BLOOD AND TISSUES FLAGELLATES/ HAEMOFLAGELLATES OF HUMAN BEINGS

1. BLOOD AND TISSUES
FLAGELLATES/
OF HUMAN BEINGS
HAEMOFLAGELLATES
Dr. SouzanH. Eassa,
Department of Medical Microbiology, College of Medicine,
University Of Duhok, Kurdistan Region, Iraq.Souzan Eassa

2. Flagellates are placed in five PHYLA and two
groups of parasites:
I. Intestinal and reproductive track
flagellates
II. Blood and tissue-dwelling flagellates
 They divided into:
 Pathogenic species of flagellates.
 Non- pathogenic species of flagellates.
Flagellates
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3. Pathogenic species of flagellates:
Intestinal flagellates
1- Giardia Spp
Genital flagellates
2- Trichomonas Spp
Haemoflagellates
1- Trypanosoma spp.
2- Leishmania spp.
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4. Life-cycle stages of trypanosomatidae.
A. promastigote; b. ophistomastigote; c. epimastigote; d. trypomastigote;
e. choanomastigote; f. amastigote; and g. paramastigote.
K. kinetoplast; N. nucleus; F. flagellum.
Hemoflagellates Anatomy and Life
Stages
There are seven
ontogenetic stages,
but not all species
have all
seven.These stages
are continuous.
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5.  Four life stages
Not all stages occur in all species
Certain stages are found in specific hosts
• Epimastigotes and Promastigotes in insect intermediate
hosts.
• Trypomastigotes and Amastigoes in definitive hosts
 Two hosts:
 Humans and their
domestics are
definitive host
 Insect vectors are
the intermediate
host
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6. Several species of
flagellate protozoa
inhabit the blood stream
and tissues of man.
1. Trypanosoma brucei:
*T. brucei have to
subspecies:
*T. b. rhodesiense
and T.b gambiense
2. T. cruzi
Hemoflagellates
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7. Leishmania Spp.
At least four major species of Leishmania parasite are
responsible for leishmaniasis which are similar in
morphology but differing in:
cultural characteristic
clinical feature,
geographical distribution.
1. L. donovani: causes visceral leishmaniasis (Kala Azar),
involving liver, spleen, and bone marrow
2. L. tropica and L. major: causes old world cutaneous
leishmaniasis (oriental sore).
3. L. braziliensis complex: cutaneous and mucocutaneous
leishmaniasis in America, involving mucous membranes
of the mouth and nose after spread from a nearby
cutaneous lesion (very rare)
4. L. mexicana complex: cutaneous leishmaniasis in
America, involving the skin at the site of a sandfly biteSouzan Eassa

8.  Leishmaniasis is a parasitic disease transmitted by the
bite of sand flies.
 Found in parts of at least 88 countries including the Middle
East.
 Different species of Leishmania cause different forms of
disease.
 In the Middle East L. major and L. tropica are the
most common species
•L. major causes skin infection
•L. tropica causes skin and visceral infection and rarely causes
mucocutaneous infection
Introduction
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9. Route of transmission
1.Mainly by insect bite (sand fly).
2. Blood transfusion.
3. Rarely transplacental.
Human is the chief host in most
area while in some area Dogs
and
Fox are hosts in addition to
human.
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10. Morphology
• Amastigote stage: small, oval,
contain a nucleus & a rod-shape
kinetoplast, no flagellum.
• Promastigote stage: found in the
vector, it’s spindle in shape, contain
a nucleus, ant. free flag. arise from
a kinetoplast at ant. End.
• Leishmania: intracellular in
macrophages, inhabit the blood &
RES
Flagellum
Kinetosome
Kinetoplast
Nucleus
anterior
posterior
Flagellum
Kinetosome
Kinetoplast
Nucleus
anterior
posterior
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11. PROMASTIGOTESAMASTIGOTES
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12. LIFE CYCLESouzan Eassa

