Diagnostic Medical Parasitology 4/e

This major reference, now in its fifth edition, updates and advances the field of diagnostic medical parasitology and reports on the dramatic changes that have occurred in this field. It includes newly recognized parasites, updated information on immunology and pathogenesis, greatly expanded tables and photographs, a new section on medical case histories, among other exciting additions and updates.

- offers a brand-new section containing medical case histories

- features a greatly expanded section covering histological diagnosis

- presents many new figures and summary tables

- provides in one volume both comprehensive information about human parasitology and relevant diagnostic methods

- includes a review of over 3,000 papers published since the release of the previous edition.

CONTENTS

PART I
Clinically Important Human Parasites I
IPhilosophy and Approach to DiagnosticParasitology3
2Intestinal Protozoa: Amebae 6
Entamoeba histolytica6Entamoeba dispar19Entamoeba moshkovskii 21Entamoeba hartmanni21Entamoeba coli 22
Entamoeba polecki 23Entamoeba gingivales24Endolimax nana 25
Iodamoeha hütschlii27Blastocystis hominis27
3Intestinal Protozoa: Flagellates and Ciliates 33
Giardia lamblia33
Dientamoeba fragilis47Pentatrichomonas hominis (Trichomonas
hominis)49
Trichomonas tenax 50Chilomastix mesnili50Enteromonas hominis51Retortamonas intestinalis51Balantidium coli51
4Intestinal Protozoa (Coccidia and Microsporidia)and Algae 57
Coccidia57Cryptosporidiumspp.57
Cyclospora cayetanensis73Isospora (Cystoisospara) belli80Sarcocystisspp.83
Microsporidia87
Algae(Prototheca)98
5Free-Living Amebae 102
Naegleria fowleri104
Acanthamoebaspp.109Balamuthia mandrillaris118Sappinia diploidea121
6Protozoa from Other Body Sites 123
Trichomonas vaginalis123Taxaplasma gondii130
7Malaria and Babesiosis 142Malaria142Babesiosis 180
8Leishmaniasis 190
Old World leishmaniasis: cutaneous
Ieishmaniasis191
Old World leishmaniasis: visceral leishmaniasis198New World lcishmaniasis: cutaneous
leishmaniasis205
New \X/orld lcishmaniasis: visceral
leishmaniasis212
9Trypanosomiasis 218
African trypanosomiasis218
Trypanosoma brucei gainbiense218Trypanosoma brucei rhodesiense 228
American trvpanosomiasis232Trypanosoma cruzi 232
Trypanosoma rangeli243
viiiContents
IO Intestinal Nematodes 249
Ascaris lunrbricoides250Enterobins vervnicularis258Trichuris trichrura261Capillaria philippinensis264
Hookworrns(Ancylostoma duodenaleandNecatoramericanus)266
Trichostrongyltrs spp.270Strongyloidesspp.271
I ITissue Nematodes 283
Trichinella spp.283
Baylisascaris procyonis294
Lagochilascaris rrrinor298
Toxocara canisandTcati(viscéral larva migransand ocular larva migrans)298
Ancylostosna brazilienseand A.caninum(cutaneouslarva migrans)302
Human eosinophilic enteritis303
Dracunculus rnedinensis304
Angiostrongylus (Parastrongylus) cantonensis(cerebral angiostrongyliasis)307
Angiostrongylus (Parastrongylus) costaricensis(abdominal angiostrongyliasis)309
Gnathostoma spinigerum310
Gnathostorna doloresi, G. nipponicum,G. hispidurn,and G.binucleatum312
Anisakis sinrplex, A. physeteris, Pseudoterranovadecipiens, Contracaecum osculatum,Hysterothylacinm aduncum,andPorrocaecumreticulatum(larval nematodes acquired fromsali water fish)312
Capillaria hepatica315
Thelaziaspp.315
12Filarial Nematodes 319
Wuchereria bancro fti321
Brugia malayi 332
Brugia timori 333
ZoonoticBrugiainfections (American brugianfilariasis)334
Tropical pulmonary eosinophilia335
Loa loa 335
Mansonella ozzardi 338
Mansonella perstans 339
Mansonella streptocerca340
Onchocerca volvulus341
Dirofilaria DirofilariaandDirofilaria
Nochtiellaspp.348
13 Intestinal Cestodes 357Diphyllobothrium laturn 357Taenia solium 362
Iitenia saginata371
Taenia saginata asiatica(ArianTaeniaorTaeniaasiatica)373
llynienolepis nana374
Ilymenolepis diminuta 376
Dipylidiurn caninum 377
14Tissue Cestodes: Larval Forms 381
Echinococcus granulosus(cysticdisease, hydatiddisease)381
Echinococcus multilocularis(alveolar disease,hydatid disease)393
Echinococcus oligarthrusandEchinococcus vogeli(polycystic hydatid disease)399
Taenia (Multiceps)spp.(Taenia multiceps, Taeniaserialis)(coenurosis)402
Spirometra mansonoidesandDiphyllobothrium spp.(sparganosis)402
NOTE:Taenia solium(cysticercosis) is discussed inchaprer13.
