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Trypanosoma brucei rhodesiense
- 1. TRYPANOSOMA BRUCEI RHODESIENSE Prepared by: NOE P. MENDEZ CENTRAL MINDANAO UNIVERSITY (CMU) npolomendez@gmail.com
- 2. Kingdom: Protista Subkingdom: Protozoa Phylum: Sarcomastigophora Subphylum: Mastigophora Class: Zoomastigophora Order: Kinetoplatida Family: Trypanomatidae Genus: Trypanosoma Species: T. brucei Subspecies: T. b. rhodesiense
- 3. 2 Interchangeable Form: Trypanomastigote Epimastigote Form: Amastigotes Promastigote Epimastigote Trypanomastigote Metacyclic Trypanosome
- 4. Kinetoplast (K) Axoneme (A)Nucleus (N) Volution Granules (VG) Flagellum (F) K A N Flagellar pocket (FP) Amastigote Promastigote
- 5. A KN Posterior End Undulating membrane (UM) F A K N F UM Epimastigote Trypanomastigote & Metecyclic Mastigote
- 7. East African Trypanosomiasis (Sleeping Sickness) Glossina morsitans (Tsetse fly)
- 8. Pathogenesis and Clinical Picture Trypanosoma Chancre Via: Lymphatic Winterbottom’s Sign Blood Stream Headache, fever, muscle and joint pain, irregular erythematous rash, and hypoplastic anaemia Invasion of CNS Sever headache, mental apathy, slow speech, deep sleep, coma and death
- 9. Progressive disease lead to C.N.S. manifestations: Insomnia Mood Changes (Dullness/Apathy) Motor and Sensory Disorders (Hypersthesia/Slurred Speech/Abnormal Gait) Convulsion Epilepsy Terminal Stage: Permanent Sleep Secondary Bacterial Infection Coma & death
- 10. Clinical Picture
- 12. Clinical Picture Demonstration of Trypanosomes Microscopic Examination Culture on Suitable Medium Animal Inoculation
- 13. Microscopic Examination Animal Inoculation C.S.F. DEMONSTRATION OF TRYPANOSOME
- 14. Clinical Picture Demonstration of Trypanosomes Microscopic Examination Culture on Suitable Medium Animal Inoculation Serological Test
- 16. Early Stage Pentaminidine or Suramin Late Stage Tryparsamide Both Early and Late Stage Eflornithine (DMFO) Ornidyl
- 17. Treatment of Patient Control of Vectors Pentamidine as prophylactic drug
Editor's Notes
- Basic Hemoflaggelatology Found in the blood They are also called kinitoplastida (contain kinetoplasts or modified mitochondria) Basic forms Amastigotes - old Leishmania stage Slightly oval (2 2-3-3 X 3 4 microns) Axonemes are like microtubules that are associated with future flagellate motility Found inside reticuloendothelial cells Multiplies by longitudinal binary fission There is generally a small zone between the K and A Promastigotes - old leptomonas stage May have various shapes from short and fat to long and thin Occasionally see volutin granules (VG) that represent waste products in the cytoplasm Epimastigotes - old crithidia stage Varies in length (12 12-doesn’t 75 microns) K is always anterior to the nucleus F pulls the body through tissues Epimastigote has an undulating membrane where the promastigote doesn The undulating membrane causes the body to undulate Trypomastigotes Metacyclic trypomastigotes This is the Trypanosome The K is posterior to the N vs the Epimastigote with the N posterior to the K Binary fission of the Promastigote Promastigote, Epimastigote and Trymastigote are the same (K first followed by the A, F, the N and then the cell) Metacyclic Tryposmastigote is the same as the tryposmastigote but is the infectious stage in the vector Trypanosome stage can’t be distinguished physically from Gambiense though biologically and biochemically different 14-33 micrometers long Smaller kinetoplast than Trypanosoma cruzi T. R. is much less adapted to man therefore causing increased reaction and tissue damage and a much higher mortality than T. G.
