AN

INTRODUCTION
DIAGNOSIS
DIAGNOSIS FOR
FOR PARASITIC
PARASITIC INFECTION
INFECTION


 Anamnesa
Anamnesa––( (The
Thehistory
historyshould
shouldinclude
includedetails
detailsofof
the
thepresenting
presentingcomplaint
complaint) )

 PPhysical
hysicalexamination
examination

 Laboratory
Laboratoryexamination
examinationespectially
espectially Parasitological
Parasitological
diagnosis
diagnosis

 Imunodiagnosis
Imunodiagnosis

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 INTRODUCTION
ANAMNESA
ANAMNESA
-Fever
Fever
-

-Gastrointestinal
CLINICAL FEATURES Gastrointestinalsymptoms
- symptoms
1CLINICAL FEATURES
(Symptom
(Symptomand
andSign)
Sign) -Fever
Feverwith
- withrespiratory
respiratorysystem
system
-Neurological
Neurologicalsymptoms
- symptoms
SPESIFIC
SPESIFIC -Fever
Feverand
- andmeningitis
meningitis//Encephalitis
Encephalitis
-Cutaneous
Cutaneoussymptoms
- symptoms
ASPESIFIC
ASPESIFIC

2
PHYSICAL
PHYSICALEXAMINATION
EXAMINATION

3
LABORATORY
LABORATORYEXAMINATION
EXAMINATION

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 INTRODUCTION
3 LABORATORY
LABORATORY EXAMINATION
EXAMINATION

DEPEND
DEPENDON ON::
Habitat Parasite
Habitat Parasite TYPE
TYPE OF
OF SPECIMEN
SPECIMEN::
Parasite distribution
Parasite distribution 1.1. Stool
Stool
2.2. Blood
Blood IMPORTANT
IMPORTANT
33 Urine
Urine
44 Sputum
Sputum
5.5. Vaginal
Vaginaldischarge,
discharge,urethral
urethral
discharge
discharge
6.6. Skin
Skinscrapings
scrapings
7.7. Liquor
LiquorCerebro
CerebroSpinal
Spinal
8.8. Tissue biopsy
Tissue biopsy
9.9. Nasal
Nasaldischarge
discharge
10.
10. Corneal
Cornealscrapings
scrapings

•Very
• Veryimportant
importantfor
forexamination
examinationHelminth
Helminthparasite
parasiteand
andProtozoa
Protozoaparasite
parasite
• •Repeating of Laboratory examination occasionally be needed
Repeating of Laboratory examination occasionally be needed
*Should
*Shouldbe beunderstood
understoodabout
aboutexamination
examinationtechnique,morphology
technique,morphologyof
of
parasite
parasiteand
andlife
lifecycle
cycleof
ofparasite
parasite

4 IMUNODIAGNOSIS
IMUNODIAGNOSIS

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 INTRODUCTION
FECAL
FECAL SPECIMENS
SPECIMENS

 Immediatelly
Immediatellyhave
havetotoexamine
examine: :
 Liquid
Liquidspecimens
specimensshould
shouldbe
beexamined
examined
within 30 minute of passage
within 30 minute of passage
 Soft
Soft(semiformed)
(semiformed)specimens
specimens11hour
hour
 Formed
Formedspecimens
specimens2424hour
hourafter
afterpassage
passage
 IfIfthis
thistime
timeisisnot
notpossible,
possible,the
thespecimen
specimenshould
shouldbe
be
placed
placedininone
oneofofthe
theavailable
availablefixatives
fixatives: :
 Formalin
Formalin10%,
10%,MIF
MIF(Merthiolate
(MerthiolateIodine
Iodine
Formalin),
Formalin),PVA
PVA(Polyvinyl
(PolyvinylAlcohol)
Alcohol)
 Generally
GenerallyHelminthic
Helminthiceggs
eggsmore
moreendure
endurewithout
without
preservation
preservationthan
thanintestinal
intestinalprotozoa
protozoa
 INTRODUCTION
FECAL
FECAL SPECIMENS
SPECIMENS

