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- 1. Classification of HelminthicParasites Class Roundworm (Nematode) Tapeworm (Cestode) Fluke (Trematode) Body Morphology Cylindrical & Fusiform Flattened & Segmented Leaf-shaped Gut Tubular None Blind Sex Male/Female Hermaphroditic Variable Intermediate host Variable One to two One to two
- 2. ∙ Intestinal - Enterobiusvermicularis (pinworm)* - Trichuris trichuria (whipworm) - Ascaris lumbricoides (large roundworm) - Ancyclostoma duodenale (hookworm) - Necator americanus (hookworm) - Strongyloides stercoralis Helminths: Nematodes
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- 4. Helminths/ Nematodes Enterobius vermicularisEggs Diagnostic Features - Oval with flat side - 60 x 30 μm - Smooth thick, colorless shell Iodine 1000x
- 5. Helminths/ Nematodes Enterobius vermicularisEggs Immature Mature Iodine 1000x Iodine 1000x
- 6. Helminths/ Nematodes Cellulose TapeMethod Pinworm Paddle
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- 8. Helminths/ Nematodes Enterobius vermicularisFemale Adult 1 mm
- 9. Helminths/ Nematodes Trichuris trichuria(Whipworm) Diagnostic Features - Barrel shaped - 55 x 25 μm - Yellow-brown thick shell - Translucent knobs at ends Immature Egg Iodine 1000x
- 10. Helminths/ Nematodes Trichuris trichuria(Whipworm)
- 11. Helminths/ Nematodes Trichuris trichuria(Whipworm)
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- 13. Helminths/ Nematodes Ascaris lumbricoides -Oval - Fertile 75x50 μm, Infertile 95x50 μm - Yellow-brown thick shell - ± Rough mamillated layer Fertile Egg Infertile Egg Iodine 600x Iodine 600x
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- 15. Helminths/ Nematodes Diagnostic Features -Smooth creamy cuticle - No radial ridges Adult female EarthEarthworm
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- 18. Mystery meningitis • Baylisascarisprocyonis; raccoon roundworm, causes larval migrans Embryonated, infective stage from raccoon feces
- 19. Ancyclostoma & Necator(hookworm)
- 20. Helminths/ Nematodes Ancyclostoma duodenale& Necator americanus (Hookworms) Diagnostic Features - Oval - 75x40 μm - Thin shell wall - 4-8 cell stage - Clear space Iodine 1000x
- 21. Helminths/ Nematodes Ancyclostoma duodenale& Necator americanus (Hookworms) Iodine 1000x Iodine 1000x
- 22. Helminths/ Nematodes Ancyclostoma duodenale(Hookworms) Ancyclostoma duodenale Necator americanus Diagnostic Features: - Bucal capsule (teeth vs cutting plates)
- 23. Helminths/ Nematodes Ancyclostoma duodenale(Hookworms)
- 24. Helminths/ Nematodes Ancyclostoma duodenale& Necator americanus (Hookworms) Embryonated Egg Rhabditiform larvae larva Iodine 1000x Iodine 400x
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- 26. Helminths/ Nematodes Strongyloides stercoralisRhabditoid Larva Diagnostic Features - 200-400 μm - Short buccal canal - Prominent genital primordium - Esophagus:Intestine 1:4
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- 28. Focus Lab Commercial ELISA Crossreacts with other round worms CDC “Home-brew“ EIA Chaffee extract of 3rd larval stage 95% sens and 99% spec. Strongyloides stercoralis Serology
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- 32. Classification of HelminthicParasites Class Roundworm (Nematode) Tapeworm (Cestode) Fluke (Trematode) Body Morphology Cylindrical & Fusiform Flattened & Segmented Leaf-shaped Gut Tubular None Blind Sex Male/Female Hermaphroditic Variable Intermediate host Variable One to two One to two Helminths/ Cestodes
- 33. Types of TapeWorms Fish Cattle Pig Insects Herbivores Diphyllo bothrium Taenia saginata Taenia solium Hymenolepis nana H. diminuta Echinococcus granulosus E. multilocularis Helminths/ Cestodes
- 34. Helminths/ Cestodes Adult Tapeworms 1.Scolex 2. Neck 3. Strobila
