Parasite – can live on (Exopara) or in host (Endopara) 5. Another person’s clothing, beddings or his immediate envi. 5.

eddings or his immediate envi. 5. Open pathways for secondary invaders

Host: (pinworm → enterobiasis → egg is infective) • Ground itch – penetration of hookworm larva
A. Definite – harbors sexual stages/ mature forms of para 6. Oneself • Amoebic colitis – hole in colon → bacteria
B. Intermediate – harbors asexual/immature stages Portals of entry • Balantidiasis – ulcer
a) 1st I.H. – harbors very early larval stages 1. Mouth – protozoa exc. Plasmodium • 1st 4 – Immunocompromised for bacteria
b) 2nd I.H. – harbors late stages 2. Skin – hookworm & threadworm; direct or percutaneous (blood ❖ Oncogenic Para:
Predator – attack living; not necessarily killing them sucking; carried by I.H.) ✓ Gongylonema neoplasticum – gastric tumors
Prey – victim 3. Nose – acantamoeba, enterobius ✓ Cysticereus fasciolaris – larva of threadworm
Scavenger – devouring dead; taking leavings of predator 4. Placenta – toxoplasma, plasmodium (RBC’s para → probably in Immunity - rarely solid
HP relationship – obtain food thru close association: circulation) • Exception: Cutaneous Leishmaniasis
a. Continuous – once inside, mature inside 5. Genitalia – Trichomonas vaginalis (STD) • Trichinosis (Trichinella spirasis) – light exposure in
b. Intervals – part intermediate, part definite Incubation period animals prevent clinical infection (large amt. given)
Symbiosis – give & take; protection a. Biologic – exposure → time demonstrate para thru excretion or • Hookworm (belief)
a. Commensalism – eating at same table; beneficial to one, not secretion (ascaris – 1 month)
• Blood fluke infection (Schistosoma japonicum)
disadvantageous to one b. Clinical – exposure → manifestation of symptoms
• Condylobia (C.anthrophaga): fly maggot infestation
a) Mutualism – beneficial to both Nomenclature: Binomial Scientific Name
Clinical evidence of Parasitism:
b) Parasitism – host is injured thru para’s activities • Kingdom – Phylum – Order – Class – Family – Genus - Species
• Not pathognomonic (diagnostically specific); dependent on:
Vectors – transmit para • Threadworm – US: S. stercoralis; England: E. vermicularis
o Scientific knowledge & clinical experience
a. Biologic – essential to life cycle (plasmodium in malaria) H-P relationship:
o Acute or chronic infection
b. Mechanical / Phoretic – infection can go on w/o it (fly in a. Carrier – para present no damage to host; no symptoms,
• Blood picture: (depenends on para & patient)
Amoebiasis) damage immediately repaired
➢ No dyscrasia (manifestation) in early amoebic colitis – normal
Zoonosis – susceptibility of host to a para b. Pathogen – damage
(bleed → anemia)
a. Euzoonosis – man & reservoir host (maintain para in envi; not Pathogenesis – start / dynamics of infection; types of damage:
➢ Moderate neutrophilic leucocytosis – bacterial invasion of colonic
necessarily infectious) 1. Traumatic damage – external / internal; manifestations:
lesion in hepatic / extraintestinal amoebiasis
b. Parazoonosis – man is incidental host (dog flea) a. Slight – harmonious w/ para
➢ Monocytosis, neutropenia, erythropenia – Visceral Leishmaniasis
c. Anthropozoonosis – acquired by man from other vertebrates b. Moderate
➢ Anemia (moderate – severe) – malaria (plasmodium RBC)
(trichinosis) c. Severe – toxemia, ascaris, pinworm in appendix
➢ Polymorphonuclear leucocytosis, monocytosis, leucopenia
d. Zooanthroponosis – acquired by other vertebrates from man • Lesion – localized (manifestation at site) or generalized (diff.
