Trypanosoma
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Microbiology Trypanosoma (Jawetts/ reading assignment) 07 February 2008 Guys. Part 1 lang to. Meron pang , b. coli, n. fowleri, a. castellani at arthropods n nksked na reading assignment di kasma ditto. Anatay antayin ni nlng… to follow.. Sinusundan namin yung sked ng micro department coinciding w/ trans date. And sabi dun reading assignment tayo ng feb 7. so eto. Enjoy. 4 units of Micro.. -brim
TRYPANOSOMA
occur in blood of mammals as mature elongated trypomastigotes multiplying epimastigotes precedes the foremation of infective trypomastigotes in the intermediate host in all species of trypanosomes that infect humans Expressed as: o African spleeing sickness o Chaga’s Disease o Asymptomatic trypanosomiasis
Trypanosoma brucei brucei parent form in Africa causes nagana in livestock and game animalas T. brucei rhodesiense and T. brucei gambiense human forms MORPHOLOGY A.
TYPICAL ORGANISM T.b. gambiense and T. b. rhodesiense vary in shape of the body and length of flagellum( 15-30μm) i. Stumpy short form Infective to the insect host and possess a full battery of enzymes for energy metabolism ii. Elongated form Requires host metabolic assistance and is specialized for rapid multiplication in the richly nutritious vertebrate bloodstream
Seen in blood as in lymph node aspirates iii. Blood form of T. cruzi present during the early acute stage and at intervals thereafter in smaller numbers
typical trypomastigotes, mean size 20 μm frequently curved in a C shape when fixed and stained
iv. Tissue forms common in heart muscle, liver, brain
develop from amstigotes that multiply to form an intracellular colony after invasion of the host cell or phagocytosis of the parasite Trypanosome rangeli infects humans w/o causing disease CULTURE T. cruzi & T. rangeli cultivated (3-6 weeks) in the epimastigote form in fluid or diphasic media VARIATION T. brucei complex undergo development of a series of genetically controlled glycoprotein antigenic coats (variant surface glycoproteins) VSGs – means of escaping the host’s antibody response by producing different antigenic membranes each trypanosome – thought to possess 1000 VSG gene – mosaic gene formation
B.
C.
Leu, Brim, Virns
1 of 3
Microbiology – TRYPANOSOMA by Jawetts (reading assignment) • •
PATHOGENESIS T. b. gambiense and T b. rhodesiense
introduced through the bite of the tsetse fly indurationa and swelling progress to trypanosomal chancre spread to lymph nodes, bloodstream, and to CNS (terminals stage) sleeping sickness syndrome: lassitude, inability to eat, tissue wasting, unconsciousness and death
T b rhodesiense Appears in CSF in 1 month Rapidly fatal produces somnolence and coma only during the final weeks of terminal infection
T b gambiense Several months Chronic and leads to progressive diffuse meningoencephalitis, w/ death from sleeping syndrome usually ff 1-2 yrs
T. cruzi
introduced when infected bug feces are rubbed into the conjunctiva, the bite site or a break in the skin subcutaneous inflammatory nodule or chagoma Chaga’s disease
Insterstitial myocarditis – most serious element
Romañas sign – unilateral swelling of the eyelids, a characteristic at onset. fever, acute lymphadenitis, dissemination to blood and tissues detected 1-2 weeks as trypomastigotes in blood multiplies mostly w/in reticuloendothelial cells
•
African forms multiply extracellularly as trypomastigotes in blood & lymphoid tissues
•
Parasitimia punctuates multiplication w/ later destruction by the host of blood forms, accompanied by bouts of intermittent fever gradually decreasing in intensity
• •
Page 2 of 3
T.b rhodesiense –common
T. cruzi – intermittent & scant Toxin relase explains systemic and local reactions. Brazilian Chaga’s Disease causes megaesophagus and megacolon
***all three trypanosomes are transmissible through the placenta, and congenital infections occur in hyperendemic areas***
Tobie’s Wenyon’s semisolid
•
Growth at 22-24 °C • Subcultured every 1-2 weeks ANIMAL INOCULATION • detected by inoculating blood intraperitoneally in mice
• •
T. b rhodesiense often detectable
T b. gambiense sometimes detectable SEROLOGY • confirmatory test o positive IHA, IFA, CF (Machado’s) tests • ELISA • Useful in blood blank screening
