Trypanosomes and African Sleeping Sickness
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Questions and Answers

What causes African sleeping sickness?

  • A bacterium
  • A virus
  • A fungal infection
  • A protozoan parasite (correct)
  • Which of the following is NOT a reason why African sleeping sickness is a major contributor to poverty in Africa?

  • The disease can be fatal, resulting in loss of life and labor.
  • The disease primarily affects rural populations who are dependent on agriculture.
  • The disease is highly contagious and can spread rapidly within a population. (correct)
  • The disease can affect livestock, leading to economic losses for farmers and pastoralists.
  • What is the primary mode of transmission for the Trypanosoma brucei parasite?

  • Inhalation of airborne particles
  • Contaminated food and water
  • Direct contact with infected individuals
  • The bite of a tsetse fly (correct)
  • What is the approximate number of African sleeping sickness cases reported annually?

    <p>1,000 (A)</p> Signup and view all the answers

    Which of the following describes the geographic distribution of African sleeping sickness?

    <p>Restricted to areas with high density of tsetse flies (A)</p> Signup and view all the answers

    What is the name of the disease that Trypanosoma brucei causes in animals, especially livestock?

    <p>Nagana (C)</p> Signup and view all the answers

    Which of the following factors influences human exposure to African trypanosomiasis?

    <p>Proximity to areas with high tsetse fly populations (B)</p> Signup and view all the answers

    Why are there no vaccines for African sleeping sickness?

    <p>The parasite is constantly evolving and changing its surface antigens, making a vaccine difficult to formulate. (D)</p> Signup and view all the answers

    Which of the following statements about African sleeping sickness treatments is TRUE?

    <p>Treatments can be toxic and have significant side effects. (C)</p> Signup and view all the answers

    What is the primary reason for the economic impact of African sleeping sickness?

    <p>Reduction in agricultural productivity and livestock production. (A)</p> Signup and view all the answers

    What mechanism allows the trypanosome to keep changing the VSG it expresses?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the primary function of the variant surface glycoprotein (VSG) in trypanosomes?

    <p>To protect the parasite from the host immune system (B)</p> Signup and view all the answers

    How does the trypanosome evade the host immune system?

    <p>By changing its surface antigen (A)</p> Signup and view all the answers

    Why is a vaccine against trypanosomes considered unlikely?

    <p>The trypanosome's VSG undergoes constant change, making it difficult to develop a stable vaccine target (B)</p> Signup and view all the answers

    What is the significance of the "waves of parasitemia" observed in chronic trypanosome infections?

    <p>They reflect the parasite's ability to evade the host immune system (D)</p> Signup and view all the answers

    How do trypanosomes survive for years in the bloodstream?

    <p>By constantly changing their surface antigens (B)</p> Signup and view all the answers

    Which of the following is NOT a key feature of trypanosome biology that contributes to the "waves of parasitemia"?

    <p>Formation of protective cysts (A)</p> Signup and view all the answers

    What is the role of hydrodynamic-flow mediated endocytosis in trypanosome immune evasion?

    <p>It facilitates the removal of antibodies that bind to VSG. (B)</p> Signup and view all the answers

    How does the trypanosome's VSG repertoire become "unlimited"?

    <p>By recombining sub-telomeric VSGs with the expression site VSG (C)</p> Signup and view all the answers

    Why does the slender form of the trypanosome proliferate rapidly?

    <p>Because it is the only form that can reproduce (C)</p> Signup and view all the answers

    What is the primary reason why African sleeping sickness is a major contributor to poverty in Africa?

    <p>The disease primarily impacts rural populations dependent on agriculture, fishing, and animal husbandry, thus disrupting economic activity. (D)</p> Signup and view all the answers

    How does the trypanosome's ability to switch its Variant Surface Glycoprotein (VSG) relate to the "waves of parasitemia" observed in chronic infections?

    <p>The switching of VSG allows the trypanosome to evade the host's immune system, leading to periodic increases in parasite numbers. (C)</p> Signup and view all the answers

    What is the primary reason for the lack of a vaccine against African sleeping sickness?

