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 6TH EDITION

DIAGNOSTIC
MEDICAL
PARASITOLOGY
LYNNE SHORE GARCIA
 Contents

Dedication v Specialized Stains for Coccidia (Cryptosporidium,

Preface xi Cystoisospora, and Cyclospora Species) and the
Acknowledgments xv Microsporidia 60
Modified Kinyoun’s acid-fast stain (cold method) 60
Modified Ziehl-Neelsen acid-fast stain (hot method)
PA RT I 63
Diagnostic Procedures 1 Carbol fuchsin negative stain for Cryptosporidium
(from W. L. Current) 66
1 Philosophy and Approach to Diagnostic Rapid safranin method for Cryptosporidium 66
Parasitology 3 Rapid safranin method for Cyclospora, using a
microwave oven 66
2 Collection, Preservation, and Shipment of Fecal Auramine O stain for coccidia (from Thomas
Specimens 6 Hänscheid) 67
Safety 6 Modified trichrome stain for the microsporidia
Fresh-specimen collection 7 (Weber—green) 68
Collection of the specimen 7 Modified trichrome stain for the microsporidia
(Ryan—blue) 70
Number of specimens to be collected (standard
recommendation) 7 Modified trichrome stain for the microsporidia
(Kokoskin—hot method) 72
Number of specimens to be collected (pros and cons of
various options) 8 Acid-fast trichrome stain for Cryptosporidium and the
microsporidia 72
Collection times 9
Specimen type, specimen stability, and need for 4 Additional Techniques for Stool Examination 77
preservation 9
Culture of larval-stage nematodes 77
Preservation of specimens 12
Harada-Mori filter paper strip culture 78
Preservatives 12
Filter paper/slant culture technique (petri dish) 79
Use of fixatives 20
Charcoal culture 80
Shipment of diagnostic specimens, biological products, Baermann technique 81
etiologic agents, or infectious substances 21
Agar plate culture for Strongyloides stercoralis 83
3 Macroscopic and Microscopic Examination of Egg studies 87
Fecal Specimens 26 Estimation of worm burdens and Kato-Katz thick film 87
Macroscopic Examination 26 Hatching of schistosome eggs 89
Microscopic Examination (Ova and Parasite Search for tapeworm scolex 91
Examination) 27 India ink injection procedure for tapeworm
Direct wet smear 27 proglottids 92
Concentration (sedimentation and flotation) 32 Qualitative test for fecal fat 94
Permanent stained smear 41 Quantitation of reducing substances (Clinitest) 95
vii

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 viii Contents

5 Examination of Other Specimens from Flow anti-pLDH Plasmodium monoclonal antibodies 148
the Intestinal Tract and the Molecular testing 149
Urogenital System 98 Automated blood cell analyzers 150
Examination for pinworm 98 Diagnosis of leishmaniasis: review of alternatives to
Cellulose tape preparations 99 conventional microscopy 150
Anal swabs 99 ICT for detection of anti-rK-39 antibodies 150
Sigmoidoscopy material 100 Concentration procedures 151
Direct saline mount 101 Cytocentrifugation technique 151
Permanent stained slide 101 Knott concentration procedure 151
Duodenal contents 102 Membrane filtration technique 151
Duodenal drainage 102 Gradient centrifugation technique 152
Duodenal capsule technique (Entero-Test) 103 Triple-centrifugation method for trypanosomes 152
Urogenital specimens 103 Special stain for microfilarial sheath 152
Trichomoniasis 103 Delafield’s hematoxylin 152
Filariasis 105
Schistosomiasis 105
8 Parasite Recovery: Culture Methods, Animal
Inoculation, and Xenodiagnosis 156
6 Sputum, Aspirates, and Biopsy Material 107 Culture methods 156
Expectorated sputum 107 Intestinal protozoa 157
Pathogenic free-living amebae 162
Induced sputum 109
Blastocystis spp. (Blastocystis hominis) 167
Aspirates 116
Pathogenic flagellates 168
Lungs and liver 116
Flagellates of blood and tissue 172
Lymph nodes, spleen, liver, bone marrow, spinal fluid,
eyes, and nasopharynx 118 Toxoplasma gondii 176
Cutaneous ulcer 120 Plasmodium and Babesia spp. 177
Cryptosporidium spp. 178
Biopsy material 120
Microsporidia 178
Skin 124
Lymph nodes 124 Animal inoculation 178
Muscle 125 Leishmania spp. 180
Rectum and bladder 126 Trypanosoma spp. 180
Toxoplasma gondii 180
7 Procedures for Detecting Blood Parasites 129 Xenodiagnosis 181
Preparation of thick and thin blood films 129
9 Fixation and Special Preparation of Fecal
Thick blood films 130
Parasite Specimens and Arthropods 183
Thin blood films 131
Combination thick and thin blood films Fixation of parasite specimens and arthropods 183
(on the same slide) 132 Protozoa 185
Combination thick and thin blood films Solutions to induce relaxation in adult helminths 185
(can be stained as either) 132 Nematodes 186
Buffy coat blood films 134 Trematodes 187
Staining blood films 135 Cestodes 187
Giemsa stain 136 Helminth eggs and larvae 188
Wright’s stain 137 Arthropods 188
General notes on staining procedures 140 Mounting and staining of parasite specimens for
Proper examination of thin and thick blood films 140 examination 189
Thin blood films 140 Nematodes 189
Thick blood films 141 Trematodes 189
Determination of parasitemia 141 Cestodes 191
Diagnosis of malaria: review of alternatives to Mounting of arthropods for examination 191
conventional microscopy 142 Mites 192
QBC microhematocrit centrifugation method 145 Fleas and lice 192
ParaSight F test 146 Ticks 193
NOW malaria test 147 Miscellaneous arthropods 193

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 Contents ix

10 Artifacts That Can Be Confused with Parasitic Disposal of contaminated materials 224
Organisms 195 Standard precautions 224
Protozoa 195 Hepatitis exposure protocol 227
Amebae 195 Dangerous properties of industrial materials 227
Flagellates 198 Current OSHA regulations for the use of
formaldehyde 228
Ciliates 198
Latex allergy 229
Coccidia and microsporidia 198
Quality systems 229
Cryptosporidium spp. and
Cyclospora cayetanensis 198 Extent of services 229
Cystoisospora belli 198 Proficiency testing 230
Microsporidia 199 In-house quality control 233
Patient outcome measures 236
Blood and body fluids 200
Continuous quality improvement, total quality
Malaria parasites and Babesia spp. 200
management, or 10-step and FOCUS-PDCA for
Leishmaniae and trypanosomes 200 performance improvement activities 237
Microfilariae 201 CLIA ’88 inspection process 238
Body fluids: ciliated epithelial cells 202 New quality guidelines 239
Helminths 203 ISO guidelines 240
Adult worms and larvae 203 CLSI (NCCLS) model 240
Eggs 204 Factors influencing future laboratory
Human cells 204 practice 241
Polymorphonuclear leukocytes 205 Managed care 241
Eosinophils 206 Financial considerations 242
Macrophages 206 Current regulations 242
Lymphocytes 207 Decentralized testing 243
Red blood cells 207 Laboratory services 244
Charcot-Leyden crystals 208 Technological trends 244
Nonhuman elements seen in feces (yeast cells) 209 Clinical decision support 245
Insect larvae 209 Personnel issues 245
Spurious infections 209 Changing demographics 245
Delusory parasitosis (delusional infestation) 210 Emerging diseases 246
Bioterrorism 246
11 Equipment, Supplies, Safety, and Quality System
Recommendations for a Diagnostic Parasitology 12 Medical Parasitology: Case Histories 249
Laboratory: Factors Influencing Future Protozoal infections 249
Laboratory Practice 212 Case 1 249
Equipment 212 Case 2 251
Microscope 212 Case 3 252
Centrifuge 216 Case 4 255
Fume hood 217 Case 5 256
Biological safety cabinet 217 Case 6 258
Refrigerator-freezer 218 Case 7 260
Supplies 218 Helminth infections 262
Glassware 218 Case 8 262
Miscellaneous supplies 218 Case 9 263
ATCC quality control organisms 219 Case 10 266
Safety: personnel and physical facilities 219 Case 11 267
General precautions 219 Case 12 269
Handwashing 220 Case 13 271
Personal protective equipment Case 14 273
(OSHA 2001 blood borne) 221 Blood parasite infections 274
Handling specimens 221 Case 15 274
Processing specimens 221 Case 16 278
Spills 222 Case 17 280