• African forms cause IFA rxns after 12 days of infxn XENODIAGNOSIS • Method of choice in Chaga’s Dse • For trained workers only! • Impractical for African forms DIFFERENTIAL DIAGNOSIS • •
Presence of specific IgM- pathognomonic for the encephalitic stage of African trypanosomiasis Differentiation of 2 specie based on total parasite DNA digestant electrophoresed on agarose gels which are then stained w/ ethidium bromide
Blood forms Size Shape Posterior Kinetoplast Developmental stages in tissues Triatomine bugs In salivary gland or proboscis In hindgut or feces
T. cruzi
T. rangeli
20μm Often c-shaped in fixed preparations Terminal, large
Over 30 μm Rarely c-shaped
Amastigote to epimastigote
Not found (only trypomastigotes)
Always absent
Usually present
Present
Present
Distinctly subterminal, small
IMMUNITY •
Strain-specific CF and protecting antibodies detected in human plasma
TREATMENT
DIAGNOSIS SPECIMENS • blood • CSF • Lymph node or primary lesion aspirates • Specimes obtaine by iliac crest, sternal bone marrow or spleen punctured MICROSCOPIC EXAM • Thick films – by Giemsa’s stain • Most reliable o Smears of blood by T b rhodesiense o Lymph gland puncture for Tb gambiense o CSF – tb rhodiense & advanced Tb gambiense CULTURE
• • • •
•
Nifurtimox (Bayer 2505) – shorten acute phase Gamma-interferon –temporary relief Suramin Sodium/ pentamidine isethionate – for African trypanosomiasis Melarsoprol / Suramin/ Tryparsamide– late dse w/ CNS involve Eflornithine – (DFbIO) for blood and CNS phases of T. gambiense and hemolytic stages of T. rhobdesiense
Microbiology – TRYPANOSOMA by Jawetts (reading assignment)
Page 3 of 3
EPIDEMIOLOGY To follow nlng yung iba.. peace ;) •
Tb gambiense
•
transmitted by the streamside tsetse Glossina palpalis West to central Africa Produce chronic infxn w/ progressive CNS involvement Human reservoir T. rhodiense
Transmitted by woodland –savanna Glossina morsitans, Glossina pallidipes and Glossina fuscipes Eastern and southeastern savannas of Africa, w/ foci West of Lake Victoria Bushbuck & other antelopes – serves as reservoir
•
American trypanosomiasis Important in Central & south America extends widely to Maryland & southern California
•
Certain triatomine bugs become as domiciliated as bedbugs & infextion may be brought in by rats, opossums or armadillos w/c may spread the infection to domestic animals such as dogs and cats Largely among poor economic circumstances
•
PREVENTION AND CONTROL • • • • •
Control depends upon searching for and then isolating and treating pxs w/ disease Controlling movements of people in & out of fly belts Using insecticides and by altering habitatas Control vectors w/ residual insectidies and habitat modification Short-lived – chemoprophylaxis w/ suramin sodium
EIGHT GIFTS THAT DO NOT COST A CENT . . . 1)
2) 3) 4)
5)
6) 7) 8)
THE GIFT OF LISTENING . . . But you must REALLY listen. No interrupting, no daydreaming, no planning your response. Just listening. THE GIFT OF AFFECTION . . . Be generous with appropriate hugs, kisses, pats on the back and handholds. Let these small actions demonstrate the love you have for family and friends. THE GIFT OF LAUGHTER . . . Clip cartoons. Share articles and funny stories. Your gift will say, "I love to laugh with you." THE GIFT OF A WRITTEN NOTE . . . It can be a simple "Thanks for the help" note or a full sonnet. A brief, handwritten note may be remembered for a lifetime, and may even change a life. THE GIFT OF A COMPLIMENT . . . A simple and sincere, "You look great in red," "You did a super job" or "That was a wonderful meal" can make someone's day. THE GIFT OF A FAVOR . . . Every day, go out of your way to do something kind. THE GIFT OF SOLITUDE . . . There are times when we want nothing better than to be left alone. Be sensitive to those times and give the gift of solitude to others. THE GIFT OF A CHEERFUL DISPOSITION . . The easiest way to feel good is to extend a kind word to someone, really it's not that hard to say, Hello or Thank You. Friends are a very rare jewel, indeed. They make you smile and encourage you to succeed. They lend an ear, they share a word of praise, and they always want to open their hearts to us . . .
