Parasitology
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| Specimen Collection and Handling : general | show 🗑
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| show | • Feces- 95% parasite specimens
• Sputum- early morning specimen is best (most concentrated)
• Urine- early morning or 1st void
• Genitalia- saline wet swabs
• Tissue and skin- sterile container
• Blood
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| Types of Specimens: feces part 1 | show 🗑
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| Types of Specimens: feces part 2 | show 🗑
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| Types of Specimens: feces part 3 | show 🗑
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| show | • Fresh blood from finger stick (best NOT to use EDTA)
• Prepare thick smear for concentration and thin smear for identification
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| show | • Consistency: liquid-trophozoites
soft-protozoan cysts and trophozoties
formed-protozoan cysts (heiminth eggs can be found in any type of stool)
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| show | • Presence of: mucus, blood or macroscopic parasites
• Color: black-blood, clay colored-barium or absence of bile, green-veggies
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| Ova, Cyst, and parasite examination: microscopic | show 🗑
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| show | • Iron hematoxylin stain- takes skill to perform; organisms stain shades of purple-gray
• Trichrome stain- easy to perform; organisms stain great and nuclear details stain red-black
• Lawless stain- rapid, 5mins stain; stains various shades of blue
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| Types of Preservation | show 🗑
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| Types of Preservation : Refrigeration | show 🗑
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| show | Good for eggs, larvae and amoebic cysts
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| show | Concentration procedures as well as preservative; good for eggs and amoebic cysts
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| Types of Preservation : PVA (Palyvinyl Alcohol) | show 🗑
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| Types of Preservation : SAF (Sodium Acetate-Acetic Acid-Formalin) | show 🗑
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| show | • Formalin-Ether Technique- Modified version replaces ether with ethyl-acetate (less volatile)
• Zinc Sulfate Flotation Technique
• MIF
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| show | • Forms 4 layers:
Ether (ethyl acetate)
Debris
Formalin
Sediment (parasites);
• Ether removes fats and oils and formalin preserves organisms
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| show | • Advantages: can stay in formalin stage indefinitely; easy to perform
• Disadvantages: small ova and cysts such as Giardia end E. nana do not sediment well
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| Concentration techniques: Zinc Sulfate Flotation Technique part 1 | show 🗑
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| Concentration techniques: Zinc Sulfate Flotation Technique part 2 | show 🗑
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| show | • Concentration and preservative
• After adding stool to the vial, break iodine ampule (mix vial well). Allow to sit undisturbed for at least 2hrs
• Forms 3 layers:
Top (formalin)
Interface (parasites)
Bottom (fecal debris)
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| Concentration techniques: MIF part 2 | show 🗑
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| Helminths :Intermediate host | show 🗑
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| Helminths: Definitive host | show 🗑
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| show | • Contain both sexes in one helminth; cestodes and trematodes (except Schistosomes)
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| show | • Segments filled with eggs
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| show | • Females larger &have straight tail
• Males curved tail with a spicule used for copulation
• Unsegmented
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| show | • Round, elongated from a few millimeters-meter in length
• Complete digestive tract (mount to anus)
• Found in intestine, blood, and tissue
• Worldwide distribution
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| Ascaris lumbricoides (Large intestinal Roundworm) part 1 | show 🗑
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| Ascaris lumbricoides (Large intestinal Roundworm) part 2 | show 🗑
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| Ascaris lumbricoides (Large intestinal Roundworm) Diagnosis | show 🗑
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| show | • “worm ball” –blockage in intestines
• “ascaris pneumonitis” –due to larvae migration in lungs
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| show | • Adults
Males 2-5mm
Females 8-13mm
• Eggs become embryonated within hours resulting in high rate of autoinfection; treat entire family of an infected individual
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| Enterobius vermicularis (Pinworm) part 2 | show 🗑
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| Enterobius vermicularis (Pinworm) Diagnosis part 1 | show 🗑
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| show | • Adults may become “stuck” to the outside of the stool as it passes the perianal folds where the female migrates to lay eggs
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| show | • Adults
Males 30-45mm long, long curved tail prominent spicule
Females 30-50mm long
• Prolapsed rectum- may occur in heavy infections
• Diagnosis- demonstrate characteristic egg in feces
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| show | • Adults
