Download - Parasites Cause Skin and Eyes Infections
-
7/29/2019 Parasites Cause Skin and Eyes Infections
1/53
BY
Sri Sundari Purbohadi
-
7/29/2019 Parasites Cause Skin and Eyes Infections
2/53
-
7/29/2019 Parasites Cause Skin and Eyes Infections
3/53
Leishmania
Dracunculus medinensis
-
7/29/2019 Parasites Cause Skin and Eyes Infections
4/53
1. Infectious Agent
Protozoan - Genus: Leishmania
Numerous species differ in
a . Natural habitat differ in various geographic
regions / countries
b . Different host / reservoirs
c . Type of disease produced a spectrum of
clinical syndromes from indolent self
resolving ulcer to fatal disseminated disease
-
7/29/2019 Parasites Cause Skin and Eyes Infections
5/53
2. Reservoir / Host(animal, man or both)
Leishmania is primarily a parasite ofwild animals and man becomes
accidental host when intrudinginto the natural habitat of theseanimals i.e. ZoonoticLeishmaniasis.
Different Leishmania species mayhave different specific zoonotic
reservoirs ega. Dogs in Visceral Leishmaniasis
in Mediterranean basinb. Wild rodents in Mexican
cutaneous Leishmaniasis
c. Common reservoirs hosts:Rodents, dogs, foxes, jackals
d. Potential hosts include cattle,horses, wild canine, sloth
-
7/29/2019 Parasites Cause Skin and Eyes Infections
6/53
3. Habitat
Physical geomorphological characteristics ofVector and Reservoir eg landscape, vegetation,
etc Environmental characteristics eg wind,
temperature, humidity, light etc
-
7/29/2019 Parasites Cause Skin and Eyes Infections
7/53
4. Vector: female Phlebotomus sandflies.
Sandflies acquire infection from feeding oninfected animals.
Physiological age movements Time of activity
Flying range
Feeding habits
Reproductive activity
Condition of alimentary canal
-
7/29/2019 Parasites Cause Skin and Eyes Infections
8/53
-
7/29/2019 Parasites Cause Skin and Eyes Infections
9/53
Sandfly bite Leishmania (promostigotes)phagocytosed by histiocytes reproducedwithin macrophage Daughter amastigotes
rupture from cell spread to othermacrophages
1. Immunological capabilities of the host
2. Infecting species of Leishmania
-
7/29/2019 Parasites Cause Skin and Eyes Infections
10/53
LOCALISEDCUTANEOUSLEISHMANIASIS
PATHOLOGY
Amastigote-filled macrophagesulcerates overlying epidermis
Oval amastigotes 2m containing 2internal structures, a nucleus andkinetoplast
Amastigotes in macrophages appearas multiple cytoplasmic dotsLeishmanDonovan Bodies
Progressive development of CMI to theparasite Macrophages activated
Kill intracellular parasitesAmastigote-filled macrophagesGranulomatous reaction Ulcer
Lesion starts as small itching solitarypapule erodes to form shallow ulcer(sharp raised borders) Extension of
ulcer (6-8 cm) Satellite lesionsdevelop along draining lymphatics. Ulcer resolve in 3 6 months and
heals spontaneously
-
7/29/2019 Parasites Cause Skin and Eyes Infections
11/53
Enormous numbers of macrophages containinglarge numbers of Leishmania
Develops in patients who lack specific cell-
mediated immune response to Leishmania. Begins as single nodule extensive ulceration
developing into satellites along draininglymphatics
-
7/29/2019 Parasites Cause Skin and Eyes Infections
12/53
Late complication of cutaneous Leishmaniasis .
Species: L.Braziliensis
Geography: Central & South America
Reservoir: Rodents, sloth
-
7/29/2019 Parasites Cause Skin and Eyes Infections
13/53
Early course and pathologic changes similar toLocalizes Cutaneous Leishmaniasis i.e. solitaryulcer appears, expands and then resolvesspontaneously.
Years after healing of primary ulcerdevelops at mucocutaneous junctions (e.g.nasal septum, anus, vulva) slowlyprogressive, highly destructive, disfiguring erodes mucosal surfaces and nearby tissues.
Destruction of nasal septumNose deformity
MCL ulcers may obstruct airways
-
7/29/2019 Parasites Cause Skin and Eyes Infections
14/53
VISCERALLEISHMANIASIS(Kala-Azar)
Potentially fatal disseminatedinfection of macrophage /monocyte system caused by
several subspecies of L.donovani.
Reservoirs in susceptible agegroups vary in different parts
of the world egHumans in India
Foxes in S. France,Central Italy, S. America
Dogs in Mediteranean basin,China, S. America
Jackals M. East, Central Asia
-
7/29/2019 Parasites Cause Skin and Eyes Infections
15/53
Sandfly bite localized collection of infected macrophagesulcer
95% infected persons can contain the disease, destroying L.Donovani by CMI.
