1. BLOOD AND INTESTINAL PROTOZOA QUICK REVIEW

2. Trypanosoma cruzi Disease--Chagas' disease. Characteristics—Blood and tissue protozoan. Life cycle: Trypomastigotes in blood of reservoir host are ingested by reduviid bug and form epimastigotes and then trypomastigotes in the gut

3. Transmission and Epidemiology—Transmitted by reduviid bugs. Humans and many animals are reservoirs. Occurs in rural Latin America.

4. Pathogenesis—Amastigotes kill cells, especially cardiac muscle leading to myocarditis. Also neuronal damage leading to megacolon and megaesophagus. Laboratory Diagnosis—Trypomastigotes visible in blood, but bone marrow biopsy, culture in vitro, xenodiagnosis, or serologic tests may be required. Treatment No effective drug for chronic disease. Prevention—Protection from bite. Insect control.

5. Trypanosoma gambiense & Trypanosoma rhodesiense Disease—Sleeping sickness (African trypanosomiasis). Characteristics—Blood and tissue protozoan. Life cycle: Trypomastigotes in blood of human or animal reservoir are ingested by tsetse fly

6. Transmission and Epidemiology—Transmitted by tsetse flies Pathogenesis—Trypomastigotes infect brain, causing encephalitis. Laboratory Diagnosis—Trypomastigotes visible in blood in early stages and in cerebrospinal fluid in late stages

7. Treatment—Suramin in early disease. Suramin plus melarsoprol if central nervous system symptoms exist. Prevention—Protection from bite. Insect control.

8. Leishmania donovani Disease—Kala-azar (visceral leishmaniasis). Characteristics—Blood and tissue protozoan. Life cycle: Human macrophages containing amastigotes are ingested by sandfly. Transmission and Epidemiology—Transmitted by Sandflies Pathogenesis—Amastigotes kill reticuloendothelial cells, especially in liver, spleen, and bone marrow. Laboratory Diagnosis—Amastigotes visible in bone marrow smear. Serologic tests useful. Skin test indicates prior infection. Treatment—Sodium stibogluconate. Prevention—Protection from bite. Insect control. Leishmania tropica, Leishmania mexicana, —Nifurtimox or benznidazole for acute dis

9. Each of the following statements concerning kala-azar is correct EXCEPT: (A) Kala-azar is caused by Leishmania donovani (B) Kala-azar is transmitted by the bite of sandflies (C) Kala-azar occurs primarily in rural Latin America (D) Kala-azar can he diagnosed by finding amastigotes in bone marrow

10. Each of the following statements concerning Trypanosoma cruzi is correct EXCEPT: (A) T cruzi is transmitted by the reduviid bug (B) T: cruzi occurs primarily in tropical Africa (C) T cruzi can be diagnosed by seeing trypomastigotes in a blood smear (D)T cruzi typically affects heart muscle, leading to cardiac failure

11. What are the chronic symptoms seen in Chagas disease?

12. Chronic symptoms includeCardiac arrhythmias Megacolon Dilated cardiomyopathy Achalasia

13. Describe the two stages of African sleeping sickness.

14. The early stage of sleeping sickness is characterized by: intermittent fever, malaise,and headache. The late stage is characterized by CNS involvement, with symptoms that includedaytime somnolence, nighttime insomnia, and persistent headaches.

15. How does Chagas disease present clinically during the acute phase?

16. Acute symptoms includeChagoma, which is inflammation at the bite site Romaña's sign, which is inflammation and swelling around the eyelids when organisms enter the conjunctiva

17. What Leishmania spp. is/are responsible for cutaneous leishmaniasis? for mucocutaneous leishmaniasis?

18. L. tropica and L. mexicana cause cutaneous leishmaniasis and L. braziliensis causesmucocutaneous leishmaniasis.

19. What characterizes the skin lesion of cutaneous leishmaniasis?

20. Cutaneous leishmaniasis presents as lesions confined to the skin that can be described as an erythematous papule at the sandfly bite, which expands and ulcerates (“boils”).

21. Can you describe the signs/symptoms of visceral leishmaniasis? Try to name 4.

22. Visceral leishmaniasis presents as: Intermittent/spiking fever with weakness (secondary to anemia). Splenomegaly with or without hepatomegaly - the spleen can become bigger than the liver. Pancytopenia - anemia, leukopenia, thrombocytopenia (patients can die of hemorrhage). Kala-azar (black fever) – skin hyperpigmentation in fair-skinned patients.