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Chapter 9 : Trypanosomiasis

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Abstract:

Human infections are caused by (West African trypanosomiasis) and (East African trypanosomiasis). Trypanosomes infecting humans in the Americas belong to the subgenus () and (). infections are asymptomatic, with no evidence of pathology; however, infections (American trypanosomiasis) can cause considerable morbidity and mortality. A simple and rapid test, the card indirect agglutination trypanosomiasis test, is available, primarily in areas of endemic infection, for the detection of circulating antigens in persons with African trypanosomiasis. Accurate identification of trypanosome species, which is necessary to clarify the epidemiology of human and animal African trypanosomiasis, has been difficult. Great progress has been made over the last 10 years through the application of DNA probe technology, although this has also revealed greater complexity than was previously supposed. The incidence of East African trypanosomiasis is characterized by short epidemics interspersed with long periods of low (often undectable) endemicity. In the chronic stage of Chagas’ disease, trypomastigotes are very rare or absent in the peripheral blood except during febrile exacerbations. Diagnosis depends primarily on culture, xenodiagnosis, or serologic tests. The patient may also be monitored through serologic tests and electrocardiograms. Serologic tests used for the diagnosis of Chagas’ disease include complement fixation, indirect fluorescent-antibody tests, indirect hemagglutination tests, and enzyme-linked immunosorbent assay (ELISA). trypomastigotes can be detected in the peripheral blood by using thin and thick blood smears and concentration techniques.

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9

Key Concept Ranking

Restriction Fragment Length Polymorphism
0.44177833
Human African Trypanosomiasis
0.42369992
Trypanosoma brucei rhodesiense
0.40153304
0.44177833
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Figures

Image of Figure 9.1
Figure 9.1

Distribution of trypanosomes in Africa. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.2
Figure 9.2

Life cycle stages of trypanosomes. Amastigotes have been confirmed in the life cycle of as one of the stages in the human host, but this stage in humans in African trypanosomiasis is only suspected and not confirmed. (Illustration by Nobuko Kitamura.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.3
Figure 9.3

Life cycle of and

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.4
Figure 9.4

trypomastigotes in peripheral blood smears. Note the small kinetoplast.

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.5
Figure 9.5

Winterbottom’s sign (enlarged cervical lymph nodes in the posterior cervical triangle). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.6
Figure 9.6

Coronal section of brain showing congested white matter and petechial hemorrhages. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.7
Figure 9.7

Morular cell in the hypothalamus. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.8
Figure 9.8

Close-up view of the meninges showing a morular cell. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Algorithm 9.1
Algorithm 9.1

African trypanosomiasis.

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.9
Figure 9.9

Life cycle of

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.10
Figure 9.10

(Top and middle) trypomastigotes in a peripheral blood smear. Note the large kinetoplast. (Bottom) Scanning electron micrograph of a trypomastigote of (Bottom photograph courtesy of David T. John.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.11
Figure 9.11

amastigotes in cardiac muscle.

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.12
Figure 9.12

Epimastigotes of

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.13
Figure 9.13

(Upper) Female child with Romaña’s sign. (Armed Forces Institute of Pathology photograph.) (Lower) Male child with Romaña’s sign. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.14
Figure 9.14

An enlarged heart in a 46-year-old man 13 days after onset of acute Chagas’ disease. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.15
Figure 9.15

Acute chagasic myocarditis. (Original photograph by B. H. Kean; from A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.16
Figure 9.16

Open chagasic heart with thinning of wall. (Original photograph by B. H. Kean; from A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.17
Figure 9.17

(Top) Posterior half of a heart with chronic chagasic cardiopathy. Note the left ventricle dilation and apical aneurysm. (Armed Forces Institute of Pathology photograph.) (Middle) Aneurysmal dilatation and thinning of the apical myocardium, plus marked concentric muscular hypertrophy. (Bottom) Same heart with thin apical myocardium. Note the light shining through the thinned muscle. (Middle and bottom photographs by J. H. Edgecome; from A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.18
Figure 9.18

Chagasic megaesophagus. (Original photography by D. N. Reifsnyder; from A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.19
Figure 9.19

Megacolon in an adult male with Chagas’ disease. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Algorithm 9.2
Algorithm 9.2

American trypanosomiasis.

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.20
Figure 9.20

Life cycle of

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Image of Figure 9.21
Figure 9.21

trypomastigote in a peripheral blood smear. Note the small kinetoplast. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
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Tables

Generic image for table
Table 9.1

Classification of trypanosomes infecting humans

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
Generic image for table
Table 9.2

Characteristics of East and West African trypanosomiasis

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
Generic image for table
Table 9.3

Methods available for the diagnosis of African trypanosomiasis ()

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
Generic image for table
Table 9.4

Methods available for the diagnosis of African trypanosomiasis ()

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
Generic image for table
Table 9.5

Characteristics of American trypanosomiais

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9
Generic image for table
Table 9.6

: principal vectors

Citation: Garcia L. 2007. Trypanosomiasis, p 218-248. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch9

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