Achieve Mastery of Medical Concepts

Study for medical school and boards with Lecturio

Trypanosoma brucei/African trypanosomiasis

African trypanosomiasis, or African sleeping sickness, is a parasitic infection caused by the protozoa Protozoa Nitroimidazoles Trypanosoma brucei. There are 2 notable subtypes, T. brucei gambiense and T. brucei rhodesiense. Transmission is primarily vector borne through the tsetse fly. Initial infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease present with localized inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation ( chancre Chancre The primary sore of syphilis, a painless indurated, eroded papule, occurring at the site of entry of the infection. Syphilis), cervical lymphadenopathy Lymphadenopathy Lymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease. Lymphadenopathy, intermittent fevers, and other nonspecific findings. If untreated, CNS involvement occurs, which is characterized by sleep Sleep A readily reversible suspension of sensorimotor interaction with the environment, usually associated with recumbency and immobility. Physiology of Sleep disturbances, behavioral changes, coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma, and death. Diagnosis is confirmed by the identification Identification Defense Mechanisms of trypanosomes on blood smear Blood smear Myeloperoxidase Deficiency or serology Serology The study of serum, especially of antigen-antibody reactions in vitro. Yellow Fever Virus. Treatment is dependent on the subtype and stage of the disease. Early treatment and prevention are key in preventing long-term sequelae and death.

Last updated: 28 Oct, 2021

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

General Characteristics and Epidemiology

General features of Trypanosoma brucei

  • Parasitic protozoan 
  • Taxonomy:
    • Family: Trypanosomatidae
    • Genus: Trypanosoma
    • Subspecies: 
      • T. brucei gambiense 
      • T. brucei rhodesiense
  • General characteristics: 
    • Single flagellum
    • Undulating membrane
    • Variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables surface glycoproteins Surface glycoproteins Glycoproteins found on the membrane or surface of cells. Human Herpesvirus 8 allow for antigenic variation.
  • Morphologic forms:
Trypanosomes in a giemsa-stained thin blood film

Trypanosomes in a Giemsa-stained thin blood film from a traveler returning from Tanzania

Image: “Trypanosomes in a Giemsa-stained thin blood film from a Spanish traveler returning from Tanzania” by Joan Gómez-Junyent et al AL Amyloidosis. License: CC BY 4.0

Associated diseases

T. brucei causes African trypanosomiasis, also known as African sleeping sickness.

Epidemiology

  • Geographic distribution:
    • Western and Central Africa (gambiense subtype)
    • Eastern and Southern Africa (rhodesience subtype)
  • Incidence Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time. Measures of Disease Frequency
    • 933 new cases reported in 2018 (> 98% were the gambiense subtype)
    • < 1 case per year in the US (in travelers)
Geographic distribution of african trypanosomiasis

Geographic distribution of African trypanosomiasis: T. brucei is only found in the blue areas.

Image: “T. brucei is only found in the blue areas” by Beck, H.E. et al AL Amyloidosis. License: CC BY 4.0

Pathogenesis

Reservoir Reservoir Animate or inanimate sources which normally harbor disease-causing organisms and thus serve as potential sources of disease outbreaks. Reservoirs are distinguished from vectors (disease vectors) and carriers, which are agents of disease transmission rather than continuing sources of potential disease outbreaks. Humans may serve both as disease reservoirs and carriers. Escherichia coli

  • T. b. rhodesiense: wild game animals Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, animalia was one of the kingdoms. Under the modern three domain model, animalia represents one of the many groups in the domain eukaryota. Cell Types: Eukaryotic versus Prokaryotic and cattle
  • T. b. gambiense: primarily humans

Transmission

  • Primarily vector-borne Vector-Borne Antimalarial Drugs transmission: tsetse fly
  • Less common:
    • Blood transfusion
    • Organ transplantation Organ Transplantation Transplantation is a procedure that involves the removal of an organ or living tissue and placing it into a different part of the body or into a different person. Organ transplantations have become the therapeutic option of choice for many individuals with end-stage organ failure. Organ Transplantation
    • Laboratory inoculation
    • Congenital Congenital Chorioretinitis infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease

