II- Trypanosomiasis

Scientific Classification of
Trypanosoma
• Domain: Eukarya
• Kindom: Protista
• Phylum: Sarcomastigphora
• Class: Zoomastogophorea
• Order: Kinetoplastida
• Family: Trypanosomatidae
• Genus: Trypanosoma
• Species: T. brucei
• Sub-species: T. b. brucei, T. b. gambiense, T. b. rhodesiense
II- Trypanosomiasis
• Etiologic agents
1- Trypanosoma brucei complex – African
trypanosomiasis (sleeping sickness)

2- Trypanosoma cruzi – American trypanosomiasis

(Chagas’ disease)
 1- African Trypanosomiasis
• Caused by infection with protozoan parasite ,
Trypanosoma brucei
• Transmitted to humans by vector, Tsetse fly (glossina
species)
• Estimated 100.000 deaths occur each year
• Sub-Saharan Africa distribuition
Trypanosoma brucei
• T. brucei causes Human African Trypanosomiasis
(HAT) or sleeping sickness
• T. brucei is not killed by the immune system
because it has a glycoprotein (VSG) coating.
 Trypanosoma brucei subspecies

• Two subspecies that are morphologically

indistinguishable cause distinct disease patterns in humans:
1) T. b. gambiense causes West African trypanosomiasis
2) T. b. rhodesiense causes East African trypanosomiasis
• A third member, T. b. brucei, under normal conditions
does not infect humans.
 Geographical Distribution of African
Trypanosomiasis

G.palpalis G.morsitans
In West Africa In East Afric
Morphology
1- Trypanosmes is an elongated , spindle-shape cell with
a single nucleus near the middle of parasite.
2- It has kinetoplast.
3- It has undulating membrane.
4- Possess a slender-single flagella at the anterior end.
5- Flagellum serve as organ of attachment and
locomotion.
6- there are four stages in life cycle.
stained under bright-field microscope
Morphology
• These species may have amastigote, promastigote,
epimastigote, and trypomastigote stages in their life
cycle.
• In human trypanosomes of the African form, however,
the amastigote and promastigote stages of development
are absent
 Basic morphology of haemoflagellates.
(1) Nucleus, (2) Karyosome,
(3) Parabasal body, (4) Blepharoplast,
(5) Axoneme,(6) Undulating membrane,
(7) Flagellum, (8) Parabasal body and
blepharoplast together constitute the
kinetoplast

Morphological stages of haemoflagellates

Life Cycle
Life Cycle
1- During a blood meal on the mammalian host, an
infected tsetse fly (genus Glossina) injects metacyclic
trypomastigotes into skin tissue. The parasites enter the
lymphatic system and pass into the bloodstream.
2- Inside the host, they transform into bloodstream
trypomastigotes
3-Trypomastigotes are carried to other sites throughout
the body, reach other body fluids (e.g., lymph, spinal
fluid), and continue the replication by binary fission
4,5- The entire life cycle of African trypanosomes is
represented by extracellular stages. The tsetse fly
becomes infected with bloodstream trypomastigotes
when taking a blood meal on an infected mammalian
host
6- In the fly’s midgut, the parasites transform into
procyclic trypomastigotes, multiply by binary fission
7- They leave the midgut, and transform into
epimastigotes
8- The epimastigotes reach the fly’s salivary glands
and continue multiplication by binary fission.
The cycle in the fly takes approximately 3 weeks.
Rarely, T. b. gambiense may be acquired congenitally
if the mother is infected during pregnancy.
Clinical Features
Stages of Infection:
• In the first stage, the trypanosomes multiply in
subcutaneous tissues, blood and lymph. This is
also called haemo-lymphatic stage.

• In the second stage, the parasites cross the

blood-brain barrier to infect the central nervous
system. This is known as the neurological or
meningo-encephalic stage.
Pathogenesis
• Incubation period: 2 weeks
• Trypanosomal chancre will develop at the site of
bite
• Via lymphatics: enlarged lymph nodes especially
posterior cervical region (Winterbottom’s sign)
• Via blood stream: headache, fever, muscle & joint
pain, irregular erythematous rash
Diagnosis
• Screening:
Serological tests are used(available only for T.gambiense)
Serological tests are not reliable

• Microscopic Examination:
Lymph & blood – Stage I infection
CSF – Stage II infection & for staging
Parasites are not easily visible in T.gambiense infections and
so concentration techniques may be used

• Clinical Examination:
For Posterior cervical lymphadenopathy
Not a Preferred method for diagnosis
Treatment
FOR STAGE I
• Pentamidine: used against T.b.gambiense.
• Suramin: used against T.b.rhodesiense.

FOR STAGE II
• Melarsoprolol: used against both the species.
• Eflornithine: effective against T.b.gambiense only.

• Combination of nifurtimox & eflornithine is effective

against T.b.gambiense only.
Immunity
• Innate Immunity:
. Apolipoprotein L-1 (APOL 1)
. Trypanolytic
• Humoral immunity:
. Major variant surface glycoprotein ( VSG)
. Trypanosoma periodically switch VSG
.Antigenic variation
. Leads to non-specific activation of humoral
immunity