2009 Perry Altman, Mark Tuttle

TAPEWORMS:
Taenia solium &
Taenia saginataas adults
Taenia solium larval disease Echinococcus granulosus
English Name T. solium = pork tapeworm
T. saginata = beef tapeworm
Cystercercosis Hydatid Cyst
Mode of transmission and the
infective form
Eating muscle tissue infected with larval
cystercerci
Ingestion of eggs from human feces (eggs
are formed by adult worms living in
human intestines)
Ingestion of embryonated eggs (not
proglottid)
Life Ccle Indirect
o Cow eats shit/proglottids in
grass larvae get into its muscle and form
cystercerci we eat the cow adult
matures in our !I we shit out gravid
proglottids
"irect Indirect
o #e eat dog shit get
cysts no adults formed in
humans (only in dogs)
$ote% E. multilocularis is emerging
problem&& rodents/fo'es&& e'tensive cysts
Migration !"in #umans Ingested cystercerci mature into adults
that hook onto the intestine via a (scole')
!astric acid and pancreatic
en*ymes release oncosphores
+ncosphores penetrate intestinal
wall and are disseminated with the
blood
+nce distributed to peripheral
tissues they die, swell, and calcify, as
they cannot complete their life cycle
+ncosphores (motile larvae)
hatch and penetrate intestine
Enter circulation and form
hydatid cysts in liver, lungs, etc&
#o! is $atholog $roduced% -dult form sits in intestines and takes
up nutrients
.sually only minimal weight loss only
problematic if the definitive host is starving
Cysticerci form in muscles and
organs including the brain
/ery problematic for brain as
they die/swell (can take years)
Cysts in organs release antigens
If cyst ruptures, release of -g can
cause shock also release of
protoscolices can make new cysts0
&iagnosis ' #hat sample1 #hat is
seen1
2resence of proglottids or eggs in feces
+nly proglottids can differentiate b/w
beef/pork
(3ice grain) calcifications in
skeletal muscle
Eosinophilia
4erology
563ay/C7 for calcified cysts
&efinitive host Humans Humans "ogs and relatives
(ntermediate host)s* T. solium = pigs or human (see cystercercosis)
T. saginata = o'
(ie, eating larvae +3 eggs of pork tapeworm
infects us for beef tapeworm only larvae infect
us)
Humans
$ote this disease also occurs in pigs, from
eating human shit
8any animals (especially herd types
around dogs humans)
+orm transmitted from human to
ne,t host
2roglottids or eggs that are released in feces Eggs
(between humans or autoinfection)
3elease of cysts or protoscoleces
-eogra$hical foci T. solium = -frica, India, 4E -sia, China,
8e'ico, 9atin -merica
T. saginata = #orldwide
8e'ico and other 9atin -merican
contries -reas of poor sanitation and
hygiene
Europe, 4& -merica, -frica, -sia,
-ustralia, $ew :ealand, .4 and Canada
4hepherds in .tah ; E& -frica
Treatment"Prevention Cooking/deep free*ing food < meat
inspection
Hygiene (cows must eat human shit0)
Hygiene
2ra*i=uantel
-lbenda*ole
Hygiene prevent dogs from
eating uncooked meat
4urgical removal w/pre6treatment
2009 Perry Altman, Mark Tuttle
$iclosamide of cysts with -g$+>
TAPEWORMS .