5% Young children, malnourished persons failure to mountadequate CMI response
Mononuclear phagocytes full with proliferating L. amastigotes replacing normal architecture of liver, spleen, LN leading to theirmassive enlargement
BM is replaced by filled with proliferating amastigots
Eventually mononuclear phagocytes accumulate in other organse.g. heart, kidney.
-
7/29/2019 Parasites Cause Skin and Eyes Infections
16/53
Normally develops
-
7/29/2019 Parasites Cause Skin and Eyes Infections
17/53
Clinical signs & symptoms
Hypergammaglobulinemia
ELISA/Formol gel
Bone marrow biopsy
Spleen or liver biopsy
Culture & Histology
-
7/29/2019 Parasites Cause Skin and Eyes Infections
18/53
Similar morphology
Isoenzyme profiles - Zymodemes
Monoclonal antibodies
DNA hybridisation - PCR
-
7/29/2019 Parasites Cause Skin and Eyes Infections
19/53
Diet
Antibiotics
Pentavalent antimony
Pentamidine
New drugs - New delivery
-
7/29/2019 Parasites Cause Skin and Eyes Infections
20/53
Vector control
Reservoir control
Treatment of active cases
Vaccination
-
7/29/2019 Parasites Cause Skin and Eyes Infections
21/53
Pentavalent antimonial drug Not absorbed orally
Given IV/ IM for 20 days for cutaneousleishmaniasis & 28 days for visceral andmucocutaneous disease.
Distributed in extravascular compartement.
Partially metabolized
Excreted in urine
-
7/29/2019 Parasites Cause Skin and Eyes Infections
22/53
Unknown
Production of oxygen free radicals
-
7/29/2019 Parasites Cause Skin and Eyes Infections
23/53
GIT upset
Fever, headache, arthralgia , rash.
IMI----( local pain & sterile abscess).
QT prolongation.
Hemolytic anaemia
-
7/29/2019 Parasites Cause Skin and Eyes Infections
24/53
Alternative to Na stibogluconate for thetreatment of visceral leishmaniasis.
For cutaneous lesion
-
7/29/2019 Parasites Cause Skin and Eyes Infections
25/53
Not absorbed orally
Given IV/ IM.
Accumulative drug & eliminated slowly in
urine ( elimination half-life 12 days). Not effectively cross blood brain barrier
Can be inhaled as a nebulized powder.
-
7/29/2019 Parasites Cause Skin and Eyes Infections
26/53
Rapid IVI can lead to severe hypotension,tachycardia , dizziness, dyspnea ( should be givenslowly over 2 hours).
IMI pain & sterile abscess
Pancreatic toxicity( acute pancreatitis)
Hypoglycemia
Hyperglycemia Reversible renal insufficiency
Rash
Metallic taste
-
7/29/2019 Parasites Cause Skin and Eyes Infections
27/53
Fever
Thrombocytopenia
Cardiac arrhythmias
GIT upset
Cough, dyspnea, bronchospasm ( with theinhaled drug )
Headache, Arthralgia
-
7/29/2019 Parasites Cause Skin and Eyes Infections
28/53
-
7/29/2019 Parasites Cause Skin and Eyes Infections
29/53
-
7/29/2019 Parasites Cause Skin and Eyes Infections
30/53
-
7/29/2019 Parasites Cause Skin and Eyes Infections
31/53
Humans become infected by drinking unfiltered water containing copepods(small crustaceans) which are infected with larvae ofD. medinensis
Following ingestion, the copepods die and release the larvae, which penetrate thehost stomach and intestinal wall and enter the abdominal cavity andretroperitoneal space.
The worm molts again 20 days and 43 days post infection
After maturation into adults and copulation, the male worms die and the females(length: 70 to 120 cm) migrate in the subcutaneous tissues towards the skinsurface
Approximately one year after infection, the female worm induces a blister on theskin, generally on the distal lower extremity, which ruptures.
When this lesion comes into contact with water, which the patient seeks to relievethe local discomfort, the female worm emerges and releases larvae
The larvae are ingested by a copepod and after two weeks (and two molts) havedeveloped into infective larvae
-
7/29/2019 Parasites Cause Skin and Eyes Infections
32/53
Dracunculiasis may result in three majordisease conditions Emergent adult worms Secondary bacterial infection Nonemergent worms When worms do not emerge they degenerate and release
antigens causing fluid filled abscesses or allergenic reactions.
If the worms become calcified they can cause inflammation
or if they remain in a joint, arthritis. Can cause paraplegia if it worm gets into the central nervous
system.
