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Chapter 9.10 : Appendixes

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Abstract:

Laboratorian must differentiate extraneous materials present in specimen from actual parasites.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Figures

Image of Figure 9.10.3-A1
Figure 9.10.3-A1

(a) trophozoite. Note the evenly arranged nuclear chromatin, central compact karyosome, and relatively “clean” cytoplasm. (b) trophozoite. Note the unevenly arranged nuclear chromatin, eccentric karyosome, and “messy” cytoplasm. These characteristics are very representative of the two organisms. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A2
Figure 9.10.3-A2

(a) trophozoite. Note the evenly arranged nuclear chromatin, central compact karyosome and “clean” cytoplasm. (b) trophozoite. Note that the nuclear chromatin appears to be evenly arranged, the karyosome is central (but more diffuse), and the cytoplasm is “messy,” with numerous vacuoles and ingested debris. The nuclei of these two organisms tend to resemble one another (very common finding in routine clinical specimens). (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A3
Figure 9.10.3-A3

(a) trophozoite. Again, note the typical morphology (evenly arranged nuclear chromatin, central compact karyosome, and relatively “clean” cytoplasm). (b) trophozoite. Although the nuclear chromatin is eccentric, note that the karyosome seems to be compact and central. However, note the various vacuoles containing ingested debris. These organisms show some characteristics that are very similar (very typical in clinical specimens). (Illustration by Sharon Belkin).

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A4
Figure 9.10.3-A4

(a) trophozoite. Note the evenly arranged nuclear chromatin, central compact karyosome, and RBCs in the cytoplasm. (b) Human macrophage. The key difference between the macrophage nucleus and that of is the size. Usually, the ratio of nucleus to cytoplasm in a macrophage is approximately 1:6 or 1:8, while the true organism has a nucleus/cytoplasm ratio of approximately 1:10 or 1:12. The macrophage also contains ingested RBCs. In cases of diarrhea or dysentery, trophozoites of and macrophages can often be confused, occasionally leading to a false-positive diagnosis of amebiasis when no parasites are present. Both the actual trophozoite and the macrophage may also be seen without ingested RBCs, and they can mimic one another. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A5
Figure 9.10.3-A5

(a) precyst. Note the enlarged nucleus (prior to division) with evenly arranged nuclear chromatin and central compact karyosome. Chromatoidal bars (rounded ends, with smooth edges) are also present in the cytoplasm. (b) PMN. The nucleus is somewhat lobed (normal morphology) and represents a PMN that has not been in the gut very long. Occasionally, the positioning of the chromatoidal bars and the lobed nucleus of the PMN can mimic one another. The chromatoidal bars will stain more intensely, but shapes can overlap, as seen here. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A6
Figure 9.10.3-A6

(a) cyst. Note that the four nuclei are very consistent in size and shape. (b) PMN. Note that the normal lobed nucleus has now broken into four fragments, which mimic four nuclei with peripheral chromatin and central karyosomes. When PMNs have been in the gut for some time and have begun to disintegrate, the nuclear morphology can mimic that seen in an cyst. However, human cells are often seen in the stool in cases of diarrhea; with rapid passage of the gastrointestinal tract contents, there will not be time for amebic cysts to form. Therefore, in cases of diarrhea and/or dysentery, if “organisms” are seen that resemble the cell in panel b, think first of PMNs, not cysts. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A7
Figure 9.10.3-A7

(a) trophozoite. This organism is characterized by a large karyosome with no peripheral chromatin, although there are normally many nuclear variations seen in any positive specimen. (b) trophozoite. Normally, the nuclear chromatin is fragmented into several dots (often a “tetrad” arrangement). The cytoplasm is normally more “junky” than that seen in . If the morphology is typical, as in these two illustrations, then differentiating between these two organisms is not that difficult. However, the morphologies of the two will often be very similar. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A8
Figure 9.10.3-A8

(a) trophozoite. Notice that the karyosome is large and surrounded by a “halo,” with very little, if any, chromatin on the nuclear membrane. (b) trophozoite. In this organism, the karyosome is beginning to fragment, and there is a slight clearing in the center of the nuclear chromatin. If the nuclear chromatin has not become fragmented, trophozoites can very easily mimic trophozoites. This could lead to a report indicating that no pathogens were present, when, in fact, is considered a definite cause of symptoms. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A9
Figure 9.10.3-A9

