lOMoARcPSD|32262012

Hemoflagellates - Lecture notes for Clinical Parasitology

Medical Technology (Southwestern University PHINMA)

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PARASITOLOGY Epimastigote
Hemoflagellates o Large nucleus is located at the
posterior end of the organism.
 Blood flagellates
o Kinetoplast is located in the anterior
 Habitat: Reticuloendothelial cells portion of nucleus.
 Subphylum mastigophora o It has an undulating membrane (half of
the body)
Blood & Tissue Flagellates
o Free flagellum at the anterior end
 Hemoflagellates
o Unicellular
o Flagellated (flagella is the Trypomastigote
locomotor organ) o The long slender body is
o Arthropod borne (vector) characterized by the posterior
located kinetoplast.
Mode of Transmission o Large nucleus is located at the
anterior end of the kinetoplast.
 Vector borne
o Undulating membrane from the
 Vertical transmission (mother-child) posterior end up to anterior end
 Blood transfusion o Extension of flagellum at the anterior
 Accidental needle prick end.
 Organ transplant (hemoflagellates
resides in lymph nodes, spleen, liver)
TAKE NOTE:
Four Morphologic Forms:
 All morphologic forms contains
1. Amastigote (Leishman- Donovan flagellum amastigote.
body)  Flagellum is located at the anterior end.
2. Promastigote
3. Epimastigote
4. Trypomastigote
No flagella
Amastigote Found in:
Amastigote  L. donovani
o Contains large single nucleus (off- (Leishmanial form)  L. tropica
center located)  L. braziliensis
o Kinetoplast: Basal bodies or  T. cruzi
blepharoplast.
o It has a small parabasal body
Flagella originate at
o Axoneme
Posterior end of the
o No flagella
Trypomastigote organism.
(Trypanosomal Found in:
form)  T. rhodesiense
Promastigote  T. gambiense
 T. cruzi
o Contains large single nucleus located
in or near the center of long slender
body.
o Kinetoplast is located in the anterior Trypanosoma spp.
end of the organism.
o It has a single free flagellum (extend
anteriorly into axoneme)
T. cruzi
 Amastigote (reticuloendothelial cells)
and Trypomastigote (blood)
 Trypomastigote – “C” or “U” shape.

The preceding notes and data are credited to my Clinical Parasitology professor and summarized in various publications.

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 Feces from Reduviid Bug (Kissing  Amastigote – seen only inside

bug) Rubbed into bite wound. the tissues.
 Blood smear (Giemsa-stained) and 4. After transformation, it will multiply
aspirate from endothelial cells. through binary fission (Tissue).
 South American Sleeping Sickness 5. Intracellular amastigote will transform
into trypomastigote. (the tissue will
burst)
T. gambiense 6. Trypomastigote can invade another
cell.
 Trypomastigote (blood)
7. Uninfected triatomine bug takes
 Long slender with Undulating
another blood meal from the infected
membrane.
person/host.
 Bite of tsetse fly
8. Trypomastigote will transform into
 Blood smear (Giemsa-stained) and
epimastigote in the midgut of triatomine
aspirate from endothelial cells.
bug and multiply.
 West African Sleeping Sickness 9. From epimastigote, it will transform to
Metacyclic trypomastigotes into the
T. rhodesiense hindgut.
10. The cycle will repeat.
 Trypomastigote (blood)
Infective stage of Human to Bug
 Long slender with Undulating
membrane.  Metacyclic trypomastigote
 Bite of tsetse fly
 Blood smear (Giemsa-stained) and Infective stage of Bug to Human
aspirate from endothelial cells.  Trypomastigote
 East African Sleeping Sickness
Trypanosomacruzi (different vectors /
treatomine bugs)
Trypanosoma cruzi Life Cycle 1. Triatoma infestans
 It exhibit the 4 stages of development. 2. Rhodnius prolixus
 In human, trypomastigote are seen 3. Panstrongylus megistus
into the blood stream. Amastigote are  These are the zoonotic mammalian
seen in the tissues. reservoir.
 Inside a vector, the 4 morphological  Seen in domestic animals
forms occurs in the midgut up to the  Other term for treatomine bugs are;
hindgut (trypomastigote). o Reduviid bug
o Kissing bug
Life Cycle
o Conenose bug
1. Infected bug (triatomine bug), takes a
blood meal into a human. Then, it will
pass the metacyclic trypomastigotes in
American trypanosomiasis
the feces. Acute trypanosomiasis:
 Feces – infected stage of
triatomine bug. Chagoma (erythematous nodule)
2. Metacyclic trypomastigotes will - Furuncle like lesions associated with
penetrate the various cells (blood and induration, central edema & regional
reticuloendothelial cells) inside the lymphadenopathy
human body. o Swelling of the neck.
3. Upon entry of Metacyclic
trypomastigotes, it will transform into Romaña’s sign
Amastigote.
- Unilateral painless bipalpebral edema
and conjunctivitis.
The preceding notes and data are credited to my Clinical Parasitology professor and summarized in various publications.

