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  • Authors: Elitza S. Theel1, Bobbi S. Pritt2
  • Editors: Randall T. Hayden3, Donna M. Wolk4, Karen C. Carroll5, Yi-Wei Tang6
    Affiliations: 1: Mayo Clinic, Rochester, MN 55905; 2: Mayo Clinic, Rochester, MN 55905; 3: St. Jude’s Children’s Research Hospital, Memphis, TN; 4: Geisinger Clinic, Danville, PA; 5: Johns Hopkins University Hospital, Baltimore, MD; 6: Memorial Sloan-Kettering Institute, New York, NY
  • Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
  • Received 18 May 2015 Accepted 03 February 2016 Published 12 August 2016
  • Bobbi S. Pritt, [email protected]
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  • Abstract:

    Parasites are an important cause of human disease worldwide. The clinical severity and outcome of parasitic disease is often dependent on the immune status of the host. Specific parasitic diseases discussed in this chapter are amebiasis, giardiasis, cryptosporidiosis, cyclosporiasis, cystoisosporiasis, microsporidosis, granulomatous amebic encephalitis, toxoplasmosis, leishmaniasis, Chagas disease, malaria, babesiosis, strongyloidiasis, and scabies.

  • Citation: Theel E, Pritt B. 2016. Parasites. Microbiol Spectrum 4(4):DMIH2-0013-2015. doi:10.1128/microbiolspec.DMIH2-0013-2015.


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Parasites are an important cause of human disease worldwide. The clinical severity and outcome of parasitic disease is often dependent on the immune status of the host. Specific parasitic diseases discussed in this chapter are amebiasis, giardiasis, cryptosporidiosis, cyclosporiasis, cystoisosporiasis, microsporidosis, granulomatous amebic encephalitis, toxoplasmosis, leishmaniasis, Chagas disease, malaria, babesiosis, strongyloidiasis, and scabies.

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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.

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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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.

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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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×).

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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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.

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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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.

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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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.

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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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×).

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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Brain biopsy with multiple invading trophozoites; cysts are also commonly seen with both and infections but are not seen in this image.

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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. Free and intracellular arc-shaped tachyzoites in a brain impression smear (Giemsa, 1000×).

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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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).

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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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×).

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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amastigotes in cardiac tissue (H&E, 400×, inset 1000×).

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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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 312 .

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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Multiple parasite forms of MO1, showing pleomorphic intracellular forms, a characteristic “tetrad” form (arrowhead) and extracellular parasites (arrow) (Giemsa, 1000×). Image from reference 312 .

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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larvae invading the intestinal mucosa in a case of hyperinfection (H&E, 1000×).

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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mature mite (left), immature mite (bottom right) and egg (top right) in an unstained preparation of skin scrapings.

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015
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Manifestation of parasitic infections in immunocompetent and immunocompromised hosts

Source: microbiolspec August 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0013-2015

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