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OVERVIEW

I.AMOEBA VI. CHILOMASTIX MESNILI X. CRYPTOSPORIDIUM

II.GIARDIASIS VII. LEISHMANIASIS XI. TOXOPLASMA GONDII
III.TRICHOMONIASIS VIII. AMERICAN TRYPANOSOMIASIS XII. CYCLOSPORA
IV.BALANTIDIUM COLI IX. AFRICAN TRYPANOSOMIASIS XIII. ISOSPORA BELLI
V.BLASTOCYSTIS HOMINIS

AMOEBA

Cyst of E. histolytica/E. dispar in an Cyst of E. histolytica/E. dispar in an Cyst of E. histolytica/E. dispar in a

unstained concentrated wet mount unstained concentrated wet mount concentrated wet mount stained with
of stool. Notice the chromatoid of stool. Notice the chromatoid iodine.
bodies with blunt, rounded ends bodies with blunt, rounded ends
(arrow). (arrow).

Cyst of E. histolytica/E. dispar in a Cyst of E. histolytica/E. dispar Cyst of E. histolytica/E. dispar

concentrated wet mount stained with stained with trichrome. Note the stained with trichrome.
iodine. Notice the chromatoid body chromatoid body with blunt ends
with blunt, rounded ends (arrow). (red arrow).

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Cyst of E. histolytica/E. dispar
stained with trichrome. Three nuclei
are visible in the focal plane (black
arrows), and the cyst contains a
chromatoid body with typically
blunted ends (red arrow). The
chromatoid body in this image is
particularly well demonstrated.
Immature cyst of E. histolytica/E.
dispar stained with trichrome. Image
taken at 1000x oil magnification and
contributed by the Kansas
Department of Health and
Environment.
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Cyst of E. histolytica/E. dispar
stained with trichrome. Two nuclei
are visible in the focal plane (black
arrows), and the cyst contains a
chromatoid body with typically
blunted ends (red arrow).
Immature cyst of E. histolytica/E.
dispar stained with trichrome. The
cyst has large vacuoles and the
chromatin around the nucleus is
clumpy. Image taken at 1000x oil
magnification and contributed by the
Kansas Department of Health and
Environment.
Immature cyst of E. histolytica. The
specimen was preserved in
poly-vinyl alcohol (PVA) and stained
with trichrome. PCR was performed
on this specimen to differentiate
between E. histolytica and E. dispar
Immature cyst of E. histolytica/E.
dispar stained with trichrome. The
cyst has large vacuoles and the
chromatin around the nucleus is
clumpy. These cysts range in size
from 10.3 to 15.7 µm. Image taken
at 1000x oil magnification and
contributed by the Kansas
Department of Health and
Environment.
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Trophozoite of E. histolytica/E. dispar Trophozoite of E. histolytica/E. dispar Trophozoite of E. histolytica/E. dispar

in a direct wet mount stained with in a direct wet mount stained with stained with trichrome.
iodine. iodine.

Trophozoite of E. histolytica/E. dispar Trophozoite of E. histolytica. The Trophozoite of E. histolytica. The

stained with trichrome.
specimen was preserved in
poly-vinyl alcohol (PVA) and stained
with trichrome. PCR was performed
on this specimen to differentiate
between E. histolytica and E. dispar.
specimen was preserved in
poly-vinyl alcohol (PVA) and stained
with trichrome. The vacuolated
cytoplasm seen in this image may be
the result of less than optimal
preservation. PCR was performed on
this specimen to differentiate
between E. histolytica and E. dispar.