(chronic) – Helminthiasis (infected w/ all roundworms)
e. Amphixenosis – man and animals areas)
➢ Hypereosinophilia (90%; normal eosinophil – 1%:
Types of para accdg. to host: • Inapparent infection – no symptoms, but infected; can be long  Trematode, Stronglyoides, Visceral larval migrans, arthropod
a. Obligate – can’t exist w/o host; most infectious or short periods → not all para are excreted → low immunity ➢ Microcytic hypochromic anemia – hookworm infection
b. Facultative – free living or parasitic (Strongyloides stercoralis / → relapse → dormant remain
• Delusional Parasitosis – obsessive complusive neurosis
threadworm) 2. Lytic necrosis – para has lytic enzymes → lyse tissues &
Types of para: • Diagnosis (2 methods):
incorporate them to their cytoplasm → bloody stool
a. Amphizoic – free living amoeba – invade brain & other sites 1. Clinical – by physician
a. Plasmodium
(Genus Naegleria & Acanthamoeba) • In endemic – familiar w/ manifestations
b. E. histolytica
b. Spurious – free living para accidentally ingested; not equipped • Uncommon disease – difficult diagnosis
c. Toxoplasma gondii (reticuloendothelial cells)
to live in humans; recovered in human feces 2. Laboratory – by MT’s; one should know:
d. Trypanosoms cruzi (WBC) & Leishmania
Infection vs Infestation a. Type of specimen to be obtained for lab analysis
• Peritonitis – intestine has holes due to enzymes
└ endopara └ ectopara; external manifestation b. How & when specimen is to be obtained
• Amoebiasis
Parasitosis – state of infection & infestation • Plasmodium – at height of fever – RBC rupturing
3. Stimulation of H-Tissue reaxn.
Super infection Autoinfection • Ascaris – wait 1 month before collection
• Para stimulation – beneficial: shows symptoms
You - own source of infection • Elephantiasis (filariasis) – young forms eliminated to blood
• Cellular infiltration at para’s site (hyperplasia – flukes)
Parasitized w/ diff. types of para Pinworm at 10 pm – 2 am
• Systematic inc. in cell types, esp. those in blood
Triumberates (hoowkworm, ascaris, – Enterobius vermicularis c. Precautions to be taken
• Eosinophilia
trichiuris trichuria) - peculiarity: pregnant female d. Specimen - processed by skilled & experienced technician
• Inc. erythropoiesis (infections w/c cause RBC loss or Subkingdom or Phylum Protozoa
- migrate to perianal at nyt
destruction) (hookworm, plasmodium)
• Unicellular
• Host walls off para by fibrous encapsulation
Sources of exposure to infection: • Some free living flagellated protozoa – have green plastids –
• Amoebic granuloma – lesion by E. histolytica synthesize CHO from inorganic substances – Plant Kingdom
1. Contaminated soil & H2O – Hookworm & threadworm
o Amoeboma – tumor (Polypoid or Ulcerative)
Skin (larva) → venous circulation → right <3 → lungs • Morphology:
• Uncomplicated amoebic colitis – ONLY w/o H-T reaxn ➢ Remarkable range in size & form (Biggest: Balantidium coli)
→ rupture alveoli → bronchi → trachea → esophagus →
4. Toxic and allergic phenomena – due to venom-producing ➢ Spherical, ovoidal or bizarre
stomach (not destroyed by gastric juice) → intestine (adult
arthropods ➢ Radial symmetry, bilateral symmetry or longitudinal torsion
stage)
• Spiders & ticks – mouth ➢ Some free living – develop into colonial aggregates
2. Food containing para’s immature infective stage (80%)
3. Blood sucking insect – I.H. (filariasis & elephantism; • Scorpions, bees, wasp, ants – caudal end ➢ Common organelles:
plasmodium) • Caterpillars – base of hollow hairs 1. Nucleus – contain chromosome
4. Domestic or wild animals harboring para (flea) • Helminth larva: o Karyosome (endosome, nucleolus) – vesicular nucleus,
o Echinococcus larva cyst – allergy aggregates of nucleus surrounded by chromatin
