Management of

parasitic diseases
Prof. Hala Elwakil, MD
Professor of medical parasitology
Faculty of medicine Ain Shams University

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1. Identify and describe the different methods used in
diagnosis of parasitic diseases.
2. Discuss the purpose, advantages and disadvantages of
direct diagnostic techniques
3. Describe the purpose, advantages and disadvantages of
indirect immunological test for the diagnosis of parasitic
disease.
4. Explain the purpose of using molecular technique in
diagnosis of parasitic diseases
5. Correlation between mod of transmission of parasitic
diseases and control measures.

Extended Modular Program 2

MANAGEMENT

DIAGNOSIS

TREATMENT

CONTROL

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 DIAGNOSIS
Why we have to diagnose parasitic disease
accurately ?

1- Treatment
Different parasites respond differently to different drugs.

2- Epidemiology
to know which individuals are infected, age differences,
sex differences, are there reservoir hosts?

3- Control
Diagnosis is key in monitoring control programs,
establishing base line data and evaluating the outcome.

Extended Modular Program 4

 Diagnosis

History (Age, occupation, residency,

previous infection)
Provisional diagnosis
Complaint
Clinical examination
Investigations Confirm the diagnosis
- Laboratory investigations
- Radiology
- Surgical intervention (Exploratory)

Prof. Hala Elwakil 5

 Laboratory diagnosis

DIAGNOSIS
DIRECT INDIRECT MOLECULAR
Urine
IHAT
Stool
LAT
Blood Serological PCR
IFAT
Sputum tests DNA probes
ELISA
Biopsy
CFT
Aspirates

Prof. Hala Elwakil

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STOOL SAMPLE EXAMINATION
 Direct diagnosis

The most reliable way to diagnose a parasitic infection

is by detection and identification of the parasitic stages in
the specimen submitted for parasitological examination as:

•Stool
•Blood
•Urine
•Anal swabs
•Aspirates
•Surgical specimens and biopsies.

Prof. Hala Elwakil 8

 Direct diagnosis

Advantages

•It is considered to be the most sensitive method

•No need for expensive reagents and equipment
•All major intestinal helminthes infections are still solely
dependent on microscopy for diagnosis

Prof. Hala Elwakil 9

 Direct diagnosis
Disadvantages

•It is labour-intensive
•well-trained microscopists is required.
•It can't differentiate between virulent and non-virulent
strains
•Not all parasites are easily accessible ( eg. toxoplasmosis)
•It may be dangerous eg. lumbar puncture

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 Direct diagnostic techniques
1-Direct Wet Mount Smear

• Wet mount is the simplest technique for the examination of

faeces

• The basic types of wet mount that should be used for each

faecal examination are saline and iodine

Prof. Hala Elwakil

 Direct wet mount smear

Saline smear Iodine smear

saline Iodine 1%

•Eggs •Cyst morphological details

•Motility of protozoal
trophozoites or larvae

Prof. Hala Elwakil

 Direct wet mount smear
Advantage

•It is simple, fast, procedure and give quick result when

positive

Prof. Hala Elwakil

2-Concentration techniques

Sedimentation Flotation

Prof. Hala Elwakil

 Concentration techniques

Prof. Hala Elwakil

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Concentration techniques

Zinc sulphate concentration technique

Prof. Hala Elwakil

 Concentration techniques

Sedimentation Floatation
• Heavy eggs (Ascaris egg) • Non Operculated eggs

• Operculated eggs (Trematodes) • Cysts

• Larvae (Strong sterc.)

• Cysts

Prof. Hala Elwakil

 Concentration techniques

Advantages

1-Separate the parasitic stages from faecal debris that gives clear field

2-Allow the detection of small numbers of organisms that may be missed

by using only a direct wet smear ( more sensitive )

Prof. Hala Elwakil

 3-Stained smears
Permanent

•It is essential for accurate diagnostic detail

•It is also suitable for long-term storage for

record purposes
.
•It essential for diagnosis of some parasites

Prof. Hala Elwakil

BLOOD SAMPLE EXAMINATION
 Blood films

Thin Thick

spread Circular motion

Air dry Air dry

methyl alcohol

Geimsa Geimsa

Malaria, Filaria, Trypanosomes.

Prof. Hala Elwakil

Thin blood films Thick blood films
Study morphological •Rapid diagnosis of low
changes of blood cells and parasitaemia
blood parasites .
•Not suitable for detailed
morphological studies of
Can’t diagnose low parasites .
parasitaemia

Prof. Hala Elwakil

URINE SAMPLE EXAMINATION
 SEDIMENTATION

Clean conical
glass receptacle

15-20 min Centrifuge (2 min)

Prof. Hala Elwakil

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TRUE OR FALSE

•Direct wet mount stool examination is the most sensitive

diagnostic test

•Blood film examination is the most reliable test for

diagnosis of blood parasites

Prof. Hala Elwakil