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Chapter 18 : Unusual Parasitic Infections

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Abstract:

Most parasites infecting humans are recognized as being able to survive easily within the human host and to possibly cause disease, but there are some organisms that only rarely infect humans. Perhaps humans are only accidental hosts. In any case, because these infections, being so rare, are not reported frequently, such parasites may not be considered possible etiologic agents. It is important to at least be aware of such parasites and of the possible disease process created by these relatively benign organisms, because they can become a problem in immunocompromised patients. This chapter discusses some of the unusual parasites that infect humans. These unusual parasites include aquatic protist, protozoa, nematodes, cestodes, trematodes, pentastomids and acanthocephalans. A majority of cases have been related to anisakine larvae such as those of , , , and spp., which are indigenous to marine fish found off both coasts of the United States as well as in Japan and Europe. Western blot results provided sufficient indirect evidence to confirm the identity of the organism as . is an avian eye trematode, found primarily in the eyes of wild and domestic birds. The acanthocephalans (thorny-headed worms) were formerly included in the same phylum as the nematodes.

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18

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Enzyme-Linked Immunosorbent Assay
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Magnetic Resonance Imaging
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Scanning Electron Microscopy
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Figures

Image of Figure 18.1
Figure 18.1

Histology of rhinosporidiosis; human nasal polyp. (Upper) Immature trophocytes; note the thick walls and the surrounding inflammatory cells. (Lower) Sporangium containing endospores. (Images from the Centers for Disease Control and Prevention.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.2
Figure 18.2

(A) Normal human spermatozoa. (B) Myxosporean spore from salmon. Note the similarities between panels A and B. (C and D) Two spores demonstrating the polar filaments. (Reprinted from reference with permission.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.3
Figure 18.3

Life cycle of spp.

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.4
Figure 18.4

Anterior end of an adult worm recovered from human feces. Note the cephalic groove, characteristic of the genus (×115). (Reprinted from reference with permission.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.5
Figure 18.5

Scanning electron micrograph of the cephalic end of a female worm recovered from human feces. Note the inner and outer leaf crowns with 12 and 24 (sometimes 10 and 20) lips, respectively, and the papillae (×630). (Photograph by the Department of Electron Microscopy, Medical Faculty, Leiden University; reprinted from reference with permission.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.6
Figure 18.6

egg. This egg cannot be differentiated from that of the hookworm.

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.7
Figure 18.7

Nodular lesion of oesophagostomiasis seen as a paraumbilical mass in an otherwise healthy 5-year-old girl in Nigeria. At laparotomy, the lesion was found to have arisen in the ascending colon and was adherent to the muscles and fascia of the anterior abdominal wall (×11). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.8
Figure 18.8

Surgically resected nodule of oesophagostomiasis. Note the worm protruding into the cavity. Specific identification of these worms is difficult, because intact specimens are rarely obtained. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.9
Figure 18.9

(1) Head of removed from the mouth of an infant. Note the mouth opening (arrow), lip papilla (L), and cephalic papillae (C). Bar, 80 μm. (2) Eggs of inside the uterus of the specimen. Note the thick, double-walled shell surrounding the fully developed embryos. Arrows point to poles containing collapsed byssi. Bar, 55 μm. (Reprinted from reference with permission.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.10
Figure 18.10

Longitudinal section through the rhabditiform esophagus in the anterior end of a mature female worm in the brain. The procorpus (pc), metacorpus (mc), isthmus (is), bulb (bu), and intestine (in) are indicated (×1,040). (Armed Forces Institute of Pathology photograph; published in . 125, 1975.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.11
Figure 18.11

egg. This egg measures 60 to 80 μm by 39 to 46 μm and has a thick shell that appears wrinkled; the ends of the egg are usually lighter in color.

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.12
Figure 18.12

egg. This egg measures 85 by 50 μm and closely resembles the egg of hookworm and ; however, it is larger.

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.13
Figure 18.13

() worms in the trachea of a turkey; note the typical Y configuration of the adult male and female worms. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.14
Figure 18.14

egg. This egg measures 78 to 95 μm by 42 to 54 μm.

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.15
Figure 18.15

. (A) Anterior end of the worm. (B) Posterior end of the worm. (C) Egg. (Panel A adapted from H. B. Ward, in the role of a human parasite. ., 1916. Panel B adapted from reference . Panel C adapted from reference .)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.16
Figure 18.16

tapeworm proglottids. Note the width of the proglottids and their very short length; also note the two genital organs in each proglottid.

