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BABESIA SPECIES

• ZOONOSIS
• Vector-IXODID tick
• Resorvoir host-mice,voles and other
rodents
• Babesia microti-common cause of
babesiosis in US
Life cycle
• Infective stage-pyriform bodies
• Diagnostic stage-trophozoite
• In RBC-trophozoites by binary fission
forms tetrad-lyse erythrocytes-release
merozoites-reinfect
• Infected cells-ingested by ticks-
transovarian transmission
Clinical features

• Incubation period-1-4 weeks
• Malaise,fever,chills,headache,fatigue
• No periodicity
• Progresses to develop hemolytic
anemia
• Splenomegaly,hepatomegaly,renal
failure
Lab diagnosis

• Microscopic examination of blood
smears
• Resemble the ring forms of
Plasmodium species
• But no pigment or other stages of
growth as in plasmodium
Treatment and control

• DOC-Clindamycin+quinine
• Exchange blood transfusion in pts
who had splenenctomy and severe
infections
• Protective clothing,insect repellents
TOXOPLASMA GONDII

• Coccidian parasite
• Reservoir host-house cat
• Infective stage-sporulated oocyst
• Diagnostic stage-immature oocyst in
feces
• Some trophozoite forms-crescentic
tachyzoites-responsible for initial
infection
• Slow growing shorter forms-
bradyzoites-cysts in chronic infection
• More severe CNS disease in
immunocompromised individuals
Clinical features

• Mostly-benign and asymptomatic
•-
headche,myalgia,fatigue,lymphadeniti
s
• c/c-
lymphadenitis,rash,hepatitis,encephal
opathy,myelitis,myocarditis,chorioreti
nitis-blindness
• Congenital infection-
• 1st trimester-spontaneous
abortion,stillbirth
• Afterwards-
epilepsy,encephalitis,microcephaly,intr
acranial
calcifications,hydrocephalus,mental
retardations,blindness,anemia,jaundice
,rash,pneumonia,diarrhoea
• In immunocompromised pts-
neurological
• More than one lesion in the brain
• Hemiparesis,seizures,visual
impairment,confusioon,lethargy
Lab diagnosis

• Serological testing-increasing
antibody titre
• ELISA for IgM Ab
• Demonstrating trophozoites and
cysts in tissue and body fluids–
defenitive method
• Biopsy specimens
• Monoclonal antibody based staining
• Culture methods
Treatment

• Pyrimethamine+sulfadiazine high
dose,then continued in lower dose
indefenitely
• Trimethoprim-sulfamethoxazole is
another option
• Steroids-if cerebral oedema develops
• Prophylaxis-
sulfamethoxazole+trimethoprim
• Avoid contact with undercooked
meat
FREE LIVING AMOEBA

• Naegleria
• Acanthamoeba
• Balamuthia
• Common route-Inhalation of cysts
Clinical features

• Naegleria fowleri- primary
meningoencephalitis
• Frontal headache,sore
throat,fever,blocked nose,positive
Kernigs sign
• Naegleria trophozoites - in brain on
postmortem
• Acanthameoba and balamuthia-
granulomatous amoebic encephalitis
and brain abscess in
immunocompromised individuals
• Acanthamoeba-keratitis(contact with
contact lens,soil,dust)
• Cutaneous infection
Lab Diagnosis

• Specimens-Nasal
discharge,CSF,corneal scrapings
• Saline wet preparation and iodine
stained smears
• Naegleria-only amoeboid
trophozoite;other 2-cyst and
trophozoite
• Can be cultured on agar plates
Treatment, prevention and
control
• Naegleria-amphotercin B
+miconazole and rifampin
• Acanthamoeba-
pentamidine,ketoconazole,flucytosine
• Balamuthia-
clarithromycin,fluconazole,sulfadiazin
e,flucytosine
• Amoebic keratitis-corneal
transplantation
• Cutaneous infections-topical
miconazole,chlorhexidine gluconate
LEISHMANIA

• Hemoflagellate
• Vector-sandfly-phlebotomus
• 3 species-
Leishmania donovani -visceral
leishmaniasis(kala-azar,dum dum fever)
L.Tropica -cutaneous
leishmaniasis(oriental sore,Delhi boil)
L.braziliensis -mucocutaneous
leishmaniasis(american
leishmaniasis,espundia,chiclero ulcer)
Leishmania donovani
Sandfly Transmission
• transmitted via mouthparts
• promastigotes regurgitated
from anterior gut
• factors in saliva enhance
infectivity
1) promastigotes

2) phagocytosis by
macrophage →
amastigote

3) replication within
macrophage

4) release and
phagocytosis of
amastigotes
4) phagocytosis of
amastigotes, or
ingestion by
vector

