Bachelor in Medical Laboratory Science

San Pedro College

12 C. Guzman Street, Davao City
Parasitology

Reporting about Trypanosoma cruzi

Members:
Tom Anthony Tonguia
Kimberly Lariosa
Florence Mae Bigot
Marielle Cailer
Kim Mamites
Jamaica Berguia

Passed by: Group 4 Parasitology (lab)

Passed to: Mr. E. Liwag, RMT
Passed on: November 29, 2016
Introduction
Chagas disease, or American trypanosomiasis, is caused by the
parasite Trypanosoma cruzi. Infection is most commonly acquired through contact with
the feces of an infected triatomine bug (or "kissing bug"), a blood-sucking insect that
feeds on humans and animals. An estimated 8 million people are infected with
Trypanosoma cruzi worldwide, mainly in Latin America where Chagas disease remains
one of the biggest public health problems, causing incapacity in infected individuals and
more than 10 000 deaths per year. Infection caused by T. cruzi existed among wild
animals but later spread to domestic animals and human beings, with relative
intensification noted at the beginning of the 20th century. Chagas disease is endemic
throughout much of Mexico, Central America, and South America where an estimated 8
million people are infected. Infection acquired from blood products, organ
transplantation, or congenital transmission continues to pose a threat.

Serological/Immunologic studies
Infections with Trypanosoma cruzi are common in Mexico, Central America, and South
America, and most people with Chagas disease in the United States acquired their
infections in endemic countries. The transmission of Chagas disease via blood
transfusion is a recognized risk, however screening tests were approved by the Food
and Drug Administration and they are currently in use by blood banks. During the acute
phase of illness, blood film examination generally reveals the presence of
trypomastigotes. Parasitologic methods, including identification of trypomastigotes in
blood by microscopy, are most effective during acute infections. Circulating parasite
levels decrease rapidly within a few months and are undetectable by most methods
during the chronic phase. During the chronic phase of infection, parasitemia is low;
immunodiagnosis is a useful technique for determining whether the patient is infected.

Positive IFA result with T. cruzi antigen (magnification 400x).

Infection can also occur from:
mother-to-baby (congenital),
contaminated blood products (transfusions),
an organ transplanted from an infected donor,
laboratory accident, or
contaminated food or drink (rare)
Stages of development of parasite
Vertebrate host
Trypomastigote found in the circulating blood
Amastigote -found intracellularly in cardiac muscle and other
tissues
Invertebrate host (reduviid bug)
Trypomastigote
Epimastigote
Morphology of Hemoflagellates
Amastigote
5 by 3 m
Round to oval
One, usually off center (nucleus)
Kinetoplast present, consisting of dotlike blepharoplast from
which emerges a small axoneme.
Parabasal body located adjacent to the blepharoplasty
Trypomastigote
12-35 m long by 2-4 m wide
C, S or U shape often seen in stained blood films
Long and slender
One, located anterior to the kinetoplast (nucleus)
Kinetoplast located in the posterior end. Undulating
membrane, extending entire body length. Free flagellum,
extending from anterior end when present.
Epimastigote
9-15m long
Long and slightly wider than promastigote form
One, located in posterior end (nucleus)
Kinetoplast located anterior to the nucleus.
Undulating membrane, extending half of body length.
Free flagellum, extending from anterior end
Promastigote
9-15 m long
Long and slender
One, located in or near center (nucleus)
Kinetoplast, located in anterior end. Single free flagellum,
extending from anterior end.
Morphology (Trypanosoma cruzi)
A flagellate of the family Trypanosomatidae.
Spindle shaped body w/c assumes a C , U or S - shaped in
stained blood smear
Possesses one flagellum and a single mitochondrion in
which the kinetoplast is situated, consisting of a specialized
DNA-containing organelle.
Has free flagellum about 1/3 of body length and the
undulating membrane is narrow
Nucleus centrally located and a large kinetoplast
The undulating membrane is best demonstrated by scanning
electron microscopy
They are slender, 16 m to 20 m long, and their posterior
end is pointed.
The protozoan commonly dies in a question mark shape, the
appearance it retains in stained smears
Amastigotes develop in muscles and other tissues.
They are spheroid, 1.5 m to 4.0 m wide, and occur in
clusters composed of many organisms.
Intermediate forms are easily found in smears of infected
tissues.
T. cruzi amastigote in heart tissue
Insect Vector
Reduviid bug/ Triatomid bug/ Assassin bug Kissing
bug/ Cone-nosed bug
Species:
1. Panstrongylus megistus
2. Triatoma infestans
3. Rhodnius prolixus

Kissing Bug
LIFE CYCLE
PATHOLOGY
Disease
Chagas disease/South American trypanosomiasis- caused
by bite of reduviid bug which defecate during the process of
feeding, accidental ingestion of bug, and blood transfusion.

Clinical features (S&S)

Acute and chronic phases
Chronic disease: Cardiomyopathy, cariospasm,
megaesopgafus, and megacolon.
Edema of the eyelid (Romanas sign)
Fever and generalized lymphadenopathy are features of the
acute disease
Diagnostic test
Diagnosis is by demonstration of trypanosomes in blood,
CSF ,fixed tissues or lymph, biopsy.
First two months: T. cruzi can be seen by direct examination
or thick blood smears.
Blood cultures and Xenodiagnosis
Serological methods:
Immunofluorescent antibody test,
Complement fixation test,
Indirect hemagglutination assay,
ELISA,
Dot-immunobinding assay,
Polymerase Chain reaction
Primary lesion (chagoma)
Appears at the site of infection, within a few hours of a bite
Slightly raised, flat non-purulent erythematous plaque surrounded by
a variable area of hard edema (ulcerate)
Commonly found on the face, eyelids, cheek, lips or the conjunctiva,
but may occur on the abdomen or limbs
Spread rapidly to the lymph nodes- When the primary chagoma is on
the face, there is an enlargement of the pre- and post- auricular and
the submaxillary glands on the side of the bite.
Romaas sign-Infection in the eyelid, resulting in a unilateral
conjunctivitis and orbital edema.
Acute stage
Appears 7-14 days after infection
Characterized by restlessness, sleeplessness, malaise, increasing
exhaustion, chills, fever and bone and muscle pains
Other manifestations: cervical, axillary and iliac adenitis,
hepatomegaly, erythematous rash and acute myocarditis
Diffuse myocarditis, sometimes accompanied by serious pericarditis
and endocarditis, is very frequent during the initial stage of the
disease.
Hematologic examination reveals lymphocytosis and parasitemia.
In children, Chagas' disease may cause meningo-encephalitis and
coma.
Death occurs in 5-10 percent of infants.
Chronic stage
The acute stage is usually not recognized and often resolves with
little or no immediate damage and the infected host remains an
asymptomatic carrier.
10-20% of victims develop a chronic disease, usually among adults.
They alternate between asymptomatic remission periods and
relapses characterized by symptoms seen in the acute phase.
Cardiac arrhythmia is common.
The chronic disease results in an abnormal function of the hollow
organs, particularly the heart, esophagus and colon.
The cardiac changes include myocardial insufficiency, cardiomegaly
and disturbances of atrio-ventricular conduction.
Disturbances of peristalsis lead to megaesophagus and megacolon.