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Chapter 10 : Artifacts That Can Be Confused with Parasitic Organisms

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Artifacts That Can Be Confused with Parasitic Organisms, Page 1 of 2

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Abstract:

  • Protozoa
    • Amebae
    • Flagellates
    • Ciliates
  • Coccidia and microsporidia
    • spp. and
    • Microsporidia
  • Blood and body fluids
    • Malaria parasites and spp.
    • Leishmaniae and trypanosomes
    • Microfilariae
    • Body fluids: ciliated epithelial cells
  • Helminths
    • Adult worms and larvae
    • Eggs
  • Human cells
    • Polymorphonuclear leukocytes
    • Eosinophils
    • Macrophages
    • Lymphocytes
    • Red blood cells
    • Charcot-Leyden crystals
  • Nonhuman elements seen in feces (yeast cells)

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Figures

Image of FIGURE 10.1
FIGURE 10.1

Various structures that may be seen in stool preparations. (Top row) Macrophage (left) and epithelial cells (right) that can be confused with trophozoites. (Second row) PMN with a fragmented nucleus (left) and artifact (right) that can be confused with spp. cysts. (Third row) Two artifacts that can resemble protozoan cysts. (Fourth row) Yeast cells (left) and an artifact (right) that can be confused with spp. and , respectively, on positive acid-fast stains; it is important to measure the structures and organisms carefully before confirming organism identification. (Bottom row) Yeast cells (left) that can be confused with microsporidial spores (however, notice the budding cell within the circle), and artifacts (right) that can also be confused with microsporidial spores; these were thought to be small yeast cells. doi:10.1128/9781555819002.ch10.f1

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.2
Figure 10.2

Fungi parasitizing . (Upper) containing ingested . (Lower) (A) (or ) sp. within the cytoplasm; (B) sp. within the nucleus. doi:10.1128/9781555819002.ch10.f2

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.3
Figure 10.3

Free-living freshwater flagellates. (Upper) . (Lower) . These organisms can be confused with parasitic protozoa, particularly if motility is seen in a wet mount of fresh stool contaminated with freshwater. doi:10.1128/9781555819002.ch10.f3

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.4
Figure 10.4

Free-living freshwater ciliates. (Left) . (Right) . (Courtesy of David Nelson.)doi:10.1128/9781555819002.ch10.f4

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.5
Figure 10.5

and . (Left) (, ), trichrome stain. (Right) , iodine wet mount. Note the size differences of the two organisms. doi:10.1128/9781555819002.ch10.f5

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.6
Figure 10.6

Various structures within the RBC. (A) Malarial “ring” form (early trophozoite); (B) platelet on the RBC surface; (C) Howell-Jolly body; (D) Cabot's ring. (Illustration by Sharon Belkin.) doi:10.1128/9781555819002.ch10.f6

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of FIGURE 10.7
FIGURE 10.7

(Top row and second row) Stain deposition on the surface of uninfected RBCs that could easily be confused with developing spp. stages. (Third row) gametocytes that have rounded up and no longer appear as the typical crescent-shaped gametocytes that are normally seen (could be due to low temperatures and/or storage for too many hours in EDTA blood). (Fourth row) Developing trophozoites that appear to resemble gametocytes (found on blood smears prepared from EDTA blood that had been collected more than 8 h previously). (Bottom row) RBCs containing Howell-Jolly bodies that could be confused with very small, young ring forms of spp. doi:10.1128/9781555819002.ch10.f7

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.8
Figure 10.8

Exflagellation of microgametocyte; these microgametes could easily be confused with some type of spirochete. These forms were seen in blood films prepared from blood stored for longer than 12 h in EDTA prior to additional smear preparation. (Left) Male gametocyte (microgametocyte) undergoing exflagellation. (Right) Single strand—very easily resembles a spirochete. doi:10.1128/9781555819002.ch10.f8

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.9
Figure 10.9

(Left) . (Right) . Note that the amastigotes have the bar structure while the amastigotes do not; also has a “halo” around the organisms. doi:10.1128/9781555819002.ch10.f9

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.10
Figure 10.10

Fungal spores ( type). Artifacts that can resemble microfilariae in stained blood films; these structures are not parasites but instead are some type of thread. Note that there is little to no internal structure visible. (Left) Courtesy of the CDC Public Health Image Library. (Middle and right) Photographed at a higher magnification than the image on the left. doi:10.1128/9781555819002.ch10.f10

