23<br />Microbial Diseases of the Cardiovascular and Lymphatic Systems<br />
The Cardiovascular System and Lymphatics System<br />Blood: Transports nutrients to and wastes from cells.<br />WBCs: Defe...
Sepsis and Septic Shock<br />Sepsis: Bacteria growing in the blood<br />Severe sepsis: Decrease in blood pressure<br />Sep...
Sepsis<br />Gram-negative sepsis<br />Endotoxins caused blood pressure decrease.<br />Antibiotics can worsen condition by ...
Sepsis<br />Puerperal sepsis (childbirth fever)<br />Streptococcus pyogenes<br />Transmitted to mother during childbirth b...
Bacterial Infections of the Heart<br />Endocarditis: Inflammation of the endocardium<br />Subacute bacterial endocarditis:...
Rheumatic Fever<br />Inflammation of heart valves<br />Autoimmune complication of Streptococcus pyogenes infections<br />F...
RF<br />RF is characterized by a constellation of findings <br />major manifestations <br />(1) migratory polyarthritis of...
RF<br />minor manifestations (nonspecific signs and symptoms) <br />fever, arthralgia<br />elevated blood levels of acute ...
RF<br />After an initial attack, there is increased vulnerability to reactivation of the disease with subsequent pharyngea...
Tularemia<br />Francisella tularensis, gram-negative rod<br />Transmitted from rabbits and deer by deer flies.<br />Bacter...
Brucellosis (Undulant Fever)<br />Brucella, gram-negative rods that grow in phagocytes.<br />B. abortus (elk, bison, cows)...
Anthrax<br />Bacillus anthracis, gram-positive, endospore-forming aerobic rod<br />Is found in soil.<br />Cattle are routi...
Anthrax<br />Gastrointestinal anthrax<br />Ingestion of undercooked food contaminated food<br />50% mortality.<br />Inhala...
Biological Weapons<br />1346: Plague-ridden bodies used by Tartar army against Kaffa.<br />1925: Plaque-carrying flea bomb...
Biological Weapons<br />
Gangrene<br />Ischemia: Loss of blood supply to tissue.<br />Necrosis: Death of tissue.<br />Gangrene	: Death of soft tiss...
Animal Bites and Scratches<br />Pasteurella multocida<br />Clostridium<br />Bacteroides<br />Fusobacterium<br />Bartonella...
Plague<br />Yersinia pestis, gram-negative rod<br />Reservoir: Rats, ground squirrels, and prairie dogs<br />Vector: Xenop...
Plague<br />Figures 23.10, 23.11<br />
Relapsing Fever<br />Borrelia spp., spirochete<br />Reservoir: Rodents<br />Vector: Ticks<br />Successive relapses are les...
Lyme Disease<br />Borrelia burgdorferi<br />Reservoir: Deer<br />Vector: Ticks<br />Figures 23.13b–c<br />
Lyme Disease<br />Figure 23.13a<br />
Lyme Disease<br />First symptom: Bull's eye rash<br />Second phase: Irregular heartbeat, encephalitis<br />Third phase: Ar...
Figure 23.12<br />
Ehrlichiosis<br />Ehrlichia, gram-negative, obligately intracellular (in white blood cells)<br />Reservoir: Deer, <br />ro...
Typhus<br />Epidemic typhus<br />Rickettsia prowazekii<br />Reservoir: Rodents<br />Vector: Pediculus humanus corporis<br ...
Typhus<br />Epidemic murine typhus:<br />Rickettsia typhi<br />Reservoir: Rodents<br />Vector: Xenopsylla cheopsis<br />
Spotted Fevers (Rocky Mountain Spotted Fever)<br />Rickettsia rickettsii<br />Measles-like rash except that the rash appea...
Spotted Fevers (Rocky Mountain Spotted Fever)<br />Figure 23.16<br />
Tick Life Cycle<br />Figure 23.17<br />
Human Herpes Virus 4 Infections<br />Ebstein  Barr Virus   EBV<br />Infectious Mononucleosis<br />Childhood infections are...
Infectious Mononucleosis<br />Figure 23.20<br />
Cytomegalovirus Infections<br />Cytomegalovirus (Human herpesvirus 5)<br />Infected cells swell (cyto-, mega-)<br />Latent...
