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Chapter 11 : Diagnostic Medical Parasitology

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Abstract:

The key to performance of diagnostic medical parasitology procedures is formal training and experience. The majority of diagnostic parasitology procedures can be performed either within the hospital setting or in an offsite location. The majority of physician office laboratories are not involved in diagnostic parasitology testing; however, as more molecular (nonmicroscopic) methods are developed, they may become more widely used in this setting. The specimen most commonly submitted to the diagnostic parasitology laboratory is the stool specimen, and the most commonly performed procedure in parasitology is the ova and parasite (O&P) examination, which comprises three separate protocols: the direct wet mount, the concentration, and the permanent-stained smear. Both flotation and sedimentation methods are available, the most common procedure being the formalin-ethyl acetate sedimentation method (formerly used was the formalin-ether method). Another simplified culture option has been developed for the isolation and identification of . This approach has proven to be much more sensitive than the examination of wet preparations alone and has been incorporated into use in many institutions with dramatic increases in the number of positive specimens identified.

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11

Key Concept Ranking

Parasitic Diseases
1.1804464
Chemicals
0.88745177
Cryptosporidium parvum
0.71428573
1.1804464
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Figures

Image of FIGURE 1
FIGURE 1

Sample of Para-Pak parasitology products (courtesy of Meridian Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 3
FIGURE 3

Fecal collection and transport vials (courtesy of Evergreen Scientific).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 4
FIGURE 4

PVA preservative (prepared with the zinc base) (courtesy of Evergreen Scientific).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 5
FIGURE 5

Example of a 10% formalin fecal concentration system, the PARA-SED system (courtesy of Medical Chemical Corporation).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 6
FIGURE 6

Example of a 10% formalin vial, the Para-Pak Ultra (courtesy of Meridian Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 2
FIGURE 2

Representative sample of stool collection vials. From left to right they are modified PVA (prepared with a copper base), SAF fixative; 5% buffered formalin, 10% buffered formalin, ZPVA (prepared with a zinc base), Unifix (single-vial collection system), and PVA (prepared with a mercury base) (courtesy of Medical Chemical Corporation).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 7
FIGURE 7

Example of a single-vial fecal collection system, Para-Pak ECOFIX (courtesy of Meridian Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 8
FIGURE 8

Example of a single-vial fecal collection system, ProtoFix (courtesy of Alpha-Tec).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 9
FIGURE 9

MERI/FLUOR DFA kit for the detection of and (courtesy of Meridian Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 10
FIGURE 10

Immunoassay for (courtesy of Meridian Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 11
FIGURE 11

ColorPAC cartridge for the detection of and . This system can be used with fresh, frozen, or formalinized stool specimens. The top cartridge shows a positive flow control, the middle cartridge shows a specimen positive for , and the bottom cartridge shows a specimen positive for . (Courtesy of Genzyme Diagnostics, distributed by Becton Dickinson.)

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 12
FIGURE 12

/ Combo (ColorPac) assay procedure (courtesy of Genzyme Corporation, distributed by Becton Dickinson).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 13
FIGURE 13

ImmunoCard STAT! / assay procedure (courtesy of Meridian Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 14
FIGURE 14

Triage parasite panel for the detection of , and the group. It is important to remember that this system requires fresh or frozen stool specimens; formalinized specimens cannot be used in this procedure. The specimen shown is positive for . (Courtesy of BIOSITE Diagnostics.)

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 15
FIGURE 15

Triage parasite panel. The specimen shown is positive for the / group. (Courtesy of BIOSITE Diagnostics.)

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 16
FIGURE 16

Triage parasite panel. The specimen shown is positive for . (Courtesy of BIOSITE Diagnostics.)

