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Chapter 12 : Medical Parasitology: Case Histories

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Abstract:

  • Protozoal infections
  • Helminth infections
  • Blood parasite infections
  • Diagnostic methods and proficiency testing

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.1
Figure 12.1

Case 1. Microscopic images (oil immersion 100× objective); permanent stained smear. doi:10.1128/9781555819002.ch12.f1

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.2
Figure 12.2

Case 1. trophozoites containing ingested RBCs. doi:10.1128/9781555819002.ch12.f2

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.3
Figure 12.3

Case 2. Protozoan. (Left) Trophozoite with “spiky” acanthapodia; (right) cyst with hexagonal double wall. doi:10.1128/9781555819002.ch12.f3

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.4
Figure 12.4

Case 3. Protozoan. (Left) Trophozoites growing on a nonnutrient agar plate seeded with bacteria; (right) stained trophozoite (note the more globular pseudopods compared with the organism in case 2). doi:10.1128/9781555819002.ch12.f4

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.5
Figure 12.5

Case 4. (Left) Stool fecal concentration sediment examined as a wet mount (appears to be negative); (right) protozoan trophozoite containing two nuclei, which are fragmented into several nuclear granules. doi:10.1128/9781555819002.ch12.f5

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.6
Figure 12.6

Case 5. (Left) Protozoan trophozoite seen in a wet mount; (right) protozoan cyst seen in a wet mount (note how round, distorted, and three-dimensional the cyst appears. doi:10.1128/9781555819002.ch12.f6

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.7
Figure 12.7

Case 5. (Left) (, ) trophozoite seen in a permanent stained smear; (right) cyst seen in a permanent stained smear (note how much more detail is seen compared to the wet mounts in Fig. 12.6 ). doi:10.1128/9781555819002.ch12.f7

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.8
Figure 12.8

Case 6. Microscopic images (oil immersion 100× objective); permanent stained smear. doi:10.1128/9781555819002.ch12.f8

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.9
Figure 12.9

Case 7. Microscopic images (oil immersion 100× objective); permanent stained smear. doi:10.1128/9781555819002.ch12.f9

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.10
Figure 12.10

Case 8. Helminth eggs. (Upper row) Wet mounts of concentration sediment. Note the polar filaments that lie between the oncosphere and the egg shell. (Bottom row) Permanent stained smear, eggs or artifacts. These images may or may not be actual eggs. On permanent stained smears, helminth egg morphology often appears distorted with very dark staining. doi:10.1128/9781555819002.ch12.f10

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.11
Figure 12.11

Case 9. Image from autopsy (colon). (Armed Forces Institute of Pathology photograph.) doi:10.1128/9781555819002.ch12.f11

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.12
Figure 12.12

Case 9. . (Top) Larvae in sputum; (second from top) short buccal capsule and genital primordium packet of cells in a rhabditiform (noninfective) larva; (third from top) clear image of the genital primordium packet of cells in a rhabditiform larva; (bottom) slit in the tail of filariform (infective) larva obtained using the Baermann concentration apparatus. doi:10.1128/9781555819002.ch12.f12

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.13
Figure 12.13

Case 10. (Top) Structure obtained from stool specimen; (lower four images) objects seen in the concentration sediment wet mount (using high dry 40× objective); second row, left is photographed at a lower magnification. (Bottom row, left, courtesy of Yanagida T et al., 18, http://www.parasitesandvectors.com/content/5/1/18 [accessed 9/14/2013].) doi:10.1128/9781555819002.ch12.f13

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.14
Figure 12.14

Case 10. gravid proglottids; note the large number of lateral uterine branches when counted on one side. doi:10.1128/9781555819002.ch12.f14

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.15
Figure 12.15

Case 11. Objects seen in the wet mount microscopic examination of concentration sediment. These objects measured about 140 by70 μm and were easily seen in the saline/iodine wet preparation examination. doi:10.1128/9781555819002.ch12.f15

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.16
Figure 12.16

Case 12. Image from autopsy (brain tissue). (From Sorvillo F et al, 2002; http://wwwnc.cdc.gov/eid/article/8/4/01-0273-f2.) doi:10.1128/9781555819002.ch12.f16

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.17
Figure 12.17

Case 12. . (Upper, left) Typical eggs isolated from raccoons; (right) adult worms isolated from raccoons. (Lower, left) Raccoon; (right) raccoon feces, “raccoon latrine.” doi:10.1128/9781555819002.ch12.f17

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.18
Figure 12.18

Case 13. Gross specimen (intracerebral lesion), measuring 3 by 4 cm. (From : a cooperative collection prepared and/or edited by H. Zaiman.) doi:10.1128/9781555819002.ch12.f18

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.19
Figure 12.19

Case 13. Routine pathology preparations from tissue seen in Fig. 12.18 . doi:10.1128/9781555819002.ch12.f19

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.20
Figure 12.20

Case 14. (Upper) Modified Ryan trichrome stain; (lower) phase-contrast microscopy. doi:10.1128/9781555819002.ch12.f20

