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Chapter 19 : Parasitic Infections in the Compromised Host

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Abstract:

This chapter discusses some of the representative opportunistic organisms that can cause disease in immunocompromised patients. Any parasitic infection in the immunocompromised host may cause more severe symptoms; however, the organisms presented in the chapter have been identified as causing severe disease in this population. Parasitic organisms causing infection include , and . Macrophages or monocytes can look like the trophozoite form of , and polymorphonuclear leukocytes, when they have been in the stool for a while, can mimic the four-nucleus mature cyst. When organisms invade the mucosal lining and are carried via the bloodstream to the liver, a somewhat different approach to diagnosis is necessary. Invasive amebiasis appears to be an emerging parasitic disease in patients infected with HIV in areas where amebic infection is endemic. Infections caused by small, free-living amebae are becoming recognized clinically as important parasitic pathogens, particularly in immunocompromised patients. Amebic meningoencephalitis caused by is an acute, suppurative infection of the brain and meninges. The cerebrospinal fluid (CSF) may have the predominantly polymorphonuclear leukocytosis, increased protein concentration, and decreased glucose concentration that are seen with bacterial meningitis. In contrast to , inhabits the duodenal area of the intestine, tends to adhere very tightly to the mucosa, and can be very difficult to recover, even after a series of five or six stool examinations. For this reason, other techniques, such as the Entero-Test string capsule, duodenal aspirate, or biopsy, may have to be used.

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.1
Figure 19.1

(Upper left) trophozoite; (upper right) cyst; (lower) gross specimen, amebic liver abscess.

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.2
Figure 19.2

(Top) trophozoite (note the large karyosome within the nucleus); (middle) trophozoites within brain tissue; (bottom) in brain tissue. (Bottom, Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.3
Figure 19.3

(Left) trophozoites (note the sharp, spiky pseudopodia); (right) cysts (note the hexagonal double wall).

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.4
Figure 19.4

(Upper left) trophozoite (note two nuclei, curved median bodies, and linear axonemes); (upper right) cyst; (lower) cyst (large) and oocysts (small) demonstrating fluorescence in the fecal FA immunoassay (note that the background demonstrates use of the counterstain).

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.5
Figure 19.5

in bone marrow.

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.6
Figure 19.6

oocysts stained using the modified acid-fast stain (note the spherical shape; oocysts measure 4 to 6 μm).

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.7
Figure 19.7

oocysts stained using the modified acid-fast stain (note the spherical shape; oocysts measure 8 to 10 μm; some oocysts do not stain, thus the organisms are said to be “modified acid-fast variable”).

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.8
Figure 19.8

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

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.9
Figure 19.9

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

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.10
Figure 19.10

Microsporidia. (Top) Microsporidial spores seen in fecal specimen (concentration sediment) stained with Ryan modified trichrome stain (note the horizontal line through some of the spores, representing the presence of the polar tubule); (middle) spores stained with specific FA reagents for the detection of spp.; (bottom) spores within a urine sediment after staining with Ryan modified trichrome stain (taken at a lower magnification).

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.11
Figure 19.11

in bone marrow (note the individual amastigotes, each one containing the bar and nucleus); specimen stained using Giemsa stain.

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.12
Figure 19.12

(Upper) Rhabditiform larvae seen in bronchoalveolar lavage fluid specimen (larvae can also be seen in sputum in heavy infections or in the hyperinfection syndrome); (lower) rhabditiform larva from fecal concentration sediment (note the short mouth opening/buccal capsule and the packet of genital primordial cells at the bottom left).

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Image of Figure 19.13
Figure 19.13

“itch mite.” (Left) Mite from skin scraping preparation (note the four pairs of legs); (right) hand of an individual with severe scabies (Norwegian scabies). (Right, Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
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Tables

Generic image for table
Table 19.1

Host defense mechanisms

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.2

Selected procedures for determination of host defense defects

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.3

Diagnosing parasitic infection in the compromised host

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.4

Parasitic infections: clinical findings in normal and compromised hosts

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.5

infections in immunocompromised patients

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.6

infections in immunocompromised patients

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.7

infections in immunocompromised patients

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.8

Prevention of cryptosporidiosis in immunocompromised patients

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.9

: updated information

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.10

: parasite development and disease

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.11

Encysted pathogenic protozoan parasites seen in human feces

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.12

: parasite development and disease

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.13

Microsporidia: updated information (AIDS patients)

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.14

infections in immunocompromised patients

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19
Generic image for table
Table 19.15

infections in immunocompromised patients

Citation: Garcia L. 2007. Parasitic Infections in the Compromised Host, p 506-548. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch19

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