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 17
FIGURE 17

Triage assay procedure (courtesy of BIOSITE Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 18
FIGURE 18

D'Antoni's iodine (used during the examination of fecal wet preparations) (courtesy of Hardy Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 19
FIGURE 19

PARA-SED fecal concentration system (courtesy of Medical Chemical Corporation).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 20
FIGURE 20

SED-CONNECT closed concentration system for the recovery of helminth eggs, larvae, protozoan cysts, coccidian oocysts, and microsporidial spores (courtesy of Medical Chemical Corporation).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 21
FIGURE 21

Formalin stool collection vial (SED-CONNECT and PARA-SED sedimentation concentration systems) (courtesy of Medical Chemical Corporation).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 22
FIGURE 22

Para-Pak CON-Trate fecal concentration system (courtesy of Meridian Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 23
FIGURE 23

Para Kit, fecal concentrator kit (courtesy of Hardy Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 24
FIGURE 24

Para Kit, fecal concentrator funnel (courtesy of Hardy Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 25
FIGURE 25

Fecal parasite concentrators (FPC [left] and FPC JUMBO [right]). These are designed for use with a 15- or 50-ml centrifuge tube. (Courtesy of Evergreen Scientific).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 26
FIGURE 26

FPC HYBRID improved version of the fecal parasite concentrator (courtesy of Evergreen Scientific).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 27
FIGURE 27

CONSED solution used for concentration procedures (courtesy of Alpha-Tec).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 28
FIGURE 28

Semiautomated sampling and examination system for fecal concentration sediments (courtesy of DiaSys Corporation).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 29
FIGURE 29

Detailed view (from Fig. 27) of the glass viewing chamber that holds a portion of the concentration sediment and rests on the microscope stage. The fecal material is viewed through the microscope focused on the contents in the chamber. (Courtesy of DiaSys Corporation).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 30
FIGURE 30

Various stains used in diagnostic parasitology (courtesy of Medical Chemical Corporation).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 31
FIGURE 31

Various reagents and stains used in the ECO-STAIN system (courtesy of Meridian Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 32
FIGURE 32

Trichrome stain (courtesy of Hardy Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 33
FIGURE 33

Trichrome-Plus stain (courtesy of Alpha-Tec).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 34
FIGURE 34

Trichrome-Blue stain used for the detection of microsporidial spores (courtesy of Meridian Diagnostics). See also Fig. 29 .

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 35
FIGURE 35

Mayer's albumin used as an adhesive for preparation of permanent stains from SAF fixative (courtesy of Hardy Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 36
FIGURE 36

Sputocol brand sputum collection kit (courtesy of Evergreen Scientific).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 37
FIGURE 37

PCA pinworm egg collection-transport apparatus. The PCA combines the utility of the cellulose tape with the ready-to-use convenience of the adhesive paddle (courtesy of Evergreen Scientific).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 38
FIGURE 38

In Pouch TV culture pouch for the growth and identification of (courtesy of BIOMED Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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Image of FIGURE 39
FIGURE 39

In Pouch TV subculture medium for the growth and identification of (courtesy of BIOMED Diagnostics).

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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References

/content/book/10.1128/9781555817961.chap11
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44. Pani, S. P.,, S. L. Hoti,, A. Elango,, J. Yuvaraj,, R. Lall,, and K. D. Ramaiah. 2000. Evaluation of the ICT whole blood antigen card test to detect infection due to nocturnally periodic Wuchereria bancrofti in South India. Trop. Med. Int. Health 5:359363.
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Tables

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TABLE 1

Body sites and specimen collection

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
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TABLE 2

Stool collection: fresh versus preserved

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
Generic image for table
TABLE 3

Preservatives and procedures commonly used in diagnostic parasitology (stool specimens)

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
Generic image for table
TABLE 4

Rapid diagnostic procedures (nontraditional approaches)

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
Generic image for table
TABLE 5

Stool processing

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
Generic image for table
TABLE 6

Sources of commercial reagents and supplies

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
Generic image for table
TABLE 7

Alternative approaches to malaria diagnosis

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11
Generic image for table
TABLE 8

Summary of commercially available kits for immunodetection of parasitic organisms or antigens

Citation: Garcia L. 2002. Diagnostic Medical Parasitology, p 274-305. In Truant A (ed), Manual of Commercial Methods in Clinical Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555817961.ch11

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