Blood flagellates-haemoflagellates

1. Blood Flagellates ( Haemoflagellates ) Prepared by: NOE P. MENDEZ CENTRAL MINDANAO UNIVERSITY (CMU) [email protected]

2. Different stages of hamoflagellates

3. Trypanosoma Leishmania

4. Life cycle of Trypanosome

5. African sleeping sickness Trypanosoma brucei gambiense : West and Central Africa, mainly human infection Trypanosoma brucei rhodesiense : East Africa, wild and domestic animal reservoirs

6. Trypanosomal chancre

7. Heamolymphatic stage (Lymph node)

8. The life cycle of Leishmania

9. Meningoencephalitis stage COMA BEFORE DEATH

10. DIAGNOSIS 1- Trypomastigotes are more in the blood. 2- Laboratory animals (mice and rats) are more susceptible to infection with posterior nuclear shift.

11. TREATMENT Earlier & more intensive treatment by suramin in the early stage and melarsoprol in the late stage of disease.

12. PREVENTION AND CONTROL 1-Protection by skin repellents. 2-Treatment of cases. 3-Control of Glossina ( vector). 4-Chemoprophylaxis in endemic areas

13. West Africa Less plentiful & Can not live in lab animals East A frica More plentiful & can live in lab animals

14. Trypanosoma cruzi

15. PATHOGENESIS AND CLINICAL PICTURE Primary lesion

16. Romana’s eye

17. Chronic Chagas ’ disease Parasite attacks : Heart muscle fibers : ECG changes , congestive heart failure. Oesophageal muscle fibers : Megaoesophagus >>>> dysphagia . Colon muscle fibers : Megacolon >>>> constipation. Less commonly CNS or thyroid gland involvement. Exacerbation of infection in immunosuppressed patients(due to drugs or AIDS).

18. DIAGNOSIS Blood film >>(C-shaped T.cruzi ). muscle biopsy by culture or animal inoculation. Xenodiagnosis . Serological tests Cruzin test (I.D.) Molecular techniques:PCR .

19. 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.

20. Different stages of Haemoflagellates

21. Lesion

22. Lesion

23. Clinical types of cutaneous leishmaniasis Leishmania major : Zoonotic cutaneous leishmaniasis Leishmania tropica : Anthroponotic cutaneous leishmaniasis Oriental sore (most common)

24. 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.

25. Diffuse cutaneous leishmaniasis Leishmaniasis recidiva

26. Cutaneous Leishmaniasis Diagnosis : Smear: Giemsa stain – microscopy for LD bodies ( amastigotes ) Biopsy: microscopy for LD bodies or culture in NNN medium for promastigotes

27. Visceral leishmaniasis There are geographical variations. The diseases is called kala-azar Leishmania infantum mainly affect children Leishmania donovani mainly affects adults

28. Presentation Fever Splenomegaly , hepatomegaly , hepatosplenomegaly Weight loss Anaemia Epistaxis Cough Diarrhoea

29. Presentation Untreated disease can be fatal After recovery it might produce a condition called post kala-azar dermal leishmaniasis (PKDL)

30. Hepatosplenomegaly

31. Mucocutaneous

32. PKDL

33. Visceral leishmaniasis Diagnosis Parasitological diagnosis: METHOD Bone marrow aspirate 1. microscopy Splenic aspirate 2. culture in NNN medium Lymph node Tissue biopsy

34. Bone marrow aspiration Bone marrow amastigotes

35. Immunological Diagnosis: Specific serologic tests: Direct Agglutination Test (DAT), ELISA, IFAT Skin test ( leishmanin test)

36. DAT test ELISA test

37. Formol -gel