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Case 18 281 Tropical pulmonary eosinophilia 394

Case 19 283 Loa loa 394
Case 20 284 Mansonella ozzardi 397
Diagnostic methods and proficiency testing 286 Mansonella perstans 398
Case 21 286 Mansonella streptocerca 399
Case 22 288 Onchocerca volvulus 400
Case 23 289 Dirofilaria Dirofilaria and Dirofilaria Nochtiella spp. 409
Case 24 292
Case 25 293 16 Intestinal Cestodes 418
Diphyllobothrium latum 418
PA RT I I Taenia solium 425
Taenia saginata 435
Clinically Important Human Parasites 297
Taenia asiatica (Asian Taenia or Taenia saginata
13 Intestinal Nematodes 299 asiatica) 437
Ascaris lumbricoides 300 Hymenolepis (Rodentolepis) nana 439
Enterobius vermicularis 308 Hymenolepis diminuta 441
Trichuris trichiura 311 Dipylidium caninum 443
Capillaria philippinensis 314
Hookworms (Ancylostoma duodenale, Necator 17 Tissue Cestodes: Larval Forms 447
americanus, and Ancylostoma ceylanicum) 316 Echinococcus granulosus (cystic hydatid disease) 447
Trichostrongylus spp. 321 Echinococcus multilocularis (alveolar disease, hydatid
Strongyloides spp. 322 disease) 458
Echinococcus vogeli (Polycystic Hydatid Disease) and
14 Tissue Nematodes 336 Echinococcus oligarthrus (Unicystic Hydatid Disease):
Trichinella spp. 336 Neotropical Echinococcosis 463
Baylisascaris procyonis 346 Taenia (Multiceps) spp. (Taenia multiceps, Taenia
serialis) (coenurosis) 465
Lagochilascaris minor 352
Spirometra mansonoides and Diphyllobothrium spp.
Toxocara canis and T. cati (visceral larva migrans and
(sparganosis) 467
ocular larva migrans) 353
Ancylostoma braziliense and A. caninum 18 Intestinal Trematodes 474
(cutaneous larva migrans) 358
Human eosinophilic enteritis 359 Fasciolopsis buski 475
Dracunculus medinensis 360 Echinostoma ilocanum 479
Angiostrongylus (Parastrongylus) cantonensis Heterophyes heterophyes 481
(cerebral angiostrongyliasis) 362 Metagonimus yokogawai 482
Angiostrongylus (Parastrongylus) costaricensis Gastrodiscoides hominis 484
(abdominal angiostrongyliasis) 365
Gnathostoma spinigerum 366 19 Liver and Lung Trematodes 487
Gnathostoma doloresi, G. nipponicum, G. hispidum, Liver Flukes 487
and G. binucleatum 368 Clonorchis sinensis 487
Anisakis simplex, A. physetesis, Pseudoterranova Opisthorchis viverrini 494
decipiens, Contracaecum osculatum, Hysterothylacium
Opisthorchis felineus 497
aduncum, and Porrocaecum reticulatum (larval
nematodes acquired from saltwater fish) 370 Fasciola hepatica 499
Capillaria hepatica 373 Fasciola gigantica 502
Thelazia spp. 373 Less Common Liver Flukes 504
Dicrocoelium dendriticum, Dicrocoelium hospes, and
15 Filarial Nematodes 377 Eurytrema pancreaticum 504
Basic Life Cycle 380 Lung Flukes 506
The Endosymbiont 380 Paragonimus westermani 506
Human Pathogens 380 Paragonimus kellicotti 512
Wuchereria bancrofti 381
Brugia malayi 391 20 Blood Trematodes: Schistosomes 516
Brugia timori 392 Schistosoma mansoni 517
Zoonotic Brugia infections Schistosoma japonicum 530
(American brugian filariasis) 393 Schistosoma mekongi 536

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Schistosoma malayensis 539 New World (Western) Leishmaniasis:

Schistosoma haematobium 539 Cutaneous Leishmaniasis 788
Schistosoma intercalatum 546 Visceral Leishmaniasis: General Comments 796
Old World (Eastern) Leishmaniasis: Visceral
21 Intestinal Protozoa: Amebae 552
Leishmaniasis 796
Entamoeba histolytica 552
New World (Western) Leishmaniasis: Visceral
Entamoeba dispar 567 Leishmaniasis 803
Entamoeba moshkovskii 568
Entamoeba bangladeshi 569
28 Trypanosomiasis 810
Entamoeba hartmanni 570
Entamoeba coli 571 African trypanosomiasis 811
Entamoeba polecki 572 Trypanosoma brucei gambiense 811
Entamoeba gingivalis 572 Trypanosoma brucei rhodesiense 822
Endolimax nana 574 American trypanosomiasis 826
Iodamoeba bütschlii 575 Trypanosoma cruzi 826
Blastocystis spp. 576 Trypanosoma rangeli 839

22 Intestinal Protozoa: Flagellates and Ciliates 584 29 Unusual Parasitic Infections 845
Giardia lamblia (G. duodenalis, G. intestinalis) 584 Aquatic protist 845
Dientamoeba fragilis 598 Rhinosporidium seeberi 845
Pentatrichomonas hominis (Trichomonas hominis) 602
Protozoa 848
Trichomonas tenax 603
Lophomonas blattarum 848
Chilomastix mesnili 604
Dictyostelium polycephalum 850
Enteromonas hominis 604
Myxozoan parasites 850
Retortamonas intestinalis 605
Trypanosoma evansi, Trypanosoma lewisi 851
Balantidium coli 605
Nematodes (the roundworms) 852
23 Intestinal Protozoa (Coccidia), Microsporidia, Ancylostoma ceylanicum 852
and Algae 612 Halicephalobus gingivalis 853
Coccidia 612 Oesophagostomum spp. 853
Cryptosporidium spp. 612 Eustrongylides spp. 855
Cyclospora cayetanensis 630 Mermis nigrescens 856
Cystoisospora (Isospora) belli 637 Dioctophyma renale 856
Sarcocystis spp. 643 Ternidens deminutus 858
Microsporidia 648 Mammomonogamus laryngeus (Syngamus laryngeus) 859
Ascaris suum 860
Algae (Prototheca) 662
Gongylonema pulchrum 861
24 Free-Living Amebae 667 Haycocknema perplexum 861
Naegleria fowleri 669 Cestodes 862
Acanthamoeba spp. 677 Diplogonoporus spp. 862
Balamuthia mandrillaris 687 Bertiella studeri 862
Inermicapsifer madagascariensis 863
Sappinia (diploidea) pedata 690
Raillietina celebensis 863
25 Protozoa from Other Body Sites 694 Mesocestoides spp. 864
Trichomonas vaginalis 694 Taenia crassiceps 865
Toxoplasma gondii 704 Trematodes 866
Alaria americana 866
26 Malaria and Babesiosis 719 Plagiorchis spp. 868
Malaria 719 Neodiplostomum seoulense 868
Babesiosis 763 Spelotrema brevicaeca 869
Brachylaima sp. 869
27 Leishmaniasis 778 Nanophyetus (Troglotrema) salmincola 870
Cutaneous Leishmaniasis: General Comments 779 Stellantchasmus falcatus 871
Old World (Eastern) Leishmaniasis: Cutaneous Phaneropsolus spinicirrus, Phaneropsolus bonnei, and
Leishmaniasis 780 Prosthodendrium molenkempi 871