    <p>The trypanosome's ability to change its VSG protein quickly makes it difficult to target a specific antigen for a vaccine. (A)</p> Signup and view all the answers

    What is the primary mechanism by which the trypanosome evades the host's immune system, leading to chronic infections?

    <p>The trypanosome's ability to switch its Variant Surface Glycoprotein (VSG) allows it to evade the host's immune system by constantly changing its surface antigens. (D)</p> Signup and view all the answers

    How does the trypanosome's ability to switch its Variant Surface Glycoprotein (VSG) affect the effectiveness of treatments for African sleeping sickness?

    <p>The rapid switching of VSG makes it challenging to develop drugs that can target the VSG effectively, as the parasite will constantly evade them. (A)</p> Signup and view all the answers

    What is the primary mechanism by which trypanosomes evade antibody-mediated immune clearance?

    <p>Trypanosomes rapidly change the VSG they express, presenting a constantly shifting target. (B)</p> Signup and view all the answers

    Which of the following statements accurately describes the role of hydrodynamic-flow mediated endocytosis in trypanosome immune evasion?

    <p>It facilitates the removal of antibodies bound to the VSG, preventing the formation of antibody-mediated immune complexes on the parasite surface. (D)</p> Signup and view all the answers

    How does the process of mosaic formation contribute to the "unlimited" VSG repertoire of trypanosomes?

    <p>Mosaic formation allows trypanosomes to create entirely new VSG genes by combining DNA segments from different VSG genes. (B)</p> Signup and view all the answers

    Which of the following best describes the role of the "slender form" and "stumpy form" differentiation in the trypanosome life cycle?

    <p>Slender forms are responsible for transmission to the tsetse fly, while stumpy forms are adapted for survival in the mammalian host. (D)</p> Signup and view all the answers

    Which of the following statements correctly explains the reason for the "waves of parasitemia" observed during a chronic trypanosome infection?

    <p>Waves of parasitemia are the result of the parasite's response to the host's immune system, with each wave representing a new antigenic variant escaping immune pressure. (B)</p> Signup and view all the answers

    Which of the following BEST represents the primary reason why vaccination against trypanosomes is considered unlikely?

    <p>The ability of trypanosomes to rapidly change the VSG they express poses a major challenge for the development of vaccines targeting a single protein. (A)</p> Signup and view all the answers

    Which of the following BEST describes the role of the VSG in trypanosome immune evasion?

    <p>VSG acts as a physical barrier that shields other trypanosome surface proteins from antibody recognition. (A)</p> Signup and view all the answers

    Which of the following best explains why trypanosomes can survive for YEARS in the bloodstream of their host?

    <p>Trypanosomes are able to evade the host's immune system by changing the VSG they express, constantly staying one step ahead of the immune response. (B)</p> Signup and view all the answers

    Flashcards

    VSG (Variant Surface Glycoprotein)

    A protein that shields trypanosomes from the immune system by masking other proteins.

    Antigenic variation

    Process by which trypanosomes change their VSGs to evade immune detection.

    Mosaic formation

    New VSGs created by recombining sub-telomeric VSGs with expression site VSGs.

    Slender to stumpy differentiation

    Transition of trypanosomes from a proliferative form to a non-proliferative form.

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    Parasitemia

    The presence of parasites in the blood, often shows waves in chronic infections.

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    Immune clearance

    The process by which the immune system eliminates detected pathogens.

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    Hydrodynamic-flow mediated endocytosis

    Mechanism by which antibodies bound to VSG are removed from the bloodstream.

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    Expression site switching

    The process of changing the specific VSG being expressed by the trypanosome.

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    Vaccine challenges for trypanosomes

    Difficulty in creating vaccines due to constant antigenic variation and VSG changes.

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    African Sleeping Sickness

    A neglected tropical disease caused by trypanosomes, transmitted by tsetse flies.

