Trypanosoma Trypanosoma &&

LeishmaniaLeishmaniaLeishmaniaLeishmania

Parasitology DepartmentParasitology Department

Medical Faculty University of Medical Faculty University of Sumatera UtaraSumatera Utara

CLASSIFICATIONCLASSIFICATION

GENUS & SPECIESGENUS & SPECIES GENERAL FEATURESGENERAL FEATURES

Genus : TrypanosomaGenus : Trypanosoma

Species :Species :

��T. gambienseT. gambiense

The trypanosomes are The trypanosomes are extracelluler & live in the extracelluler & live in the blood plasma.blood plasma.

��T. gambienseT. gambiense

��T. rhodesienseT. rhodesiense

��T. cruziT. cruzi

blood plasma.blood plasma.

Generally, they have Generally, they have torpedotorpedo--shaped body shaped body flattened on both sidesflattened on both sides

The shape o/t posterior The shape o/t posterior varies according to the varies according to the species (species (T. cruziT. cruzi, have , have pointed extremities)pointed extremities)

CLASSIFICATIONCLASSIFICATION

GENUS & SPECIESGENUS & SPECIES GENERAL FEATURESGENERAL FEATURES

Genus : LeishmaniaGenus : Leishmania

Species :Species :

��L. donovaniL. donovani

The leishmanias occur The leishmanias occur as intracelluler parasite as intracelluler parasite in their mamalian hosts. in their mamalian hosts.

��L. donovaniL. donovani

�� L. tropicaL. tropica

�� L. braziliensis, etcL. braziliensis, etc

in their mamalian hosts. in their mamalian hosts. The typical leishmanial The typical leishmanial parasite in the parasite in the vertebrate is a small, vertebrate is a small, oval organism. Usually oval organism. Usually found i/t macrophage & found i/t macrophage & other mononuclear other mononuclear phagocytesphagocytes

Stage of Leishmania & Stage of Leishmania & Trypanosoma in Man & Insect HostTrypanosoma in Man & Insect Host

Stage Stage o/t o/t ParasiteParasitess

AmastogoAmastogotete

PromastiPromastigotegote

EpimastiEpimastigotegote

TrypomaTrypomastigotestigote

L. L. tropica tropica & &

L. L. brazieliebrazieliensisnsis

IntracellulIntracellular in ar in macrophamacrophages of ges of skin & skin & subcutansubcutaneus tissueeus tissue

In In midgut, midgut, later later probosciproboscis of sand s of sand fly fly (Phlebot(Phlebotomus)omus)

LackingLacking LackingLacking

Stage of Leishmania & Stage of Leishmania & Trypanosoma in Man & Insect HostTrypanosoma in Man & Insect Host

Stage Stage o/t o/t ParasiteParasitess

AmastogoAmastogotete

PromastiPromastigotegote

EpimastiEpimastigotegote

TrypomaTrypomastigotestigote

L. L. donovandonovanii

Intracellular Intracellular in in macrophages macrophages :predominantl:predominantly in liver, y in liver, spleen, bone spleen, bone marrow& marrow& lymphnodeslymphnodes

In midgut, In midgut, later later proboscis proboscis of sand fly of sand fly (Phleboto(Phlebotomus)mus)

LackingLacking LackingLacking

Stage of Leishmania & Stage of Leishmania & Trypanosoma in Man & Insect HostTrypanosoma in Man & Insect Host

Stage Stage o/t o/t ParasiteParasitess

AmastogoAmastogotete

PromastiPromastigotegote

EpimastiEpimastigotegote

TrypomaTrypomastigotestigote

T. T. gambiegambiense & T. nse & T. rhodesierhodesiensense

LackingLacking LackingLacking In In salivary salivary glands of glands of GlossinaGlossina

In proboscis In proboscis of tsetse fly, of tsetse fly, transfer transfer stage to stage to man; 1man; 1stst in in bloodstrea, bloodstrea, lymphnodes, lymphnodes, CNSCNS

Stage of Leishmania & Stage of Leishmania & Trypanosoma in Man & Insect HostTrypanosoma in Man & Insect Host

Stage Stage o/t o/t ParasiteParasitess

AmastogoAmastogotete

PromastiPromastigotegote

EpimastiEpimastigotegote

TrypomaTrypomastigotestigote

T. cruziT. cruzi Intracellular Intracellular in in macrophages macrophages : skin, : skin, lymphnodes, lymphnodes, liver, spleen, liver, spleen, myocardium, myocardium, brain, brain, endocrine endocrine glandsglands

