College of Allied Medical Professions Parasitology Laboratory

Department of Medical Technology Questions for Research/Worksheet

Clinical Parasitology
Module 2: Macroscopic Evaluation of Stool & Intestinal Nematodes
Worksheet / Questions for Research

Introduction:

Stool specimens submitted for parasitic study should first be examined macroscopically to determine the consistency
and color of the sample. The specimen should be screened and examined for the presence of gross abnormalities. To perform
this macroscopic examination, the laboratory must receive a fresh, unpreserved stool specimen. Because most laboratories
receive fecal specimens already in fixative, this step is often skipped because these macroscopic characteristics cannot
be determined. In such situations, a notation of the gross appearance, either on the actual specimen container or on the
requisition form, is recommended at the time of specimen collection. The consistency or degree of moisture in a stool
specimen may serve as an indication of the types of potential parasites present. For example, soft or liquid stools may suggest
the presence of protozoan trophozoites. Protozoan cysts are more likely to be found in fully formed stools. Helminth eggs and
larvae may be found in liquid or formed stools. The color of a stool is important because it may indicate the condition of the
patient, such as whether a patient has recently had a special procedure (e.g., a barium enema) or if the patient is on antibiotic
therapy. The range of colors varies, including black to green to clay, and colors in between. The color of normal stool is brown.
Unusual colors, such as purple, red, or blue, typically suggest that the patient is on a particular medication.

Gross abnormalities possibly found in stool include adult worms, proglottids, pus, and mucus. First, the surface of the
stool should be examined for parasites, such as pinworms. tapeworm proglottids, and adult. Worms. The sample should then
be broken up—a wooden applicator stick works nicely for this task—and examined once more for macroscopic parasites,
especially adult helminths. Samples containing adult worms may be carefully washed through a wire screen. This process
allows for the retrieval and examination of the parasites for identification purposes. Other macroscopic abnormalities in the
specimen may have parasitic indications. For example, blood and/or mucus in loose or liquid stool may suggest the presence
of amebic ulcerations in the large intestine. Bright red blood on the surface of a formed stool is usually associated with irritation
and bleeding. Several possible terms may be used to describe the macroscopic appearance of a stool specimen.

Learning Objectives:
The students are expected to,
1) Learn how to evaluate stool sample.
2) Master the correct collection and proper labelling of the container.

Topic: I. MACROSCOPIC EVALUATION OF STOOL

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 College of Allied Medical Professions Parasitology Laboratory
Department of Medical Technology Questions for Research/Worksheet

Container with label

Picture of the specimen (Should be inside the

container with label)

MACROSCOPIC EVALUATION OF STOOL

Consistency Formed
Color Brown
Odor Foul Odor
Presence of mucus There is no presence of mucus
Presence of blood There is no presence of blood

Topic: II. Intestinal Nematodes

Draw what is needed below and write their distinct characteristics below the drawing on the blacks provided. (You can draw
digitally or through paper. Which ever way you are comfortable)

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 College of Allied Medical Professions Parasitology Laboratory
Department of Medical Technology Questions for Research/Worksheet

ASCARIS LUMBRICOIDES

Fertilized egg, Unfertilized egg Fertilized egg, not Adult worm

decorticated
Decorticated fertilized eggs
lack an outer mammillated,
albuminous coating. In
addition, corticated fertilized
eggs have a less visible
chitin shell than
decorticated.
Unfertilized eggs are longer
than fertile eggs (up to 90
µm). Their shell is thinner,
and their mammillated layer
has varying protuberances.
Unfertile eggs mostly
contain refractile granules.
decorticate The color of adult Ascaris
The fertilized egg has a more lumbricoides worms is often
rounded shape than the creamy-white with a pink tint.
unfertilized egg. Fertilization Fine striations on the cuticle
of the egg produces an are apparent. Regarding the
immature unicellular sex of this worm, adult males
embryo. Moreover, it has a are typically short, rarely
thick shell covering called exceeding 30 cm in length.
chitin which lies between the They are thin and have a
embryo and the distinct incurved tail. On the
mammillated albuminous other hand, the length of an
substance (corticated). adult female ranges from 22
to 35 cm, which is about the
thickness of a pencil lead.

TRICHURIS TRICHUIRA

Trichuris trichuira ova Trichuris trichuira adult worm

The eggs of Trichuris trichiura are 50-55 µm by 20-25 μm Trichuris trichiura adult males measure between 30 and 45
in size. They are barrel-shaped, have a thick shell, and millimeters in length and have a coiled posterior end,
each end has a pair of polar "plugs." The ova are while female adults are about 35-50 millimeters in size and
considered unembryonated when excreted in feces. have a straight rear end. The anterior end of both sexes is

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 College of Allied Medical Professions Parasitology Laboratory
Department of Medical Technology Questions for Research/Worksheet

long and whip-like. Adults are found in the host's large

intestine, cecum, and appendix.