o Ascaris - Ascarase
 o Compact nucleus - ↑ chromatin, ↓ nucleoplasm • T. hominis – intestine - Short , posterior flagella don’t pass mouth
o Nuclear membrane • T. vaginalis – prostate gland & vagina - Definite body torsion, ellipsoidal, double-
o G. lamblia & D. fragilis – 2 common nuclei at trophozoite  Haemosporidia , B&T flagell. – hematophagous invertebrate host wall
o Balantidium coli – 2 dissimilar nuclei 3. Factors of Encystation: B. Family: Chilomastigidae (GIT)
2. Cytoplasm a. Deficiency or overabundance of food a. Genus: Chilomastix
a. Endoplasm – around nucleus b. Excess of catabolic products 1. Chilomastix mesnili / Cercomonas intestinalis
- Dense, granular c. pH change • Diarrheic stool – troph
- Food vacuoles – contain undigested food d. Desiccation of medium • Semi-formed stool – troph & cyst
- Materials inside: e. Depletion or excess O2 supply • Formed - cyst
a) Chromatoidal bodies – stored food; f. Overpopulation a) Troph – asymmetric pyriform (safty-pin) due to spiral groove
glycogen or protein ❖ E. coli cyst wall is more resistant to E. hisolytica - 6-20 x 3-10 microns
b) Mitochondria 4. 2 types of encystment: - 1 spherical nucleus anterior, w/ central karyosome
c) Golgi apparatus a. Protective (flagellates, amoeba, ciliates) – outside host body; no - 6 minute blepharoplast anterior to nucleus → give rise
d) Microsomes morphologic change in cyst to 3 anterior free flagella (2 on each nucleus’ side, 1
e) ER b. Reproductive (amoeba, flagellates)–amoeba produce into the cytostome)
b. Ectoplasm – less granular, around endoplasm; functions: amoebiates: - See food vacuoles
✓ Locomotor apparatus • E. coli – 16; E. histolytica – 8; Amoeba – 8 b) Cyst – lemon shaped, 7-10 x 4.5-6 microns
✓ Procurement of food • Nuclei divide during cystic stage → ↑ troph. no. ff. Excystation - 1 vesicular nucleus & cytostome w/ flagella inside
✓ Food ingestion (under favorable - Nipple-like projection
✓ Respiration conditions) - Troph. Characteristics maintained
✓ Metabolic waste discharge • Contain glycogen reserves, condensed C. Family Tetramitidae (GIT)
✓ protection • Dedifferentiation of protoplasm • 3 anterior flagella w/ 4 th trailing (posterior)
3. Food vacuoles 5. Factors involved in Excystation: • Pyriform, no axostyle, anterior nucleus w/ karyosome
4. Contractile vacuoles (pulsating) a. Osmotic changes in medium a. Genus: Enteromonas
- Osmoregulators b. Enzymatic action of org. on inner surface of cyst wall 1. Enteromonas hominis / Tricercomonas intestinalis
- In Protozoa c. In parasitic – favorable pH & enzymatic action of host tissue a) Troph – 4-10 x 3-6 microns
- Not in Sarcodina & Mastigophora 6. Sexual stages in life cycle: (book) - Hyaline pear, jerky forward movement
- Not developed in Sporozoa • Ciliates – conjugation - Ovoidal nucleus (anterior), no mouth,
5. Plasma membrane - Blepharoplast in front of nucleus
• Sporozoa – alteration of sexual & asexual; Sporogony
- Amoeba – no constant shape, changes form by extending b) Cyst – 6-8 x 4-6 microns
• Coccidian
& retracting of temporary pseudopodia - 2 nuclei, one on each end (binary fission)
2 Grps of Flagellates:
- Heliozoa & Radiolaria – ectoplasm secreted nonliving - 2 nuclei after encystation
1. Atrial – intestinal/GIT, oral, genital
calcareous & siliceous shell w/c has - Ovoidal, well defined cyst wall
2. Blood & tissue flagellates
perforations where pseudopodia are projected D. F: Hexamitidae
6. Cyst wall – secreted by ectoplasm • 2 nuclei side by side
FLAGELLATES OF GIT
7. Cytostome – cell mouth • 6 or 8 flagella, paired axonemes, bilateral symmetry
Subphylum: Mastigophora
8. Cytopyge – cell anus
Class: Zoomastigophorea • 5 genera – only GL is pathogenic
 If no pyge – Excretory vacuoles at aboral end