+L/0ES:
Diphyllobothrium latum Fasciola hepatica / Paragonimus
westermani
Cercarial dermatitis
English Name ?ish 7apeworm 9iver ?luke (sheep) / 9ung fluke @ird 4chistosomes (?luke)
Mode of transmission and the
infective form
Improperly cooked fish with larval stage
2leurocercoid larvae
Encysted cercariae (metacercariae) on
water plants/crabs/etc are eaten&
Cercariae directl infect via skin
Life Ccle Indirect
o #e eat fish with larvae in
them adult forms in our gut we shit out
proglottids/eggs
Indirect herma$hrodite
o 9iver% adult in bile duct
eggs/feces go to water larva
infects snail snail releases
cercariae that encyst on
plants/crabs/etc we eat these
o 9ung% same e'cept adult
is in lung so see eggs in sputum or
feces (ie, if sputum is swallowed)
Indirect se$arate se,es
+emale !"in Male canal
o Involves mollusks and
water birds humans accidental
hosts for cercariae
Migration !"in #umans 9arva matures into tapeworm in small
intestine 7akes about > months
Can grow ABm long (largest human
tapeworm)
9iver% larvae hatch in small
intestine and penetrate !I wall
disseminate into blood, migrate to
liver and penetrate capsule go to
biliary duct
9ung% same thing but end up in
lung cavity
?ail to form functional
schistosomulum
"ie in skin inflammation0
#o! is $atholog $roduced% CD will get megaloblastic (pernicious)
anemia from vitamin @AC uptake by strobila
@iliary obstruction
7raumatic hepatitis if severe
infection
4evere dermatitis is caused when
the cercariae die in the skin causing an
inflammatory reaction&
&iagnosis ' #hat sample1 #hat is
seen1
2roglottids/eggs in feces .nembryonated eggs in feces
Eosinophilia
4evere dermatitis w/skin scraping
showing cercariae
&efinitive host -ny fish eating carnivore (humans) Humans and other mammals #ater @irds ; sort of humans (dead6end)
(ntermediate host)s* Copepod (water flea) ?ish #ater snail #ater snail
+orm transmitted from human to
ne,t host
Eggs hatch in water and are ingested by water
flea, which are then eaten by fish
Eggs in human feces hatch 8iracidium
penetrates snail
Humans are dead6end hosts
-eogra$hical foci !reat lakes, 4candinavia and @altic 3egion #orldwide #orldwide especially !reat 9akes region
Treatment"Prevention $iclosamide 2ra*i=uantel 2ra*i=uantel
2009 Perry Altman, Mark Tuttle
+L/0ES:
Schistosoma mansoni Schistosoma japonicum Schistosoma haematobium
English Name @lood ?luke @lood ?luke @lood ?luke
Mode of transmission and
the infective form
Cercariae directl infect via skin
(hyaluronidase virulence factor)
Cercariae directl infect via skin
(hyaluronidase virulence factor)
Cercariae directl infect via skin
(hyaluronidase virulence factor)
Life Ccle Indirect se$arate se,es
+emale !"in Male canal (continues for
years0)
-dult in mesenteric veins eggs/feces go to
water larva infects snail snail releases cercariae
they infect us via skin ; disseminate
Indirect se$arate se,es
+emale !"in Male canal (for
years0)
4ame as S. mansoni
Indirect se$arate se,es
+emale !"in Male canal (for
years0)
-dult in bladder veins eggs/feces
go to water larva infects snail snail
releases cercariae they infect us via skin
; disseminate
Migration !"in #umans 2enetrates skin
physiological/morphological change into
schistosomulum (cercaria loses tail fresh HC+ to
salt HC+ glycolysis to fermentation tegument
takes up human -gs for evasion) @lood
9ung 9iver veins
4chistosomulum feeds on plasma and
eventually mates in the liver as an adult
4ame as S. mansoni 4ame as S. mansoni e'cept bladder veins
instead of mesenteric veins
#o! is $atholog $roduced% Eggs released in mesenteric veins migrate
to intestinal lumen (proteases help migration)
EBD of eggs will deposit into tissues and
die causing chronic fibrosis of organs/blood
vessels
2ortal/pulmonary hypertension, ascites,
esophageal varices (which can rupture)
4ame as S. mansoni
Eggs released in bladder veins
migrate to 1ladder lumen (see hematuria
early)
EBD of eggs will deposit into tissues
and die causing chronic fibrosis of organs
and blood vessels
@ladder fibrosis, obstructive
uropathy, renal failure/carcinoma
&iagnosis ' #hat sample1
#hat is seen1
"eposited egg w/in feces
o Lateral spine
Eosinophilia
9iver .ltrasound
"eposited egg w/in feces
o No spine
Eosinophilia
9iver .ltrasound
"eposited egg w/in urine (; some