Smallest nematode
Possess a long cylindrical esophagus and lack a posterior bulb
• Eggs hatch in mucosa of intestine and are rarely seen in feces
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| Strongyloides stercoralis (Threadworm): Rhabditiform larva (noninfective) | show 🗑
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| show | • 600um long
• Lacks a bulb on the esophagus
• Notch at the end of tail
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| Strongyloides stercoralis (Threadworm): free living cycle part 1 | show 🗑
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| show | • If favorable environmental conditions exist the larvae will mature into a free-living adult
• If unfavorable environmental conditions exist the larvae moult into the infective filiariform larvae
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| show | • Filariform larvae penetrate the skin of the host
• Larvae enter the circulatory system and migrate to the heart and then to lungs
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| Strongyloides stercoralis (Threadworm): parasitic cycle part 2 | show 🗑
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| Strongyloides stercoralis (Threadworm): parasitic cycle part 3 | show 🗑
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| Strongyloides stercoralis (Threadworm): autoinfection | show 🗑
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| show | • 3 stages
Cutaneous- initial skin penetration
Pulmonary- larval migration through lungs
Intestinal- symptoms depend on worm load. Immunocompromised patients may exhibit leukocytosis and eosinophilia
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| show | • Hyper-infection syndrome- may lead to death from tissue damage
Occurs in the immunocompromised (ADIS, drugs)
Can be transferred through organ transplantation
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| show | • Male 8-11mm long; possess a bursa which aids in speciation of hookworm
• Females 10-13mm long
• Adults may live 2-14 years
• Rarely seen in stools since firmly attached to mucosa
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| Necator americanus (New World Hookworm) and Ancylostoma duodenale (Old world Hookworm): Rhabditiform larvae | show 🗑
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| show | • 700um long
• Straight esophagus (1/4 length body)
• Pointed tail
• Long buccal cavity
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| show | • Pneumonitis
• Allergic reactions- “ground itch”
• Anemia- each adult worm consumes 0.2ml of blood/day
• Cutaneous larvae migrans- migration of dog hookworms (Ancyclostoma braziliensis and caninum) through subcutaneous tissue causing intense itching
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| show | • Demonstrate characteristic egg in feces
• Do not see larvae in feces (unless specimen left at room temp)
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| Remember: differentiating hookworm adults | show 🗑
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| Blood and Tissue Nematodes: Trichinella spiralis (Trichina Worm) adults | show 🗑
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| Trichinella spiralis (Trichina Worm): Infective stage | show 🗑
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| show | Muscle biopsy showing encysted larvae in striated muscle (larvae form pork migrate to skeletal muscle and penetrate individual fibers and begin to grow, eventually becoming encysted by infiltrating leukocytes)
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| Trichinella spiralis (Trichina Worm): Clinical disease | show 🗑
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| show | • Required an arthropod as an intermediate host. When infected arthropod takes a blood meal, the microfilariae are released into human host
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| show | • Diagnosis made by examining Giemsa stained think and thin smears (except Onchocerca volvulus- skin scraping from modules)
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| show | • Sheathed
• NO nuclei in tip of tail
• Nocturnal periodicity- 9pm-2am greatest concentration in blood
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| show | Permanent blockage of lymphatic system can occur in the upper extremities
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| Wuchereria bancrofti: Diagnosis | show 🗑
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| Brugia malayi: Microfilaria | show 🗑
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| Brugia malayi: Elephantiasis | show 🗑
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| Brugia malayi: Diagnosis | show 🗑
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| show | Found in Far East
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| show | Found in Africa
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| Loa Loa (eye Worm): Microfilaria | show 🗑
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| show | Causes calabar swellings (allergic reaction to warm migration in tissue and death in capillaries)
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| show | • Demonstrate in blood smear (thick and thin) sheathed microfilaria with continuous nuclei in tail
• Worm may migrate across conjunctiva
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| Onchocerca volvulus (Blinding worm): Microfilaria | show 🗑
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| Onchocerca volvulus (Blinding worm): Clinical disease | show 🗑
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| show | • Demonstrate from skin “snips”/tissue scrapings unsheathed microfilaria with NO nuclei in tail
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| Remember: ONchochercus Volvulus | show 🗑
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| show | NO nuclei in tip of tail