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o There is no cases of sleeping 2. Tsetse fly will inject the metacyclic

sickness in the Philippines. trypomastigote.
3. Metacyclic trypomastigote will infect the
Chronic trypanosomiasis:
different body cells (reticuloendothelial
No characteristic symptom and it may last cells)
for 20 years or more 4. Metacyclic trypomastigote will then
transform into trypomastigotes and
- Cardiomegaly, Megaesophagus & multiply through binary fission.
Megacolon (enlargement) 5. It can also invade other cells into the
o Lymph nodes are part of blood.
reticuloendothelial cells. 6. Uninfected Tsetse fly will take a blood
Laboratory tests: meal into an infected person.
7. The bloodstream of trypomastigote will
 Giemsa staining – Trypomastigote transform into procyclic trypomastigote
 Blood Cultures – NNN medium (Novi in tsetse fly into its midgut. Then,
Macneal Nicole medium) multiply.
8. Procyclic trypomastigote will leave the
 Xenodiagnosis - (ipakakagat si midgut and form into epimastigote.
infected person kay treatomine bug, 9. After transforming into epimastigote, it
and then i-open yung gut ng bug and will multiply into the salivary gland and
titignan kung may trypomastigote) transform into metacyclic
 Serologic test – IFA, CFT, IHA, ELISA trypomastigote.
 Dot-immunobinding: small amounts of TAKE NOTE:
sample is used.
 This cycle has no amastigote.
 Molecular testing - amplify DNA from
kinetoplast Infective stage of Human to Tsetse fly

- Metacyclic trypomastigote
TAKE NOTE:
Infective stage of Tsetse fly to Human
 T. cruzi – “C” shaped & infective stage
is located in feces of treatomine bug. - Trypomastigote
 T. brucei – slender shaped TAKE NOTE:
Treatment  Brucei brucei and rhodensiense have
- Nifurtimox & Benznidazole the same life cycle.
Trypanosoma brucei gambiense
Trypanosoma brucei complex  Glossina palpalis
 Trypanosoma brucei brucei  Glossina tachinoides
 Trypanosoma brucei gambiense
 Trypanosoma brucei rhodesiense West African (Gambian) Sleeping
Life cycle – Trypanosoma brucei complex Sickness

 In Trypanosoma brucei complex, the  Hemolymphatic stage:

infective stage of metacyclic - Fever, headache, joint and muscle
trypomastigote is seen into the pain, malaise, tachycardia, dizziness &
salivary gland. rashes.
Life Cycle 1. Chancre
2. Lymphadenophathy
1. Tsetse fly takes blood meal into
uninfected person.

The preceding notes and data are credited to my Clinical Parasitology professor and summarized in various publications.

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3. Winterbottom sign o Jericho boil

(enlargement/edema from the o Baghdad boil
bite of tsetse fly). o Aleppo button
 Braziliensis
 Meningoencephalitic stage:
o American leishmaniasis
- Neurologic symptoms: apathy, behavioral o Mucocutaneous leishmaniasis
changes, headache, & sleep pattern o New world leishmaniasiss
changes.  Donovani
o Kerandel’s sign o Visceral leishmaniasis
o Somnolence (sleeping o Kala-azar fever
sickness) o Dumdum fever

Hemolymphatic stage: Leishmania tropica (mosquito)

 Chancre  Phlebotomus papatasii

o Hard painful lesion at the site of  Phlebotomus sergentii
inoculation. Leishmania braziliensis
 Winterbottom sign  Phlebotomus peruensis
o Enlargement of the posterior  Phlebotomus verrucarum
cervical lymph node and have a
ripe plum consistency. Leishmania donovani

Meningoencephalitic stage:  Phlebotomus argentipes

 Kerandel sign Life cycle – Leishmania spp.

o Delayed sensation to pain  Leishmania vector (sandfly)
Trypanosoma brucei rhodesiense
1. Sandfly will takes a blood meal (it
 Glossina morsitans injects promastigote into the skin of
 Glossina swynnertoni uninfected host)
2. Promastigotes are phagocytized by
East African (Rhodesian) Sleeping
macrophages.
Sickness
3. Promastigotes will then transform into
Rhodesian trypanosomiasis amastigote inside the macrophages
and multiply then the macrophages will
 More rapid and fatal burst (nasa bloodstream na yung
 CNS involvement appear early amastigote).
 Neurologic deterioration is rapid 4. Uninfected sandfly will take a blood
meal from infected host. (sandfly takes
Laboratory tests:
blood meal with amastigote)
1. Microscopic examination 5. Amastigote will parasitize the different
2. Serologic tests – IFAT, ELISA, IHAT, cells.
CATT & CIATT 6. Amastigote will transform into
promastigote within midgut.
Treatment 7. Then, it will divide within the midgut and
 Pentamidine migrate to the proboscis.
 Suramin 8. The cycle will repeat

Subphylum: Mastigophora Leishmania spp.

Cutaneous leishmaniasis:
 Tropica
o Old world leishmaniasis  Skin ulcer, painless lesions “leprematous
o Cutaneous leishmaniasis leprosy” & lesions do not heal
o Oriental sore

The preceding notes and data are credited to my Clinical Parasitology professor and summarized in various publications.

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spontaneously and tend to relapse after

treatment.
 Skin and subcutaneous
Mucocutaneous Leishmaniasis:

 Espundia, Tapir nose & chiclero ulcer.

 Nasal pharyngeal

Leishmania braziliensis
Mucocutaneous leishmaniasis:
Espundia

- Metastatic spread of lesion to oronasal

and pharyngeal mucosa
Tapir nose

- Disfiguring leprosy-like tissue destruction

and swelling
Chiclero ulcer

- Erosion of the pinna of the ear

Visceralleishmaniasis:
“Kala-azar or DumDumfever”

 Twice-daily elevation of fever,

splenomegaly and cachexia, parasites
are numerous in reticuloendothelial cells
of the spleen, liver, lymph nodes, bone
marrow and other organs
Diagnostic Tests:

 Biopsy
 Serologic Test: CFT, IFAT, Counter
current electrophoresis techniques
 Montenegro test
 Formol – gel test
 TPAG ratio
Treatment

 Amphotericin B (treatment of choice)

 Pentamidine
 Metronidazole
 Nifurtimox

The preceding notes and data are credited to my Clinical Parasitology professor and summarized in various publications.

Downloaded by Nxnx Jdjs (sjsjjioiioo@gmail.com)