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level: Level 1

Questions and Answers List

level questions: Level 1

Question	Answer
area of biology concerned with the phenomenon of dependence of one living organism on another	Parasitology
– deals with the parasites that cause human infections and the diseases they produce; broadly divided into two parts: protozoology and helminthology	Medical Parasitology –
Living together; the association of two living organisms, each of a different species	SYMBIOSIS
Association of two different species of organisms that is beneficial to one and neutral to the other	COMMENSALISM
Association of two different species of organisms that is beneficial to both	MUTUALISM
Association of two different species of organisms that is beneficial to one at the other’s expense	PARASITISM
A parasite, which lives within the body of the host. The presence of an endoparasite causes an: INFECTION Most of the protozoan and helminthic parasites causing human disease are endoparasites.	ENDOPARASITE
Inhabit only the body surface of the host without penetrating the tissue. (e.g. head lice, ticks) The presence of an ectoparasite causes an: INFESTATION	ECTOPARASITE
Most parasites are obligate parasites; cannot exist without a host. Need a host at some stage of their life cycle to complete their development and to propagate their species Depends entirely upon their host for existence Ex. Toxoplasma gondii, Plasmodium spp.	OBLIGATE
May exist in a free-living state or become parasitic when the need arises (e.g. Strongyloides)	FACULTATIVE
Infect an unusual host; establishes infection in a host where it does not normally live (e.g. Echinococcus granulosus, Dipylidium caninum, Dirofilaria immitis, Ancylostoma caninum)	ACCIDENTAL/INCIDENTAL
Remain in or on the host for its entire life Ex. Strongyloides, Loa loa, Taenia solium	PERMANENT
Live in the host for a short time (e.g. Plasmodium spp.)	TEMPORARY
Passes digestive tract of humans without infecting them (e.g. Eimeria sardinae)	SPURIOUS
Infect a host where they cannot develop further (e.g. Toxocara canis)	ABERRANT
Female parasite capable of reproducing eggs without being fertilized by a male and whose eggs contain larva that immediately hatches (e.g. Strongyloides	PARTHENOGENETIC
Usually protozoans; able to multiply in fecal matter outside human body	COPROPHILIC
Lives inside red blood cells (e.g. Plasmodia, Babesia, Leishmania)	HEMATOZOIC
Lives inside cells or tissues (e.g. Trichinella spiralis)	CYTOZOIC
Lives in body cavities (Mansonella spp.)	COELOZOIC
Resides in intestines (Tapeworms, Entamoeba histolytica)	ENTEROZOIC
ACCORDING TO PATHOGENECITY, Capable of causing disease	PATHOGENIC
Commensals; incapable of causing disease (e.g. Trichomonas tenax, Entamoeba gingivalis)	NONPATHOGENIC
CLASSIFICATION OF HOSTS Host in which the adult parasite lives and undergoes sexual reproduction May be human or any other living being however in majority of human parasitic infections, humans are the final hosts (e.g. filarial, roundworm, hookworm	DEFINITIVE/FINAL
CLASSIFICATION OF HOSTS, Host in which the larval stage of the parasite lives or the asexual multiplication takes place. If there are more than one IH, these can be classified as 1st and 2nd IH.	INTERMEDIATE
CLASSIFICATION OF HOSTS Parasite does not develop further to latter stages Parasite remains alive and is able to infect other susceptible host Harbors the parasite; will only serve as a transport medium; no further development occurs. Ex. Paragonimus metacercaria in raw wild board meat Diphyllobothrium latum plerocercoid larva in big carnivorous fish	PARATENIC
CLASSIFICATION OF HOSTS Harbors parasite; allows the parasite life cycle to continue and become additional sources of infection Ex. Pigs – reservoir host of Balantidium coli Field Rats – reservoir host of Paragonimus westermani Cats – reservoir host of Brugia malay	RESERVOIR
Host in which the parasite is not usually found (e.g. man in echinococcosis)	ACCIDENTAL
CLASSIFICATION OF VECTORS A vector, which not only assists in the transfer of parasites but the parasites undergo development or multiplication in their body as well; also called as true vectors.	BIOLOGIC