Host risk factors

Life cycle Cycle The type of signal that ends the inspiratory phase delivered by the ventilator Invasive Mechanical Ventilation and pathophysiology

  • Tsetse fly feeds on an infected human or mammal host → becomes infected with trypomastigotes ( infectious Infectious Febrile Infant form)
  • Infected tsetse fly bites host → injects trypomastigotes into host tissue → chancre Chancre The primary sore of syphilis, a painless indurated, eroded papule, occurring at the site of entry of the infection. Syphilis develops, secondary to localized inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation
  • Trypomastigotes migrate to regional lymphatics → disseminate through the bloodstream
  • Motility Motility The motor activity of the gastrointestinal tract. Gastrointestinal Motility of trypomastigotes allows invasion of the surrounding connective tissues, including CSF and CNS.
  • Disease progression is dependent on subspecies:
    • Rhodesiense: incubation Incubation The amount time between exposure to an infectious agent and becoming symptomatic. Rabies Virus period of weeks
    • Gambiense: incubation Incubation The amount time between exposure to an infectious agent and becoming symptomatic. Rabies Virus period of months to years
Pathogenesis of african trypanosomiasis

Image illustrating the pathogenesis of African trypanosomiasis

Image by Lecturio. License: CC BY-NC-SA 4.0

Clinical Presentation

African trypanosomiasis has 2 stages: the hemolymphatic stage and the neurologic stage

Stage 1: hemolymphatic phase

  • Localized symptoms:
    • Painful chancre Chancre The primary sore of syphilis, a painless indurated, eroded papule, occurring at the site of entry of the infection. Syphilis at the site of inoculation
      • Erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion
      • Induration Induration Dermatologic Examination
      • Variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables appearance
      • Resolves spontaneously
    • Winterbottom sign: 
      • Painless lymphadenopathy Lymphadenopathy Lymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease. Lymphadenopathy of posterior cervical lymph nodes Lymph Nodes They are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system. Lymphatic Drainage System: Anatomy
      • Characteristic of T. b. gambiense infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease
  • Nonspecific systemic symptoms:
  • Less common symptoms:
Cutaneous manifestations of african trypanosomiasis

Cutaneous manifestations of African trypanosomiasis:
A: a fine, pink rash Rash Rocky Mountain Spotted Fever on the abdomen
B: trypanosomal chancre Chancre The primary sore of syphilis, a painless indurated, eroded papule, occurring at the site of entry of the infection. Syphilis on the patient’s left arm Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy that occurs at the site of inoculation

Image: “Typical clinical manifestations of acute African trypanosomiasis imported from Uganda” by Paul M et al AL Amyloidosis. License: CC BY 2.0

Stage 2: neurologic phase Neurologic phase Tick-borne Encephalitis Virus ( meningoencephalitis Meningoencephalitis Encephalitis)

  • Headache Headache The symptom of pain in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of headache disorders. Brain Abscess:
    • Persistent
    • Refractory to analgesics
  • Lymphadenopathy Lymphadenopathy Lymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease. Lymphadenopathy
  • Behavioral changes:
  • Neurologic symptoms:
    • Ataxia Ataxia Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharynx, larynx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. Ataxia-telangiectasia
    • Sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology disorders
    • Tremors
  • Sleep Sleep A readily reversible suspension of sensorimotor interaction with the environment, usually associated with recumbency and immobility. Physiology of Sleep disorder: 
    • Daytime somnolence
    • Nighttime insomnia Insomnia Insomnia is a sleep disorder characterized by difficulty in the initiation, maintenance, and consolidation of sleep, leading to impairment of function. Patients may exhibit symptoms such as difficulty falling asleep, disrupted sleep, trouble going back to sleep, early awakenings, and feeling tired upon waking. Insomnia
    • Severe enough to cause anorexia Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa, wasting, and malnutrition Malnutrition Malnutrition is a clinical state caused by an imbalance or deficiency of calories and/or micronutrients and macronutrients. The 2 main manifestations of acute severe malnutrition are marasmus (total caloric insufficiency) and kwashiorkor (protein malnutrition with characteristic edema). Malnutrition in children in resource-limited countries
  • Progression to coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma and death, if untreated
Time course of the african trypanosomiasis disease