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Haplorchis taichui 872 Infections in the pediatric patient 946

Gymnophalloides seoi 872 Cryptosporidium spp. 946
Metorchis conjunctus (North American liver fluke) Giardia lamblia 946
873 Pediculus humanus capitis 946
Schistosoma mattheei 874 Sarcoptes scabiei 946
Philophthalmus lacrimosus 875 Infections in the compromised patient 946
Achillurbainia spp. 875 Laboratory infections 948
Pentastomids 875 Intestinal protozoa 948
Armillifer spp., Linguatula serrata, and Free-living amebae 948
Sebekia spp. 875
Plasmodium spp. 948
Acanthocephalans 876 Trypanosoma brucei gambiense and T. brucei
Macracanthorhynchus hirudinaceus and rhodesiense 948
Moniliformis moniliformis 876 Trypanosoma cruzi 950
30 Parasitic Infections in the Compromised Host 883 Leishmania spp. 950
Toxoplasma gondii 951
Entamoeba histolytica 885
Specimen handling 951
Free-living amebae 895
Summary 951
Blastocystis spp. 903
Giardia lamblia 903
32 Immunology of Parasitic Infections 954
Toxoplasma gondii 905
Cryptosporidium spp. 907 Amebiasis 960
Cyclospora cayetanensis 910 Giardiasis 964
Cystoisospora (Isospora) belli 912 Toxoplasmosis 966
Sarcocystis spp. 913 African trypanosomiasis 968
Microsporidia 914 American trypanosomiasis 970
Leishmania spp. 918 Malaria 973
Strongyloides stercoralis 923 Helminth infections 978
Plasmodium spp. 926 Summary 981
Babesia spp. 927
American trypanosomiasis 929 33 Antibody and Antigen Detection in Parasitic
Crusted scabies 930
Infections 986
Protozoal infections 993
31 Health Care-Associated and Laboratory- Amebiasis 993
Acquired Infections 935 Babesiosis 995
Health Care-Associated (Nosocomial) infections 935 Chagas’ disease 996
Gastrointestinal infections 936 Cryptosporidiosis 997
Cryptosporidium spp. 936 Cyclosporiasis 997
Giardia lamblia 939 Giardiasis 997
Entamoeba histolytica 940 Leishmaniasis 998
Microsporidia 941 Malaria 999
Cystoisospora (Isospora) belli 941 Toxoplasmosis 1001
Hymenolepis nana 942 Trichomoniasis 1004
Taenia solium 942 Helminth infections 1004
Blood and tissue infections 942 Cysticercosis 1004
Plasmodium spp. 942 Hydatid disease 1005
Babesia spp. 943 Fascioliasis 1007
Trypanosoma brucei gambiense and T. brucei Filariasis 1007
rhodesiense 943 Paragonimiasis 1009
Trypanosoma cruzi 943 Schistosomiasis 1010
Leishmania donovani 944 Strongyloidiasis 1011
Toxoplasma gondii 944 Toxocariasis 1012
Infections with ectoparasites 945 Trichinosis 1013
Pediculus spp. and Phthirus pubis 945 Intradermal tests 1014
Sarcoptes scabiei 945 Casoni test 1014
Myiasis 945 Montenegro test 1014