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Trophozoite of E. histolytica/E.
dispar, measuring approximately
16.7 µm, stained with trichrome. The
image was taken at 1000×
magnification and contributed by the
Kansas Department of Health and
Environment.
Trophozoite of E. histolytica with
ingested erythrocytes stained with
trichrome.
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Trophozoite of E. histolytica with
ingested erythrocytes stained with
trichrome. The ingested erythrocytes
appear as dark inclusions. The
parasite above shows nuclei that
have the typical small, centrally
located karyosome, and thin,
uniform peripheral chromatin.
Trophozoite of E. histolytica with
ingested erythrocytes stained with
trichrome.
Trophozoites of E. histolytica with
ingested erythrocytes stained with
trichrome. The ingested erythrocytes
appear as dark inclusions. The
parasites above show nuclei that
have the typical small, centrally
located karyosome, and thin,
uniform peripheral chromatin.
Trophozoite of E. histolytica ingested
erythrocytes stained with trichrome.
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Numerous E. histolytica trophozoites Closer view of E. histolytica

in a rectal biopsy, H&E stained. trophozoites in the rectal biopsy
Arrows indicate examples of shown in Figure A. Arrows indicate
trophozoites with visible nuclei. examples of trophozoites with visible
nuclei. Note the typical small, central
Trophozoite of E. histolytica with karyosomes, fine peripheral
ingested erythrocytes (arrow), under chromatin, and “ground-glass”
differential interference contrast cytoplasm.
(DIC) microscopy.

II. GIARDIASIS

G. duodenalis cyst in a wet mount G. duodenalis cyst in a wet mount G. duodenalis cyst in a wet mount
stained with iodine. stained with iodine. stained with iodine.

G. duodenalis cyst in a wet mount G. duodenalis cyst in a wet mount G. duodenalis cyst in a wet mount

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stained with iodine. stained with iodine. under differential interference

contrast (DIC) microscopy. Image
taken at 1000× magnification.

Two G. duodenalis cysts in a wet G. duodenalis cyst stained with G. duodenalis cyst stained with
mount under DIC microscopy; image trichrome. trichrome.
taken at 1000× magnification.

G. duodenalis cyst stained with G. duodenalis cyst stained with G. duodenalis cyst stained with
trichrome. Sometimes the cytoplasm trichrome. trichrome.
of the cyst may retract from the cell
wall.

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G. duodenalis cyst stained with G. duodenalis cysts stained with G. duodenalis cyst stained with
trichrome. Sometimes the cytoplasm trichrome. trichrome. Sometimes the cytoplasm
of the cyst may retract from the cell of the cyst may retract from the cell
wall. wall.

G. duodenalis cyst stained with G. duodenalis cyst stained with G. duodenalis trophozoite in a wet
trichrome. trichrome. Sometimes the cytoplasm mount stained with iodine.
of the cyst may retract from the cell
wall.

G. duodenalis trophozoite in a wet G. duodenalis trophozoite stained G. duodenalis trophozoite stained

mount under differential interference with trichrome. with trichrome.
contrast (DIC) microscopy. Image
taken at 1000× magnification.

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Giardia duodenalis trophozoite G. duodenalis trophozoites. Image G. duodenalis trophozoites in Kohn

stained with trichrome contributed by the Vermont stain.
Department of Health Laboratory.

Cysts of G. duodenalis (lower right)

and oocysts of Cryptosporidium
parvum (upper left) labeled with
commercially available
G. duodenalis trophozoites in a
immunofluorescent antibodies.
Giemsa stained mucosal imprint

TRICHOMONIASIS

Two trophozoites of T. vaginalis Trophozoite of T. vaginalis in a Trophozoite of T. vaginalis in a

obtained from in vitro culture, vaginal smear, stained with Giemsa. vaginal smear, stained with Giemsa.
stained with Giemsa.

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Trophozoite of T. vaginalis in a
vaginal smear, stained with Giemsa.

BALANTIDIUM COLI

B. coli cyst (dart) and trophozoite B. coli trophozoite in a primate fecal

(arrow) in the same field, from a sample. Note the prominent groove
primate fecal sample. of the cytostome (arrow), cilia
(darts), and starch granules within
B. coli cyst in a wet mount, the cell.
unstained.

