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    (2019A) K.D. Chatterjee - Parasitology Protozoology and Helminthology-Chatterjee Publications (2011)

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    THIRTEENTH EDITION PARASITOLOGY (Protozoology and Helminthology) With two hundred fourteen illustrations OC ere Met (s0s) PARASITOLOGY PROTOZOOLOGY AND HELMINTHOLOGY IN RELATION TO CLINICAL MEDICINE With two hundred fourteen illustrations By K.D. CHATTERJEE ip, CAL) Professor of Medicine (PAIRTEENTH EDITION] Dr. D. CHATTERJEE m0. (cay © Vay) CBS CBS PUBLISHERS & DISTRIBUTORS PVT. LTD. NEW DELHI + BENGALURU - PUNE - KOCHI - CHENNAI ase" eat ISBN OP AL-2W.IHIOS w Gee w — yoo First Edition : Aupust, 1987 cal Telli thot: April, 19két Reprinted = Jamuiry, 1981 Reprinted : Kinuary, 1982 Thirteenth Fitine : September 200 Reprinted : Febewary, 2018 Copyright © by Dr D. Chatterjee M.D, (Culy 4 Amrita Banerjee Road, Kalkisa - 7M) 026 AlLtiphts teserved, Na part of thy bonk may be Feprentuced vr transmitted in any fe ea m. electronica mechanical, including phavexnpying, recunin, and retrieval sytem withault pcemissinn. in sili Copyeight Dr. D. Chatterjee M.D. Cal, rm oF by any Oo any information storae from the Registered Proprietor af the Published bys Sutin K. Jain and produced by Vinod K. Jain for CHS Publishers ae Distributors Pst. Lid, S819/X1 Praliad Street, 24 Amari Road, Daryayany, New Delhi 110002, India Small chspubte val com, delhi@ebpxtcom + wwvy.chypd eum Branches: * Aetigatur: Seems House, 2975, ik Cross. KR. Road, Bansankaré 2nd Stage. Bengali - $6007 Ph 491 80-2677167879 Fan: +91-80-26771680 * E-mail: chxbng nny ‘cont, buigalore@ebspad cam + Pune: Bhuruk Prestige, Sr. No, $2°12/24 1402. pre, Hovcli Near Keta-Dehn Road By-pass, Pune = 4] 1054 Ph: $+91-20-6870405K059, 32342277 Email Punes# bsp com * Kochi: 3/14, Kalluvitakam. Lissie Hespital Road, Kochi - 68208. Keraly © Ph. -+91-aB4-4089081-65, SX: #91 484-4059068 + E-mail cachiatectapeLeom * Cherie: 20, West Pask Road, Shenoy Nagur, Chena, 410300 phe 9-44 26200600, 26278620 © Fans 49 | bk toy E-mail: chennai chp com Printect a : ‘Thomvon Pres tindia) Lid, New Det - 110 03 PREFACE TO THE THIRTEENTH EDITION 12 new informations wherever Necessity, The velume of ing the original purpase, aumely, to provide a book of ‘The text has been revised and brought up to date by the book however has been appreciably enlarged, maint hudly size. ‘The book was out of print for a considerable period, The inconvenience caused thereby is regretted. Lam sincerely thankful to Mrs. N. Chatterjee, Miss S. Chatterjee and Mr. S. Nath for their efforts to bring aut this edi Calcutta Dr. D. Chatterjee M.D. ¢Cal) 28th September 2009 Prof, K.D. Chamerjee acknowledged the help which be had received! inthe past from the following persons: Dr. DR. Seaton of Liverpool Schoo! of Tropical Medicine. Dr. T.Clive Backhouse, Hony, Consultant Parasitologist to the Tropical Section of St. Vineent’s Hospital, Sydney: formerly Senior Lecturer in Parasitology, Schoo! of Public Health and Tropical Medicine, University of Sydney. Dr. Leroy J. Olson, Assistant Professor, Department of Microbiology and Dr, Howard C. Happs, Professor and ‘Chairman, Department of Pathology, University of Texas. Dr. Jahn W. Orr, Professor of Pathology, University of Birmingham, Dr. JIL. Buckley, Professor of Helminthalogy, London School of Hygiene and Tropical Medicine. Dr. W. Peters, Professor of Parasitology. Liverponl School of Tropical Medicine. Dr. H, Spencer, Professor of Pathology, St. Thamas's Hospital Medical Schoo!, London. Dr. George 8, Nelson, Professor of Helminthology, London School of Hygiene and Tropical Medicine, Dr. D, Chatterjee acknowledges the help which he received for this edition from the following persion: ‘Dr. A.K. Bandyopadhyay, Reid. Associate Prof. & Head, Dept. of Helminihology, School of Tropical Medicine, Calcutta. Dr. N.K, Jana, Reader. Dept. of Zoology, Charuchundra College, Cateutta, Bandyopadhyay, Head, Dept. of Physidlogy. RPM. College, Hoogly, West Bengal, ‘Mr, U, Hazra, Reader & Head, Dept. of Zoology. R.PM. College, Hoogly, West Bengal. PREFACE TO TH FIRST EDITION it preasit rasitic Diserse ‘This book has been developed from the author's previous baok entitled Hrance Pa eae Soe oe which, aecording to many, was considered 18 be a comprehensive treatise —a reference i¢ to the undergraduates on account of its lange size, " wR ‘volume hastherefoe heen ae }o a handy sige, in which elaborate discussions tis ee avoided, Dutall basic facts with which a médical student should be familiar, have been dealt with. In short, eghoukd SEIVE Btn Sank of ready reference on Parasitology, dealing with ihe essential characters of parasites infecting man, as also the Pathogenic effects and methods af diagnosis. ‘The book lias heen divided into four sections. The first is an introductory section describing the terminology and general principles of parasitological studies, Then there are two sections: Protozoology and Helminthology. In each Section the parasites of man have been classified! and deseribed under the following headings: Geographical distrib. on, habital. morphology and life cycle, pathogenicity und clinical features, diagnosis, (reatment and prophylaxis, ‘The concluding setion is by way of an appendix, detailing vatious techniques adopted for parasitological diagnosis, (Trestment of parasitic infections has beet added! inthe appendix from the Ath Edition.) This book is adequately ilusieaied with the line diy Piled tables to assi rams and coloured plates and there are also specially com: cussed in the text, In faet, no pains have been sents as possible and the author hopes that he has been ! 's Medical Parasitology. which will not anly be of help in their elassswork but Wi ive them a better understnding of the subject. if the book should be ‘equally useful 16 teachers laboratory workers and practitioners, the authar would feel amply rewarded for his efforts. ‘The author desires to record his appreciation oth table 10 pravide a complet valuable serviees rendered i i aor desi by Sree Saraswaty Press Ltd,.in the Cateutia 21st August 1957 SOR Past GENERAL INTRODUCTION Itt SECTION 1 PROTOZOOLOGY Charter 1, PROTOZOA : patie i 1-17 I. PHYLUM SARCOMASTIGOPHORA 1B-8Y I, PHYLUM APICOMPLEXA..... 90-137 IV, PHYLUM CILIOPHORA. 138-140 V. PHYLUM MICROSPORA M1 SECTION 11 HELMINTHOLOGY Vi. PHYLUM PLATYHELMINTHES: CLASS CESTOIDEA ‘VII, PHYLUM PLATYHELMINTHES: CLASS TREMATODA 199-258 VII. PHYLUM NEMATHELMINTHES: CLASS NEMATODA APPENDIX | DIAGNOSTIC PROCEDURES A. Examination of Stoal for Parasites... wo 260-266 B. Examination of Blood for Parasites . . 266-273 C, Cultural Examination 173-276 ‘1D, Examination of Biopsy Material... 276-278 APPENDIX ID ‘TREATMENT OF PARASITIC INFECTIONS List of Drugs: Dosage and Methads of Administration . 219-293 Inde: 295-298 GENERAL INTRODUCTION yeu i) 3) Parasite. A living organism? which receives nourishment and sbeller from aiiotter organism where it lives Host. An organism whieh hashoure she parasite Association of living things which five together: An association which is formed belween aninials of different species may be divided mig thee categories: Svmbjaas’s, An association in which bath are s0 dependent upon exci other that ane cannot five witha the help ‘of the other, None of the parincrs suffers any hsm fron the 2ssoeiation. ‘Commnensativin, Ae association in which the parasite only is deriving benefit without causing Coonmensal is capable of eadling wn independent Hie. ‘Parusitivn. An association in which the parasite derives benefit and the ust pets nothing bw return but always suffers seme injury, buwever slight the iajury maybe. The hos, athe sume time, offers some resistanige 1 the injury done by the paraste ad there may be some adaptation (oferumce) between the parasite on the lst. A perrasive has lost its power of independent life Zoonosts, Evolution of a human disease naturally acquired from an on primarily confined to vertebrate animals, Literally. the term “zoonosis” means a disease of animals iis, (rypanovemiasis (Chagas disease ‘and “Rhodesian” Meeping sickness) trichinelliasis and echinococcosis are typical examples of zoonotic diseases. eto-paarasite UEctozim): Lives outside om the surface of the boxy of the bist. Enu-parayire (Enrazexe\: Lives inside the bry of tke bust in the bkood, tissues, badly cavities, digestive tact and other organs Femporary Parasite: Ni uury to its host, A, sits host for u short perio. Permanent Pecasite: Leads a partsitie life throughout the whnke peril ts Hie. Facultative Parasite: Lives a parasitic life when-apportunity arises. Obligatory Parasite: Cannot exist without a parasitic life: Qeeastonal or Accidental Puracite: Anacks an unusual host, Wandering or Aberrant Parasite: Happens to reach a place where it cannot live. The living organisms may be anials, plans (bacteria) or viruses but this book is concerned omy wih amimaly that ate parities man a 2° Parasrrovocy 7 asite utilises the sexual method of Definitive Host: Either harbours the adult stage of the parasite or where the m rato cd byob dire reproduction, In the majority of human parasitic infections, man is the definitive host r however, man aets as the intermediate host. Inter it ci val developments are completed in te Hosl: Harbus he larval tage ofthe parse, In cme cases, aval developments iss {vo different intermediate hosts, which are being referred to as irst and secoat i \ ins viable without further develop. Pararewic Host (A carrier or transport host: A host, where the parasite remains viable without fort ‘slop ment, Each parasite possesses two names. a generic and a specifics he farmer begins vith a sre icky ee Hal small leer, after which comes the designator's name. followed by punctuation and Rae you sl sre specific names are in italics but not the designator's name, For example, the common intestinal rouri oct Pa Ascaris hiuhricoides Linnaeus, 1758. This means that it belongs to the Genus Ascaris and the manne of the speci ides ‘as given by Linnarus in the year 1758, When the name assigned to the parasite i lifer transferred, the commect name ix writen ay usual followed by the original name with the year in pareihess ‘The animal parasites which medieal men have to deal 1. Phyluin Protozoa Meatiend ‘Protazaniegy. 