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34 Histologic Identification of Parasites 1019
Protozoa 1020
Amebae 1020
Flagellates 1024
Ciliates 1024
Coccidia 1025
Microsporidia 1027
Helminths 1029
Nematodes 1029
Cestodes 1039
Trematodes 1045
Blood Parasites 1052
Malaria 1052
Leishmania 1053
Trypanosomes 1055
Filaria 1056
35 Medically Important Arthropods 1077
Arthropods and their relationship to disease 1077
Biological vectors of microorganisms 1077
Bites and envenomation 1078
Tissue invasion 1081
Entomophobia and delusional infestation
(parasitosis) 1082
Class Insecta (insects) 1083
Order Diptera (flies, mosquitoes, and midges) 1083
Myiasis 1090
Order Hemiptera (true bugs) 1098
Order Coleoptera (beetles) 1100
Order Siphonaptera (Fleas) (Ctenocephalides spp.,
Xenopsylla cheopis, Pulex irritans [Human Flea],
Tunga penetrans, Nosopsyllus fasciatus, Echidnophaga
gallinacea, and “Sand Fleas”) 1102
Order Anoplura (sucking lice) 1104
Order Mallophaga (biting and chewing lice) 1106
Order Hymenoptera (bees, wasps, and ants) 1106
Order Blattaria (cockroaches) 1108
Class Arachnida (ticks, mites, spiders, and
scorpions) 1109
Subclass Acari (ticks, mites, and chiggers) 1109
Subclass Araneae (spiders) 1118
Subclass Scorpiones (scorpions) 1122
Other arthropods 1122
Class Chilopoda (centipedes) 1122
Class Diplopoda (millipedes) 1123
Class Crustacea (copepods, crabs, crayfish, etc.) 1123
Control of arthropods of medical importance 1123
Physical control 1124
Biological control 1124
Chemical control 1124
36 Treatment of Parasitic Infections 1134
Albendazole (Albenza) (Amedra) 1134
Amphotericin B (AmBisome) (Gilead) 1135
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Contents xiii
Amphotericin B (Fungizone) (X-Gen) 1153
Artemether (Artenam) (Aarenco, Belgium) 1154
Atovaquone (Mepron) (GlaxoSmithKline) 1154
Atovaquone-Proguanil (Malarone)
(GlaxoSmithKline) 1155
Benznidazole (Rochagan) (Roche, Brazil) 1155
Bithionol (Bitin) (CDC) 1156
Chloroquine Phosphate (Aralen) (Sanofi, Others) 1156
Crotamiton (Eurax) (Ranbaxy) 1156
Dapsone (Jacobus) 1157
Diethylcarbamazine Citrate USP (Hetrazan) (CDC) 1157
Diloxanide Furoate (Furamide, Entamide)
(Boots, England) 1157
Eflornithine (Difluoromethylornithine, Ornidyl)
(Sanofi) (CDC) 1158
Fumagillin (Fumidil-B) 1158
Furazolidone (Furoxone) 1158
Iodoquinol/Diiodohydroxyquin (Yodoxin)
(Glenwood, Others) 1158
Ivermectin (Stromectol, Sklice) (Merck, Sanofi) 1159
Lumefantrine/Artemether (Coartem, Riamet)
(Novartis) 1160
Malathion (Ovide) (Taro Pharmaceuticals) 1160
Mebendazole (Generics) 1160
Mefloquine Hydrochloride (Generics) 1161
Melarsoprol (Mel-B) (CDC) 1162
Metronidazole (Flagyl, IV Flagyl) (Searle/Pfizer,
Baxter) 1162
Miltefosine (Impavido, Miltex) (Paladin, Canada)
(CDC) 1163
Niclosamide (Yomesan, Niclocide)
(Bayer, Germany) 1163
Nifurtimox (Lampit) (Bayer HealthCare) (CDC) 1163
Nitazoxanide (Alinia) (Romark) 1164
Paromomycin (Generics) (Sun Pharma) 1164
Pentamidine Isethionate (Pentam 300, Nebupent)
(APP Pharmaceuticals) 1165
Permethrin (Nix [Insight Pharmaceuticals], Elimite
[Prestium Pharma]) 1166
Polyhexamethylene Biguanide (Baquacil)(Zeneca) 1166
Praziquantel (Biltricide) (Bayer) 1166
Primaquine Phosphate (Sanofi-Aventis) 1167
Propamidine Isethionate (Brolene)
(Aventis, Canada) 1167
Pyrantel Pamoate (Pin-X, Reese’s Pinworm Medicine)
(Quartz Specialty Pharmaceuticals, Reese) 1168
Pyrethrin with Piperonyl Butoxide (Rid)
(Bayer, Others) 1168
Pyrimethamine (Daraprim) (Amedra) 1168
Quinidine Gluconate (Generics) 1169
Quinine Sulfate or Quinine Dihydrochloride (Many
Manufacturers) 1169
Spiramycin (Rovamycine) (Sanofi-Aventis) 1169
Stibogluconate Sodium (Pentostam, Solustibosan)
(GlaxoSmithKline) (CDC) 1170
Suramin Sodium (Germanin) (Bayer, Germany)
(CDC) 1170
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Thiabendazole (Mintezol) (Merck) 1170 A2.3 Procedure for processing preserved stool for
Tinidazole (Tindamax) (Mission Pharmaceuticals) 1171 the ova and parasite examination by using the
Triclabendazole (Egaten) (Novartis) 1172 traditional two-vial collection kit 1210
A2.4 Procedure for processing sodium acetate-acetic
APPENDIXES 1175 acid-formalin (SAF)-preserved stool for the ova
and parasite examination 1211
A P P END IX 1 Information Tables 1176 A2.5 Use of various fixatives and their recommended
A1.1 Classification of human parasites 1176 stains: fecal specimens preserved using polyvinyl
A1.2 Distribution of selected parasitic infections in the alcohol (PVA) 1212
Americas 1179 A2.6 Use of various fixatives and their recommended
A1.3 Distribution of selected parasitic infections in stains: fecal specimens preserved in the Universal
Europe 1179 Fixative, TOTAL-FIX 1213
A1.4 Distribution of selected parasitic infections in Tables
Africa 1180 A2.1 Steps in the trichrome staining procedure (mercuric
A1.5 Distribution of selected parasitic infections in chloride-based PVA-preserved stool specimens) 1214
Asia 1180 A2.2 Steps in the trichrome staining procedure
A1.6 Distribution of selected parasitic infections in (non-mercuric chloride-based PVA-preserved
Oceania 1181 stool specimens) 1215
A1.7 Cosmopolitan distribution of common parasitic A2.3 Steps in the iron hematoxylin staining procedure
infections (North America, Mexico, Central (mercuric chloride-based PVA-preserved stool
America, South America, Europe, Africa, Asia, and specimens) (Spencer-Monroe method) 1216
Oceania) 1181 A2.4 Steps in the iron hematoxylin staining procedure
A1.8 Body sites and specimen collection 1182 (mercuric chloride-based PVA-preserved stool
A1.9 Body sites and possible parasites recovered specimens) (Tompkins-Miller method) 1217
(trophozoites, cysts, oocysts, spores, adults, larvae, A2.5 Steps in the iron hematoxylin staining procedure
eggs, amastigotes, and trypomastigotes) 1183 (incorporating the carbol fuchsin step) 1218
A1.10 Body site, specimen and procedures, recommended A2.6 Steps in the trichrome staining procedure
methods, relevant parasites, and comments 1184 (Universal Fixative [no mercury, no formalin,
A1.11 Examination of tissue and body fluids 1189 no PVA]) 1219
A1.12 Key characteristics of protozoa of the intestinal A2.7 Oil-mounted permanent stained smears
tract and urogenital system 1191 (no Permount is used) 1220
A1.13 Key characteristics of tissue protozoa 1194 A2.8 Tips on stool processing and staining 1221
A1.14 Key characteristics of helminths 1196
AP P E ND IX 3Common Problems in Parasite
A1.15 Key characteristics of most common parasites
Identification 1222
found in blood 1198
A1.16 Diagnostic laboratory report information that Figures
should be relayed to the physician 1200 A3.1–A3.25 Paired drawings of “look alikes” 1222
A1.17 Pros and cons of stool specimen collection and A3.26 Relative sizes of helminth eggs 1233
testing options 1201 Tables
A1.18 Approaches to stool parasitology: test ordering 1203 A3.1 Entamoeba spp. trophozoites versus
A1.19 Pros and cons of ova and parasite examination macrophages 1223
options 1204 A3.2 Entamoeba spp. cysts versus polymorphonuclear
A1.20 Laboratory test reports: optional comments 1206 leukocytes (PMNs) 1224
A1.21 Estimated prevalence of parasitic diseases A3.3 Entamoeba histocolytica versus Entamoeba coli
worldwide 1207 precysts and cysts 1226
A3.4 Endolimax nana versus Dientamoeba fragilis 1227
A P P END IX 2Flowcharts and Staining Tables for A3.5 Adult nematodes and/or larvae found in stool
Diagnostic Procedures 1208 specimens: size comparisons 1234
Flowcharts
A2.1 Procedure for processing fresh stool for the ova AP P E ND IX 4Quality Control Recording
and parasite examination 1208 Sheets 1235
A2.2 Procedure for processing liquid specimens for the A4.1 Diagnostic parasitology quality control (QC)
ova and parasite examination 1209 (reagents) 1236

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A4.2 Diagnostic parasitology quality control (QC) A5.7 Sources of parasitologic specimens 1253
(reagents)—example for multiple reagents 1237
A4.3 Diagnostic parasitology quality control (QC) AP P E ND IX 6 Reference Sources 1254
(culture)—example of a worksheet 1238
A4.4 Equipment maintenance 1239 “Late-Breaking” Published
AP P E ND IX 7
Information 1257
APPENDIX 5 Commercial Supplies and Suppliers 1241
Molecular Panels for
AP P E ND IX 8
Tables
Parasitology 1278
A5.1 Sources of commercial reagents and supplies 1242
A5.2 Addresses of suppliers listed in Table A5.1 1245 AP P E ND IX 9 FAQs 1284
A5.3 Sources of available reagents for immunodetection
of parasitic organisms or antigens 1246 AP P E ND IX 10Current Procedural Terminology
A5.4 Addresses of suppliers listed in Table A5.3 1248 (CPT) Codes in Parasitology 1304
A5.5 Commercial suppliers of diagnostic parasitology
products 1249 GLOSSARY 1307
A5.6 Sources of additional teaching materials, including
case histories 1252 Index 1321