15 Intestinal Trematodes 41 1Fasciolopsis huski411
Echinostoma ilocanunr416Ileterophyes heterophyes417Metagonimus yokogatvai 419Gastrodiscoides honunis 420
16Liver and LungTrematodes 423
Liver flukes423
Clonorchis sinensis423Opisthorchis viverrini429Opisthorchis felineus431Fasciola hepatica432
Fasciola gigantica435
Less common liver flukes436
J)icrocoeliuzn dendriticzun, Dicrocoelium hospes,andi-urvirezna pancreaticuzzz436
Lung flukes438
Paragonirnusspp.438
17Blood Trematodes: Schistosomes 445Schistosoma mansoni 446Schistosoma japonicum 458Schistosoma mekongi 463Schistosoma haematobium 466Schistosoma intercalatum472
Contentsix
18Unusual Parasitic Infections478Aquatic Protist478
Rhinosporidium seeheri478
Protozoa482
Myxozoan parasites482
Nematodes 483Oesophagostomumspp.483
Eustrongylides spp.485
Mernns nigrescens486Micronema deletrix487Dioctophyma renale 487Ternidens deminutus488
Mammomonogarmas laryngeus (Syngarnuslaryngeus)488
Ascaris suum 489
Gongylonema pulchrurn 489Haycocknema perplexum490Cestodes490
Diplogonoporusspp.490
Bertiella studeri491
Inermicapsifer madagascariensis491Railhetina celebensis491
Mesocestoides spp.492Taenia crassiceps492
Trematodes493Maria ainericana493
Plagiorchisspp.493Neodiplostomum seoulense494
Spelotrema brevicaeca494Brachylaimasp.494
Troglotrema salmincola494Stellantchasmus falcatus494
Phaneropsolus bonneiandProsthodendriun:molenkempi 495
Phaneropsolus spinicirrus495
Haplorchis taichui 496Gymnophalloides seoi 496
Met-orchis conjunctus(North Arnerican liverfluke)497
Schistosoma mattheei498
Philophthalmus lacrimosus498Achillurbainiaspp.499
Pentastomids499
Armilliferspp.,Linguatula serrata,andSebekiaspp.499
Acanthocephalans500
Macracanthorhynchus hirudinaceusandMoniliformismonili formis500
19Parasitic Infections in the CompromisedHost 506
Entamoeba histolytica508Free-Living amebae518
Giardia lamblia522
Taxaplasmagondii523
Cryptosporidiumspp.524Cyclospora cayetanensis528Isospora(Cystoisospora)belli530Sarcocystisspp.531
Microsporidia532
Leisbmaniaspp.537
Strongyloides stercoralis540Crusted (Norwegian) scabies 540
20Nosocomial and Laboratory-AcquiredInfections549
Nosocomial infections 549
Nosocomial gastrointestinal infections550Cryptosporidiumspp.550Giardia lamblia 553Entamoeba histolytica 554Microsporidia555
Isospora (Cystoisospora) belli555
Hymenolepis nana 555Taenia solium555
Nosocomial blood and tissue infections 556Plasmodium spp. 556Bahesiaspp.556
Trypanosoma brucei gambienseandT.bruceirhodesiense556
Trypanosoma cruzi 556Leishnrania donovani 557Toxoplasina gondii 557
Nosocomial infections with ectoparasites 557Pediculusspp.andPhthirus pubis 557
Sarcoptes scabiei557Mlyiasis557
Nosocomial infections in the pediatric patient 558Cryptosporidiumspp.558Giardia lamblia558
Pediculus bumanus capilis 558
Sarcoptes scabiei558
Nosocomial infections in the compromised
patient558
Laboratory infections560Intestinal protozoa560Free-livingamebae560Plasmodiumspp.560
'1 rypanososna brucei gambienseandT.bruceirhoclesiense560
Trypanosoma cruzi 562Leisbmaniaspp.562Toxoplasma gondii 562Specimcn handling563
Summary 563
xContents
21 Immunology of Parasitic Infections 567
Amebiasis 570Giardiasis575Toxoplasmosis 577
African trypanosomiasis579
American trypanosomiasis 580
Malaria582Summary 586
22Antibody and Antigen Detection in ParasiticInfections592
Protozoal infections594Amebiasis594
