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Chapter 14 : Parasites

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Abstract:

This chapter includes some of the opportunistic parasites that can cause disease in immunocompromised patients. Although most parasitic infections are known to cause more severe symptoms when a host's immune system is impaired, the representative organisms presented in this chapter have been identified as causing the most severe disease in this population group. Malaria, spp., , and spp. are the principal parasites that may be transmitted with bone marrow, kidney, or liver homografts, and microsporidia are the principle parasites transmitted with xeno-transplants. The organisms discussed in the chapter are , free-living amebae, , , spp., , , spp., microsporidia, spp., , and (crusted scabies). It is important for the laboratorian and clinician to be aware of problems that these organisms can cause in immunocompromised patients and of the proper diagnostic techniques and their clinical relevance. Organism eradication is effective using cotrimoxazole, trimethoprimsulfamethoxazole (TMP-SMX), pyrimethaminesulfadiazine, primaquine phosphate-nitrofurantoin, and primaquine phosphate-chloroquine phosphate. The drug of choice is TMP-SMX, which is classified as an investigational drug for treatment of infection. The diagnosis can be confirmed by demonstration of the mites, eggs, or scybala (fecal pellets).

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Figures

Image of Figure 1.
Figure 1.

(Top left) trophozoite (true pathogen; note the ingested RBCs in the cytoplasm); (top right) cyst (unable to differentiate the true pathogen from the nonpathogen ); (bottom) gross specimen of amebic liver abscess. (Courtesy of Armed Forces Institute of Pathology.)

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 2.
Figure 2.

(Top left) trophozoite (note two nuclei, curved median bodies, and linear axonemes); (top right) cyst; (bottom) cyst (large) and sp. oocysts (small) (demonstrating fluorescence using the fecal fluorescent-antibody immunoassay; some will use a counterstain, while others will not).

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 3.
Figure 3.

(Top left) sp. oocysts stained using modified acid-fast stain (note the spherical shape; oocysts measure 4 to 6 μm); (top right) sp. oocysts (note that sporozoites are visible in some of the oocysts, which are infective when passed, regardless of whether the sporozoites are visible or not); (bottom) histologic section of intestinal tissue showing organisms within parasitophorous vacuoles at the brush border. (Courtesy of Armed Forces Institute of Pathology.)

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 4.
Figure 4.

oocysts stained using modified acid-fast stain (note the spherical shape; oocysts measure 8 to 10 μm; some oocysts do not stain, and thus the organisms are said to be “modified acid-fast variable”). These oocysts are not infectious when passed, regardless of the stool consistency.

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 5.
Figure 5.

() . (Top) Immature oocyst (contains single sporocyst) stained using modified acid-fast stain; (bottom) more mature oocyst (contains two sporocysts) in a saline wet mount of stool concentration sediment.

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 6.
Figure 6.

sp. in muscle tissue (note the bradyzoites contained within the sarcocyst).

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 7.
Figure 7.

Microsporidia. (Top) Microsporidial spores seen in fecal specimen (concentration sediment) stained with Ryan blue modified trichrome stain (note the horizontal line through some of the spores, representing the presence of the polar tubule); (middle) spores stained with Gram stain reagents for the detection of intra-cellular spores; (bottom) spores within a urine sediment after being stained with an optical brightening agent (note that some of the spores are intracellular, while some are outside the cells).

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 8.
Figure 8.

trophozoites within brain tissue (note the large karyosome within the nucleus). (Courtesy of Armed Forces Institute of Pathology.)

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 9.
Figure 9.

(Top left) sp. trophozoites (note the sharp, spiky pseudopodia); (top right) sp. cysts (note the hexagonal double wall); (bottom) skin lesion caused by sp. infection in an immunocompromised host.

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 10.
Figure 10.

in brain tissue; both trophozoites and cysts are found in many of the same CNS tissues as those which harbor organisms. (Courtesy of Armed Forces Institute of Pathology.)

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 11.
Figure 11.

(Top) in tissue culture (note the somewhat crescent-shaped tachyzoites); (bottom) organisms in tissue.

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 12.
Figure 12.

(Top left) cutaneous leishmaniasis (typical lesion); (top right) same lesion after therapy; (bottom left) in bone marrow (note the individual amastigotes, with each one containing a bar and nucleus); (bottom right) promastigotes from culture (specimen was stained using Giemsa stain).

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 13.
Figure 13.

(Top) trypomastigote (note the large kinetoplast at one end and the large central nucleus); (bottom) amastigotes in cardiac tissue.

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 14.
Figure 14.

. (Top) Rhabditiform larvae seen in fecal concentration sediment (note the short mouth opening/buccal capsule and the packet of genital primordial cells at the bottom left of the image); (middle) notched tail (“slit in tail”) seen in filariform/infectious larvae; (bottom) larvae in tissue (disseminated infection at a higher magnification).

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Image of Figure 15.
Figure 15.

“itch mite” (note the egg and immature and mature mites).

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
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Tables

Generic image for table
Table 1.

Parasitic infections: clinical findings in immunocompetent and immunocompromised patients

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14
Generic image for table
Table 2.

Parasitic infections in the compromised host: diagnostic options

Citation: Garcia L. 2009. Parasites, p 283-330. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch14

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