GROUP CASE

STUDIES IN
PARASITOLOGY
MIRANDA, Pearlregine
RUIZ, Kimberly
TIBULE, Althea
VICTORIO, Jimna
PARASITOLOGY CASE STUDY 1:

A MEDICAL LABORATORY SCIENTIST WAS

EXAMINING A SPECIMEN, WHICH APPEARED TO BE
STAINED WITH HEMATOXYLIN AND EOSIN (H & E).
FIGURE A SHOWS WHAT WAS SEEN ON THE SLIDE AT
200× MAGNIFICATION.

Figure A
1. Based from the figure presented, what specimen was used to
prepare
• the slide?
The specimen used to prepare the slide was a muscle biopsy.
2. Based from your answer in number 1, do you think that this is
the ideal and typical specimen that should be used in the
identification of the parasite? Why or why not?
• Yes, because this specific parasite is able to localize in the skeletal muscles.
1) Ingestion of undercooked meat with encysted larvae

• When the encysted larvae are digested in the

stomach, the larvae excysts and develops into an
adult worm. The female worm deposits larvae in
the mucosa and passes through the lymphatic
system and into striated muscles.
 3. Identify the parasite and its stage as based on the figure presented.
Justify your answer by enumerating the diagnostic features relevant
in the identification of the parasite.
 Coiled larvae
 Nurse cell that develops in the striated skeletal
muscle
 Inflammatory infiltrates surrounding the nurse
cell

Trichinella spiralis, encysted larvae

4. What is the parasitic infection of the patient?

• Trichinosis or Trichinellosis
5. What enzymes are relevant to aid in the diagnosis and
identification of the parasite? Enumerate your answers and beside
each indicate its importance in making your diagnosis.
• Creatine phosphokinase
 Elevated levels suggesting that muscle damage may be mediated indirectly
by these activated granulocytes

• Lactate Dehydrogenase
 Elevated levels suggesting that muscle damage may be mediated indirectly
by these activated granulocytes

• Aldolase
Elevated levels indicate myositis
6. Illustrate a step by step FLOWCHART to aid in the identification
of• COMPLETE
the parasite.
BLOOD COUNT  BLOOD CHEMISTRY
Increased WBCs  Increased muscle enzymes
 CKP
Eosinophilia  LDH
 Aldolase

 SEROLOGIC DIAGNOSIS
 Detection of specific anti-Trichinella
antibodies
 IgE
 DIRECT IDENTIFICATION
VIA MUSCLE BIOPSY
 IgG
(DELTOID MUSCLE)
 ELISA
 Trichinoscopy (conventional)
 Indirect fluorescent antibody test
 Artificial digestion
 Latex Agglutination
 Histologic Analysis
 Immunoblotting
 Western blot
PARASITOLOGY CASE STUDY 2:

A MALE PATIENT WAS ADMITTED TO A LOCAL HOSPITAL

DUE TO FEVER AND CHILLS. UPON HIS INTERVIEW HE
STATED THAT HE HAD PREVIOUSLY TRAVELLED TO AFRICA
3 WEEKS BEFORE HE EXPERIENCED SYMPTOMS. A SAMPLE
FROM THE PATIENT WAS OBTAINED AND WAS EXAMINED
BY THE LABORATORY. THE IMAGES BELOW FROM
FIGURES A-D WERE CAPTURED AT 1000× MAGNIFICATION.

Figure A Figure B Figure C Figure D

1. What type of specimen should you collect from the patient? Why?
• The specimen to be collected must be BLOOD. This is because this parasite is found
in the blood, the infected mosquito takes a blood meal and injects sporozoites into the
blood stream. Then it enters liver cells and invade RBCs.

2. Enumerate your considerations that you have to keep in mind in

collecting the specimen from your patient. Beside each, indicate the
rationale why
• Usage of is it important.
anticoagulant
 The anticoagulant prevents the blood from clotting which entraps the organism.

• Sample must be prepared 1 hour after collection

Because it may cause morphological changes of parasite if prolonged.
3. What is the preferred stain to be used for this type of specimen?
Justify your answer.
• Use of GIEMSA STAIN is the recommended and most reliable procedure for
staining thick and thin blood films. Giemsa solution is composed of eosin and
methylene blue (azure). The EOSIN component stains the parasite nucleus red, while
the METHYLENE BLUE component stains the cytoplasm blue.
4. Based from your answer in number 3, what quality control
measures should you consider before using the stain? Enumerate
your answers.
• Prepare a thin film of blood known to be positive for malaria, ideally containing P.
vivax parasites.
• Prepare 3% and 10% working solutions from the new Giemsa stain stock, using
water buffered at pH 7.2.
• Fix the slide with methanol, and allow them to dry. Stain the slide.
• Examine slides to check for the quality of stain
• If necessary, adjust the staining time, and repeat steps 1–4 until the expected results
are obtained.
• Record details, observations and actions in the QC log-book, with the name of the
staff member who performed QC.
 5. What diagnostic feature is seen in
Figure A? • Occupies 75% of RBC
• James’ dot
• RBC size is enlarged, oval fimbriated margin

Figure A

. What diagnostic feature is present in Figure D?

