BLOOD AND TISSUE PARASITES

  HEMOFLAGELLATES

FOUND MULTIPLYING IN BLOOD OR TISSUE OF HUMANS

v      ORDER - KINETOPLASTIDA

v      REQUIRE AN ARTHROPOD INTERMEDIATE HOST

v      THEY EXHIBIT VARYING MORPHOLOGY IN SPECIFIC LOCATIONS IN BOTH HUMANS AND ARTHROPODS

TRYPANOSOMA BRUCEI

v      SUBSPECIES OF TRYPANOSOMA BRUCEI ARE RESPONSIBLE FOR AFRICAN SLEEPING SICKNESS

v      2 SUBSPECIES – TRYPANOSOMA RHODESIENSE (EAST) & TRYPANOSOMA GAMBIENSE (WEST)

v      ALMOST  IDENTICAL

v      DISEASE TRANSMITTED BY BITE OF THE TSETSE FLY

v      LIFE CYCLE AND DISEASE

v      TRYPOMASTIGOTE  ENTERS CIRCULATION FROM SALIVARY GLAND OF THE FLY

v      ORGANISM ARE INJECTED WHEN THE INFECTED FLY BITES THE HUMAN

v      TRYPOMASTIGOTES MULTIPLY IN PERIPHERAL BLOOD EARLY IN DISEASE;  INVADES LYMPHATIC SYSTEM & CNS

v      CAUSES INTERMITTENT FEVER

v      LYMPH GLANDS ENLARGE THEN ATROPHY 

v      FEVER, HEADACHES AND NIGHT SWEATS; JOINT AND MUSCLE PAIN

v      LETHARGY AND MOTOR CHANGES

v      UNTREATED PATIENTS HAVE BRAIN AND CNS INVOLVEMENT

v      PROGRESSIVELY LETHARGIC - SLEEP - COMA – DEATH

METHOD OF DIAGNOSIS

v      SPECIES APPEAR IDENTICAL

v      EXAMINE FLUID FROM BITE SITE (CHANCRE) OR BUFFY COAT OF BLOOD

v      THIN OR THICK BLOOD SMEARS ARE STAINED WITH GIEMSA OR WRIGHT STAIN

v      LATE IN INFECTION: TRYPOMASTIGOTE ARE FOUND IN LYMPH NODES AND CNS

v      IgM IS ELEVATED IN SERUM AND CSF

TRYPANOSOMA CRUZI (CHAGAS’ DISEASE)

v      FOUND IN CENTRAL AND SOUTH AMERICA

v      CAUSES CHAGAS’ DISEASE, A DEBILITATING CONDITION

v      INSECT VECTOR IS REDUVID BUG (KISSING BUG)

v      NOT FOUND IN SALIVARY GLAND OF INSECT

v      INSECT DEFECATES AS IT BITES, THE PERSON RUBS FECES INTO WOUND

METHOD OF DIAGNOSIS

v      FOUND IN MACROPHAGES OF THE BLOODSTREAM

v      ARE FOUND MULTIPLYING AS AMASTIGOTE FORM L.D.BODIES  IN STAINED TISSUES SUCH AS HEART

v      C-SHAPED TRYPOMASTIGOTE FORMS CAN BE FOUND IN BLOODSTREAM EARLY IN INFECTION

v      CULTURE FOR EPIMASTIGOTES

v      PCR REACTION TO DETECT THE PRESENCE OF THE PARASITE

v      IN SOME CASES, ALLOW THE BUG TO FEED AND THEN EXAMINE THE FECES

DISEASE

v      SYMPTOMS INCLUDE FEVER, WEAKNESS; ENLARGED SPLEEN, LIVER, LYMPH NODES

v      CHRONIC- ENLARGED WEAK HEART CAN CAUSE DEATH

v      ACUTE INFECTION (COMMON IN CHILDREN) RESULT IN CHAGOMA REACTION AT BITE SITE

v      PERIORBITAL EDEMA IF BITTEN NEAR THE EYE – ROMANA’S SIGN

v      CARDIAC GANGLIA DESTRUCTION, MEGACOLON AND OFTEN RAPID DEATH

LEISHMANIA

v      4 PATHOGENIC SPECIES COMPLEXES - LOOK ALIKE BUT WITH DIFFERENT CLINICAL REACTIONS – L. TROPICA (OLD WORLD), L. MEXICANA (NEW WORLD), L. BRAZILIENSIS AND L. DONOVANI