in feces)
o Terminal spine
Eosinophilia
&efinitive host Humans ; #ater @irds Humans ; #ater @irds Humans ; #ater @irds
(ntermediate host)s* #ater 4nail #ater 4nail #ater 4nail
+orm transmitted from
human to ne,t host
Eggs from human waste hatch in water 8iracidia
released infects mollusk 4ame as S. mansoni 4ame as S. mansoni
-eogra$hical foci 4outh/Central -merica, -frica, Caribbean 4E -sia 7ropical -frica, 8iddle East
2009 Perry Altman, Mark Tuttle
Treatment"Prevention 4anitation snail reduction reducing carrier
population (cause a lot of spread0)
Eosinophils ; other cell6mediators
IgE/-/! low worm load all help F target%
schistosomulum
2ra*i=uantal
4anitation snail reduction
reducing carrier population (cause a
lot of spread0)
Eosinophils ; other cell6
mediators IgE/-/! low worm load
all help F target% schistosomulum
2ra*i=uantal
4anitation snail reduction reducing
carrier population (cause a lot of spread0)
Eosinophils ; other cell6mediators
IgE/-/! low worm load all help F
target% schistosomulum
2ra*i=uantal
2009 Perry Altman, Mark Tuttle
NEMATO&ES:
Enterobius vermicularus / Trichuris trichiura scaris lumbricoides Trichinella spiralis
English Name 2inworm / #hipworm -scarias 7richinosis
Mode of transmission and
the infective form
Ingestion of eggs from scratching/dust or
auto6infection if eggs hatch and enter
rectum/vagina (rare)
-scaris egg (embryonated form not fresh
ones) is ingested
Eating undercooked meat
encysted with larvae
Life Ccle "irect life cycle se$arate se,es "irect life cycle se$arate se,es "irect life cycle in mammals
se$arate se,es
Migration !"in #umans 2inworm%
o Ingested eggs hatch in small
intestine
o 8igrate to colon and mature
into adult
o ?emale lays eggs on perianal
skin
o Eggs are infectious
((embryonated)) after G6Hhr
#hipworm%
o 4ame, e'cept eggs deposited
into feces
o Eggs take >6Gwk to be
embryonated0
o +ccurs easiest in warm, sandy
soils
9arvae hatch in small intestine
penetrate !I wall @lood 9iver
Heart 9ungs emerge into
alveoli
8igrate up trachea esophagus
swallowed mature into adults0
o (-uto6infection)
Eggs take C6>wk to become
embryonated
9arvae ingested penetrate columnar
epithelium of small intestine and become
adults release more larvae
7hese larvae penetrate lamina propria
@lood 9ymph 7issues 4keletal
muscle encyst in a $urse cell for years
9arvae that donIt reach muscle will die
and cause inflammation
#o! is $atholog $roduced% 4evere perianal itching from irritation
of eggs
8ay be asymptomatic
#hipworm% high intensity infections
anemia, bloody diarrhea rectal prolapse0
9arval migration% pneumonitis
and liver enlargement
-dults% !I obstruction
-berrant migration% peritonitis
Canine ascaris % eye and brain
inflammation (visceral larva migrans)
o Humans are wrong host
larva dies inflammation
Intestinal (Awk)% nausea, vomiting,
diarrhea
E'traintestinal (C
nd
wk)% myalgia
(muscles invaded), other organs invaded,
petechiae (@/Is)
Ig! -b response w/eosinophilia due to
larval migration to tissues (peaks in >
rd
wk
as larvae encyst)
o ?ever and myalgia host
response
o 2etechial hemorrhages
blood vessel migration of larvae
2009 Perry Altman, Mark Tuttle
&iagnosis ' #hat sample1
#hat is seen1
4cotch6tape test on perianal region for
microscopic detection of eggs nocturnal
egg6laying
$+ eosinophilia (no tissue invasion)
?ecal/4putum eggs/larvae
(characteristic)
+ccasionally whole worms
e'pelled
2eripheral @lood 4mear
(eosinophilia)
4erology (Ig! due to tissue
invasion)
8uscle biopsy (tease out spiraled
larva)
No eggs in feces2
Ig! antibody titer to trichinosis (slow)
"iet of uncooked meat
&efinitive host Human Human -ll mammals
(ntermediate host)s* Human Human -ll mammals
+orm transmitted from
human to ne,t host
Egg is ingested and hatches into larvae in the
small intestine
Egg is ingested and hatches into larvae in
the small intestine
Encysted 9arvae
-eogra$hical foci #orldwide #orldwide especially 7ropics and
4outhern .4
.4-, and many other parts of the #orld
Treatment"Prevention 2yrantel pamoate
@etter hygiene and sanitation
8ebenda*ole, 2yrantel pamoate
Eggs resist disinfectants/sewage
treatment
Ivermectin
Cooking AHB?, deep free*ing
2ig feed properly cooked
NEMATO&ES:
ncylostoma spp! / "ecator spp! Strongyloides Wuchereria bancrofti / Brugia spp. /
Onchocerca spp.