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| Remember: Brugia Malyi | show 🗑
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| show | Name repeats and so do nuclei, continuously in tip of tail
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| Cestodes (Tapeworms) general part 1 | show 🗑
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| show | • Hermaphroditic- mature proglottids contain both male and female reproductive organs
• 4 cup shaped suckers on scolex (except Diphyllobothrium latum which has 2 suctorial grooves)
• Worldwide distribution
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| show | Human is definitive host
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| show | • Scolex has an unarmed rostellum
• Consists of as many as 2,000 proglottids (10-15ft long)
• Adults may live 25 years
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| Taenia saginata (Beef Tapeworm): Infective stage | show 🗑
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| Taenia saginata (Beef Tapeworm): Diagnostic stage | show 🗑
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| show | Human may serve as definitive or intermediate host
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| show | • Scolex has armed rostellum
• Consists of any many as 1,00 proglottids; 6-10ft long
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| show | • Infection caused by larvae of parasite- human is intermediate host
Man ingest the egg of T. solium
Egg passes through the stomach and hatches in the intestine
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| Taenia solium (Pork Tapeworm): Cysticercosis part 2 | show 🗑
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| Taenia solium (Pork Tapeworm): Diagnostic stage | show 🗑
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| Remember the hermaphroditic tapeworm | show 🗑
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| show | • Does not require an intermediate host; may have intermediate host such as flea or beetle
• Most common human tapeworm in the U.S
• Heavy infections can occur through autoinfection
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| Hymenolepis nana (Dwarf Tapeworm): adults | show 🗑
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| Hymenolepis nana (Dwarf Tapeworm): stages | show 🗑
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| Hymenolepis diminuta (Rat Tapeworm) | show 🗑
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| show | • Infective stage- ingestion of flea
• Diagnostic stage- demonstrate characteristic egg in feces
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| Diphyllobothrium latum (Broad Fish Tapeworm) | show 🗑
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| Diphyllobothrium latum (Broad Fish Tapeworm) : adults | show 🗑
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| Diphyllobothrium latum (Broad Fish Tapeworm) : stages | show 🗑
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| Diphyllobothrium latum (Broad Fish Tapeworm) : clinical disease | show 🗑
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| Echinococcus granulosus (Hydatid Tapeworm): adult | show 🗑
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| Echinococcus granulosus (Hydatid Tapeworm): normal life sycle | show 🗑
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| show | • Infective stage- man (intermediate host) ingests egg
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| Echinococcus granulosus (Hydatid Tapeworm): diagnostic stage part 1 | show 🗑
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| Echinococcus granulosus (Hydatid Tapeworm): diagnostic stage part 2 | show 🗑
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| show | • Found worldwide in children
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| Dipylidium caninum (Dog Tapeworm): adult | show 🗑
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| Dipylidium caninum (Dog Tapeworm): normal life cycle | show 🗑
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| Dipylidium caninum (Dog Tapeworm): stages | show 🗑
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| Trematodes (Flukes): general info | show 🗑
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| Fasciolopsis buski (Giant Intestinal Fluke) | show 🗑
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| show | • Large fluke, 75mm long by 20mm wide
• Poorly developed suckers
• Live in intestines of pigs and humans
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| Fasciolopsis buski (Giant Intestinal Fluke): stages | show 🗑
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| Fasciolopsis buski (Giant Intestinal Fluke): clinical disease | show 🗑
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| Fasciola hepatica (Liver Fluke) | show 🗑
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| show | • Large fleshy fluke 30mm long 13mm wide
• Live in bile ducts of liver
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| show | • Infective stage- ingestion of raw aquatic vegetation (Ex. Water chestnuts) with encysted metacercariae
• Diagnostic stage- detect characteristic eggs in feces (eggs resemble F. buski)
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| show | • Larvae elicit inflammatory response in liver
• Stone formation may occur
• Eosinophilia may occur during larvae migration
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| Clonorchis sinensis (Chinese Liver Fluke) | show 🗑
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| show | • Long and narrow, 20mm long and 3-5mm wide
• Live in bile ducts of liver
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| show | • Infective stage- ingestion of raw fish infected with metacercariae
• Diagnostic stage- demonstration of characteristic eggs in feces (operculated with shoulders and small knobs at abopercular end)
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