Viral Hemorrhagic Fevers<br />
Ebola Virus<br />Figure 23.21<br />
American Trypanosomiasis (Chagas’ Disease)<br />Trypanosoma cruzi<br />Reservoir: Rodents, opossums, armadillos<br />Vecto...
Toxoplasmosis<br />Toxoplasma gondii<br />Figure 23.23<br />
Malaria<br />Plasmodium vivax, P. ovale, P. malariae, P. falciparum<br />Anopheles mosquito<br />Figure 12.31b<br />
Malaria<br />Figure 23.25<br />
Malaria<br />Figure 23.24<br />
Malaria<br />Figure 12.19<br />
OTHER PROTOZOA<br />BLOOD and TISSUE PROTOZOA<br />Plasmodium<br />Babesia<br />Trypanosomabrucei<br />Trypanosomacruzi<br...
PROTOZOA FROM OTHER BODY SITES<br />Free-living Amebae<br />Naegleria<br />Acanthamoeba<br />Trichomonasvaginalis<br />
PLASMODIUM<br />Disease: Malaria<br />P. vivax: Benign tertian malaria<br />P. malariae: Quartan malaria<br />P. falciparu...
Infected RBC: <br />P. vivax and P. ovale: reticulocytes<br />P. malariae: senescent erythrocytes<br />P. falciparum: eryt...
P. falciparum: Blood Stage Parasites<br />Thin Blood Smears<br />Fig. 1: Normal red cell; <br />Figs. 2-18: Trophozoites (...
Gametocytes of P. falciparumin thin blood smears.  Note the presence of a “Laveran’s bib”, which is not always visible.<br />
P. falciparumrings have delicate cytoplasm and 1 or 2 small chromatin dots.  Red blood cells (RBCs) that are infected are ...
P. falciparum schizonts: seldom seen in peripheral blood.  Mature schizonts have 8 to 24 small merozoites; dark pigment, c...
Plasmodium malariae: Blood Stage Parasites<br />Thin Blood Smears<br />Fig. 1: Normal red cell; Figs. 2-5: Young trophozoi...
P. malariae rings:have sturdy cytoplasm and a large chromatin dot.  The red blood cells (RBCs) are normal to smaller than ...
P. malariaeschizonts:have 6 to 12 merozoites with large nuclei, clustered around a mass of coarse, dark-brown pigment.  Me...
P. malariaetrophozoites:have compact cytoplasm and a large chromatin dot.  Occasional band forms and/or "basket" forms wit...
Plasmodium ovale: Blood Stage Parasites<br />Fig. 1: Normal red cell; <br />Figs. 2-5: Young trophozoites (Rings); <br />F...
P. ovale gametocytes: round to oval, and may almost fill the red blood cells (RBCs).  Pigment is brown and more coarse tha...
Plasmodium vivax: Blood Stage Parasites<br />Thin Blood Smears<br />Fig. 1: Normal red cell; <br />Figs. 2-6: Young tropho...
P. vivax gametocytes: round to oval with scattered brown pigment and may almost fill the red blood cell (RBC).  RBCs are e...
P. vivax rings: have large chromatin dots and can show amoeboid cytoplasm as they develop. RBCs can be normal to enlarged ...
P. vivax schizonts: large, have 12 to 24 merozoites, yellowish-brown, coalesced pigment, and may fill the red blood cell (...
P. vivaxtrophozoites:show amoeboid cytoplasm, large chromatin dots, and have fine, yellowish-brown pigment. <br />
Positive IFA result with P. malariaeschizont antigen.<br />
TRYPANOSOMA BRUCEI<br />Disease: African trypanosomiasis<br />T. b. gambiense: Gambian trypanosomiasis, West & Mid-African...
Site in host: lymph glands, blood stream, brain<br />Portal of entry: skin<br />Source of infection: tsetse fly<br />Winte...
Trypomastigote: slender to fat and stumpy forms; in Giemsa stained films – C or U shaped forms NOT seen; small, oval kinet...
A dividing parasite is seen at the right. Dividing forms are seen in African trypanosomiasis, but not in American trypanos...
Tsetse fly. The vector of African trypanosomiasis<br />
Winterbottoms sign<br />
TRYPANOSOMA CRUZI<br />Disease:American trypanosomiasis, Chaga’s disease<br />Lab Dx: Giemsa stained thick and thin blood ...