B. coli trophozoite in a wet mount,

1000× magnification. Note the
visible cilia on the cell surface.
Image contributed by the Oregon
Public Health Laboratory.
B. coli trophozoite in a wet mount, B. coli trophozoite in a Mann's
500× magnification. Note the visible hematoxylin stained smear, 500×
cilia on the cell surface. magnification. Note the cytosome
(black arrow) and the bean shaped

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macronucleus.

B. coli trophozoite under differential B. coli trophozoites in colon tissue B. coli trophozoites in colon tissue
interference contract (DIC) stained with hematoxylin and eosin stained with hematoxylin and eosin
microscopy, 500× magnification (H&E) at 200x magnification. (H&E) at 400x magnification.

BLASTOCYSTIS HOMINIS

Blastocystis sp. in an unstained wet Blastocystis sp. in an unstained wet Blastocystis sp. in a wet mount
mount. mount. under differential interference
contrast (DIC) microscopy.

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Blastocystis sp. in a wet mount Blastocystis sp. in a wet mount Blastocystis sp. in a wet mount
under differential interference stained with iodine. stained with iodine.
contrast (DIC) microscopy.

Blastocystis sp. stained with Blastocystis sp. stained with Blastocystis sp. stained with
trichrome. The nuclei in the trichrome. The nuclei in the trichrome.
peripheral cytoplasmic rim are peripheral cytoplasmic rim are
visible, staining purple. visible, staining purple.

Blastocystis sp. stained with Blastocystis sp. stained with

trichrome. trichrome.

CHILOMASTIX MESNILI

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Trophozoite of C. mesnili from a Trophozoite of C. mesnili from a Trophozoite of C. mesnili from a

stool specimen, stained with stool specimen, stained with stool specimen, stained with
trichrome. Image taken at 1000x trichrome. Image taken at 1000x trichrome. Image taken at 1000x
magnification. magnification. magnification.

Trophozoite of C. mesnili from a Cyst of C. mesnili in a stool Cyst of C. mesnili in a stool

stool specimen, stained with specimen, stained with trichrome. specimen, stained with trichrome.
trichrome. Image taken at 1000x Image taken at 1000x magnification. Image taken at 1000x magnification.
magnification.

Cyst of C. mesnili in a stool Cyst of C. mesnili in a stool Cyst of C. mesnili in a stool

specimen, stained with trichrome. specimen, stained with trichrome. specimen, stained with trichrome.

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Image taken at 1000x magnification.
Cyst (lower) and trophozoite (upper)
of C. mesnili in a stool specimen,
stained with trichrome. Image taken
at 1000x magnification.
Leishmania sp. amastigotes in a
Giemsa-stained tissue scraping.
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Image taken at 1000x magnification. Image taken at 1000x magnification.
Cyst of C. mesnili in a concentrated
wet mount of stool, stained with
iodine. Image taken at 1000x
magnification.
LEISHMANIASIS
Leishmania (Viannia) panamensis Leishmania (Viannia) panamensis
amastigotes in a Giemsa-stained amastigotes in a Giemsa-stained
tissue scraping. Identification to the tissue scraping.
species level is not possible based on
morphology and other diagnostic
techniques such isoenzyme assay or
PCR are needed.
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Leishmania (Viannia) panamensis
amastigotes in a Giemsa-stained
tissue scraping.
Leishmania tropica amastigotes from
an impression smear of a biopsy
specimen from a skin lesion. In this
figure, an intact macrophage is
practically filled with amastigotes
(arrows), several of which have a
clearly visible nucleus and
kinetoplast.
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Leishmania sp. amastigotes;
touch-prep stained with Giemsa.
Amastigotes of Leishmania sp. in a
biopsy specimen from a skin lesion,
stained with hematoxylin and eosin
(H&E).
Leishmania sp. amastigotes;
touch-prep stained with Giemsa.
Leishmania mexicana in a biopsy
specimen from a skin lesion stained
with H&E. The amastigotes are lining
the walls of two vacuoles, a typical
arrangement. The species
identification was derived from
culture followed by isoenzyme
analysis.
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Leishmania sp. promastigotes from

culture.

