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Haemoflagellates Leishmaniasis & Trypanosomiasis
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Different stages of Haemoflagellates
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The life cycle of Leishmania
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Leishmania Parasites and Diseases
SPECIES Cutaneous leishmaniasis Leishmania tropica* Leishmania major* Leishmania aethiopica Leishmania mexicana Mucocutaneous leishmaniasis Leishmania braziliensis Visceral leishmaniasis Leishmania donovani* Leishmania infantum* Leishmania chagasi * Endemic in Saudi Arabia
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Sand fly
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amastigotes
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promastigotes
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promastigotes
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lesion
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lesion
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lesion
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Clinical types of cutaneous leishmaniasis
Leishmania major: Zoonotic cutaneous leishmaniasis: wet lesions with severe reaction Leishmania tropica: Anthroponotic cutaneous leishmaniasis: Dry lesions with minimal ulceration Oriental sore (most common) classical self-limited ulcer
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Uncommon types Diffuse cutaneous leishmaniasis (DCL):
Caused by L. aethiopica, diffuse nodular non-ulcerating lesions. Low immunity to Leishmania antigens, numerous parasites. Leishmaniasis recidiva (lupoid leishmaniasis): Severe immunological reaction to leishmania antigen leading to persistent dry skin lesions, few parasites.
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Diffuse cutaneous leishmaniasis
Leishmaniasis recidiva
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cutaneous leishmaniasis
Diagnosis: Smear: Giemsa stain – microscopy for LD bodies (amastigotes) Biopsy: microscopy for LD bodies or culture in NNN medium for promastigotes
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NNN medium
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Treatment No treatment – self-healing lesions Medical: Surgical:
Pentavalent antimony (Pentostam), Amphotericin B +/- Antibiotics for secondary bacterial infection. Surgical: Cryosurgery Excision Curettage
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Visceral leishmaniasis
There are geographical variations. The diseases is called kala-azar Leishmania infantum mainly affect children Leishmania donovani mainly affects adults
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Presentation Fever Splenomegaly, hepatomegaly, hepatosplenomegaly
Weight loss Anaemia Epistaxis Cough Diarrhoea
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Untreated disease can be fatal
After recovery it might produce a condition called post kala-azar dermal leishmaniasis (PKDL)
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Fever 2 times a day due to kala-azar
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hepatosplenomegaly
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mucocutaneous
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PKDL
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Visceral leishmaniasis
Diagnosis Parasitological diagnosis: METHOD Bone marrow aspirate microscopy Splenic aspirate culture in NNN medium Lymph node Tissue biopsy
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Bone marrow aspiration
Bone marrow amastigotes
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(2) Immunological Diagnosis:
Specific serologic tests: Direct Agglutination Test (DAT), ELISA, IFAT Skin test (leishmanin test) for survey of populations and follow-up after treatment. Non specific detection of hypergammaglobulinaem by formaldehyde (formol-gel) test or by electrophoresis.
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DAT test ELISA test
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Formol-gel
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Treatment: Pentavalent antimony (Pentostam) Amphotericin B Treatment of complications: Anaemia Bleeding Infections etc.
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Trypanosomiasis
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African Trypanosomiasis
Life cycle of Trypanosoma brucei gambiense & T. b. rhodesiense
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African sleeping sickness
Trypanosoma brucei rhodesiense: East Africa, wild and domestic animal reservoirs Trypanosoma brucei gambiense: West and Central Africa, mainly human infection
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Tsetse fly
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Pathology and clinical picture
Skin stage: chancre. Haematolymphatic stage: generalized lymphadenopathy, anaemia, generalized organ involvement. Central nervous system stage (CNS): Meningoencephalitis. (Development of the disease more rapid in Trypanosoma brucei rhodesiense)
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chancre
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Winterbottom’s stage
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3rd stage CNS
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Lymph node aspirate
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trypanosoma
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CSF
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AMERICAN TRYPANOSOMIASIS
LIFE CYCLE OF Trypanosoma cruzi
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Reduviid (Triatomine) bug
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Diagnosis Blood film Serology: IFAT Xenodiagnosis: feeding bugs on a suspected cases.
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T. cruzi causes cutaneous stage (chagoma)
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Ocular (Romana’ sign)
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C-shape
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TREATMENT African trypanosomiasis For early infection pentamidine
suramin For late infection eflornithine (Diflouromethylornithine- DFMO) American trypanosomiasis (Chaga’s disease) benznidazole nifurtimox
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Trichomonas vaginalis
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Transmission: sexual intercourse contact with contaminated objects.
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Pathology Female: vaginitis, profuse thin yellowish discharge with bad smell Male: invasion of urethra, prostate and seminal vesicles, causing urethritis but mostly asymptomatic.
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trophozoites
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Diagnosis Identification of parasite by microscopy of discharge. Examination of vaginal or urethral discharge for T. vaginalis
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Treatment: metronidazole (flagyl). Note: Treat sexual partner because infection is mostly asymptomatic in males.
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