Trypomastigote:shape is short & stubby to long & slender; in Giemsa stained blood films – C or U shaped; kinetoplast is la...
Trypanosomacruzicrithidia<br />
Trypanosoma cruzi: Leishmanial form <br />
Riduviid bug:the vector of American trypanosomiasis<br />
Ramana's sign: unilateral conjunctivitis and orbital edema  <br />
TOXOPLASMA GONDII<br />Disease:Toxoplasmosis<br />Site in host: All organs<br />Portal of entry: <br />Ingestion of oocyst...
- Definitive host: domestic cats<br />    - Intermediate host:  infected rodents<br />Accidental intermediate host: humans...
T. gondiioocysts in a fecal floatation (100×).<br />
A: Positive reaction (tachyzoites + human antibodies to Toxoplasma + FITC-labelled antihuman IgG = fluorescence.)<br />B: ...
LEISHMANIA<br /><ul><li>Disease:
L. tropica complex: Old Word Cutaneousleishmaniasis (oriental sore, Aleppo boil, Delhi ulcer, Baghdad boil)
L. mexicana complex: New Word Cutaneousleishmaniasis (chiclero ulcer, bay sore)
L. braziliensis complex: Mucocutaneusleishmaniasis (espundia, uta)
L. donovani: Visceral leishmaniasis (kala-azar or black disease, Dumdum fever)</li></li></ul><li><ul><li>Lab Dx: Giemsa st...
Site in host: Monocytes/macrophages of skin & mucosa
Portal of entry: Skin
Source of infection: Phlebotomus or Lutzomiya fly</li></li></ul><li>
L. tropicaamastigotes:ovoid in shape; large & eccentric nucleus; small, rodlikekinetoplast positioned opposite the nucleus...
Leishmaniasis<br />
BABESIA<br />Disease:Babesiosis<br />Lab Dx: Giemsa stained thick and thin blood smears<br />
Babesiamicroti infection, Giemsa stained thin smear.  The organisms resemble P. falciparum; however Babesia parasites pres...
Infection with Babesia.  Giemsa stained thin smears showing the tetrad, a dividing form pathognomonic for Babesia.  Note a...
Schistosomiasis<br />Figure 23.28<br />
Schistosomiasis<br />Tissue damage (granulomas) in response to eggs lodging in tissues<br />
Schistosomiasis<br />Figure 23.27a<br />
SCHISTOSOMA MANSONI<br /><ul><li>Disease: Schistosomiasis, intestinal schistosomiasis, bilharziasis “snail fever”
Site in host: veins of LI
Portal of entry: skin
Definitive host: humans, baboons & rodents
Intermediate host: snail (Biomphalaria sp & Tropicorbis sp)
Infective stage: cercariae
Lab Dx: eggs in stool; rectal or liver biopsy</li></li></ul><li>
Biomphalaria spp.<br />
Schistosomamansoni eggs:large (length 114 to 180 µm) and have a characteristic shape, with a prominent lateral spine near ...
Male and female schistosomes. <br />
SCHISTOSOMA HAEMATOBIUM<br /><ul><li>Disease: Urinary schistosomiasis, schistosomalhematuria, urinary bilharziasis
Site in host: veins of urinary bladder
Portal of entry: skin
Definitive host: humans, monkeys & baboons
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Bloodlytmphatic diusease

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Bloodlytmphatic diusease

  1. 1. 23<br />Microbial Diseases of the Cardiovascular and Lymphatic Systems<br />
  2. 2. The Cardiovascular System and Lymphatics System<br />Blood: Transports nutrients to and wastes from cells.<br />WBCs: Defend against infection.<br />Lymphatics: Transport interstitial fluid to blood.<br />Lymph nodes: Contain fixed macrophages.<br />
  3. 3. Sepsis and Septic Shock<br />Sepsis: Bacteria growing in the blood<br />Severe sepsis: Decrease in blood pressure<br />Septic shock: Low blood pressure cannot be controlled<br />Figure 23.3<br />
  4. 4. Sepsis<br />Gram-negative sepsis<br />Endotoxins caused blood pressure decrease.<br />Antibiotics can worsen condition by killing bacteria.<br />Gram-positive sepsis<br />Nosocomial infections<br />Staphylococcus aureus<br />Streptococcus pyogenes<br />Group B streptococcus<br />Enterococcus faecium and E. faecalis<br />
  5. 5. Sepsis<br />Puerperal sepsis (childbirth fever)<br />Streptococcus pyogenes<br />Transmitted to mother during childbirth by attending physicians and midwives.<br />
  6. 6. Bacterial Infections of the Heart<br />Endocarditis: Inflammation of the endocardium<br />Subacute bacterial endocarditis: Alpha-hemolytic streptococci from mouth<br />Acute bacterial endocarditis: Staphylococcus aureus from mouth<br />Pericarditis: Streptococci<br />
  7. 7. Rheumatic Fever<br />Inflammation of heart valves<br />Autoimmune complication of Streptococcus pyogenes infections<br />Figure 23.5<br />
  8. 8.