English Name Hookworm +ilariasis (tropical)
Mode of transmission and the
infective form
4lender filariform larva penetrates between the
toes of shoeless human often via hair follicle
4lender filariform larva penetrates
between the toes of shoeless human often
via hair follicle
4pread by biting insects
mos=uitos carrying larvae
Life Ccle "irect Cycle se$arate se,es "irect Cycle se$arate se,es Indirect life cycle
Migration !"in #umans 9arvae travel from foot to alveoli of
lungs via blood
!row in alveoli, coughed up,
swallowed, mature as adults in small
intestine
9arvae travel from foot to alveoli
of lungs via blood
!row in alveoli, coughed up,
swallowed, mature as adults in small
intestine eggs
produced/released/hatch within
intestine
Egestion of larvae from mos=uito
goes to lymphatics mature into
adults
9arvae develop to adult form in
leg and genital lymph nodes
-dult form produces
microfilariae
#o! is $atholog $roduced% "iarrhea, abdominal pain, weight loss,
iron deficiency from anemia
Hookworm is attached to intestinal wall
sucking on blood
2neumonitis from alveolar infiltration
Canine hookworm % (cutaneous larva
migrans)
o Humans are wrong host
larva dies inflammation
Eggs hatch within intestine0
o -uto6infect%
rhabditiform larvae molt in
intestine become filiaform
penetrate intestine (re6infect)
lungs
o @uild up of larvae is a
problem in immunosuppressed
patients
9ymph node infestation promotes
chronic inflammation and
fibrosis/blocking of lymphatics
Improper lymph drainage
elephantiasis (esp& Wuchereria ;
Brugia)
7reatment can stop infection, but
damage is often permanent
+nchocerciasis ((river
blindness))% larvae transmitted by
blackflies
2009 Perry Altman, Mark Tuttle
o -dults live in lymph
nodes, skin
o 8icrofilariae in tissues
supporting eye inflammation
blindness
&iagnosis ' #hat sample1 #hat is
seen1
@iopsy leading edge of skin rash
Eggs of hookworm in feces (not
diagnostic of species)
Eosinophilia
3habditiform (rod6shaped) larvae
in feces
No eggs in feces2
4tring test% string in !I, larvae
attach, remove ; analy*e
E9I4-
Wuchereria% -g blood test (great)
-ll others% microfilariae in blood
o 8ust test at time
mos=uitos were biting (often at
night)
&efinitive host Human Human Human
(ntermediate host)s* Human Human (; nonhuman mammal reservoirs) 8os=uito /ector
+orm transmitted from human to
ne,t host
Eggs 9arva (in soil) 9arva (in soil, or auto6infect) 8icrofilariae
-eogra$hical foci 4&E& .4 ; 7ropics 7ropics IndoChina 7ropics
Treatment"Prevention 4anitation wearing shoes
8ebenda*ole
Iron and /itamin 4upplement
7reat anemia
4anitation wearing shoes
7hiabenda*ole
-lbenda*ole ; Ivermectin
Ivermectin
"iethylcarbama*ine
Brugia have endosymbiotic
bacteria that can be targeted
PROTO3OA:
Plasmodium #$alciparum% viva&% ovale% & malariae' Trypanosomiasis brucei
#gambiense/rhodesiense'
Trypanosomiasis cru(i
English Name 8alaria -frican 7rypanosomiasis, (4leeping
4ickness), $agana "isease
-merican 7rypanosomiasis Chagas
Mode of transmission
and the infective form
4pread by female Anopheles mos=uito carrying
sporo*oites
-lso blood transfusion, I/ needles, or congenital
E'tracellular flagellated proto*oa
(trypomastigote) spread by
7setse ?ly bite
Intracellular flagellated proto*oa (trypomastigote)
spread by
3eduviid bug ((kissing bug)) bite
-lso eating uncooked food with contaminated feces
blood transfusion/transplants labs