13. Cutaneous Leishmaniasis
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14. L. tropica and L. major
• Cutaneous leishmaniasis,
Oriental sore, Baghdad boil,
Delhi ulcer.
• Two types:
1. L. tropica- Dry (urban),
chronic course, late
ulceration
2. L. major-Moist (rural), acute
course, early ulceration &
exudation
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15. Cutaneous Leishmaniasis
• Characterized by one or more
sores, papules or nodules on the
skin, develop within a few weeks of
the sandfly bite, however they can
appear up to months later.
• Sores can change in size and
appearance over time.
• Sore looking like a volcano with a
raised edge and central crater,
usually painless but can become
painful if secondarily infected
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16. • Skin sores of cutaneous
leishmaniasis can heal on their
own, but this can take months or
even years and can leave
significant scars and be
disfiguring on the skin.
• L. tropica infection can spread to
contiguous mucous membranes
(upper lip to nose).
• Swollen lymph nodes may be
present near the sores (under
the arm if the sores are on the
arm or hand…)
Cutaneous Leishmaniasis
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17. Mucocutaneous
Leishmaniasis
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18. L. braziliensis complex and L. mexicana complex
 Mucocutaneous; American leishmaniasis (new world),
 Identical to Oriental sore but may produce later mucous
membrane involvement.
- occurs if a cutaneous lesion on the face spreads to
involve the nose or mouth
- This rare mucosal involvement may occur if a skin
lesion near the mouth or nose is not treated.
 Painful, can cause great deformity with erosion of the nose,
palate, or larynx or ear.
 Odema, tissue destruction & secondary bacterial infection
may occur .
 May occur months to years after original skin lesion and can be
very disfiguring
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19. Souzan Eassa

20. Visceral Leishmaniasis
 L. donovani infection
 Visceral leishmaniasis, kala-azar, dum dum fever,
Black dis.
 Transmitted by sand fly
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21. Souzan Eassa

22. Pathology & symptoms
Phagocytosed parasites are present in blood and
numerous in spleen, liver, lymph nods, bone marrow,
intestinal mucosa.
Incubation period is 1-4 months.
Fever 400C (intermittent), often with two peaks daily
Chills & sweating may be present.
Hepato-splenomegally ,Lymph adenopathy.
Bleeding from gum, lips, nose, intestinal mucosa
Anemia, leukopenia, thrombocytopenia
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23. Post kala-azar dermal
leishmaniasis
Nodular skin lesion, containing many
organisms, usually over the dorsum of the
hands & face and appear 1 or 2 years after
cure of the disease
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24. DiagnosisCutaneous and Mucocutaneou
Leishmaniasis
Early diagnosis and treatment is critical to avoid
disfigurement
Patients with any of the following findings should
be referred early to avoid long term complications:
 Big lesions (greater than an inch in size)
 Many lesions (3 or more)
 Sores on the face, hands and feet and over joints.
 Sores that will not heal have to be referred for
evaluation – even if not “typical” for leishmaniasis
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25. Diagnosis
 Biopsies should be done for diagnosis but require special
training to avoid further disfigurement.
 Scraping of the lesion margin & make an impression smear to
see the amastigote stage.
 Direct visualization of the parasite (Amastigote in liver and
spleen) by making slid stained with Leishman or Giemsa stain
for 20 min. to see the Amastigote in monocyte, macrophages,
less commonly in neutrophils.
 Find the parasite in the tissue biopsy (L.N. Spleen, Liver, skin
lesion.
 Serology tests by IFA and ELISA.
 Molecular tests PCR.
 Culture in NNN media (Novy-MacNeal-Nicolle medium ).

26. Treatment
 Bed rest, well balanced diet
with high protein & vitamins.
 Appropriate antibiotics for
secondary Bacterial infection.
 Blood Transfusion for severe
anaemia. Souzan Eassa
 Antimony
(Pentostam®, Sodium
stibogluconate) is the
drug of choice
 Fluconazole may
decrease healing time in
L. major infection

27. Prevention
• Suppress the reservoir: dogs,
rats, gerbils, other small
mammals and rodents
• Suppress the vector (Prevent
sand fly bites): Sand fly
• Most important at night
• Sleeves down
• Screening of doors & windows
by fine mesh
• Insect repellent w/ DEET
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28. Questions?
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