Tripanosoma Brucei/Tripanosomiasis Africana

Características Generales y Epidemiología

Características generales de Trypanosoma brucei Trypanosoma brucei African trypanosomiasis, or African sleeping sickness, is a parasitic infection caused by the protozoa Trypanosoma brucei. There are 2 notable subtypes, T. brucei gambiense and T. brucei rhodesiense. Transmission is primarily vector borne through the tsetse fly. Trypanosoma brucei/African trypanosomiasis

• Protozoo parásito
• Taxonomía:
  • Familia: Trypanosomatidae Trypanosomatidae Trypanosoma brucei/African trypanosomiasis
  • Género: Trypanosoma
  • Subespecie:
    • T. brucei gambiense T. brucei gambiense A hemoflagellate subspecies of parasitic protozoa that causes gambian or West african sleeping sickness in humans. The vector host is usually the tsetse fly (glossina). Trypanosoma brucei/African trypanosomiasis
    • T. brucei rhodesiense T. brucei rhodesiense A hemoflagellate subspecies of parasitic protozoa that causes rhodesian sleeping sickness in humans. It is carried by glossina pallidipes, g. Morsitans and occasionally other species of game-attacking tsetse flies. Trypanosoma brucei/African trypanosomiasis
• Características generales:
  • Flagelo único
  • Membrana ondulante
  • Las glicoproteínas de superficie variables permiten la variación antigénica.
• Formas morfológicas:
  • Epimastigote Epimastigote Trypanosoma brucei/African trypanosomiasis (forma no infecciosa)
  • Tripomastigotes metacíclicos (etapa infecciosa para humanos)

Enfermedades asociadas

T. brucei causa la tripanosomiasis africana, también conocida como enfermedad del sueño africana.

Epidemiología

• Distribución geográfica:
  • África occidental y central (subtipo gambiense)
  • África oriental y meridional (subtipo rhodesience)
• Incidencia:
  • Los LOS Neisseria casos globales se encuentran actualmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niveles históricamente bajos, la gran mayoría debidos a T. b. gambiense
  • < 1 caso por año en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria EE.UU ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum viajeros)

Patogénesis

Reservorio

• T. b. rodesiense: animales de caza y bovinos
• T. b. gambiense: principalmente humanos

Transmisión

• Principalmente transmisión por vectores: mosca tsetsé
• Menos común:
  • Transfusión de sangre
  • Trasplante de órgano
  • Inoculación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum laboratorio
  • Infecciones congénitas

Factores de riesgo del huésped

• Residencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum regiones endémicas
• Exposición prolongada a vectores

Ciclo de vida y fisiopatología

• La mosca tsetsé se alimenta de un huésped humano o mamífero infectado → se infecta con tripomastigotes (forma infecciosa)
  • Los LOS Neisseria tripomastigotes migran al AL Amyloidosis intestino medio de la mosca tsetsé → se replican (fisión binaria)
  • Migran a la glándula salival → se diferencian en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum epimastigotes (forma no infecciosa)
  • Después de aproximadamente 3 semanas, los LOS Neisseria epimastigotes se diferencian en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum tripomastigotes metacíclicos
• La mosca tsetsé infectada pica Pica Pica is an eating disorder characterized by a desire or recurrent compulsion to eat substances that are nonnutritive and not food. These compulsions and ingested substances are inappropriate for age or culture. Pica al AL Amyloidosis huésped → inyecta tripomastigotes metacíclicos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tejido del huésped → se desarrolla un chancro, secundario a inflamación localizada
• Los LOS Neisseria tripomastigotes migran a los LOS Neisseria vasos linfáticos regionales → se diseminan a través del torrente sanguíneo
• La motilidad de los LOS Neisseria tripomastigotes permite la invasión de los LOS Neisseria tejidos conjuntivos circundantes, incluidos el LCR y el SNC.
• La progresión de la enfermedad depende de las subespecies:
  • Rhodesiense: período de incubación de semanas
  • Gambiense: periodo de incubación de meses a años

Presentación Clínica

La tripanosomiasis africana tiene 2 estadios: el estadio hemolinfático y estadio neurológica

