 Let's move on to the protozoa that can affect the bloodstream. First and foremost is malaria. Malaria is broken down into four separate species. You have Plasmodium vivax, Plasmodium ovale, Plasmodium falsiperum, and Plasmodium malariae. The transmission for malaria is through the anopheles mosquito. Our symptoms typically include fever, headache, anemia, and splenomegaly. To diagnose this, you do a blood smear and you will see a trophozoite ring that is formed within the red blood cell as the red blood cell is the host for malaria. You can also see a schizont which contains marozoites. To treat this, we use chloroquine as well as primoquine if we suspect a hypnozoite state. The hypnozoite state is the dormant form in the liver. Of note, Plasmodium vivax and Plasmodium ovale have a 48 hour fever cycle. So you will have fever on day one and day three and so forth. Plasmodium malariae has a 72 hour fever cycle. So you will have fever on day one and then on day four. This diagram will explain the life cycle of malaria within the body and in the mosquito. Let's start down here with number one. A mosquito will bite a host and infect it with the sporozoites. Those sporozoites then can travel to the human liver where they will form a hypnozoite stage that is dormant. This can remain in the liver for quite some time. At some point in time, the hypnozoites can then form marozoites and pass into the blood stream. At this point, it will go through the human blood cell cycle where it will continuously replicate until it is far enough along to form gametocytes. Gametocytes are the sexual stage of the Plasmodium protozoa, which is the infectious stage. At this point, if someone receives a mosquito bite, the mosquito will actually draw the infected blood with the gametocytes into itself where it will then undergo the mosquito stage of the virus and form oocysts. Moving on, we have Babesiosis, which is caused by the Babesia protozoa. This is transmitted through the exodes tick. The exodes tick bites and transmits the Babesia organism. Symptoms of Babesiosis include fever and hemolytic anemia. We diagnose this with a blood smear where you see a ring form or a Maltese cross. The Maltese cross appears like this in the blood smear. We can also do PCR to determine an infection with Babesiosis. Treatment for Babesiosis is Atovequan and Azithromycin. We typically see the Babesia organism in the northeastern United States. The most at risk for severe disease associated with Babesiosis are those who are a splinic. So we immediately think someone with sickle cell anemia. Let's discuss Chagas disease. Chagas disease is caused by Trapanazoma cruzi. Trapanazoma cruzi is transmitted through a bite from the reduvid bug. The reduvid bug deposits feces on the skin and the bite causes itching. The host will then scratch that bite pushing the feces into the bite which will then pass into the bloodstream. We mainly see these in South America. Symptoms of Chagas disease include unilateral periorbital swelling. Advanced disease can have dilated cardiomyopathy with an apical atrophy, megacolon, and megasophagus. To diagnose, we can do a blood smear and see the triplomastagotes in the blood smear as you see here on the left. Treatment for Chagas disease is Benznidazole and Niferidomox. A way to remember the treatment is cruising in my bins with a fur coat on. So cruise is for Trapanazoma cruzi. So cruising in my bins, Benznidazole, with my fur coat on, Niferidomox. Moving on, Lashmaniasis is caused by the Lashmania donovani organism. It is transmitted through the sand fly. There are two different types of Lashmaniasis that can cause infection. It can be a visceral Lashmaniasis where we see spiking fevers, hepatosplenomegaly and pansytopenia, or we can see a cutaneous Lashmaniasis where we have skin ulcers. To diagnose this, we can use a biopsy where we see macrophages that will contain amastagotes. In this picture on the right, you can see in the bone marrow a macrophage that contains the amastagotes inside of it. Treatment is with Amphotericin B and Sodium Stiboglucinate. Finally, Trichomonas vaginalis. Trichomonas vaginalis is a sexually transmitted infection. And be careful not to confuse this with Gardanella vaginalis. Be careful not to confuse Trichomonas vaginalis with Gardanella vaginalis. Gardanella is a bacterial vaginosis caused by a gram variable bacterium. Trichomonas vaginalis is a protozoa. Trichomonas vaginalis include a foul smelling greenish discharge and it can also cause itching and burning. To diagnose we use a wet mount and you will see trophozoites that are motile on that wet mount. You can also see on the cervix what is known as a strawberry cervix which is a punctate cervical hemorrhage. As you can see in this video on the left there are many motile Trichomonas vaginalis organisms moving around in this phase contrast wet mount. Treatment for Trichomonas vaginalis includes metronidazole. Remember get gap on the metro so the T in get gap is Trichomonas vaginalis. We will give metronidazole to both the patient that is infected as well as their partner for prophylaxis as there is a potential that they could continue to spread. Of note this must be transmitted sexually because the Trichomonas vaginalis protozoa cannot exist outside of the human body because it will not form cysts.