• Chagas disease
• African sleeping disease
• Leshminiasis

• causative agents
  • Trypanosoma b. gambiense
    • more chronic (mnth-yrs)
    • no major animal reservoir
    • case detection, tx to elim.
  • Trypanosoma b. rhodesiense
    • zoonosis: transmitted by antelope, cattle
    • kill in period of wks
    • target animal
• vector- tsetse fly

• early stage- asymptomatic (tryps found in blood and lymph nodes)
• late stage: CNS involvement and tryps in CSF

• exclusively in sub saharin Africa
  • gambiense (W. Africa)
  • rhodensiense (E. Africa)

Especially seen in areas of civil war: Sudan, DR Congo, Angola

• undulating membrane is how the flagella will move it

1. tse tse fly introduce organism
2. gains access to blood stream and replicate (rhod: weeks, gam: months, yrs)
   • enlarge post. cervical lymph nodes
   • access to meningnes and cause meningitis

• the organism would appear and disappear in the blood
• VSG switches (so now you make Ab to one variant of VSG but no the other)- antigenic variation

• gambian
  • Winterbottom's cervical adenopathy
  • asymp. for months or years
  • intermittent fever- Ag variation
  • weight loss
  • CNS involvement
    • diurinal somnolescence with nocturnal insomnia
    • constant headache
    • behavioral changes
• rhodesian HAT: wks for symptoms

• microscopy
  • lymph node aspirates
  • blood smear
• nonspecific lab elevation
  • ESR
  • increase IgG
  • increase IgM
• late stage: look at CSF sediment
• anion exchange centrifugation

• suramin for blood borne disease
• melarsoprol for CNS penetration
  • very toxic drug basically cause you are arsenic poisoning the protozoa and hoping that happens before you kill the patient

• gambian HAT
  • no zoonotic reservoir
  • case detection, management
• rhodesian HAT
  • cattle zoonotic reservoir
  • vector control
  • veterinary control

• mainly in South America
• vector: reduviid bug aka kissing bug

1. as kissing bug it feeds on you, it will deposit its feces on your face
2. the feces contain the protozoa, and scratching at that area will cause infection
3. go into blood and replicate
   • predisposition for mycoardial fibers of the heart

• chagoma- indurated lesion at site of parasite entry
• Romana's sign (when conjunctiva is port of entry)
• malaise, fever, facial edema
• high parasitemias, lymphocytosis
• severe myocarditis with EKG changes

• cardiomyopathy
  • left ventricular aneurysm
  • conduction defects
• denervation at the colon and esophagus leads to megacolon and megaesophagus (they are basically not functional)

• acute
  • myocarditis in epidemiologic settings
  • parasite detection
  • parasite cultivation and xenodiagnosis
  • T. cruzi IgM
• chronic
  • T cruzi specific IgG
  • Abbot Labs
  • Gulf Labs
  • PCR

Above all, you must do blood smear.

• antiparasitic drugs limited
• pacemakers
• gamma interferon
• cardiac transplantation (reactivation of acute disease occurs because of post op immunosuppression)

• visceral leishmaniasis
  • kala azar (black pigments)
  • major cause of morbitity and mortality
  • opportunisitic infection in HIV/AIDS
• cutaneous leishmaniasis
• mucocutaneous leishmaniasis

• emerging opportunistic infection among AIDS
• causative agents: L. donoviani (Asia, Africa)
  • esp. seen in East Africa
  • seen a lot in India, Sudan
• potential reservoir: dogs

• majority self resolving
• full blown kala azar
  • spiking fever
  • weight loss
  • hepatosplenomegaly
  • pancytopenia
  • hypergammaglobinemia
  • hyperpigmentation
• children under 5 are most susceptible group

1. organism transmitted by sand fly
2. organism will coat itself with C3b complement because it wants to be engulfed by macrophages
3. selectively replicate within the macrophage
   • accumulates in reticuloendothelial system (spots where there are a lot of macrophages)
     • spleen
     • liver
     • bone marrow

• fine needle aspiration of spleen
  • 90% sensitive
  • hemorrhagic complications
• bone marrow aspiration
• intradermal leishmanin skin test

look for macrophages containing amastigotes

• pentavalent antimony (SbV)- documentation of cure by symptomatic improvements
• new less toxic alternatives

• cutaneous manifestations
  • develop where parasite inoculate
  • wet lesion: pizza like with raised borders overlying purulent exudate
  • dry lesion: smaller and covered with crust
• diffuse cutaneous leishmaniasis
  • cutaneous nodules and plaques
  • more common in HIV/AIDS
• dx- biopsy of findings

• new world
  • L. mexicana
  • L. amozonesis
  • L. brazillensis
• old world
  • L major (sub Saharan West Africa, Russia, Iran)
  • L. tropica (West China, India, Pakistan, Central Asia, West Chain)