A vector, which assists in the transfer of parasitic form between hosts but is not essential in the life cycle of the parasite. Ex. Housefly – Amebiasis Cockroach - Ascariasis	MECHANICAL/PHORETIC
Harbors pathogen and is asymptomatic	CARRIER
Period between the entry of parasite in the host and subsequent recovery of the form/s of parasite in samples	PRE-PATENT PERIOD/ BIOLOGIC INCUBATION
Period between infection to development of symptoms	CLINICAL INCUBATION PERIOD
Individual becomes infected by his/her own Nematodes: Capillaria philippinensis, Enterobius vermicularis, Strongyloides Cestodes: Taenia solium, Hymenolepis nana Protozoan: Cryptosporidium hominis, Cryptosporidium parvum	AUTOREINFECTION
Already infected individuals are further infected with same species (e.g. Strongyloides)	SUPERINFECTION/HYPERINFECTION
SOURCES OF INFECTION Most common Lack of sanitary toilets and the use of night soil or human excreta as fertilizer allow the eggs to come in contact with the soil and form the development of specific parasites Ex. Hookworm, Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis (HATS)	SOIL
SOURCES OF INFECTION Cysts of amebae or flagellates; cercaria of schistosomes	WATER
SOURCES OF INFECTION Trematodes (Flukes) and Cestodes (Tapeworms)	FOOD
SOURCES OF INFECTION Mosquitoes – Malaria, Filarial worms Triatoma bugs – Trypanosoma cruzi Phlebotomus sandflies – Leishmania spp	ARTHROPODS
SOURCES OF INFECTION Cats – direct sources of Toxoplasma infection Rats – may be infected with Hymenolepis nana	ANIMALS
SOURCES OF INFECTION Asymptomatic carriers of Entamoeba histolytica working as food handlers.	ANOTHER INDIVIDUAL
MODES OF TRANSMISSION, Most common method Cestodes, Trematodes, Intestinal Protozoans are foodborne	ORAL (FECAL-ORAL)
Another important mode of transmission Hookworm and Strongyloides stercoralis enter upon exposure to soil Schistosoma spp. is acquired when cercariae in water penetrate the skin	SKIN PENETRATION
Transmit parasites through their bites Malaria, Filariasis, Leishmaniasis, Trypanosomiasis, Babesiosis	ARTHROPODS
Toxoplasma gondii Trophozoites can cross the placental barrier during pregnancy TRANSMAMMARY INFECTION Ancylostoma and Strongyloides - may be transmitted through mother’s milk	CONGENITAL TRANSMISSION
MODES OF TRANSMISSION, Enterobius vermicularis	INHALATION OF AIRBORNE EGGS
MODES OF TRANSMISSION, Trichomonas vaginalis	SEXUAL INTERCOURSE
Seen in case of transfusion malaria and toxoplasmosis after organ transplantation	IATROGENIC TRANSMISSION
– most commonly submitted sample for examination of parasites The most common procedure performed is the examination of a stool specimen for Ova and Parasites (O&P).	Stool
All-purpose fixative; buffered with sodium phosphate to preserve morphological characteristics - 5% concentration: recommended for protozoan cysts - 10% concentration: recommended for helminth eggs and larvae - When the stool specimen is added to the vial, the final ratio of stool to preservative is 1:3 - Preserved stool can be concentrated using Formalin-Ether/Ethyl Acetate Concentration Technique (FECT/FEACT)	FORMALIN
- Used to preserve fresh stool/fresh fecal specimen in preparation for staining the stool smears - Provides excellent preservation of protozoan trophozoites and cysts - For many years, considered as the “gold standard” - Contains mercuric chloride which is highly toxic to humans	SCHAUDINN’S SOLUTION
- Plastic resin that serves to adhere a stool sample onto a slide - Normally incorporated into the Schaudinn’s solution - Main advantage: preservation of protozoan cyst and trophozoites for permanent staining - Stool preserved in PVA can be concentrated using FECT - Modified PVA: using non-mercuric compounds such as copper sulfate or zinc sulfate (used with trichrome stain) - Disadvantage: use of mercuric chloride	POLYVINYL ALCOHOL (PVA)
- Components both fix and provide stain color - Contains Merthiolate (Thimerosal) and Iodine that act as staining components - Formalin acts as a preservative - Useful for fixation of intestinal protozoans, helminth eggs, and larvae - Disadvantages: Contains mercury compounds (thimerosal) Staining of preserved stools in MIF yields unsatisfactory results or not as good as Schaudinn’s fluid	MERTHIOLATE IODINE-FORMALIN (MIF)
