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Chapter 18 : Parasites

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Abstract:

Parasites are an important cause of human disease worldwide. Malaria alone was responsible for 584,000 estimated deaths in 2013, while millions of others died from Chagas disease, African trypanosomiasis, strongyloidiasis, amebiasis, leishmaniasis, ascariasis and schistosomiasis ( ). Eleven parasitic infections have been identified by the World Health Organization (WHO) as neglected tropical diseases because they threaten the health of millions of individuals and disproportionately impact impoverished individuals ( ). The Centers for Disease Control and Prevention (CDC) has also identified five parasitic infections that have significant public health implications for individuals living in the United States, demonstrating that parasitic infections are not limited to the tropical regions of the world.

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Figures

Image of Figure 1
Figure 1

Resected segment of colon showing multiple ulcers with focal perforation due to amebiasis. Amebic liver abscess with vial of aspirated abscess material demonstrating the characteristic “anchovy paste” appearance (Gross photos courtesy of Dr. Mae Melvin and Dr. E. West, CDC Public Health Image Library). / trophozoite (left) and cyst (right) (modified trichrome, 1000×). Reproduced with permission from Pritt BS. . Northfield, IL: College of American Pathologists, 2014. If ingested RBCs are seen within the cytoplasm of the trophozoite, then a presumptive diagnosis of can be made. Otherwise, the trophozoites and cysts of and are indistinguishable. Note that two of the four nuclei are visible within the cyst as well as a prominent chromatoid body.

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 2
Figure 2

trophozoites containing two nuclei, central axonemes and curved median bodies (left) and cyst with two of four nuclei visible (right) (trichrome stain, 1000×). Reproduced with permission from Pritt BS. . Northfield, IL: College of American Pathologists, 2014.

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 3
Figure 3

Round oocysts of sp. stained with a modified acid-fast stain. Note that not all oocysts stain equally and that sporozoites can occasionally be seen within some oocysts (1000×).

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 4
Figure 4

Round oocysts of stained using a modified acid-fast stain (1000×). They have a similar appearance to the oocysts of but are larger (8 to 10 μm in diameter). Note that not all oocysts stain uniformly, producing unstained “ghost” cells.

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 5
Figure 5

Immature oocyst of containing one sporocyst (modified acid-fast, 1000×). The oocysts are significantly larger than those of spp. and , measuring approximately 33 μm in length.

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 6
Figure 6

Microsporidial spores of in a concentrated fecal specimen demonstrating a characteristic band-like stripe (trichrome blue stain, 1000×). These tiny spores measure 0.8 to 1.4 μm in length and are therefore challenging to identify on standard microscopic preparations.

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 7
Figure 7

spp. trophozoites and cysts in a skin biopsy of an ulcerating skin lesion. Organisms are seen invading blood vessels in the dermis (left, H&E, 200×; arrow shows lumen of blood vessel). Higher magnification shows trophozoites with a small nucleus and large karyosome (top right) and cysts with a characteristic hexagonal double cell wall (bottom right) (H&E, 1000×).

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 8
Figure 8

Brain biopsy with multiple invading trophozoites; cysts are also commonly seen with both and infections but are not seen in this image.

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 9
Figure 9

. Free and intracellular arc-shaped tachyzoites in a brain impression smear (Giemsa, 1000×).

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 10
Figure 10

Characteristic ulcer of cutaneous leishmaniasis with proximal lymphatic spread (courtesy of Dr. Martins Castro and Dr. Lucille K. Georg, CDC PHIL). Air-dried impression smear from the edge of a cutaneous ulcer shows a macrophage containing numerous amastigotes (arrowhead denotes the macrophage nucleus, Giemsa, 1000×). A nucleus and rod-like kinetoplast can be seen within individual amastigotes (arrows).

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 11
Figure 11

trypomastigotes in a Giemsa-stained peripheral blood film. Note the characteristic large kinetoplast at the posterior end, central nucleus, and free flagellum at the anterior end (top, 1000×). amastigotes in cardiac tissue (H&E, 400×, inset 1000×).

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 12
Figure 12

life cycle stages in the human host: early stage trophozoite (top left), late-stage trophozoite (top right), mature schizont (bottom left) and gametocyte (bottom right); (Giemsa, 1000×). Images from reference .

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 13
Figure 13

Multiple parasite forms of MO1, showing pleomorphic intracellular forms, a characteristic “tetrad” form (arrowhead) and extracellular parasites (arrow) (Giemsa, 1000×). Image from reference .

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 14
Figure 14

larvae invading the intestinal mucosa in a case of hyperinfection (H&E, 1000×).

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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Image of Figure 15
Figure 15

mature mite (left), immature mite (bottom right) and egg (top right) in an unstained preparation of skin scrapings.

Citation: Theel E, Pritt B. 2016. Parasites, p 411-466. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0013-2015
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