Trypanosomes

Question 1

two diseases caused by trypanosoma?

Answer 1

chagas disease and african sleeping sickness

Question 2

once kinetoplastids infect you (trypanosoma/leishmania)….

Answer 2

you are infected for life

Question 3

kinetoplastids are found

Answer 3

in the blood (different forms w flagella or no flagella)

Question 4

the kinetoplast structure? function?

Answer 4

contains DNA organized into minicircles and maxicircles similar to mitochondrial DNA function and need for etensive posttranslational editing is unknown in close association with the basal body in the base of the flagellum

Question 5

trypanosoma cruzi vector? parasite form in vector? parasite form in blood? parasite form in tissue? distribution?

Answer 5

triatomine bugs epimastigote, metacyclic tryp trypomastigote amastigote americas

Question 6

trypanosoma brucei vector? parasite form in vector? parasite form in blood? parasite form in tissue? distribution?

Answer 6

tsetse fly epimastigote, metacyclic tryp trypomastigote extracellular sub-saharan africa

Question 7

leishmania vector? parasite form in vector? parasite form in blood? parasite form in tissue? distribution?

Answer 7

sand fly promastigote - (blood) amastigote global except australia

Question 8

trypanosoma lifecycle

Answer 8

Question 9

remale reduviids prefer to lay eggs…

Answer 9

in cracks crevices

high in rural/poor housing

Question 10

transmission of trypanosomes

Answer 10

animal reservoir for trypanosomes/reduviids = rats,, racoons, skunks, dogs

human-human via blood transfusion/organ transplant

sugarcane juice, guava juice, acai juice

Question 11

in chagas disease, what kills you?

Answer 11

heart disease

Question 12

how many people in US infected w chagas disease?

Answer 12

300,000 with T cruzi

Question 13

phases of T cruzi infection

Answer 13

Question 14

romana sign

Answer 14

eye infection

T cruzi acute phase infection

Question 15

acute chagas disease

Answer 15

febrile; can cause myocarditis and meningoencephalitis

romanas sign = unilateral painless periorbital edema

indurated lesion at site of parasite entry = chagoma

1-2 weeks incubation

**amastigotes in heart muscle

After a stage of initial parasitemia, trypomastigotes pass to the cardiac muscle and smooth muscle lining the intestinal tract. Here they transform into the amastigote

stage. In the heart, this causes myocarditis in the early stages.

Question 16

amastigote vs trypomastigotes

Answer 16

Amastigotes are intracellular form with short/no flagella

trypomastigotes travel in blood and have long flagella

Question 17

t cruzi strains 1 vs 2

Answer 17

type 1 strains are LESS pathogenic than type 2

type 2 occur in southern south america and are human/peridomestic types

type 1 are sylvatic

Question 18

congenital chagas

Answer 18

1-10% of + mothers will past to baby

–severe respiratory distress, meningoencephalitis, hepatosplenomegaly, or myocarditis

Question 19

ekg findings from chagas

Answer 19

conduction issues!

-widened QRS

RBBB (right bundle branch block)

Question 20

chronic chagasic cardiopathy

Answer 20

80% of chronic chagas disease causes heart disease!

conduction issues, arrhythmias, sudden cardiac death, heart failure, thromboembolism, aneurysms

Question 21

chagas GI disease

Answer 21

mega-esophagus or mega-colon (chagasic colopathy) / distended belly

severe constipation and difficulty swallowing

(disrupted autonomic fx)

Question 22

reactivated chagas disease

Answer 22

in immunocompromised host

CNS abscess-like lesions (ring enhanced)

meningoencephalitis

acute myocarditis

febrile episodes + transplant rejection

panniculitis

Question 23

diagnosis of acute chagas

Answer 23

blood smear

peripheral blood will show C shaped trypomastigote with prominent kinetoplast

Question 24

diagnosis of chronic chagas

Answer 24

T cruzi specific antibody (IgG)

–use 2 different serologic test with 2 different antigens

Question 25

chagas treatment

Answer 25

benznidazole (1st line) and nifurtimox \*not FDA approved; get from CDC very effective for acute phase! less for chronic

Question 26

sleeping sickness - other name?

Answer 26

african trypanosomiasis

Question 27

african sleeping sickness outlook

Answer 27

300-500K infected in africa--\> FATAL infection (death in 2 years) very toxic drugs with increasing resistance

Question 28

HAT = human african trypanosomiasis epidemiology?

Answer 28

subsaharan Africa T.b. gambiense (west coast) T.b. rhodesiense (east coast) east african trypanosmiasis (rhodes) is more common in travelers; BUT west (gambi) is more common in endemic populations

Question 29

what do tourists do in east africa to get HAT?

Answer 29

safari!!!! it is a zoonosis very aggressive biting fly! (tsetse)

Question 30

vector for HAT

Answer 30

_tse tse fly (glossina species)_ ## Footnote G.palpalis breeds along rivers, streams, lakes (West Africa) G.morsitans breeds in wooded savannah (East Africa) \*charateristic _cleaver wing_

Question 31

what explains the persistence and resistance of trypanosomiasis

Answer 31

antigenic variation/change! it changes its dense coat of variant surface glycoproteins (VSG) -variant clones that express an alternate VSG gene lacks antigenic cross-reactivity and persists!

Question 32

east and west HAT comparison

Answer 32

Question 33

presentation and progression of HAT

Answer 33

fatal if untreated infected tsetse fly bite --\> parasites injected and replicate into blood (haemo-lymphatic stage) -\> fever, itching, headahces, myalgias, hepatomegaly, anemia winterbottoms sign = posterior cervical adenopathy --\> meningoencephalitic stage

Question 34

winterbottoms sign

Answer 34

posterior cervical adenopathy sign of HAT

Question 35

rhodesiense (east) vs gambiense (west) prognosis

Answer 35

Rhodes --\> death in weeks to months, fulminant illness, shock--\> death may occur before CNS invasion occurs Gambiense --\> early stage unrecognized, CNS invasion after 1-2 years --\> death due to coma/malnutrition

Question 36

what do you see in CSF when sleeping sickness is being diagnosed?

Answer 36

lymphocytes!

Question 37

PSG syndrome of sleeping sickness

Answer 37

(PSG = polysomnography) An alteration of the normal distribution of sleep and wakefulness, proportional to the severity of symptoms. An alteration of the structure of sleep episodes, with the abnormal occurrence of REM sleep.

Question 38

travelers with sleeping sickness do not present with

Answer 38

sleeping issues usually just an acute febrile illness

Question 39

lumbar puncture for HAT/sleeping sickness will show...

Answer 39

CSF with elvated wBC, IgM, total protein, ICP and MOTT cells = large eosinophilic plasma cells that have failed to secrete their antibodies

Question 40

MOTT cells in CSF indicate

Answer 40

afircan sleeping sickness

Question 41

HAT/sleeping sickness treatment early gambiense? late gambiense? early rhodes? late rhodes?

Answer 41

EG = pentamidine LG = eflornithine + nifurtimox ER = suramin (doesnt cross BBB) LR = melarsoprol (arsenical = very toxic)