- Advantage: Does not contain mercuric chloride; long shelf-life - Disadvantage: Images are not as sharp after staining as compared with those fixed in PVA or Schaudinn’s solution	SODIUM ACETATEACETIC ACID FORMALIN (SAF)
Both the concentration and permanent stained smear can be prepared - It is also possible to perform fecal immunoassay procedures from some of these vials.	SINGLE-VIAL COLLECTION SYSTEMS
- 2 mg of stool + 1 drop of 0.85% NaCl (NSS) + coverslip - Routine method of stool examination - Can be stained with Nair’s Buffered Methylene Blue (BMB) solution - Micrometry is used to measure cysts and ova (ex. differentiation between cysts of Entamoeba histolytica and E. hartmanni is based entirely on their sizes) - LPO (x100) of entire 22x22 mm coverslip & HPO (x400) of at least 1/3 of the coverslip area of both saline and iodine - OIO (x1000) is not recommended (organism morphology is not clear) - The use of iodine is optional Eggs of helminths are also readily seen. o Rhabditiform larvae of Strongyloides stercoralis are detected in freshly passed stool	DIRECT FECAL SMEAR
50-60 mg of stool is placed over a glass slide; covered with cellophane paper soaked in a mixture of glycerin and malachite green solution - GLYCERIN: clearing solution - MALACHITE GREEN: gives a pale green color minimizing the brightness of the microscopic field - Best examined within 10-20 minutes - Useful in mass stool examination; technique is simple and economical - Very good in detecting eggs with thick shells (e.g. Ascaris and Trichuris) but not eggs with thin shells (e.g. Hookworm) - Not able to detect protozoan cysts and trophozoites	KATO THICK SMEAR
BEST technique for the recovery of: -Schistosoma (heavy spine) -Operculated eggs - Trematode eggs - Cestode eggs - T. trichiura eggs - C. philippinensis	SEDIMENTATION CONCENTRATION
- Main Reagents: o 40% HCl: dissolve albuminous material o Ether: dissolve neutral fats/lipids and CHO in the stool - Recommended for the recovery of Trichuris, Capillaria, and trematode eggs, especially Schistosoma - Choice if stool material comes from animals like cats and dogs - Disadvantage: destruction of protozoan cysts	SEDIMENTATION CONCENTRATION, ACID ETHER CONCENTRATION TECHNIQUE (AECT)
Main Reagents: o 40% HCl: dissolve albuminous material o Ether: dissolve neutral fats/lipids and CHO in the stool - Recommended for the recovery of Trichuris, Capillaria, and trematode eggs, especially Schistosoma - Choice if stool material comes from animals like cats and dogs - Disadvantage: destruction of protozoan cysts	SEDIMENTATION CONCENTRATION, ACID ETHER CONCENTRATION TECHNIQUE (AECT)
Most commonly used - Main Reagents: o 10% Formalin: all-purpose fixative o Ether: dissolve neutral fats/lipids and CHO in the stool; explosive and flammable o Ethyl Acetate: alternative for ether	FORMALIN-ETHER/ETHYL ACETATE CONCENTRATION TECHNIQUE (FECT/FEACT
Useful in the recovery of both helminth eggs and protozoan cysts - FECT can be done with formalin-preserved and PVA-preserved samples - More parasites can be recovered from formalin-preserved samples - Morphology is also better preserved in formalin than in PVA - Sediments from FECT can be stored for a long period of time.	FORMALIN-ETHER/ETHYL ACETATE CONCENTRATION TECHNIQUE (FECT/FEACT)
BEST technique for recovery of: - Protozoan cysts - Nematode eggs except for T. trichiura and C. philippinensis (heavy due to bipolar mucus plugs)	FLOTATION CONCENTRATION
- operculated and/or very dense eggs such as unfertilized Ascaris eggs do not concentrate well in the flotation method; sedimentation technique is recommended - Main Reagent: 33% Zinc Sulfate solution - Specific Gravity Range: 1.18-1.20 - FRESH STOOL SPECIMEN: 1.18 - FORMALIN PRESERVED SPECIMEN: 1.20 - If parasites are exposed to high specific gravity, distortion and shrinkage of protozoan cyst and thin nematode eggs may occur - To ensure detection of all possible organisms, both the surface film and the sediment must be examined.	ZINC SULFATE FLOTATION