 The
Thespecimens
specimens should
shouldnot
notbe
becontaminated
contaminatedwith
with
 Water
Water––because
because water
watermay
maycontain
contain free-
free-
living
livingorganisms
organismsthat
thatcan
canbe
bemistaken
mistakenfor
for
human
humanparasites
parasites
 Urine
Urine––may
maydestroy
destroymotile
motileorganisms
organisms
 Prior
Priortotoexamination
examination, ,fecal
fecalspecimens
specimensshould
should
never
neverbe beincubated
incubatedor
orfrozen.
frozen.
 AAchatartic
chatarticwith
withan
anoil
oilbase
baseshould
shouldnotnotbebeused,
used,
and
andaastool
stoolsoftener
softener(taken
(takeneither
either orally
orally or
oras
asaa
suppository)
suppository)isisusually
usuallyinadequate
inadequateforforobtaining
obtaining aa
purged
purgedspecimen.
specimen.
 INTRODUCTION
FECAL
FECAL SPECIMENS
SPECIMENS

 Repeating
Repeatingfecal
fecalexamination
examinationafter
aftertherapy
therapy: :

 Ascariasis,
Ascariasis,2-3
2-3weeks
weeks after
aftertherapy
therapy
 Protozoa
Protozoainfection,
infection,3-4
3-4weeks
weeksafter
after
therapy
therapy
 Taeniasis,
Taeniasis,5-6
5-6 weeks
weeksafter
aftertherapy
therapy
EXAMINATION OF HELMINTH PARASITE

SPECIMENS
SPECIMENS
( (most
most important
important) )

 FECAL
 FECALSPECIMENS
SPECIMENS

 BLOOD AND TISSUE SPECIMENS

&
 BLOOD AND TISSUE SPECIMENS

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When finished
 EXAMINATION OF HELMINTH PARASITE

FECAL
FECAL SPECIMENS
SPECIMENS
- Consistency ( hard,formed,soft,loose,diarrhoei )
- Colour
MACROSCOPIC - Odor
- Foreign bodies (blood,mucus,pus,parasites ,etc. )

LABORATORY TECHNIQUES FOR

EXAMINATION OF INTESTINAL
HELMINTH

QUALITATIVE
MICROSCOPIC
QUANTITATIVE
 EXAMINATION OF HELMINTH
PARASITES
FECAL
FECAL SPECIMENS
SPECIMENS

QUANTITATIVE QUALITATIVE

PI C
CO
OS
CR
MI
 DIRECT WET SMEAR METHOD
 FLOTATION METHOD
 MERTHIOLATE IODINE FORMALDEHYDE (
*STOLL DILUTION METHOD MIF ) METHOD
*KATO – KATZ CELLOPHANE THICK  CELLOPHANE TAPE METHOD
SMEAR METHOD  CONCENTRATION METHOD
 KATO’ S THICK SMEAR METHOD
 FORMALIN – ETHER METHOD ( RITCHIE )
 QUANTITATIVE
QUANTITATIVE EXAMINATION
EXAMINATION

EXAMINATION OF HELMINTH PARASITE

FECAL
FECAL SPECIMENS
SPECIMENS
DIRECT WET SMEAR METHOD
Place 1 drop of 0,85% NaCl on a
clean,dry microscope slide