DMP6_Garcia_FM.indd 15 11/24/15 9:51 PM

This page intentionally left blank
 Preface

During the past few years, the field of diagnostic medical parasitology has seen
dramatic changes, including newly recognized parasites, emerging pathogens in
new geographic areas, bioterrorism considerations and requirements, alternative
techniques required by new regulatory requirements, reevaluation of diagnostic
test options and ordering algorithms, continuing changes in the laboratory test
menus, implementation of testing based on molecular techniques, reporting for-
mats and report comments, coding and billing requirements, managed-care rel-
evancy, increased need for consultation and educational initiatives for clients,
and an overall increased awareness of parasitic infections from a worldwide
perspective. We have seen organisms like the microsporidia change from the
status of “unusual parasitic infection” to being widely recognized as among the
most important infections in both immunocompetent and compromised patients.
With confirmation of the fifth human malaria, Plasmodium knowlesi, this field
has expanded dramatically. More sensitive diagnostic methods for organism
detection in stool specimens are now commercially available for Entamoeba
histolytica, Entamoeba histolytica/E. dispar, Giardia lamblia, Cryptosporidium
spp., and Trichomonas vaginalis. Reagents are actively being developed for other
organisms such as Dientamoeba fragilis, Blastocystis spp., and the microsporidia.
We have seen Cyclospora cayetanensis coccidia become well recognized as the
cause of diarrhea in immunocompetent and immunocompromised humans. We
continue to see new disease presentations in compromised patients; a good
example is granulomatous amebic encephalitis caused by Acanthamoeba spp.,
Sappinia diploidea, and Balamuthia mandrillaris. With the expansion of trans-
plantation options, many parasites are potential threats to patients who are
undergoing immunosuppression, and these must be considered within the con-
text of this patient group. Transfusion transmission of potential parasitic patho-
gens continues to be problematic. Transfusion in general is becoming more
widely recognized as a source of infection, and donors are also more likely to
come from many parasite-endemic areas of the world. It is also important to
recognize the many neglected parasitic infections seen within the United States;
indeed, the world continues to shrink in terms of infectious diseases.
With expanding regulatory requirements related to the disposal of chemi-
cals, laboratories are continuing to review the use of mercury compounds as
specimen fixatives and learning to become familiar with organism morphology
when using substitute compounds. Permanent staining of fecal smears confirms

xvii

DMP6_Garcia_FM.indd 17 11/24/15 9:51 PM

 xviii Preface

that none of the substitute fixatives provide results of the same quality found
with the use of mercuric chloride-based fixatives. However, the key issue is
whether the intestinal parasites can be identified using these alternative fixa-
tives, not how “perfect” they look. Many fixative options are now available,
including single-vial collection systems, some of which are coupled with their
own stains. Requirements also mandate that any laboratory using formalin
must have formalin vapor monitored as both an 8-hour time-weighted average
and 15-minute readings. Most laboratories are now familiar with the regula-
tions on protection of health care workers from blood and other body fluids
and have implemented specific changes that are no longer optional. Although
laboratories were already using many of the safety recommendations, these
regulations delineate in detail what must be done and documented. Regulatory
information based on new shipping requirements is also included.
On the basis of excellent suggestions and comments, I have made the fol-
lowing changes in this new edition: (i) the chapter on case histories has been
expanded and contains a large number of parasite medical case histories (case
history, study questions, correct answer and discussion, and illustrative material);
(ii) some of the life cycles have been redrawn, and new life cycles have been
added; (iii) algorithms have been expanded; (iv) new tables and figures have
been added throughout the book; (v) additional drawings and photographs
have been added; (vi) extensive color images have replaced the black and white
images; (vii) extensive updated text information is included, all of which was
taken from a comprehensive literature review of all aspects of diagnostic medi-
cal parasitology; (viii) additional examples of unusual parasitic infections are
included; (ix) the chapter on arthropods has been expanded and includes addi-
tional photographs and drawings and expanded text; (x) the chapter on the
immunology of parasitic infections has been enlarged, and updated information
on both antigen and antibody detection methods continues to be included in
this edition; (xi) the chapter on histological identification of parasites has been
dramatically expanded with diagrams of various parasites and their visual pre-
sentations in tissue sections, with greatly enhanced legends for all images;
(xii) diagnostic methods using newer immunoassay and “dipstick” technology
are included; and (xiii) the chapter on quality control has been expanded to
include information on instrumentation and equipment, safety regulations,
quality control and quality systems information, continuous quality improve-
ment, and managed-care considerations. The appendixes have been expanded to
contain more information on artifacts; expanded lists and photographs of prod-
ucts and commercial suppliers; algorithms for ordering specific tests that com-
plement the ova and parasite examination; flowcharts for processing stool
specimens; quality control recording sheets for use in the laboratory; and gen-
eral references and relevant web sites. One of the most important expanded
areas of the sixth edition is found in Appendix 7, which contains information
that has been published within months prior to the final printing of this edition.
This “late-breaking” synopsis of very recent publications can assist the reader
in having access to the latest information available. I encourage you to review
this section as you read various chapters throughout the book. A more compre-
hensive discussion of molecular methods has also been added to the sixth edi-
tion and can be found in Appendix 8. Appendix 9 contains comprehensive
information on the most frequently asked questions for all aspects of human
parasitology, and Appendix 10 contains information related to CPT coding for
testing options for diagnostic parasitology.
The approach to the sixth edition of the book has been revised to present
the diagnostic methods first, then the didactic discussion of parasitic infections

DMP6_Garcia_FM.indd 18 11/24/15 9:51 PM

 Preface xix

as the second component of the book. This change was made to ensure that the
most recent and relevant material would be updated right before editing. My
objective is to provide the user with clear, concise, well-organized, clinically
relevant, cost-effective, and practical quality procedures for use in the clinical
laboratory setting. To use and fully understand these methods for the parasites
discussed, it is imperative that the user also understand information related to
life cycle, morphology, clinical disease, pathogenesis, diagnosis, treatment, epi-
demiology, and prevention. My intent is to provide a comprehensive discussion
of both aspects of the field of diagnostic medical parasitology: first, relevant
diagnostic methods designed to detect and identify the organisms present, and
second, a comprehensive discussion of the individual parasites. I believe that the
book fulfills these objectives and provides readers, whether they are laboratorians,
physicians, or other health care professionals, with not only comprehensive, but
very practical information.
It is also important for readers to understand that there are many diagnos-
tic test options available to the clinical laboratory; not every laboratory will
approach the diagnosis of parasitic infections in the same way. The key to qual-
ity and clinically relevant diagnostic work is a thorough understanding of the
pros and cons of each option and how various options may or may not be rel-
evant for one’s particular geographic area, laboratory size and range of exper-
tise, client base, number and type of patients seen, personnel expertise and
availability, equipment availability, educational initiatives, and communication
options, just to name a few variables. However, it is also important to under-
stand the regulations and technical recommendations that govern and guide this
type of laboratory work; many of these guidelines are related to coding and
reimbursement, proficiency testing, and overall clinical relevance.
The use of product names is not intended to endorse specific products or to
exclude substitute products. Also, because of possible advances and changes in
the therapy of parasitic infections, independent verification of drugs and drug
dosages is always recommended. The diagnostic procedures are intended for
laboratory use only by qualified and experienced individuals or by the person-
nel under their direct supervision. Every effort has been made to ensure accuracy;
however, ASM Press and I encourage you to submit to us any suggestions, com-
ments, and information on errors found.