TRYPANOSOMA
occur in blood of mammals as mature elongated trypomastigotes multiplying epimastigotes precedes the foremation of infective trypomastigotes in the intermediate host in all species of trypanosomes that infect humans Expressed as: o African spleeing sickness o Chaga’s Disease o Asymptomatic trypanosomiasis
Trypanosoma brucei brucei parent form in Africa causes nagana in livestock and game animalas T. brucei rhodesiense and T. brucei gambiense human forms MORPHOLOGY A.
TYPICAL ORGANISM T.b. gambiense and T. b. rhodesiense vary in shape of the body and length of flagellum( 15-30μm) i. Stumpy short form Infective to the insect host and possess a full battery of enzymes for energy metabolism ii. Elongated form Requires host metabolic assistance and is specialized for rapid multiplication in the richly nutritious vertebrate bloodstream
Seen in blood as in lymph node aspirates iii. Blood form of T. cruzi present during the early acute stage and at intervals thereafter in smaller numbers
typical trypomastigotes, mean size 20 μm frequently curved in a C shape when fixed and stained
iv. Tissue forms common in heart muscle, liver, brain
develop from amstigotes that multiply to form an intracellular colony after invasion of the host cell or phagocytosis of the parasite Trypanosome rangeli infects humans w/o causing disease CULTURE T. cruzi & T. rangeli cultivated (3-6 weeks) in the epimastigote form in fluid or diphasic media VARIATION T. brucei complex undergo development of a series of genetically controlled glycoprotein antigenic coats (variant surface glycoproteins) VSGs – means of escaping the host’s antibody response by producing different antigenic membranes each trypanosome – thought to possess 1000 VSG gene – mosaic gene formation
B.
C.
Leu, Brim, Virns
1 of 3
Microbiology – TRYPANOSOMA by Jawetts (reading assignment) • •
PATHOGENESIS T. b. gambiense and T b. rhodesiense
introduced through the bite of the tsetse fly indurationa and swelling progress to trypanosomal chancre spread to lymph nodes, bloodstream, and to CNS (terminals stage) sleeping sickness syndrome: lassitude, inability to eat, tissue wasting, unconsciousness and death
T b rhodesiense Appears in CSF in 1 month Rapidly fatal produces somnolence and coma only during the final weeks of terminal infection
T b gambiense Several months Chronic and leads to progressive diffuse meningoencephalitis, w/ death from sleeping syndrome usually ff 1-2 yrs
T. cruzi
introduced when infected bug feces are rubbed into the conjunctiva, the bite site or a break in the skin subcutaneous inflammatory nodule or chagoma Chaga’s disease
Insterstitial myocarditis – most serious element
Romañas sign – unilateral swelling of the eyelids, a characteristic at onset. fever, acute lymphadenitis, dissemination to blood and tissues detected 1-2 weeks as trypomastigotes in blood multiplies mostly w/in reticuloendothelial cells
•
African forms multiply extracellularly as trypomastigotes in blood & lymphoid tissues
•
Parasitimia punctuates multiplication w/ later destruction by the host of blood forms, accompanied by bouts of intermittent fever gradually decreasing in intensity
• •
Page 2 of 3
T.b rhodesiense –common
T. cruzi – intermittent & scant Toxin relase explains systemic and local reactions. Brazilian Chaga’s Disease causes megaesophagus and megacolon
***all three trypanosomes are transmissible through the placenta, and congenital infections occur in hyperendemic areas***
Tobie’s Wenyon’s semisolid
•
Growth at 22-24 °C • Subcultured every 1-2 weeks ANIMAL INOCULATION • detected by inoculating blood intraperitoneally in mice
• •
T. b rhodesiense often detectable
T b. gambiense sometimes detectable SEROLOGY • confirmatory test o positive IHA, IFA, CF (Machado’s) tests • ELISA • Useful in blood blank screening
• African forms cause IFA rxns after 12 days of infxn XENODIAGNOSIS • Method of choice in Chaga’s Dse • For trained workers only! • Impractical for African forms DIFFERENTIAL DIAGNOSIS • •
