Parasites causing anemia

Parasites causing Anemia

1. Parasites Causing Anemia Undersupervision Of : Dr. Azza El- Ghareeb , Assistant Professor And Head Of Medical Parasitology Department , Faculty Of Medicine , October 6 University

2. Anemia Def : Reduction in the concentration Of HB in the peripheral blood below the normal for the age and sex of the patient: <13 gm. /100 ml for adult male <11.5 gm./100 ml for adult female & infant <14 gm. /100 ml for new born

3. P. falciparum Malaria Normochromic Hemolysis , Hypersplenism Parasite Disease Type of anemia Mechanism L. donovani Leishmaniasis Normochromic Spleen and bone marrow involvement T. gambiense Sleeping sickness Normochromic Haemolysis , removal of immune sensitized RBCs, Reduced bone marrow activity A. duodenale N. americanus Hookworm Hypochromic microcytic Haemorrhage T. trichiura Trichuriasis Normochromic Haemorrhage S. haematobium Schistosomiasis Normochromic Haemorrhage The Parasites Causing Anemia

4. 1-Plasmodium falciparum Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites M alaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood.

5. Malaria Symptoms Symptoms of malaria may include fever, chills, vomiting, diarrhoea, cough, stomach, pain and muscular aches and weakness. If infected with the malaria parasite, Plasmodium results in the most severe form of malaria and if left untreated, it can cause serous illnesses. Like seizures, mental confusion, kidney failure, coma and death.

6. How can malaria be treated : Malaria is treated with a class of drugs called antimalarial. Antimalarial drugs are designed to attack the parasites that cause malaria, preventing them from spreading while also killing them off so they cant continue causing infection. How can malaria be prevented : Be aware of the places that are malaria risk zones, the main symptoms and how long it takes for symptoms to start. If prescribed, take anti-malarial medicines strictly as directed. Anti malarial medicines are not 100% Immediately see a doctor and seek treatment if a fever develops after entering a malaria-risk zone, and for up to 3 months after leaving the area

7. 2- Leishmania donovani

8. Clinical Manifestation Variable - Incubation 3-100+ weeks Lowgrade fever Hepato -splenomegaly Bone marrow hyperplasia Anemia , Leucopenia & Cachexia Hypergammaglobulinnemia Epistaxis , Proteinuria, Hematuria Most severe form of the disease, may be fatal if left untreated Usually associated with fever, weight loss, and an enlarged spleen and liver Anemia (low RBC), leukopenia (low WBC), and thrombocytopenia (low platelets) are common Lymphadenopathy may be present Visceral disease from the Middle East is usually milder with less specific findings than visceral leishmaniasis from other areas of the world Cutaneous Leishmaniasis

9. Suppress the reservoir : dogs, rats, gerbils, other small mammals and rodents Suppress the vector : Sandfly Critical to preventing disease in stationary troop populations Prevent sandfly bites : Personal Protective Measures Most important at night Sleeves down Insect repellent w/ DEET Permethrin treated uniforms Permethrin treated bed nets Prevention Antimony ( Pentostam ® , Sodium stibogluconate ) is the drug of choice Given under an experimental protocol at Walter Reed Army Medical Center (WRAMC) 20 days of intravenous therapy Available at WRAMC for all branches of the military Requires patient to come to WRAMC Treatment

10. 3-Trypansome gambiense Testes Fly

11. Symptoms The symptoms begin within 1 to 4 weeks. Fever Personality changes Disturbance of sleep patterns Troubles with walking and talking Aching muscles and joints Slurred speech Seizures Rashes Swelling around the eyes and hands Headaches Fatigue Prolonged sleep Death shortly happens a few months after the invasion of the central nervous system .

12. Medicines used to treat this disorder include: Eflornithine (for T. b. gambiense only) Melarsoprol Pentamidine (for T. b. gambiense only) Suramin ( Antrypol ) Some patients may receive combination therapy Treatment Pentamidine injections protect against T. b. gambiense . But not against T. b. rhodesiense . Because this medicine is toxic, using it for prevention is not recommended. Insect control measures can help prevent the spread of sleeping sickness in high-risk areas. Prevention Tsetse Fly Trap

13. 4- Ancylostoma duodenale & Necator americanus (Hook worm) A . Duodenale N. Americanus