(a) trophozoite. Note the large karyosome surrounded by a clear space. The cytoplasm is relatively “clean.” (b) . Although the karyosome is similar to that of , note that the cytoplasm in is much more heavily vacuolated and contains ingested debris. Often, these two trophozoites cannot be differentiated. However, the differences in the cytoplasm are often helpful. There will be a definite size overlap between the two genera. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A10
Figure 9.10.3-A10

(a) RBCs on a stained fecal smear. Note that the cells are very pleomorphic but tend to be positioned in the direction the stool was spread onto the slide. (b) Yeast cells on a stained fecal smear. These cells tend to remain oval and are not aligned in any particular way on the smear. These differences are important when the differential identification is between containing RBCs and containing ingested yeast cells. If RBCs or yeast cells are identified in the cytoplasm of an organism, they must also be visible in the background of the stained fecal smear. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A11
Figure 9.10.3-A11

(a) cyst. Note the shrinkage due to dehydrating agents in the staining process. (b) cyst. In this case, the cyst exhibits no shrinkage. Only three of the four nuclei are in focus. Normally, this type of shrinkage is seen with protozoan cysts and is particularly important when a species is measured and identified as either or . The whole area, including the halo, must be measured prior to species identification. If just the cyst is measured, the organism would be identified as (nonpathogenic) rather than (possibly pathogenic). (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A12
Figure 9.10.3-A12

(a) rings. Note the two rings in the RBC. Multiple rings per cell are more typical of than of the other species of human malaria. (b) rings. In one of the RBCs are four small rings. This particular arrangement is called the Maltese cross and is diagnostic for spp. However, the Maltese cross configuration is not always present. infections can be confused with cases of malaria, primarily because multiple rings can be seen in the RBCs. Another difference involves ring morphology. rings are often of various sizes and tend to be very pleomorphic, while those of tend to be more consistent in size and shape. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A13
Figure 9.10.3-A13

(a) rhabditiform larva. Note the short buccal capsule (mouth opening) and the internal structure, including the genital primordial packet of cells. (b) Root hair (plant material). Note that there is no specific internal structure and the end is ragged (where it was broken off from the main plant). Often plant material mimics some of the human parasites. This comparison is one of the best examples. These artifacts are occasionally submitted as proficiency testing specimens. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A14
Figure 9.10.3-A14

(a) egg. This egg has been described as having a thick, radially striated shell containing a six-hooked embryo (oncosphere). (b) Pollen grain. Note that this trilobed pollen grain has a similar type of “shell” and, if turned the right way, could resemble a egg. This represents another confusion between a helminth egg and a plant material artifact. When examining fecal specimens in a wet preparation, tap on the coverslip to get objects to move around. As they move, you can see more morphological detail. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.3-A15
Figure 9.10.3-A15

(a) egg. This egg is typical and is characterized by the barrel shape with thick shell and two polar plugs. (b) Bee pollen. This artifact certainly mimics the actual egg. However, note that the actual shape is somewhat distorted. This is an excellent example of a parasite “look-alike” and could be confusing. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.5-A1
Figure 9.10.5-A1

Procedure for processing fresh stool for the ova and parasite examination. Special stains will be necessary for and (modified acid-fast) and the microsporidia (modified trichrome, calcofluor). Immunoassay kits are now available for some of these organisms. If the permanent staining method (iron hematoxylin) contains a carbol fuchsin step, the coccidia will stain pink. Symbols: †, some protozoa may not be identified using the wet examination only; ‡, protozoa (primarily trophozoites) can be identified and cysts can be confirmed.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.5-A2
Figure 9.10.5-A2

Procedure for processing liquid specimens for the ova and parasite examination. Polyvinyl alcohol (PVA) and specimen will be mixed together on the slide, allowed to air dry, and then stained (fixation is sufficient for liquid specimen but not for formed stool). Symbols: †, some protozoa may not be identified from the concentration procedure; ‡, protozoa (trophozoites can be identified).

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.5-A3
Figure 9.10.5-A3

Procedure for processing preserved stool for the ova and parasite examination. Fixatives and effects: mercuric chloride, best polyvinyl alcohol (PVA) (trichrome, iron hematoxylin); zinc, current best substitute (trichrome, hematoxylin probably okay); copper sulfate, fair substitute (trichrome, iron hematoxylin: both fair to poor); sodium acetate-acetic acid-formalin, good substitute for PVA fixative (iron hematoxylin is best, and trichrome is okay).