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.21
Figure 12.21

Case 15. Blood films stained with blood stains. (Upper left) Thick blood film; (right) thin blood film. (Lower left) Thick blood film; (lower right) thin blood film. doi:10.1128/9781555819002.ch12.f21

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.22
Figure 12.22

Case 16. (Upper) Lesion on patient's arm; (lower) skin biopsy specimen from margin of lesion. doi:10.1128/9781555819002.ch12.f22

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.23
Figure 12.23

Case 16. Cutaneous leishmaniasis. (Left) Skin macrophage containing Leishman-Donovan bodies (note the nucleus and bar-shaped kinetoplast, arrows); (right) sand fly vector of leishmaniasis. (Images courtesy of the CDC Public Health Image Library.) doi:10.1128/9781555819002.ch12.f23

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.24
Figure 12.24

Case 16. (Left) Wet mount of organisms from culture; (right) Giemsa-stained smear of culture sediment. doi:10.1128/9781555819002.ch12.f24

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.25
Figure 12.25

Case 17. (Upper row, left) Objects seen in Giemsa-stained thin blood film; (right) example of organisms multiplying within the blood/patient blood film. (Bottom, left and right), Organisms in human blood films. Note the key structures indicated by circles. doi:10.1128/9781555819002.ch12.f25

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.26
Figure 12.26

Case 18. Blood films stained with Giemsa stain. (Left) Thick blood film; (right) thin blood film. doi:10.1128/9781555819002.ch12.f26

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.27
Figure 12.27

Case 18. Thin blood films stained with blood stains. “band” forms are evident where the developing trophozoites spread across the RBC. Note that the infected RBCs are normal to smaller than normal size compared with the uninfected RBCs. Also, note the dark malarial pigment seen in the band form on the right. doi:10.1128/9781555819002.ch12.f27

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.28
Figure 12.28

Case 19. Thin blood films stained with blood stains. In the image on the left, note the three small rings that are seen outside of the RBC (circle); this is very unusual for a case of malaria, but can be seen in blood films in which spp. are present. There are a number of rings in the image on the right, including the typical Maltese cross formation with four ring forms (circle). doi:10.1128/9781555819002.ch12.f28

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.29
Figure 12.29

Case 20. Thin blood films stained with blood stains (courtesy of the CDC Public Health Image Library). These organisms tend to mimic and . doi:10.1128/9781555819002.ch12.f29

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.30
Figure 12.30

Case 21. Objects seen in a wet mount (left) and a permanent stained smear (right). The structure on the right measures approximately 16 μm, and the structures on the left measure approximately 65 μm. doi:10.1128/9781555819002.ch12.f30

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.31
Figure 12.31

Case 21. Objects in a concentrated fecal sediment stained with modified acid-fast stain. (Left) Note the individual sporozoites within the oocyst wall (circle); these are not visible in every oocyst. Remember, all oocysts are immediately infectious when passed, regardless of whether the sporozoites are visible or are not seen within the oocyst. (Right) Note the cross/diagonal lines within the microsporidian spores (circles), representing the polar tubule. doi:10.1128/9781555819002.ch12.f31

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.32
Figure 12.32

Case 22. These images (trichrome stain) contain structures that did not stain using Wheatley's trichrome stain; they measure approximately 8 to 10 μm and appear as “ghost” cells. doi:10.1128/9781555819002.ch12.f32

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.33
Figure 12.33

Case 22. (Upper) This image contains a modified acid-fast stain of stool using a 1 to 3% acid decolorizer (no stronger); oocysts, measuring approximately 8 to 10 μm, are seen. Notice that some stain and some remain clear (resemble wrinkled cellophane); thus they are modified acid-fast variable. Even with the 1% acid decolorizer, some oocysts may appear clear or very pale. Most laboratories are currently using 1% acid for the decolorizer. oocysts are not sporulated when passed, so no internal structures will be seen within the oocysts. (Lower, left) When a modified safranin technique is used, the oocysts uniformly stain a brilliant reddish orange if fecal smears are heated in a microwave during staining (courtesy CDC Public Health Image Library, photographed at a larger magnification [8 to 10 μm]); (right) note the autofluorescence of the oocysts; this preparation used the filters appropriate for calcofluor white. The autofluorescence can vary tremendously among clinical specimens; some oocysts may fluorescence at between ± to 31. doi:10.1128/9781555819002.ch12.f33

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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Image of Figure 12.34
Figure 12.34

Case 25. Microsporidial spores stained with the modified trichrome stain (Ryan Blue). (Upper) Note the diagonal or horizontal lines within the spores, indicating the presence of the polar tubules (circle). (Lower) Spores photographed at a lower magnification; however, some of the polar tubules are visible (circle). Although these two images clearly demonstrate the spore and polar tubule morphology, some fecal smears are too thick and spores may not be visible. doi:10.1128/9781555819002.ch12.f34

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
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References

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Tables

Generic image for table
TABLE 12.1

Parasitemia determined from conventional light microscopy: clinical correlation

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
Generic image for table
TABLE 12.2

Test kits for , , and / group

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12
Generic image for table
TABLE 12.3

Approaches to stool testing: recommended orders

Citation: Garcia L. 2016. Medical Parasitology: Case Histories, p 249-295. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch12

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