uses saturated table salt solution; stools are directly mixed with the brine solution (SG: 1.20) - Helminth eggs like Hookworm and Schistosoma become badly shrunken - Not useful for operculated eggs like Clonorchis, Opistorchis, and Heterophyids because these do not float in brine solution.	BRINE FLOTATION
Boiled sugar solution with phenol - Best for recovery of coccidian oocysts mainly Cryptosporidium, Cyclospora, and Cytoisospora	SHEATHER’S SUGAR FLOTATION
Stools positive for Hookworm ova or Strongyloides rhabditiform larva can be cultured until filariform larva develop	STOOL CULTURE
- Positive stools are mixed with moistened soil or granulated charcoal. - Larvae are harvested using the Baermann procedure - Baermann procedure: based on active migration or movement of larvae from feces suspended in water - Advantage: greater amount of fresh stool used; better chance of larval recovery	COPRO CULTURE AND BAERMANN FUNNEL TECHNIQUE
Uses test tubes and filter paper strips - Positive stool (0.5-1g) is smeared in the middle third of the filter paper and placed into a test tube with 7 mL (3-4 mL) (1/2 inch) of boiled or distilled water - Keep the tube at room temperature in the dark for 7-10 days; examine daily	HARADA-MORI OR THE TEST TUBE CULTURE METHOD
- Filariform larvae will move downwards and be recovered from the water at the bottom of the tube - Strongyloides larvae may instead move upwards and accumulate at the upper end of the strip - Caution must be exercised in handling the filter paper	HARADA-MORI OR THE TEST TUBE CULTURE METHOD
- More sensitive - 2 g of fresh stool is placed in the center of the agar plate - Plates are sealed with tape to prevent accidental infection and placed in RT for 2 days - In positive cases, larvae will crawl over the agar, making visible tracks over it. - Examine microscopically for the evidence of larvae at the ends of tracks away from the stool	AGAR PLATE CULTURE FOR Strongyloides stercoralis
Boeck and Drbohlav’s diphasic medium (modified by Dobell and Laidlaw) - Balamuth’s monophasic liquid medium (amebae and other intestinal protozoa) - Cleveland Collier’s Medium - Diamond’s Medium (for T. vaginalis) NNN (Novy-McNeal-Nicolle) Medium for Leishmania and Trypanosoma Schneider’s Insect Tissue Culture Medium – recommended in vitro culture of Leishmania; more sensitive than NNN; uses cells of Drosophila	CULTURE MEDIA FOR INTESTINAL PROTOZOA
Recommended method of WHO - Uses a measured amount of stool which has been sieved through a wire mesh - Uniform amount of stool is examined through the use of a template with a uniform-sized hole in the middle. - Allow the cellophane coverslips to soak in the glycerin mixture for about 24 hours - Allow the preparation to stand for 1 hour at RT to allow clearing of fecal material - Do not overclear; thin shelled hookworm eggs may disappear - Clearing time extended to 24 hours for S. mansoni eggs	KATO-KATZ METHOD OR CELLOPHANE-COVERED THICK SMEAR
Uses 0.1 N NaOH that acts as a stool diluent; saponifies fat and frees eggs from debris - The amount of diluted stool used for egg counting is measured by stoll pipettes - Total egg count is multiplied by a factor depending on the amount of stool used - Routine: 4 g feces; multiply by factor 100 to obtain # of eggs/gram stool - Sensitivity is determined by the consistency of the stool	STOLL DILUTION EGG COUNT
- Easiest to use - 2 mg of stool is smeared - Egg counts on direct smear are reported as eggs/smear	DIRECT SMEAR METHOD OF BEAVER
- Eggs in 20 mg stool are concentrated by salt flotation on the squared grid on the roof of the chamber which can be counted	MCMASTER’S EGG COUNTING CHAMBER
- Most reliable - The two most commonly used are the Wheatley modification of the Gomori tissue trichrome stain and the iron-hematoxylin stain - Permanent stained smears are examined using oil immersion objectives (×600 for screening, ×1000 for final review of 300 or more oil immersion fields) - The permanent stained smear is the most important procedure performed to confirm the diagnosis of intestinal protozoan infections. - MODIFIED ACID-FAST: recommended for intestinal coccidia - MODIFIED TRICHROME: recommended for intestinal microsporidia	PERMANENT STAINED SMEARS
