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Bio 1 Case Study - Chagas' Disease

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Angela Chi

on 5 August 2013

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Transcript of Bio 1 Case Study - Chagas' Disease

Chagas' Disease
References
Diagnosis
CHAGAS'S DISEASE
(American Trypanosomiasis)
Determining the Diagnosis
Acquatella, H. (2007). Echocardiography in Chagas heart disease. Circulation, 115, 1124-1131.
Andrews, Norma. "Trypanosoma cruzi and Chagas' Disease" Online Video Clip. YouTube. 1 Apr. 2010. Web. 30 July. 2013.
Centers for Disease Control and Prevention. (2013). Parasites - American Trypanosomiasis (also known as Chagas Disease). Retrieved July 30, 2013.
Centers for Disease Control and Prevention (2013). Lyme disease. Retrieved August 1, 2013.
FreeMD. (2010). Hypertensive cardiomyopathy. Retrieved August, 1, 2013, from FreeMD.
Garcia, L.S. (2007). Practical guide to diagnostic parasitology. ASM Press: Washington D.C.
Hidron, A., Vogenthaler, N. (2010). Cardiac involvement with parasitic infections. Clinical Microbiology Reviews, 23(2), 324-349
Kirchhoff, L.V., Weiss, L.M., Wittner, M., & Tanowitz, H.B. (2004). Parasitic diseases of the heart. Frontiers in bioscience: a journal and virtual library., 9, 706-723.
Lanjewar, D, N., Agale, S.V., Chitale, A.R., & Joshi+, S.R. (2006). Sudden death due to cardiac toxoplasmosis. Journal of the Association of Physicians of India, 54, 244-245.
Lemke, Thomas, David Williams, Victoria Roche, and William Zito. Foye's Principles of Medicinal Chemistry. Pennsylvania: Lipponcott Williams & Wilkins, 2008. Print.
Maron, B.J. (2011). Hypertrophic cardiomyopathy. Braunwald's heart disease: A textbook of cardiovascular medicine.
Medical Books Online. (2012). Chapter 368 - American trypanosomiasis (Chagas' disease). Retrieved July 30, 2013, from Medical Books Online.
Samual, J., Oliveira, M., & Mello De Oliveira, J.A. (1981). Apical aneurysm of Chagas's heart disease. British Heart Journal, 46, 432-437.
Shapira, O.M. (2013). Left ventricular aneurysm and pseudoaneurysm following acute myocardial infarction. Retrieved July 30, 2013, from Wolters Kluwer Health.
The Free Dictionary. (2013). Cardiomyopathy. Retrieved July 31, 2013, from Medical Dictioning, The Free Dictionary.
Unnikrishnan, M & Burleigh, B.A. (2004). Initibition of host connective tissue growth factor expression: A novel Trypanosoma cruzi-mediated response. The Journal of the Federation of American Societies for Experimental Biology, 18(14), 1625-1635.
The Case Study
Giemsa Stain Finding
What is Chagas Disease?
It is caused by the protozoan parasite, Trypanosoma cruzi, which is carried by triotomine bugs (aka "kissing bug"), a type of reduviid bug.

T. Cruzi is an intracellular pathogen
Triotomine targets areas of exposed skin, such as the face
Medical Intervention/Treatment
It's a tropical disease that is mainly contracted in poor, rural areas of Central and South America. However, it's reported in the southern United States.
Currently there are only cures for the acute phase of the disease. They are, namely, benznidazole and nifurtimox.
Benznidazole
drug depletes trypanothione, the protective enzyme for the t-cruzi parasite, which allows the white blood cells to attack the parasite
two or three daily doses for a period of 30 - 60 days
Acute Phase
Swelling at the infection site
Fever
Fatigue
Rash
Body Aches
Nausea, diarrhea, & vomiting
Swollen glands
enlargement of the liver or spleen
Chronic Phase
Irregular heartbeat (cardiac arrhythmias)
inflamed, enlarged heart (cardiomyopathy)
Congestive heart failure
Sudden Cardiac arrest
Difficulty swallowing due to enlarged esophagus
Abdominal pain or constipation due to enlarged colon
Nifurtimox
drug undergo oxidation followed by reduction and in the process, generates reactive oxygen species (ROS), such as the superoxide radical anion, hydrogen peroxide, and hydroxyl radical
these species are potent oxidants that produce oxidative stress that can damage the DNA of the parasite
drug also inhibits trypanothione reductase, which inhibits trypanothione formation, which is the protective enzyme for t-cruzi
two or three daily doses for a period of 60 - 90 days
Remember these? Okay
Apparent physical symptoms
Structural organ damage
Myocarditis
(Inflammatory Cardiomyopathy)
Determining the Diagnosis
Automatically Eliminated Diagnoses
Myocardial infarction (MI) Hypertensive & Hypertrophic Cardiomyopathy (HCM)
Lyme Disease
Given Facts:
1. 43 year old, Male, Brazilian
2. Hx: Cardiac Arrhythmias (Irregular/abnormal heartbeat)
3. Died suddenly
3. Autopsy:
- Apical Ventricular Aneurysm
(the outward swelling, or ballooning, of weakened blood vessel walls)
- Cardiac Inflammatory Responses in Numerous Areas
- Cardiomyopathy (Enlargement/thickening/stiffening of heart muscle tissue)
- "Nests" of organisms
Chagas' Disease
(American Trypanosomiasis)
Protozoan parasite, Trypanosoma cruzi
Common in the Central and South Americas
Acute stage symptoms
- at exposed regions - swelling, rash
Results in myocarditis
Toxoplasmosis
Protozoan, Toxoplasma gondii
Leading cause of foodborne illness in the US
Possible severe consequences in immunocompromised and pregnant individuals
Results in myocarditis
Amebiasis
Determining the Diagnosis
Parasite, Entamoeba histolytica
Common in those living in poor tropical areas
Mainly asymptomatic, but can result in liver abscess, lesions in bowel, bloody diarrhea
Results in pericarditis
African Trypanosomiasis
Parasite, Trypanosoma brucei
Found only in rural Africa
E.g. Painful sores, skin rash, extreme fatigue. Severe CNS symptoms, e.g. slurred speech, seizures, personality changes
Results in myocarditis
Trichinellosis/Trichinosis
Nematode Parasite, Trichinella spiralis
Commonly found in undercooked pork prods
Initially - migration to GIT causes N/V, diarrhea. THEN facial edema, weakening of pulse and BP, respiratory and kidney complications
Results in myocarditis
Trypanosoma Cruzi Life Cycle
Giemsa stain shows that the cause of myocarditis is PARASITIC.

There are 5 possible parasitic diseases that result in cardiac inflammation
Reminder: The detected organism looks like this,
Signs and Symptoms
Full transcript