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DR. KELI MEM203 Parasitology-1
DR. KELI MEM203 Parasitology-1
DR. KELI MEM203 Parasitology-1
MICROBIOLOGY II
• Surgery.
• Specimen:
• Splenic aspirate and biopsy- 96-98% sensitive but not commonly done due to the risk of splenic rupture
and hemorrhage.
• Bone marrow aspirate (Sternum or iliac crest)-is 60-80% sensitive.
• Skin biopsy and scrapings of the ulcer in cutaneous disease.
• Blood/serum
• Techniques:
• Microscopy; staining for amastigotes
• Culture for promastigotes- NMN medium
• Serology for Ab
• Leishman skin test (LST)
• PCR
• Biochemical tech
11/24/2023 Dr. Keli 31
Leishmaniasis Treatment
1. Sodium Stibogluconate (Pentavalent antimonial) - 20 mg/kg/day IV
or IM for 28 days, dose mixed with 50ml of 5% dextrose in water
and infused over 10 mins.
2. Alternative 1st line drug - Amphotericin B: 0.5-1 mg/kg IV slow
infusion (6-8 hrs) dissolved in 500mls of dextrose 5%, on alternate
days. 14-20 infusions for a total dose of 1.5gms.
3. Pentamidine
4. Alternative agents: Miltefosine, Ketoconazole, Paramomycin,
Sitamaquine
• Specimen: • Methodology:
• Concentration techniques:-
• chancre fluid, • Haematocrit centrifugation tech for buffy
• lymph node aspirates, coat
• mini anion-exchange/centrifugation
• blood/serum • Quantitative Buffy Coat (QBC) technique
• bone marrow • Giemsa staining of blood-
trypamastigotes
• cerebrospinal fluid. • sediment Isolation of the parasite by
inoculation of rats or mice for spinal fluid
• Antibody detection has sensitivity and
specificity
• Specimen:
• Blood
• Serum
• Techniques:
• Microscopy for amastigotes; thin/thick smears
• Buffy coat for motile parasites
• Culture (NNN/LTI media)
• Innoculation in mice
• Xenodiagnosis
• Ab serodiagnosis
• Specimen: • Technique:
• Stool • Microscopy (trophozoites/cysts):
• Serum -Formalin acetate
• Duodenal biopsy -Haematoxylin/eosin stain
• Duodenal fluids • Ag detection: serology: enzyme
immunoassays
• PAR detection via
immunofluorescent assays
• PCR
• Specimen:
• Stool (care infective oocyst)
• Serum
• Biopsy
• Technique:
• Acid fast staining for oocysts: Kinyoun;Ziel-Neelsen
• Centrifugation
• Enzyme immunoassays
• PCR
• Ab detection
• Specimen:
• High vaginal swabs (HVS)
• Urethral discharge
• Urine
• Serum
• Prostatic secretions
• Technique:
• Microscopy (direct) for trophozoites (no cysts!)
• Direct immunofluorescent test (IFAT)
• Culture
11/24/2023 Dr. Keli 61
Plasmodium
• Plasmodium is a malaria causing parasite.
• (Blood and tissue protozoa)
There are four types of plasmodia that cause malaria:-
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium malariae
• Plasmodium falciparum
• plus system
• + represents 1-10/100 thick blood films
• ++ represents 11-100/100 thick blood films
• +++ represents 1-10 per single thick blood film
• ++++ > 10 parasites per single thick blood film
• Specimen:
• Fine needle biopsy
• Serum
• Techniques:
• Microscopy for protoscolisces
• Ab detection techniques (serology)
• Imaging tech
- Plain CXR, Chest CT Scan
- Liver US, Abdominal CT Scan
- Brain CT Scan, MRI
- Bone X-rays
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Hydatid disease Tx
• Treatment:
Medical
- Albendazole 10-15mg/Kg/day
- High dose Mebendazole 40-50 mg/Kg/day
- Praziquantel 40mg Kg/day
Surgical Rx:
• Liver Cysts - PAIR (Percutaneous Aspiration Injection & Re-aspiration).
• Other surgical options e.g. resection, partial hepatectomy, Lobectomy
etc
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NEMATODES (NEMATHELMINTHES)
• Nematodes are round worms with acylindrical body and complete
digestive tract including the mouth and an anus.
• The body is covered with a noncellular, highly resistant coating called a
cuticle.
• Nematodes have separate sexes;-female usually larger than male. The
male typically has a coiled tail.
• Medically important nematodes are divided into two categories
according to their primary location in the body.i.e
Intestinal nematodes
Tissue nematodes
11/24/2023 Dr. Keli 109
Intestinal nematodes
Intestinal nematodes include
• Ascaris(giant round worm)-causes ascariasis(human)
• Necator & Ancylostoma (the two hookworm)
• Strongyloides(small roundworm)-causes strongoloidiasis
• Enterobius(pinworm)-causes enterobiasis(human)
• Trichuris(whipworm)-causes trichuriasis(human);may cause diarrhea
and rectal prolapse in children.
• Trichinella.
• Specimen:
• Stool
• Technique:
• Microscopy for ova:
• FECT/FEACT (ether/ethyl acetate)
• Radiology - U/S (biliary). X-ray (I.O).
• Barium meal
• Duodenoscopy
• Macroscopy (adults)
• SURGICAL Rx:
- Intestinal Obsruction - Laparotomy.
- Partial intestinal obstruction - Conservative. Hypertonic saline enema.
- Pancreato-biliary ascariasis - Removal: Sphincteromy(ERCP),
Choledochotomy
• Specimen:
• Stool
• Duodenal aspirates
• Serum
• Technique:
• Microscopy for ova/larvae:
• Direct/conc FECT/FEACT
• Culture for L2 larvae:
-harada-mori
-damp charcoal
-agar plate culture
• Serology for Ab
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11/24/2023 Dr. Keli 120
Filariasis
• Filarial worms – tissue nematodes (Filarioidea)
• Pathogenic forms:
- Wuchereria bancrofti
- Brugia malayi & B. timori
- Loa loa
- Onchocerca volvulus
Non-pathogenic forms:
- Mansonella spp.
Oncocerciasis – subcutaneous filariasis affecting skin & eye – O. volvulus.
Loa loa – eye worm
11/24/2023 Dr. Keli 121
• General features of filarial worms:
- Use arthropods as vectors of their transmission- Anopheles, Culex,
Aedes, Mansonia mosquitoes.
- Females produce larvae – microfilariae.
- Adult worms live in lymphatics, subcutaneous tissues, muscles &
body cavities.
- Humans – only significant hosts
• Specimen:
• Blood: note periodicity
• Serum
• Tissue
• Techniques:
• Microscopy for microfilaria; staining (Giemsa/Wrights)
• Knotts concentration technique
• Filtration techniques (nucleophore membrane)
• Ag detection (Immunoassays; rapid test)
• PCR
• Ab
• Macroscopy
b) Family: Reduviidae
Triatoma infestans (kissing bug)
b) Family: Tungidae
Tunga penetrans (jigger flea)
• Diagnosis
• History and typical clinical features
• Extraction of a mite
• The black dot at end of burrow
• Treatment
• gamma benzene hexachloride
• benzyl benzoate emulsion
• permethrin
• Ivermectin
11/24/2023 Dr. Keli 153
REFERENCES
• Sherri’s Medical Microbiology 7th edition
• Medscape
• www.cdc.gov