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.17
Figure 18.17

egg. This egg measures 63 to 68 μm by 50 μm; note the resemblance to the egg.

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.18
Figure 18.18

. (A) Scolex. (B) Egg. (C) Mature proglottid. Note the description of the egg in the text related to the illustration. (Adapted from an original drawing by R. Blanchard, in E. C. Faust, , Lea & Febiger, Philadelphia, Pa., 1929, and reference .)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.19
Figure 18.19

. Retinal photographs showing budding cysticercus in situ. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of Renio Freeman.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.20
Figure 18.20

cysticercus after surgical removal from the eye. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of Renio Freeman.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.21
Figure 18.21

. Living mesocercaria removed from a human liver at autopsy. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of R. S. Freeman.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.22
Figure 18.22

. Mesocercaria in the patient’s pons. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of R. S. Freeman.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.23
Figure 18.23

in the human eye. Note the relationship to the optic disk and macula. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of R. S. Freeman.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.24
Figure 18.24

isolated from a patient. (1) Ventral view of the holotype. (2) Ventral view of the structure of the terminal portion of the reproductive system. c, cirrus; cs, cirrus sac; gp, genital pore; mt, metraterm; os, oral sucker; pg, prostate gland, sv, seminal vesicle. (Reprinted from reference with permission.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.25
Figure 18.25

Photographs of two species of collected from the same patient. ( ) The anterior part of , showing the spinose cirrus and the tegumental spines. Bar, 0.05 mm. ( ) Unstained adults of , showing the larger excretory bladder (exb) and the more conspicuous border. Bar, 0.5 mm. ( ) Unstained adults of . Bar, 0.5 mm. (Reprinted from reference with permission.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.26
Figure 18.26

. Note the pyriform adult trematode, which is covered with scale-like spines on the tegument; eggs can be seen to the right of the labels, while the ventral sucker can be seen immediately above the label. The ventral sucker has a crescentric group of 12 to 16 hollow spines (scleritis) (not visible in this image). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.27
Figure 18.27

Eggs of from the feces of a patient, detected by formalin-ether sedimentation (unstained) (A) and cellophane thick-smear technique (malachite green stained) (B). (Reprinted from reference with permission.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.28
Figure 18.28

Specimen of (ventral view, unstained) showing various structures within this fluke. (Reprinted from reference with permission.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.29
Figure 18.29

Adult sp. trematode. Note oral sucker (os), pharynx (ph), cirrus sac (cs), acetabulum (ventral sucker) (ac), uterus (ut), and testes (te). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.30
Figure 18.30

Life cycle of the tongue worms (pentastomids) and spp. (1) Humans ingest raw or inadequately cooked snake or lizard; (2) humans ingest eggs on vegetation or in water; (3) humans ingest the flesh of intermediate hosts containing infective larvae.

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.31
Figure 18.31

Nonencysted mature larva attached to the abdominal surface of a human diaphragm (×4). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.32
Figure 18.32

Encysted larva on the surface of the liver of a 55-year-old Zairian. The cyst contains a C-shaped larva (×12). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.33
Figure 18.33

Thorny-headed worm. Note the proboscis, which is covered with spines. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.34
Figure 18.34

Life cycle of the acanthocephalans (thorny-headed worms).

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.35
Figure 18.35

, complete adult specimen, approximately 133 mm long (×5). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.36
Figure 18.36

proboscis attached to pig bowel wall. The insertion of the toothed proboscis, along with the inflammation, ulceration, and hemorrhage caused, are seen in this low-power view. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.37
Figure 18.37

. A single tooth on the proboscis is visible at this higher magnification. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.38
Figure 18.38

egg. This egg measures 80 to 100 μm by 50 μm, has a thick, dark brown, textured shell, and contains a developed acanthor larva with hooks. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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Image of Figure 18.39
Figure 18.39

egg. This egg measures 90 to 125 μm by 65 μm and contains a fully developed acanthor larva with visible hooks. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
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References

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Tables

Generic image for table
Table 18.1

Unusual parasitic infections

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18
Generic image for table
Table 18.2

Human parasites acquired from the ingestion of raw or poorly cooked fish

Citation: Garcia L. 2007. Unusual Parasitic Infections, p 478-505. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch18

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