Babesiosis597
Chagas'disease597Cryptosporidiosis598Cyclosporiasis598Giardiasis598
l.cishmaniasis598Malaria600
Toxoplasmosis601Trichomoniasis603
Order Anoplura (sucking lice)694
Order Mallophaga (biting and chewing lice)696Order Hymenoptcra (becs, wasps, and arts)696Order Blattaria (cockroaches)698
Class Arachnida (ticks, mites, spiders, andscorpions)699
Subclass Acari (ticks, mites, and chiggers)699Subclass Araneae (spiders)708
Subclass Scorpiones (scorpions)710
Other arthropods 711
Class Chilopoda (centipedes)711
Class Diplopoda (millipedes)712
Class Crustacea (copepods, crabs, crayfish, etc.)712control of arthropods of medical importance 712Physical control712
Biological control712
Chemical control715
25 Treatment of Parasitic Infections 718
PART II
Diagnostic Procedures 759
Helminth infections60426
Collection, Preservation, and Shipment of Fecal
Cysticercosis604
Specimens761
Safety761
Fresh-specimen collection762
Collection of the specimen762
Number of specimens to be collected (standard
recommendation)762
Number of specimens to be collected (pros and cons of
various options)763
Collection tintes764
Hydatid disease
Fascioliasis605
Filariasis606
Paragonimiasis
Schistosomiasis
Strongyloidiasis
605
607
608
609
Toxocariasis610
Trichinellosis610
Intradermal tests611Casoni test611Montenegro test611
23Histologic Identification of Parasites 616
24Medically Important Arthropods 670
Arrhropods and their rclationship to disease 670Biological vectors of microorganisms670
Bites and cnvenomation671
Tissue invasion676
Entomophobia and delusory parasitosis676Class Insccta (insects)678
Order Diptera (Hies, mosquitoes, and midges)679Myiasis683
Order Hemiptera (crue bugs)690
Order Coleoptera (beetles)692
Order Siphonaptera (flcas)(Ctenocephalidesspp.,Xenopsylla cheopis, Pulex irritans[human flea],Tunga penetrans, Nosopsyllus fasciatus, Echidnophagagallinacea,and "land fleas")693
specimen type, specimen stability, and need forpreservation764
Preservation of specimens768
Preservatives768
Formalin768
MIF769
SAF771
Schaudinn's fluid772
PVA772
Modified PVA773
Single-vial collection systems (other than SAF)773Use of fixatives774
Quality control for stool fixatives774
Procedure notes for use of preservatives775
Proccdure limitations for use of preservatives775Shipment of diagnostic specimens, biological products,etiologic agents,orinfectious substances775
27Macroscopic and Microscopic Examination ofFecal Specimens 782
Macroscopic examination 782
Contentsxi
Microscopic examination (ova and parasiteexamination)783
Direct wet smear783
Concentration (sedimentation and flotation)788Formalin-ethyl acetate sedimentationconcentration789
Iodine-trichrome stain for sediment792Zinc sulfate flotation concentration794Commercial fecal concentration devices796
Automated workstation for the microscopie analysisof fecal concentrates797
Permanent stained smear797
Preparation of material for staining798
Trichrome stain802
Iron hematoxylin stain807
Modified iron hematoxylin stain (incorporating thecarbol fuchsin step)811
Polychrome IV stain 812Chlorazol black E stain813
Specialized stains for coccidia(Cryptosporidium,Isospora,andCyclosporaspecies) and themicrosporidia813
Modified Kinyoun's acid-fast stain (cold method) 813
Modified Ziehl-Neelsen acid-fast stain (hotmethod)816