TransitioTransitional stage nal stage onlyonly

In In midgut midgut of of triatomid triatomid bugbug

In feces of In feces of triatomid triatomid bug, transfer bug, transfer stage to stage to man, man, present in present in blood stream blood stream only during only during acute acute attacksattacks

TypeType West African West African trypanosomiasis trypanosomiasis

East African East African trypanosomiasistrypanosomiasis

Causative AgentCausative Agent T. gambienseT. gambiense T. rhodesienseT. rhodesiense

GeneralGeneral ��Transmission is of a Transmission is of a

�� humanhuman--vectorvector--human human

�� cycle (domestic cycle)cycle (domestic cycle)

�� Reservoirs host : wild Reservoirs host : wild

�� animalanimal

�� Transmission is Transmission is

between animalbetween animal--vectorvector--human (sylvanic human (sylvanic cyclea)cyclea)

���� animalanimal ��

VectorVector Glossina sp. (G. Glossina sp. (G. palpalis,G. tachinoides, palpalis,G. tachinoides, G.fuscipes)G.fuscipes)

African trypanosomiasis divided in African trypanosomiasis divided in three phasesthree phases

PhasePhase Clinical FeturesClinical Fetures

SubcutaneusSubcutaneus --48 hours after bite 48 hours after bite

--local multiplication, ulcer, local multiplication, ulcer, primary chancre (primary chancre (T. T. primary chancre (primary chancre (T. T. rhodesienserhodesiense))

HaemolymphaticHaemolymphatic --3 weeks after bite3 weeks after bite

--Characteristic : numerous wave Characteristic : numerous wave o/t trypanosome populations o/t trypanosome populations appear at irregular intervals i/t appear at irregular intervals i/t blood stream, lymphadenophaty blood stream, lymphadenophaty (Winterbottom’s sign)(Winterbottom’s sign)

African trypanosomiasis divided in African trypanosomiasis divided in three phasesthree phases

PhasePhase Clinical FeturesClinical Fetures

HaemolymphaticHaemolymphatic -- intermittent attacks : intermittent attacks : pyrexia, papular skin rashes, pyrexia, papular skin rashes, headache, edema, joint & headache, edema, joint & headache, edema, joint & headache, edema, joint & muscle painsmuscle pains

MeningoencephalitiMeningoencephaliticc

-- The CNS is affected.Increase The CNS is affected.Increase

IgM, WBC & ptoteins in spinal IgM, WBC & ptoteins in spinal fluidfluid

--Insomnia, motor & sensory Insomnia, motor & sensory disorderss, somnolence, disorderss, somnolence, convulsion……convulsion……sleeping sicknesssleeping sickness

American trypanosomiasis American trypanosomiasis (Chagas’disease)(Chagas’disease)

�� Modes of infections : blood transfusion, Modes of infections : blood transfusion, transplacental transmission & laboratory transplacental transmission & laboratory accidentsaccidents

�� The diseases :The diseases :�� The diseases :The diseases :

AcuteAcute : Romana’s sign, chagoma, low : Romana’s sign, chagoma, low fever, malaise, hepatospleenomegaly, fever, malaise, hepatospleenomegaly, lymphadenophaty, meningoencephalitislymphadenophaty, meningoencephalitis

American trypanosomiasis American trypanosomiasis (Chagas’disease)(Chagas’disease)

�� Chronic : Chronic :

cardiac sequlae, gastrointestinal formscardiac sequlae, gastrointestinal forms

�� Congenital : prematureCongenital : premature

LeishmaniasisLeishmaniasis

The disease may take one o/t following The disease may take one o/t following three forms :three forms :

�� Cutaneus leishmaniasis (Oriental sore) : Cutaneus leishmaniasis (Oriental sore) : multiple nodular lesionmultiple nodular lesionmultiple nodular lesionmultiple nodular lesion

