Leishmania, Trypanasomes And Toxoplasma Spp

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Leishmania is also known as

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Kala-azar, Oriental sore, espundia

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Leishmania is

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Kinteoplastidia (flagellates)

Obligate intracellular protozoa

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Human infection of Leishmania is caused by

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21 of 30 species:

• Phlebotomine (old world) sand flies
• Lutzomyia species (new world)

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The usual host of Leishmania

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Zoonotic

Dog

Fox

Rodent

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Visceral disseminated Disease caused by

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L. donovani complex

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L. donovani complex species

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• L. donovani
• L. infantum
• L. chagasi

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L. donovani complex geographical location

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North Africa

East Africa

South America

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Cutaneous Leishmanias

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• L. mexicana complex (L. mexicana, L. amazonensis, L. vanazuelensis)
• L. tropica

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L. braziliensis complex

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mucocutaneous, disfiguring lesions

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Cutaneous lesions immunity

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Self-limiting

Provide protection immunity

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Infective stage of Leishmania spp.

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promastigotes

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Leishmania promastigotes become

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amastigotes after being phagocytized by macrophages

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Where do Leishmania spp. multiply

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Inside the macrophages

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The vector for Leishmania (Life cycle)

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Sandfly takes a blood meal taking up amastigotes

Sandfly takes a blood meal and injects promastigotes

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Amastigotes in sandfly

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become promastigotes in midgut

multiply and migrate to probicus

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What factors go into a Leishmania infection

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parasite

host

and other factors depend on whether cutaneous or visceral leishmaniasis results

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Cutaneous skin lesions

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Mainly on the face arms and legs

Typically self healing; can create significant disability and permanent scars

Will gain immunity

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Diffuse cutaneous

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L. mexicana

Difficult to treat

Resembles leprosy

Does not spontaneously heal

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What type of lesion causes relapses

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Diffuse cutaneous

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Mucocutaneous

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Disfiguring lesions to the face;

Mucous membranes

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What causes mucocutaneous lesions

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L. braziliensis

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Treatment for mucocutaneous lesion

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Reconstructive surgery of deformities; important part of therapy

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What is the fatal form of Leishmania

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Visceral leishmaniasis

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Visceral leishmaniasis symptoms

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• Irregular fever
• Weight loss
• Swelling of the liver and spleen
• anemia

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Geographical location of visceral leishmaniasis

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• Bangladesh
• Brazil
• Ehthiopia
• India
• Nepal
• Sudan

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PKDL

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Post Kala-azar dermal leishmaniasis

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Incubation period of Visceral leishmania

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Can be months or years

Involving the internal organs

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What is the confirmatory test for VL

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amsatigotes in:

• Lymph nodes (50-65%)
• Bone marrow (53-86%)
• Spleen (93-99%)

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Three species that cause VL

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• L. donovani (East Africa and India
• L. infantum (Eu, N. Africa, and Latin america
• L. Chagasi

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Specimen types for Leishmania

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• Smears
• Touch imprint

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What to look for in laboratory diagnosis of Leishmania?

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Dark nucleus and bar-like kinetoplast within the cytoplasm of macrophages

2-4um

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How long does it take to culture Leishmania

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10-21 days

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Trypanosoma spp is what kind of parasite

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flagellate

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African Trypanosoma

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Brucei:

• rhodesiense
• gambiense

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Geographic distribution of Trypanosoma brucei spp

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Central Africa (Tsetse fly) belt

East and West African Sleeping sickness

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Geographic distribution of American trypanosoma

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Mexico

Central America

South America

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American trypanosoma vector

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Kissing bug (Triatoma spp.)

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What does American trypanosoma cause

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Chaga's disease

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Chaga's disease causes

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• enlarged weakened heart
• fever
• weakness
• enlarged spleen, liver, lymph nodes
• Sudden death
• Can cross placenta

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Chagoma/ Romanan's sign near eye

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Initial bite of kissing bug in children

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Trypanosoma brucei gambiense

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West African Sleeping sickness

Less virulent- limited to lymphatics only

98% of all cases

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Trypanosoma brucei rhodesiense

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East African Sleeping sickness

Rapid and aggressive- spreads to CNS can be fatal

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Trypanosoma cruzi

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Chagas disease

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The most fatal form to Trypanosoma

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Trypanosoma brucei rhodesiense

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Infective stage of Trypanosoma cruzi

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metacyclic trypomastigotes

passes in feces of bite wound

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Diagnostic stage of trypanosoma cruzi

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intracellular amastigote

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Infective stage of Trypanosoma brucei

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metacyclic trypomastigotes

injected in a blood meal

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Where do Trypanosoma brucei develop

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In salivary gland

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Diagnostic stage in Trypanosoma brucei

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trypomastigotess

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Stain used in lab diagnosis of Trypanosoma spp

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Blood (Giemsa)

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Appearance of Trypanosoma in Giemsa stain

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14-33um long X 1.5-3.5um wide

Granular, pale blue cytoplasm with dark blue granules

reddish centrally located early

small kinetoplast at posterior end

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Coccidian protozoa

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Toxoplasma gondii

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What portion of the world has antibodies to Toxoplasm gondii

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1/3

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What kind of disease is Toxoplasma gondii

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Foodborne disease

Sever illness in congenital infection

Immunocompromised: Pregnancy

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TORCH

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Toxoplasma

Other disease

Rubella

Cytomegalovirus

Herpes Simplex virus

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Toxoplasma gondii oocysts

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• Shed in cat feces
• 48-72 hours to sporulate

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Intermediate host in toxoplasma gondii

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rodents

birds

Parasites develop into tissue cyst bradyzoites

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How to cats become infected with toxoplasma gondii

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ingest sporulated oocysts in mice

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Where does sexual development occur for toxoplasma gondii

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cat intestines

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Oocyst of toxoplasma gondii can be found in:

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• infected milk
• contaminated food
• transplacental infection
• undercooked raw meats
• transplant from a positive donor

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Infective stage of toxoplasma gondii

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oocyst

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Diagnostic stage of toxoplasma gondii

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cyst

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Clinical manifestations of toxoplasma gondii

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• Asymptomatic- initial fever and swelling
• Congential- antibodies protect fetus from infection

If infected during pregnancy can be passed on

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If fetus become infected with toxoplasma gondii

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Can cause severe damage or death:

• intracellular calcification
• choroidoretinitis: eye disease
• hydrocephaly
• pyschomotor disturbances and convulsions

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Clinical manifestations of aquired toxoplasma gondii

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• Flu-like, lymphadenopathy
• Fever
• Headache
• myalgia
• may have mononucleosis- like symptoms

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Immunocompromised patients with toxoplasma gondii

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• Opportunistic infection
• almost always from a previous infection
• CNS: Encephalopathy, meningoencephalitis, cerebral mass lesion

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Lab diagnosis of Toxoplasm gondii

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Culture

• Animals
• Tissue culture
• blood, CSF, biopsy
• Amniotic fluid

PCR

• Positive may be due to latent infection
• Must use source that doesn't have latent infection

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Toxoplasma gondii morphology

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Stain with Giemsa or can be tagged with flourescent antibodies

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Toxoplasma gondii treatment

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• Not needed for normal healthy patient
• Recommended: pregnant women, ocular infection, immunocompromised, severe infection
• Infectious disease specialist consult typically recommended

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Tissue sample for L. tropica

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skin

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Tissue sample for L. donovani

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spleen

bone

liver