Clinical Parasitology

Samples, signs and symptoms Mohieddin Abdul Fattah

Type of specimens taken for parasitologic diagnosis:

1.Blood 2.Stool 3.Urine 4.CSF 5.Vaginal discharge 6.Bronchoalveolar lavage (BAL). 7.Aspirates 8.Tissues and skin (biopsies)

Parasites in blood samples
 Parasites in blood film (thin or thick) 1. Plasmodium • P. vivax, ovale, malariae: ring , schizonts & gametocytes • P. falciparum: ring and gametocytes only 2. Trypanosoma • African: Trypomastogotes • American: Trypomastigotes 3. Filariae: Microfilariae • W. bancrofti • Brugia malayiae • Loa loa  Parasites in Buffy coat layer: 1. Those detected in blood film 2. Toxoplasma 3. visceral leishmaniae

Other Samples for parasitologic diagnosis:
1. Stool:
• • • • • Heterophyes, Fasciola and schistosoma eggs Eggs, segments of intestinal cestodes. Eggs or larvae of intestinal nematodes. Trophozoites, or cysts of Entamoeba, Balantidium and Giardia. Oocysts of intestinal coccidia (cryptosporidium)

2. Urine:
• • • • Trichomonas vaginalis trophozoite Schistosoma eggs, W. bancrofti, O, volvulus (microfilariae) Pthiurus pubis (pubic Flea), Sarcoptes (scabies mite).

4. CSF:
• Trypanosoma (trypomastigotes), • Naegleria trophozoites (Free living amoebae).

Other Samples for parasitologic diagnosis
5. Aspirates from affetced organs;  Duodenum: Giardia, Strongyloides, Fasciola.  Liver: L. donovani, Entamoeba histolytica  Spleen: L. donovani  bone marrow: L. donovani.  LN: Trypanosoma, Leishmania and Toxoplasma. 6. Biopsies:  Muscle: encysted Larva of T. spiralis  Skin: A. cutaneous Lesihmania, B. Onchocerca, C. Medina worm, D. Myiasitic larvae, E. Sarcoptes, and F. Tunga flea

• Other samples for parasitologic diagnosis
 Rectal Biopsy: 1. Schistosoma mansoni, 2. Entamoeba histolytica
6) Vaginal discharge: • T. vaginalis trophozoites 7) Sputum:  Strongyloides larvae,  Ascaris larvae,  hookworm larvae.  Entamoeba histolytica (amebic lung abscess)

Symptoms and signs caused by parasitic infections
• Fever
1. • • • • 2. • • • • Acute fever Malaria Toxoplasmosis. Trichinosis. American trypanosomiasis. Chronic fever: Prepatent fascioliasis. Visceral leishmaniasis. Toxocariasis. Katayama fever (schistosomiasis) • Filarial fever. 3. Recurrent fever: • Malaria.

• Coma 1. Cerebral malaria. 2. African Trypanosomiasis.
• 1. 2. 3. 4. 5. 6. Anaemia: Diphylobothriasis. Hookworm infection. Malaria. visceral leishmaniasis. Fasciolasis schistosomiasis.

Symptoms and signs caused by parasitic infections
• Eosinophilia: 1. Filariasis 2. Fascioliasis. 3. Schistosomiasis. 4. strongyloidiasis. 5. Toxocariasis 6. Trichinosis – Hypopigmented skin macules: 1. Onchocerciasis (patches over shins). 2. Post-Kala-Azar dermal leishmanoid. – Hyperpigmented skin macules: 1. Onchocercal dermatitis (Sowda). 2. Visceral leishmaniasis (Kala-Azar). 3. Chronic pediculosis. • 1. 2. 3. 4. • 1. 2. 3. Lymphadenopathy: Filariasis Toxoplasmosis. African trypanosomiasis. American trypanosomiasis Myocarditis: Chagas’ disease. Trichinosis. Rhodesian trypanosomiasis. 4. Acute toxoplasmosis 5. Heterophyes (granuloma around the egg).

Symptoms and signs caused by parasitic infections
• 1. 2. 3. Diarrhea (Bloody): Amoebic dysentery. Balantidium coli. Kala-Azar (infiltration of submucosa with leishmaniacontaining macrophage→ mucosal ulceration. 4. Falciparum malaria (plugging of mucosal capillaries with parasitized RBCs). 5. Heavy trichuriasis.
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Watery diarrhea: Trichinosis (food poisoning) Cryptosporidium. Giardia lamblia (malabsorption). Hymenolepis nana (during development of cysticercoids in the villi). Strongyloides stercoralis Capillaria philippinensis. (malabsorption). Schistosomiasis mansoni (profuse diarrhea or dysentery). Primary heavy hookworm infection.

Symptoms and signs caused by parasitic infections • Intestinal obstruction: 1. Ascariasis. 2. Chagas’s disease (Chronic (megacolon). 3. Taenia saginata 4. Taenia solium • Jaundice: 1. Obstructive (Fasciola). 2. Haemolytic (falciparum malaria, bilious remittent fever). • Worm passed from anus or mouth: • Ascariasis (anus & mouth). • Oxyuris. (anus) • Taenia saginata (anus)

Epidemiologic aspects of parasitic infections
• Parasites transmitted by undercooked meat: 1. Taenia saginata. 2. Taenia solium. 3. Trichinella. 4. Toxoplasma, 5. Fasciola (Halzoun).

• Parasites transmitted by autoinfection (nosocomial). 1. Cryptosporidium. 2. Entamoeba histolytica. 3. Giardia lamblia, 4. Strongyloides. 5. Oxyuris. 6. Cysticercosis. 7. Capillaria Philippinensis. 8. Hymenolepis nana

Epidemiologic aspects of parasitic infections
• Soil mediated helminth infections: 1. Hookworms 2. Strongyloides 3. Ascaris 4. Toxocara 5. Trichuris trichiura. 6. Capillaria hepatica • Opportunistic Infections: 1. Strongyloides. 2. Cryptosporidium 3. Toxoplasma 4. Acanthamoeba (GAE). 5. Giardia.

• Sexually transmitted parasites: 1. T. vaginalis 2. S. scabeii. 3. Phthirus pubis. 4. Parasites transmitted by auto infection.