  9. 9. RF<br />RF is characterized by a constellation of findings <br />major manifestations <br />(1) migratory polyarthritis of the large joints <br />(2) carditis, <br />(3) subcutaneous nodules<br />(4) erythemamarginatum of the skin<br />(5) Sydenham chorea, a neurologic disorder with involuntary purposeless, rapid movements.<br />
  10. 10. RF<br />minor manifestations (nonspecific signs and symptoms) <br />fever, arthralgia<br />elevated blood levels of acute phase reactants<br /> CRP, ESR, ASO<br />The diagnosis is established by the so-called Jones criteria: <br />evidence of a preceding group A streptococcal infection, with the presence of two of the major manifestations listed above or one major and two minor manifestations<br />
  11. 11. RF<br />After an initial attack, there is increased vulnerability to reactivation of the disease with subsequent pharyngeal infections, and the same manifestations are likely to appear with each recurrent attack.<br />Carditis is likely to worsen with each recurrence, and damage is cumulative. <br />valvular disease <br />cardiac murmurs, cardiac hypertrophy and dilation, and heart failure, arrhythmias (particularly atrial fibrillation in the setting of mitral stenosis), thromboembolic complications, and infective endocarditis.<br />
  12. 12. Tularemia<br />Francisella tularensis, gram-negative rod<br />Transmitted from rabbits and deer by deer flies.<br />Bacteria reproduce in phagocytes.<br />Figure 23.6<br />
  13. 13. Brucellosis (Undulant Fever)<br />Brucella, gram-negative rods that grow in phagocytes.<br />B. abortus (elk, bison, cows)<br />B. suis (swine)<br />B. melitensis (goats, sheep, camels)<br />Undulating fever that spikes to 40°C each evening.<br />Transmitted via milk from infected animals or contact with infected animals.<br />
  14. 14. Anthrax<br />Bacillus anthracis, gram-positive, endospore-forming aerobic rod<br />Is found in soil.<br />Cattle are routinely vaccinated.<br />Treated with ciprofloxacin or doxycycline.<br />Cutaneous anthrax<br />Endospores enter through minor cut<br />20% mortality<br />
  15. 15. Anthrax<br />Gastrointestinal anthrax<br />Ingestion of undercooked food contaminated food<br />50% mortality.<br />Inhalational anthrax<br />Inhalation of endospores.<br />100% mortality.<br />Figure 23.7<br />
  16. 16. Biological Weapons<br />1346: Plague-ridden bodies used by Tartar army against Kaffa.<br />1925: Plaque-carrying flea bombs used in the Sino-Japanese War.<br />1950s: U.S. Army spraying of S. marcescens to test weapons dispersal.<br />1972: International agreement to not possess biological weapons.<br />1979: B. anthracis weapons plant explosion in the Soviet Union.<br />1984: S. enterica used against the people of The Dalles.<br />2001: B. anthracis distributed in the United States<br />
  17. 17. Biological Weapons<br />
  18. 18. Gangrene<br />Ischemia: Loss of blood supply to tissue.<br />Necrosis: Death of tissue.<br />Gangrene : Death of soft tissue.<br />Gas gangrene<br />Clostridium perfringens, gram-positive, endospore-forming anaerobic rod, grows in necrotic tissue<br />Treatment includes surgical removal of necrotic tissue and/or hyperbaric chamber.<br />
  19. 19. Animal Bites and Scratches<br />Pasteurella multocida<br />Clostridium<br />Bacteroides<br />Fusobacterium<br />Bartonella hensellae: Cat-scratch disease<br />
  20. 20. Plague<br />Yersinia pestis, gram-negative rod<br />Reservoir: Rats, ground squirrels, and prairie dogs<br />Vector: Xenopsylla cheopsis<br />Bubonic plague: Bacterial growth in blood and lymph<br />Septicemia plague: Septic shock<br />Pneumonic plague: Bacteria in the lungs<br />