Fixative: PVA - Expected results: Background debris will be green and protozoa will show blue-green to purple cytoplasm. The nuclei and inclusions will be red or purple-red and sharply delineated from background.	WHEATLEY’S TRICHROME STAIN FOR FECAL SPECIMENS
Oldest method (created over a century ago) but more difficult - Reveals excellent morphology of the intestinal protozoa - In some cases, the nuclear detail of organisms is considered to be stained clearer and sharper than when stained with trichrome - Modifications: > Spencer-Monroe method > Tompkins-Miller method: longer method; uses 2% phosphotungstic acid as decolorizer	IRON HEMATOXYLIN STAIN
Expected results: > Protozoa cytoplasm: blue to purple > Protozoa nuclear material: dark blue to dark purple > Debris and background material: light blue, sometimes with pink tint	IRON HEMATOXYLIN STAIN
Fixative: 5-10% Formalin or SAF - Expected results: Spores: ovoid, refractile; spore wall is bright pinkish red Polar tube: seen as a stripe or as a diagonal line across the spore Bacteria and debris: stain green, some stain red	MODIFIED TRICHROME STAIN FOR MICROSPORIDIA (WEBER-GREEN)
Specimen: Fresh stool or fixed (5-10% Formalin or SAF) - Expected results: Spores: ovoid, refractile; spore wall is bright pinkish red Polar tube: seen as a stripe or as a diagonal line across the spore Bacteria and debris: stain blue, some stain red - If the stool is semi-formed or formed, the amount of artifact material is much greater, and the spores are much harder to detect and identify. - The number of spores varies according to the stool consistency (the more diarrheic the stool, the more spores that are present).	MODIFIED TRICHROME STAIN FOR MICROSPORIDIA (RYAN-BLUE)
- Kinyoun’s Method of Acid-Fast Staining is recommended - Weaker decolorizer (2% H2SO4) compared to the original Acid-Fast Staining method - The oocyst of the coccidians stain pink to red with a blue or green background	MODIFIED ACID-FAST FOR COCCIDIANS
Rarely requested and no longer clinically relevant - Requires mixing a small amount of feces with water and straining the mixture through a series of wire screens (graduated from coarse to fine mesh) to look for scolices and proglottids	RECOVERY OF THE TAPEWORM SCOLEX
- The appearance of scolices after therapy is an indication of successful treatment. - If the scolex has not been passed, it may still be attached to the mucosa; the parasite is capable of producing more segments from the neck region of the scolex, and the infection continues. - If this occurs, the patient can be retreated when proglottids begin to reappear in the stool	RECOVERY OF THE TAPEWORM SCOLEX
Used to recover Enterobius vermicularis, Taenia spp., and Schistosoma mansoni eggs	PERIANAL SWAB
moves out through the anus at night time and deposits eggs on the perianal skin	Enterobius gravid female
can crawl out of the anus and in the process, ova are squeezed out of the segment and are deposited on the perianal skin	Taenia spp. gravid segments
A piece of transparent adhesive tape is pressed firmly against perianal skin, and the adhesive surface of the tape is spread on a glass slide	CELLULOSE TAPE OR SCOTCH TAPE METHOD
The slide is then placed under microscope and observed for parasitic eggs. o A drop of toluene or xylol may be placed between the tape and the slide to clear the preparation. o The specimen should be collected for 3 consecutive days at early in the morning before the patient has taken a bath or before the patient has washed the perineum; can also be obtained late at night when patient have already slept for several hours o At least 4 to 6 consecutive negative tapes are required to rule out the infection.	CELLULOSE TAPE OR SCOTCH TAPE METHOD
Next to feces, the largest number of parasites are found in the	BLOOD
Several species of helminthic parasites (e.g. filariae) and protozoan parasites (e.g. Plasmodium, Trypanosoma, Babesia) are in the blood at some stage of their life cycle. Blood films can be prepared from fresh, whole blood collected containing no anticoagulants, anticoagulated blood, or sediment from the various concentration procedures	BLOOD
often used to stain the microfilarial sheath	Delafield’s hematoxylin stain