- Basic forms Amastigotes - old Leishmania stage Slightly oval (2 2-3-3 X 3 4 microns) Axonemes are like microtubules that are associated with future flagellate motility Found inside reticuloendothelial cells Multiplies by longitudinal binary fission There is generally a small zone between the K and A Promastigotes - old leptomonas stage May have various shapes from short and fat to long and thin Occasionally see volutin granules (VG) that represent waste products in the cytoplasm Epimastigotes - old crithidia stage Varies in length (12 12-doesn’t 75 microns) K is always anterior to the nucleus F pulls the body through tissues Epimastigote has an undulating membrane where the promastigote doesn The undulating membrane causes the body to undulate Trypomastigotes Metacyclic trypomastigotes This is the Trypanosome The K is posterior to the N vs the Epimastigote with the N posterior to the K Binary fission of the Promastigote Promastigote, Epimastigote and Trymastigote are the same (K first followed by the A, F, the N and then the cell) Metacyclic Tryposmastigote is the same as the tryposmastigote but is the infectious stage in the vector
- Basic forms Amastigotes - old Leishmania stage Slightly oval (2 2-3-3 X 3 4 microns) Axonemes are like microtubules that are associated with future flagellate motility Found inside reticuloendothelial cells Multiplies by longitudinal binary fission There is generally a small zone between the K and A Promastigotes - old leptomonas stage May have various shapes from short and fat to long and thin Occasionally see volutin granules (VG) that represent waste products in the cytoplasm Epimastigotes - old crithidia stage Varies in length (12 12-doesn’t 75 microns) K is always anterior to the nucleus F pulls the body through tissues Epimastigote has an undulating membrane where the promastigote doesn The undulating membrane causes the body to undulate Trypomastigotes Metacyclic trypomastigotes This is the Trypanosome The K is posterior to the N vs the Epimastigote with the N posterior to the K Binary fission of the Promastigote Promastigote, Epimastigote and Trymastigote are the same (K first followed by the A, F, the N and then the cell) Metacyclic Tryposmastigote is the same as the tryposmastigote but is the infectious stage in the vector
- Host – Animals ( eg bushbuck, hartebeeste hartebeeste, lion, hyena, cattle, dogs, reedbuck, waterbuck, sheep, goats, etc.) occasionally man Location – Blood, LN LN’s, Spleen, CNS Intermediate host – Glossina moristans group (prefers a dry warm climate) Infective stage – metacyclic trypomastigote The incubation period for T. R. is 3-21 days and is usually 5-14 days. T. G has an incubation period from months to years. Commonly seen in hunters, honey and firewood gatherers, fisherman and tourists in game areas Basic Hemoflaggelatology Found in the blood They are also called kinitoplastida (contain kinetoplasts or modified mitochondria) Basic forms Amastigotes - old Leishmania stage Slightly oval (2 2-3-3 X 3 4 microns) Axonemes are like microtubules that are associated with future flagellate motility Found inside reticuloendothelial cells Multiplies by longitudinal binary fission There is generally a small zone between the K and A Promastigotes - old leptomonas stage May have various shapes from short and fat to long and thin Occasionally see volutin granules (VG) that represent waste products in the cytoplasm Epimastigotes - old crithidia stage Varies in length (12 12-doesn’t 75 microns) K is always anterior to the nucleus F pulls the body through tissues Epimastigote has an undulating membrane where the promastigote doesn The undulating membrane causes the body to undulate Trypomastigotes Metacyclic trypomastigotes This is the Trypanosome The K is posterior to the N vs the Epimastigote with the N posterior to the K Binary fission of the Promastigote Promastigote, Epimastigote and Trymastigote are the same (K first followed by the A, F, the N and then the cell) Metacyclic Tryposmastigote is the same as the tryposmastigote but is the infectious stage in the vector Trypanosome stage can’t be distinguished physically from Gambiense though biologically and biochemically different 14-33 micrometers long Smaller kinetoplast than Trypanosoma cruzi T. R. is much less adapted to man therefore causing increased reaction and tissue damage and a much higher mortality than T. G.
- Known as African sleeping sickness Endemic in 36 countries and affects from 20,000 to 50,000 annually Untreated is universally fatal Animal infections may have more impact than human infections by decreasing the food supply ( eg cattle, sheep, goats, pigs, chickens) From Manson’s Tropical Diseases, pp 1172, Saunder’s 1996. East African upland savanahs Causes sporadic disease Acute form 3rd important parasitic diseases globally afrer Malaria and Schistimiasis Forest region In savannah
- I. Local Tissue – T. chancre – painful boil with interstitial inflammatory reaction II. Lymph-node involvement – hyperplasia of endothelial linings of blood sinuses and perivascular infiltrates of leukocytes. Usually rapid and fulminant course resulting in death within a few months III. CNS – “sleeping sickness sickness” with headache, paroxysmal fever, extreme weakness, rapid weight loss, encephalomyelitis, mental deterioration, coma, and death within 1 year Edema – peripheral, ascites, pulmonary, pericardial, effusion Cardiac – non-specific ECG changes, CHF Endocrine – amenorrhea, impotence, spontaneousabortion GI – diarrhea CNS – altered reflexes, hyperesthesia, paraesthesia paraesthesia, seizures, aberrant mentation mentation, sleep disturbance, ataxia, slurred speech, paralysis, etc.
