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Blood- Tissue- Flagellates

Parasitology (Our Lady of Fatima University)

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BLOOD & TISSUE FLAGELLATES PROMASTIGOTE

(HEMOFLAGELLATES)  “LEPTOMONAS STAGE”
 Spindle – shaped body
 Presence single free flagellum arising from
What are hemoflagellates?
 Kinetoplast at anterior end
 These are the parasites that inhabit the tissue
 15 – 20 um 1.5 – 3.5 um
and the blood of human with the aid of phoretic
 No undulating membrane
vector
 Flagella – found in the posterior part of the
body

Characteristics:
EPIMASTIGOTE
1) Fusiform body – spindle shaped body
 “CRITHIDIA STAGE”
2) Nucleus centrally located
 Spindle-shaped , longer
3) Single flagellum
 Single nucleus with karyosome
4) Kinetoplast - an accessory body found in many
 Parabasal body
protozoa, primarily the Mastigophora; It contains
 Blepharoplast
DNA and replicates independently.
 Axoneme  flagellum
Function – coordination of movement
 Undulating membrane along the course
 Parabasal body - A structure near the nucleus  Flagellum - found/starts at the center of the
in certain parasitic flagellates. body
 Blepharoplast - A basal body in certain
flagellated protozoans that consists of a
minute mass of chromatin embedded in the
cytoplasm at the base of the flagellum
5) Axoneme – found at inner portion

4 STAGES
1. Amastigote
2. Promastigote TRYPOMASTIGOTE
3. Epimastigote  “TRYPANOSOMA STAGE”
4. Trypomastigote  Nucleus located anterior to Kinetoplast
 Full body length undulating membrane
AMASTIGOTE  Body of the parasite is curved
 “LEISHMANIA STAGE”  Flagella – start at the anterior part of its body
 Ovoidal shaped
 Single nucleus with karyosome
 Parabasal body
 Blepharoplast
 Axoneme
 Found intracellularly in monocytes,
 Endothelial cells
 NON-FLAGELLATED STAGE
 Non-motile

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Hemoflagellates (Family: Trypanosomatidae)

MODE OF TRANSMISSION:
Genus :
1. Bite blood-sucking invertebrate
A. Trypanosoma brucei gambiense
a. Glossina flies (scientific name) or
Trypanosoma brucei rhodesiense Tse – tse fly(common name)
Trypanosoma cruzi b. Reduviid bug
B. Leishmania tropica 2. Ingestion infected feces of intermediate host by
Leishmania braziliense definitive host
Leishmania donovani 3. Entrance / inoculation of parasite through
abrasion / break skin.
C. Leptomonas
D. Herpetomonas NOTE:
E. Phytomonas
Trypanosoma group
causative agent of Sleeping Sickness
Leishmania group
TRYPANOSOMA causative agents of Leishmaniasis

MORPHOLOGY:
 Elongated spindle – shaped body w/ more or less
rounded posterior end & Tapering anterior end
 Parabasal body
Axoneme usually 1 single

Blepharoplast structure

 Single flagellum arising from blepharoplast &

runs
 Anterior to form the margin of undulating
membrane
 Oval nucleus at center w/ central karyosome

Life Cycle

Trypanosoma brucei

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Trypanosoma brucei gambiense DIAGNOSIS

 Microscopic examination smear from lymph,
Geographical Dist: Central & West Coast of Africa  Blood(febrile) & CSF(sleeping sickness)
 Detect anti-trypanosome Antibodies
Disease : A. Immunoflourescense test
 Gambian Sleeping Sickness B. Indirect hemagglutination test (IHAT)
 West African Trypanosomiasis
Habitat: CULTURE MEDIUM : NNN (Novy MacNeal Nicole)
o FEBRILE STAGE (Blood & Lymph nodes)
fever, nausea, etc TREATMENT
o SLEEPING SICKNESS (Cerebrospinal fluid)  Pentamidine & Suramin: very effective if given
during blood - lymphatic stage
the parasite can be found in the brain
 Tryparsamide: 2-3 grams  15-20 weeks
Reproduction: Longitudinal binary fission  Metarsoprol - for late stage with CNS
Final Host: Man involvement

Intermediate Host: Tse- tse fly (Glossina spp.)

