PARA LEC

Amastigote or leishmanial form

round to oval with ovoid nucleus with large karyosome

-Intracellular form, no flagella and undulating membrane

-Dotlike blepharoplast where axoneme is attached

-Presence of parabasal body § Diagnostic stage for Leishmania spp and

Trypanosoma cruzi. § Found in tissue, muscle and CN

Promastigote or Leptomonas form

elongated and spindle-shaped with pointed end and a free flagellum that arise from the kinetoplast at the anterior end

- Only seen at blood sample is collected immediately after transmission or during cultures

Epimastigote or Crithidial

elongated and spindle- shaped with free flagellum continues from the anterior end backward along the margin of the undulating membrane and the ends of the kinetoplast

- Kinetoplast which is situated anterior to the nucleus Wider than promastigotes

Found in the vector

. Trypomastigote or

Trypanosomal

morphologically similar to the epimastigote except that the flagellum on the margin of the undulating membrane ends at the kinetoplast

- C, S and U shate

- Kinetoplast which is situated posterior to

the nucleus.

§ Diagnostic stage of

Trypanosoma spp. except

T. cruzi

§ Seen in peripheral blood

Cutaneous

leishmaniasis

There is ulceration in the skin, which upon healing leaves an ugly scar. Diffuse cutaneous

leishmaniasis causes widespread thickening of the skin wherein the lesion resembles those of lepromatous leprosy and these lesions does not heel spontaneously.

Mucocutaneous

leishmaniasis

- The initial lesion at the bite site is papule that later develop into an ulcer.

Metastatic spread may occur on the oronasal and pharyngeal mucosa, causing highly disfiguring leprosy like tissue destruction and swelling (Tapir nose).

- Lips, nose and other soft parts may be affected

Visceral leishmaniasis

The usual clinical manifestations are fever,

malaise, and weight loss, loss of appetite, cough, diarrhea, anemia, wasting, skin darkening, splenomegaly, hepatomegaly

and lymphadenopathy. § The phagocytosed parasites are present only in small numbers in the blood but they are numerous in the reticuloendothelial cells of the spleen, liver, lymph nodes, bone marrow, intestinal mucosa and other organs.

Leishmania braziliensis complex

Other name:

– Mucocutaneous leishmaniasis , Chiclero ulcer,

Espundia, Forest yaws, Pian bois and Uta

Vector:

– Sandfly (Lutzomyia and Psychodopygus)

– Infective stage to vector: Amastigote

– Infective stage to human: Promastigote

Symptoms:

– Mucocutaneous ulcer

Diagnosis

– Biopsy of ulcerated ulcer à GS à Amastigotes

– Schizodeme and zymodeme analysis

Treatment

– Sodium stibogluconate (Pentosam)

Leishmania donovani complex

Vector:

– Sandfly

– Lutzomyia for L. chagasi

-Phlebotomus sandfly for L. donovani & L. infantum

Symptoms:

– Visceral leishmaniasis, kala-azar, dum dum fever

Diagnosis:

– Montenegro skin test / Leishmanin

– Giemsa-stained slides from BM, blood (buffy coat), lymph

nodes, biopsies

Treatment:

– Amphotericin B

– Allopurinol (AIDS)

– Combination of paramomycin & miltefosine

Leishmania mexicana complex

Vector: – Sandfly (Lutzomyia)

Reservoir host: – Forest rodents

Symptoms: – Bay sore, chicleros ulcer, cutaneous leishmaniasis

Diagnosis: – Giemsa stain, NNN medium and sero. test

Treatment: – Sodium stibogluconate (Pentosam)

Leishmania tropica complex

Vector: – Sandfly (Phlebotomus)

Reservoir host: – Dogs (possible)

Symptoms: – OWCL oriental sore, Delhi boils, baghdad boils dry or

urban cutaneous leishmaniasis

Diagnosis: – Aspiration of fluid under the ulcer bed: GS:

amastigotes – Culture and Sero. test

Treatment: – Sodium stibogluconate (Pentosam)

ORIENTAL SORE

• AKA:

• Delhi boil

• Baghdad boil

• Red papule at the site of

bite with pruritus

chicleros ulcer

• AKA: New World cutaneous

leishmaniasis

• Single-pus containing ulcer

• Affects ear and surrounding cartilage

Trypanosoma brucei gambiense

Vector:

– Tse tse fly (Glossina palpalis, Glossina tachinoides)

Symptoms:

– WASS with chancre,Winterbottom’s sign and Kerandel’s

sign, Gambian trypanosomiasis

Diagnosis:

– Blood, lymph nodes aspirates and CSF

– Blood: Diagnostic: trypomastigote

– CSF: Sediment preparation, INC CSF protein, INC CSF IgM

Treatment:

– Suramin (acute therapy)

– Melarsoprol (chronic therapy)

– Pentamidine

– Eflornithin

Trypanosoma brucei rhodisiense

Vector:

– Tse tse fly (Glossina morsitans, Glossina pallidipes)

Symptoms:

– East African Sleeping sickness, Rhodesian trypanosomiasis

– More virulent than WASS

– (+/-) Winterbottom sign, (-) lymphadenopathy, (+)

myocarditis

Diagnosis:

– Same with T.b.gambiense

Treatment:

– Suramin (acute therapy)

– Melarsoprol (chronic therapy)

Trypanosoma cruzi

Vector: – Reduviid bug / Triatomid bug

(Panstrongylus megistus)

Symptoms: – Chagas’ disease, American

trypanosomiasis

Diagnosis:

– Giemsa stain of blood: Amastigotes

– Xenodiagnosis (noninfected vector: feces of bug)

Treatment:

– Nifurtimox (Lampit)

Balantidium coli

the largest intestinal protozoa, the only pathogenic ciliate inhabiting the large intestine. It exhibits both trophic and cystic stages.

Chagoma

erythematous painful nodule produced as a result of proliferation of histiocytes and WBC in the site of bite, common in lips and nose.

Romaña’s sign

edema around the eyes in the orbital region

Mega Disease

destruction of the effector cells of the parasympathetic(autonomic nervous system) organs in chronic infection §

Organs affected: Mega colon, mega uterus, mega esophagus, heart are usually enlarged.

SOMNOLENCE

excessive sleepiness

Daytime somnolence followed by nighttime insomnia