1M, Phylum Platyhelminihes and Fhylim Nemnathelminthes— ML Phylum Arthropoda Medical Emtomelaey. While describing aninsal are divided inte three main groups: ‘Medical Hetuiuthatogs, Parasites centsin rules of zoological nomenclature are followed and cach phylum may be further subdivided as follows; Superclase Supestarily ‘ + Phylum + Subphylum 5 Class 4 Onder 5 Family , Genus 4 4 4 Subclass Suborder Subfamily. > Species WED IN EST mea ene “The study of animal parasites infecting man andl producing Histary of the discovery of the parasite, 2, Geographical distribution Habitat inside the hurman host, 4 Morphology and life cycle (staining methods aad euttiva ion). Modes of infection: Reservoir Host, souitces of infection Effect of the parasite: Pathogenic lesions. Clinical Immunological responses, Methods for specific diagnosis 9. Approved therapy for eradica 10. Prophylactic mwasires for the History. The dae etlge regarding i Geographical Distribution, Sy ns should include the following: portal of entry, Vehicle of teansmixsion, ‘manifestations Kine of the paras infection Ench par i afer emtesng lence, selects a ell in the pl Particular place of abode in the host, The Sse whote it is introduced or the parasite. on GENERAL INTRODUCTION 3 eering the body through a particufur route, may travel through various organs til it srowth to sexual maturity. In some cases, the larval farm af the parasite, after getting into its normal habitat, does nat develop directly into adult worm, but takes a cireumroutons path and on arrival for the second lime. at the same place is growing 10 Maturity. av in the ease wf Asc Fuméricedes, The parasite, in some caves, may grows to maturity al its bormal site of localisation and then may migrate tt suitable site 10 enable its progeny ta be transferred to a second host, as ih Schistosoma; or it may discharge its larvae which are carried ta some distant places either 4 be taken up by an intermediate host, as in Wuchereria, or remain encysted in the striped muscle. as in Thichinella, The sites of such localisation (Figs. | & 2) will no doubt give an idew about the pathogenic effects and the channels through which the progeny may come out of the human host, Tmmunology. There ate two main types of irmrmnaity: Inge ane Acyptired, Jamate ions is ot dependent upon previous *ssposure fo infection und ty not she result of specific e sponses of immunocompetent cells, Itasprobably related a the genetic consti- ‘ution of the bast, The example of genetic inate immunity of man to “human parasite infection seen arn st west Africans ws jhe thore resistant than white Americans to hoekwarm infection Viva malaria. Itisalsa known that African children earryang the siclescell rat (HbS heteruzyBotesare relatively resistant to P?falesparian infection, Acymiredimmanity may be gradually built up nfection or aay be inchucedl stills in eutanecksFeishmancas's (Oriental sore Tiss Known a ete amma fis, annum boxes 1 2G fraction of 75 inimunoglobalin may be passively ransferredta a newborn infant vw placenia and anitk of 8n immune pregnant woman which is known 2 erst smrarny, In hyperenaeraicmalarious area infants born from imestane oth eryarethus protected forthe fist 6 mionttyaf lifeagainst Pj iperumninfectinn, Therealer. the child suffers fram malarial attack for 25 yours, when the acquired immunity is gradually bil paid asthe shu growsup becomes tolerant ore infection, i $0) mm) containing a medium of thioglycollate preparation, Norse serum and an anerlay of a rich scullure af T, visita abu Been proven ie a serum medium containing thivgly collate 22 panasttotocy q Wal periitin-inditvted sarephstacill: whch ane hs qultwre sievhi & NI polyeeme ears naalia are mum: aval fe cll rumen i 1961 dev ation, which does mat require Pradices pie growth af the amoeb Culture is res a routine siagrnistie proce Suscepplibe Anat + may be e\perimentally reprexluceal cats, digs OAK AMAAKES Hh Aime Mens sh piv the evslomie mucersa 00 the rifection is invariably fatal within a periog 2to3d AY Ns Fok occur an kittens, In vfs (pups). the intestinal lesions ats Similar in morpho 4 these fount én man ane! the anima live 1 * esaans iol epee anmal. Hepa cael he tus ut euiiptying (Shatter and Frye's mechum) Rohn, fea the ste ‘lation of among rae preven Of ener microorpan my ang oe as eon pralosed Ww hamuers Intracieeal inoculation An white py Tce ap lentoanes marae kc ain. Gaecieshal waaay nection ta ahs the effevk of ariacbiowlal ms, pathogenic PRETTY «A AW atrtag 6 Hn Hs trch ¢ campieme yest, prcepntin tes, immobilisation ofaica with hyper-imewune sera of mubbics ana reat of. detlsti’s Sith fluorescein lage Mono us any Irily stiggest the devolapment af specific Fuhes inthe sera of indisiduals suffering from amoebiass, pac Aeularly amvasive (hepatic) amocints oral antibodies however de) Mot prot The iniviudl sebo hay Fecoveted fiom amocbiacis against re Life Cycle, ltstolstiw pases is ile cycle tg only an wae hast the evelopment tryphocsnite anal eyst ‘The mature qusdran the infective form of the parasite. When these cyst. are swallowed along FHI he contaminate food ad drink by a suscephible person, they a capuble of further development insite hi gun ‘The fully develope cysts. this gaining L pay unaltered thmough the stomach, The Syst all fy estan to the action uf the gusti¢ jice but is digested by the action of trypsin an the intestine. The exevtuiton occurs whet the ¢¥st teaches the caecum oF the lower pat of the ileum (neutral or slighily alkaline meviuth, Daring the process. the cytoplasm hody retracts and Roasens tsclf Irom the cyst-wall, Vignnus amoebend movements cause 2 rent to appear in the cys-vall thiough which a fist a small mass af cytoplanin and thea wl imately the whole buxly comes out Esch cyst liberates a single amiocbasvth four nuclei, 2 terramue eats umawhae which eventually fnrms exght amoebulie Tropez sh by the divisian of nuclei With successive Fission of ey. plasm, The soung amoebubie hein actively motile, unvauke the tiswes and ultimately lodge in the subencome tans ‘oF the large ut dese mons! habia. Here they grow smd mip by binary fission, 115 be med tht the tap “one phase of the pa ig the characteristic lesion of ame binsis, During woth, £. nwofeio secretes a proeoli enzymes of the mature af hisolysin Which brings aba de “arvcton aid necrnis of sss amd heneby Delp the pacaie in baining nourishment through absorption ofthese dissed tse jie, The tnwieinvading amoebae gray sede fom the deal iss towards he rangi cal ones ann way the topos WE isa often wander abo in te rnsecs of he eae entering mig deeper layers sometimes actully find their way inl the radicles af the portal vein to be caried sivay tothe ver where their fuser prozress may be arrested. [nthe liver the trophic fora ray fora time prot aad satiply tency des tac Hee wc an intasion i always wo he looked upan ae a acendenhcete pat ‘the paraste hecaasc w Far ws ts hiolpical aspect is eomcemed i has renchesha dead em ‘Those parasies that ren He tatestinal wall may couse an attack af acute dysentery ulcerative colitis ie ‘which lunge tember uf trophevoites are discharged along with the slough, ‘Th ‘agann is a Foss tes the species sll becaune by casing vie dysentery it muy enmplcily exterminawe its win race It k not the aliens ens oft pari case sch a desiratve lesion but (fee bm Somporatin: pease wih the om, etabiohing mil dnt fen so a Ho pe tsi which cap ng theo jean ee Pathogenicity of the purayite is ubviowly a disadvantage te ise, 2 After sometine, when th effest of the parasite vn the host js prada Imerease An the tolerance of the host, the lesions eco ts wt fea ject Horst the pupsess shite My pussae thi we un. There are mainly two phases of ory Stig of pre-e yssie form ly toned down together with the eomeritan! = esc and commence to heal, The parasite now finds it Liflcult contin its He eyetesokely in the trophocoite stage and therefore. prepangs fea to produce strains which wl save the ics fom exit A cera aur of hese phar ats Uschnged nies ee tl Amd are tector! smal pre-eystic Fs fn hich the eysts ae developed PHYLUM SARCOMASTIGOPHORA GENUS ENTAMOEBA 23 LIFE CYCLE OF ENTAMOEBA HISTOLYTICA ASUPERFICIAL ULCER (OF § COLON IN AN ANOEBIC CARRIER