HAEMOFLAGELLATES. Dr. Anuluck Junkum Department of Parasitology Faculty of Medicine

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1 HAEMOFLAGELLATES Dr. Anuluck Junkum Department of Parasitology Faculty of Medicine

2 Objective Can describe the morphology, life cycle, pathology, diagnosis and prevention of Leishmania spp. and Trypanosoma spp.

3 FAMILY: TRYPANOSOMATIDAE MEDICAL IMPORTANT GENERA Leishmania spp. Trypanosoma spp.

4 Morphology Amastigote (Leishmanial form) oviod shape 1 nucleus & kinetoplast Short flagellum (axoneme) Found in intracellular of mammalian hosts a

5 Promastigote (Leptomonad form) Spindle shaped The flagellum & kinetoplast is located in front of the near the anterior end of the body nucleus, Found in the insect host & culture media f

6 Epimastigote ( Crithidial form) The flagellum exits the cell anterior of nucleus and is connected to the cell body for part of its length by an undulating membrane The kinetoplast is located near the nucleus Found in the insect host

7 Trypomastigote (Trypanosomal form) The flagellum lies attached to the cell body for most of its length by an undulating membrane The kinetoplast is near the posterior end of the body Found in the mammalian host bloodstream & infective stages in the fly vector

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10 Leishmania spp.

11 Leishmaniasis

12 Cases in Thailand, Suratthani, 1996 Nan, 2005 Phangnga, 2006 Nakorn Sri Thammarat, 2007 Songkhla, 2007 Bangkok, 2007 Lop Buri, Lamphun, Songkhla & Trang, 2012 Nan & Lamphun, 2014

13 Life cycle Sandfly: vector Promastigote: IF Human Amastigote

14 Sandflies (Phlebotomus & Lutzomyia )

15 Leishmaniasis Cutaneous leishmaniasis Oriental sore Leishmania tropica, L. siamensis Mucocutaneous leishmaniasis Espundia L. braziliensis Visceral leishmaniasis Kala-azar L. donovani, L. infantum, L. siamensis

16 Cutaneous leishmaniasis Leishmania tropica, L. siamensis Portugal, Spain, Italy, Iran, Saudi Arabia, Turkey, (Thailand) papules & nodules ulcerate scar scraping and biopsy of the sore, stain with Giemsa stain

17 Cutaneous leishmaniasis

18 Cutaneous leishmaniasis Skin biopsy macrophage Amastigote

19 Mucocutaneous leishmaniasis Leishmania braziliensis South Mexico to Paraguay Northern part of Argentina Mucosal lesion at nose, lips, pharynx, larynx scraping, biopsy and puncture of the ulcer in mucous membrane, stain with Giemsa stain

20 Mucocutaneous leishmaniasis

21 Visceral leishmaniasis Leishmania donovani, L. siamensis America (Agentina,Brazil) Africa (Sudan,Kenya) Asia (China,India) Splenomegaly, hepatomegaly biopsy and puncture of splenic, bone marrow, stain with Giemsa stain, serodiagnosis

22 Visceral leishmaniasis Thin smear Culture

23 Treatment USA: pentavalent antimony (sodium stibogluconate): expensive selections for initial therapy : oral miltefosine, topical paromomycin, amphotericin B Thailand: itraconazole: 5 mg/kg/day for 3 months (CL, ML) amphotericin B: 50 mg IV for 1 month (VL)

24 Trypanosoma spp.

25 Trypanosomiasis African trypanosomiasis [African sleeping sickness] American trypanosomiasis [Chagas disease]

26 African trypanosomiasis

27 T. b gambiense T. b rhodesiense Kenya, Tanzania :20,000-50,000 cases/year

28 African trypanosomiasis แมลงว นเหงาหล บ Tsetse fly (Glossina spp.)

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30 Trypanosoma brucei

31 African trypanosomiasis T. b rhodesiense (Acute disease) T. b gambiense (Chronic disease) Sleeping sickness

32 Sign & symptom 1 st stage Multiply in subcutaneous tissues, blood and lymph node Fever, rash, swelling of the face and hands, headaches, fatigue, aching muscles and joints, itching skin, and swollen lymph nodes Lymphadenopathy

33 2 nd stage Neurological or meningoencephalic phase Changes of behavior, confusion, sleepy during the day, insomnia at night, sleepiness (may be uncontrollable), coma & death

34 Giemsa stain smear Laboratory diagnosis - blood, lymph node, bone marrow, CSF trypomastigote Serodiagnosis

35 Treatment Type of Trypanosomiasis Stage 1 (Early or Hemolymphatic Stage) Stage 2 (Late or Neurologic Stage) East African trypanosomiasis (caused by Trypanosoma brucei rhodesiense) Suramin (IV) Melarsoprol (IV) West African trypanosomiasis (caused by Trypanosoma brucei gambiense) Pentamidine isethionate (IM) or Suramin (IV) Melarsoprol (IV) or Eflornithine (IV)

36 American trypanosomiasis - Mexico, Central America, & South America million people infected - 50,000 patient die/year

37 American trypanosomiasis Chagas disease Triatomid bug or Assassin bug or kissing bug (มวนเพชฌฆาต)

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39 Trypanosoma cruzi

40 Sign & symptom No symptoms or very mild symptoms The acute phase Symptoms include: Fever General ill feeling Swelling of one eye if the bite is near the eye (Romana s sign) Swollen red area at site of insect bite

41 Sign & symptom The chronic phase Cardiomegaly (Heart failure) Megaesophagus, megacolon (Digestive problems)

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44 Dilated cardiomegaly Megacolon in a Chagas' disease patient

45 Laboratory diagnosis Giemsa stain smear - blood, CSF Trypomastigote C shaped Serodiagnosis : ELISA

46 Laboratory diagnosis Xenodiagnosis Bug feed on patient s blood 30 days Fecal examination trypomastigote Patient with American tryponosomiasis

47 Treatment Benznidazole Nifurtimox

48 PREVENTION Vector control: spraying insecticides Personal protection: bednets, repellent House management

49 Haemoflagellates (flagellates of tissues and blood) Diseases Vector Distribution Leishmaniasis Sandfly (ร นทราย) America, Africa, Asia African Tsetse fly Africa trypanosomiasis (แมลงว นเหงาหล บ) (African Sleeping sickness) American Triatomid bug or South America trypanosomiasis Assassin bug or kissing bug (Chagas disease) (มวนเพชฌฆาต)

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