AMERICAN TRYPANOSOMIASIS

T. cruzi trypomastigotes in a thick T. cruzi trypomastigotes in a thick T. cruzi trypomastigotes in a thick

blood smear stained with Giemsa. blood smear stained with Giemsa. blood smear stained with Giemsa.

T. cruzi trypomastigote in a thin Three T. cruzi trypomastigotes in a T. cruzi trypomastigote in a thin

blood smear stained with Giemsa. thin blood smear stained with blood smear stained with Giemsa.
Note the typical C-shape of the Giemsa.
trypomastigote that characterizes T.

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cruzi in fixed blood smears.

Higher magnification of Figure C, T. Higher magnification of Figure C, T. T. cruzi trypomastigote in a thin

cruzi. cruzi. blood smear stained with Giemsa.

Higher magnification of Figure A, T. T. cruzi trypomastigote in a thin Higher magnification of Figure C, T.

cruzi. blood smear stained with Giemsa. cruzi.
Note the more anterior location of
the nucleus.

T. cruzi trypomastigote in a thin Higher magnification of Figure E, T. Trypanosoma cruzi trypomastigote in

blood smear stained with Giemsa. cruzi. cerebrospinal fluid (CSF) stained

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with Giemsa.

Trypanosoma cruzi trypomastigote in Trypanosoma cruzi amastigotes in Higher magnification of Figure A.

cerebrospinal fluid (CSF) stained heart tissue. The section is stained
with Giemsa. with hematoxylin and eosin (H&E).

Trypanosoma cruzi amastigotes in Higher magnification of Figure C. Trypanosoma cruzi amastigotes in

heart tissue. The section is stained heart tissue. The section is stained
with H&E. with H&E.

Higher magnification of Figure E. The Trypanosoma cruzi epimastigote Trypanosoma cruzi epimastigotes
amastigotes in this image appear to from culture. Note the location of the from culture. Note the location of the

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be transforming into kinetoplast anterior to the nucleus. kinetoplast anterior to the nucleus.
trypomastigotes.

Triatomine bug, Trypanosoma cruzi

vector, defecating on the wound
after taking a blood meal.

Triatomine bugs, the vector of

Trypanosoma cruzi vectors.
Triatomine bug, Trypanosoma cruzi
vector.

AFRICAN TRYPANOSOMIASIS

Trypansoma brucei ssp. in a thick Trypansoma brucei ssp. in a thick Trypansoma brucei ssp. in a thick
blood smear stained with Giemsa. blood smear stained with Giemsa. blood smear stained with Giemsa.

Trypomastigotes of T. brucei ssp. in a

Trypanosoma brucei ssp. in a thin Trypanosoma brucei ssp. in a thin blood smear stained with Giemsa.
blood smear stained with Giemsa. blood smear stained with Giemsa.

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Trypomastigotes of T. brucei ssp. in a

blood smear stained with Giemsa. Trypanosoma brucei ssp. in a thin Trypanosoma brucei ssp. in a thin
blood smear stained with blood smear stained with
Wright-Giemsa. Wright-Giemsa.

Trypanosoma brucei ssp. in a thin Trypanosoma brucei ssp. in a thin Trypanosoma brucei in a thin blood
blood smear stained with blood smear stained with smear stained with Wright-Giemsa.
Wright-Giemsa. Wright-Giemsa.