- Glossina palpalis
- Glossina fuscipes
- Glossina tachinoides
Infective Stage: Metacyclic trypomastigote
Diagnostic Stage: Trypomastigote (in blood)

2 stages of development :
1. Trypomastigote  vertebrate host
2. Epimastigote  Invertebrate host

Habitat:
 Blood
 LN
 CSF
 Connective tissue Intracellular space brain
 Lymph channels throughout body

PATHOGENESIS
 Adenitis – inflammation of lymph nodes
 Tachycardiac – rapid heart beat
 Dizziness
 Muscle pain
 Meningoencephalitis
1st year of infection: FEVER (ON/OFF)
2nd year of infection: SLEEPING
3rd year of infection: SLEEP (COMA) & DEATH
 Chancre – location where the fly bite
 WINTERBOTTOM SIGN – enlargement of the
post cervical area of the spine
o Consistency : Plum
o This sign means that the parasite is
active and may enter the CNS
 Kerandel’s sign - delayed reaction to pain

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Trypanosoma brucei rhodisiense  Thin blood smear stained with Giemsa.

 Typical trypomastigote stages (the only stages
found in patients), with a posterior kinetoplast,
Geographical Dist : East Africa
a centrally located nucleus, an undulating
Disease : membrane, and an anterior flagellum.
 East African Sleeping Sickness
 Rhodesian Sleeping Sickness  The two Trypanosoma brucei species that cause
Course of infection  1 year human trypanosomiasis, T. b. gambiense and T.
b. rhodesiense, are undistinguishable
Morphology, Pathogenesis, Life cycle morphologically.
 resembles T. gambiense
Symptomatology :
 More severe manifestation
 Course rapid
 Death early if CNS is involved
 Fever,myalgia,rigor,lethargy,mental disturbance

FINAL HOST: Man

INTERMEDIATE HOST: Tse-tse fly (Glossina spp.)

Glossina morsitans
Glossina pallidipes
Glossina swynertoni

PREVENTION
1) Reduction of contact w/ Tse-Tse flies through
control measures against them( traps, screen,
insecticide)
2) Reduction of human infection by diagnosis &
treatment of infected person

Clinical Features:
 Infection occurs in 3 stages.A trypanosomal
chancre can develop on the site of inoculation.
 This is followed by a hemolymphatic stage with
symptoms that include fever, lymphadenopathy,
and pruritus.
 In the meningoencephalitic stage, invasion of
the central nervous system can cause
headaches, somnolence, abnormal behavior,
and lead to loss of consciousness and coma.
The course of infection is much more acute with
T. b. rhodesiense than T. b. gambiense.

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PATHOGENESIS
Trypanosoma cruzi
 CHAGOMA - Subcutaneous lesion/ edema
 ROMAÑAS SIGN  Peri orbital swelling of the
Synonym : eyelid
1. Schozitrypanum cruzi o Allergic reaction
2. Trypanosoma escomele o Bite of the bug
3. Trypanosoma triatomae  EARLY STAGE: Few motile organism in the
blood
Disease : South American Trypanosomiasis o ACUTE STAGE: Febrile stage
(Sleeping sickness) o CHRONIC STAGE: Sleeping sickness
(Chagas disease )  Can invade heart, colon, spleen, esophagus
 MYOCARDITIS
Habitat:  MEGACOLON
 Reticulo endothelial cells  MEGAESOPHAGOUS
 Cardiac muscle
 Central Nervous system LAB DIAGNOSIS:
1. Microscopic demonstration of parasite stained
Geographical Distribution: blood smear / lymph node aspirate
Central & South America 2. Culture NNN med or Chang’s medium
3. Serological: CF (Complement Fixation)
 T. cruzi: American trypanosomiasis was first
4. XENODIAGNOSIS – uses virgin bug (cultured in
described by Carlos Chagas in Brazil in 1909.
the lab)for the diagnosis
The infection, Chagas' disease, is caused by
5. Cruzin’s test
the hemoflagellate Trypanosoma cruzi
 T. cruzi: the disease is a public health threat PROGNOSIS:
in most Latin American countries, although  Bad if CNS & Heart involved
cases due to blood derivatives or blood
transfusion has been reported in non- TREATMENT
endemic regions.  Primaquine (partially effective)
 Nifurtimox (acute cases)
MOT : o There is no entirely available drug for
1. Bite of reduviid bug which defecate at site of treatment / prevention of the disease
inoculation
2. Accidental ingestion of bug
3. Blood transfusion

Intermediate host:
- Reduviid bug
- Virgin bug
- Triatomid bug
- Assassin bug
- Kissing bug
- Cone nose bug
- Triatoma rubro fasciata (scientific name)