Microfilariae and Trypanomastigotes are large and motile in fresh blood preparations. Their presence can be easily detected - Species identification is not possible.	WET/FRESH PREPARATION
Larger quantity of blood can be tested - Increased volume of blood present on thick film may allow the malaria parasite to be detected even with low parasitemia. - Compared with a thin film, a thick film is about 30 times more sensitive and can detect about 20 parasites/μL of blood. - The examination should be performed at low magnification to detect microfilariae.	STAINED SMEAR: THICK FILMS
A search for malarial organisms and trypanosomes should be completed using oil immersion (at least 300 fields) - The thick blood film is prepared by spreading a few drops of blood (using a circular motion) over an area approximately 2 cm in diameter. - If whole blood is used: examiner should continue stirring about 30 seconds to prevent the formation of fibrin strands. - The blood films must be laked before or during staining (rupture of all RBCs); the only structures that are left on the blood film are white blood cells, platelets, and parasites. - The disadvantages are that the red cells are lysed (dehemoglobinized) and the morphology of the parasites is distorted, so that species identification becomes difficult. - The WBCs on the stained blood film serve as the quality control - Reporting (Paniker)	STAINED SMEAR: THICK FILMS
- The initial screening should be done with the low-power microscope objective - Microfilariae are carried with the smear during preparation and typically are located at the edges or feathered end of the thin film. - Before a smear is reported as negative for the presence of parasites, a minimum of 300 fields should be examined.	STAINED SMEAR: THIN FILMS
The thin blood film is routinely used for parasite identification to the species level. - The WBCs on the stained blood film serve as the quality control - If the smears are prepared from anticoagulated blood, which is more than an hour old, the morphology of both parasites and infected RBCs may not be typical. - Slides are fixed with methanol before staining.	STAINED SMEAR: THIN FILMS
- Thick smear is first dehemoglobinized and the two are then stained together. - Do not allow the methanol to contact the thick film when fixing the thin film. - The stained thin smear is examined first. If the thin smear is negative, the thick smear should be searched for parasites.	STAINED SMEAR: COMBINED THICK AND THIN FILMS
Collected using heparinized capillary tube Centrifuged; microfilariae and trypanosomes are visualized at the buffy coat area examined under a microscope	CAPILLARY TUBE METHOD
Capillary tube is broken at the area of the white cell layer after centrifugation and then stained with Giemsa or Wright’s stain. - L. donovani, trypanosomes, and H. capsulatum (a fungus with intracellular elements resembling those of L. donovani) occasionally may be detected in the large mononuclear cells found in the buffy coat - With L. donovani, the nuclear material stains dark red-purple, and the cytoplasm is light blue. - H. capsulatum appears as a large dot of nuclear material (dark red-purple) surrounded by a clear halo. - Trypanosomes in the peripheral blood also concentrate with the buffy coat cells.	BUFFY COAT FILMS
- Capillary tube precoated with Acridine Orange and Potassium Oxalate. After centrifugation, the tube is read using a UV microscope. - The DNA of the parasite takes up Acridine Orange (fluorochrome) stain causing fluorescence	QUANTITATIVE BUFFY COAT (QBC)
May be concentrated to detect microfilariae	KNOTT’S CONCENTRATION
- In cases of low microfilaremia - 1 mL of blood is mixed with 10 mL of 2% Formalin - Supernatant is discarded - Sediment is studied (smeared and stained) - The disadvantage of the procedure is that the microfilariae are killed by the formalin and therefore are not seen as motile organisms.	KNOTT’S CONCENTRATION
- Useful when density of microfilariae is low - Uses Swinney membrane filter where microfilariae is recovered - Membrane filtration recovers most species of microfilariae; however, because of their small size, Mansonella perstans and M. ozzardi may not be recovered. - This is the most sensitive method of detecting small numbers of microfilariae, but it is expensive for routine use. - The blood is passed through a polycarbonate filter that contains a 2-μm pore. - Distilled water is passed through the filter, lysing the red blood cells and improving the visualization of the parasites.	MEMBRANE FILTRATION