• No chromatophores – dependent on manufactured food a. Genus: Giardia
➢ Locomotion:
• Nutrition: parasitic / holozoic 1. Giardia lamblia / Cercomonas intestinalis / Lamblia intestinalis
1. Amoeba – free flowing → Pseudopodia
• 1 nucleus or neuromotor apparatus (axoneme w/ or w/o flagella) a) Troph – rounded anteriorly, pointed posteriorly
2. Flagellates – flagella → arise from kinetoplast
• Some have cytostome - Ventral: w/ sucking disc (attachment)
3. Ciliates – cilia → arise from basal granules (B. coli)
• Reproduction: longitudinal binary fission - 9.5–21 x 5-15 microns
➢ Primitive nervous system (flagellate)
- 1 pair of ovoidal nuclei, one on each side of midline
- Kinetoplast → parabasal body & blepharoplast • Life cycle: simple exc. Trypanosomes (di- or polymorphic)
w/ central karyosome
➢ Energizing part A. Family: Bodonidae (GIT & genital)
- 2 Parabasal bodies – sausage shaped, obliquely
➢ Connected w/ axoneme → intracytoplasmic • 2 flagella (1 anterior, 1 posterior)
posterior to sucking disc
portion of flagellum; motor component • Flagella arise from blepharoplast in front of anterior nucleus
- Habitat: crypts at duodenum of small intestine
Life Cycle among Protozoa a. Genus: Retortamonas – parasitic to man, harmless commensal
- 4 pairs of flagella from 4 pairs of blepharoplast:
1. Asexual – binary fission → nucleus of parent divides mitotically → 1. Retortamonas intestinalis
i. 2 bleph → 2 axonemes → lateral crossed flagella
cytoplasmic separation a) Troph – small, 4-9 x 3-4 microns; bigger nucleus
ii. Median bleph → thicker axoneme (axostyle) →
• Amoeba – no axial gradient & plane of division - Pyriform, vacuolated cytoplasm
posterior flagella
• Flagellate – along longitudinal axis - Anterior end has cleft cytostome (shallower),
iii. Bleph near sucking disc → v. short axoneme →
• Ciliate – in transverse plane - Vesicular nucleus w/ central karyosome
central / ventral flagella
• Sporozoa / Malarial parasite (plasmodium) – trophozoite - 2 minute blepharoplast w/c give rise to flagellum
iv. Lateral uncrossed flagella
→schizont → young schizont → mature schizont → inc. - Longer flagella anterior; shorter passes thru mouth
b) Cyst – double walled, football shaped, 8-12 long, 7-10 breadth
→rupture & release merozoites b) Cyst – transfer stage, non-flagellated
- Young: 2 nuclei; mature: 4 nuclei & crossed fibrils
2. Host to host transfer (troph, cyst, sexual) - Small, 4-7 x 3-4 microns
- Excystation: at duodenum, 5-30 mins.
- Pyriform, double walled, single nucleus
• E. gingivalis, D. fragilis,Trichomonas – troph; droplet sray Life Cycle:
2. Retortamonas sinensis – bigger than a) w/ smaller nucleus
• T. tenax – mouth Mature cyst
- More cavernous cytostome
 ↓ ingested thru food - Anterior cytostome opposite UM - Nonspecific urethritis – flagellate in 10% - 20% of subjects &
Stomach - D Female Male 20 – 30% on those who had trichomonas vaginitis
↓ unchanged rSedimented urine Urine - US – most common acquired STInfection
Duodenum oVaginal secretions Prostatic secretions - Diagnosis:
↓ excystation pVaginal scrapings ff. massage of prostate gland a) found in:
Trophozoite (binary fission) l
↓ feed and grow et spray (mouth) or use of contaminated utensils
Large intestine (dehydration of feces) - Harmless commensal
↓ encystation - Recover troph from: b)
2-nucleated cyst ✓ Tartar between teeth b) in wet films – 60% recovery
↓ ✓ Gingival margins of gums ✓ Best specimen: thru vaginal speculum (applicator stick)
4-nucleated cyst (mature) ✓ Tonsillar crypts ✓ Phase contrast microscopy – observe flagella & UM
↓ 2. Trichomonas hominis ▪ Female urethral discharge – (+) when no bacteria; if
Passed out together w/ feces - 2nd most common flagellate from GIT (cecum of L. intestine) w/ → difficult
