Blood Flagellates (Haemoflagellates)

Prepared by:

NOE P. MENDEZCENTRAL MINDANAO UNIVERSITY (CMU)

npolomendez@gmail.com

Different stages of hamoflagellates

• Trypanosoma• Leishmania

Life cycle of Trypanosome

African sleeping sicknessTrypanosoma brucei gambiense: West

and Central Africa, mainly human infection

Trypanosoma brucei rhodesiense: East Africa, wild and domestic animal reservoirs

Trypanosomal chancre

Heamolymphatic stage (Lymph node)

The life cycle of Leishmania

Meningoencephalitis stage

COMA BEFORE DEATH

DIAGNOSIS• 1- Trypomastigotes are more in

the blood. • 2- Laboratory animals (mice and

rats) are more susceptible to infection with posterior nuclear shift.

TREATMENT• Earlier & more intensive

treatment by suramin in the early stage and melarsoprol in the late stage of disease.

PREVENTION AND CONTROL

• 1-Protection by skin repellents.• 2-Treatment of cases.• 3-Control of Glossina (vector).• 4-Chemoprophylaxis in endemic

areas

West AfricaLess plentiful &

Can not live in lab animals

East AfricaMore plentiful &can live in lab

animals

Trypanosoma cruzi

PATHOGENESIS AND CLINICAL PICTURE

• Primary lesion

Romana’s eye

Chronic Chagas’ diseaseParasite attacks:

1. Heart muscle fibers: ECG changes , congestive heart failure.

2. Oesophageal muscle fibers:Megaoesophagus >>>> dysphagia.

3. Colon muscle fibers:Megacolon >>>> constipation.

4. Less commonlyCNS or thyroid gland involvement.

5. Exacerbation of infection in immunosuppressed patients(due to drugs or AIDS).

DIAGNOSIS 1. Blood film >>(C-shaped T.cruzi).2. muscle biopsy by culture or

animal inoculation.3. Xenodiagnosis.4. Serological tests5. Cruzin test (I.D.)6. Molecular techniques:PCR.

TREATMENT • Primaquine orally (destroys

trypomastigotes in blood and decreases tissue invasion).

• Nifurtimox (Lampit): 8-10 mg/kg/day for two months. Or

• Benznidazole (Radanil): 5mg/kg/day for two months.

• Symptomatic treatment.

Different stages of Haemoflagellates

Lesion

Lesion

Clinical types of cutaneous leishmaniasis• Leishmania major:

Zoonotic cutaneous leishmaniasis• Leishmania tropica:

Anthroponotic cutaneous leishmaniasis• Oriental sore (most common)

Uncommon types• Diffuse cutaneous leishmaniasis (DCL):

- Caused by L. aethiopica, diffuse nodular non-ulcerating lesions.

• 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

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

Presentation

Untreated disease can be fatal

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

Hepatosplenomegaly

Mucocutaneous

PKDL

Visceral leishmaniasisDiagnosis

(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:

• Specific serologic tests: Direct Agglutination Test (DAT), ELISA, IFAT

• Skin test (leishmanin test)

DAT test

ELISA test

Formol-gel