Final host: Man

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HABITAT: Visceral organ

LEISHMANIA o Reticuloendothelial cells
o Bone marrow
 3 species recognized according to clinical entities : o Spleen
1) Cutaneous o Lymph node
2) Mucocutaneous o Liver
3) Visceral
 Differentiation among species causing disease in FINAL HOST: Man
human is difficult  Clinical grounds
INTERMEDIATE HOST: Sandfly (Plebotomus spp.)
2 Morphological Stages Plebotomus argentipes
1. Amastigote Plebotomus chinensis
- found intracellularly in vertebrate host Lutzomyia
(human)
2. Promastigote
- found midgut of intermediate host
(sandfly )

Life cycle

MODE OF TRANSMISSION:
1. Insect bite
2. Blood transfusion
3. Congenital transmission
4. Accidental needlestick injury

PATHOLOGY
 Papule formation at site of bite  bloodstream
 engulf by macrophages & endothelial cells
 Incubation period: 2 – 4 months
 Headache, malaise, bleeding mucous membrane
spleens & hepatomegaly
 Kala-azar - black fever
 Splenomegaly
 Hepatomegaly

DIAGNOSIS
Leishmania donovani  Demonstrate parasite from blood & tissue
Smear  Amastigote
 Causative agent of VISCERAL LEISHMANIASIS  Splenic puncture
o Kala-azar disease  Bone marrow aspiration
o Dum-dum fever  Hepatic/ Lymph node puncture
o Black disease
CULTURE MEDIUM: NNN (Novy MacNeal Nicole)
Geographical Distribution :
 Worldwide – India, Asia, Southern,Russia, TREATMENT:
Northern China, East Africa, all countries 1. Pot. antimony tartrate
bordering Mediteranean 2. Antimony tartrate
3. Neostibosan
4. Hydroxy stilbamidine
5. Isethionate

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6.
Leishmania tropica Leishmania braziliensis
 Causative agent of CUTANEOUS LEISHMANIASIS
 Causative agent of MUCOCUTANEOUS
 Old World Cutaneous Leishmaniasis
LESIHMANIASIS
o Wet / Rural cutaneous leishmaniasis,
 New World Cutaneous Leishmaniasis
Dry / Urban cutaneous leishmaniasis,
o Espundia, Bubas, Chiclero ulcer
Oriental Sore, Delhi boil, Baghdad boil,
(Leishmania mexicana), Uta (Leishmania
Jerico boil, Aleppo button
peruviana), American leishmaniasis
Geographical distribution : Synonym : L. tropica var. Americana
 Israel, Jordan, Iran, Portugal, Spain, Southern
France, North Africa, Southern France, North Geographical Distribution : Central & South America
Africa, Southeast Asia, Countries in the Morphology : resembles L. tropica
mediteranean, Europe, & Central America
Habitat :
Habitat :  Tissue cell, endothelial cell, monocyte, mucous
 Leishmania tropica is a parasite of skin of human membrane, nose (nasal septum), mouth &
1. Endothelial cells of capillaries of infected pharynx
areas  Not found peripheral blood
2. Nearby lymph nodes  Rarely localized in visceral organ
3. Within mononuclear cells, neutrophilic
leukocyte FINAL HOST: Man
 Not found peripheral blood
 Rarely dessiminate INTERMEDIATE HOST: Sandfly (Plebotomus spp.)
 Mainly cutaneous Plebotomus peruensis
Plebotomus verucarrum
FINAL HOST: man Lutzomyia
Psychodopygus
INTERMEDIATE HOST: Sandfly (Plebotomus spp.)
Plebotomus papatasii PATHOLOGY:
Plebotomus sergenti  Weeping lesion (face, mouth, nasal cartilage of
the facial bone)
PATHOLOGY:  Erosion of nasal septum and palate (Tapir nose)
 Incubation period: 2 – 4 weeks
 1O lesion  reddish papule, itchy, gradually DIAGNOSIS:
enlarges, soft at center rupture  ulcer 1. Smear from ulcer ® demonstrate amastigote
formation (large raised with indurated edges) stage
 Ulcer may be single / multiple 2. Serology – CFT
 Most often seen on exposed area of body 3. Culture – Novy MacNeal Nicole (NNN)
 2O bacterial infection are common 4. Montenegro Skin Test

DIAGNOSIS: TREATMENT:
1) Smear of exudate ulcer edge 1. Berberine sulfate
2. Fuadin
Wright/ Giemsa stain

Demonstrate amastigote stage

mononuclear cells
2) Culture- Novy MacNeal Nicole (NNN)
3) Biopsy of ulcer
4) Serology
5) Dermal test

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