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.11
Figure 10.11

Bronchial epithelium cells. When these cells disintegrate, the ciliary tufts may be visible and may be confused with protozoan flagellates or ciliates (detached ciliary tufts = ciliocytophthoria). doi:10.1128/9781555819002.ch10.f11

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.12
Figure 10.12

(Top) Root hair. (Middle) Root hair. Note that there is no internal structure visible within the root hairs. (Bottom) rhabditiform larva. Note the short buccal cavity at the head end of the larva and the genital primordial packet of cells within the curved portion of the body (arrow). doi:10.1128/9781555819002.ch10.f12

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.13
Figure 10.13

worms. (Upper) Adult worms (called hairworms or horsehair worms), which measure 20 to 50 cm long and are very slender. (Lower) Characteristic structure of worms. (A) Diagram of anterior end; (B) diagram of posterior end of a male worm in the genus ; (C) whole worm. Bar, 1 cm. (Illustration by Sharon Belkin.) doi:10.1128/9781555819002.ch10.f13

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of FIGURE 10.14
FIGURE 10.14

(Top) Slug recovered in stool; note the linear markings on the body. (Second) Underside of the slug. (Third) Fresh, living trematode; note the resemblance to the slug. (Bottom) Actual slug; note the markings on the body (this slug transmits ). (Top and second, courtesy of Larry D. Gray, Clinical Microbiology Laboratory Consultants, LLC; bottom two images courtesy of the CDC Public Health Image Library.) doi:10.1128/9781555819002.ch10.f14

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of FIGURE 10.15
FIGURE 10.15

Various artifacts that may be seen in stool preparations (wet mounts or permanent stained smears). Many of these structures are pollen grains or egglike objects. Visually, they can be confused with some of the following helminth eggs: , , hookworm, and . doi:10.1128/9781555819002.ch10.f15

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of FIGURE 10.16
FIGURE 10.16

Various artifacts that may be seen in stool preparations (wet mounts). Note the egg-like structure in the fourth row (left). There is a small bubble (within the circle) that mimics the small knob found at the abopercular end of a egg. doi:10.1128/9781555819002.ch10.f16

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of FIGURE 10.17
FIGURE 10.17

Various types of pollen grains and a root hair. These structures can mimic various helminth eggs (, ), as well as nematode larvae. (Bottom row, left) Plant root hair (can mimic helminth larvae). (Row 4 from top: left, courtesy of Randy Oliver, photo by Gretchen D. Jones, United States Department of Agriculture; right, courtesy of http://cactiguide.com/forum/viewtopic.php?t=12480&view=next [accessed 7/23/13]). doi:10.1128/9781555819002.ch10.f17

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.18
Figure 10.18

(Upper) “Beaver bodies,” which are algae occasionally found in stool; (lower) leaf structure which resembles a trematode. (Courtesy of Joseph Dipersio.) doi:10.1128/9781555819002.ch10.f18

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.19
Figure 10.19

(Left) PMNs in a fecal specimen stained with trichrome stain. Note the lobed nuclei; if these cells have been in the stool for some time (unpreserved), the nuclei may fragment into four or five pieces, thus resembling multiple nuclei seen in amebic cysts. Note the two RBCs in the upper left. (Middle) Macrophages. Although these cells often resemble amebic trophozoites, the ratio of nuclear material to cytoplasm is quite different from that seen in actual protozoa (more nuclear material per cytoplasm in human cells). (Right) PMNs and macrophages; also note the eosinophil (arrow). doi:10.1128/9781555819002.ch10.f19

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.20
Figure 10.20

White blood cells in a stained blood film. ( ) Lymphocyte. ( ) Basophil. ( ) Eosinophil. ( ) Monocyte. ( ) PMN. doi:10.1128/9781555819002.ch10.f20

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.21
Figure 10.21

Charcot-Leyden (CL) crystals. These crystals are formed from the breakdown products of eosinophils and basophils and may be present in the stool, sputum, or other specimens with or without eosinophils. They tend to stain red to red-purple on the permanent stained fecal smears, often darker than nuclear material, and although the shape is consistent, there is a large size range in a single fecal smear or sputum mount. (Upper, left and right) CL crystals in trichrome-stained fecal smear. (Lower, left) CL crystals in a sputum specimen. (Lower, right) Pineapple crystals in stool. These may be confused with CL crystals; however, the pineapple crystals are much more slender. doi:10.1128/9781555819002.ch10.f21