Image showing the time course of African trypanosomiasis from initial infection to chronic illness months to years later (depending on the subspecies involved)

Image by Lecturio. License: CC BY-NC-SA 4.0

Diagnosis and Management

Diagnosis

  • Confirmatory tests:
    • Presence of trypomastigotes
    • Serologic testing: 
      • Card agglutination test for trypanosomiasis (CATT)
      • ELISA ELISA An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. St. Louis Encephalitis Virus
      • PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)
  • Supportive findings:
    • Hemolytic anemia Hemolytic Anemia Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia
    • Leukocytosis Leukocytosis A transient increase in the number of leukocytes in a body fluid. West Nile Virus
    • Thrombocytopenia Thrombocytopenia Thrombocytopenia occurs when the platelet count is < 150,000 per microliter. The normal range for platelets is usually 150,000-450,000/µL of whole blood. Thrombocytopenia can be a result of decreased production, increased destruction, or splenic sequestration of platelets. Patients are often asymptomatic until platelet counts are < 50,000/µL. Thrombocytopenia
    • ↑ Inflammatory markers ( erythrocyte sedimentation rate Erythrocyte Sedimentation Rate Soft Tissue Abscess and CRP)

Management

  • Rhodesiense subspecies: 
    • Stage 1: suramin
    • Stage 2: melarsoprol 
  • Gambiense subspecies: 
    • Stage 1: pentamidine
    • Stage 2: niturtimox and eflornithine

Prevention

  • No vaccine Vaccine Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa), antigenic proteins, synthetic constructs, or other bio-molecular derivatives, administered for the prevention, amelioration, or treatment of infectious and other diseases. Vaccination or prophylactic treatment is available.
  • Vector control with insecticides Insecticides Pesticides designed to control insects that are harmful to man. The insects may be directly harmful, as those acting as disease vectors, or indirectly harmful, as destroyers of crops, food products, or textile fabrics. Trypanosoma cruzi/Chagas disease and insect repellants
  • Wear long sleeves and pants, and use neutral-colored clothing

