: ̗̀➛ nido ♡ᰔ૮₍˃ ⤙˂ ₎ა

HEMOFLAGELLATES

Characteristic/ Trypanosoma cruzi Trypanosoma brucei complex

Organism

Common Name

Geographical ● Mostly in poor, rural areas of: ● “Tsetse Belt of Africa”

Distribution ○ Mexico → ⅔ of African content
○ Central America
○ South America

● Chronic Chagas disease is a major health problem in many

Latin American countries

Pathogenesis ● American Trypanosomiasis or Chagas Disease ● African trypanosomiasis

○ Acute and Chronic → it differs according to the location of the disease

● Sleeping Sickness

Habitat ● Reticuloendothelial cells ● ACUTE:

○ Macrophages and monocytes can be invaded ○ Reticular tissues of lymph & spleen
● CHRONIC:
○ CNS

Intermediate Host ● Triatomine bug ● Tsetse Fly

● Reduviid bug
● Kissing bug
→ the supporting character to T. cruzi which act as vectors

→ other genera that compose of the kissing bug:

● Rhodnius
● Panstrongylus
● Triatoma

Reservoir Host ● Man ● Man

● Other vertebrates (dogs and pigs) ● Other vertebrates

Infected form to man ● Metacyclic Trypomastigote ● Metacyclic Trypomastigote

: ̗̀➛ nido ♡ᰔ૮₍˃ ⤙˂ ₎ა

Infected form to ● Typical Trypomastigote ● Typical Trypomastigote

triatomine bug

Mode of Infection ● Skin penetration ● Bite of Tsetse Fly

○ Biting the face / near the lips

→ If it defecates a fluid, it can move to the lowest point of the skin and
penetrate there

Laboratory ● Blood smears ● Blood smears (thick & thin)

Identification ● Tissue biopsy ● Tissue biopsy
● Culture ● Culture
● serology ● Serology

Specimen Source ● Blood ● Blood

● Tissue (sometimes) ● Tissue

Manifestations ● ACUTE: → Pathogenesis: Sleeping Sickness

○ Chagoma
■ are furuncle-like lesions represent → 3 stages of Infection
the site of entry of the parasite, and can ● Trypanosomal Chancre
appear at the site of inoculation ○ Develop on the site of inoculation
■ most likely focal inflammation of the ○ Appears as a wound with a rugged edge
infected site ● Hemolymphatic stage
○ Symptoms:
○ Romana’s Sign ■ Fever
■ an eyelid swelling if the parasite penetrates ■ Lymphadenopathy
through the conjunctiva ● Enlargement of your lymph
nodes
● CHRONIC ■ Pruritus
○ Megacolon ■ Winterbottom’s sign
■ Enlargement of the intestine ● frequently in T.brucei gambiense,
○ Cardiomyopathy the posterior cervical lymph
■ It can also cause severe cardiomyopathy nodes are enlarged, non-tender,
that grows MyoCells from the tissue and have the consistency of ripe
plums
■ Kerandel sign
● Delayed sensation for pain
● Meningoencephalitic stage
○ Invades the CNS causing the following:
■ Headaches
■ Somnolence
: ̗̀➛ nido ♡ᰔ૮₍˃ ⤙˂ ₎ა

■ Abnormal behavior
■ Loss of consciousness
■ Coma

→ Course of infection is much more acute with T.b.rhodesiense than

T.b.gambiense

→ Evasion of immune response due to antigenic variation

→ Only the epimastigote and trypomastigote forms are

exhibited by T.brucei complex

→ Remember, there is no promastigote and amastigote in T.b.

complex.

Diagnosis ● Microscopic examinations → Demonstration of highly motile trypomastigotes in the

○ For motile parasites, fresh anticoagulated blood or
its buffy coat
○ After getting the buffy coat, we perform thin and
thick blood smears
■ Thin smear → thumb-like
■ Thick smear → drop of blood in a centavo
■ Stain with Giemsa : Amastigote &
Trypomastigote (C, S, & U)
■ Only seen by direct exam or thick blood
smears in the first 2 months
○ Isolation of agent / culture in:
■ Novy- MacNeal- Nicolle (NNN) medium
■ Liver Infusion Tryptose (LIT)
○ Inoculation into lab rats/mice
○ Xenodiagnosis
■ Already obsolete since it is invasive
○ Antibody detection
■ Indirect fluorescent antibody test (IFA)
■ Enzyme Immunoassay (EIA)
following:
○ Expressed fluid from a chancre
○ Lymph node aspirate
○ CSF
● Thick and thin blood films/ smearing:
○ Can be stained with Giemsa
● Buffy coat concentration
○ Method is recommended to detect parasites when
they occur in low numbers
● Examination for trypomastigotes
○ Is usually done during the hemolymphatic stage of
the disease, and is more useful for diagnosis to T.
brucei rhodesiense
→ other:
● enzyme-linked immunosorbent assay
● immunofluorescence
● indirect hemagglutination test
● mini-anion exchange centrifugation technique
● PCR

Treatment ● Acute phase: → dependent of the stage

○ Nifurtimox ● Lymphatic stage:
○ Benznidazole ○ Pentamidine
○ Suramin
: ̗̀➛ nido ♡ᰔ૮₍˃ ⤙˂ ₎ა

● Late stage with CNS involvement (if you’re going to go into

a coma)
○ Melarsoprol
○ Tryparsamide
● For early (chancre) & late stages of Gambian sleeping
sickness
○ Eflornithine

Prevention and Control ● Control of the vector by application of effective insecticides to
the walls & thatched roofs of the dwellings
● Proper information, education, & communication among
communities
● Community sanitation
● Blood screening for transfusion in endemic areas
● Through killing those tsetse flies via insecticides
● Proper information
● Control of the vector by application of effective insecticides
to the walls and & thatched roofs of the dwellings (quite
similar to prevention of T. cruzi infection)
● Proper information, education, & communication among
communities
● Blood screening before transfusion in endemic areas
● Community sanitation

General Characteristics

T.b. gambiense T.b. rhodesiense

● Causes West African ● Causes East AFrican

sleeping sickness sleeping sickness

● West Africa ● East

● Central Africa ● Southeast Africa

● Salivarian ● Salivarian
trypanosomes trypanosomes

● Vector tsetse fly Vector tsetse fly

(Glossina palpalis) (Glossina morsitans)
: ̗̀➛ nido ♡ᰔ૮₍˃ ⤙˂ ₎ა

Difference between T. brucei & T. cruzi

Types of T. brucei T. cruzi

forms:

Slender ● Long & thin ● Has a single

● 29 um form
● Free flagellum (monomorphic)
● 20 um in length
● Curves
(c-shaped)

Stumpy ● Thick & short ● Kinetoplast is

● 18 um large
● Typically no ● Larger than T.
free flagellum, brucei
but a short 1
may be present

Intermedi ● Moderately ● Sometimes

ate thick body appear as a
● 23 um long bulge at a
● Free flagellum posterior end
of medium ● Flagellum is a
length medium in
length