- Serum and CSF IgM is often elevated (often 10X over normal) CSF protein levels are usually elevated. An increase of protein after treatment may be an indication of relapse. Immunoflourscent antibody (IFAT) and ELISA may be useful for screening. IFAT may be useful for assessing cure. NNN media can be used for culture but is unreliable due to the few organisms present in most specimens Inoculation of mice with heparinized blood Tissue phase Fluid aspirated from a chancre Hemolymphatic phase Lymph-node aspirate Concentrated of the blood buffy coat ( Giemsa stain) CNS phase Double centrifugation technique Giemsa stain
- Serum and CSF IgM is often elevated (often 10X over normal) CSF protein levels are usually elevated. An increase of protein after treatment may be an indication of relapse. Immunoflourscent antibody (IFAT) and ELISA may be useful for screening. IFAT may be useful for assessing cure. NNN media can be used for culture but is unreliable due to the few organisms present in most specimens Inoculation of mice with heparinized blood Tissue phase Fluid aspirated from a chancre Hemolymphatic phase Lymph-node aspirate Concentrated of the blood buffy coat ( Giemsa stain) CNS phase Double centrifugation technique Giemsa stain
- Serum and CSF IgM is often elevated (often 10X over normal) CSF protein levels are usually elevated. An increase of protein after treatment may be an indication of relapse. Immunoflourscent antibody (IFAT) and ELISA may be useful for screening. IFAT may be useful for assessing cure. NNN media can be used for culture but is unreliable due to the few organisms present in most specimens Inoculation of mice with heparinized blood Tissue phase Fluid aspirated from a chancre Hemolymphatic phase Lymph-node aspirate Concentrated of the blood buffy coat ( Giemsa stain) CNS phase Double centrifugation technique Giemsa stain
- Serum and CSF IgM is often elevated (often 10X over normal) CSF protein levels are usually elevated. An increase of protein after treatment may be an indication of relapse. Immunoflourscent antibody (IFAT) and ELISA may be useful for screening. IFAT may be useful for assessing cure. NNN media can be used for culture but is unreliable due to the few organisms present in most specimens Inoculation of mice with heparinized blood Tissue phase Fluid aspirated from a chancre Hemolymphatic phase Lymph-node aspirate Concentrated of the blood buffy coat ( Giemsa stain) CNS phase Double centrifugation technique Giemsa stain
- Serum and CSF IgM is often elevated (often 10X over normal) CSF protein levels are usually elevated. An increase of protein after treatment may be an indication of relapse. Immunoflourscent antibody (IFAT) and ELISA may be useful for screening. IFAT may be useful for assessing cure. NNN media can be used for culture but is unreliable due to the few organisms present in most specimens Inoculation of mice with heparinized blood Tissue phase Fluid aspirated from a chancre Hemolymphatic phase Lymph-node aspirate Concentrated of the blood buffy coat ( Giemsa stain) CNS phase Double centrifugation technique Giemsa stain
- Increased total IgM level in serum due to antigenic variation of the surface coat of the parasite. Trypanosome posses genes that code for about 1000 variant forms of their surface glycoproteins (SVG). Switch to a different variant produces a new generation not susceptible to attack by immune factors specific to the previous generation. Serum and CSF IgM is often elevated (often 10X over normal) CSF protein levels are usually elevated. An increase of protein after treatment may be an indication of relapse. Immunoflourscent antibody (IFAT) and ELISA may be useful for screening. IFAT may be useful for assessing cure. NNN media can be used for culture but is unreliable due to the few organisms present in most specimens Inoculation of mice with heparinized blood Tissue phase Fluid aspirated from a chancre Hemolymphatic phase Lymph-node aspirate Concentrated of the blood buffy coat ( Giemsa stain) CNS phase Double centrifugation technique Giemsa stain Trypanosomes can evade the immune system
- Avoid biting fly habitats (brushy areas along lakes). Stay in open country. Clear brush from around human dwellings Destroy breeding grounds Traps for flies Infected patients should not breast feed or donate blood Isolate and treat all cases Release sterile male flies Insect precautions