-lso transplacental or during birth
Life Ccle Indirect life cycle
o Mos4uito% !ametes sporo*oites
o #uman% 4poro*oites
mero*oites
Indirect 9ife Cycle
o Tsetse +l% 9ives
in gut
o #uman% 3eplicates
in @ody ?luids
Indirect 9ife Cycle
o Reduviid 1ug% 9ives in gut
o #uman% 3eplicates in tissues
(released into blood)
Migration !"in
#umans
Egestion of sporo*oites from mos=uito
hepatocytes
Hepatocytes release mero*oites 3@Cs
(chronic)
?orm gametocytes 4ucked up by
mos=uitos
7rypomastigotes replicate
by binary fission in various body
fluids blood, lymph, C4? and
meninges
7rypomastigotes invade various cells at site of
infection morph into amastigotes
-mastigotes replicate by binary fission in the
body tissues morph into trypomastigotes
released into blood
Invade more tissues, cycle repeats
2009 Perry Altman, Mark Tuttle
#o! is $atholog
$roduced%
9ysing of 3@Cs by the mero*oite stage&
Vivax/Ovale% immature 3@CIs w/&uff Ag
o 3elatively benign (flu6like)
symptoms
o Can be dormant in liver and
relapse even after blood is cleared of
mero*oites
alariae% mature 3@CIs
o No liver involvement no
relapses
!alciparum% any 3@CIs
o No liver involvement no
relapses
o -nemia (due to hemolysis)
o Capillary (plugging) due
hemolysis results in cerebral/placental
malaria ; renal failure
o Induces 2fE82A adhesive protein
on 3@CIs for se=uestration (evasion) clogs
capillaries by binding platelets/other 3@Cs
((rosetting))
o -ntigenic variation to evade -b
defenses
o 4ickle cell heteroIs (Hb-4) are
protected
T.b. gambiense%
Initially an inflamed nodule
7rypanosomes constantly
display different antigens
Inflamed lymph nodes
fever, myalgia, arthralgia
Inflammation of the C$4 ;
meninges progresses as
trypanosome spreads
2rogresses to (sleeping
sickness) (also lethargy,
retardation, hemiplegia, etc)
T.b rho"esiense%
4imilar to above, but more
virulent, severe, and fatal&
9ymphadenopathy is
uncommon
C$4 invasion occurs early
9ittle chronicity vs&
gambiense
-symptomatic, acute, or chronic
Chagoma% erythematous ; indurated area at
site of bite
o ?ollowed by rash/edema around eyes
and face (3omaJaIs 4ign)
-cute%
o Commonest/severest in children
o .sually C$4 involved
o ?ever, chills, myalgia, fatigue, etc
o 2arasites in blood sparse for KAyo
ptIs
o Either recovery, death, or
chronicity
Chronic%
o 2roliferation and spread to viscera
o >BD develop (mega6syndrome)%
hepatosplenomegaly, myocarditis, enlargement
of esophagus ; colon& @/c dead nerve cells
donIt control growth&
o 8egacardia ; meningoencephalitis
o "estruction of tissues is thought to be
an automimmune reaction
8ultiple 7/@6cell evasion strategies0
&iagnosis ' #hat
sample1 #hat is seen1
2eripheral @lood smear for malarial forms
o Vivax/Ovale% single ring forms
(immature tropho*oite in 3@C), or swollen
3@C w/up to CG mero*oites
o !alciparum% multiple ring forms
(immature tropho*oites in 3@C) banana6
shaped gametocytes
-b testing (some cross6reactivity)
2C3 test for malaria genome
@lood smears, lymph
aspirations, C4? may all show
e'tracellular parasites (larger
than 3@C)
#interbottom 4ign% swollen
lymph nodes on posterior neck
4erology
-cute% blood smear should show parasites
Chronic% organisms leave blood, so use biopsy
of viscera
4erology
&efinitive host 8os=uito /ector Humans and Hoofed 8ammals Humans and Hoofed 8ammals
(ntermediate host)s* Human 7setse ?ly 3eduviid @ug
+orm transmitted
from human to ne,t
host
!ametes 7rypomastigote 7rypomastigote