pg hDOF INFEO, warune rst oF E ssiten iuston Ouse Fug Canon car road Fett SYS roo ENTAMOEBA HISTOLYTICA UNDERGOING ENCYSIRENT 1 THE INTESTINAL LUMEN, 1 VEGETAIIVE FORAY ? PRE-GYSTC FOFI EVOLUTION OF LIVER ABSCESS J FROMINTESTINAL INFECTION TISSUE RADE AMOEBA { mucnecrig By \EINARY FISSION ‘ Ay INTESTINAL LESION NSS Angeme bvsentesy "> amasesmapeDuLcen int THE sueMucous TISSUE veGeTATIVE ADEA AT THe marci OFLIVER |” ABSCESS ¢ EXGYSTATION OF F hisrca INTHE LUMEN OF CAECUM f mmoepanuinetyes “\awoeaa wanna Te heen Te TUES Fig. 9—Showing the mode of infection, evolution of intestinal sna Deptt Teslany and development of carrier slate, = ener Dancer a Wthe parasite happens toner a resisiant host, the injuries prosluged ate mens! (special USeTS ony) Tp yg ah, F bistobatecenot only Temas inte trophonts stage ut mahaples at the margin Of pea abil, Fae Aaa fom mew tine prey an es fos opiate is spetes. Tse petbom are Sanstant source of infection 19 others, - TDS mare quodriucleae cysts are the most resistant and infective forms of the Parasite and are pafticuly ie sgitped whem a tate of equim fas het east hemeen the hot and the pare, Bute eae Precey Tretorn waite une 0 desc inthe wih they ave palo and theechre necnag transference In arother suxcepable hint. where they can graw and contin thle hfe cxcle as stated above Revervolrs of tnfstion. Natural infection of E. Asti seen only among men and monkeys, Heace, ani the commonest source of infection Suna ess upd whe the mse ume of nel a wi Wn Be sa A Wk is thous ne ‘Ampatant faxtor ithe spread of the disease tw man, muy be fegatled as rear nin ol Bintticw Modes of Infection. Trancmission of £.hesttrica from man man fs feted trols is ene tape ang arcom oxcur through the ingestion of thew cyst. Aue uadanuclenleeysls are the Infect. ores fr th Cae ay cottamination of drinking water. vegetable and fod are the primary cities. Ealing oF uncooke srectables and fruits which have been fertilised with bnfecied human facces hs often led te the occumence of the “Wnsuse Occasionally. drinking water supply contaminated with infected acces pees tse 16 epidemics. ole of Carviers. Handling of food by infected individuals teystspassers or eyt-camters)appeais to be a ven cae acres, Tere ae tae typesof canter: “cinta” and “conaksseat The former ane capponed eo tee Fanacntalts "carmen who have gover sullered form anwehis dysentery and whose henlh appene tocar impiire, The fat are nase wh have recovered Frm a linical ata of acute amie dysentery enpbornites which pas out wih he evacuation ehh and gacuss ofa patent observed ‘Small ulcers involving only the mucosa, Extensive superficial uleers with hypersci Marked scarring of intestinal wall with thinning, dilatation and socculation, Eatensive adhesions with the neighbouring viscera, ‘Localised thickening of the intestinal wall leading to a narrowing of the eas, small superficial in diameter. nnvish OF blackagh al ulcers der na extend heyond the muscularis mucosae, Deep ulcers are invited ty ate with adjacent ulgers. When the destruction ix nq ian tissue begins Wo form) an the Foor of the helium of th necrosed tissue jn wl nore, an are ‘nthe cells are in various stages, of deg: al degenerated area sce we men a the bawel PHYLUM SARCOMASTIGOPHORA GENUS ENTAMOEBA a Fig, 12 Enlyiniestina esas in acs aie Fig. I'—ntesine of wenie amochi dyventces. dysentery Showing avonsed lors The be of mrt of the wlan Show ing the sd Fev atinn sd wera, ‘ed with ach ugh ae Hypo cae sara coc ofthese ices 6. Generalised thickening of the bowel wall rendering it palpable. In emaciated patients the course of the entire ‘thickened colon may became easily visible and palpable. 7. Formation of tumour-like masscs of granelation tissue (amoebic granuloma or amoelnia, Clinically il is difficult to differentiate amocboma from carcinoma and the diagnosis tests upan the demonstration of Arapho- -Zoites of E. histalytira in sections of tissues, obtained by biopsy oF al autopsy. 28 PARASITOLOGY acute exacerbati ‘Stool in Intestinal Amoebiasis. The general character of the stool will vary with the inestinal eandition. tt may be fluid «diarrbocict, semi-fluid or even formed, with of without adherent traces of mucus andior blood, Examunation of FHYLUM SARCOMASTIGOPHORA GENUS ENTAMOEBA (29 ‘he sto}, both macroscopically and microscopically, helps put only 1¢ establish the diagnosis of intestinal anmobrasis Jyut to differentiate from) other dyseuteric conditions, Alhough the demoastration of £ Araolytara in the sisal of infected persons forms one of the conclusive evidences. the importance of masking 9 ¢ytological study of Uke dysen serie too! has been greatly emphasised. It has been observed that the cellular character ofthe stand in amweebie and hacillary dysentery isso specific that a diagnosis can be based aa thiy point alone: table is appended below. i show the macroscopic and microscopic differences Between the stuns af amoebic and bacillary dysentery ‘Avarnie DiSerENY Thana Dee tote Kamen da (Oe 1M mations wy Relatively conus, Small Gflewine Rdourless Date Bright rat Blood al mucus mined wath face Ieee and cin, no faces Acid Alkaline Cosas Pind vacuo adheien ie commer Maid acu arent ae buto the aun Mierascapic (Figs. 16 & 17} Rac. In clamp, reds yellow a coue size of im vleoa, bright an color Pus eras Scam Numeraus across Very few Large ind sumerous, many of dhem cornai RBLC,. besce maar fat Ehntafie Fawn Prevent Seace Pranere aus Very evn Nil Gwist cris Nil umcras Panasre ‘Tiphosaites oF abi il Barras Many matic hocenix Nil CL oman Present Nil Incidence of Liver Abscess, In the iapics about 210 Mf per cent faverage S per cent) of the snl viuals infected with histatica satfer from hepatic complications. The incidence of liver abscess is less common in women and is fare in children under ten years. History of amoebic dysentery may not be obtained in mone than SO per cent of eases. Mepatic cempbaion may develop a anytime during intestiaafevion a generaly appears when the intel > mpm hue sabaided In the majarty of ese Me hepatic complication appears aficr about ane tree months of the disappearance of the dyeemene ack Cates have been rep whete Bnet abscess hve develope afer a lise of mats or eee sea 135 rare Reular feature hat patents sflerng from acute dysenieic symprome do rarely reeset hepatic eomplitions Only 1m al amber of cases both the iesine and the liver are snvolved a the same tre, and these cases ane anwariably fatal ‘Genesis of Hepatic Lesions, The wupteoroites of & Aistolvicu are cursed as enboti by the radickes of the portal vein fram the ase of an amoebic ulcer in the large intestine, usually fram the caecum anelthe ascending colon. The Capillary system (Fig, 18) ofthe liver iets aan efficent filter and holds these parasites. Once established. they uty in large sumbers and proceed incary on he eytolytie action, tn gourse of time, local accurmaation of the Amoehae will cause obstruction fo the citewlatton and produce thrombosis of the portal venules (sinusoids) resulting in anaemic necrosis of the surrounding liver-cells. The primary lesion thus appears t be a focal necrosis ofthe liver ‘alls which forms the siarting point of a liver abscess and the process of destruction then continues in concentric fayers (Fig. 19) Al firs the necrotic material consists of «solid slough and later he centre liquefis by eytolytic action ‘ofamochoe snd the liquefaction extends radially. A fairly big-sized abscess is formed by coalescence af these miliary abscesses, Diffuse Amoehic Hepatis, The symdrime of sigbly cnlaned and tence liver, right upper quadrant pwn, screen! fever and eveceytont in paticts wi avahic dysentery somes referred was “line cael hepa The enstonce of such aa cances ts douiwed. because caret painsiem ad binpyy suds of material blaine Gc liver de neither texeal any Pathological evidence af dite a combi ta a on ‘Fig, 16—St00! im urate armvehic dysentery, [Note the seanty cellar exodate. clumped red amd cells, py knee adies an ropharaies FE fisafnaca with ingested rec Bl cell, collar exstate ‘containing pus eels, macrophages wth hageytose res ist thurs ormircnoa inte colon a tam. smal 18 12 a) Sfugenframecha. ecg sed int phseute stage by the naclear character The size of the nucleus o faitly ig (2 ia 8S im "The hatyoome 1 a Lape circular mss, cota an poniiann andl 9M rounded by retracts plabwles Cyuoplsemic melsmins ones ol 10 bacteria and ether ood partckes but aver red Alval cells The traphuronic ave rately gem ithe faeces The vais a scene tala teal and iether sper wal shape The eytoplawn com yagi 20Mlrmine a Or tain a lagge glycogen mass (iedaphilc™ buy Thee ave STL kage pb tpme soul cil lat joa chouraiodl balex Pig: 21 The deeeadthc ory cad mpietoes ibe oe ence are the same: ‘Mlostoeystis hans. Aya cornsmn mote a human enetine, ws fe Bseoeree in (912 Taney and pathic ae stil not slew Now some workers cansider i ae agrokigscon unr new sen Amt Unc ts usually symptoms ox may he associated ily miestinal sy mpsomis ana amasenpinm syndrene pariculal) in potiens with AIDS devewse ‘The fre fving amehse are Fmd es ater, mal an ms oa aed may infect man. The severapbica seta Pathogenic ftee-vang amactae aig worldwide ‘They are aciobic wabheeabcramvectae whih are anagtobye. These aad ae ditinet from £, dnsiofvtie. They beloag to the peaus Nacglena veuth smaller tmpbarnites and a flagellate phise), gcius Acamiamosta (wih large mophozoves amd wo Magelne sage) and genes Balamuiia large tnopuoates ata no Magelins suge) The specie of difleent genera ore ay flkins (av Gens Naeger: Specs N.fovert Pumary amoebie Wesingoencephalitis (PAM) is cove hy antachoRapellte Nacqlevr NY, fondeed is themntoeran wat sssociated nal disease, hut A graders 69 feeling non-pstbopenae arta {B) Gems Acanikamocha Species A. cella, A. celberii. A profi, A. evades Acamihamaebae are ourdiocametmodiseate:granulamuious umachicexcephalits GAESSndahrnicarnchic brain (CAR) (e} Gesu Balausbia: Species macular Granutomatous amachse enceptutitis (GAR) is also caved by leplomiysid free: Insing amochae, mow designated as Blamuathia Frmury amoebae meningoencephalits 1PAM) and conic amebic beratitc (CAK) occur an healhy inhib, whekeas ranaliontous amwcbic encephalin (GATE sfondi wrmnuadeficiee sss, 1N finer can easily be distinguished fn Acarihamccha by ats mace rapid movement, temporary fge-swiring Agee stage and rounded cysts: Acanthamoeba has thoen-iks peocess acanhapeds}. moves much mare slowly, there is an apelie Sage te. Freesving form ofthe parasite and angular double-walled pts. A fosier esis a three forms. @trophozeite form or ariel form (found am surface a vegetation snl mm, fee ‘swimming Tage fore (rapidly rie B-TligelTate form found 8 srface layer ofthe waters anc eyst-oe resp fomm (ued same Incatvn asthe trophazovtess, There is rapa irastonrnati fom ons form tothe other form “Tee Hopheies and flag ate farms are rfexttve ta man, Geographical Distrito. Warkdwide, in warm fresh water Morphology. The tmphozote form of these frsz-livin anioebac shows brisk progressive movement a rounded pseudopodia ntupodiak Their size Naty frm 6 to 15 ymin diameter They are slay-shaped with ane Bra and Oh promt extremity Limes” form) The cies sigh, (2 yan) an has large mcheokos ar Fie mclear meanbeane THEE 18a periciar fala which ov close inspection is Hound fw consist of 4 tof vacwoles, The trophozoites nay be ne ved 1 cerebrospinal ful and in thse of the Brain “The Hlagllale farm a psur-shaped cell with 2 gel, In water, seme whieh helps ithe spread of the parasite to new water bodies. The Ange ‘mlhiplicalvon, This forth is et abserved i the cerebrospinal aid ancl im brain ‘The ey ae uninuclefed and poses double €ys wall Cyt i mx fac im CSF ori tin Life Cycle, foster completes the lie pete im the euerna envionment (Pig, 3044 The life cycle emits tee singe tun araoebsad tophoginie form, a acemnant cys form, and Magsliag foam The sail antoeka gets tenformed from trap trophozoites assume nunsteplicating flagellate for, form call EVE to the: izophazate fon 0 I sum faptlate be wit The flag ‘4 Cyst develops freon trpizaite form. Troslanvotes enibipty bry lamar fae ey SHC WSH ily vetcyst under favenrable conilitin " ee eee ae nes Fathopemiciiy. Maman pateeaicy dese arnt us ben cal dems fouen mbit a thal Is canes lB a te ita aye ly H reverts fk planrone an Heep prenahle ceniion, ancl ual necator race Infection to CHS win sol crass rer ee Breda” C5 ilocan nearersaty cyst TROPHOZOMTE \g FLAGELLATE A. Acantnamoaba cubertsan 8. nagglane town Fig, MLife cycle of pathugenicFresiving: amachoe. Diagnosis. Examinat ct mount preparation of CSF under anien cope demonurates dhe mile rapbiwrotes. Staining oF “CSP sme sith Wright or Giemsa stain As aso helpful. lumescent antibealy staining of CSF may demonstrate the amocb Proteose peptone glivose medium suppoas the growth of these free-living anechae This is a felt CORCEPT in hmUN Hisease that was first reported by Fowler and Carter mn 1965, Cases sh far repanedd were from “Austzaa Ceechunfevakia, USA, Brian al New Zealand Pan and Ghosh (1971) repond 2 aves from Ea Cae) “The hrm peimary” Was wed by tt 1966) to cTerenate eum dat cand by iste, secondary to lx ese whete i he bal, “The disease 1 caused by the frcediving umochue of the gems Nacglcria whic are found ln res water, mud, sis voll, pollu army lake water, scams, pomls,sadooe snitaning pools. Mist of the hie infections. though tall have beet Ease by. Natron finer Human infections pebuhy cit ies Taam mesopbary geal comurinton rig aia in wae heavily fee withthe veganism er uth Cone coat sue ro slit af pts of desing animal nur which suppurts ie growth af the anchor The Ucave dius a pespordeance amongst chibi mal srg ahs and amacks thne Wh ey af active ie Ince period i anand $-7 ds. N, fier dies ace pose eeu nevi, These subwe ae spate neurrpican cereal Favicon takes ace tevugh the cfochry nerve, ie amvchar have been emer inxs me i the nerve Giament. The infamy extemal mn the sburachooul val cern, The cellu compen of Ihe exes comets rip {inditacroplges on equal peoperions thr witha sarying sume efanmebue, Supra poten Teves of cenebegpinal Maid ae ‘higher thum that foun in bacienal pyigeme meningitis. The discine y characterised by acuicomvet wf upper respiratary rat Inlectio followed by spmptome and signs of meting 46 PARASITOLOGY taimsel with Wright of Giettioy seeded With E. coh The Psi ana can Be toned rcpttion ave ceria dest mee plies CSF at an Ms inorescets antibody sta Fcan be dime. Amocbae may be cultured at tan nT ates sel be conic he aMlremadagnans of every ease ete merits INRIA 1 SL hazel 8 ler, Thee tn apa al eur, ef ema, The ers A Om te ‘set of sym poms is 40> days The ileal between expan in fection ean a a ne toons aot moe than 7 days (Cena cf 196M), ’ ¢ amphotericin: BU ‘Fhe chowee of Unig for Nacpleria vnlection the present momeat és large chose of antifungal atic arp . itday LN for several days) or Ketocomazole (0 rg daily erally fr ane min) everal species of Acturdiwmowa (A. custo, A. cuthertsanit, A. plunge, A ian eS species 64. citlhernumt. In aoumunccompromisea people A. irs couoe granulomas amecbic meniRgo IAL) ‘ei emmnles o dea alter weks of eth py can eau cme ceri Hara PEC ‘Geographical Distribution. The geographical distribution of Aeanthunanwiar is worldwide, The ‘condition. Tre im Hof Lratrmission i unknow annd rc duc fr contact swath warm fresh water. Mornblags, These are wo moepblogical tn: (2 ophorem, and (cyst Bal Imphoznite an eyst foamy ea be he soiee of infeetinn w man, There 1s mo flagellate stage én parse ‘A pho is 20-30 jum in size Uarger than those of selena and it has a rough exterior with several sping-like projections {camhopay shih moves slowly The tpn ae a sale csr cota dense ean sored by hala Med ovies surface with south inner Wall wih several spores. Cysts are spherical and 18 yom n diameter Jats Crete The eel is compris oft stage: tropbnacite and eyst stages (Fig, 308), Man aequiresinGection by inhaiiog Sie emits wopboz0ies. cyst by det invisnna raumatived kal or eye The trophonts invade the cvs er, he Blond stream producing granulomaians amnebic encephalitis (GAE). The infection of bra is nol associated cam multiply on rachis Pathogenicity and Clinical Features, Granolomatous amoebis encepialitis (GAE) acre Persons having immunnsuppressive therapy or immunacompmmisel patients such than T days. The disease 's characterised by focal granulomatens lesion nf the brain With & prolonged clinical course Jn GAE- ceil coum in CSF is predominandy Iymphoxytes and glucose content will mo be appreiahly lowered. ln bnin fioues, wophozaites or eysts of acanihamaeba may be Four. antatnocha canes chronic scan} amoeba keratitis which is ow a serious problem contact Jens User (spe Ws dae to direct wmiculatinn of amoeba: tranhnzates or eyst into comea during insertion of conteminec dae aoe ag aminton of et mount prepution af CSF or come scraping under microscope may chews quate tmphozes aaa rn aetiamact Topnovaites and cya forms canbe the sun of infection man, The mabe ofan sare taconlact wih fresh wter, Culture agar plies seeded wih E. rl leo ep India Auonescemt anubyy a ene inh aa wed forth agnosis af isa, Hitopatologieal examination of tate ieee oe may demonstrate traphaevites and cysts ‘Treatment, These 1s no effective sreament for granulo lesions caused by acanthamocka cum be Healed with enucleatia in debilitated or chronically it ay AIDS patients. Incubation period is meee ‘The onset of the disease (GAEI is tnsidiras ly soll rest iatows amuebie eneaph alts cated by Acanthamoeba bit silat oF of ulver and eorneal wsplant Balamuthia memdioris (epeomyxid (re-iving arwebab pradoses gralemaous Amocbic encephalitic (GAE) in AIDS Patients, Geographical Distribution, Worldwite, Several eases of GAE caused By & mana ports of the war y aris howe been reported fromm differnt Morphology; thas trophorvite ond cyst fonnts The to Tobose oF fingerlike “There is no Mhgelluied forma parssite is spherical and ¢.30 pm in diameter {Life Cyele and Mode of tnfeetion, [1 is web, Pathogenicity. It causes CNS infcetiun (GAE} in the similar ion (GAE) in he sine way a8 produced by Ag Dette Won iy mace the CSF whereas both nophozones snd cysts ate fin in bran yen Peake. The trophzoites with pseudapnis can be gran i ‘Treatment, Noshing 1s known about is treatment ohweies of balamutia show two forms er bra ‘The trophoenite i 12466 forms af pseudaphdia either b ® pm in Length and stiggishly monile. The cys! similar to inthanncha. F The Smophozoites ean be identified MEE may be helpful im the detection a PHYLUM