v      INFECTION OCCURS FROM INJECTION OF THE LARVAE FROM AN  INFECTED SANDFLY- THE INTERMEDIATE HOST

v      PHAGOCYTIC CELLS INGEST THE PARASITE BUT CANNOT KILL THEM

v      SANDFLY INGESTS THE CELL

MAJOR CLINICAL FORMS OF LEISHMANIASIS

v      LEISHMANIA TROPICA AND MEXICANA

·         CUTANEOUS LEISHMANIASIS OR OLD WORLD LEISHMANIASIS

·         IDENTIFY AMASTIGOTES IN MACROPHAGES OF SKIN LESIONS

v      LEISHMANIA BRAZILIENSIS

·         MUCOCUTANEOUS LEISHMANIASIS OR NEW WORLD LEISHMANIASIS

·         IDENTIFY AMASTIGOTES AT PERIPHERY OF THE LESION

v      LEISHMANIA DONOVANI

·         VISCERAL LEISHMANIASIS,  “KALA AZAR”, DUMDUM FEVER

·         IDENTIFY AMASTIGOTES IN EARLY SKIN LESION AND L.D. BODIES IN R.E. SYSTEM, SPLEEN, LYMPH NODES , BONE MARROW AND LIVER

·         ALSO PRESENT IN FECES, URINE AND NASAL DISCHARGES

BLOOD SPOROZOA

v      MALARIA INFECTIONS AND TOXOPLASMOSIS

v      WORLDWIDE PROBLEM - TRAVEL ALLOWS POSSIBILITY OF INFECTION ANYWHERE IN THE WORLD

v      PRODUCE A SPORE FORM THAT IS INFECTIVE FOR THE DEFINITE HOST AFTER IT IS INGESTED OR INJECTED BY A BITING INSECT

v      SEXUAL (GAMETOCYTE PRODUCTION AND SPOROGONY) AND ASEXUAL (SCHIZOGONY) REPRODUCTION

v      HAVE A TWO HOST LIFE CYCLE

v      FOUR  MAJOR SPECIES OF PLASMODIUM

·         PLASMODIUM VIVAX –TERTIAN MALARIA

·         PLASMODIUM MALARIAE – QUARTAN MALARIA

·         PLASMODIUM OVALE – OVALE MALARIA

·         PLASMODIUM FALCIPARUM – MALIGNANT MALARIA

 

LIFE CYCLE - PLASMODIUM SPECIES

v      ANOPHELES MOSQUITO BITES HUMAN AND ACQUIRES THE MICROGAMETES (MALE) AND MACROGAMETES (FEMALE) FROM BLOOD

v      SEXUAL REPRODUCTION IN HE FEMALE MOSQUITO

v      INFECTIVE STAGE: OOCYTES WITH MANY SPOROZOITES RUPTURE AND SPOROZOITES MIGRATE TO THE SALIVARY GLAND OF THE INFECTED MOSQUITO

v      METHOFD OF INFEFCTION: MOSQUITO BITES ANOTHER HUMAN INJECTING SPOROZOITES

v      EXOERYTHROCYTIC PHASE: SPOROZOITES TRAVEL TO THE PARENCHYMAL CELLS OF THE LIVER AND PENETRATES  LIVER CELLS, CRYPTOZOITES PRODUCED AND MEROZOITES ARE RELEASED TO INVADE CIRCULATING RBC’S

v      DIAGNOSTIC STAGE- ERYTHROCYTIC PHASE:  MEROZOITES INVADES RBC , FORMS TROPHOZOITE, SCHIZONT PRODUCTION, THE RBC RUPTURES AND THE MEROZOITES RELEASED TO PENETRATE NEW CELLS

v      THE CYCLE OF RBC INVASION, SCHIZOGONY AND CELL RUPTURING CONTINUES

v      LATER IN THE INFECTION SOME MEROZOITES FORM MICROGAMETOCYTES AND MACROGAMETOCYTES WHICH THE MOSQUITO INGESTS WHEN IT FEEDS FROM THE HUMAN