-eogra$hical foci $ot the .4 or #estern Europe&
7ropical for falciparum&
T.b. gambiense% #est/Central -frica
T.b. rho"esiense% East -frica
Central and 4outh -merica, 4ome 4outhern .&4&-&
Treatment"Prevention !alciparum F meflo=uine
-ll others F chloro=uine
4uramin (does not cross
blood6brain barrier)
$one reallyL try nifurtimo' for acute
$o vaccine
2009 Perry Altman, Mark Tuttle
2rima=uine for hypno*oites
$o vaccine
8elarsoprol for C$4
involvement
$o vaccine
PROTO3OA:
To&oplasma gondii Entamoeba histolytica )iardia *ntestinalis
English Name 7o'oplasmosis -mebic "ysentery !iardia
Mode of transmission and
the infective form
+ocysts passed from feline feces ingested by
human 7achy*oites
-lso transplacentally ; via transfusions
(rarely)
Cyst is ingested usually from unsaniti*ed water
?ecal6oral oral6anal
-lso se'ual transmission cutaneous amebiasis
Cyst is ingested usually from unsaniti*ed
water
?ecal6oral oral6anal
Life Ccle Indirect 9ife Cycle
o Cat% +ocysts in cat feces&
8ust mature in soil before it becomes
infective0
o #uman% +ocysts
7achy*oites @rady*oites
"irect 9ife Cycle (can be indirect via
flies/cockroaches)
o Humans eat shit/cyst, shit out more
cysts, eat shit/cysts again
"irect 9ife Cycle
o Humans eat shit/cyst, shit
out more cysts, eat shit/cysts again
Migration !"in #umans +o*ites mature into tachy*oites,
which infect muscle and neural cells
(intracellular) encyst (brady*oites)
-lso can locali*e to fetus in pregnant
women
Cysts ingested stomach acid stimulates
their growth into tropho*oites
7ropho*oites grow in gut and invade tissues
; blood stream (tropho*oites not infectious)
Cysts released in feces
?lagellated tropho*oites grow in
gut
2009 Perry Altman, Mark Tuttle
#o! is $atholog
$roduced%
Immunocompetent% asymptomatic
Immunocompromised (esp& cell
mediated)% encephalitis with necrotic
brain lesions
?etus% chorioretinitis (inflammation)
reactivates later in life
7ropho*oites secrete to'ins and en*ymes to
digest human tissues
o Colitis ; bloody diarrhea (tissue
damage)
o $ecrotic ulcers in mucosa
4ystemic dissemination% invade blood and
cause liver, brain and lung abscesses
o ?ever, leukopenia, etc (kill
neutrophils0)
Immunity is -b/complement based 76cells
important for preventing relapses
$ote% most amoebae are actually
commensal in humans (Must not this one)
+ften asymptomatic
Causes brief diarrheal illness,
which can result in malabsorption
4udden onset of watery steatorrhea
(foul smelling), flatulence
$o tissue destruction0 (mild
inflammation)
4pontaneously resolves no spread
past !I
Ig- deficient people are very
susceptible and can have chronic
infections
&iagnosis ' #hat sample1
#hat is seen1
4erology for presence of T. gon"ii
-b
Ig-/Ig8 for newborns (since mom
gave Ig!)
!I% -meba/cysts in stool or mucosal biopsy
serology (NED sensitive)
4ystemic% C7 scan serology (OOD
sensitive)
8icroscopy/staining% tropho*oite
has two nucleoli ; adhesive disk
?lourescent labeled cysts in stool
&efinitive host Cat Human Human and animals
(ntermediate host)s* Humans, mammals ; birds Human Human and animals
+orm transmitted from
human to ne,t host
7issue encysted brady*oite
(humans normally dead6end host)
Cyst (resistant semi6stable in environment) Cyst in feces (very resistant to chlorination
boil to kill)
-eogra$hical foci #orldwide #orldwide #orldwide
Treatment"Prevention 4ulfonamide < pyrimethamine
Cook meat to AHB?