Migrating larvae of Ascaris lumbricoides, Strongyloides stercoralis, and Hookworm spp. A-S-H: Heart-To-Lung Migration	SPUTUM
sputum may be viscous, streaked with blood, and tinged with brownish flecks, which are clusters of eggs (“iron filings”)	Paragonimus westermani ova
Migrating larvae of Ascaris lumbricoides, Strongyloides stercoralis, and Hookworm spp. A-S-H: Heart-To-Lung Migration B. Paragonimus westermani ova – sputum may be viscous, streaked with blood, and tinged with brownish flecks, which are clusters of eggs (“iron filings”) C. Echinococcus granulosus hooklets from pulmonary hydatid cysts: Pulmonary Hydatid Disease	SPUTUM
Protozoa such as: 1. Entamoeba histolytica trophozoites from pulmonary amebic abscess 2. Cryptosporidium parvum oocyst 3. Nonpathogenic Entamoeba gingivalis and Trichomonas tenax	SPUTUM
Very good specimen for the diagnosis of Trichomonas vaginalis (most frequent parasite)	URINE AND UROGENITAL TRACT SPECIMENS
rounded and globular structure exhibiting jerky, tumbling motility	Trichomonas vaginalis:
in the Philippines, the most common aspirate submitted for parasitic diagnosis comes from the liver to rule out hepatic amebic abscess caused by Entamoeba histolytica Also used in the recovery of Echinococcus granulosus hydatid cyst composed of hydatid sand and scolices	TISSUE ASPIRATES
is used in the diagnosis of Giardia lamblia and Strongyloides stercoralis ▪ Giardia’s “falling leaf” motility is rarely seen; Strongyloides larvae are very motile ▪ Centrifugation of the specimen before examination is important ▪ If the specimen cannot be completely examined within 2 hr after it is taken, any remaining material should be preserved in 5% to 10% formalin.	Duodenal aspirate
is a simple, convenient method for collecting duodenal contents. ▪ The terminal end of the yarn should be yellow-green, indicating that it was in the duodenum. ▪ After 4 hours, the yarn is retrieved and the mucoidal material clinging to the yarn is examined for parasites including S. stercoralis, G. lamblia, Cryptosporidium spp., microsporidia, and the eggs of Clonorchis sinensis ▪ If the specimen cannot be completely examined within 1 hr after removal of the yarn, the material should be preserved in 5% to 10% formalin or PVA-mucus smears should be prepared.	the Duodenal Capsule Technique (Entero-Test)
must be centrifuged at 7000 g for 10 minutes, Trypomastigotes of Trypanosoma cruzi, Trypanosoma brucei rhodesiense, Trypanosoma brucei gambiense Trophozoites of Naegleria and Parastrongylus larvae must be within 20 minutes since trypomastigotes perish and the morphology and motility of Naegleria trophozoites are affected within the time period	CSF
Useful in the diagnosis of Trichinella spiralis infection Useful in the diagnosis of larval infection with Taenia solium resulting in cysticercosis or larval infection with Spirometra spp. resulting in sparganosis	MUSCLE BIOPSY
reveal the presence of deposited eggs of Schistosoma japonicum Schistosoma mansoni, Schistosoma japonicum	Rectal Biopsy
obtained to diagnose subcutaneous filariasis (Onchocerca & Mansonella) or leishmaniasis by grasping with a forceps or elevating a portion of skin with the tip of needle. Tip of the small cone of the skin is then sliced with a sharp blade or razor.	SKIN SNIP
Wet mount preparation of lymph node aspirate and chancre fluid are used as rapid methods for demonstration of trypanosomes. o Biopsies from liver, spleen, bone marrow, and lymph nodes are taken in visceral leishmaniasis for demonstration of Leishman Donovan (LD) bodies. o All biopsy tissues must be submitted to the laboratory without the addition of formalin fixative. If there is delay in transport or processing, the specimen should be placed in polyvinyl alcohol fixative o Adult filarial worms can sometimes be found in section of biopsied lymph node. o Corneal scrapings are useful in diagnosis of acanthamoeba keratitis.	SKIN BIOPSY