v      SEXUAL STAGE IS COMPLETED IN THE MOSQUITO

PLASMODIUM VIVAX

v      MOST WIDELY DISSEMINATED AND MOST PREVALENT

v      CAN CAUSE RELAPSES DUE TO REPEATED EXOERYTHROCYTIC CYCLES IN THE LIVER

v      ERYTHROCYTIC CYLCES CAN START AGAIN YEARS AFTER INITIAL INFECTION

v      ALL STAGES SEEN ON SMEAR

v      INFECTS RETICULOCYTES

v      INFECTED ERYTHROCYTES APPEAR ENLARGED, PALE AND MAY HAVE SCHUFFNER DOTS

 

PLASMODIUM FALCIPARIUM

v      THE MOST DEADLY MALARIA

v      INFECTS ANY RED BLOOD CELL

v      CELLS BECOME STICKY

v      THROMBOSIS OF CAPILLARIES

v      CELLS ARE NORMAL SIZE AND COLOR

v      MULTIPLE PARASITES IN CELL

v      LIVER AND KIDNEY INVOLVEMENT

v      LYSIS OF RBC’S  CAUSES HGB IN URINE - BLACKWATER FEVER

v      USUALLY ONLY RING FORMS

v      BANANA SHAPED GAMETOCYTE

PLASMODIUM MALARIAE

v      CAN ONLY INVADE OLDER CELLS

v      NORMAL SIZE AND COLOR

PLASMODIUM OVALE

v      INFECTS RETICULOCYTES

LABORATORY DIAGNOSIS OF MALARIA

v      CAN IDENTIFY TROPHOZOITES, SCHIZONTS OR GAMETOCYTES IN PERIPHERAL BLOOD

v      BLOOD SHOULD BE DRAWN IN BETWEEN PAROXYSMS TO BE ABLE TO ISOLATE THE PARASITE

v      SUBSEQUENT SPECIMENS SHOULD BE DRAWN AT 6-12 HOURS

v      THIN AND THICK SMEARS SHOULD BE EXAMINED

v      LOOK FOR SIGNS OF INFECTED RBC’S ON STAINED SLIDES

v      COMPARE SIZE AND COLOR TO UNINFECTED CELLS

v      NOTE INCLUSIONS (SCHUFFNER DOTS)

v      NOTE STAGES PRESENT

 

DISEASE

v      ALL CAUSE SPLEEN ENLARGEMENT, INTERMITENT FEVER AND CHILLS, PAIN IN JOINTS AND ANEMIA FROM RED CELL DESTRUCTION

v      NAUSEA, VOMITING AND DIARRHEA AMONG INITIAL SYMPTOMS

v      HIGH IGM AND IGG LEVELS SUGGEST CURRENT OR RECURRENT INFECTION

v      ELEVATED IGG INDICATES PAST INFECTION

BABESIA

v      INTRAERYTHROCYTIC HUMAN PARASITE

v      INFECT CATTLE AND HUMANS

v      TICK IS THE DEFINITE HOST

v      IN THE HUMAN HOST, IT MULTIPLIES IN THE RBC'S

v      ALTERNATING ASEXUAL AND SEXUAL REPRODUCTION STAGES

v      INFECTIONS CAN BE TRANSMITTED THROUGH BLOOD TRANSFUSIONS

DISEASE

v      MALARIA-LIKE SYMPTOMS; FEVER, CHILLS, SWEATING AND MYALGIA

v      MANY CASES ARE ASYMPTOMATIC

v      HEMOLYTIC ANEMIA AND MILD SPLEEN AND LIVER DISEASE

v      SEVERE CASES CAUSE RENAL FAILURE, DISSEMINATED INTRAVASCULAR COAGULATION AND RESPIRATORY SYNDROME

LABORATORY DIAGNOSIS

v      PARASITE VISIBLE IN WRIGHTS STAIN OR GIEMSA STAIN THIN BLOOD SMEAR

v      PARASITES APPEAR AS SMALL, DELICATE, FRAGILE RING FORM TROPHOZOITE IN RBC’S; THEY LIE IN PAIRS OR AS TETRADS IN A MALTESE CROSS FORMATION