5) promastigotes
• replication
• attachment to
epithelium

6) promastigotes
• Infective stage-promastigote
• Diagnostic stage-amastigote
• Resorvoir host-dogs,foxes,jackals
Clinical features

• Gradual onset with fever,diarrhoea,
anemia
• Progresses to enlargement of
organs,weight loss
• Post kala azar dermal leishmaniasis
in persistent cases
Visceral Leishmaniasis
• 3 possibly related species
• L. donovani (Asia, Africa)
• India (kala azar)
• reticuloendothelial system affected
• spleen, liver, bone marrow, lymph nodes
• onset is generally insidious
• progressive disease
• 75-95% mortality if untreated
• death generally within 2 years
Clinical Presentation
• incubation period
• generally 2-6 months
• can range 10 days to years
• fever, malaise, weakness
• wasting despite good appetite
• spleno- and hepatomegaly,
enlarged lymph nodes
• depressed hematopoiesis
• severe anemia
• leucopenia
• thrombopenia → petechial
hemorrhages in mucosa
Post Kala Azar
Dermal Leishmaniasis
• due to inadequate treatment
• nodular lesions
• easily cured with treatment
(in contrast to DCL)
Lab diagnosis

• Amastigote stage in tissue biopsy,
bone marrow examination, lymph
node aspiration
• Serology
• Culture of blood, bone marrow
demonstrates the promastigote
Treatment

• 1st drug of choice-oral miltefosine
• Parenteral stibogluconate
• Control of resorvoir hosts,protection
from sandfly bite
L.tropica

• Incubation period-2 weeks-2 months
• 1 st sign –red papule at the site of bite
• Intense itching-enlarges and ulcerates
• Exudes a serous material-secondary
bacterial infection
Cutaneous
Leishmaniasis
• incubation period: 2 weeks
to several months
• chronic ulcerated, papular,
or nodular lesion
• lesion is painless, non-
tender, non-pruritic and
usually clean
• occasionally satellite
lesions and/or palpable
lymph nodes
Diffuse Cutaneous
Leishmaniasis
• scaly, not ulcerated,
nodules
• chronic and painless
• numerous parasites
in lesions
• seldom heal despite
treatment

L. mexicana
Lab diagnosis

• Demonstration of amastigotes in
stained smears
• Serology
• DNA probes
Treatment

• DOC-stibogluconate
• Application of heat to the lesion
• Protection from bites
L.braziliensis

• Clinical features similar to tropica
• Involvement of mucus membranes
and related tissue structures
• Diagnosis and treatment-same as
tropica
Mucocutaneous Leishmaniasis
• primarily L. braziliensis
(espudia)
• two stages
• simple skin lesion
• 2o mucosal involvement
• can occur long after primary
lesion (up to 16 years)
• frequently in naso-
pharyngeal mucosae
• metastasis via blood or
lymphatic systems
• variable types and sizes of
lesions
• chronic and painless
TRYPANOSOMES

• T.gambiense-african
trypanosomiasis(sleeping sickness)
Vector-tsetse fly
• T.cruzi-chagas disease(american
trypanosomiasis)
Vector-reduvids
T.gambiense
• Infective stage-metacyclic
trypomastigote
• Diagnostic stage-blood stream
trypomastigote
Clinical features

• Earliest-an ulcer at the site of bite
• Followed by
lymphadenopathy,fever,myalgia,arth
ralgia
• Posterior cervical lymphadenopathy-
characteristic-WINTERBOTTOM SIGN
• c/c-CNS involvement->death
• Winterbottom's sign is the swelling of
lymph nodes (lymphadenopathy) along
the back of the neck, in the
posterior cervical chain of lymph nodes,
as trypanosomes travel in the
lymphatic fluid and cause inflammation.
• It may be suggestive of cerebral infection.
Lab diagnosis

• Thick and thin blood films
• aspirations from lymph node,
concentrated spinal fluid
• Serology,immunoflurescence,ELISA,a
gglutination methods
Treatment

• -Suramin is the DOC
• -melarsoprol is the DOC
• Control breeding sites of the vector
• Protective clothing
T.Cruzi
Clinical features

• Earliest-development of a
chagoma(erythematous and indurated
area)
• Followed by a rash and edema around
eyes and face
• Fever, chills and rigor
• CNS involvement
• c/c-
hepatosplenomegaly,myocarditis,enl
argement of oesophagus and colon
• Sudden death-heart block and brain
damage
Lab diagnosis

• Thick and thin films
• Biopsy specimens from lymph nodes,
liver spleen shows the Amastigote
stage.
• Serology
• Xenodiagnosis
• PCR
Treatment

• DOC-NIFURTIMOX
• Also allopurinol
• Bug control, eradication of nests