Parasites affecting renal system: Helminthes: Schistosomiasis Hydatid disease Filariasis Protozoa: Malaria Babesiosis Leishmaniasis Schistosomiasis: Schistosoma haematobium (Urinary schistosomiasis) Geographical distribution: - Africa: scattered areas. In Egypt, it is prevalent all over the Nile Valley. Some area in Asia and Europe - Habitat: Schistosoma haematobium adults live in the vesical and pelvic venous plexuses in man surrounding the kidney, pelvis, urinary bladder, urethra, prostate, seminal vesicles, lower 1/3 of uterus and vagina. - Definitive host: man. - Intermediate host: snail Bulinus truncatus in Egypt. - Reservoir host: no reservoir host. - Diagnostic stage: Large sized egg with terminal spine (in urine) - Infective stage: furcocercus cercaria. - Stages in life cycle: egg → miracidium→ sporocyst→ furcocercus cercaria→ adult. - Mode of infection: Infection occurs by skin penetration. - Drinking water may lead to infection when cercaria penetrates the mucus membrane of the mouth. - schistosomulum is carried by the blood → left side of the heart → systemic circulation→ intestinal capillary bed→ intra-hepatic branches of the portal vein where it matures → Then male carries the female→ migrates out of the liver in the portal vein against the blood stream to reach the vesical and pelvic plexuses to deposit the eggs→ Eggs appear in urine 10 weeks after infection. Schistosoma mansoni (Intestinal schistosomiasis) - Geographical distribution: It is widespread in Africa. - In Egypt, Nile delta, but after construction of the high dam, it invaded Upper Egypt. It is found in Saudi Arabia, Yemen and Tropical America. - Habitat: the inferior mesenteric vein draining the large intestine, and in the portal system. - Definitive host: man. - Intermediate host: snail Biomphalaria alexandrina in Egypt. - Reservoir host: monkeys and rodents. - Diagnostic stage: Large sized egg with lateral spine (in stool) - Infective stage, life cycle and mode of infection like S. haematobium Effect of schistosoma haematobium and mansoni on renal system: - Renal involvement occurs due to precipitation of immune complexes in the glomerular vascular bed leading to end-stage renal failure. - Schistosoma haematobium gives rise to renal problems as a result of direct invasion of the urinary tract. Egg deposition may induce chronic bladder infection, calcification and fibrosis with extension to the ureters, and carcinoma of the bladder, especially squamous cell carcinoma. The fibrosis may lead to irregular ureteral stenoses and eventually to dilatation, resulting in either hydronephrosis or reflux nephropathy. - Schistosoma mansoni and S. haematobium can cause portal hypertension and an enlarged spleen (hepatosplenic schistosomiasis) have an increased frequency (15%) of renal disease; this infection is clinically characterized by variable proteinuria ranging from asymptomatic to nephrotic syndrome - Both types can cause nephrotic syndrome. Treatment: praziquantel Echinococcus granulosus (Hydatid disease) Distribution: Worldwide, where dogs are used as pets or as guards or for herding. Hosts: Definitive hosts are dogs, wolfs, wild canines. Intermediate hosts are grazing herbivorous animals, and accidentally man. Habitat: Small intestine of dogs Infective stage: swallowing egg with food or drink Effect on renal system: - most hydatid cysts occur in the liver and lungs, some cysts involve other sites such as the kidneys (2%). - Also can cause nephrotic syndrome Wuchereria bancrofti Disease: Bancroftian filariasis, wuchereriasis, and elephantiasis. Distribution: Tropical and sub tropical countries including some foci in Egypt. Host: Final host: In nature, only mankind. Intermediate host: Female mosquitoes of the genera Culex, Aedes, and Anopheles. 