�� Mucocutaneus leishmaniasis : ulcerMucocutaneus leishmaniasis : ulcer

�� Visceral leishmaniasis : Kala AzarVisceral leishmaniasis : Kala Azar

Kala azarKala azar

�� Causative agent : Causative agent : L. donovani, L. donovani,

L. infantum, L. chagasiL. infantum, L. chagasi

�� Incubation period : 2Incubation period : 2--3 months3 months

Affected organ : REC o/t spleen, liver, BM, Affected organ : REC o/t spleen, liver, BM, �� Affected organ : REC o/t spleen, liver, BM, Affected organ : REC o/t spleen, liver, BM, lymph nodes, intestinal mucosalymph nodes, intestinal mucosa

�� Dx : finding parasite in stained smears Dx : finding parasite in stained smears from spleenic punture, skin test, multiple from spleenic punture, skin test, multiple cultures in NNN, serologycultures in NNN, serology

Phlebotomus spPhlebotomus sp

�� Small size hairy gnats Small size hairy gnats or midges : 1.5or midges : 1.5--4 mm 4 mm in lengthin length

�� Commonly known as Commonly known as

�� At rest, the 2 wings At rest, the 2 wings are held upward & are held upward & outward, the coastal outward, the coastal margins from angles margins from angles of about 60 degrees of about 60 degrees

Commonly known as Commonly known as the sand fliesthe sand flies

��

of about 60 degrees of about 60 degrees with each other & with each other & with the bodywith the body

�� The females alone have piercing mouth The females alone have piercing mouth parts & are blood suckersparts & are blood suckers

�� These gnats are active at night & when These gnats are active at night & when there is little or no windthere is little or no wind

Phlebotomus spPhlebotomus sp

there is little or no windthere is little or no wind

�� They rest in shelters in crevices, caves, They rest in shelters in crevices, caves, among vegetation & dark corners og among vegetation & dark corners og buildingsbuildings

�� Their weak, noiseless flight is ussally in Their weak, noiseless flight is ussally in short ‘hops’short ‘hops’

�� The flies are of medium size, brownish in The flies are of medium size, brownish in colour, the body is waspcolour, the body is wasp--like, the wings like, the wings when at rest are crossed scissors like & when at rest are crossed scissors like & extend well beyond the tip o/t abdomenextend well beyond the tip o/t abdomen

Glossina spGlossina sp

extend well beyond the tip o/t abdomenextend well beyond the tip o/t abdomen

�� The wing venation is characteristic in that The wing venation is characteristic in that 44thth longitudinal vein bendssharply upward longitudinal vein bendssharply upward before it meets the anterior transverse before it meets the anterior transverse vein vein

�� The sout proboscis The sout proboscis points bayonetpoints bayonet--like in like in front o/t headfront o/t head

�� A characteristic onion A characteristic onion shaped bulb is shaped bulb is

Glossina spGlossina sp

shaped bulb is shaped bulb is situated at the base situated at the base o/t haustellumo/t haustellum

�� Both sexed feed Both sexed feed avidly & exclusively avidly & exclusively on bloodon blood

Glossina palpalisGlossina palpalis (Tse tse fly)(Tse tse fly)

Reduviid bugsReduviid bugs

�� Vector of Chagas DiseaseVector of Chagas Disease

�� The head o/t arthropod is more or less The head o/t arthropod is more or less elongated or cone shaped & has elongated or cone shaped & has remarkably free movementremarkably free movementremarkably free movementremarkably free movement

�� The sturdy three segmented proboscisThe sturdy three segmented proboscis

�� The piercing stylets can extend far beyond The piercing stylets can extend far beyond the tip o/t proboscisthe tip o/t proboscis

�� The parasite is sucked up by the vector The parasite is sucked up by the vector bugs as free trypomastigote or bugs as free trypomastigote or intracellular amastigote within the host intracellular amastigote within the host cellcell

Reduvid bugsReduvid bugs

cellcell

�� In the midgut o/t vector, the organism In the midgut o/t vector, the organism becomes flagellated a& binary becomes flagellated a& binary multiplication occursmultiplication occurs

Reduviid bugsReduviid bugs

�� The flagellated from The flagellated from migrates ti the migrates ti the hindgut & transforms hindgut & transforms into the slender into the slender metacyclic metacyclic metacyclic metacyclic trypomastigote form. trypomastigote form. The parasites are The parasites are discharged i/t feces discharged i/t feces o/t bug at the time of o/t bug at the time of a blood meala blood meal

�� Kissing bug Kissing bug ((Triatoma infestansTriatoma infestans))

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