations,blindness,anemia,jaundice,rash,pneumonia,diarrhoeace,rash,pneumonia,diarrhoea

• In immunocompromised pts-In immunocompromised pts-neurologicalneurological

• More than one lesion in the brainMore than one lesion in the brain

• Hemiparesis,seizures,visual Hemiparesis,seizures,visual impairment,confusioon,lethargy impairment,confusioon,lethargy

Lab diagnosisLab diagnosis

• Serological testing-increasing Serological testing-increasing antibody titreantibody titre

• ELISA for IgM AbELISA for IgM Ab

• Demonstrating trophozoites and Demonstrating trophozoites and cysts in tissue and body fluids–cysts in tissue and body fluids–defenitive methoddefenitive method

• Biopsy specimens Biopsy specimens

• Monoclonal antibody based stainingMonoclonal antibody based staining

• Culture methodsCulture methods

TreatmentTreatment

• Pyrimethamine+sulfadiazine high Pyrimethamine+sulfadiazine high dose,then continued in lower dose dose,then continued in lower dose indefenitelyindefenitely

• Trimethoprim-sulfamethoxazole is Trimethoprim-sulfamethoxazole is another optionanother option

• Steroids-if cerebral oedema developsSteroids-if cerebral oedema develops

• Prophylaxis-Prophylaxis-sulfamethoxazole+trimethoprimsulfamethoxazole+trimethoprim

• Avoid contact with undercooked Avoid contact with undercooked meatmeat

FREE LIVING AMOEBAFREE LIVING AMOEBA

• NaegleriaNaegleria

• AcanthamoebaAcanthamoeba

• BalamuthiaBalamuthia

• Common route-Inhalation of cystsCommon route-Inhalation of cysts

Clinical features Clinical features

• Naegleria fowleri- primary Naegleria fowleri- primary meningoencephalitismeningoencephalitis

• Frontal headache,sore Frontal headache,sore throat,fever,blocked nose,positive throat,fever,blocked nose,positive Kernigs signKernigs sign

• Naegleria trophozoites - in brain on Naegleria trophozoites - in brain on postmortempostmortem

• Acanthameoba and balamuthia-Acanthameoba and balamuthia-granulomatous amoebic encephalitis granulomatous amoebic encephalitis and brain abscess in and brain abscess in immunocompromised individualsimmunocompromised individuals

• Acanthamoeba-keratitis(contact with Acanthamoeba-keratitis(contact with contact lens,soil,dust)contact lens,soil,dust)

• Cutaneous infection Cutaneous infection

Lab DiagnosisLab Diagnosis

• Specimens-Nasal Specimens-Nasal discharge,CSF,corneal scrapings discharge,CSF,corneal scrapings

• Saline wet preparation and iodine Saline wet preparation and iodine stained smearsstained smears

• Naegleria-only amoeboid Naegleria-only amoeboid trophozoite;other 2-cyst and trophozoite;other 2-cyst and trophozoitetrophozoite

• Can be cultured on agar platesCan be cultured on agar plates

Treatment, prevention and Treatment, prevention and controlcontrol

• Naegleria-amphotercin B Naegleria-amphotercin B +miconazole and rifampin+miconazole and rifampin

• Acanthamoeba-Acanthamoeba-pentamidine,ketoconazole,flucytosinpentamidine,ketoconazole,flucytosinee

• Balamuthia-Balamuthia-clarithromycin,fluconazole,sulfadiazinclarithromycin,fluconazole,sulfadiazine,flucytosinee,flucytosine

• Amoebic keratitis-corneal Amoebic keratitis-corneal transplantationtransplantation

• Cutaneous infections-topical Cutaneous infections-topical miconazole,chlorhexidine gluconatemiconazole,chlorhexidine gluconate

LEISHMANIALEISHMANIA

• HemoflagellateHemoflagellate

• Vector-sandfly-phlebotomusVector-sandfly-phlebotomus

• 3 species-3 species-Leishmania donovaniLeishmania donovani -visceral -visceral

leishmaniasis(kala-azar,dum dum leishmaniasis(kala-azar,dum dum fever)fever)