xix

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 Acknowledgments

I would like to express my thanks to the many colleagues and students who
have helped shape my perspective regarding the field of medical parasitology
over the years, especially Rodney D. Adam, Yost Amrein, Bruce Anderson,
Michael J. Arrowood, Lawrence Ash, M. Teresa Audicana, Kevin Baird, Gordon
Ball, Ralph Barr, J. L. Barratt, Brent Barrett, Marilyn Bartlett, Zvi Bentwich,
Henry Bishop, Byron L. Blagburn, Kenneth Borchardt, Peter Boreham, Emilio
Bouza, Richard Bradbury, Thomas Brewer, Bobbi Pritt, David Bruckner, Sandra
Bullock-Iacullo, Andrew Butcher, Guy Cabral, Ann Cali, Vita Cama, Sandy
Cairncross, Elizabeth Canning, David Casemore, Francis Chan, Ray Chan,
Francois Chappuis, James Cherry, Peter L. Chiodini, John Christie, Frank E. G.
Cox, John Cross, Deirdre Church, C. Graham Clark, D. P. Clark, William E.
Collins, Peter G. Contacos, Frank Cox, Janet Cox-Singh, S. L. Croft, William
Current, A. J. da Silva, Peter Deplazes, Paul DeRycke, Dickson Despommier,
L. S. Diamond, J. P. Dubey, Mark Eberhard, Johannes Eckert, David Ellis, J. T.
Ellis, Gaétan Faubert, Ronald Fayer, Sydney Finegold, Joe Forsyth, Jacob
Frenkel, Thomas Fritsche, H. H. Garcia, Omai Garner, P. J. Gavin, S. Geerts,
Robert Goldsmith, Bruno Gottstein, Thaddeus K. Graczyk, Carlos Graeff-
Teixeira, Martin P. Grobusch, David A. Haake, Paul Hackendorf, Pauline Hahn,
Thomas Hanscheid, Rachidul Haque, J. Harkness, William J. Hausler, George
Healy, Barbara Herwaldt, Donald Heyneman, George Hillyer, S. L. Hoffman,
Peter Horen, Peter Hotez, Henry D. Isenberg, David John, E. H. Johnson,
Stephanie Johnston, Irving Kagan, Ray Kaplan, Kevin R. Kazacos, John Kessel,
Mary Klassen-Fischer, Evelyn Kokoskin, Elmer Koneman, W. A. Krotoski, Jaime
LaBarca, David A. Leiby, William Lewis, David Lindsay, Andrea Linscott, M. D.
Little, Earl Long, Edward Markell, D. Marriott, Marilyn Marshall, A. Mathis,
Blaine Mathison, Alan J. Magill, Francine Marciano-Cabral, A. M. Marty,
Alexander Mathis, James H. McKerrow, James McLaughlin, Diane McMahon-
Pratt, Donald P. McManus, Mae Melvin, Michael Miller, Anthony Moody,
Clinton K. Murray, William Murray, Ronald Neafie, Ron Neimeister, Ann
Nelson, Susan Novak, Thomas Nutman, Thomas Orihel, Ynes Ortega, Robert
Owen, Josephine Palmer, Graeme Paltridge, Liron Pantanowitz, Mark Perry,
David Persing, William A. Petri, Jr., Michael Pfaller, N. J. Pieniazek, Dylan R.
Pillai, Kathy Powers, E. Pozio, Paul Prociv, Gary W. Procop, Fred Rachford,
Sharon L. Reed, Barth Reller, Julie Ribes, Andrew Rocha, William Rogers, Jon
Rosenblatt, Allen G. P. Ross, Norbert Ryan, Judy Sakanari, Carol Santaloci,

xxi

DMP6_Garcia_FM.indd 21 11/24/15 9:51 PM

 xxii Acknowledgments

Peter Schantz, Frederick L. Schuster, James Seidel, Nicholas Serafy, J. A.

Shadduck, Harsha Sheorey, Irwin Sherman, Robyn Shimizu, Balbir Singh, James
Smith, Rosemary Soave, Frank J. Sorvillo, S. L. Stanley, Jr., John Steele, Deborah
Stenzel, Damian Stark, Linda Stetzenbach, Charles Sterling, James J. Sullivan,
Alex Sulzer, Kevin S. W. Tan, Egbert Tannich, Herbert Tanowitz, Mehmet
Tanyuksel, William Trager, Peter Traynor, Antonio R. L. Teixeira, Sam Telford,
William Trager, Allan R. Truant, Jerrold Turner, Saul Tzipori, Jacqueline A.
Upcroft, Peter Upcroft, Tom van Gool, Eric Vanderslice, Jacob Verweij, Govinda
Visvesvara, Marietta Voge, Susanne Wahlquist, Kenneth Walls, Rainer Weber,
Wilfred Weinstein, Louis Weiss, P. P. Wilkins, John Williams, John Wilson,
Marianna Wilson, Jeffrey J. Windsor, Washington Winn, Martin Wolfe, Donna
Wolk, Johnson Wong, Lihua Xiao, Nigel Yeates, Judy Yost, Wenbao Zhang,
Charles and Wiladene Zierdt, and many others whom I may have failed to men-
tion specifically. If the information contained in this edition provides help to
those in the field of microbiology, I will have succeeded in passing on this com-
posite knowledge to the next generation of students and teachers.
Special thanks go to Sharon Belkin for her additional illustrations for this
edition. I also thank Ronald Neafie from the Armed Forces Institute of
Pathology for providing many photographs to illustrate several areas of the
book, particularly the information on histological identification of parasites,
and Herman Zaiman for providing slides that he has prepared and/or edited
from many contributors worldwide. Very special thanks go to the group at the
Centers for Disease Control and Prevention for the use of many of their clinical
parasitology images; these images are invaluable to the microbiology community
and include images contributed to CDC by many others, as well.
I would like to thank members of the editorial staff of ASM Press, especially
Ellie Tupper; they are outstanding professionals and made my job not only
challenging but fun.
Above all, my very special thanks go to my late husband, John, for his love
and support for the many projects that I have been involved in over the years.
I could never have undertaken these challenges without his help and under-
standing, a true partnership.

DMP6_Garcia_FM.indd 22 11/24/15 9:51 PM

PART I
Diagnostic
Procedures
Another random document with
no related content on Scribd:
 DANDO UMA QUEDA
Á VISTA DE UMA DAMA QUE SE ENTENDE SER A CELEBRADA
BABÚ.

Filena, o ter eu cahido

Nenhum susto me tem dado,
Porque a vossos pés prostrado
Me julgo então mais subido:
Direis que fiquei sentido,
Mas sabei que não sentira,
Inda que me não subira
A cahir onde cahi,
Si como no chão me vi,
Com vosco em terra me vira.

Porém que isso me succeda,

Por mais quédas que inda dê,
Não creio, pois vejo que
Não tenho com vosco quéda.
Vossa crueza me veda
Este bem que eu tanto abraço:
Quem viu similhante passo,
Que encontre meu desvario,
Filena, em vosso desvio
A minha quéda embaraço.
Confesso que então cahido
Fiz tenção de me sangrar,
Mas não me quiz mais picar,
Porque assaz fiquei corrido.
Não andei pouco advertido,
Fallo como quem vos ama;
Porque eu sei, formosa dama,
Que por mais que me sangrasse,
Livre estou de que chegasse
A vêr-me por vós na cama.

E com toda essa desgraça

Por satisfeito me dera
Si com cahir merecêra
Siquer cahir-vos em graça:
Mas porque, Filena, faça
D’esta quéda estimação,
Inda sobeja razão,
Si a quéda motivo é
De prostar-me a vosso pé
Para beijar-vos a mão.