14. Pathogensis & Clinical Features When filariform larva enters the skin, they cause severe local itching Erythematous papular rash may develop Scratching and secondary bacterial infection may follow This condition is called Ground itch, occurs when large number of larvae penetrate the skin, more common with necator Larvae sometimes cause creeping eruption- more common in animal hookworms When larvae enters the alveoli, they may cause minute local haemorrhages . Clinical pneumonitis develops only in massive infections Important manifestations of ancylostomiasis is in the intestine Worms attach to gut mucosa by their buccal capsules Suck a portion of intestinal villi, utilise gut epithelial cells and plasma for their food The worm sucks in blood, which passes out undigested through its intestines Adult ancylostome can suck about 0.2ml blood and necator sucks 0.03ml per day The worms frequently leave one site and attaches to another site

15. In hookworm disease, intestinal absorption of iron is normal so oral administration of iron can correct anemia Hookworm infection cause intestinal syndrome resembling peptic ulcer- with epigastric pain, dyspepsia and vomiting. Reddish or black stool, diarrhoea may be seen in acute stage Anaemia leads to lassitude and dullness, hypoprotenemia etc Severe hookworm anemia leads to cardiac failure

16. Treatment MEBENDAZOLE PYRANTEL PAMOATE THIABENDAZOLE is less effective BEPHENIUM HYDROXYNAPHTHOATE is active against Ancylostoma but not against Necator The best way to avoid hookworm infection is not to walk barefoot in areas where hookworm is common and where there may be human fecal contamination of the soil. Also, avoid other skin contact with such soil and avoid ingesting it. Infection can also be prevented by not defecating outdoors and by effective sewage disposal systems. Prevention & Control

17. 5- Schistosoma haematobium

18. Infection occurs when skin comes in contact with contaminated freshwater in which certain types of snails that carry the parasite are living. Freshwater becomes contaminated by  Schistosoma  eggs when infected people urinate or defecate in the water. The eggs hatch, and if the appropriate species of snails are present in the water, the parasites infect, develop and multiply inside the snails. The parasite leaves the snail and enters the water where it can survive for about 48 hours.  Schistosoma parasites can penetrate the skin of persons who come in contact with contaminated freshwater, typically when wading, swimming, bathing, or washing. Over several weeks, the parasites migrate through host tissue and develop into adult worms inside the blood vessels of the body. Once mature, the worms mate and females produce eggs. Some of these eggs travel to the bladder or intestine and are passed into the urine or stool. Symptoms of schistosomiasis are caused not by the worms themselves but by the body’s reaction to the eggs. Eggs shed by the adult worms that do not pass out of the body can become lodged in the intestine or bladder, causing inflammation or scarring. Children who are repeatedly infected can develop anemia, malnutrition, and learning difficulties. After years of infection, the parasite can also damage the liver, intestine, spleen, lungs, and bladder. Clinical Picture

19. The drug of choice for treating all species of schistosomes is praziquantel . Cure rates of 65-90% have been described after a single treatment with praziquantel . In individuals not cured, the drug causes egg excretion to be reduced by 90%.[55] Praziquantel affects the membrane permeability of the parasite, which causes vacuolation of the tegument. It paralyses the worm and exposes it to attack by the host immune system. However, as praziquantel is ineffective on developing schistosomula , it may not abort early infection. Treatment Prevention Avoid swimming or wading in freshwater Drink safe water. Although schistosomiasis is not transmitted by swallowing contaminated water, if your mouth or lips come in contact with water containing the parasites, you could become infected . Water used for bathing should be brought to a rolling boil for 1 minute to kill any cercariae Don’t Swim Bilharzia

20. 6-Trichuris trichiura

21. Light infestations (<100 worms) are frequently asymptomatic. Heavy infestations may have bloody diarrhea. Long-standing blood loss may lead to iron-deficiency anemia. Rectal prolapse is possible in severe cases. Vitamin A deficiency may also result due to infection. Mechanical damage to the mucosa may occur as well as toxic or inflammatory damage to the intestines of the host. Finger clubbing Clinical manifestations Endoscopy often shows adult worms attached to the bowel mucosa Trichuris Egg

22. TREATMENT Mebendazole ( Vermox ) Causes worm death by selectively and irreversibly blocking glucose uptake and other nutrients in the susceptible adult intestine where helminths dwell. Administer a second course if patient is not cured within 3-4 wk. Albendazole ( Albenza ) Decreases whipworm ATP production, causing energy depletion, immobilization, and death. Avoid ingesting soil that may be contaminated with human feces Wash your hands with soap and warm water before handling food. Teach children the importance of washing hands to prevent infection. Wash, peel, or cook all raw vegetables and fruits before eating Prevention

23. THANK YOU Prepared by : Dr. Beshoy Elwy