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Chapter 30 : Sputum, Aspirates, and Biopsy Material

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Abstract:

Expectorated sputum may be submitted for examination for parasites though it is not one of the more common specimens. Concentrated stained preparations of induced sputum specimens are commonly used to detect and differentiate trophozoite and cyst forms from other possible causes of pneumonia, particularly in AIDS patients. When noninduced sputum and the direct fluorescent-antibody technique were used, the sensitivity was 55%; this is within the range reported in the literature for the diagnosis of pneumonia from induced sputum. Duodenal aspirates to be evaluated for , , spp., , or the microsporidia may require concentration by centrifugation prior to microscopic examination for motile organisms and permanent stains. The organisms can be demonstrated in stained impression smears of lung material obtained by open or brush biopsy. can also be seen in stained smears of tracheobronchial aspirates, although examination of lung tissue is more likely to reveal the organisms. With a number of the stains that are available, the cyst walls stain but the cyst contents do not; however, only the methenamine silver stain is discussed in this chapter. Skin snips are placed immediately in a drop of normal saline or distilled water and covered so that they will not dry; teasing the specimen with dissecting needles is not necessary but may facilitate release of the microfilariae.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Figures

Image of Figure 30.1
Figure 30.1

spp. eggs. (Left) Operculated eggs in a sputum specimen. (Right) Eggs photographed at a higher magnification.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.2
Figure 30.2

(Left) containing ingested polymorphonucluear leukocytes within large vacuoles. (Right) containing ingested red blood cells.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.3
Figure 30.3

(Left) from the mouth (stained with Giemsa stain). (Right) from a genital specimen (stained with Giemsa stain). Note the large nucleus in and the fact that this flagellate is somewhat smaller than

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.4
Figure 30.4

(Upper) Note that the “parentheses” are visible; this is a well-stained preparation (methenamine silver stain). (Lower) Microsporidian spores. Note polar tubule within circle (methenamine silver stain).

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.5
Figure 30.5

trophozoites within the cyst wall (stained with Giemsa stain). Note that the cyst wall is not visible when Giemsa stain is used.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.6
Figure 30.6

containing ingested red blood cells within the cytoplasm; morphologically this organism is , and this would be the species designation if organisms were isolated from liver abscess material.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.7
Figure 30.7

Liver abscess caused by Amebae would be found at the advancing margin of the lesion; the last portion of the aspirated material might reveal the organisms. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.8
Figure 30.8

Hydatid disease (). (Upper left) Hydatid cyst with scolices budding off from the germinal layer. (Upper right) Immature scolices, with the dark area being the hooklets. (Lower left) Higher magnification of the scolices taken from the hydatid cyst fluid. (Lower right) Hooklets from disintegrating scolices. Reprinted from reference .

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.9
Figure 30.9

Note the large karyosome and lobate pseudopodia. Spinal fluid should be examined on a slide, not in a counting chamber, where protozoan trophozoites could mimic white blood cells. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.10
Figure 30.10

cyst. Note the fluorescence of the cyst wall. Trophozoites do not fluoresce when calcofluor white is used.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.11
Figure 30.11

Microsporidial spores. (Upper left) Spores in a corneal scraping specimen; (upper right) spores in a fecal specimen (both images stained with silver stain). (Lower left) Microsporidial spores in a urine sediment; (lower right) spores from nasopharyngeal aspirate (both images stained using calcofluor white).

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.12
Figure 30.12

Proper way to aspirate material from below the ulcer bed ( spp.); sterile saline (0.5 to 1.0 ml) can be injected under the ulcer prior to aspiration. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.13
Figure 30.13

cutaneous lesion. (Upper) Lesion prior to therapy; (lower) lesion after therapy.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.14
Figure 30.14

(Upper) amastigotes in a cell, stained with Giemsa stain. (Lower left) spp. oocysts stained with modified acid-fast stain. Note that the sporozoites are visible within some of the oocysts. (Lower right) Microsporidial spores stained with methenamine silver stain. Note the similarity to small yeast cells.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.15
Figure 30.15

mites from skin scrapings. (Upper) Note the two mites to the left of center. (Lower) Note the two eggs, the small nymph, and the adult mite (photographed at a higher magnification). If the light is too strong when examining the scrapings in saline, the mites will probably not be seen.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.16
Figure 30.16

culture sediment. Note the promastigotes from the culture sediment. The typical “rosette” formation in the left image is frequently seen.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.17
Figure 30.17

Microfilariae (Giemsa stain). (Left) In this image, the microfilariae from a skin snip saline preparation are visible after staining. (Right) Microfilariae from blood; note that the characteristic nuclei are more easily seen in this preparation.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.18
Figure 30.18

spp. larvae in a squash preparation of muscle biopsy tissue; note the encysted larvae. This specimen is unstained.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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Image of Figure 30.19
Figure 30.19

(Upper) eggs seen in a squash preparation of a bladder biopsy specimen. This specimen is unstained. (Armed Forces Institute of Pathology photograph.) (Lower) eggs from a rectal biopsy specimen.

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30
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References

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Tables

Generic image for table
Table 30.1

Examination of impression smears

Citation: Garcia L. 2007. Sputum, Aspirates, and Biopsy Material, p 859-880. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch30

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