Epidemiology: - Pyriform, 5-14 x 7-10 microns (bigger than tenax) ▪ Male - ↑ ID
- Transmission: viable cyst swallowed (H2O or food) - w/ free trailing posterior end (flagella at margin of UM) c) Culture methods – for best ID
- Intimate contact w/ infected - Semi-rigid axostyle, thick costa ✓ Modified diamond med. – 93% effective
- More prevalent in children (in large families, crowded) - Cytostomal cleft opposite UM d) Serology
- Sx max. frequency: childhood or puberty - Single ovoidal nucleus w/ conspicuous karyosome ✓ Gel Diffusion (GD)
- Higher in warm - No parabasal body ✓ Indirect Hemagglutination Test (IHA) – glycogen w/ para
- Giardasis (STD) – homosexual anal/oral sexual practices - Diarrheic stool – pseudopodial extension at side of UM as antigen; more sensitive than GD
- Contagious - Filth flies – mechanical vector (in food) ✓ Monoclonal Fluorescent Antibody (FA) – 86% of 88
Diagnosis: - Presence – indicate unnatural condition; commensal ✓ Pap smear – 56% → not so efficient
- Not pathogenic, just opportunists - Troph in fresh, unformed stools F. F. Monocercomonadidae
- Fluoroscopy – hypermotility at duodenum & jejunum 3. Trichomonas vaginalis a. Genus: Dientamoeba
- X-ray – mucuosal defects - Like tenax except: 1. Dientamoeba fragilis
- Diarrheic stool – no proper absorption – Steatorrheic stools ▪ Larger (7-23 microns): ave: 13 microns - Link bet. Flagellates & amoeba
- Zinc SO4 – few cyst ▪ Shorter UM - Binucleate, only troph
- 3 patterns of excretion: ▪ Anterior of axostyle may be split into fibrils - Amoeba-like flagellate w/c doesn’t have flagellum
1. High – para in nearly all samples ▪ Uniformly distributed nuclear chromatin - Order: Trichomonadida
2. Low – para in 40% of specimen ▪ Siderophil granules around delicate costa & axostyle - Small: 3-10 micron
3. Mixed pattern – 1-3 weeks high, laternating w/ short ▪ Less conspicuous cytostome - w/ hyaline pseudopodia (leaf-like)
- Sting test / Enterotest – identifying troph in duodenal fluid ▪ Pos. flagella about ½ - food vacuoles w/ bacteria
by intubation - In human vagina & prostate gland - NM – no peripheral chromatin karyosome (large & central;
- ELISA or Immunofluorescent (IF) – detect cyst & troph - Female host: mucosal surface of vagina ingesting bacteria & tetrad like discrete granules)
- Normal blood picture – uncomplicated Giardasis WBC & phagocytosed by macrophage - 1 or 2 nuclei
- Flatulence, fatty stool - Slight alkaline medium or more acid than healthy vagina - In large intestine (cecum & upper colon)
Treatment: - Peak incidence: 16-35 y.o (greatest sexual activity) - Unknown MoT
- Quinacrine / Atabrine (adult: 0.1g 3x a day for 5 days) - In pop. w/ ↑ risk for venereal dis. (Gonorrea & Trichomoniasis) - Carried inside egg of nematode like Histomonas meleagridis
- Metronidazole – 2nd choice: carcinogenic on rats; - 100% of female partners of men w/ Trichomoniasis – infected (causes turkey’s blackhead)
mutagenic on bacteria; not used on pregnant women; w/ - Metronidazole on woman alone → 60 – 80% cure; but w/ male - In eggs of E. vermicularis
alcohol → Disufiram effect partner → 95% cure - Not pathogenic, doesn’t produce organic lesions in intestine,
E. F. Trichomonadidae - Die in not more than 35-40 mins in H2O, or outside body > only irritation in intestinal mucosa → mucous diarrhea
• Cytostome 40° - Examine stool
• 3-5 free flagella, additional 1 at margin of undulating membrane - Survive in wet sponges (sev. hrs) & in urine (more than 24 hrs)
• Axostyle protrudes thru posterior - Occur in communal bathing or sharing douche equipment BLOOD & TISSUE FLAGELLATES (HAEMOFLAGELLATES)
• No cystic stage, non-transplantable - Most commonly acquired STInfection • Biological vector: blood sucking insect