Trypanosoma brucei ssp. in a thin

Trypanosoma brucei ssp. in a thin blood smear stained with Giemsa.
blood smear stained with The trypomastigote is beginning to
Wright-Giemsa. divide; dividing forms are seen in

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Cryptosporidium spp. oocysts (pink
arrows) in wet mount. A budding
yeast (brown arrow) is in the same
field.
Cryptosporidium sp. oocyst stained
with trichrome. Oocysts may be
detected, but should not be
confirmed by this method. Trichrome
staining is inadequate for a definite
diagnosis because oocysts will
appear unstained. Here the
Cryptosporidium oocyst is
represented by a red arrow; the blue
arrows represent yeast.
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African trypanosomes, but not in
American trypanosomes.
CRYPTOSPORIDIUM
Cryptosporidium parvum oocysts in
wet mount, under differential
interference contrast (DIC)
microscopy. The oocysts are rounded
and measure 4.2 µm - 5.4 µm in
diameter. Sporozoites are visible
inside the oocysts, indicating that
sporulation has occurred.
Cryptosporidium parvum oocysts
stained with modified acid-fast.
Against a blue-green background,
the oocysts stand out in a bright red
stain. Sporozoites are visible inside
the two oocysts to the right in this
image.
Cryptosporidium sp. oocysts stained
with trichrome. Oocysts may be
detected, but should not be
confirmed by this method. Trichrome
staining is inadequate for a definite
diagnosis because oocysts will
appear unstained. Here the
Cryptosporidium oocysts are
represented by red arrows; the blue
arrow represents yeast.
Cryptosporidium parvum oocysts
stained with modified acid-fast.
Against a blue-green background,
the oocysts stand out in a bright red
stain.
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Cryptosporidium sp. oocysts stained
with modified acid-fast.
Unstained Cryptosporidium sp.
oocysts (black arrows) on a slide
stained with modified acid-fast. The
slide was counterstained with
malachite green.
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Cryptosporidium sp. oocyst stained
with modified acid-fast.
Cryptosporidium sp. oocysts stained
with Ziehl-Neelson modified
acid-fast. Image contributed by the
Oregon State Public Health
Laboratory.
Cryptosporidium sp. oocysts (red
arrows) that did not take up the
modified acid-fast stain. The slide
was counterstained with methylene
blue. Note that yeast cells did stain
red (yellow arrows).
Cryptosporidium parvum oocysts
stained with the fluorescent stain
auramine-rhodamine.
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Cryptosporidium sp. oocysts labeled
with immunofluorescent antibodies.
Images contributed by the Kansas
Department of Health and
Environment.
Cryptosporidium sp. oocyst labeled
with immunofluorescent antibodies.
Images contributed by the Kansas
Department of Health and
Environment.
Cryptosporidium sp. oocysts (yellow
arrows) and cysts of Giardia
duodenalis (red arrow) labeled with
immunofluorescent antibodies.

Cryptosporidium sp. oocysts (yellow

arrows) and cysts of Giardia
duodenalis (red arrows) labeled with
immunofluorescent antibodies.

TOXOPLASMA GONDII

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Toxoplasma gondii tachyzoites, Toxoplasma gondii cyst in brain Toxoplasma gondii cyst stained with
stained with Giemsa, from a smear tissue stained with hematoxylin and hematoxylin and eosin.
of peritoneal fluid obtained from a eosin.
laboratory-inoculated mouse.

Unstained cyst of T. gondii. Toxoplasma gondii sporulated oocyst Toxoplasma gondii sporulated oocyst
in an unstained wet mount. in an unstained wet mount, viewed
under differential interference
contrast (DIC) microscopy.

Unsporulated T. gondii oocyst in an Unsporulated oocyst of T. gondii in T. gondii oocysts in a fecal floatation.
unstained wet mount. an unstained wet mount, viewed
with differential interference contrast
(DIC) microscopy.

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Higher magnification of T. gondii

oocysts in a fecal floatation.
Peripheral retinochoroiditis.
Severe, active retinochoroiditis.

Central, healed retinochoroiditis.

CYCLOSPORA

Oocyst of C. cayetanensis in an Oocyst of C. cayetanensis in an Oocyst of C. cayetanensis in an

unstained wet mount. Image unstained wet mount. Image unstained wet mount of stool. Image
courtesy of the Oregon State Public courtesy of the Oregon State Public taken at 1000x magnification.
Health Laboratory. Health Laboratory.