  21. 21. Plague<br />Figures 23.10, 23.11<br />
  22. 22. Relapsing Fever<br />Borrelia spp., spirochete<br />Reservoir: Rodents<br />Vector: Ticks<br />Successive relapses are less severe<br />
  23. 23. Lyme Disease<br />Borrelia burgdorferi<br />Reservoir: Deer<br />Vector: Ticks<br />Figures 23.13b–c<br />
  24. 24. Lyme Disease<br />Figure 23.13a<br />
  25. 25. Lyme Disease<br />First symptom: Bull's eye rash<br />Second phase: Irregular heartbeat, encephalitis<br />Third phase: Arthritis<br />Figure 23.14<br />
  26. 26. Figure 23.12<br />
  27. 27. Ehrlichiosis<br />Ehrlichia, gram-negative, obligately intracellular (in white blood cells)<br />Reservoir: Deer, <br />rodents<br />Vector: Ticks<br />Figure 23.15<br />
  28. 28. Typhus<br />Epidemic typhus<br />Rickettsia prowazekii<br />Reservoir: Rodents<br />Vector: Pediculus humanus corporis<br />Transmitted when louse feces rubbed into bite wound<br />
  29. 29. Typhus<br />Epidemic murine typhus:<br />Rickettsia typhi<br />Reservoir: Rodents<br />Vector: Xenopsylla cheopsis<br />
  30. 30. Spotted Fevers (Rocky Mountain Spotted Fever)<br />Rickettsia rickettsii<br />Measles-like rash except that the rash appears on palms and soles too.<br />Figure 23.18<br />
  31. 31. Spotted Fevers (Rocky Mountain Spotted Fever)<br />Figure 23.16<br />
  32. 32. Tick Life Cycle<br />Figure 23.17<br />
  33. 33. Human Herpes Virus 4 Infections<br />Ebstein Barr Virus EBV<br />Infectious Mononucleosis<br />Childhood infections are asymptomatic.<br />Transmitted via saliva<br />Characterized by proliferation of monocytes<br />Burkitt’s lymphoma<br />Nasopharyngeal carcinoma<br />Cancer in immunosuppressed individuals, and malaria and AIDS patients<br />
  34. 34. Infectious Mononucleosis<br />Figure 23.20<br />
  35. 35. Cytomegalovirus Infections<br />Cytomegalovirus (Human herpesvirus 5)<br />Infected cells swell (cyto-, mega-)<br />Latent in white blood cells<br />May be asymptomatic or mild<br />Transmitted across the placenta; may cause mental retardation<br />Transmitted sexually, by blood, or by transplanted tissue<br />
  36. 36. Viral Hemorrhagic Fevers<br />
  37. 37. Ebola Virus<br />Figure 23.21<br />
  38. 38. American Trypanosomiasis (Chagas’ Disease)<br />Trypanosoma cruzi<br />Reservoir: Rodents, opossums, armadillos<br />Vector: Reduviid bug<br />Figures 23.22, 12.33d<br />
  39. 39. Toxoplasmosis<br />Toxoplasma gondii<br />Figure 23.23<br />
  40. 40. Malaria<br />Plasmodium vivax, P. ovale, P. malariae, P. falciparum<br />Anopheles mosquito<br />Figure 12.31b<br />
  41. 41. Malaria<br />Figure 23.25<br />
  42. 42. Malaria<br />Figure 23.24<br />
  43. 43. Malaria<br />Figure 12.19<br />
  44. 44. OTHER PROTOZOA<br />BLOOD and TISSUE PROTOZOA<br />Plasmodium<br />Babesia<br />Trypanosomabrucei<br />Trypanosomacruzi<br />Toxoplasmagondii<br />Leishmania<br />
  45. 45. PROTOZOA FROM OTHER BODY SITES<br />Free-living Amebae<br />Naegleria<br />Acanthamoeba<br />Trichomonasvaginalis<br />
  46. 46. PLASMODIUM<br />Disease: Malaria<br />P. vivax: Benign tertian malaria<br />P. malariae: Quartan malaria<br />P. falciparum: Malignant tertian malaria<br />P. ovale: Ovale tertian malaria<br />Lab Dx: Giemsa stained thick and thin blood smears; IFA; PCR<br />
  47. 47. Infected RBC: <br />P. vivax and P. ovale: reticulocytes<br />P. malariae: senescent erythrocytes<br />P. falciparum: erythrocytes of all ages<br />Cyclic paroxysm of fever:<br />P. vivax and P. ovale: every 48 hours<br />P. malariae: every 72 hours<br />P. falciparum: every 36-48 hours<br />
  48. 48.