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    Trypanosoma brucei

    A unicellular parasite that causes African sleeping sickness in humans and animals.

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    Tsetse fly

    The insect vector responsible for transmitting Trypanosoma brucei.

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    Epidemiology

    The study of how diseases spread and can be controlled.

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    Control measures

    Steps taken to reduce the spread of diseases like sleeping sickness.

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    Nagana

    The disease caused by Trypanosoma brucei in animals, leading to economic loss.

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    Sub-Saharan Africa

    The region where African sleeping sickness is most prevalent.

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    WHO report 2016

    The document that discusses the economic impact of sleeping sickness in Africa.

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    Rural populations

    Groups most affected by African sleeping sickness, often dependent on agriculture.

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    Fatal disease

    A disease that can lead to death if untreated, like sleeping sickness.

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    Trypanosome transmission

    Trypanosomes are transmitted to humans and animals by tsetse flies.

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    Impact of African Sleeping Sickness

    African sleeping sickness causes about 1,000 cases per year with high fatality if untreated.

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    Nagana economic impact

    Nagana, caused by Trypanosoma brucei in animals, leads to $4.5 billion loss annually in Africa.

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    Disease foci

    Major concentrations of African sleeping sickness are found in the Democratic Republic of the Congo.

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    Control of HAT

    Control measures are necessary to manage the spread of African sleeping sickness in rural areas.

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    Unlimited VSG repertoire

    The potential for trypanosomes to produce a vast array of VSGs through antigenic variation.

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    VSG recombination

    The process where sub-telomeric VSGs combine with expression site VSGs to create new mosaics.

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    Waves of parasitemia

    The observed cycles of parasite density in the blood during chronic infection.

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    Slender form proliferation

    The rapid growth phase of trypanosomes before differentiation to stumpy form.

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    Stumpy form

    A non-proliferative form of trypanosomes that differs from the slender form.

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    Antibody removal mechanism

    Hydrodynamic-flow mediated endocytosis clears antibodies binding to VSGs.

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    Vaccine limitation

    The difficulty in creating effective vaccines due to the rapid change of VSGs in trypanosomes.

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    Study Notes

    Trypanosomes and African Sleeping Sickness

    • Trypanosomes are the cause of African sleeping sickness, a fatal disease.
    • In humans, there are approximately 1,000 cases per year, though historically the number was much higher.
    • Treatments for sleeping sickness can be highly toxic.
    • Nagana is a major contributor to poverty in Africa due to trypanosomes in animals, causing economic impact of US$4.5 billion per year.
    • Trypanosomiasis (HAT) only occurs in 36 sub-Saharan countries with tsetse flies.
    • Rural populations dependent on agriculture, fishing, or animal husbandry are most vulnerable to this disease caused by tsetse flies.
    • Two sub-species of African trypanosomes are responsible for HAT: T.b. rhodesiense (severe, ~10% of cases) and T. b. gambiense (chronic, ~90% of cases). They have distinct geographic profiles.
    • Trypanosomes are unicellular and extracellular parasites.
    • Transmission occurs via tsetse flies.

    Learning Objectives

    • Trypanosomes cause African sleeping sickness.
    • The epidemiology of sleeping sickness and the role of tsetse flies in spreading it.
    • Trypanosomes have distinct life cycle stages adapted to different host and vector niches.
    • The mechanisms trypanosomes use to evade the host immune system.
    • Biological aspects of trypanosomes that lead to waves of parasitaemia in chronic infections.

    African Sleeping Sickness - Epidemiology and Control

    • 1896-1906 saw 300,000 to 500,000 deaths in Uganda and Congo Basin due to sleeping sickness (mostly).
    • The 1920 epidemic was controlled by mobile teams that screened millions.
    • Control measures in the 1960s nearly eliminated the disease but relaxation caused a resurgence in the 1970s.
    • A resurgence of human African trypanosomiasis (HAT) caused by Trypanosoma brucei rhodesiense in Ethiopia has been reported in 2022 (after 30 years), with two of the four patients dying before treatment could begin.