With an applicator stick, transfer a

small amount ( 2 mg ) of fecal sample
and emulsify in the saline drop

Place a coverslip over the suspension

 QUALITATIVE
QUALITATIVE EXAMINATION
EXAMINATION

EXAMINATION OF HELMINTH PARASITE

FECAL
FECAL SPECIMENS
SPECIMENS

DIRECT WET SMEAR

ANOTHER QUALITATIVE
EXAMINATION AND
QUANTITATIVE
EXAMINATION

TO BE STUDIED IN FECAL
EXAMINATION
 EXAMINATION OF PROTOZOA PARASITE

 EXAMINATION METHOD OF INTESTINAL PROTOZOA

 DIRECT METHOD
 MERTHIOLATE IODINE FORMALDEHYDE (MIF)
METHODE

 EXAMINATION METHOD OF BLOOD AND TISSUE

PROTOZOA
 THIN BLOOD SMEAR WITH GIEMSA STAIN
 THICK BLOOD SMEAR WITH GIEMSA STAIN

 EXAMINATION FOR Trichomonas vaginalis

 CHARACTERISTIC OF FECES WITH AMOEBA

MACROSCOPIC
 Acidic in character
 Foul smelling
 Produce less mucus compared to bacillary
dysentery, less sticky.
 With or without blood ( Blood may be
found in solid feces )
 In some cases mucosal wall may come out
CHARACTERISTIC OF FECES WITH AMEBA
MICROSCOPIC

 Plenty
Plenty of
of bacteria
bacteria

 Entamoeba
Entamoeba histolytica
histolytica (+)
(+) containing
containing erythrocytes.
erythrocytes.

 Erit
Erithhro
rocytes
cytes in in reuleaux
reuleaux (( chain
chain )) formation.
formation.

 Charcot
Charcot Leyden
Leyden crystals
crystals (( unspecific
unspecific for
for ameba
ameba
dysentery, can be found also in other parasitic
infection
infection e.g e.g Stro
Strongyloides
ngyloides stercoralis
stercoralis)) -- from
from
eosino
eosinoph philil desintegration.
desintegration.

 Pus
Pus less
less abundant
abundant compared
compared to to bacillary
bacillary dysentery,
dysentery,
if
if no
no se
secondary
condary infection
infection

 Ma
Macrophages
crophages in in bacillary
bacillary dysentery
dysentery mimics
mimics
Entamoeba
Entamoeba histolytica
histolytica butbut nucleus
nucleus andand pseudopods
pseudopods
differs..
differs

 Cyst
Cyst found
found in in carrier
carrier patients
patients and
and cases
cases with
with light
light
infection.
infection.
 Charcot-Leyden crystals
( From eosinophil desintegration )

Source : Atlas of Medical Parasitology. Prayong Radomyos.

 Charcot-Leyden crystals
( From eosinophil desintegration )

Source : Atlas Parasitologi Kedokteran, Zaman P.

Alih Bahasa : Anwar C.; Mursal Y.
EXAMINATION METHODS FOR BLOOD PROTOZOA

Thin blood smear with Giemsa

staining

Purpose :
For the examination of blood protozoa, e.g. : Plasmodium,
Trypanosoma, Babesia etc.

Prepared in two stages :

(1). Prepare the blood smear
(2). Do the color staining.
EXAMINATION METHOD FOR BLOOD PROTOZOA

Blood slides with Giemsa staining

(1). Preparation of Thin blood film

 Place blood slide in upright position, allow

to dry, keep away from dust or small insects

 With an automatic pipette take a measured quantity of blood

from a finger
 Prepare a smear on the clean glass slide using the end of
another glass slide
• Allow the slide to dry in a dust free and insect free environment.
 EXAMINATION METHOD FOR BLOOD PROTOZOA

Blood slides with GIEMSA staining

(2). Staining procedure

ALLOW TO DRY

Fix with methyl Wash slowly with

Stain with standard
alcohol (3-5) tap water
minutes menit Giemsa for 45 minutes
EXAMINATION METHOD FOR BLOOD PROTOZOA
Thick blood smear with Giemsa stain

Purpose :
Rapid examination of blood protozoa
( for mass survey and screening )

Conducted in two stages :

(1). Prepare thick blood film
(2). Staining the blood film
EXAMINATION METHOD FOR BLOOD PROTOZOA
Thick blood smear with GIEMSA stain