Comparison of Flagellated Protozoa

Table: Comparison of clinically relevant flagellated protozoa Protozoa Nitroimidazoles
Protozoa Protozoa Nitroimidazoles Giardia Giardia A genus of flagellate intestinal eukaryotes parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. Nitroimidazoles Leishmania Leishmania Leishmania species are obligate intracellular parasites that are transmitted by an infected sandfly. The disease is endemic to Asia, the Middle East, Africa, the Mediterranean, and South and Central America. Clinical presentation varies, dependent on the pathogenicity of the species and the host’s immune response. Leishmania/Leishmaniasis Trypanosoma Trichomonas Trichomonas A genus of parasitic flagellate eukaryotes distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. Nitroimidazoles
Characteristics
  • 4 pairs of flagella Flagella A whiplike motility appendage present on the surface cells. Prokaryote flagella are composed of a protein called flagellin. Bacteria can have a single flagellum, a tuft at one pole, or multiple flagella covering the entire surface. In eukaryotes, flagella are threadlike protoplasmic extensions used to propel flagellates and sperm. Flagella have the same basic structure as cilia but are longer in proportion to the cell bearing them and present in much smaller numbers. Helicobacter
  • Ovoid shape
  • Adhesive disc Adhesive Disc Giardia/Giardiasis
  • Anaerobe
  • Antigenic variation
  • Single, polar flagellum
  • Slender, elongated body
  • Single, polar flagellum
  • Undulating membrane
  • Thin, irregularly shaped
  • Antigenic variation
  • 5 flagella Flagella A whiplike motility appendage present on the surface cells. Prokaryote flagella are composed of a protein called flagellin. Bacteria can have a single flagellum, a tuft at one pole, or multiple flagella covering the entire surface. In eukaryotes, flagella are threadlike protoplasmic extensions used to propel flagellates and sperm. Flagella have the same basic structure as cilia but are longer in proportion to the cell bearing them and present in much smaller numbers. Helicobacter
  • Undualting membrane
  • Ovoid shape
  • Facultative anaerobe
Forms
  • Cyst
  • Trophozoite
Transmission
  • Vector (tsetse fly, kissing bug)
  • Blood transfusion
  • Sexually transmitted
Clinical
  • Giardiasis Giardiasis An infection of the small intestine caused by the flagellated protozoan giardia. It is spread via contaminated food and water and by direct person-to-person contact. Giardia/Giardiasis
  • Leishmaniasis Leishmaniasis Leishmania species are obligate intracellular parasites that are transmitted by an infected sandfly. The mildest form is cutaneous leishmaniasis (CL), characterized by painless skin ulcers. The mucocutaneous type involves more tissue destruction, causing deformities. Visceral leishmaniasis (VL), the most severe form, presents with hepatosplenomegaly, anemia, thrombocytopenia, and fever. Leishmania/Leishmaniasis
  • African sleeping sickness
  • Chagas disease Chagas disease Infection with the protozoan parasite trypanosoma cruzi, a form of trypanosomiasis endemic in central and south america. It is named after the brazilian physician carlos chagas, who discovered the parasite. Infection by the parasite (positive serologic result only) is distinguished from the clinical manifestations that develop years later, such as destruction of parasympathetic ganglia; chagas cardiomyopathy; and dysfunction of the esophagus or colon. Trypanosoma cruzi/Chagas disease
  • Trichomoniasis
Diagnosis
  • ELISA ELISA An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. St. Louis Encephalitis Virus
  • DFA
  • NAAT
  • Stool microscopy Stool Microscopy Giardia/Giardiasis
  • Blood smear Blood smear Myeloperoxidase Deficiency
  • Biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma
  • PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)
  • Leishmanin skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions test
  • Antibody titers
  • Microscopy of vaginal secretions
  • NAAT
  • Urine Urine Liquid by-product of excretion produced in the kidneys, temporarily stored in the bladder until discharge through the urethra. Bowen Disease and Erythroplasia of Queyrat or urethral swab culture
Treatment
  • Metronidazole Metronidazole A nitroimidazole used to treat amebiasis; vaginitis; trichomonas infections; giardiasis; anaerobic bacteria; and treponemal infections. Pyogenic Liver Abscess
  • Tinidazole Tinidazole A nitroimidazole alkylating agent that is used as an antitrichomonal agent against trichomonas vaginalis; entamoeba histolytica; and giardia lamblia infections. It also acts as an antibacterial agent for the treatment of bacterial vaginosis and anaerobic bacterial infections. Nitroimidazoles
  • Nitazoxanide
Depends on the clinical syndrome:
Depends on the clinical disease:
  • Metronidazole Metronidazole A nitroimidazole used to treat amebiasis; vaginitis; trichomonas infections; giardiasis; anaerobic bacteria; and treponemal infections. Pyogenic Liver Abscess
  • Tinidazole Tinidazole A nitroimidazole alkylating agent that is used as an antitrichomonal agent against trichomonas vaginalis; entamoeba histolytica; and giardia lamblia infections. It also acts as an antibacterial agent for the treatment of bacterial vaginosis and anaerobic bacterial infections. Nitroimidazoles
Prevention
  • Handwashing
  • Water treatment
  • Insecticides Insecticides Pesticides designed to control insects that are harmful to man. The insects may be directly harmful, as those acting as disease vectors, or indirectly harmful, as destroyers of crops, food products, or textile fabrics. Trypanosoma cruzi/Chagas disease
  • Insect repellents
  • Protective clothing
  • Insecticides Insecticides Pesticides designed to control insects that are harmful to man. The insects may be directly harmful, as those acting as disease vectors, or indirectly harmful, as destroyers of crops, food products, or textile fabrics. Trypanosoma cruzi/Chagas disease
  • Insect repellents
  • Bed nets
  • Protective clothing
  • Treatment of sexual partners
  • Use of condoms Condoms A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. Nonhormonal Contraception

DFA: direct immunofluorescence assay
NAAT: nucleic acid amplification Nucleic acid amplification Laboratory techniques that involve the in-vitro synthesis of many copies of DNA or RNA from one original template. Septic Arthritis test