-
7/29/2019 Parasites Cause Skin and Eyes Infections
33/53
None until the female worms cause an allergic reaction by releasingmetabolic wastes into host. This occurs at the onset of migration to theskin. a rash accompanied by severe itching
nausea
vomiting
diarrhea
dizziness
edema
Reddish papule-blister (local itching and intense burning).
Blister ruptures, becomes abscessed-very painful.
Secondary bacterial infections of opening possible. Retreating worm can draw bacteria under skin as well.
There may be later symptoms fibrosis of the skin, muscles, tendons and joints (may interfere with
locomotion or use of limbs)
-
7/29/2019 Parasites Cause Skin and Eyes Infections
34/53
Adult in joint
Calcified lesion in soft
tissues
-
7/29/2019 Parasites Cause Skin and Eyes Infections
35/53
DIAGNOSIS:
Diagnosis is made from the local
blister, worm or larvae.
The outline of the worm under
the skin.
Some people claim to be able tofeel the worm moving towards
the surface of the skin.
Finding Calcified worms.
-
7/29/2019 Parasites Cause Skin and Eyes Infections
36/53
Drug TherapyMetronidazole
To help prevent bacterial infections
Anti-inflammatory to help reduce swelling
Treatment includes the extraction of the adult guinea worm
by rolling it a few centimeters per day
Usually takes weeks or months depending on how long the worm is.
Exposing area to cold water helps remove worm faster.
Preferably by multiple surgical incisions under local
anesthesia.
Infection does not make a person immune
-
7/29/2019 Parasites Cause Skin and Eyes Infections
37/53
Filter, boil, or treat water with chlorine to kill intermediate host.
Finely-meshed cloth or, better still, a filter made from a 0.15 mm nylon mesh, is all
that is needed to filter out the copepods from the drinking water.
Avoid bathing or wading in drinking water.
Village-based volunteers demonstrating the use of cloth filter on a clay pot to
filter drinking water
Construction of copings around well heads or the
installation of boreholes with hand pumps.
Borehole is a deep and narrow well.
Coping is a cap/cover over a well
Key is to prevent copepod growth by controlling sunlight.
Light increases the food source of the copepod.
-
7/29/2019 Parasites Cause Skin and Eyes Infections
38/53
-
7/29/2019 Parasites Cause Skin and Eyes Infections
39/53
Caused by the parasite Onchocerca volvulus. Affects 20 million people worldwide. Non-fatal dermal and ocular disease Human definitive host; fly intermediate host No animal reservoir ofO. volvulus Three main symptoms (occur 1-3 yrs after initial
infection): Skin lesions (microfilariae in dermis) Painless nodules (where tissues thin, bone) Eye lesions (blindness assoc. with dead mf)
Spread by blood-sucking blackfly Transmits parasite to the eye
Parasite invades the anterior chamber Causes corneal ulceration, fibrosis, and blindness
-
7/29/2019 Parasites Cause Skin and Eyes Infections
40/53
Simuliumdamnosum
-
7/29/2019 Parasites Cause Skin and Eyes Infections
41/53
-
7/29/2019 Parasites Cause Skin and Eyes Infections
42/53
-
7/29/2019 Parasites Cause Skin and Eyes Infections
43/53
-
7/29/2019 Parasites Cause Skin and Eyes Infections
44/53
History
Symptoms
Microfilaria in nodules
-
7/29/2019 Parasites Cause Skin and Eyes Infections
45/53
Avoid black flies in endemic areas
Ivermectin
kills larvae but does not affect adult worms
Moxidectin currently in phase III clinical trials for treatment of
Onchocerciasis
kills both adults and microfilaria
-
7/29/2019 Parasites Cause Skin and Eyes Infections
46/53
-
7/29/2019 Parasites Cause Skin and Eyes Infections
47/53
Loasis is similar to onchocercaisis
It can also cause blindness
-
7/29/2019 Parasites Cause Skin and Eyes Infections
48/53
Deer flyCrysops
-
7/29/2019 Parasites Cause Skin and Eyes Infections
49/53
Loa loa matures in its vector
the deer fly.
Worm migrates to the mouth of the fly.
Transmitted to a human when the fly bites
Microfilariae migrate through the subcutaneoustissue.
Cause inflammation
Settle in the cornea and conjunctiva
Worms can grow to more than an inch in length.
-
7/29/2019 Parasites Cause Skin and Eyes Infections
50/53
A transient subcutaneous swelling markingthe migratory course through the tissues of
the adult filarial eye worm that appear most
frequently on the back of the hand or on the
arm.
-
7/29/2019 Parasites Cause Skin and Eyes Infections
51/53
History
Symptoms
Microfilaria recovered from conjunctivae
-
7/29/2019 Parasites Cause Skin and Eyes Infections
52/53
Avoid deer flies in endemic areas
Diethyl carbamazine kills larvae
-
7/29/2019 Parasites Cause Skin and Eyes Infections
53/53