Haemoflagellates

Leishmaniasis & Trypanosomiasis

 Protozoan Groups

Apicomplexans

Amebas
Ciliates

Flagellates
 Protozoan Taxonomy
• Morphological taxonomy • Molecular taxonomy
– Phylum sarcomastigophora – Indicate that morphological
• Subphylum mastigophora relationships are tenuous
– Flagellates – Divergence between phyla
» Phytoflagellates of protozoa as great as
» Zooflagellates between kingdoms (ie
• Subphylum sarcodinia animalia, fungi and plantae)
– Amoebas – Revisions are continuously
– Foramiferans occurring
– Radiolarians
– Phylum Ciliophora
• Ciliates
– Phylum Apicomplexa
• parasitic protozoa
• Spore forming protozoans
Intracellular Parasitic Flagellates
 Parasitic Kinetoplastids
• Phylum Euglenozoa
– Subphylum Kinetoplasta
• Class Trypanosomatidea
– Trypanosoma spp
– Leishmania spp
 Trypanosomiasis
• African sleeping sickness – Eastern hemisphere
– Trypanosoma brucei
– Vector – Tsetse Fly - Glossina spp

Immages from links at http://www.biosci.ohio-state.edu/~parasite

 Trypanosomiasis
• Chaga’s disease – Western hemisphere
– Trypanosoma cruzi
– Vector – assassin bug – Rhodnius spp, Panstrongylus spp and
Triatoma spp
Leishmaniasis
• Leishmania spp
• Vector – sandfly – OW Phlebotomus spp,
NW Lutzomyia, Brumptomyia
• Similar protozoan to Trypanosoma sp
• Cutaneous and visceral forms of disease
Life Cycle of Leishmania
Different stages of Haemoflagellates
The life cycle of Leishmania
 Leishmania Parasites and Diseases
SPECIES Disease
*Leishmania tropica
*Leishmania major Cutaneous leishmaniasis
Leishmania aethiopica
Leishmania mexicana
Leishmania braziliensis Mucocutaneous leishmaniasis

*Leishmania donovani
*Leishmania infantum Visceral leishmaniasis
Leishmania chagasi

Endemic in Saudi Arabia *

Sand fly
amastigotes
promastigotes
promastigotes
lesion
lesion
lesion
 Clinical types of cutaneous leishmaniasis
• Leishmania major: Zoonotic cutaneous
leishmaniasis: wet lesions with severe reaction
• Leishmania tropica: Anthroponotic cutaneous
leishmaniasis: Dry lesions with minimal ulceration

Oriental sore (most common) classical self-

limited ulcer
 Uncommon types
• Diffuse cutaneous leishmaniasis (DCL):
Caused by L. aethiopica, diffuse nodular non-
ulcerating lesions. Low immunity to Leishmania
antigens, numerous parasites.
• Leishmaniasis recidiva (lupoid leishmaniasis):
Severe immunological reaction to leishmania
antigen leading to persistent dry skin lesions, few
parasites.
Diffuse cutaneous leishmaniasis

Leishmaniasis recidiva
 cutaneous leishmaniasis

Diagnosis:

• Smear: Giemsa stain – microscopy for LD

bodies (amastigotes)

• Biopsy: microscopy for LD bodies or

culture in NNN medium for promastigotes
NNN medium
Treatment

• No treatment – self-healing lesions

• Medical:
o Pentavalent antimony (Pentostam), Amphotericin B
o +/- Antibiotics for secondary bacterial infection.

• Surgical:
o Cryosurgery
o Excision
o Curettage
 Visceral leishmaniasis

• There are geographical variations.

• The diseases is called kala-azar
• Leishmania infantum mainly affect children
• Leishmania donovani mainly affects adults
 Presentation
• Fever
• Splenomegaly, hepatomegaly,
hepatosplenomegaly
• Weight loss
• Anaemia
• Epistaxis
• Cough
• Diarrhoea
Untreated disease can be fatal

After recovery it might produce a condition

called post kala-azar dermal leishmaniasis
(PKDL)
Fever 2 times a day due to kala-azar
hepatosplenomegaly
mucocutaneous
PKDL
 Visceral leishmaniasis

Diagnosis
(1) Parasitological diagnosis: METHOD

Bone marrow aspirate 1. microscopy

Splenic aspirate 2. culture in NNN medium

Lymph node
Tissue biopsy
Bone marrow aspiration

Bone marrow amastigotes

:Immunological Diagnosis )2(

• Specific serologic tests: Direct Agglutination

Test (DAT), ELISA, IFAT
• Skin test (leishmanin test) for survey of
populations and follow-up after treatment.
• Non specific detection of
hypergammaglobulinaem by formaldehyde
(formol-gel) test or by electrophoresis.
DAT test

ELISA test
Formol-gel
Treatment:
• Pentavalent antimony (Pentostam)
• Amphotericin B
Treatment of complications:
• Anaemia
• Bleeding
• Infections etc.
Trypanosomiasis
 African Trypanosomiasis

Life cycle of Trypanosoma

brucei gambiense & T. b. rhodesiense
 African sleeping sickness

Trypanosoma brucei rhodesiense: East

Africa, wild and domestic animal reservoirs

Trypanosoma brucei gambiense: West and

Central Africa, mainly human infection
Tsetse fly
 Pathology and clinical picture
1. Skin stage: chancre.
2. Haematolymphatic stage: generalized
lymphadenopathy, anaemia, generalized
organ involvement.
3. Central nervous system stage (CNS):
Meningoencephalitis.
(Development of the disease more rapid in
Trypanosoma brucei rhodesiense)
chancre
Winterbottom’s stage
3rd stage CNS
Lymph node aspirate
trypanosoma
CSF
AMERICAN TRYPANOSOMIASIS

LIFE CYCLE OF Trypanosoma cruzi

Reduviid (Triatomine) bug
 Diagnosis
• Blood film
• Serology: IFAT
• Xenodiagnosis: feeding bugs on a suspected
cases.
T. cruzi causes cutaneous stage (chagoma)
Ocular (Romana’ sign)
C-shape
 TREATMENT
African trypanosomiasis
For early infection
• pentamidine
• suramin
For late infection
• eflornithine (Diflouromethylornithine- DFMO)

American trypanosomiasis (Chaga’s disease)

• benznidazole
• nifurtimox
Trichomonas vaginalis
Transmission:

• sexual intercourse
• contact with contaminated objects.
 Pathology

Female:
vaginitis, profuse thin yellowish discharge with
bad smell

Male:
invasion of urethra, prostate and seminal vesicles,
causing urethritis but mostly asymptomatic.
trophozoites
 Diagnosis

• Identification of parasite by microscopy of

discharge.
• Examination of vaginal or urethral
discharge for T. vaginalis
Treatment:
metronidazole (flagyl).

Note:
Treat sexual partner because infection is
mostly asymptomatic in males.