TISSUE SPOROZOA

TOXOPLASMA GONDII

v      SPOROZOAN - INFECTS AND UNDERGOES SCHIZOGONY IN NUCLEATED CELLS OF ALMOST ALL ANIMALS AND BIRDS

v      THE CAT HAS BEEN CITED AS THE ONLY DEFINITE HOST

v      TWO DISTINCT LIFE CYCLES

v      ENTERIC STAGE

v      MULTIPLIES IN THE INTESTINAL CELLS OF DOMESTIC ANIMALS (CAT IS THE PREFERRED  HOST

v      SECOND STAGE

v      MULTIPLIES IN CIRCULATING WHITE BLOOD CELLS UNTIL CONTROLLED BY THE IMMUNE SYSTEM

v      IMMUNE SYSTEM CAUSES CYSTS TO FORM

v      MAY REMAIN DORMANT AS LONG AS THE IMMUNE SYSTEM IS FUNCTIONING

v      INFECTION  OF HUMANS IS BY INGESTING THE INFECTIVE OOCYST BY CONTAMINATED FOOD AND WATER, FROM CONTAMINATED SOIL AND CAT LITTER

v      IN HUMAN IT CAN FORM PSEUDOCYSTS IN TISSUES

CLINICAL SYMPTOMS

v      BASIC RESPONSE TO TISSUE INVASION IS INFLAMMATION

v      LESIONS OCCUR IN ANY TISSUE

v      DIAGNOSIS DEPENDS ON SEROLOGY TESTING

v      HIGHLY SYMPTOMATIC IN EARLY STAGES

v      USUALLY ASYMPTOMATIC WHEN CONTROLLED BY IMMUNE SYSTEM

v      SERIOUS CONCERN - TOXOPLASMA MAY BE TRANSFERRED ACROSS THE PLACENTA

v      CAN CAUSE BLINDNESS, MENTAL RETARDATION OR BLINDNESS OR DEATH OF INFANT

HELMINTHS

TRICHINELLA SPIRALIS (TRICHINA WORM)

v      CAUSE OF DISEASE, TRICHINOSIS

v      ENCYSTED LARVAE IN MUSCLE OF RAW OR UNDERCOOKED MEAT (MOSTLY PORK)

v      LARVAE IS RELEASED BY DIGESTIVE JUICES

v      CARRIED IN CIRCULATORY SYSTEM

v      DEVELOPS IN STRIATED MUSCLES

v      CONSIDERED TO ACCIDENTAL INFECTION IN HUMANS

LABORATORY DIAGNOSIS

v      DIFFICULT TO RECOVER ADULTS OR LARVAE IN A STOOL SPECIMEN

v      ENCYSTED LARVAE FOUND IN STRIATED MUSCLE (NURSE CELLS) AND BIOPSY; SEROLOGY AND A HISTORY OF EATING UNDERCOOKED PORK OR BEAR

v      INTERDERMAL SKIN TEST

v      XRAYS THAT SHOW CALCIFIED LARVAE INDICATING PREVIOUS INFECTION

DISEASE

v      SYMPTOMS INCLUDE PERIORBITAL EDEMA, FEVER, MUSCULAR PAIN OR TENDERNESS, HEADACHE AND GENERAL WEAKNESS

v      EOSINOPHILIA IS COMMON;HEMORRHAGES OF FINGERNAILS AND RETINAS AND RASH

THE FILARIAE – TISSUE NEMATODES (ROUNDWORMS)

v      LIVE IN VAROIUS HUMAN TISSUE LOCATIONS

v      MICROFILARIAE TRAVEL TO LYMPHATICS, BLOOD OR SKIN

v      REQUIRE AN ARTHROPOD INTERMEDIATE HOST FOR TRANSMISSION

v      PREVALENT IN PERIPHERAL BLOOD AT SPECIFIC DAY OR EVENING; NOCTURNAL OR DIURNAL (DAYTIME)

v      MICROFILARIA, IDENTIFIED BY ITS PERIODICITY AND ITS LOCATION IN THE HOST

v      MORPHOLOGY INCLUDE THE ABSENCE OR PRESENCE OF A SHEATH AND THE PRESENCE AND ARRANGEMENT OF NUCLEI IN THE TAIL

LABORATORY DIAGNOSIS

v      FOR WUCHERERIA BANCROFTI, BRUGIA MALAYI AND LOA LOA LOCATE MICROFILARIAE IN STAINED BLOOD SMEAR OR CENTRIFUGE BLOOD SAMPLES AND LYSE RBC'S TO CONCENTRATE MICROFILARIAE IN SPECIMEN