Differential Diagnosis

  • Chagas disease Chagas disease Infection with the protozoan parasite trypanosoma cruzi, a form of trypanosomiasis endemic in central and south america. It is named after the brazilian physician carlos chagas, who discovered the parasite. Infection by the parasite (positive serologic result only) is distinguished from the clinical manifestations that develop years later, such as destruction of parasympathetic ganglia; chagas cardiomyopathy; and dysfunction of the esophagus or colon. Trypanosoma cruzi/Chagas disease: an infection caused by the American trypanosome, T. cruzi. Acute infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease may present with inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation at the inoculation site Inoculation site Yellow Fever Virus ( chagoma Chagoma Trypanosoma cruzi/Chagas disease), fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever, and lymphadenopathy Lymphadenopathy Lymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease. Lymphadenopathy. Untreated chronic infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease can progress to severe complications, including megacolon Megacolon Megacolon is a severe, abnormal dilatation of the colon, and is classified as acute or chronic. There are many etiologies of megacolon, including neuropathic and dysmotility conditions, severe infections, ischemia, and inflammatory bowel disease. Megacolon, megaesophagus Megaesophagus Trypanosoma cruzi/Chagas disease, and cardiomyopathy Cardiomyopathy Cardiomyopathy refers to a group of myocardial diseases associated with structural changes of the heart muscles (myocardium) and impaired systolic and/or diastolic function in the absence of other heart disorders (coronary artery disease, hypertension, valvular disease, and congenital heart disease). Cardiomyopathy: Overview and Types. The diagnosis can be confirmed using blood smear Blood smear Myeloperoxidase Deficiency, serology Serology The study of serum, especially of antigen-antibody reactions in vitro. Yellow Fever Virus, or PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR). Treatment with benznidazole Benznidazole Trypanosoma cruzi/Chagas disease or nifurtimox Nifurtimox A nitrofuran thiazine that has been used against trypanosomiasis. Trypanosoma cruzi/Chagas disease is effective only in the acute phase Acute phase Short Bowel Syndrome.
  • Bacterial or fungal meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis: Symptoms of bacterial meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis may mimic those of the 2nd phase of sleeping sickness, including fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever, headache Headache The symptom of pain in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of headache disorders. Brain Abscess, confusion, and myalgias Myalgias Painful sensation in the muscles. Tick-borne Encephalitis Virus. Diagnosis is confirmed by CSF analysis CSF analysis Meningitis and/or serologic testing. Specific bacterial causes of meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis vary depending on age group and risk factors. 
  • Malaria Malaria Malaria is an infectious parasitic disease affecting humans and other animals. Most commonly transmitted via the bite of a female Anopheles mosquito infected with microorganisms of the Plasmodium genus. Patients present with fever, chills, myalgia, headache, and diaphoresis. Plasmodium/Malaria: a mosquito-borne infectious Infectious Febrile Infant disease caused by Plasmodium Plasmodium A genus of protozoa that comprise the malaria parasites of mammals. Four species infect humans (although occasional infections with primate malarias may occur). These are plasmodium falciparum; plasmodium malariae; plasmodium ovale, and plasmodium vivax. Species causing infection in vertebrates other than man include: plasmodium berghei; plasmodium chabaudi; p. Vinckei, and plasmodium yoelii in rodents; p. Brasilianum, plasmodium cynomolgi; and plasmodium knowlesi in monkeys; and plasmodium gallinaceum in chickens. Antimalarial Drugs species. Malaria Malaria Malaria is an infectious parasitic disease affecting humans and other animals. Most commonly transmitted via the bite of a female Anopheles mosquito infected with microorganisms of the Plasmodium genus. Patients present with fever, chills, myalgia, headache, and diaphoresis. Plasmodium/Malaria often presents with fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever, rigors Rigors Fever, diaphoresis, jaundice Jaundice Jaundice is the abnormal yellowing of the skin and/or sclera caused by the accumulation of bilirubin. Hyperbilirubinemia is caused by either an increase in bilirubin production or a decrease in the hepatic uptake, conjugation, or excretion of bilirubin. Jaundice, abdominal pain Abdominal Pain Acute Abdomen, hemolytic anemia Hemolytic Anemia Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia, hepatosplenomegaly Hepatosplenomegaly Cytomegalovirus, and renal impairment. A blood smear Blood smear Myeloperoxidase Deficiency shows a single pleomorphic Pleomorphic Bacteroides ring. Rapid testing for Plasmodium Plasmodium A genus of protozoa that comprise the malaria parasites of mammals. Four species infect humans (although occasional infections with primate malarias may occur). These are plasmodium falciparum; plasmodium malariae; plasmodium ovale, and plasmodium vivax. Species causing infection in vertebrates other than man include: plasmodium berghei; plasmodium chabaudi; p. Vinckei, and plasmodium yoelii in rodents; p. Brasilianum, plasmodium cynomolgi; and plasmodium knowlesi in monkeys; and plasmodium gallinaceum in chickens. Antimalarial Drugs antigens can also be performed. Management requires a prolonged course of multiple antimalarial drugs Antimalarial drugs Malaria, a vector-borne parasitic disease caused by Plasmodium spp., is transmitted via injection of sporozoites or immature forms of the parasite into a person’s bloodstream. Sporozoites then infect the hepatocytes and differentiate into schizonts, which subsequently rupture, and merozoites invade red blood cells. Antimalarial Drugs.
  • Psychiatric illness: Due to late-stage behavioral manifestations, sleeping sickness may be misdiagnosed as a psychiatric illness, especially in immigrants to nonendemic areas. It is important to evaluate for possible epidemiological exposure Exposure ABCDE Assessment to prevent this misdiagnosis.