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.22
Figure 10.22

Yeast cells in clinical specimens. (Upper and middle) Trichrome-stained fecal smears. Depending on the size and permanent stain used (trichrome, modified acid-fast, modified trichrome), single yeast cells can often be confused with the coccidia or microsporidia. (Bottom left) Various yeasts in blood films; (right) within monocytes. doi:10.1128/9781555819002.ch10.f22

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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Image of Figure 10.23
Figure 10.23

(Top row, left) egg (130 to 150 μm by 63 to 90 μm) (image is lower magnification than egg); (right) egg (38 to 45 μm by 22 to 30 μm). (Middle row, left) egg (51 to 68 μm by 30 to 35 μm), passed in the stool (resembles egg of ); (right) eggs in liver. (Bottom row, left) egg; (right) egg. Note the striated shell of compared with the nonstriated shell seen in the egg. doi:10.1128/9781555819002.ch10.f23

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
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References

/content/book/10.1128/9781555819002.garcia.ch10
1. Belding DL. 1965. Textbook of Parasitology, 3rd ed. Appleton-Century-Crofts, New York, NY.
2. Patterson DJ. 2003. Free-Living Freshwater Protozoa. ASM Press, Washington, D.C.
3. Smith JW,, McQuay RM,, Ash LR,, Melvin DM,, Orihel TC,, Thompson JH. 1976. Diagnostic Medical Parasitology: Intestinal Protozoa. American Society of Clinical Pathologists, Chicago, IL.
4. Ashfag-Drewett R,, Allen C,, Harrison RL. 1990. Detached ciliary tufts: comparison with intestinal protozoa and a review of the literature. Am J Clin Pathol 93:541545.
5. Hadziyannis E,, Yen-Lieberman B,, Hall G,, Procop GW. 2000. Ciliocytophthoria in clinical virology. Arch Pathol Lab Med 124:12201223.
6. Mahoney CA,, Sherwood N,, Yap EH,, Singleton TP,, Whitney DJ,, Cornbleet PJ. 1993. Ciliated cell remnants in peritoneal dialysis fluid. Arch Pathol Lab Med 117:211213.
7. Vila M,, Thompson K,, Erdem G. 2011. Motile ciliary microorganisms in peritoneal fluid. Diagn Cytopathol 39:606607.
8. Beaver PC,, Jung RC,, Cupp EW. 1984. Clinical Parasitology, 9th ed. Lea & Febiger, Philadelphia, PA.
9. Garcia LS. 2007. Diagnostic Medical Parasitology, 5th ed. ASM Press, Washington, DC.
10. Leonidas DD,, Elbert BL,, Zhou Z,, Leffler H,, Ackerman SJ,, Acharya KR. 1995. Crystal structure of human Charcot-Leyden crystal protein, an eosinophil lysophospholipase, identifies it as a new member of the carbohydrate-binding family of galectins. Structure 3:13791393.
11. Rosenberg HF,, Dyer KD,, Foster PS. 2013. Eosinophils: changing perspectives in health and disease. Nat Rev Immunol 13:922.
12. Fuehrer HP,, Igel P,, Auer H. 2011. Capillaria hepatica in man—an overview of hepatic capillariosis and spurious infections. Parasitol Res 109:969979.
13. Narumoto J,, Ueda H,, Tsuchida H,, Yamashita T,, Kitabayashi Y,, Fukui K. 2006. Regional cerebral blood flow changes in a patient with delusional parasitosis before and after successful treatment with risperidone: a case report. Prog Neuropsychopharmacol Biol Psychiatry 30:737740.
14. Freudenmann RW,, Lepping P. 2009. Delusional infestation. Clin Microbiol Rev 22:690732.
15. Aw DC,, Thong JY,, Chan HL. 2004. Delusional parasitosis: case series of 8 patients and review of the literature. Ann Acad Med Singapore 33:8994.
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Tables

Generic image for table
TABLE 10.1

Artifacts and other confusing cells and organisms

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10
Generic image for table
TABLE 10.2

Artifacts that resemble parasites

Citation: Garcia L. 2016. Artifacts That Can Be Confused with Parasitic Organisms, p 195-211. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch10

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