SARCOMASTIGOPHORA GENUS GIARDIA AJ ‘The parasites belonging to this group of protwaa possess one or more flagella i “These are classed, according to their habitat, into two rnp 1, Evrstieat, Oar ante Genital Fu : i Fascri.ares—Tnfecting the intestinal canal, oral eavty and the genital tract ‘They are mostly non-pathogenic. . - z 3 2 Bute aN Tisse Fut ates —Infecting the wiser system id sous Hssties oF the bey. Inch gener which are puthogeni¢ 1 man: (a) Tryymanawns and ch) Leis wf thems the power af matty Order Genus Retortamonachla Cslormsti, Resnrtamenas Diploroonautica wis, Enterumacas Trichomonas ‘Taicharminas, Pentatrictusnanss. Diente Flagellatcs inhabiting the intestine fom the mayor group. One species €Trichimnonus rem) is cavity and the ather species (Frichunvuas veginatis| in the female genital tract. Although nune ofthese flagellates has yet been proved to have any pathogenic role, the cliniciansare inlined to implicate Givedey site sana. as a cause of certain diamboeie disorder and Triehomnas veaxénulis as a cause of inflanumation of the vaginal naacosa, 7; howmmas possesses five free anterior flagellin and is aceuningly piace unser semis Pentairichomonas Classification, These flagellates contain the following ener: 1, Genus Giardia. G-ntetiah Dvoxden ant Genus Chilomasin: G. meu ¢Caseurms Genus Exteroronas: £, mina: (Largs inestine—nite species Genus Retortamonas ¢Ernbadwoiask £. stn Langs imestine—re spies) Genus Pentatrichaminiay: Peeatrichvnnooue Inanins estes] Fogo Genus Trichomonas, T rena (Tethys gums) T smginas (Vag 1. Genus Diemtamoela D. fragilis (Colonie mibcosal crypts ‘Generic Character, All these flagellates except the Trichomomids, tnive a trephazoite andl a cystic phase, The trophozoites possess multipke Magella which arise from blephiraphists, An undulaing membrane soporte at the hase by a basal fibre (costa) may ar may aol be prevent. The nuclear characters are distinstive im every species, An axostyle (a central supporting rod) and a eylostame representing a raimientary anauh, are also abservest in sumte Spevies, Repraduction occurs by binary fission of the blepharvplast ame the nucleus, followed by longitudinal spit fing af the body inlo two. Eneysiment is a protcetive process except hie Emevamonas apd Giana, Mature eysts Tibsrated in the faces are the infective stages of the parasite. The cysts when swallowed wilh contaminated fad, liberate the trophozoites inthe smatlof the fayge imestine. These llagellatey complete thea ite cycle in a single bent eccond hos! Being required only forthe comtiauation of the species, Exvepting Giardia these pasites ean readily he vated in the same medium as wsed for E, iusto wind in the oral First seen by Leeuwenhock (1681) while examining, Geographical Distribution, World-wide, Habitat, Duodenum and the upper part of jejunum of man, phat iste in twa phases —trophozaite und cyst (P Mampi i ape thes He of enna ado rachel and whe side-on it resembles a loagilt ly’ split pear. The dorsal surface is convex and the ventral surface ts concave sige ep ag a cane on Sod Bling ovo te oa a a 48 PARASITOLOGY Cyst. The fully formed evse is oval in shape and measures 12 sum fong by 7 yim broad. The axosiyles hie more ‘or less diagonally, forming a sort of diving fine within the eyst-Wall. There are four nuclei which may remain clustered al one ead or he an pas at opposite poles. The remains of the Hagella and the margins of the sucking dise may be seen in the cytoplasm, Am acid environment often causes the vation, Karapetyan (1962) has described a method for the cultivation of Giardia together with an yeu Carnfida guitermendi: it grew well ona medium of chick embry extract, human serum, Hottinger’s digest (tryptis digest) and Hank's solution, Immunology. The disease giardiasis iy commun in younger age group but uncomman in adult, sugyesting that an efficient immunity has developed, Both humoral and cellular mechanisms are emportant for parasite clea Uisease usually affects IZA deficient person and famibody can be detected on surfiee of giartia trophozoites. obiained fram jejunal fluid and jejunal biopsies, Raised litre of unti-Giarcia IgG can be detected in patient with giardiasis for a long time after primary infection, The presence Of anti-Giardia 51g in hurtan breast mifk protects breast-fed infants from giardiasis disease, Life Cyele, In the trophozoate stage, the parasite multiplies in the intewine of man by binary fission. When cor tions in the duodenum are unfavourable, encystment occurs. usally in the lafge intestine, During eneystment, a thick resistant wall is secreted by the parasite and the cell then divides into two within the cyst. Infection of man is brought about by ingestion of cysts. Within 20 minutes of ingestion, the cyst haiches aut two traphozoites which then multiply {in enormous numbers and cokonise in the disklenuin, To avoid the high acidity of duodenum Giardia often localises in the biliary tract (gall bladder) Pathogenicity. Wath the help of the sucking disc the porasite attaches iiself on 1 the conver surfaces of the epithelial cells in the intestine and may cause a disturhance of intestinal function, feading 10 malabsorption wf fal. Consequently, the patient may complain of persistent laoseness af bowels, anid mild steatorrhaea (passage of yell ish and greasy stools im whieh there isexcess af fa), The parasite is also capable sf producing harm by its toxic effect (allergy), traumatic and imitative effect as well as by spotiative action, 4, by diverting the nutriments. Clinically the eases may be divided as follows 41) Silent cases without any syndrome, (3) General: Fever, ansteri Fig. M1 —Trophurolte and eyst of Gi Surtace view (Tyan side view a semi-prafile Hew (21 ofa eapneinte,¢3) eyst symptom, (2) Intestinal: Chronic enteritis, acute enterocolitis ad allergic manifestations. (4) Chronic eholecystopathy ‘The person having hypo- or agammaglobulingemia and malnourished persons are more susceptible to giardiasis, Histological studies of maces biopsies fom the duowenb. ad proximal jejunum in patients with Gi fut by Brandborg ef si" 19657) revealed tissue invasion. Trophowites af Giardia intestinalis were found in the muconal tissues fromthe epithelium to the suhmuceasa. They cated very Hite nmcosal damnaye and dhd noi excite any inflame Laboratory Diagnosis, This includes the Following: (3) A microscopical examination ofa freshly passed stool for the demonsiraion of giatdia trophozoites and cysts: ‘the former are found in a diarrhoeic stool of after a purgative. Fluorescen! method using monoclonal antibodies and ELISA test, for the detection of giardia antigen in facees re not in routine use. Sensitivity and specificity of fecal antigen ELISA test are reported to be high, (b) Giardia trophozoites may be recovered foth from aspirates af avadlenum and jejunum by Enuernvevt (c) Antigiordia antibody detection in serum is not useful in dingnosis of disease, (d) DNA-based techniques (specific DNA probes for giardia) are available naw, Treatment, Schneider (1961) reported good results with a derivative of imidazole (metronidazole). Metronida zole (25) mg three times daily for 5 days), trimidazole (2 gms une). furazolidone (100 mg 4 times uaily for 7-10 days) have been found to be effective for giardinsis. ‘and malabsorption © Gastrwentereligy, 52. p. 143, PHYLUM SARCOMASTIGOPHORA GENUS CHILOMASTIN. MESNILI 4) ‘common flagellate living ay a harmless cavnmensal in the cae= *suin of tian. Trepiezaites are pear-shaped boxes, meassriny 10 tn 15 man eng By to 6 jamin breadth, The round oval nu ated anteriorly und by its side fies the large conspicuous mouth ‘feylostome|. The posterior extremity is deswn out to a fine point. There are three long aiterior free Aagelia and the fourth one is shot and lies within the cytestome, There are no undakiting membrane and axn- style. The cva4) are Jemon-shaped with a small projection at the ante= fiorend, measuring 7 to 10 jm along its longinudinal axis. The single fucleus fies near the centre, Remnants af the buceal apparatus iy also visible UFig, 32) On . EE or ‘These are coiirion flagellates of the traps amd are frequently ab A2—Teephomite and yet oF C me served in diarthoeic stools, They exist only in the thophovoite phase and there is. evstie phase. The flagellates re Pear-shaped bodies and measure 10 10 12 jum in length, The single ovoid nucleus is situated at the round interior end and a clefi-like depression (eytostome! lies at its side, These are 3 40-5 anterior flagella which are free. A thicker agelium passes backwards along the side of the body forming the undulating membrane and coming oul free a the Posterior pointed end. The undulating membrane is supported al the base by a rod-like structure, the costa. The axostyle rans down the middle of the boxy and ends in the pointed tal ike extrem Am attempt has been made to classify the genus Trichomonas ininthe following species according tot (Fig 33): ff ratuerichamanas Hum inis (8 jurm)}— Inbal Wf the ileo-eaceal region. . Trichomoncs renney—Inhabiting the oral cavity, being found around the tartar of the teeth and in pyorthocie sockets, Pentatachamanas noma: Tnenomonas vaginas Tachomonas tena (7 boseats T. angst lg. 38—Intestinol, vagina! ane eral Trichemenads. (ust say