a. Genus: Trichomonas - 2.5 M cases/ yr (asymptomatic fem - 3-15%; prosti – 50-75%) • Family: Trypanosomatidae
• Troph: - WBC & Trichoonads – present in vaginal secretions (liquid, • Genera:
o Have costa at base of undulating membrane greenish/yellow) & cover mucosa to urethral orifice & clitoris 1. Leishmania (tropica, braziliensis, donovani)
o ALL are parasitic - Gram (+) cocci & Gram (-) rods may be seen → 2° infection 2. Trypanosoma (gambiense, rhodesiense, cruzi)
1. Trichomonas tenax (T. elongata, T. buccalis) - I.P.: 4-28 days 3. Leptomonas
- Pyriform, 5-12 microns (smaller, more slender than vaginalis) - Vulvar pruritus, vaginal pruritus, vaginal discharge → acute 4. Crethedia
- 5th flagella doesn’t reach pos. end w/ no free pos. extension (after menstruation – inc. vaginal acidity) 5. Herpetomonas
- Costa-chromatic basal rod same length as UM - Dysuria (difficult, painful urination) – 20% of fem. 6. Phytomonas
- 1 bleph. - 90% - have cervical erosions → predisposition to cervical • Stages: (old name)
- Parabasal body – 1 fibril & shorter thicker body carcinoma (AIDS) 1. Amastigote (Leishmania)
- Thick axostyle – start near bleph, extend behind body - Cause prostatis & rarely reversible sterility 2. Promastigote (Leptomonas)
- Ovoidal, vesicular, anterior nucleus w/ chromatin - Male: latent, irritating persistent or recurring urethritis 3. Epimastigote (Crethedia) - UM
 4. Trypomastigote (Trypanosoma) – more elongated
a. Metacyclic
b. Typical
A Leishmania
• 2 stages:
✓ Amastigote – vertebrate host
✓ Promastigote – invertebrate host (Phlebotomiae / sandflies)
• Reservoir host: domesticated & wild animals
• Life Cycle:
❖ Vertebrate:
Bite of infected sandfy → promastigote on skin → engulfed by
RES cells (macrophage) → amastigote → binary fission →
parasitized cell ruptures → Free Amastigote taken by sandflies
OR taken by macrophage
❖ Invertebrate:
Amastigote ingested in gut of sandfly → promastigote (8-20
days) → migrate to pharynx → buccal cavity & mouth →
promastigote in salivary gland transmitted to vertebrate
1 L. tropica
a Minor – dry or urban type cutaneous leishmaniasis
- Oriental sore (wright stain)
- On skin (RES), lymph nodes, neutrophil
- Not found in peripheral blood unless vicinity of ulcer
- Cultivation: NNN (Novy, Mc Neal, Nicolle) medium
- Anthroponosis - common to man
- Sandfly vectors:
➢ Phlebotomus papatasii – India, Pakistan, Afghan,
Mediterranean
➢ P. sergentii – Iran, Iraq, Crete, Portugal, Israel,
Leban.
➢ P. perfilievi – Italy & Sicily
➢ P. pernicrosus – Spain
- I.P.: 6 months
- Good prognosis
- Life-long immunity
b Major – rural or we Cutaneous Leishmaniasis
- Spherical amastigote w/ 1 nucleus
- Zoonosis – human infections occuring sporadically
- P. papatasii & P. caucasicus
- Good prognosis
- High degree of immunity for wt & dry types
- Shorter IP (6 days)
2 L. mexicana & L. braziliensis complex – New World Cutaneous /
Mucocutaneous Leishmaniasis
a L. mexicana complex – fast growing
- L. mexicana mexicana – Chiclero ulcer (face & ears) (Chicle
ulcerative lesions on gum harvesting from sapodilla tress)
- L. mexicana amazonensis – rarely infects human
- L. mexicana pifanoi – dessiminated cutaneous leishmaniasis
- L. mexicana enrietti – in lab animals
b L. braziliensis complex – slow growing
- L. braziliensis braziliensis – Espundia (most notorious of
American Leish. → mutilation, treatment resistance,
persistent)
- L. braziliensis guyanenis – Pian Bois (Forest yaws) – single
ulcerative lesions that metastasize over torso & extremities
- L. braziliensis panamanensis – rare nasopharyngeal
involvement, doesn’t metastasize
- L. braziliensis peruviana – UTA (self-limiting lesions that don’t lymphocytes, proliferation of EC, neuroglial cells bet.