  49. 49. P. falciparum: Blood Stage Parasites<br />Thin Blood Smears<br />Fig. 1: Normal red cell; <br />Figs. 2-18: Trophozoites (among these, Figs. 2-10 correspond to ring-stage trophozoites); <br />Figs. 19-26:Schizonts (Fig. 26 is a ruptured schizont); Figs. 27, 28: Mature macrogametocytes (female); Figs. 29, 30:  Mature microgametocytes (male).<br />
  50. 50. Gametocytes of P. falciparumin thin blood smears.  Note the presence of a “Laveran’s bib”, which is not always visible.<br />
  51. 51. P. falciparumrings have delicate cytoplasm and 1 or 2 small chromatin dots.  Red blood cells (RBCs) that are infected are not enlarged; multiple infection of RBCs more common in P. falciparum than in other species.  Occasional appliqué forms (rings appearing on the periphery of the RBC) can be present.<br />
  52. 52. P. falciparum schizonts: seldom seen in peripheral blood.  Mature schizonts have 8 to 24 small merozoites; dark pigment, clumped in one mass.<br />
  53. 53. Plasmodium malariae: Blood Stage Parasites<br />Thin Blood Smears<br />Fig. 1: Normal red cell; Figs. 2-5: Young trophozoites (rings); <br />Figs. 6-13: Trophozoites; <br />Figs. 14-22: Schizonts; Fig. 23: Developing gametocyte; <br />Fig. 24:Macrogametocyte (female); <br />Fig. 25: Microgametocyte (male).<br /> <br />
  54. 54. P. malariae rings:have sturdy cytoplasm and a large chromatin dot.  The red blood cells (RBCs) are normal to smaller than normal (3/4 ×) in size.<br />
  55. 55. P. malariaeschizonts:have 6 to 12 merozoites with large nuclei, clustered around a mass of coarse, dark-brown pigment.  Merozoites can occasionally be arranged as a rosette pattern. <br />
  56. 56. P. malariaetrophozoites:have compact cytoplasm and a large chromatin dot.  Occasional band forms and/or "basket" forms with coarse, dark-brown pigment can be seen.<br />
  57. 57. Plasmodium ovale: Blood Stage Parasites<br />Fig. 1: Normal red cell; <br />Figs. 2-5: Young trophozoites (Rings); <br />Figs. 6-15: Trophozoites; <br />Figs. 16-23: Schizonts; <br />Fig. 24:Macrogametocytes (female); <br />Fig. 25: Microgametocyte (male).<br /> <br />
  58. 58. P. ovale gametocytes: round to oval, and may almost fill the red blood cells (RBCs).  Pigment is brown and more coarse than that of P. vivax.  RBCs are normal to slightly enlarged (1 1/4 ×), may be round to oval, and are sometimes fimbriated.  Schüffner's dots are visible under optimal conditions.<br />
  59. 59. Plasmodium vivax: Blood Stage Parasites<br />Thin Blood Smears<br />Fig. 1: Normal red cell; <br />Figs. 2-6: Young trophozoites (ring stage parasites); <br />Figs. 7-18:Trophozoites; <br />Figs. 19-27:Schizonts; Figs. 28 and 29: Macrogametocytes (female); <br />Fig. 30: Microgametocyte (male).<br /> <br />
  60. 60. P. vivax gametocytes: round to oval with scattered brown pigment and may almost fill the red blood cell (RBC).  RBCs are enlarged 1 1/2 to 2 × and may be distorted.  Under optimal conditions, Schüffner's dots may appear more fine than those seen in P. ovale.<br />
  61. 61. P. vivax rings: have large chromatin dots and can show amoeboid cytoplasm as they develop. RBCs can be normal to enlarged up to 1 1/2 × and may be distorted.  Under optimal conditions, Schüffner's dots may be seen.<br />
  62. 62. P. vivax schizonts: large, have 12 to 24 merozoites, yellowish-brown, coalesced pigment, and may fill the red blood cell (RBC). <br />
  63. 63. P. vivaxtrophozoites:show amoeboid cytoplasm, large chromatin dots, and have fine, yellowish-brown pigment. <br />
  64. 64. Positive IFA result with P. malariaeschizont antigen.<br />