the thie phase} 3. Trichominas agi (13 jim\— Geographical distrubition is worldwide. Inhabiting the female genital trac also found in the urinary tract of bottt males ancl females. fn this species Although certain morphological differences (the length of the parasite, fateral flagellum) have been painted! aut. they are not of sufficient help in the distinguishing of the spocies. These fugstlates ure of no pathogenic importance except T. vaginatic which is found in Iarge numbers fn the levearrhocie discharge of females and is regarded by the gynaecologists a8 the cause of inflammation of the vaginal muceca. In ease of man, 7: vaginulh infection is 1 seXtally imwmitied disease causing urethritis, Infection has also been re corded in newborn female and female children, yostome is Jess wanspicuous, nuclear charavter sind the course af the rethal d ve und prostatic secre aoe helptul in the diagnosis of disease. Serological tests Whe THA aul et dil seis Molecular mcthoxls are ther available new tests. Treatment with metromiarnle of both sexta! TANTS fen effective and prevents recurrence Enteromonas hominis (a Fonseca, 1915). A rare » cies living asa Imnrmiess commmemsal the Small large imestine Of man, Thopha-oitcs ane sraull pear-shaped bees andl: measure 8 yu Fong by oyu roan, They possess tour Nagetla, three directed anteriorly and lying free, the fourth posteriorly, remaming adherent to the margin of the body ‘and ending in a free terminal fash. The nucleus is situated al the anterine rounded © ‘oF tesa as the trophozoites and contain 1 tod nuclei which may be arranged at opposite poles (F Retortamonas (Embadomonas) intestinalis (Wenyen sind O° 917), Wis also known ay Erabacemomay ‘testialts, A rare harraless commensal of the intestine fsmall or kurge} of man, Troplerseites are small oval bxaliey measuring 3 jum long by 3 jim broad, The nucleus is at the antenier end andl by its side fies the eytestome, Flagelt {Wo in umber, one directed anteriorly and the other posteriorly passing through the eytostome before becoming free ‘The evsis are small pear-shaped bod iste (Fig. 85), On TROPHOZOITE ST. TROPHOZOTE cyst Fig. 38—Tropharaite and eyst af ig, M4—Tropbnzoite and eyst of Enero h Eovlewtomenars ante Dientamocba feats cps and Doel E918}. This the smalles (5 to X jum anche rarest of the intestinal amoebae ofr, Is mare de ‘soribes ils marphoinuy very well, for i és binucleate ancl its cytoplasin 15 very fragile. The cytoplacne contains many food vacuoles aan bacteria but never re hed cells. The nuclear character shaws the Lange chro {un grantles, usually fn wane, feeening & star-shaped cluster Fig. 363, There is no eywrie phase D. fangs was previously belied tbe nom pathogenic hut wom es boom assisted wit imermitern iar, a lence, abdominal pain, etc Life cyele #8 pt fully saiderstow, Based om ¥ reclassified ay am uberrynt 36—Morphology of 1. favs etsy in te trope phase) |. Biaucleare Form: 2, uninucleste farm; 3, macleae earstet These flagellates live in the blood oF tissues of man insects which serve ay intermediary hosts (vectors). The other animals, ‘They pass through a eyete in the gut of Hy includes 60 genera which are of pathogen’ ‘importance to man: Trypunosiena and Leishmania, These parasites are comparatively complex in strocture. having developed organelles for locomotion and a nuctear spparalus adapted for spectal functions, The structural pat tem shows the following peculiarities: 1 Boon ~The shape varies nthe flag arn wom lagellae ages inthe former the ely is chotel, nae ane fen ‘eure while tn the tatters round ar ecad 3 2Neci21s—A large rived or oval structure usually inte in ihe centre of the dy; Ass 11S comcemed with the natn fupetins ofthe parasite. tt often called trophoncles 3. Rixrtort ast— Its smaller hod coapared tothenuclews, generally tounweroa-shapsd anutissmuateder ter an front corbehindthe nucleus: Hoare puistedout thatthe kisetoplastis necessary for he development insect hosts hut wot form scaboninthevertebratc hows 4 Fuscans xr A thin Mancike sirstureansing fom a small grate sal toy) near ihe inctopnt and coming ta Be salen enc of the body asa fice Mazelhum. The Mazellum aay he abvent sn ceramn types. 5. Unoctariwn Mime —I is ange oF then of protoplasm. formed by the Magetiarn wfc while curving asound the bly. is thrown into number of fois te numb varyine avon wo the Bengt athe ey toplnmic boy Inthe pas the names these developmental sages were dered fom tho peneran whit ‘the corresponding @ages.are the most characteristic forms. Hoare and Wallace 1964p pried ‘oul tal the mames, based nn genera, are no approgate, because lana. heeng subjeet to Inter hatoal Code of Zntical Nomenclature. ae Ube ob charped They ped Mes > G) ames which are not in any tay eurmevied withthe tava such as genera, hetice a change Hh she zoological narne will net ecessaity lead tn abieration am desenpuise terms, They have utilised the “flagellar characteristics” to serve ava basi for these names The arangement of the flagellum in the body, as determines hy ts staring point (andicate by the postion of the Tinetplat is couse and peuns of emerrence. has heen conser dscns the vans sages For the terminology. they have used the roi “mas” Hc Grek mses. laps Proreirigala cemmbined with the appropriate prefives. The new terms devised (Fig, 37} ate & flows: 1. Armestigote (for former “leishmanial” stage). Represented hy rounded forms without ary Cota gens tot the gems Lean un eer SS ‘Amasipate —Chosnamastigalt J promuingote for toner leprae” sages Repeal y ors wih he inet a plot iyiiganteno nthe suc antenlear kinenpla i-th lagcllim ansang ea emzeEes Bee from the anterior end of the body, ay tin the genus Lepsranmonas cand others. ar * pruloanasaone oe former arypanosr"otypanomorlas”tge). Represented by fore nat the capitan over thee tna ear histopl)the comuesig fagellum arises near it, them passes Ubrovih dhe ey anal emerges from the anterior era [there is no undulsting membrane as inthe penis Herpetomarmns only This sage is bein Tagellates hick infest heman being “4, Epimastigate (for fortuer “erik” sage), Represented by: fori withthe hinew- ‘astiyingaeterior and clove tothe males (javtanucear Lancione agli arising ear iremerges rom the side of the body to run along a sort undulating migra, os nthe Fig, 37—Devetapinental stages of fnew genus Blasio rithiha an] inthe stages the geran Trypunwscmet egjanesomatid Magellstes. 'S Trypwmastigote for the true “arypanesore” stages Me term is not derived from ge- (Afi Hoare and Walle 4 snus Trypanowama (Ge Trypan, to bore: sora, bey Represeie by forms with postmelear hinetoplast stunted athe pose: vce ofthe body? the iagellum arses nea and eer pes fram these of he bouy fo run along alg uulting reese, as in the genus Frspeenarome fh Cheeumutiiemte, anew term for ihe peculiat “barley-comn” form, sually wth the kinetoplast lying atthe anterior end of teu tantenuctea kineloplast the lagellum asses noo and emerges al the aneriag et of the oy thm & wide tn ‘Shaped reser ir typical of ahe insect gerns Crihidia Generic Character. These exist 2 trypomastigotes an vertebrate hosts ¢man ad animals), some (7, cruci) assume ing amastgote forms They pass their life cyele in two hosts vertebrate and inset, While developing insie the insect Hoare, Cecil A. ang Wallace, Franklin G (1966), Developmemal sages of Trypanncomatid flagellates: 3 new terminokogy 52, PARASITOLOGY sig arn! metacyetic fT F trypom: host hey pass throwel the stages of amistigoe, promastayne, ePATANENNE TT at trom oe Vena Hieaiow cam take place in any of these developmental stages. Trane i another by blooa-sckinge inets: After an infective feed, x vertaim tile MAY TT accretion, another indi dual: any bite before the expiry of this period is.aa-intfective final development of metaeyelie form oF trypomastigeres, Wa main types of devclopmet ‘i en proceed fara [arbre tera los ype i cpm mga med iy the proventriculus, lubial cavity and salivary glinds, as in 7. breece’ subgroup. Tranistt tel by the bite af the inscet 2. Pansterior Sunina (Stereos WOruIs Wo the hineleguit, si Heivist or by rubbing the slop inthe intestine from where they pass hack, — 1 of facoes af the tseet, ay in 7 inset, as in 7, crncs norphslo i) —Iigested Irypomaistigot T. crust and. few Transmission occurs by i aecal matter into: the wound caused by the bite of 1 . Morphology of Trypomastigotes. Accompanying diagram (Fig, 38) shows the gener of the trypomasiigote form of a trypanosome. Unduiating morbrane Polvmonphion uf Feypunastigates. These ave forms mesa Which fer in the shape and size of the bay, presence or absence of a free flagellum and the position of the nucleus, The rypomastigotes of 7. bruce! sub-proup are polymorphic. Nocleus Method ef Reproduction. Repraduction ogeurs by MiN888t_ Axonarne lomynudinal fission, 1 begins with the division Fig, 3K Morphology try pomastgote form, of the kinetaplast and the basal boul followed later by the division of the nucleus. The Aageltum with the ui jachilating membrane remains with onc of the halves of the basal buy. while « new one develops fram the ether. The eyiaplasmic body then splits longitudinally from the anterior end ‘Classification. Trypanosomes af Man, The trypanosomes which infect man are the Fallowin, 4. 