(1). Preparation of Thick blood smear

 Blood is prepared similar to thin blood smear

 Place 1-2 drops of blood on a glass slide.
 Spread evenly, forming a circle of 1-1,5 cm in diameter
 Allow to dry, keep away from dust or insect.
EXAMINATION METHOD FOR BLOOD PROTOZOA

Thick blood smear with GIEMSA stain

(2). Staining procedure

UNFIXATION

ALLOW TO DRY

Stain with standard Rinse slowly

Giemsa for 45 minutes With top water
EXAMINATION METHOD FOR BLOOD PROTOZOA
COMPARISON OF THIN AND THICK BLOOD SMEAR

THIN BLOOD SMEAR

- Morphology and stages of Plasmodium falciparum

- Erythrocytes are intact ( due to fixation )

- Slow to prepare
- Used for examination of moderate and heavy infection
THICK BLOOD SMEAR
- Morphology and stages of Plasmodium not clearly
defined
- Erythrocytes are lysed, only stroma from erythrocytes
are seen.
- Preparation and staining are faster ( can be used for
mass survey examination )
- Commonly used for light infection.
EXAMINATION for Trichomonas vaginalis

METHOD OF EXAMINATION :
(1). Direct examination
(2). Culture

Direct method :
(1). Direct wet mount
(2). Staining
 EXAMINATION for Trichomonas vaginalis

 Specimens for examination :

 (1). Women : vaginal discharge
( using vaginal spikulum )
 (2). Men : discharge from urethra or prostate,
and centrifugated urine specimens
EXAMINATION for Trichomonas vaginalis

DIRECT EXAMINATION

Cotton bulb

5% Glukose

Materials used :
-Test tube containing 5% glucose

( in physiological saline solution )

- Cotton bulb
Clinical Syndromes Associated with
Parasitic infection
 GASTROINTESTINAL
 Watery diarrhea
 Giardia lamblia (stool for cyst or trophozoites)
 Bloody diarrhea
 Entamoeba histolytica (stool for cyst or
trophozoites)
 Malabsorbtion
 Strongyloides stercoralis (stool for larvae)
 Worm passage
 Taenia solium (stool for ova or proglottids)
 PYREXIAL
 Fever, anemia, splenomegaly
 Plasmodium malariae (blood film)
 Fever, malaise, lymphadenopathy
 Toxoplasma gondii (serology)
 Fever, myalgia, eosinophilia
 Trichinella spiralis (muscle biopsy)
 HEPATOBILIARY
 Cystic hepatic masses
 Entamoeba histolytica (serology with or without
diagnostic aspiration)
 Recurrent suppurative cholangitis
 Fasciola hepatica (stool for operculated ova)
 Hepatic fibrosis, portal hypertension and
varices
 Schistosoma mansoni (stool for operculated ova)
 PULMONIC
 Transient pulmonary infiltrates with
eosinophilia
 Ascaris limbricoides, Hookworm (stool for ova and
larva)
 Filaria (serology)
 GENITOURINARY
 Vaginitis
 Trichomonas vaginalis (wet smear, culture)
 Hematuria
 Schistosoma hematobium (urine for operculated
ova)
 Glomerulonephritis and nephrotic syndrome
 Plasmodium malariae and Plasmodium falciparum
(blood film), Schistosoma japonicum (stool for
ova)
 NEUROLOGIC
 Cerebral mass lesions
 Cysticercus cellulosae (serology with or without
cerebral biopsy)
 Basilar meningitis
 Anggiostrongylus cantonensis (CSF for
eosinophilia)
 Meningoenchephalitis and encephalopathy
 Acanthamoeba (CSF for trophozoites)
 OCULAR
 Chorioretinitis and uveitis
 Toxoplasma gondii (funduscopy and serology)
 DERMATOLOGIC
 Pruritus ani
 Enterobius vermicularis (cellophane tape
prepration)
TERIMAKASIH