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C02 Hematology
C02 Hematology
Nematodes (Roundworms)
Separate sexes Female = larger, pointed tail
Male = smaller, curved tail
Life cycle Egg stage > Larval stage > Adult stage
Aphasmids Lacks phasmids or caudal chemoreceptors
“TCT”: Trichuris-Capillaria-Trichinella
Phasmids w/ caudal chemoreceptors
Hookworm
S. stercoralis
W. bancrofti
B. malayi
Amphid Cephalic chemoreceptors
Oviparous Lays eggs in unsegmented stage (unembryonated)
Ovoviviparous/oviviparous Lays eggs in segmented stage (embryonated)
Viviparous/larviparous Larva
Frequency “EAT”: Enterobius > Ascaris > Trichuris
Small intestines “CASH”: Capillaria, Ascaris, Strongyloides, Hookworms
Large intestines “ET”: Enterobius, Trichuris
Heart-to-lung migration “ASH”: Ascaris, Strongyloides, Hookworm
Extraintestinal Nematodes Filarial worms = lymphatics and subcutaneous tissues
T. spiralis = muscles
A. cantonensis = meninges
Visceral Larva Migrans T. canis and T. cati
Triad of infection/Unholy 3 “HAT”: Hookworm, Ascaris, Trichuris
Ascaris lumbricoides
Characteristics Resembles common earthworm
Fertilized Egg 3 layers:
-Inner: Vitelline membrane
-Middle: Glycogen layer
-Outer: Mammilation (corticated)
Trematodes
Phylum Platyhelminthes
Class Trematoda
Characteristics Living worms: creamy white and yellowish
Adult: flat and ribbon-like (masking tape)
1 IH only
Cestode body Scolex = anterior attachment organ
Neck = region of growth
Strobila = chains of segments or proglottids
-Immature, mature, ripe/gravid (filled w/ eggs)
Order Pseudophyllidea False tapeworm (Ex. D. latum)
Scolex: Spoon-shaped w/ bothria (slit-like sucking grooves), no hooklets
Strobila: Anapolytic (not shedding segments)
Egg: operculated w/ aboperculum, immature when laid
Stages: Coracidium > Procercoid > Plerocercoid
IH: 2 IH (Copepods and fresh water fish)
Order Cyclophyllidea True tapeworm
Scolex: Quadrate, w/ 4 cuplike suckers (rostellum w/ or w/o hooklets)
Strobila: Apolytic (shedding segments)
Egg: non-operculated, embryonated (mature when laid), hexacanth embryo
IH: 1 IH
Require vertebrate IH T. solium (IH: pig)
T. saginata (IH: cattle)
Require invertebrate IH D. caninum (MOT: ingestion of “pulgas”)
May or may not require IH H. nana
Diphyllobothrium latum
Characteristics Largest tapeworm of man
Causes Vit. B12 deficiency anemia
Uterus Rosette formation
Lab. Diagnosis 1. Stool examination
= Egg: Diagnostic stage
Taenia saginata Taenia solium
Scolex None, no rostellar hooks w/ rostellum armed w/ 2 rows of
large and small hooklets
Length 25 m 7m
# of proglottids 1000-2000 <1000
Gravid proglottid 15-20 lateral branches 7-13 lateral branches
(dichotomous or tree-like) (dendritic or fingerlike)
Eggs Spherical, striated, inside is an embryo Spherical, striated, inside is an embryo
w/ 6 hooklets w/ 6 hooklets
Larva Cysticercus bovis Cysticercus cellulosae
Pathogenesis Taeniasis saginata Taeniasis solium, cysticercosis
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Hymenolepis nana Hymenolepis diminuta
Characteristics Smallest tapeworm of man
Scolex w/ rostellum armed w/ a ring of 20- w/ an unarmed rostellum
30 spines
Eggs w/ oncosphere enclosed in an inner w/ oncosphere enclosed in an inner
membrane w/ 2 polar thickenings, membrane w/ 2 polar thickenings, but
from each w/c arise 4-8 polar w/o filaments
filaments
IS Direct: Eggs Cysticercoid larva
Indirect: Cysticercoid larva
DH Man Rat
Dipylidium caninum
Proglottids w/ double set of reproductive organs and genital pore on each side of the
lateral margin
Mature & gravid proglottids: melon seed/pumpkin seed/rice grain-shaped
Eggs Egg packet (8-15 eggs)
IH Ctenocephalides canis (dog flea)
Ctenocephalides felis (cat flea)
Pulex irritans (human flea)
DH Dogs or cats
Man: accidental host
Echinococcus granulosus
Characteristics Shortest tapeworm (only 3 segments: immature, mature, ripe/gravid)
Anti-P1
Eggs Resembles Taenia egg