Question for Research

1. Differentiate Ascaris lumbricoides, E. vermicularis and T. trichiura ADULT WORMS (5 pts)

Ascaris lumbricoides
• The color of adult Ascaris lumbricoides worms is often creamy-white with a pink tint. Fine striations on the
cuticle are apparent. Adult Ascaris worms are described as the largest intestinal nematodes. Regarding the
sex of this worm, adult males are typically short, rarely exceeding 30 cm in length. They are thin and have a
distinct incurved tail. On the other hand, the length of an adult female ranges from 22 to 35 cm, which is
about the thickness of a pencil lead.

E. vermicularis
• Adult female Enterobius vermicularis worms range in length from 7 to 14 mm and are up to 0.5 mm in width.
The mature female worm's color is yellowish-white and has primitive organ systems: a digestive tract,
intestinal tract, and reproductive components. Additionally, the adult female has a distinct, pointed tail like a
pinhead, which gives "pinworm" as its common name. On the other hand, adult male worms are also
yellowish-white in color and often smaller in size than females, measuring between 2 and 4 mm in length and
no more than 0.3 mm in width.

Trichuris trichiura
• Adult whipworms typically measure 2.5 to 5 centimeters in length. The adult's anterior position is colorless
and possesses a narrow esophagus. The posterior end has a pinkish-gray appearance, and it contains
digestive and reproductive organs. In addition, matured males are often smaller than the matured female
worm. Along with a digestive system, intestinal tract, and reproductive organs, the male adult whipworm is
identifiable by its curled tail. Adult T. trichiura has a broad posterior end that resembles a whip handle. The
anterior end is significantly smaller and resembles the whip. These two morphological characteristics are
what give the whipworm its name.

2. Can freshly passed Ascaris lumbricoides can be effective immediately? (2 pts)

• Ingestion with freshly passed A. lumbricoides will not cause any infection. According to its life cycle, freshly
passed feces usually contains an unfertilized egg, and this stage isn't infective yet. A. lumbricoides is only
considered infective once the larvae develop on fertile eggs in moist, warm, shaded soil within 18 days to
several weeks.

3. How does trichuriasis causes prolapse rectum? (3 pts)

• Rectal prolapse occurs when the colon's lower part, right inside the anal canal, is turned inside out and
swells up outside the body. The rectum loses internal support during a whipworm infection, in which the
worms burrow their thin heads into the intestinal lining, which loosens the elastic epithelium. Hence, it
weakens the surrounding muscles.

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 College of Allied Medical Professions Parasitology Laboratory
Department of Medical Technology Questions for Research/Worksheet

4. Differentiate hookworms and S. stercoralis based on their rhabditiform and filariform larva.
Hookworms Strongyloides stercoralis
Rhabditiform The average newly-hatched hookworm The rhabditiform larva stage of S. stercoralis
Larva rhabditiform larva measures 15 by 270 has an average size of 220 by 15 µm. The
µm. After five days, the larva will have larva has a small buccal cavity and a
doubled in length, ranging from 540 to 700 notable genital primordium.
m. The morphological features include a
long oral cavity known as a buccal
cavity or buccal capsule and a tiny genital
primordium.
Filariform The rhabditiform larva will complete its The filariform larva stage of S. stercoralis has
Larvae second molt, becoming the infective, an average length of 690 µm. In addition, two
nonfeeding filariform larva. Two characteristics distinguish the filariform larva
distinguishing traits aid in the identification of S. stercoralis compared to the hookworm: it
of its filariform morphology. Its first feature has a longer esophagus than the hookworm,
is that the slender larva's esophagus is and the tail of S. stercoralis is notched
shorter than its counterpart with instead of a pointed tail.
Strongyloides stercoralis. On the other
hand, the hookworm filariform larva has a
prominent pointed tail.

5. How does creeping eruption occur? (5 pts)

• Cutaneous Larva Migrans also termed 'creeping eruption,' occurs when hookworms live in dogs' and cats'
intestines, in which eggs are shed in feces and hatch in one day after excretion in soil. These larvae mature
into infective larvae over a week. Worms move like snakes in response to vibration and heat. Skin contact
with worms in feces can transmit the infection. Hookworms live in damp sand, and most people catch it via
barefoot walking on polluted, contaminated grounds in hot climates. The most typical clinical presentation is
a tiny reddish papule that slowly evolves into a serpiginous pruritic rash (about 1–2 cm per day). The
presentation of these particular symptoms varies depending on the parasite. A. braziliense manifests within
an hour, while U. stenocephala may take longer for papular lesions to appear.

REFERENCES:

Centers for Disease Control and Prevention. (2019, July 19). Ascariasis. Centers for Disease Control and Prevention.
https://www.cdc.gov/dpdx/ascariasis/index.html

Centers for Disease Control and Prevention. (2017, December 19). Trichuriasis. Centers for Disease Control and
Prevention. https://www.cdc.gov/dpdx/trichuriasis/index.html

Maxfield, L., & Crane, J. S. (2021, July 18). Cutaneous Larva Migrans. Nih.gov; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK507706/

Trichuriasis. (n.d.). Standford University. Retrieved February 13, 2022, from

https://web.stanford.edu/group/parasites/ParaSites2002/trichuriasis/trichsymptoms.html

Zeibig, E.A. (2013). Clinical Parasitology: A Practical Approach. 2nd Ed. Elsevier.

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