1- Habitate: The adults live in the affarent lymphatics close to the lymph nodes of man. Life cycle: as in diagram Effect on renal system: - Glomerular disease associated with filariasis is thought to be immune complex mediated. - It causes nephrotic syndrome. - Also treatment of wucheraria can increase the incidence of nephrotic syndrom in those patients Malaria Hosts: - The definitive host : female anopheles mosquitoes. - The intermediate host : man. Infective stage: - Sporozoite from bite of female anopheles mosquito Diagnosis: - blood film, and serology Life cycle as in following diagram Type species and morphology: - Plasmodium malariae: It causes quartan malaria with paroxysms every 72 hours. - Plasmodium vivax: It is the cause of benign tertian malaria or vivax malaria. It is called tertian because its erythocytic cycle, and hence the paroxysms every third day. - Plasmodium ovale: this species causes ovale, or mild, tertian malaria - Plasmodium falciparum: It is the cause of malignant tertian and subtertian malaria. It is the most virulent Plasmodium spp. in man. The above picture shows some effects of malaria on human Effect on renal system Only two types of the malaria parasites, namely, P. malariae (quartan malaria) and P. falciparum (falciparum malaria), are clearly associated with renal disease, and this occurs only in a small percentage of patients. Plasmodium malariae - Renal involvement in the course of quartan malaria is generally characterized by nephrotic syndrome. A membranoproliferative type of glomerulonephritis Plasmodium falciparum - Nephrotic syndrome or proteinuria is rare and, if present, is usually associated with the same type of glomerular lesions as in quartan malaria. - renal involvement in falciparum malaria is usually transient and disappears when the infection is brought under control. A striking feature of falciparum malaria is the occurrence of acute renal failure with or without overt hemoglobinuria. - The pathology in this context consists of tubulointerstitial damage such as tubular necrosis, hemoglobin and cellular casts in tubuli, and interstitial edema - These lesions seem to be due to impaired blood flow in the microcirculation as a consequence of increased rigidity and adhesiveness of erythrocytes, hypovolemia, intravascular coagulation, and hemolysis. Babesiosis Babesia is a tick-borne intraerythrocytic parasite. In Europe, Babesia bovis and Babesia divergens are transmitted from cattle to humans. Asplenic persons are particularly susceptible to this disease. In the United States, most infections are caused by a rodent parasite, Babesia microti, usually in patients with intact spleens. In severe cases involving massive hemolysis, renal involvement, resulting in acute renal failure is seen. LEISHMANIASIS - Infective stage: Infection occurs by bite of female sand fly (flebbotomus papatassi) injecting promastigote of visceral leishmaniasis (leishmania donovani) into the blood - Diagnosis: Blood film, splenic smear and serology - Life cycle : as in diagram. Effect on renal system: - Glomerular lesions are observed with visceral leishmaniasis (kalaazar) caused by Leishmania donovani. - Cutaneous or mucocutaneous leishmaniasis caused by other Leishmania species (Leishmania tropica, Leishmania mexicana, etc.) are not associated with renal disease - The pathological picture is nephrotic syndrom - Amyloidosis can be a complication of kala-azar. - Kala-azar is usually associated with hyperimmunoglobulinemia with high IgG levels and circulating immune complexes. References: 1- Paniker’s Textbook of parasitology. 2- - Garcia, LS. & Bruckner, DA. (eds.), 2016 : Diagnostic Medical Parasitology 6th edition. Wiley. 3- - Roberts, LS. & Janovy, JJ. (eds.), and Nadler Steve, 2012: Foundations of Parasitology. 9th edition McGraw hill. Some internet sites useful in Parasitology: 1- http://www.parasitesonline.net. 2- http://www.Freebooks4doctors.com. 3- http://www.cdfound.to.it/HTML/atlas.htm 4- http://www.bhj.org/books/liver/contents.htm 5- http://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects76.html 6- http://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects52.html 7- http://www.nlm.nih.gov/mimcom/reference.html 8- http://www.nlm.nih.gov/mesh/subhierarchy2003.html 9- http://www.nlm.nih.gov/mimcom/news/tropmedwg.html 10- http://www.cdc.gov/ 11- http://pathmicro.med.sc.edu/book/parasit-sta.htm 12- http://www.dpd.cdc.gov/dpdx/ 13- http://www.diplectanum.dsl.pipex.com/purls/ 14- http://www.aber.ac.uk/~mpgwww/Edu/EduIndex.html 15- http://www.k-state.edu/parasitology/ 16- http://www.cvm.okstate.edu/~users/jcfox/htdocs/clinpara/Index.htm 17- http://www.sciencedirect.com/science/journal/00144894 18- http://www.parasite.org.au/ 19- http://www.parasitology.com/ 20- http://www.udel.edu/medtech/dlehman/medt372/images.html 21- http://www.parasitologyindia.org/ 22- http://www.parasitesonline.net/ 23- http://compepid.tuskegee.edu/syllabi/pathobiology/pathology/parasitology/in dex.htm 24- http://www.livjm.ac.uk/parasitology/ 25- http://www.med.nyu.edu/parasitology/