  65. 65. TRYPANOSOMA BRUCEI<br />Disease: African trypanosomiasis<br />T. b. gambiense: Gambian trypanosomiasis, West & Mid-African sleeping sickness<br />T. b. rhodesiense: Rhodesian trypanosomiasis, East African sleeping sickness<br />Lab Dx: Giemsa stained thick and thin blood smears or lymph exudate (early stage); Giemsa stained smears of CSF (late stage)<br />
  66. 66. Site in host: lymph glands, blood stream, brain<br />Portal of entry: skin<br />Source of infection: tsetse fly<br />Winterbottom’s sign: enlargement of posterior cervical LNs<br />
  67. 67.
  68. 68. Trypomastigote: slender to fat and stumpy forms; in Giemsa stained films – C or U shaped forms NOT seen; small, oval kinetoplast located posterior to the nucleus; a centrally located nucleus, an undulating membrane, and an anterior flagellum. The trypanosomes length range is 14-33 µm <br />
  69. 69. A dividing parasite is seen at the right. Dividing forms are seen in African trypanosomiasis, but not in American trypanosomiasis (Chagas' disease)<br />
  70. 70.
  71. 71. Tsetse fly. The vector of African trypanosomiasis<br />
  72. 72. Winterbottoms sign<br />
  73. 73. TRYPANOSOMA CRUZI<br />Disease:American trypanosomiasis, Chaga’s disease<br />Lab Dx: Giemsa stained thick and thin blood smears for the trypomastigote; histopath exam for the amastigote<br />Site in host: Tissues – heart; blood<br />Portal of entry: skin<br />Source of infection: Kissing bug Triatomidae<br />
  74. 74. Trypomastigote:shape is short & stubby to long & slender; in Giemsa stained blood films – C or U shaped; kinetoplast is large, oval & located posterior to the nucleus; anterior long free flagellum<br />
  75. 75. Trypanosomacruzicrithidia<br />
  76. 76. Trypanosoma cruzi: Leishmanial form <br />
  77. 77. Riduviid bug:the vector of American trypanosomiasis<br />
  78. 78. Ramana's sign: unilateral conjunctivitis and orbital edema  <br />
  79. 79. TOXOPLASMA GONDII<br />Disease:Toxoplasmosis<br />Site in host: All organs<br />Portal of entry: <br />Ingestion of oocyst contaminated water<br />Aerosolization of oocyst contaminated dust or litter<br />Consumption of raw or undercooked cyst infected meat<br />Transplacental passage of the tachyzoite<br />
  80. 80. - Definitive host: domestic cats<br /> - Intermediate host: infected rodents<br />Accidental intermediate host: humans<br />Lab Dx: IFAT and ELISA; Giemsa-stained smears of exudates, aspirates or tissues<br />
  81. 81. T. gondiioocysts in a fecal floatation (100×).<br />
  82. 82. A: Positive reaction (tachyzoites + human antibodies to Toxoplasma + FITC-labelled antihuman IgG = fluorescence.)<br />B: Negative IFA for antibodies to T. gondii.<br />
  83. 83. LEISHMANIA<br /><ul><li>Disease:
  84. 84. L. tropica complex: Old Word Cutaneousleishmaniasis (oriental sore, Aleppo boil, Delhi ulcer, Baghdad boil)
  85. 85. L. mexicana complex: New Word Cutaneousleishmaniasis (chiclero ulcer, bay sore)
  86. 86. L. braziliensis complex: Mucocutaneusleishmaniasis (espundia, uta)
  87. 87. L. donovani: Visceral leishmaniasis (kala-azar or black disease, Dumdum fever)</li></li></ul><li><ul><li>Lab Dx: Giemsa stained tissue sections or impression smears
  88. 88. Site in host: Monocytes/macrophages of skin & mucosa
  89. 89. Portal of entry: Skin
  90. 90. Source of infection: Phlebotomus or Lutzomiya fly</li></li></ul><li>
  91. 91. L. tropicaamastigotes:ovoid in shape; large & eccentric nucleus; small, rodlikekinetoplast positioned opposite the nucleus; rodlikeaxoneme perpendicular to the kinetoplast<br />
  92. 92. Leishmaniasis<br />
  93. 93. BABESIA<br />Disease:Babesiosis<br />Lab Dx: Giemsa stained thick and thin blood smears<br />
  94. 94.