1. brave’ subygroup (human strain)—Causes African trypanosomiasis, T; bruce’ gemabiense causes Gambisn form of sleeping sick: and Central Africa and T. bruret rhadesiense causes Rhodesian form of sleeping sickness in 2, T. eruzi— Causes South American trypanosomiasis (Chagas” disease). 3. T.rangefi—A non-pathogenic trypanosome found in the blood of man in Venevuela and also in Colombia ‘Trypanosomes of Animals. Besides man, trypanosomes are found im various animals, a few of them ar enumerated below: al Structute Fa POSTERIOR END ae ANTERIOR END stewc. FT. leveal in rats transeitied by rat eas swontoa Trice crimal san} found in wild came anal domesic animals af topical A es “nayama” in same of the domestic animals 7 evans, cases “sutra in horses and inaey of Ind: mechanical transi by blond-sucking ly, taba Taner. causes ios disease (a semen disease in horscs and ames of Eure, America, Nom rca and nit Hel by coitus Tema, causes "male wakes” Plast an nis inseet cycle T-viva and 7 cemglensy cause ds Trypanosoina lewis! Rest, 1880. natural Bo! parasite ofthe common brown and Black rts i al ‘ lack ruts in all parts of the work Bens teeny obs for demos on an! indy. Abs: Ki a ing Sond pans. measrane slg win gh ‘The equpls is es fro pnts The mocks vil she ad pine aneravly atte honing she ee eae sks th of he boy, The Line sa shaped. hs a ensvers ponion Iying at ibe Tineece ee posterior ty. Hlth crs are sharply pointed and the mauating membrane 1s nck much Folded. The ea i: al the duals ponvews a (ree Hayellum. I ism putbuagenic hs the rt Pee i cme ‘The ved ispassedin tu host: ral and ral fea, Ln at's they live a y a (68 Hyponistigotes and multiply by binary longi tal son for opi of si rich mos fhe Pome zes de The sat flea beesnies inte iy kang a's Hl onaiang the eypamastipie form, These estate ively the midegalandrntan i and ii erareigies ten ety rast the vse Hagel he ree Te ee ee ret ar pon-immtineraticking eras nected, They lef development iniheflealassforSioTdse ica: transmitted by G marssam vom! horses in South Aanerica: transilied mechanically by tabanid it has 0 Kiel catile: transmitted by tsetse fies. rypanenene Trypanosoma ranged Veyera, 1920, 1 has been fours in the peripheral Mook! af man in Venere sncastnng 26 10 34 pn in eth aia possessing & inule deasely stung Ronetoplat and as ronmitelly oltre rom F ou The sect tus dimidaata ane P gene The metacyel nypomastigotes have bece wbserved an the fates proboscis ata he amlectn os probably iam fo he Nertcbrate hosts (man and sag! by the Pte ofthe invest” Te onda mn the Arai alles. Colombia reserable amply and like cycle of a trypanowonne (7 area those al F rungedt Bowl Veneedetin ant Colombian man ‘Ne: Aratecavcod homan iy paneamaic causal ty 7 vr is heen repre nfnaa (Candraputlistrit of Makarhirat IRM Posver et al (2006) Inulin Journal of Medal Mcrbrolergy (2005) 2401) 72-4] ‘rwn-patharpente Lo The parasite causiiey African teypartosemiasts he in Zolhant Ut wi Ihas ‘The paras was Uiscovered by David Bruce ia 1890 and be suggested it to be the waits snow Kriow that Y: brunet an caitle presluces a tnnld or napparent infection. Henee the worse been questioned. After a careful study of Bruce's iMlustranon Hoare (1971 ts sone anced thi fdmivture of T rmgofense ywhuch was responsable for the disease im the-caithe am Zula ‘The trypannsnme causing disease im man was first discovered in Gambia by Forde and Button in 1902 and in Rhwsdesta by Stephens and Fantham im 1909, observa idemivlogical pattem the African trypanosomiasis (African sleeping sickness) used i be ‘and “Rhodesian” sleeping sickness caused By a sharply characterised species of trypano- ss are of the opinion that ther is litle justifi- Basing on eliniee: classified. as “Garnbian' ‘somes tamed as 7. gambiewe and F. rhadestense respectively, Zoolog: cation in giving a species status to cach type of the disease ‘his realised that T. brucet subereup comprises a single species comlaining strains oF subspe specificity and virulence. It ancludes te Following: 1. "The uininta staf (previously resiricted t0 the “type species" 7: broverb, This is widespread throughout the tselse belt of Africa, This sirain doesnot infect man. 11is to be noted that abalanced state of affairs appears to exist between the African) panosomes ind sheir wild pame animal and the adapted egaresms lo litle harm their hosts 3 The linen sinain (Formerly called T. xuubiense and 7. rhadestense). This iy nat so widespread, On el “epidemiological pattern the following forms are recognised: tay Rhodestan”™ y aeute disease {1 °Gambian” sleeping sickness a chronic diseuse. hig sickness. although chwnic, is more like the acute “rhodes for, ‘Atiompts va clisify the African sleeping sickness frican trypanosomiasis) stricily in above terms isto be avoided hecattse these African trypanosomes of man are “adapting themselves to theit hosts and iy sich, variations in elinieal and epidemiological behaviour are to be expectet Hoare (1971) suggesied that the brucei-rhodesi brave’ and may be designated as follows: Truce’ bn of T. gambie Morphologically (resting infectivity dire ‘nse complex should he reparded as a subspecies of T. 7, T. heucei gambiense; Trhustestense as a virulent noyodeme these strains are indistinguishable and can only be differentiated by their behaviour in man ‘human volunteer), Rickanan and Robson (1970) have introduced a simple sensitivity test (blood incubation infectivity test) by whiel it is possible 10 identify whether a strain, isolated from a tsetse Bly or a demestic or a game animal, is an animal strain (7; bruce?) ora human infectivity strain ("72 rhodenieme™). “Hood mewhation infectivity ext*®, The stmin of 7: lravee ww be vested 1s a frst ynoeulate ines ras oF Me apd! When the paractaemia » established aes" mi of cardiac blond watdaoyn, About 025 ral of this blond is akew in each of dhe 2 Mijas Fottes To one bexile 2 anf of himan biacd ad an anticonguitont (0.25 mg of 24% go. oxalate with wlucuse adkled 1 a strength of 4 ngimnl 0 Blood) #8 taken. This comtiutes the test sve " Ormerod (1967). Cecil Toubaok of Meine, 12H Fal WB Saunders Co.. pW LG Gusdtnin 1970 Teas, Rex. Sev. Trop, Mest & se. G4, p. 797, = Feickman, LR andl Robson, J, (1970. The bland incubation ialectisiy test— A simpletest which may serve na distinguish Thence fromm Te rhstesienve: Hull Wh, He, Org. A, p50, " Se ed A874) Thisrepresenttbe rie ample ube foe. thebaman Blow vapid 2 mf phnsphae- bere ne Aarti wiuiines hen Hoth the comple alter sents auNing are incubated in 4 waier bait far § furs at 37°C. Fae revs sth hh le nea rer vec ah te TN ae a animal oryge anal wnocalatyey sep DoAIMVe, te the rai Mons ete forn an ee ine he a maculae wh the car ape fe esi be Rete, te ta Wath the Iran own having tendered nom sete Ws be al ons com Habitat. 7 braves icevsentally a parasite of eonnective tissues, where it mmltiphies readily. I eonsiimes aa ‘mou amount of shakes, aiinpect ! tz ek gh md srough he yates a al invade the blood irs cousins parasite {nna sli he bain, Is tobe ook tht Afrca lex ping sickness is asec of Ine central nerve em Prevaletie of 7 rm et, As already stad the inal srainsef T braced occur throughout the tsetse bell af Adsica but the human siains are nots widespread. i ‘The ehrimic ~gamisiense” strain is found mainly in West Aftica (from Gambia te the Congo), Central Africa amd scattered areas of East Africa, particularly Ugand ‘The acute “rhodesiense" strain is distributed only jw East Atriga, particularly 4 Tang Rihoesia and Malawi. The chronic “2m 2i" strain (pathology similartygambiense”) is found in Botswana. Rhowesia. Zambia and Poe ‘upoese East Africa. Theasite"zambee strain teverabling “shodesiense”)isfound in Tanzania, Uganda and Kenya Morphology, 7: braced eaints in the vericbrate hosts as irypomastigote form. It is an elongated rather flattened spitdle-shaped organism with a blunted posterior end anda finely pointed anterior end. The nucleus large, oval an ka, Uganda, Zamna, central in position, The Kinetoplast is small al iy si Mac ated at the posterior end The flagelhiin stars from the Coreen Fsirior eNtremity near the kincioplas curves around the body inthe fom of an undulating membrane Maggy lacy tem continues beyond the amterior end as a free flagellum, ic 2 ryperastipate “The undulating: membrane is thirwvn into fokls the name tber of which (asuslly 3 to 4) varies with the length of the parasite. Iris an actively mate Magellte AP ROLOBICAL ry, Paltnsphison The pote Tbe ae 2 ee Polyrmonpic. Individual parasites Wary in size and shape nae eer Zs ean Inthe different stages of theis existence. Two main forms athens aid are recognised the one, short, thick, stupy farm (14) Stoner. inman sem long by 3 ym. broad) with mo fce Mayellum of hav ing only a very small one: the othe, long, slender form Midgar ot 20 jm long by 3 yur hroady, having w conspicumsly ‘wae ty ence Jung fre Rigellum. Between these Iwo forms, interme farm afiate form ane wccosinnally observed. The firs form 0 Slengated fom ‘sppear isa long, slender one and Inter when the infetion 9! persion is established the short, stumpy form together with the ie a fimermediate one uppear (Fig. 39). ” Aunigenic vusiant, 4 succession of variants wccur in rege Moe afer Vicker T. bene infection beste in animals trabbist and nan. rms. Soin inal