L.TropicaL.Tropica -cutaneous -cutaneous leishmaniasis(oriental sore,Delhi boil)leishmaniasis(oriental sore,Delhi boil)

L.braziliensisL.braziliensis -mucocutaneous -mucocutaneous leishmaniasis(american leishmaniasis(american leishmaniasis,espundia,chiclero ulcer)leishmaniasis,espundia,chiclero ulcer)

Leishmania donovaniLeishmania donovani

Sandfly Transmission

• transmitted via mouthparts• promastigotes regurgitated

from anterior gut• factors in saliva enhance

infectivity

1) promastigotes

2) phagocytosis by macrophage amastigote

3) replication within macrophage

4) release and phagocytosis of amastigotes

4) phagocytosis of amastigotes, or ingestion by vector

5) promastigotes• replication• attachment to

epithelium

6) promastigotes

• Infective stage-promastigoteInfective stage-promastigote

• Diagnostic stage-amastigoteDiagnostic stage-amastigote

• Resorvoir host-dogs,foxes,jackals Resorvoir host-dogs,foxes,jackals

Clinical featuresClinical features

• Gradual onset with fever,diarrhoea, Gradual onset with fever,diarrhoea, anemiaanemia

• Progresses to enlargement of Progresses to enlargement of organs,weight lossorgans,weight loss

• Post kala azar dermal leishmaniasis Post kala azar dermal leishmaniasis in persistent casesin persistent cases

Visceral Leishmaniasis• 3 possibly related species

• L. donovani (Asia, Africa)• India (kala azar)

• reticuloendothelial system affected• spleen, liver, bone marrow, lymph nodes

• onset is generally insidious• progressive disease

• 75-95% mortality if untreated• death generally within 2 years

Clinical Presentation• incubation period

• generally 2-6 months• can range 10 days to years

• fever, malaise, weakness• wasting despite good appetite• spleno- and hepatomegaly,

enlarged lymph nodes• depressed hematopoiesis

• severe anemia• leucopenia • thrombopenia petechial

hemorrhages in mucosa

• due to inadequate treatment• nodular lesions• easily cured with treatment

(in contrast to DCL)

Post Kala Azar Dermal Leishmaniasis

Lab diagnosisLab diagnosis

• Amastigote stage in tissue biopsy, Amastigote stage in tissue biopsy, bone marrow examination, lymph bone marrow examination, lymph node aspirationnode aspiration

• SerologySerology

• Culture of blood, bone marrow Culture of blood, bone marrow demonstrates the promastigotedemonstrates the promastigote

Treatment Treatment

• 11stst drug of choice-oral drug of choice-oral miltefosinemiltefosine

• Parenteral stibogluconateParenteral stibogluconate

• Control of resorvoir hosts,protection Control of resorvoir hosts,protection from sandfly bitefrom sandfly bite

L.tropicaL.tropica

• Incubation period-2 weeks-2 monthsIncubation period-2 weeks-2 months

• 1 st sign –red papule at the site of 1 st sign –red papule at the site of bitebite

• Intense itching-enlarges and Intense itching-enlarges and ulceratesulcerates

• Exudes a serous material-secondary Exudes a serous material-secondary bacterial infectionbacterial infection

Cutaneous Leishmaniasis

• incubation period: 2 weeks to several months

• chronic ulcerated, papular, or nodular lesion

• lesion is painless, non-tender, non-pruritic and usually clean

• occasionally satellite lesions and/or palpable lymph nodes

Diffuse Cutaneous Leishmaniasis

• scaly, not ulcerated, nodules

• chronic and painless• numerous parasites

in lesions• seldom heal despite

treatment

L. mexicana

Lab diagnosisLab diagnosis

• Demonstration of amastigotes in Demonstration of amastigotes in stained smearsstained smears