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.5-A4
Figure 9.10.5-A4

Procedure for processing sodium acetate-acetic acid-formalin (SAF)-preserved stool for the ova and parasite examination. SAF can also be used with EIA, fluorescent-antibody, and cartridge immunoassay kits and the modified trichrome stain for microsporidia.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Image of Figure 9.10.5-A5
Figure 9.10.5-A5

Use of various fixatives and their recommended stains. PVA, polyvinyl alcohol; SAF, sodium acetate-acetic acid-formalin. Five or 10% formalin, SAF, and some of the single-vial systems can also be used with immunoassay kits and the modified trichrome stains for microsporidia.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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References

/content/book/10.1128/9781555817435.chap9.10
1. Ash, L. R.,, and T. C. Orihel. 1984. Atlas of Human Parasitology, 2nd ed. ASCP Press, Chicago, IL.
2. Ashfag-Drewett, R.,, C. Allen,, and R. L. Harrison. 1990. Detached ciliary tufts: comparison with intestinal protozoa and a review of the literature. Am. J. Clin. Pathol. 93:541545.
3. Garcia, L. S. 2007. Diagnostic Medical Parasitology, 5th ed. ASM Press, Washington, DC.
4. Garcia, L. S. 2009. Practical Guide to Diagnostic Parasitology, 2nd ed. ASM Press, Washington, DC.
5. Garcia, L. S.,,and R. Y. Shimizu.1997. Evaluation of nine immunoassay kits (enzyme immunoassay and direct fluorescence) for detection of Giardia lamblia and Cryptosporidium parvum in human fecal specimens. J. Clin. Microbiol. 35:15261529.
6. Garcia, L. S.,, and R. Y. Shimizu. 2000. Detection of Giardia lamblia and Cryptosporidium parvum antigens in human fecal specimens using the ColorPAC combination rapid solid-phase qualitative immunochromatographic assay. J. Clin. Microbiol. 38:12671268.
7. Hanson, K.L.,,and C. P. Cartwright.2001. Use of an enzyme immunoassay does not eliminate the need to analyze multiple stool specimens for sensitive detection of Giardia lamblia. J. Clin. Microbiol. 39:474477.
8. Isenberg, H. D. (ed.). 2004. Clinical Microbiology Procedures Handbook, 2nd ed., vol. 2, p. 9.0.19.10.8.3. ASM Press, Washington, DC.
9. Wilson, M.,, and P. M. Schantz,. 2000. Parasitic immunodiagnosis, p. 11171122. In G. T. Strickland (ed.), Hunter's Tropical Medicine and Emerging Infectious Diseases, 8th ed. W. B. Saunders Co., Philadelphia, PA.
1.Code of Federal Regulations (29CFR1910. 1200 and 29CFR1910.1926).
2.Code of Federal Regulations (29CFR1910. 1450).
3.Code of Federal Regulations (29CFR1910. 1048) Update 27 May 1992.
4. Garcia, L.S.2007. Diagnostic Medical Parasitology, 5th ed. ASM Press, Washington, DC.
1.American Medical Association. 2009. Current Procedural Terminology (CPT) 2009. AMA Press, Chicago, IL.

Tables

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Table 9.10.1-A1

Clinical specimens: summary of artifacts resembling parasites

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.2-A1a

Body sites and specimen collection

MIF, merthiolate-iodine-formalin; SAF, sodium acetate-acetic acid-formalin; PVA, polyvinyl alcohol; FA, fluorescent-antibody assay.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.2-A1b

Body sites and specimen collection

MIF, merthiolate-iodine-formalin; SAF, sodium acetate-acetic acid-formalin; PVA, polyvinyl alcohol; FA, fluorescent-antibody assay.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.2-A2

Body sites and possible parasites recovered (trophozoites, cysts, oocysts, spores, adults, larvae, eggs, amastigotes, and trypomastigotes)

This table does not include every possible parasite that could be found in a particular body site. However, the most likely organisms have been listed. Modified from Garcia, L. S. 2007. , 5th ed. ASM Press, Washington, DC.

Disseminated in severely immunosuppressed individuals.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.2-A3a

Body site, specimen, and recommended stain(s)

PAS, periodic acid-Schiff; EM, electron microscopy; FA, fluorescent antibody.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.2-A3b

Body site, specimen, and recommended stain(s)

PAS, periodic acid-Schiff; EM, electron microscopy; FA, fluorescent antibody.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.2-A4a

Examination of tissues and body fluids

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.2-A4b

Examination of tissues and body fluids

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.2-A5a

Protozoa of the intestinal tract and urogenital system: key characteristics

PVA, polyvinyl alcohol; EM, electron microscopy.