Dizeis que quereis tomar,

Para dar, vosso conselho:
Quereis conselho de velho?
Nunca o tomeis para o dar:
Os olhos se hão de fechar
Para o dar, e abrir da mão,
Com razão ou sem razão,
Que os negocios que se tractam,
Com conselhos que dilatam,
Nunca se conseguirão.
Si conselhos não tomaes,
Quando alvedrios rendeis,
Como conselhos quereis,
Quando alvedrios pagaes?
Sem conselho me mataes,
E daes-me a vida em conselho?
Este estylo é já tão velho
Na eschola da tyrannia,
Que da mais tyranna harpia
Podereis vós ser espelho.
 JULGA
O P. COM SUBTILEZA TODA A CULPA DE ACONTECIMENTOS
INIQUOS NO TEMPO ABSTRACTO. ENTENDE-SE SER ESTA
OBRA SATYRA AO GOVERNADOR ANTONIO DE SOUSA DE
MENEZES, POR ALCUNHA O BRAÇO DE PRATA

Tempo, que tudo trasfegas,

Fazendo aos pelludos calvos,
E pelos tornar mais alvos
Até os bigodes lhe esfregas:
Todas as caras congregas,
E á cada uma pões mudas;
Tudo acabas, nada ajudas:
Ao rico pões em pobreza,
Ao pobre dando riqueza,
Só para mim te não mudas.

Tu tens dado em malquerer-me,

Pois vejo que dá em faltar-te
Tempo só para mudar-te,
Si é para favorecer-me:
Por conservar-me e manter-me
No meu infeliz estado,
Até em mudar-te has faltado,
E estás tão constante agora,
Que para minha melhora
De mudanças te has mudado.
Tu que esmaltas e prateias
Tanta guedelha dourada,
E tanta face encarnada
Descoras, turbas e affeias:
Que sejas pincel não creias,
Si não dias já passados,
Mas si esmaltes prateados
Branqueam tantos cabellos,
Como branqueando pellos,
Não me branqueias cruzados?

Si corres tão apressado,

Como paraste commigo?
Corre outra vez, inimigo,
Que o teu curro é meu sangrado:
Corre para vir mudado,
Não pares por mal de um triste;
Porque si pobre me viste,
Paraste ha tantas Auroras,
Si de tão infaustas horas,
O teu relogio consiste?

O certo é, que és um caco,

Um ladrão da mocidade,
Por isso nessa cidade
Corre um tempo tão velhaco:
Farinha, assucar, tabaco
No teu tempo não se alcança;
E por tua intemperança
Te culpa o Brazil inteiro;
Porque sempre és o primeiro
Movel de qualquer mudança.
Não ha já quem te supporte,
E quem armado te vê
De fouce e relogio, crê
Que és o precursor da morte:
Vens adeante de sorte
E com tão fino artificio
Que á morte forras o officio;
Pois ao tempo de morrer,
Não tendo já que fazer,
Perde a morte o exercicio.

Si o tempo consta de dias,

Que revolve o céu opaco,
Como tu, tempo velhaco,
Constas de velhacarias?
Não temes que as carestias,
Que de ti se hão de escrever,
Te darão á aborrecer
Tanto ás futuras edades,
Que ouvindo as tuas maldades
A cara te hão de trocer.

Si porque penas me dês,

Páras cruel e inhumano,
O céu sancto e soberano
Te fará mover os pés:
Esse azul movel que vês
Te fará ser tão corrente,
Que não parando entre a gente
Preveja a Bahia inteira
Que has de correr a carreira
Com pregão de delinquente.
 Á LUIZ CESAR DE MENEZES
GOVERNADOR DE ANGOLA, PEDINDO-LHE DE CARCONDA
CERTO FAVOR OU DESPACHO POR TITULOS DE COMEDIAS

Meu príncipe, d’esta vez

Espero que o plectro obre,
Ainda que para um pobre
Tudo succede al revéz:
O que tão raro me fez,
Levante-me hoje de raso,
Que é já meu timbre em tal caso
Querer por solo querer,
Porfiar hasta vencer
Los empenos de un acaso.

Tanta tragedia e inopia

Tenho em Angola soffrido,
Que em mim se vê el parecido
Del mentir de la Ethiopia:
De tal retrato e tal cópia
Foi causa um general zêlo,
Mas por divino modelo
Quem tanto me fez cahir,
Tanto me viu resurgir:
Lo que juizios del cielo!
Senhor: favores tão grandes
Nunca os poderei pagar:
Mas eu hei de vos mandar
Un valiente Negro en Flandes:
Ao senhor Vasco Fernandes,
A quem por fé tanto adoro,
Por quien a Cruz Sancta imploro,
Que lhe dê Sancta Cruz Neto,
Tambem mandar-lhe prometto
Un esclavo en grilhos de oro.

Dois negros são não pequenos,

Que offereço de antemão;
E posto que só dois são
Pocos bastan, si son buenos:
A El-rei, quando não dê menos,
Ao menos o servirei
Com muita amigavel lei,
E prometto desde aqui
Que tenha em Carconda em mi
El maior Amigo El-rei.
 REDARGUE
O P. A DOUTRINA OU MAXIMA DO BEM VIVER QUE MUITOS
POLITICOS SEGUEM DE INVOLVER-SE NA CONFUSÃO DE
HOMENS PERDIDOS E NESCIOS, PARA PASSAR COM MENOS
INCOMMODO ESTA HUMANA VIDA

Que nescio que eu era então

Quando cuidava o não era!
Mas o tempo, a edade, a era
Puderam mais que a razão:
Fiei-me na discrição,
E perdi-me, em que me pez,
E agora dando ao travez,
Vem no cabo á conhecer
Que o tempo veiu a fazer
O que a razão nunca fez.

O tempo me tem mostrado

Que, por me não conformar
Com o tempo e com logar,
Estou de todo arruinado:
Na politica de estado
Nunca houve principios certos,
E posto que homens expertos
Alguns documentos deram,
Tudo o que nisto escreveram
São contingentes acertos.
Muitos por vias erradas
Têm acertos mui perfeitos,
Muitos por meios direitos
Não dão sem erro as passadas:
Cousas tão disparatadas
Obra-as a sorte importuna,
Que de indignos é columna.
E si me ha de ser preciso
Lograr fortuna sem sizo,
Eu renuncio á fortuna.

Para ter por mim bons fados

Escuso discretos meios,
Que ha muitos burros sem freios
E bem afortunados:
Logo os que andara bem livrados,
Não é propria diligencia,
É o ceu e sua influencia,
São forças do fado puras,
Que põem mentidas figuras
No theatro da prudencia.

De diques de agua cercaram

Esta nossa cidadella,
Todos se molharam nella,
E todos tontos ficaram:
Eu, á quem os céus livraram
D’esta agua, fonte da asnia,
Fiquei são da fantasia
Por meu mal, pois nestes tratos
Entre tantos insensatos
Por sisudo eu só perdia.
Vinham tontos em manada,
Um simples, outro doudete,
Este me dava um moquete,
Aquell’outro uma punhada:
Tá: que sou pessoa honrada,
E um homem de entendimento,
Qual honrado ou qual talento?
Foram-me pondo num trapo,
Vi-me tornado um farrapo,
Porque um tolo fará cento.

Considerei logo então

Os baldões que padecia,
Vagarosamente um dia,
Com toda a circumspecção:
Assentei por conclusão
Ser duro de os correger,
E livrar do seu poder,
Dizendo com grande magua:
Si me não molho nesta agua,
Mal posso entre estes viver.

Eia: estamos na Bahia,

Onde agrada a adulação,
Onde a verdade é baldão,
E a virtude hypocrisia:
Sigamos esta harmonia
De tão fatua consonancia,
E inda que seja ignorancia
Seguir erros conhecidos,
Sejam-me a mim permittidos
Si em ser besta está a ganancia.
Alto pois com planta presta
Me vou ao Dique botar,
E ou me hei de nelle afogar,
Ou tambem hei de ser besta:
Do bico do pé até a testa
Lavei as carnes e os ossos:
Ei-los vêm com alvoroços
Todos para mim correndo,
Ei-los me abraçam dizendo:
«Agora sim que é dos nossos.»