• SerologySerology

• DNA probesDNA probes

TreatmentTreatment

• DOC-stibogluconateDOC-stibogluconate

• Application of heat to the lesionApplication of heat to the lesion

• Protection from bitesProtection from bites

L.braziliensisL.braziliensis

• Clinical features similar to tropicaClinical features similar to tropica

• Involvement of mucus membranes Involvement of mucus membranes and related tissue structuresand related tissue structures

• Diagnosis and treatment-same as Diagnosis and treatment-same as tropicatropica

Mucocutaneous Leishmaniasis• primarily L. braziliensis

(espudia)• two stages

• simple skin lesion• 2o mucosal involvement

• can occur long after primary lesion (up to 16 years)

• frequently in naso-pharyngeal mucosae

• metastasis via blood or lymphatic systems

• variable types and sizes of lesions• chronic and painless

TRYPANOSOMESTRYPANOSOMES

• T.gambiense-african T.gambiense-african trypanosomiasis(sleeping sickness)trypanosomiasis(sleeping sickness)

Vector-tsetse flyVector-tsetse fly

• T.cruzi-chagas disease(american T.cruzi-chagas disease(american trypanosomiasis)trypanosomiasis)

Vector-reduvidsVector-reduvids

T.gambienseT.gambiense

• Infective stage-metacyclic Infective stage-metacyclic trypomastigotetrypomastigote

• Diagnostic stage-blood stream Diagnostic stage-blood stream trypomastigotetrypomastigote

Clinical featuresClinical features

• Earliest-an ulcer at the site of biteEarliest-an ulcer at the site of bite

• Followed by Followed by lymphadenopathy,fever,myalgia,arthlymphadenopathy,fever,myalgia,arthralgiaralgia

• Posterior cervical lymphadenopathy-Posterior cervical lymphadenopathy-characteristic-WINTERBOTTOM SIGNcharacteristic-WINTERBOTTOM SIGN

• c/c-CNS involvement->deathc/c-CNS involvement->death

• Winterbottom's sign is the swelling of Winterbottom's sign is the swelling of lymph nodeslymph nodes ( (lymphadenopathylymphadenopathy) along ) along the back of the neck, in the the back of the neck, in the posterior cervicalposterior cervical chain of lymph nodes, chain of lymph nodes, as trypanosomes travel in the as trypanosomes travel in the lymphatic fluidlymphatic fluid and cause and cause inflammationinflammation..

• It may be suggestive of cerebral It may be suggestive of cerebral infection.infection.

Lab diagnosisLab diagnosis

• Thick and thin blood filmsThick and thin blood films

• aspirations from lymph node, aspirations from lymph node, concentrated spinal fluidconcentrated spinal fluid

• Serology,immunoflurescence,ELISA,aSerology,immunoflurescence,ELISA,agglutination methodsgglutination methods

Treatment Treatment

• -Suramin is the DOC-Suramin is the DOC

• -melarsoprol is the DOC-melarsoprol is the DOC

• Control breeding sites of the vectorControl breeding sites of the vector

• Protective clothingProtective clothing

T.CruziT.Cruzi

Clinical featuresClinical features

• Earliest-development of a Earliest-development of a chagomachagoma(erythematous and (erythematous and indurated area)indurated area)

• Followed by a rash and edema Followed by a rash and edema around eyes and facearound eyes and face

• Fever, chills and rigorFever, chills and rigor

• CNS involvementCNS involvement

• c/c-c/c-hepatosplenomegaly,myocarditis,enlhepatosplenomegaly,myocarditis,enlargement of oesophagus and colonargement of oesophagus and colon

• Sudden death-heart block and brain Sudden death-heart block and brain damagedamage

Lab diagnosisLab diagnosis

• Thick and thin filmsThick and thin films

• Biopsy specimens from lymph nodes, Biopsy specimens from lymph nodes, liver spleen shows the Amastigote liver spleen shows the Amastigote stage.stage.

• SerologySerology

• XenodiagnosisXenodiagnosis

• PCRPCR

TreatmentTreatment

• DOC-NIFURTIMOXDOC-NIFURTIMOX

• Also allopurinolAlso allopurinol

• Bug control, eradication of nestsBug control, eradication of nests