• Thin ring, ameboid in

appearance

Figure D
7. Based from your previous answers in numbers 5 and 6, identify
the specific parasite that is causing the infection of the patient.
• Plasmodium ovale
PARASITOLOGY CASE STUDY 3:

A SPECIMEN FROM A FEMALE PATIENT WAS SUBMITTED TO

THE LABORATORY FOR PROCESSING AND FOR
IDENTIFICATION OF THE PARASITE THAT MIGHT BE
PRESENT IN THE SAMPLE. MICROSCOPIC EXAMINATION OF
THE SAID SPECIMEN REVEALED THE FOLLOWING:

Figure A Figure B
1. What diagnostic feature is seen in Figure A as being pointed by the
yellow arrow?
•SOMATIC COLUMN

2. Examine carefully Figure A, aside from your answer in number 1,

what are the two (2) other diagnostic features evident to help in the
identification of the parasite? Enumerate your answers.
• Nucleus irregularly spaced to the tip
• Short cephalic space
3. Identify the parasite using your answers in number 1 and 2 as
your •basis.
Loa loa
4. Illustrate a step by step flowchart of the procedures that you must
consider to accurately identify the parasite.
Identification of the adult
worm by a microbiologist or Identification of an adult
pathologist after its removal worm in the eye by a health
from under the skin or eye care provider

Identification of
antibodies against Loa
loa on specialized blood
test
Identification of the
microfilariae on a blood
smear made from blood
taken from the patient
between 10AM and 2PM
5. Enumerate and briefly describe symptoms that the patient might
experience in relation to the parasite seen in Figure A and B.
• CALABAR SWELLING/FUGITIVE SWELLING
• A transient subcutaneous swelling marking the migratory course through the
tissues, they are presumed to reflect hypersensitivity reactions to allergens
released by migrating adult worms
• Subconjunctival migration of adult worms
• Nephropathy generally manifests as proteinuria with or without mild hematuria and is
believed to be due to immune complex deposition.
• Encephalopathy is usually mild, with vague central nervous system (CNS)
symptoms.
PARASITOLOGY CASE STUDY 4:

A 40 YEAR OLD FARMER VISITED HIS HEALTH CARE

PROVIDER DUE TO ABDOMINAL DISTENSION, IRREGULAR
AND SPASMODIC DIARRHEA, AND ABDOMINAL CRAMPING.
HE MENTIONED THAT HE IS AN OUTDOOR PERSON AND
USUALLY SPENDS HIS WEEKENDS FISHING AND CAMPING.
THE PATIENT WAS REQUESTED TO SUBMIT A STOOL SAMPLE
FOR EXAMINATION. FIGURES A AND B REVELED WHAT WAS
OBSERVED MICROSCOPICALLY ON THE SLIDE.

Figure A Figure B
What is the object seen in figures A and B, identify?
• POLLEN GRAIN
2. If you identified that the object is a parasite, enumerate the
diagnostic features that will help you aid you in its identification,
otherwise please proceed to question number 3.
3. If you had concluded that it is not a parasite, what features will
tell you that it is not? Enumerate your answers.
• Pollen grains are smaller in size
• Football-shaped with spine-like protuberance
• When deposited, it is unembryonated and unsegmented
4. Should microscopic examination (Fecalysis) which is our
conventional method used in the laboratory be replaced/ be
supplemented with new and updated techniques (Molecular
biological techniques e.g. PCR) in the diagnosis and identification of
parasites? Justify your answers in a tabulated manner by comparing
their advantages
TESTS and disadvantages.
ADVANTAGES DISADVANTAGES
• Easy procedure
• Relies on the skills of medical
Fecal (stool) exam or ova and • Considered the “gold standard”
technologist
parasite test (O&P) for the diagnosis of parasitic
• Labor-intensive
diseases
• Used when stool exams do not • Invasive procedure
Endoscopy/Colonoscopy
reveal the cause of the disease • Expensive
Antigen detection methods (e.g.
• Specific detection method • Expensive
EIA)
Molecular techniques • Expensive
• High sensitivity and specificity
(e.g. PCR) • Complex procedure