Estadio 1: fase hemolinfática

• Síntomas localizados:
  • Chancro doloroso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el sitio de inoculación.
    • Eritema
    • Induración
    • Apariencia 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
    • Resuelve espontáneamente
  • Signo de Winterbottom:
    • Linfadenopatía indolora de los LOS Neisseria ganglios linfáticos cervicales posteriores
    • Característico de las infecciones por T. b. gambiense
• Síntomas sistémicos inespecíficos:
  • Fiebre intermitente
  • Cefalea
  • Malestar
  • Artralgias
• Síntomas menos comunes:
  • Inflamación facial
  • Hepatoesplenomegalia
  • Linfadenopatía generalizada
  • Cardiomiopatía
  • Erupción pruriginosa y eritematosa

Estadio 2: fase neurológica (meningoencefalitis)

• Cefalea:
  • Persistente
  • Refractaria a analgésicos
• Linfadenopatía
• Cambios de comportamiento:
  • Cambios de personalidad
  • Confusión (dificultad para concentrarse y completar tareas)
  • Trastornos sensoriales
  • Apatía
  • Psicosis
• Síntomas neurológicos:
  • 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
  • Trastornos sensoriales
  • Temblores
• Trastornos del sueño:
  • Somnolencia diurna
  • Insomnio nocturno
  • Lo suficientemente grave como para causar 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, emaciación y desnutrición
• Progresión al AL Amyloidosis 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 y muerte, si no se trata

Diagnóstico y Tratamiento

Diagnóstico

• Pruebas confirmatorias:
  • Presencia de tripomastigotes
    • Frotis de sangre (grueso o delgado)
    • Aspirado de tejido de chancro
    • Biopsia de ganglio linfático
    • Análisis del LCR
  • Pruebas serológicas:
    • Prueba de aglutinación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum tarjeta para tripanosomiasis
    • Ensayo inmunoabsorbente ligado a enzimas ( 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, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
    • 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)
• Hallazgos de soporte:
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica
  • Leucocitosis
  • Trombocitopenia
  • ↑ Marcadores inflamatorios (velocidad de eritrosedimentación y 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))

Tratamiento

• Subespecie rhodesiense:
  • Estadio 1: suramina
  • Estadio 2: melarsoprol
• Subespecie gambiense:
  • Estadio 1: pentamidina
  • Estadio 2: nifurtimox Nifurtimox A nitrofuran thiazine that has been used against trypanosomiasis. Trypanosoma cruzi/Chagas disease y eflornitina

Prevención

• No hay vacuna ni tratamiento profiláctico disponible.
• Control de vectores con insecticidas y repelentes de insectos
• Use mangas largas y pantalones, y use ropa de colores neutros.

Comparación de Protozoos Flagelados

Diagnóstico Diferencial

• Enfermedad de Chagas: una infección causada por el tripanosoma americano, T. cruzi. Las infecciones agudas pueden presentarse con inflamación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el sitio de inoculación ( chagoma Chagoma Trypanosoma cruzi/Chagas disease), fiebre y linfadenopatía. Las infecciones crónicas no tratadas pueden progresar a complicaciones graves, como 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, megaesófago y miocardiopatía. El diagnóstico se puede confirmar mediante frotis de sangre, serología o 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). El tratamiento con benznidazol o nifurtimox Nifurtimox A nitrofuran thiazine that has been used against trypanosomiasis. Trypanosoma cruzi/Chagas disease es efectivo solo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la fase aguda.
• 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 bacteriana o fúngica: los LOS Neisseria síntomas de la 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 bacteriana pueden parecerse a los LOS Neisseria de la 2da fase de la enfermedad del sueño, como fiebre, cefalea, confusión y mialgias. El diagnóstico se confirma mediante análisis del LCR y/o pruebas serológicas. Las causas bacterianas específicas de la 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 varían según el grupo de edad y los LOS Neisseria factores de riesgo.
• 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: una enfermedad infecciosa transmitida por mosquitos causada por especies de 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. La 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 menudo se presenta con fiebre, escalofríos, diaforesis, ictericia, dolor Dolor Inflammation abdominal, anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica, hepatoesplenomegalia e insuficiencia renal. Un frotis de sangre muestra un anillo pleomórfico único. También se pueden realizar pruebas rápidas para antígenos de 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. El tratamiento requiere un ciclo prolongado de múltiples medicamentos antipalúdicos.
• Enfermedad psiquiátrica: debido a las manifestaciones conductuales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum etapa tardía, la enfermedad del sueño puede diagnosticarse erróneamente como una enfermedad psiquiátrica, especialmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inmigrantes a áreas no endémicas. Es importante evaluar la posible exposición epidemiológica para evitar este diagnóstico erróneo.