Dei por besta em mais valer,

Um me serve, outro me presta,
Não sou eu de todo besta,
Pois tractei de o parecer:
Assim vim á merecer
Favores e applausos tantos
Pelos meus nescios encantos,
Que emfim e por derradeiro
Fui gallo do seu poleiro
E lhes dava os dias sanctos.

Já sou na terra bem visto,

Louvado e engrandecido,
Já passei de aborrecido
Ao auge de ser bemquisto:
Já entre os grandes me alisto,
E amigos são quantos topo:
Estou fabula de Esopo,
Vendo fallar animaes,
E fallando eu que elles mais,
Bebemos todos num copo.
Seja pois a conclusão,
Que eu me puz aqui a escrever
O que devia fazer,
Mas que tal faça, isso não:
Decrete a Divina mão,
Influam malignos fados,
Seja eu entre os desgraçados
Exemplo da desventura,
Não culpem minha cordura,
Que eu sei que são meus peccados.
 DESCREVE
O RICO FEITIO DE UM CELEBRE GREGORIO DE NEGREIROS
EM QUE VARIAS VEZES FALLA, MOÇO COM QUEM
GRACEJAVA COM DIVERTIMENTO NAQUELLE SITIO

ROMANCE

Eu vos retrato Gregorio,

Desde a cabeça á tamanca,
Co’ um pincel esfarrapado
Numa pobrissima tabua.
Tão pobre é nossa gadelha,
Que nem de lendias é farta,
E inda que cheia de aneis,
São aneis de piassaba.
Vossa cara é tão estreita,
Tão faminta e apertada,
Que dá inveja aos Buçacos,
E que entender ás Thebaidas.
Tende dois dedos de testa
Porque da frente á fachada
Quiz Deus e a vossa miseria
Que não chegue á pollegada.
Os olhos dois ermitães,
Que em uma lobrega estancia
Sempre fazem penitencia
Nas grutas da vossa cara.
Dois arcos quizeram ser
As sobrancelhas, mas para
Os dois arcos se acabarem
Até de pello houve falta.
Vosso pae vos amassou,
Porém com miseria tanta,
Que tremeu a natureza
 Que algum membro vos faltára.
Deu-vos tão curto o nariz,
Que parece uma migalha,
E no tempo dos defluxos
Para assoar-vos não basta.
Vós devieis de ser feito
No tempo em que a lua se acha
Pobrissima já de luz,
Correndo á minguante quarta.
Pareceis homem meminho,
Como o meminho da palma,
O mais pequeno na rua,
E o mais pobresinho em casa.
Vamos aos vossos vestidos,
E peguemos na casaca,
Com tento, porque sem tento
A leva qualquer palavra.
Anda tão rota, senhor,
Que tenho por coisa clara
Que no Tribunal da Rota
De Roma está sentenciada.
A vossa grande pobreza
Para perpetua lembrança
Dedico á de Manuel Trapo,
Que foi no mundo affamada.
 Á HENRIQUE DA CUNHA
CHEGANDO DO SITIO DA ITAPEMA Á CAJAHYBA

ROMANCE

Senhor Henrique da Cunha,

Vós que sois lá na Itapema
Conhecido pelo brio,
Graça, garbo, e gentileza:
Vós que aonde quer que estais
Todo o mundo se vos chega
A escutar a muita graça,
Que vos chove á bocca cheia:
Vós que partindo de casa,
Ou seja ao remo, ou á vela,
Bem que venhais sem velame,
Vindes fiado na verga:
E apenas tendes chegado
A esta Cajahyba amena,
Logo São Francisco o sabe,
Logo Apollonia se enfeita:
Logo chovem os recados,
Logo a canôa se apresta,
Logo vai, e logo encalha,
Logo a toma, volta e chega:
Logo vós a conduzis
Para a Casa das galhetas,
Onde o melado se adoça,
Onde a garapa se azeda:
Entra ella, e vós tambem,
Assenta-se, e vós com ella
E assentada lhe brindais
Á saude das parentas.
Vós: mas baste tanto vós,
 Si bem que a Musa burlesca
Anda tão desentoada,
Que em vez de cantar, vozea.
Ás vossas palavras vamos,
Vamos ás vossas promessas,
Que com serem infinitas,
Não são mais que as minhas queixas.
Promettestes-me, ha dois annos,
De fazer-me aquella entrega
Da viuva de Naim,
Que hoje é gloria da Itapema.
Não me mandastes comboy,
Necessaria diligencia,
Para um triste que não sabe
Nem caminho, nem carreira.
Tão penoso desde então
Fiquei com tamanha perda,
Que ou a pena ha de acabar-me,
Ou ha de acabar-se a pena.
Mas inda fio e confio
Na Senhora Dona Tecla
Que nas dez varas de hollanda
Hei de amortalhar a peça.
Disse amortalhar, mal disse,
Melhor resurgir dissera,
Que em capello tal resurge
A mais defuncta potencia.
Vós me tirastes o ganho:
Sois meu amigo, paciencia;
Por isso diz o rifão
Que o maior amigo apega.
Só vós soubestes logra-la,
Que sois com summa destreza
Grande jogador de gorra,
Pela branca e pela negra.
Jogais a negra e a branca,
E tudo na eschola mesma,
 Bem haja escrava e senhora,
Que uma de outra se não zela.
Esta é a queixa passada,
Porém a presente queixa
É que a todos os amigos
Mandastes mimos da Terra.
A uns peças de piassabas,
A outros fizeste a peça,
E eu já essa peça tomára,
Por ter de vós uma prenda.
Enviar-me alguma cousa,
Mais que seja um pau de lenha,
Terei um pau para os caens,
Que é o que ha na nossa terra.
Lembre-vos vosso compadre,
Que o tal Duarte de Almeida
Co’ a obra parou, emquanto
A piassaba não chega.
Mandae-me uma melancia,
Que ainda que é fruita velha,
Não importa o ser passada,
Como de presente venha.
Mandae-me um par de tipoyas,
Das que se fazem na Terra,
A dois cruzados cada uma,
Que eu mandarei a moeda.
Mandae-m’as sem zombaria,
Que eu vo-las peço de veras,
Porque não peço de graça
Quanto a dinheiro se venda.
Mandae-me boas novas vossas,
E em que vos sirva e obedeça,
Que como vosso captivo
Irei por mar e por terra.
Mandae-me novas da mãe,
Das filhas muitas novellas,
Pois em faze-las excedem
 Cervantes e outros poetas.
E perdoae disparates
De quem tanto vos venera,
Que por em tudo imitar-vos
Vos quer seguir na pespega.
 PEDINDO-SE
A SOLTURA DE UM MULATO Á SEU SENHOR

Não estamos nos Ilheos,

Que é terra de meus peccados,
Mas estamos melhorados
Aqui na Madre de Deus:
E si aquelles tabaréus
Por vossa mesma verdade
Dão tão geral liberdade
Aos delinquentes da terra,
Vós c’o peccador que erra
Como usaes tal crueldade?

Um castigo tão tyranno,

Uma prisão tão severa,
Satisfaria a uma fera,
E eu cuidei que ereis humano:
Ha pouco menos de um anno
Que está esse peccador
Purgando com grande dor,
E com trabalho infinito,
Á principio o seu delicto,
E agora o de seu senhor.