References

  1. Riedel, S., Jawetz, E., Melnick, J.L., Adelberg, E.A. (2019). Jawetz, Melnick & Adelberg’s Medical Microbiology, pp. 722-733 and 730-732. New York: McGraw-Hill Education.
  2. Krishna, S., Lindner, A., Lejon, V. (2021). Human African trypanosomiasis: Epidemiology, clinical manifestations, and diagnosis. UpToDate, Retrieved May 08, 2021, from https://www.uptodate.com/contents/human-african-trypanosomiasis-epidemiology-clinical-manifestations-and-diagnosis 
  3. Krishna, S., Lindner, A., Lejon, V. (2021). Human African trypanosomiasis: Treatment and prevention. UpToDate, Retrieved May 08, 2021, from https://www.uptodate.com/contents/human-african-trypanosomiasis-treatment-and-prevention
  4. Pearson, R.D. (2020). African trypanosomiasis (African sleeping sickness). MSD Manual Professional Version. Retrieved June 13, 2021, from https://www.msdmanuals.com/professional/infectious-diseases/extraintestinal-protozoa/african-trypanosomiasis
  5. Dunn, N., Wang, S., and Adigun, R. (2021). African trypanosomiasis. StatPearls. Retrieved June 13, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK519580/
  6. Hnaide, H.A. (2019). African trypanosomiasis (sleeping sickness). In Chandrasekar, P.H. (Ed.), Medscape. Retrieved June 13, 2021, from https://emedicine.medscape.com/article/228613-overview
  7. Centers for Disease Control and Prevention. (2020). Parasites – African trypanosomiasis (also known as sleeping sickness). Retrieved June 13, 2021, from https://www.cdc.gov/parasites/sleepingsickness/

USMLE™ is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). MCAT is a registered trademark of the Association of American Medical Colleges (AAMC). NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc (NCSBN®). None of the trademark holders are endorsed by nor affiliated with Lecturio.

Study on the Go

Lecturio Medical complements your studies with evidence-based learning strategies, video lectures, quiz questions, and more – all combined in one easy-to-use resource.

Learn even more with Lecturio:

Complement your med school studies with Lecturio’s all-in-one study companion, delivered with evidence-based learning strategies.

User Reviews

¡Hola!

Esta página está disponible en Español.

🍪 Lecturio is using cookies to improve your user experience. By continuing use of our service you agree upon our Data Privacy Statement.

Details