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Oocyst of C. cayetanensis in an Oocyst of C. cayetanensis? stained Oocysts of C. cayetanensis stained

unstained wet mount of stool. Image with trichrome; while the oocyst is with trichrome; while the oocyst is
taken at 1000x magnification. visible, the staining characteristics visible, the staining characteristics
are inadequate for a reliable are inadequate for a reliable
diagnosis. diagnosis.

Oocyst of C. cayetanensis viewed Oocyst of C. cayetanensis viewed Oocyst of C. cayetanensis viewed

under UV microscopy. under UV microscopy. under UV microscopy.

Oocyst of C. cayetanensis viewed Oocyst of C. cayetanensis viewed Oocyst of C. cayetanensis viewed

under UV microscopy. under UV microscopy. under UV microscopy.

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Oocysts of C. cayetanensis stained
with modified acid-fast stain. Note
the variability of staining in the four
oocysts.
Oocyst of C. cayetanensis stained
with modified acid-fast stain.
Oocyst of C. cayetanensis stained
with safranin (SAF).
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Two oocysts of C. cayetanensis
stained with modified acid-fast stain.
Both oocysts failed to take up the
carbol fuschin stain. Image courtesy
of the Arizona State Public Health
Laboratory.
Oocysts of C. cayetanensis stained
with modified acid-fast stain.
A pair of oocysts of C. cayetanensis
stained with safranin (SAF).
Oocysts of C. cayetanensis stained
with modified acid-fast stain. Note
the wrinkled edge and the lack of
stain in the two oocysts. Image
courtesy of the Arizona State Public
Health Laboratory.
Oocysts of C. cayetanensis stained
with modified acid-fast stain.
Oocyst of C. cayetanensis stained
with safranin (SAF).
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Oocyst of C. cayetanensis (yellow Oocyst of C. cayetanensis stained Oocyst of C. cayetanensis stained

arrow) along with an oocyst of with safranin (SAF). with safranin (SAF).
Cryptosporidium parvum (red
arrow), stained with safranin (SAF).
Cryptosporidium spp. also stain with
the safranin and modified acid-fast
stains.

Oocyst of C. cayetanensis viewed Oocyst of C. cayetanensis viewed Oocyst of C. cayetanensis viewed

under differential interference under differential interference under DIC microscopy.
contrast (DIC) microscopy. The contrast (DIC) microscopy. The
refractile globules are easily visible refractile globules are easily visible
under DIC. under DIC.

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A pair of oocysts of C. cayetanensis
viewed under DIC microscopy.
Immature oocyst of C. belli stained
with safranin, containing a single
sporoblast.
Oocyst of C. belli viewed under
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Rupturing oocyst of C. cayetanensis
viewed under DIC microscopy. One
sporocyst has has been released
from the mature oocyst; the second
sporocyst is still contained within the
oocyst wall.
Immature oocyst of C. belli stained Immature oocyst of C. belli stained
with safranin, containing a single with acid-fast, showing a single
sporoblast. sporoblast.
Immature oocyst of C. belli in an Same oocyst as in Figures A and C
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ultraviolet (UV) microscopy, showing unstained wet mount showing a but viewed under ultraviolet (UV)
two sporoblasts. single sporoblast. fluorescent micrscopy.

Immature oocyst of C. belli in an Same oocyst as in Figures B and D Same oocyst as in Figure A but
unstained wet mount showing two but viewed under UV microscopy. viewed under differential
sporoblasts. interference contrast (DIC).

Same oocyst as in Figure B but Oocyst of C. belli in the epithelial Oocyst of C. belli in the epithelial
viewed under ultraviolet (UV) cells of a mammalian host, stained cells of a mammalian host, stained
fluorescent micrscopy. with H&E (yellow arrow). with H&E (yellow arrow).

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