Carbol fuchsin negative stain forCryptosporidium(fromW. L. Carrent)819
Rapid safranin method forCryptosporiditinz819
Rapid safranin method forCyclospora,using amicrowave oven819
Auramine O stain for coccidia (from ThomasHanschcid)819
Modified trichrome stain for the microsporidia(Weber-green)821
Modified trichrome stain for the microsporidia (Ryan-blue)823
Modified trichrome stain for the microsporidia(Kokoskin-hot method)825
Acid-fast trichrome stain forCryptosporidi:nnand themicrosporidia826
28Additional Techniques for Stool Examination 83 ICulture of larval-stage nematodes831Harada-Mori filter paper strip culture832
Filter paper/slant culture technique (petri dish)833Charcoal culture834
Baermann technique835
Agar plate culture forStrongyloides stercorales837
Egg studies840
Estimation of worm burdens840
Hatching of schistosome eggs842Search for tapeworm scolex 844Qualitative test for fecal fat845
Quantitation of reducing substances (Clinitest)847
29 Examination of Other Specimens from theIntestinal Tract and the Urogenital System 850
Examination for pinworm 850
Cellulose tape preparations851
Anal swabs85 I
Sigmoidoscopy material 852
Direct saline mount853Permanent stained slide 853
Duodenal contents 854Duodenal drainage854
Duodenal capsule technique (Entero-Test)854
Urogenital specimens 855'I'richomoniasis855Filariasis856
Schistosomiasis856
30 Sputum,Aspirates, and Biopsy Material 859
Expectorated sputum 859Induced sputum 861Aspirates868
Lungs and lever868
Lymph nodes, spleen, liver, boue marrow, spinal fluid,cyes, and nasopharynx869
Cutaneous ulcer871Biopsy material871Skin876
Lymph rodes876Muscle876
Rectum and hladder877
31Procedures for Detecting Blood Parasites 881
Preparationofthick and thin blood films 881Thick blood films 882Thin blond films884
Combination thick and thin blond films (on the sanieslide)884
Combination thick and rhin blond films (can be stainedas eithcr)884
Buffy coat blond films886Staining blond films887Giemsa stain888
Wright's stain889
Genet-al notes on staining procedures 891
Proper examination of thin and thick blood
films 891
Thin blood films891Thick blood films893Determination of parasitemia893
Diagnosisofmalaria: rcview of alternatives toconventional microscopy 894
QBC microhemarocrit centrifugation method895ParaSight F test896
NOW malaria test 900
xiiContents
Flow anti-pLD1 IPlasmodiummonoclonalantibodies901
PCR 902
Automatcd blond ccll analyzcrs 903
Diagnosis of leishmaniasis: review of alternatives to
conventional microscopy903
ICT for dctection of anti-rK-39 antibodies 903
Concentration procedures903Cytocentrifugation technique903Knott concentration procedure 904Membrane filtration technique 904Gradient centrifugation technique905Triple-centrifugation method for trypanosomes905
Special stain for microfilarial sheath905Dclaficld's hematoxylin905
32 Parasite Recovery: Culture Methods, AnimalInoculation, and Xenodiagnosis 910
Culture methods 910Intestinal protozoa911Pathogenic free-living amebae917
Pathogenic flagellates922Flagellates of hlood and tissue 926
Toxoplasma gondii931PlasmodiumandBabesiaspp.931
Cryptosporidiwnspp.932I\,licrosporidia932
Animal inoculation 932Leishmaniaspp.932Trypanosomaspp.933Toxoplasma gondü933
Xenodiagnosis933
33 Fixation and Special Preparation of FecalParasite Specimens and Arthropods 936
Fixation of parasite specimens and arthropods 936Protozoa937