v      ONCHOCERCA VOLVULUS; LOCATE MICROFILARIAE IN SKIN SNIPS OF TISSUE NODULE AND ADULTS IN EXCISED NODULE

WUCHERERIA BANCROFTI

v      CAUSATIVE AGENT OF BANCROFTIAN FILARIASIS OR ELEPHANTIASIS

v      LIMITED TO THE TROPICS AND IS NOCTURNAL

v      INTERMEDIATE HOST IS A MOSQUITO EITHER CULEX, AEDES AND ANOPHELES

v      LARVAE MAY CRAWL INTO BITE WOUND INTO BLOOD WHEN MOSQUITO BITES HUMAN

v      DEVELOPS INTO THE ADULT IN THE LYMPHATIC SYSTEM; MICROFILARIAE IN BLOOD

v      FEMALE RELEASES THOUSANDS OF SHEATHED MICROFILARIAE INTO CIRCULATION

v      MICROFILARIAE HAVE A SHEATH AND NUCLEI DO NOT EXTEND TO THE TIP OF THE TAIL

DISEASE

v      TROPICAL DISEASE, NOT COMMON IN U.S.

v      DAMAGE IS PRODUCED BY THE HOSTS IMMUNE RESPONSE TO THE ADULT WORMS

v      CAUSES GRANULOMATOUS LESIONS, CHILLS, FEVER AND EOSINOPHILIA

v      EDEMA, HYPERPLASIA, LOCALIZED SWELLING, REDNESS AND LYPHANGITIS ESPECIALLY IN THE FEMALE AND MALE GENITALIA AND EXTREMITIES

BRUGIA MALAYI

v      LIMITED TO THE FAR EAST

v      ANOPHELES AND MANSONIA MOSQUITOES TRANSMIT IT

v      ADULT FOUND IN LYMPHATICS, BLOOD

v      CLINICAL MANIFESTATIONS SIMILAR TO WUCHERERIA

v      DISTINGUISHING CHARACTERISTIC IS THE PRESENCE OF A SHEATH AND THE NUCLEI EXTEND TO TIP; TERMINAL NUCLEI SEPARATED

LOA LOA (EYE WORM)

v      LIMITED TO AFRICA RAIN FOREST AND IS DIURNAL

v      INTERMEDIATE HOST IS THE CHRYSOPS FLY

v      LARVAE IS INJECTED INTO THE SKIN AND MATURE IN SUBCUTANEOUS TISSUE

v      FEMALES RELEASE SHEATHED MICROFILARIA INTO BLOODSTREAM

v      THEY ARE SHEATHED AND NUCLEI EXTEND TO THE TIP OF THE TAIL

DISEASE

v      CALABAR SWELLING – TEMPORARY INFLAMMATORY REACTIONS PARTICULARLY AROUND THE EYE

v      SWELLINGS CAUSE PAIN AND DISEASE CAN BE CHRONIC OR ACUTE

ONCHOCERCERCA VOLVULUS

v      CAUSES ONCHOCERCOSIS OR RIVER BLINDNESS

v      LIMITED TO CENTRAL AMERICA AND AFRICA

v      INTERMEDIATE HOST IS THE BLACK FLY

v      ADULTS ARE ENCAPSULATED IN FIBROUS TUMORS IN HUMAN SUBCUTANEOUS TISSUES

v      MICROFILARIAE FOUND AND MIGRATE SUBCUTANEOUSLY; RARELY FOUND IN BLOOD AND LYMPHATIC SYSTEM; ADULT INJECTS UNSHEATHED LARVAE INTO SUBCUTANEOUS TISSUE

v      UNSHEATHED AND NUCLEI THAT DO NOT EXTEND INTO THE TIP OF THE TAIL

DISEASE

v      CAUSES BLINDNESS, MOST SERIOUS COMPLICATION, WHEN MICROFILARIAE COLLECTS IN CORNEA AND IRIS CAUSING KERATITIS AND ATROPHY OF THE IRIS