IH Sheep (IS: eggs)
Man: accidental IH
DH Dog
Lab. Diagnosis 1. Exploratory cyst puncture
2. Roentgenogram (x-ray)
3. Immunologic tests:
= Bentonite flocculation test (TS, EG)
= Casoni (intradermal test)
Protozoans
Characteristics Unicellular
Animal-like protists
Division: Fission
No cell wall w/ outer membrane (periplast)
Cytoplasm: ectoplasm (outer) and endoplasm (inner)
Contains at least 1, and some several nuclei
Some contain vacuoles: for storage and transport
Hemotogranules Special organs for locomotion
-Sarcodina/Rhizopoda = Amoeba (pseudopods)
-Mastigophora/Flagellata
-Ciliophora/Ciliata
-Sporozoa = no definite locomotory organelle
Class Rhizopoda
Trophozoites Motile
Feeding stage
Diarrheic/liquid stool
Destroyed by iodine
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Cyst Non-motile
Nonfeeding stage
Well-formed stool
Infective stage
Characteristics w/ cystic stage except Entamoeba gingivalis
Inhabit the large intestine except Entamoeba gingivalis
Commensals except Entamoeba histolytica
Life cycle Trophozoite > Precystic > Cystic > Metacystic stage
Entamoeba True amoeba
Peripheral chromatin (trophozoite and cyst)
Chromatoidal bars (cyst)
Endolimax/Iodamoeba Other amoeba
No peripheral chromatin
No chromatoid bars
Entamoeba histolytica Entamoeba coli
Trophozoite -Motility: Unidirectional & progressive -Motility: several directions, sluggish
-1 pseudopod (finger-like) -Many pseudopods (blunt & rounded)
-Endoplasm: w/ RBC but no bacteria -Endoplasm: w/ bacteria, yeasts and
or cell detritus (clean-looking) cell detritus (dirty-looking)
-Nucleus: not visible when stained; -Nucleus: when stained, consists of
consists of thin nuclear membrane w/ thicker nuclear membrane w/ layer of
layer of uniformly sized fine variously sized chromatin granules
chromatin granules distributed along unevenly distributed along the inside
inside the border of nuclear memb. border of nuclear membrane
-Karyosome: fine, centrally located -Karyosome: large, eccentrically
(Bull’s eye) located
Cyst -Chromatoidal bars: coffin/rod/cigar/ -Chromatoidal bars: splinter-like/
sausage-shaped witch-broom/whisked broom
-Mature cyst w/ 1-4 nuclei -Mature cyst w/ 1-8 nuclei
Endolimax nana Smallest amoeba
Size = RBC
[Trophozoite]
-Karyosome: large round dot
[Cyst]
-Usually oval
-Nuclei: 4 (cross-eyed)
Iodamoeba butschlii [Trophozoite]
Iodamoeba williamsi -Karyosome: w/ cluster of achromatic granules
[Cyst]
-Large iodine-staining glycogen vacuole
Entamoeba gingivalis Associated w/ gum infection
[Trophozoite]
Karyosome: small and centrally located
Pseudopodia: similar to E. histolytica but does not exhibit true progressive
locomotion
Opportunistic Amoeba
Characteristics Free-living amoeba
Inhabits the CNS
Does not indicate fecal contamination
Cause PAM (fatal)
Includes: Naegleria, Acanthamoeba, Hartmanella
Laboratory Methods
Examination of Blood
Detect agents of Malaria
Babesiosis
Trypanosomiasis
Leishmaniasis
Filariasis
Thick blood films Screening (malaria)
Thin blood films Identification of malarial species
Concentration techniques 1. Preparation of buffy coat smears:
-L. donovani
-Trypanosomes
-Microfilaria
2. Knott’s concentration membrane filtration
-Detection of microfilaria
3. Fluorochrome acridine orange in microhematocrit centrifuge format
-QBC blood parasite detection method
Examination of Fecal Specimens
Stool fixatives 1. Formalin = all purpose fixative
= 5% conc.: protozoan cysts
= 10% conc.: helminth eggs and larvae
2. Schaudinn’s fluid = w/ HgCl2
3. Polyvinyl alcohol (PVA) = for Trichrome stain (w/ HgCl2)
4. Merthiolate-iodine-formalin (MIF) = a.k.a. Thimerosal
= Merthiolate and Iodine: staining components
= Formalin: preservative
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5. Sodium-acetate-formalin (SAF)
= Advantage: does not contain HgCl2
Direct wet mount 1. Saline mount = 0.85% NSS
2. Iodine mount = protozoan cysts (not trophozoites)