metastasize), involve nasopharynx Blood vessels & perivascular sheath
• Cultivation: NNN medium - 2 forms of trypanosomiasis in Africa:
• LC: same except Genera of sandflies: 1. by rhodesiense → short, end fatally w/in 1 yr
✓ Hertigla 2. by gambiense → longer, milder, ends w/in 1 ½ yr (CNS)
✓ Wareleya - Culture in Weimann’s medium (also rhodesiense)
✓ Brumptomyia 2 T. rhodesiense – Rhodesian trypanosomiasis
✓ Lutzomyia – 310 species - East African Sleeping Sickness
• Sporadic zoonosis 3 T. cruzi – South American Trypanosomiasis
• Dx: demonstrate amastigote: - Chagas disease
➢ Culture in NNN - Vertebrate – all stages exc. Metacyclic trypo.
➢ Serology: o Typ. Tryp – blood
✓ Modified Montenegro intradermal rxn. o Amast., promast., epimast – REC & tissue
✓ Pellegrino test cells
• Chiclero – no Rx - Invertebrate: epimast – gut
3 L. donovani – Visceral Leishmaniasis or Kala-azar Meta. Tryp. – rectum
- In viscera (liver, spleen, BM, lymph nodes) - Bite of infected Reduviid bug (defecate) → rubbed into punctured
- IP: 10 days – more than 1 yr. wound introducing Meta. Tryp. → blood as Tryp. → RES & tissue
B Trypanosoma cells as Amast. →divide → promast. → epimast. → typical tryp. In
• Has typical trypomastigote peripheral blood → bug eats →typ. Tryp. Taken out from man→
• Vertebrate & invertebrate host ingested → intestinal tract → short epimast → multiply → long
epimast → in hindgut before meta. Tryp in 8-10 days → rectum →
• Transmission from insect vector:
feces of bug (no defecation – no infection)
✓ Anterior station – thru bite of blood sucking fly
- Insect vectors:
o Tse-Tse fly: T. gambiense – Glossina palpalis
o Reduviid or Triatomid bugs
T. rhodesiense – Glossina morsitans
✓ Panstrongylus megistus
o Stages:
✓ Rhodnius prolixus
▪ Epimastigote
✓ Triatoma infestans
▪ Trypomastigote Metacyclic
- Other MoT:
▪ Trypomastigote Typical
✓ Thru placenta
✓ Posterior station: fecal contamination of bite of arthropod vector
✓ Thru mother’s milk
o T. cruzi
✓ Sexual contact
o Stages:
✓ Blood transfusion
▪ Complete 5
✓ Accidental ingestion of parasitized bug
▪ T. typical – vertebrates
- 3 forms: Acute, Subacute & Chronic
▪ T. metacyclic - invertebrates
- Initial lesion: Chagoma
• Infection of man of 2 types:
- C-shaped tryp in peripheral blood
✓ African trypanosomiasis (gambiense & rhodosiense)
- Culture in NNN medium
✓ American trypanosomiasis (cruzi)
- Biopsy of chagoma
1 T. gambiense – Gambian trypanosomiasis
- MID or West African Sleeping Sickness
- LC (also for rhodesiense)
Metacyclic trypomastigote (infective stage) → bite of Tse-
Tse fly → trypomastigote invades bloodstream → binary
division → reticular interstices of lymph nodes & spleen →
CSF → typical trypomastigote → taken up by fly → go into
fly’s gut → divide → metamorphosed to epimastigote →
multiply → metacyclic trypomastigote
- Entire cycle in fly: 20 days
- IP: 2-23 days
- Chronic disease w/ 3 progressive stages:
1. Acute – trypomastigote in bloodstream → local
inflammatory rxn. (subside in 1-2 weeks) → enter
bloodstream → multiply → PARASITEMIA
2. Subacute – Tryp in lymph node → produce injurious
effects on every tissue & organ of body (1st: lymph) →
proliferation of Endotheliel cells lining sinuses
3. Chronic – CNS invasion → enter subarachnoid space
then brain substance → infiltration of plasma cells &