Solutions to induce relaxation in adult helminths 938Nematodes 939
Trematodes 940Cestodes940
Helminth eggs and larvae 940
Arthropods 940
Mounting and staining of parasite specimens for
examination 941Nematodes 941Trematodes 942Cestodes943
Mounting of arthropods for examination 944
Mites944
Fleas and lice 944Ticks945
Miscellaneous arthropods945
34Artifacts That Can Be Confused with ParasiticOrganisms 947
Protozoa947
Amebae 947
Flagellates949Ciliates949
Coccidia and microsporidia949
Cryptosporidiumspp. andCyclospora
cayetanensis949Isospora belli950Microsporidia951
Blood and body fluids 951
Malaria parasites andBabesiaspp.951
Leishmaniae and trypanosomes 951
Microfilariae951
Body fluids: ciliated epithelial cells953
Helminths 953
Adult Worms and larvac 953
Eggs954
Human cells 954Polymorphonuclear leukocytes 956
Eosinophils956Macrophages 956Lymphocytes 957Red blond cells 957Charcot-Leyden crystals957
Nonhuman elements seen in feces (yeast cells) 957Insect larvae958
Spurious infections958
Delusory parasitosis959
35 Equipment, Supplies, Safety, and Quality SystemRecommendations for a Diagnostic ParasitologyLaboratory: Factors Influencing FutureLaboratory Practice 961
Equipment 961
Microscope 961
Centrifuge965
Fume hood 965
l iological safety cabinet965Refrigerator-freezer 966Supplies966
Glassware 966
Miscellaneous supplies967
ATCC quality control organisms 967
Safety: personnel and physical facilities967Gencral précautions967I-landwashing968
Personal protective equipment (OSHA 2001 bloodborne)969
Handling specimens 970Processing specimens970Spills972
Contentsxiii
Disposai of contaminated materials973Standard precautions974
Hepatitis exposure protocol976
Dangerous properties of industrial materials976Current OSHA regulations for the use offormaldehyde977
Latex allergy978
Quality systems979
Extent of services979
Proficiency testing979
In-house quality control982
Patient outcome measures986
Continuous quality improvement, total qualitymanagement, or 10-step and FOCUS-PDCA forperformance improvement activities987CI.IA'88inspection process989
New quality quidelines989
ISO guidelines989
CLSI (NCCI,S)model990
Factors influencing future laboratory practice990Managed care992
Financial considerations993Deccntralized testing993Laboratory services993Technological trends994Clinical decision support994Personnel issues995
Changing demographics995Emerging diseases995
36Medical Parasitology: Case Histories 998
Protozoal infections998
Helminth infections1007Blood parasite infections1016Diagnostic methods 1024
APPENDIXES 1027
APPENDIX I
Information Tables 1028
A 1.1Classification of human parasites 1028
AI.2Distribution of selected parasitic infections in theAmericas 1031
A1.3Distribution of selected parasitic infections inEurope 1031
A I.4Distribution of selected parasitic infections inAfrica1032
AI.5Distribution of selected parasitic infections inAsia1033
A1.6Distribution of selected parasitic infections inOceania 1033
AI.7Cosmopolitan distribution of common parasiticinfections (North America, Mexico, Central
America, South America, Europe, Africa, Asia,and Oceania) 1034
AI.8Bodv sites and specimen collection1035A1.9Bodv sites and possible parasites recovered
(trophozoites, cysts, oocysts, spores, adults,
larvae, eggs, amastigotes, and
trypomastigotes)1036