Zymodeme analysis is based on the identification of various isoenzymes found in cultured isolates of . These zymodemes (given separate numbers) tend to separate into two groups: those from symptomatic patients, some of whom have extraintestinal amebiasis, tend to group with the zymodeme isolates characteristic of the pathogen , while those from asymptomatic carriers tend to group with the zymodeme isolates characteristic of the nonpathogen

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.2-A5b

Protozoa of the intestinal tract and urogenital system: key characteristics

PVA, polyvinyl alcohol; EM, electron microscopy.

Zymodeme analysis is based on the identification of various isoenzymes found in cultured isolates of . These zymodemes (given separate numbers) tend to separate into two groups: those from symptomatic patients, some of whom have extraintestinal amebiasis, tend to group with the zymodeme isolates characteristic of the pathogen , while those from asymptomatic carriers tend to group with the zymodeme isolates characteristic of the nonpathogen

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.2-A5c

Protozoa of the intestinal tract and urogenital system: key characteristics

PVA, polyvinyl alcohol; EM, electron microscopy.

Zymodeme analysis is based on the identification of various isoenzymes found in cultured isolates of . These zymodemes (given separate numbers) tend to separate into two groups: those from symptomatic patients, some of whom have extraintestinal amebiasis, tend to group with the zymodeme isolates characteristic of the pathogen , while those from asymptomatic carriers tend to group with the zymodeme isolates characteristic of the nonpathogen

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.2-A6a

Tissue protozoa: characteristics

CNS, central nervous system; BAL, bronchoalveolar lavage; GI, gastrointestinal; FA, fluorescent antibody; PAS, periodic acid-Schiff.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.2-A6b

Tissue protozoa: characteristics

CNS, central nervous system; BAL, bronchoalveolar lavage; GI, gastrointestinal; FA, fluorescent antibody; PAS, periodic acid-Schiff.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.2-A7a

Helminths: key characteristics

GI, gastrointestinal; CNS, central nervous system.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.2-A7b

Helminths: key characteristics

GI, gastrointestinal; CNS, central nervous system.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.2-A7c

Helminths: key characteristics

GI, gastrointestinal; CNS, central nervous system.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.2-A8a

Parasites found in blood: characteristics

GI, gastrointestinal.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.2-A8b

Parasites found in blood: characteristics

GI, gastrointestinal.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.2-A9a

Parasitic infections: clinical findings in healthy and compromised hosts

CNS, central nervous system; PVA, polyvinyl alcohol; EM, electron microscopy.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.2-A9b

Parasitic infections: clinical findings in healthy and compromised hosts

CNS, central nervous system; PVA, polyvinyl alcohol; EM, electron microscopy.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.2-A10

Fecal antigen detection method options

FITC, fluorescein isothiocyanate.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.6-A1a

Sources of commercial reagents and supplies

PVA, polyvinyl alcohol; MIF, merthiolate-iodine-formalin; SAF, sodium acetate-acetic acid-formalin; W, Wheatley; G, Gomori; DMSO, dimethyl sulfoxide; +, with acetic acid; −, without acetic acid.

Use grade with high hydrolysis and low viscosity for parasite studies.

Used for the identification of microsporidial spores in stool or other specimens.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.6-A1b

Sources of commercial reagents and supplies

PVA, polyvinyl alcohol; MIF, merthiolate-iodine-formalin; SAF, sodium acetate-acetic acid-formalin; W, Wheatley; G, Gomori; DMSO, dimethyl sulfoxide; +, with acetic acid; −, without acetic acid.

Use grade with high hydrolysis and low viscosity for parasite studies.

Used for the identification of microsporidial spores in stool or other specimens.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.6-A2a

Addresses of suppliers listed in Table 9.10.6-A1

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.6-A2b

Addresses of suppliers listed in Table 9.10.6-A1

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.6-A3

Sources of available reagents for immunodetection of parasitic organisms or antigens

Any procedure for the group or requires the use of fresh or fresh, frozen stools. All other tests (with the exception of direct fluorescent antibody [DFA] for the combination) can be used with fresh, frozen, or preserved stools (formalinized base, not PVA [some single-vial systems without PVA may be acceptable; consult the manufacturer]). Since the combination tests (DFA) are based on visual recognition of the fluorescing oocysts and/or cysts, the specimens must not be frozen if fresh stools are used for testing.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.6-A4

Addresses of suppliers listed in Table 9.10.6-A3

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.6-A5a

Commercial suppliers of diagnostic parasitology products

Much of the updated immunology testing information provided by Marianna Wilson (CDC). Abbreviations: DFA, direct fluorescent antibody; IB, immunoblot; IFA, indirect fluorescent antibody; IgG and IgM, immunoglobulins G and M; LA, latex agglutination; Rapid, rapid immunochromatographic. Company names may not reflect recent mergers and subsequent name changes.