  95. 95. Babesiamicroti infection, Giemsa stained thin smear.  The organisms resemble P. falciparum; however Babesia parasites present several distinguishing features: they vary more in shape and in size; and they do not produce pigment. <br />
  96. 96. Infection with Babesia.  Giemsa stained thin smears showing the tetrad, a dividing form pathognomonic for Babesia.  Note also the variation in size and shape of the ring stage parasites and the absence of pigment. <br />
  97. 97. Schistosomiasis<br />Figure 23.28<br />
  98. 98. Schistosomiasis<br />Tissue damage (granulomas) in response to eggs lodging in tissues<br />
  99. 99. Schistosomiasis<br />Figure 23.27a<br />
  100. 100. SCHISTOSOMA MANSONI<br /><ul><li>Disease: Schistosomiasis, intestinal schistosomiasis, bilharziasis “snail fever”
  101. 101. Site in host: veins of LI
  102. 102. Portal of entry: skin
  103. 103. Definitive host: humans, baboons & rodents
  104. 104. Intermediate host: snail (Biomphalaria sp & Tropicorbis sp)
  105. 105. Infective stage: cercariae
  106. 106. Lab Dx: eggs in stool; rectal or liver biopsy</li></li></ul><li>
  107. 107. Biomphalaria spp.<br />
  108. 108. Schistosomamansoni eggs:large (length 114 to 180 µm) and have a characteristic shape, with a prominent lateral spine near the posterior end.  The anterior end is tapered and slightly curved.  When the eggs are excreted, they contain a mature miracidium<br />
  109. 109.
  110. 110.
  111. 111.
  112. 112.
  113. 113. Male and female schistosomes. <br />
  114. 114. SCHISTOSOMA HAEMATOBIUM<br /><ul><li>Disease: Urinary schistosomiasis, schistosomalhematuria, urinary bilharziasis
  115. 115. Site in host: veins of urinary bladder
  116. 116. Portal of entry: skin
  117. 117. Definitive host: humans, monkeys & baboons
  118. 118. Intermediate host: snail (Bulinus, Physopsis, and Biomphalaria sp)
  119. 119. Infective stage: cercariae
  120. 120. Lab Dx: eggs in stool; cystoscopy</li></li></ul><li>Bulinus spp.<br />
  121. 121. S. haematobium eggs:large and have a prominent terminal spine at the posterior end<br />
  122. 122.
  123. 123. S.haematobium:adult schistosomes live in pairs in the pelvic veins (especially in the venous plexus surrounding the bladder); males are 10-15 mm in lenght by 0,8-1 mm in diameter, and have a ventral infolding from the ventral sucker to the posterior end forming the gynecophoric canal. Adult male with female in the copulatory groove. <br />
  124. 124. SCHISTOSOMA JAPONICUM<br /><ul><li>Disease: Schistosomiasis, Katayama fever
  125. 125. Site in host: veins of SI
  126. 126. Portal of entry: skin
  127. 127. Definitive host: humans, dogs, cats, horses, pigs, cattle, deer, caribou & rodents
  128. 128. Intermediate host: snail (Oncomelania)
  129. 129. Infective stage: cercariae
  130. 130. Lab Dx: eggs in stool; liver biopsy</li></li></ul><li>Onchomelania, hupensis spp. <br />
  131. 131. S. japonicum egg:typically oval or subspherical, and has a vestigial spine (smaller than those of the other species)<br />
  132. 132.
  133. 133. Cercaria<br />
  134. 134.
  135. 135.
  136. 136.
  137. 137. Schistosomiasis<br />Figure 23.27b<br />

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