    Animal Trypanosomiasis

    • Cattle and game are affected by a disease known as Nagana.
    • Nagana ("to be depressed") in cattle causes lethargy, substantial weight loss, and decreased productivity.
    • T. brucei (including rhodesiense and gambiense) cause Nagana.
    • Trypanosomes significantly reduce the productivity of livestock in sub-Saharan Africa.

    Control of African Sleeping Sickness

    • Target the parasites in the host through screening and treatment programs for humans.
    • Treat domestic cattle.
    • Eliminate wild animal reservoirs of the disease.
    • Promote improved public health (better community health).
    • Target the vector through spraying insecticides (e.g. DDT - now outlawed in many places), insecticide-treated fly traps, and insecticide-treated bed nets.
    • Re-implementing control programs started in the 1990's led to improved outcomes.

    Vector Control

    • Blue fly traps—cost around $250 per square mile and need replacing every 5 months.

    Current Situation

    • A resurgence of human African Trypanosomiasis (HAT) caused by Trypanosoma brucei rhodesiense in Ethiopia has been reported in 2022 (after 30 years), with two of the four patients dying before treatment could begin.

    African Sleeping Sickness - Symptoms and Pathology

    • The first stage involves inflammation at the tsetse fly bite site, often resulting in a local chancre.
    • The early stage is characterized by regular bouts of fever and flu-like symptoms.
    • Swollen lymph nodes (Winterbottom's sign).
    • Early stage symptoms are generally milder in gambiense cases, but can be severe in rhodesiense cases and lead to substantial loss of function, including behavioural changes and potentially coma.

    Trypanosome Lifecycle

    • Vector: Glossina sp (tsetse flies)
    • Host: Mammals (including humans)
    • Trypanosomes mature through multiple stages.
    • The 4 stages to remember are: Slender (proliferative), Stumpy (non-proliferative), Procyclic, and Metacyclic.
    • They inhabit the blood, skin, adipose tissue, and central nervous system (late stage disease only)
    • Trypanosomes are taken into the insect midgut upon tsetse biting and travel to salivary glands.

    Trypanosome Immune Evasion

    • VSG: Variant Surface Glycoprotein.
      • Protection.
      • Keeps trypanosomes hidden from host immune cells (antibodies, complement, immune cells).
      • Constant antigenic variation (switching expression sites and/or swapping in new VSG genes) allows the parasites to continuously switch their surface proteins to evade the host immune response.
    • Hydrodynamic Flow: Antibodies are swept to the posterior part of the cell.
    • There are three methods to immune evasion.

    Trypanosome Motility

    • Motility is important for host infection.
    • Motility is essential for successful host infection
    • Mice infected with parasites that have an inducible motility defect, cleared their parasites in 16 hours.

    Hydrodynamic Flow and High Antibody Titers

    • Hydrodynamic flow less effective at high antibody titers.
    • Trypanosomes express a single VSG at a given time.
    • VSG is highly immunogenic (an immune response).
    • A strong antibody response eventually overwhelms hydrodynamic flow, which is a defense mechanism, and eventually kills the cell.
    • Trypanosomes keep returning (waves) because they keep producing new VSGs.

    Summary

    • The infection begins with an initial bite and inflammation at the site. Trypanosome numbers increase in the blood, lymphatics and tissues, causing symptoms like fever, and swelling in the lymph nodes. Finally parasites pass into the CNS (central nervous system) causing more serious symptoms (mental/behavioural changes,coma). Trypanosomes remain in the blood, skin, and adipose tissue (fat) for extended periods, largely through evasion mechanisms, most notably antigenic variation of VSG, to evade host immune attacks.

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    Description

    Explore the effects of trypanosomes on human health and agriculture, particularly focusing on African sleeping sickness. Understanding its economic impact and transmission via tsetse flies is crucial for regional health. Learn about the species involved and vulnerable populations in sub-Saharan Africa.

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