$o vaccine
8etronida*ole followed by Iodo=uinol
!ood hygiene
$o vaccine
8etronida*ole
$ita*o'anide (2regnant women)
$o vaccine
2009 Perry Altman, Mark Tuttle
PROTO3OA:
Cryptosporidium spp! #hominis & parvum' Trichomonas vaginalis +eishmania donovani
English Name 7richomoniasis 9eishmaniasis
Mode of transmission and the
infective form
+ocysts are ingested
?ecal6oral, oral6anal
?lagellated e'tracellular proto*oan infects
genital tract via ?.CPI$!00 (47")
-lso occasionally by fomites neonates via
birth canal
64pread by phlobotomine sand flies
carrying the promastigote
6-lso direct contact with lesions
mechanically by stable flies or sharing
needles
Life Ccle "irect 9ife Cycle
o Humans eat shit/cyst, shit out
more cysts, eat shit/cysts again
"irect Cycle Indirect or direct cycle
o ?lagellated free
promastigote in vector egested into
host
o 2romastigotes are
phagocytosed by macrophages
morph into amastigotes
o $on6flagellated
intracellular amastigote in
definitive hosts are taken up by
new vectors morph into
promastigotes
Migration !"in #umans +ocysts are ingested
"evelop into tropho*oites in !&I& lumen
Enter into enterocyte cytoplasm
(intracellular)
4tays in genital tract of men and
women
Egestion of promastigotes from
mos=uito into human blood
7aken up by macrophages, spread
to various tissues
#o! is $atholog $roduced% +ften asymptomatic
Immunocompetent% causes mild watery
diarrhea w/o blood spontaneously resolves
Immunocompromised% severe
dehydration due to massive diarrhea can be
fatal and lasts months or years
3arely disseminates from !I tract
8ost fre=uent Quly6-ug in children
#omen% commonly
asymptomatic (scant, watery vaginal
discharge)
o /aginal discharge
((frothy))
o /aginitis (itching,
painful urination)
8en%
o 8ostly asymptomatic
carriers ((reservoirs) for women)
o +ccasionally, urethritis
or prostatitis
/isceral leishmaniasis (kala6
a*ar)% multi6organ infection -I"4
opportunist
o #. "onovani$ #.
infantum$ #. chagasi
o ?atal, chronic, or even
asymptomatic
o 3eticulo6endothelial
system invasion enlarged
spleen ; liver
o ?ever, rigor, chills,
fatigue (anemia)
Cutaneous leishmaniasis%
ulcerative, skin disfiguring infection
o #. tropica$ #. ma%or
o 3ed pruritic papule
enlarge/ulcerate skin
disfigured (slow healing)
o C
o
infection common
2009 Perry Altman, Mark Tuttle
8ucocutaneous leishmaniasis%
destruction of mucous membranes ;
related tissues
o #. bra&iliensis
uncommon disease
o Initially cutaneous
(untreated) progresses (even
years later) often oral/nasal
mucosae w/damage to nearby
structures
o C
o
infection common
R"ominant 7HA response self6
limited
R"ominant 7HC response
progressive
&iagnosis ' #hat sample1 #hat is
seen1
-ntibody6linked stains of stool
+ocysts are acid6fast positive
Indirect immunofluorescence assay
/aginal discharge smear
motile flagellated organism
2ap smear with fluorescent -b
stain
Clinical presentation
8olecular detection methods
most accurate
8C9//9% amastigotes in clinical
specimens or promastigotes in culture
tissue
/9% organ biopsies (visuals)
buffy coat venous blood preps urinary
-gs culture
&efinitive host 8ammals Humans 8ammals/Humans
(ntermediate host)s* 8ammals Humans 8os=uito
+orm transmitted from human to
ne,t host
+ocysts are released with feces into a water
supply (resistant to chlorination boil to kill)
?lagellated proto*oan 47" -mastigote (in macrophage) ingested by
mos=uito
-eogra$hical foci #orldwide #orldwide /isceral% @angladesh, @ra*il,
India, $epal, 4udan
Cutaneous% -fghanistan, @ra*il,
Iran, 2eru, 4audi -rabia, 4yria (also
@ra*il, 2eru)
8ucocutaneous% @olivia, @ra*il,
2eru, Central -merica
Treatment"Prevention 2aromomycin
$ita*o'anide (2regnant women)
2oor response in immunocompromised
8etronida*ole
7reat male as well to prevent
relapse
I/ antimony compounds
C9% inMection of antimony
directly into lesion or parenterally
8C9% stibogluconate6pentosam
/9% liposomal amphotericin @
$o vaccine
2009 Perry Altman, Mark Tuttle
2009 Perry Altman, Mark Tuttle
ECTOPARAS(TES: Sarcoptes scabiei Pediculus humanus capitis Pediculus humanus corporis Pthirus pubis
English Name Itch 8ite 4cabies Head 9ice @ody/Clothing 9ice 2ubic/Crab 9ice
Mode of transmission and the
infective form
Close personal contact for
transmission of mites
Close personal contact or use of
communal combs
Eggs/9ice in fibers of clothing 9ice in coarse hair are
transferred w/se'ual (or close)
contact
Life Ccle "irect life cycle "irect life cycle "irect life cycle "irect life cycle
Migration !"in #umans 8ate in skin pits
?emale mite tunnels
within epidermis, leaving
feces and eggs behind
Hatching larvae migrate
to skin surface where they
molt and mate
egglarvanymphadult
(AG days on human)
$it (egg) glued to
hairlarval stages feed on
blood moltadults live in
hair feed on blood
$it (egg) glued to
clothinglarval stages feed
on blood moltadults live
in clothing feed on blood
$it (egg) glued to
coarse hairlarval stages
feed on blood moltadults
live in coarse hair feed on
blood
o Eyelashes,
armpit/pubic hair
#o! is $atholog $roduced% 4kin irritation due to
immune response to
eggs/feces (itchy0)
4ee pyogenic response
Immunosuppressed
(-I"4) Crusted 4cabies
(SST of mites)
Itching due to
hypersensitivity to bites
(saliva)
"o not spread diseases
Itching due to
hypersensitivity to bites
(saliva)
/ector for trench fever
(B. 'uintana) ; typhus ((.