Hy, Sh. Yi Encl new variant emerges at 3.4 days? iniervals, peas bly by sclectiow of mutant, This appears depend apo defen by leucneyta ‘ogganism {avaaueytosis but net newtrophilia), I fail the final variant multiplies unchecked. Eisch {he ability of the host’s defence mechanism and shen the ‘wave of parasitaemia is accompanied by fever and followed ‘may be thal the outer proteinaceous coat may protect the escaping from the how's defence mechanism. ‘Annther feature is that the antibodies develap 10 a series wnuologicaly distinct type variant in the serum of hunts Exch rise inantiealy tire coincides with she disappearance of the homhalogaus variant and shor wre hes tec eliminated, a new antigenic type immediately arises, colt Visceral Phase. Rartham (11) cyerved an ‘lagellae “tate forms” im the capillaries ef internal arguns af the verschrate hint, Ormewel ait! Venkatesan (1971) found amastigotes and splscromast jgotes (small spherical farms with an PHYLUM SARCOMASTIGOPHORA GENUS TRYPANOSOMA 55 lat shoot foee Haye ond pleas of rats amoxtl aie oT brucer Th ot eatlict wa rw th swollen hor ‘6 Botswana strain these necult viscera fens i 08) ang fe the shu tela tas ses which anvil the blew teem Ht ve alu penned vel ples may mot he the only site and plier sale may ypsannty the hans daining Renetion. When stained with Leishmansr some other modifications Romanowvsk sian the eytaplusm and the (lulating membtaneappearpalehiue, the wuclewsredish purple corred: the hinetoplast andthe fagetlum cask eos se Fig, 0) Cultivation, N.N.N. medium is not generally stitable for the cultivation of this trypanosome. I has bees: cultivated inc medium of Ringer's solution with soxiim chloride, Tyrode's solution and citrated human blood, Long slender tarms of Iryponvastigote, similar w mid-gut forms of terse fly are en- countered in culture, Animal Inoculation, Laboratory animals, ike mice, ratyand guinea pigs are erally inoculated fordemonstrating the Fly, 40—Prspwnowna Brnced « peripheral blend fim. typomastigotesw hen they'are ripheral blood of man. In haben ‘whelming parasitaemiaand killsthe animalina few days. When oculated inratssomeal these irypomastigetes (5106 percent) developposteri neleusissituated poste riorly close tothe kinetoplast or behind it see Fig. 41). T brucei in rabbits (syringe transmitted infection} causes a chronic infection lasting & few weeks and most of the animals die after shout 410.5 wees. Immunology. 7 bru ion both in animals (rabbits) and man stimulates the output of large quantities: of immin- ‘globulin, most of it 1s im non-specific BeM (19S) rather tham in ‘the IpG (75) range. having nev affinity for the infecting argan- iam The host is unable ta produce specific protective antibrxly trge” antigens vr the antibody producing cells ho no re from macrophages te go into action ‘nuclear forms.ic..the ‘ceive any messa I is alsa known that infection with this African trypano- some is associated with profound immunosuppressive effects depressed that ‘The humoral immiune response is so severe the patient will not be able i resist asty Bxcteri Orher serum aatibodkies found i Urypsnosen which prevents) multiplicamen of ny (2) heteniphalanabody, particularly in Thr ebineste sfoetion, hish apy in screening IypeS OF Erypanositonts Life Cycle. T. brucet passes its} ‘The vertebrate hosts (defin “The insect (intermediate) hosts are several species oft G, pattidipes, G. owynnertoni and G, morstens Development in man cau orber vertebrate hosts, The melaeyeliec slag ced by the bite of infected glossina develap into lang slender forms a the aite af inoculation, These beceme "slumps" via “intermediate forms (F ut Puree (rfvutestnee™ Strub) i ne pperpheral blwoal af a rudent, rivsleat forms ales sheep-erythiowytes and This fact may help c cycle in two differeat hosts (Fig. 421 c hosts} are man, game and domestic animals. setse fly (Glecsiner) andi le G. palpalis, G, rachinotdes, nfective form) of lrypamastigotes intros multiply by binary longitudinal fission at 39). Subsequently the parasites invade eee na “a = 56 PanastovoGy Fava nasi tor Trypanosoma odosansa Teypancacma: crane Giaravy eetargeront Af 2s LIFE CYCLE of / Trypanosoma gembiense 6 7. rhodesiense 1 Form tound in pangheral boa 2 Gttom 2 Long trea ean in mg as 1150 dy {3 Epsmastigote farm in salary ganas 4. Metacyctc torn savy ‘Gan (26m 98y) PHYLUM SARCOMASTIGOPHORA GENUS TRYPANOSOMA ST jy the sont stumpy spent ansids the cul mpey biological dev the blood ig, The trypamasti up by the tsetse fly alomg with ity blood-nical and undergo a inseet host before besoin Devefopmment tector fle. The short stumpy: forms of trypeomast nscet first change their morphology tthe mid-gut, Leng slender forms (the kinetoplas! Iying avin ay between the nucleus and the poster rnb appear hich pass to the pasteriog end of the extra perinnphie space (a space between the pertrophie aera an 1c to multiply for some days. By the 15th elay. they escape fran the ant triculis (the pu itor isthe same als that oF the ania _ pass on io the Hypopharyns and eventually reach the salrvary epithelial cells), where they em pa enter the Lene of the pe form), Then they formeands to the fie lands through the opening of the salivary dicts. Hene they rauliply and change their morphol ani! then into fonts nf sryprmangigeres which are jective #0 m ‘The time token for the complete evolution of the infective forms (retry: fv stage inside the tsetse My feahout 20 days, These terse Mies remain avfective for the rest of their live ried extending up 1 18S days: There isn evidene onal irypanersomes inthe fly un its alsprings. The tetse Mies prvnluce 3 nthe subewaneows comaceliveUssie exci fy) By producing a lange 3m aw specific inuruinoglobullins which ane however nol capable af set the antigen, Antibodies are prodiced in response to the secret iv cf alt ex-ante trypon ty ny heavily wiring the ste of infection with macrophages, dhe wells competent ov ea wih the invaders “The neutrophils tke peculiarly Title interest n the defence and are therefore mat much an evidence a host's response in two way: me > - — — — sa PARASITOLOGY Trypanosoma krueei subgroup (African trypanosomiasis} Ea Am intace eats Fy srtroavorey metacyete Irypomantgetes SUREIDIAAY HOSTS Ths, i will be Let "+ defemive mecttanisan tat itis the: defence which plays the dominant ove the living mypomastigs issue spaces. The release ef kinins may elp to altract macruphages: 1 eases the capillary peemscalibity of Liswwes ani may expluin the sedemaious sullen subeumanewus fxs a ne ste of dBfetion Prathrgenie lesion. There is severe damage nf the perivascular connective tisswes. The bundle feulagen fibres are disrupted anu the fibroblasts are destroyed Fg, $4—Glovsous pup, te inset West for “bambi” stain af F Bea ‘The lesions are found mainly in the Anil modes and the central nervous systenn, “The capillary blond vessels of the cemma! nervous system are noi surrounded hy any connective the nerve cells are embraced by the overlapping fibrous processes of the astrox throughout the central nervous st rates Bil tes. An increase of glial cells oceur system and the cerebral perivascular spaces are “cuffed” with manonuclear cells (perivascular cujfing), Cerebral softening may rest fram thrombosis of these “cuffed” vessels, The choroid plexus is severely congested and infiltrated with monaeytes. often comaining & lange number of parasites, There is heav’y cellular infilration in the leptomeninges but slight infehration im the brain substance The fymmph textes in early stages show congestion. haemorrhages nd marked proliferation of macrophage cells: in the later stages they undergo devenerative changes ‘with extensive fibrosis Clinical Pathology Blond. Leucocytosis (monocytosis) and anaemia, On account of a high rise of gamma globulin, the erythro yte sedimentation rate is rarsed and the scrum aldelyyde test becomes positive: it also causes un auto-agghutination of red blond cells. Cerebrospinal fluid. The pressure is raised. the cell count ($0 t0 100 per mm) and protein content (100-150 mg) ane increased. The rise of globulin content gives 1 "tabetic” typeof colloidal gold curve. The parasites may be demon strated in the CSF. The increased cell count is mot sufficient to cause any \urbidity of the CSF. (Clinieal Features (sve Fig. 42). A history of expoware to tsetse bite is often available (even a nomial tseise bite causes a severe maction) A trypanasomal chancre may develop athe sie of inoculation of trypomastigotes intrcuced by the bite of the infected tsetse fly (often passes unobserved or confused with a normal tsetse bite). tis a hard painful nodule and fluid withdravsn ftom it coniains actively dividing try pomastigotes: it subsides in 8 week oF two without suppursting, In “rhodesian" fonn the symptoms appear first after 2 weeks of the bite, whereas in “gambian”” and “zambesi" forms the symptoms may be delayed for up to a year. 60 PARASITOLOGY It js characterised by infection of the Blood stream, involvement and enlargement of lymph ness luter generalised) and eventually invasion of the central nervous system. The early symptoms are fluctuating in “rhodesian” form), severe headache, loss of noctumal sleep and a fecling of oppression

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