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ページの作成:「{{Floating_Menu}} ==Pathogen== *''Trypanosoma brucei'' **''Trypanosoma brucei gambiense'' **''Trypanosoma brucei rhodesiense'' ===Morphology=== #amastigote #promastigot…」
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==Pathogen==
*''Trypanosoma brucei''
**''Trypanosoma brucei gambiense''
**''Trypanosoma brucei rhodesiense''
===Morphology===
#amastigote
#promastigote
#epimastigote
#trypomastigote
::nucleus, kintoplast, undulating membrane, flagellum
===Life cycle===
*''T. brucei'' group don't infect human cells
*''T. cruzi'' needs to infect human cells to multiply
==Vector==
*tsetse fly
**genus ''Glossina''
**adult 6-15 mm long
==Epidemiology==
*>70% of cases in recent 10 years are reported from DRC
*10-100 new cases in a year in Angola, Central African Republic, Chad, Congo Republic, Gabon, Guinea, Malawi and South Sudan
==African trypanosomiasis==
*sleeping sickness
{|class="wikitable" style="width:800px"
|-
!
!style="width:40%"|''Trypanosoma brucei gambiense''
!style="width:40%"|''Trypanosoma burcei rhodesiense''
|-
!Distribution
|
*West Africa
**Broader area of West Africa to the west of Great Rift Valley
**In 24 countries
|
*East Africa
**Limited to the east of Great Rift Valley
**In 13 countries
|-
!Vector
|
*''Glossina palpalis''
*In humid environment
**rivers and waterholes
*Anthroponotic; human-to-human
|
*''Glossina morsitans''
*In dryer environment
**Savannah
*Mainly bite animals
|-
!Infectivity
|
*Mainly infect to human
*Adapted to human, leading to relatively slow and mild disease progression compared to ''rhodesiense''
|
*adapted to animals
**leading to relatively rapid progress of disease
|-
!Human infection
|
*98% of total cases
*Chronic infection
*Incubation months to years
|
*2% of total cases
*Acute infection
*Incubation weeks to months
|}
===''Trypanosoma brucei brucei''===
*Trypanosomiasis of stock and wild animals
**"Nagana"
*no human infection
===pathogenesis===
#trypanosomal chancre after tsetse fly bite
#acute hemolymphatic stage
##fever, headache, myalgia, arthralgia, lymphadenopathy, splenomegaly
#chronic meningoencephalitic stage
##headache, alteration of mental status, coma
*more acute by ''T. brucei rhodesiense'', slower by ''T. brucei gambiense''
===diagnosis===
*serology
**card agglutination test for trypanosomiasis (CATT)
**mass population screening
**low sensitivity/specificity
*molecular
**PCR, LAMP
*microscopy
**chancre fluid, blood, lymph node aspirate, CSF
***centrifugation and examination of buffy coat
**wet praparation for motile trypanosoma
**Giemsa stain (with fixed)
====define the clinical stage of ''rhodesiense''====
*lumbar puncture
**CSF WBC > 5 cell/mm<sup>3</sup> stage 2
===treatment===
*should commence in earlier stage
**difficult to treat in CNS involvement
*acute stage
**suramin > pentamidine
**suramin side effects
***90% urticaria
***50% adrenal cortical damage
***peripheral neuropathy - axonal or demyelinating
***renal dysfunction
*chronic stage
**melarsoprol (Mel B)
***only for ''T. b. rhodesiense''
**eflornithine (DL-a-difluoromethilornithine; DFMO)
***only for ''T. b. gambiense''
**nifurtimox-eflornithine; NECT
***only for ''T. b. gambiense''
*both stage
**fexinidazole
***only for ''T. b. gambiense''
***should be administered within 30 min. after solid meal
==Pathogen==
*''Trypanosoma brucei''
**''Trypanosoma brucei gambiense''
**''Trypanosoma brucei rhodesiense''
===Morphology===
#amastigote
#promastigote
#epimastigote
#trypomastigote
::nucleus, kintoplast, undulating membrane, flagellum
===Life cycle===
*''T. brucei'' group don't infect human cells
*''T. cruzi'' needs to infect human cells to multiply
==Vector==
*tsetse fly
**genus ''Glossina''
**adult 6-15 mm long
==Epidemiology==
*>70% of cases in recent 10 years are reported from DRC
*10-100 new cases in a year in Angola, Central African Republic, Chad, Congo Republic, Gabon, Guinea, Malawi and South Sudan
==African trypanosomiasis==
*sleeping sickness
{|class="wikitable" style="width:800px"
|-
!
!style="width:40%"|''Trypanosoma brucei gambiense''
!style="width:40%"|''Trypanosoma burcei rhodesiense''
|-
!Distribution
|
*West Africa
**Broader area of West Africa to the west of Great Rift Valley
**In 24 countries
|
*East Africa
**Limited to the east of Great Rift Valley
**In 13 countries
|-
!Vector
|
*''Glossina palpalis''
*In humid environment
**rivers and waterholes
*Anthroponotic; human-to-human
|
*''Glossina morsitans''
*In dryer environment
**Savannah
*Mainly bite animals
|-
!Infectivity
|
*Mainly infect to human
*Adapted to human, leading to relatively slow and mild disease progression compared to ''rhodesiense''
|
*adapted to animals
**leading to relatively rapid progress of disease
|-
!Human infection
|
*98% of total cases
*Chronic infection
*Incubation months to years
|
*2% of total cases
*Acute infection
*Incubation weeks to months
|}
===''Trypanosoma brucei brucei''===
*Trypanosomiasis of stock and wild animals
**"Nagana"
*no human infection
===pathogenesis===
#trypanosomal chancre after tsetse fly bite
#acute hemolymphatic stage
##fever, headache, myalgia, arthralgia, lymphadenopathy, splenomegaly
#chronic meningoencephalitic stage
##headache, alteration of mental status, coma
*more acute by ''T. brucei rhodesiense'', slower by ''T. brucei gambiense''
===diagnosis===
*serology
**card agglutination test for trypanosomiasis (CATT)
**mass population screening
**low sensitivity/specificity
*molecular
**PCR, LAMP
*microscopy
**chancre fluid, blood, lymph node aspirate, CSF
***centrifugation and examination of buffy coat
**wet praparation for motile trypanosoma
**Giemsa stain (with fixed)
====define the clinical stage of ''rhodesiense''====
*lumbar puncture
**CSF WBC > 5 cell/mm<sup>3</sup> stage 2
===treatment===
*should commence in earlier stage
**difficult to treat in CNS involvement
*acute stage
**suramin > pentamidine
**suramin side effects
***90% urticaria
***50% adrenal cortical damage
***peripheral neuropathy - axonal or demyelinating
***renal dysfunction
*chronic stage
**melarsoprol (Mel B)
***only for ''T. b. rhodesiense''
**eflornithine (DL-a-difluoromethilornithine; DFMO)
***only for ''T. b. gambiense''
**nifurtimox-eflornithine; NECT
***only for ''T. b. gambiense''
*both stage
**fexinidazole
***only for ''T. b. gambiense''
***should be administered within 30 min. after solid meal