typhi)
Itching due to
hypersensitivity to bites
(saliva)
&iagnosis ' #hat sample1 #hat
is seen1
4ymptoms and history
(C
nd
infestation =uicker
response)
8ost common in hands,
feet, knees, armpits, butt,
stomach, between shoulder
blades
4kin scraping for mites,
eggs and fecal pellets
o Cannot
visuali*e w/naked eye
9arge, seen by naked
eye
9arge, seen by naked
eye
9arge, seen by naked
eye
&efinitive host Human Human Human Human
(ntermediate host)s* Human Human Human Human
+orm transmitted from human
to ne,t host
8ite UarachnidV $it/9ouse UinsectV $it/9ouse UinsectV $it/9ouse UinsectV
-eogra$hical foci #orldwide hygiene #orldwide kids #orldwide poverty #orldwide 47"s
Treatment"Prevention 9indane (esp& under
nails)
?ine tooth comb
Insecticide shampoo
Insecticide shampoo
Ivermectin shampoo
?ine tooth comb
Insecticide shampoo
2009 Perry Altman, Mark Tuttle
Ivermectin shampoo Ivermectin shampoo
ECTOPARAS(TES:
+eeches Tic,s -T.E/S
English Name
9eeches 7icks @ot fly / "emode'
Mode of transmission
and the infective form
"irect contact "irect contact "irect contact / $ormal fauna
Life Ccle Indirect life cycle Indirect life cycle Indirect life cycle / "irect life
cycle
Migration !"in
#umans
$one #alk around superficially 8yiasis (fly maggot grows in
body) / $ormal fauna of sebaceous
glands ; hair follicles
#o! is $atholog
$roduced%
@lood sucking on skin
Aeromonas hy"rophila is
a pathogenic symbiont
Inflammatory response to tick
-gIs Sbasophils
7akes some time usually to
transmit the diseases they are a
vector for
7ick paralysis% ascending
paralysis due to to'ins in female
ticks affecting nerve conduction
"eer ticks (). scapularis)%
9yme ; @abesia
#ood ticks (*.
variabilis/an"ersoni)% 3& rickettsii
4kin irritant / +vergrowth in
immunosuppressed
3andom note% 7ungiasis = sand fleas
lay eggs in skin ; under nails swell
painful
&iagnosis ' #hat
sample1 #hat is seen1
4ymptoms and history 9arge, seen by naked eye 4een in skin / 1
&efinitive host
Human +ther animals / humans +ther animals / humans
(ntermediate host)s*
+ther animals +ther animals +ther animals / humans
+orm transmitted from
human to ne,t host
-dult leech Immature ; adult ticks UarachnidV 9arvae / $ormal fauna
-eogra$hical foci
#orldwide #orldwide #orldwide
Treatment"Prevention 3emove them
.sed occasionally to
prevent blood congestion, eg
3emove them
/accines against tick salivary
proteins mostly veterinary use
(reduces feeding time of tick due to
3emove them / Ignore them
2009 Perry Altman, Mark Tuttle
keep capillaries open in skin
grafts (they have
anticoagulants)
Sbasophils)