A1.10Body site, specimen and procedures,recommended methods, relevant parasites, andcomments 1037
A 1. I 1Examination of tissue and body fluids 1042A1.12Key characteristics of protozoa of the intestinaltract and urogenital system 1044
AI.13Key characteristics of tissue protozoa 1047A1.14Key characteristics of helminths 1049AI.15Key characteristics of parasites found in
blood1052
A I.16Diagnostic laboratory report information that
should be relayed to the physician 1054
A I.17Pros and cons of stool specimen collection and
testing options1055
A1.18Approaches to stool parasitology: test
ordering1057
A I.19Pros and cons of ova and parasite examinationoptions 1058
AI.20Laboratory test reports: optional
communs 1060
AI.2IEstimated prevalence of parasitic diseasesworldwide 1061
APPENDIX 2
Flowcharts and Staining Tables for DiagnosticProcedures 1062
Flowcharts
A2.IProcedure for processing fresh stool for the ovaand parasite examination 1062
A2.2Procedure for processing liquid specimens for theova and parasite examination 1063
A2.3Procedure for processing preserved stool forthe ova and parasite examination by using thetraditional two-vial collection kit 1064
A2.4Procédure for processing sodium acétate-aceticacid-formalin (SAF)-preserved stool for the ovaand parasite examination1065
A2.5Use of various fixatives and their recommendedstains1066
Tables
A2.ISteps in the trichrome staining procedure(mercuric chloride-based PVA-preserved stoolspecimens)1067
A2.2Steps in the trichrome staining procedure(non-mercuric chloride-based PVA-preserved stoolspecimens) 1068
xivContents
A2.3Steps in the iron hematoxylin staining procedure
(mercuric chloride-based PVA-preserved stool
specimens) (Spencer-Monroe method) 1069A2.4Steps in the iron hematoxylin staining procedure
(mercuric chloride-based PVA-preserved stool
specimens) (Tompkins-Miller method) 1070A2.5Steps in the iron hematoxylin staining procedure
(incorporating the carbol fuchsin stop)1071A2.6Oil-mounted permanent stained smears (no
Permount is used) 1072
A2.7Tips on stool processing and staining 1073
APPENDIX 3
Common Problems in Parasite Identification 1074Figures
A3.I-A3.25Paired drawings of "look alikes" 1074A3.26Relative sizes of helminth eggs 1080
Table
A3. IAdult nematodes and/or larvae found in stoolspecimens: size comparisons 1081
APPENDIX 4
Quality Control Recording Sheets 1082
A4.IDiagnostic parasitology quality control (QC)(reagents)1083
A4.2Diagnostic parasitology quality control (QC)
(reagents)-example for multiple reagents 1084A4.3Diagnostic parasitology quality control (QC)
(culture)-example of a worksheet 1085A4.4Equipment maintenance 1086
APPENDIX 5
Commercial Supplies and Suppliers 1089
Tables
A5.ISources of commercial reagents and
supplies1090
A5.2Addresses of suppliers listed in Table A5.1 1092A5.3Sources of available reagents for immunodetectionof parasitic organisms or antigens 1094
A5.4Addresses of suppliers listed in Table A5.3 1095A5.5Commercial suppliers of diagnostic parasitologyproducts1096
A5.6Sources of parasitologic specimens 1099A5.7Sources of Kodachrome study slides (35 mm,2 x 2) for rental 1 100
A5.8Sources of additional teaching materials, includingcase histories1100
APPENDIX 6
Reference Sources 1 101
APPENDIX7
Color Plates of Diagnostic Stages of HumanParasites 1104
APPENDIX 8
"Late-Breaking" Published Information 1120
GLOSSARY 1151INDEX 1165