Not Food and Drug Administration cleared for in vitro diagnostic use.

No updated information received since publication of the previous edition of this book.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.6-A5b

Commercial suppliers of diagnostic parasitology products

Much of the updated immunology testing information provided by Marianna Wilson (CDC). Abbreviations: DFA, direct fluorescent antibody; IB, immunoblot; IFA, indirect fluorescent antibody; IgG and IgM, immunoglobulins G and M; LA, latex agglutination; Rapid, rapid immunochromatographic. Company names may not reflect recent mergers and subsequent name changes.

Not Food and Drug Administration cleared for in vitro diagnostic use.

No updated information received since publication of the previous edition of this book.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.6-A5c

Commercial suppliers of diagnostic parasitology products

Much of the updated immunology testing information provided by Marianna Wilson (CDC). Abbreviations: DFA, direct fluorescent antibody; IB, immunoblot; IFA, indirect fluorescent antibody; IgG and IgM, immunoglobulins G and M; LA, latex agglutination; Rapid, rapid immunochromatographic. Company names may not reflect recent mergers and subsequent name changes.

Not Food and Drug Administration cleared for in vitro diagnostic use.

No updated information received since publication of the previous edition of this book.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.6-A5d

Commercial suppliers of diagnostic parasitology products

Much of the updated immunology testing information provided by Marianna Wilson (CDC). Abbreviations: DFA, direct fluorescent antibody; IB, immunoblot; IFA, indirect fluorescent antibody; IgG and IgM, immunoglobulins G and M; LA, latex agglutination; Rapid, rapid immunochromatographic. Company names may not reflect recent mergers and subsequent name changes.

Not Food and Drug Administration cleared for in vitro diagnostic use.

No updated information received since publication of the previous edition of this book.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Table 9.10.6-A5e

Commercial suppliers of diagnostic parasitology products

Much of the updated immunology testing information provided by Marianna Wilson (CDC). Abbreviations: DFA, direct fluorescent antibody; IB, immunoblot; IFA, indirect fluorescent antibody; IgG and IgM, immunoglobulins G and M; LA, latex agglutination; Rapid, rapid immunochromatographic. Company names may not reflect recent mergers and subsequent name changes.

Not Food and Drug Administration cleared for in vitro diagnostic use.

No updated information received since publication of the previous edition of this book.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.6-A6

Sources of parasitologic specimens (catalogs of available materials and price lists available from the companies and person listed)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Table 9.10.6-A7

Sources of Kodachrome slides (35 mm, 2 by 2 in.)

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
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Untitled

CPT codes for diagnostic parasitology

Each time a procedure requires multiple codes for billing, this information should be included in your protocol manuals, possibly in a separate section within the appendix (specifying that the procedure includes multiple coded procedures, thus the need for multiple codes; define procedure and each code required [could be in table format]). This information is similar to that required for the use of laboratory algorithm testing, in which multiple steps/procedures are required to complete a more comprehensive test or series of tests.

AFB, acid-fast bacilli.

Use nonspecific code due to the fact that no analyte is listed.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Untitled

CPT codes for diagnostic parasitology

Each time a procedure requires multiple codes for billing, this information should be included in your protocol manuals, possibly in a separate section within the appendix (specifying that the procedure includes multiple coded procedures, thus the need for multiple codes; define procedure and each code required [could be in table format]). This information is similar to that required for the use of laboratory algorithm testing, in which multiple steps/procedures are required to complete a more comprehensive test or series of tests.

AFB, acid-fast bacilli.

Use nonspecific code due to the fact that no analyte is listed.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10
Generic image for table
Untitled

CPT codes for diagnostic parasitology

Each time a procedure requires multiple codes for billing, this information should be included in your protocol manuals, possibly in a separate section within the appendix (specifying that the procedure includes multiple coded procedures, thus the need for multiple codes; define procedure and each code required [could be in table format]). This information is similar to that required for the use of laboratory algorithm testing, in which multiple steps/procedures are required to complete a more comprehensive test or series of tests.

AFB, acid-fast bacilli.

Use nonspecific code due to the fact that no analyte is listed.

Citation: Garcia L. 2010. Appendixes, p 772-831. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch9.10

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