Presence of specific IgM- pathognomonic for the encephalitic stage of African trypanosomiasis Differentiation of 2 specie based on total parasite DNA digestant electrophoresed on agarose gels which are then stained w/ ethidium bromide
Blood forms Size Shape Posterior Kinetoplast Developmental stages in tissues Triatomine bugs In salivary gland or proboscis In hindgut or feces
T. cruzi
T. rangeli
20μm Often c-shaped in fixed preparations Terminal, large
Over 30 μm Rarely c-shaped
Amastigote to epimastigote
Not found (only trypomastigotes)
Always absent
Usually present
Present
Present
Distinctly subterminal, small
IMMUNITY •
Strain-specific CF and protecting antibodies detected in human plasma
TREATMENT
DIAGNOSIS SPECIMENS • blood • CSF • Lymph node or primary lesion aspirates • Specimes obtaine by iliac crest, sternal bone marrow or spleen punctured MICROSCOPIC EXAM • Thick films – by Giemsa’s stain • Most reliable o Smears of blood by T b rhodesiense o Lymph gland puncture for Tb gambiense o CSF – tb rhodiense & advanced Tb gambiense CULTURE
• • • •
•
Nifurtimox (Bayer 2505) – shorten acute phase Gamma-interferon –temporary relief Suramin Sodium/ pentamidine isethionate – for African trypanosomiasis Melarsoprol / Suramin/ Tryparsamide– late dse w/ CNS involve Eflornithine – (DFbIO) for blood and CNS phases of T. gambiense and hemolytic stages of T. rhobdesiense
Microbiology – TRYPANOSOMA by Jawetts (reading assignment)
Page 3 of 3
EPIDEMIOLOGY To follow nlng yung iba.. peace ;) •
Tb gambiense
•
transmitted by the streamside tsetse Glossina palpalis West to central Africa Produce chronic infxn w/ progressive CNS involvement Human reservoir T. rhodiense
Transmitted by woodland –savanna Glossina morsitans, Glossina pallidipes and Glossina fuscipes Eastern and southeastern savannas of Africa, w/ foci West of Lake Victoria Bushbuck & other antelopes – serves as reservoir
•
American trypanosomiasis Important in Central & south America extends widely to Maryland & southern California
•
Certain triatomine bugs become as domiciliated as bedbugs & infextion may be brought in by rats, opossums or armadillos w/c may spread the infection to domestic animals such as dogs and cats Largely among poor economic circumstances
•
PREVENTION AND CONTROL • • • • •
Control depends upon searching for and then isolating and treating pxs w/ disease Controlling movements of people in & out of fly belts Using insecticides and by altering habitatas Control vectors w/ residual insectidies and habitat modification Short-lived – chemoprophylaxis w/ suramin sodium
EIGHT GIFTS THAT DO NOT COST A CENT . . . 1)
2) 3) 4)
5)
6) 7) 8)
THE GIFT OF LISTENING . . . But you must REALLY listen. No interrupting, no daydreaming, no planning your response. Just listening. THE GIFT OF AFFECTION . . . Be generous with appropriate hugs, kisses, pats on the back and handholds. Let these small actions demonstrate the love you have for family and friends. THE GIFT OF LAUGHTER . . . Clip cartoons. Share articles and funny stories. Your gift will say, "I love to laugh with you." THE GIFT OF A WRITTEN NOTE . . . It can be a simple "Thanks for the help" note or a full sonnet. A brief, handwritten note may be remembered for a lifetime, and may even change a life. THE GIFT OF A COMPLIMENT . . . A simple and sincere, "You look great in red," "You did a super job" or "That was a wonderful meal" can make someone's day. THE GIFT OF A FAVOR . . . Every day, go out of your way to do something kind. THE GIFT OF SOLITUDE . . . There are times when we want nothing better than to be left alone. Be sensitive to those times and give the gift of solitude to others. THE GIFT OF A CHEERFUL DISPOSITION . . The easiest way to feel good is to extend a kind word to someone, really it's not that hard to say, Hello or Thank You. Friends are a very rare jewel, indeed. They make you smile and encourage you to succeed. They lend an ear, they share a word of praise, and they always want to open their hearts to us . . .
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