- 35. Helminths/ Cestodes Scolex ofTapeworms T. Solium H. nana Echinococcus spp. T. saginata H. diminuta Diphyllobothrium latum
- 36. Helminths/ Cestodes Life Cycleof Tape Worms Definitive Host Intermediate Host
- 37. Helminths/ Cestodes Life Cycleof Tape Worms Intermediate Host Definitive Host Intermediate Host Cestode T. solium
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- 40. Cysticercosis Slaughtered pig inPapua-Indonesia Brain CT of a patient in Lima Dr. Sukwan Handali 2006
- 41. Helminths/ Cestodes Embryonated TapewormEggs H. nana Oval ~45μm Bipolar inner membrane 4-8 polar filaments H. diminuta Round ~70μm Striated outer shell Thin inner membrane T. solium & saginata Round ~40μm Thick, radial striation brown shell Iodine 1000x Iodine 1000x Iodine 1000x
- 42. Helminths/ Cestodes D. latumEggs Dx Features: - Oval - 60 x 40 μm - Operculated - terminal knob - cleavage fills entire shell Iodine 1000x Iodine 1000x
- 43. Life cycle ofD. latum
- 44. Diphyllobothrium latum duringColonoscopy
- 45. Helminths/ Cestodes Proglottid ofTapeworms T. solium T. saginata D. latum Dx Features: - 3 x 11 mm - 11 x 5 mm - 20 x 5 - central uterus - 7-13 lateral - 15-30 lateral
- 46. Classification of HelminthicParasites Class Roundworm (Nematode) Tapeworm (Cestode) Fluke (Trematode) Body Morphology Cylindrical & Fusiform Flattened & Segmented Leaf-shaped, Suckers Gut Tubular None Blind Sex Male/Female Hermaphroditic Variable Intermediate host Variable One to two One to two Helminths/ Trematodes
- 47. Types of Flukes Helminths/Trematodes Fluke Common name Paragonimus westermani Oriental lung fluke Clonorchis sinensis Chinese or oriental fluke Fasciola hepatica Sheep liver fluke Schistosoma spp. - - - - -
- 48. Types of Flukes Helminths/Trematodes
- 49. Schistosoma Adult Worm Helminths/Trematodes “The 1-2 cm long male possess a deep ventral groove or canal in which it carries the longer more slender female in life-long copulatory embrace.”
- 50. Life cycle ofSchistosomas
- 51. Schistosoma Eggs Helminths/ Trematodes S.haematobium Oval ∼ 180 μm Terminal spine S. mansoni Oval ~180 μm Lateral spine
- 52. Schistosoma Eggs Helminths/ Trematodes S.mekongi Oval ~80 μm Vestigial spine Mekong River area S. japonicum Oval ~100 μm Vestigial spine
- 53. Schistosoma Eggs inTissue Helminths/ Trematodes S. mansoni Liver S. spp Liver S. mansoni Intestinal wall
- 56. Parasite Diagnostic Assays ∙Nucleic acid test - Syndromic GI PCR: (1) axTAG GPP, Luminex xTag gastrointestinal pathogen panel (Luminex Corporation, Toronto, Canada) (2) FilmArray, FilmArrayTM Gastrointestinal Panel (BioFire Diagnostics, Salt Lake City, UT)
- 59. Syndromic GI Assays ∙Accuracy ∙ Sensitivities and specificities are superior or comparable to conventional and molecular methods ∙ Advantages ∙ Comprehensive coverage of etiologies ∙ Allow consolidation of multiple laboratory tests ∙ Disadvantages ∙ Cost ∙Future needs ∙ Larger studies to determine sensitivity and specificity of all targets ∙ Significance of multiple positive targets (30% of positives) Khare et al JCM 2014 Buss et al JCM 2015
- 61. Case 1: 61 yearold sushi lover was referred for upper endoscopy to evaluate typical longstanding dyspepsia and reflux type symptoms. What is the diagnosis?
- 63. Case 2: Pt withhepatic abscess? Which amoeba is seen in stool?
- 65. Case 3: Biopsy froma 27 y/o women who complained of belching, flatulence and diarrhea. What can be seen in the lumen?
- 67. Intramuscular cyst inthe right scapular area of a 33 y/o Hispanic male H&E stain Case 4: 60 y/o with CGD with profuse diarrhea
- 68. Concentrated stool, ModifiedAFB stain
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- 71. Case 6: 50 y/oman with HTLV infection and respiratory failure
- 72. Bronchial aspirate, Bacterialculture on blood agar
- 73. Case 7: Oncology patienton chemotherapy with pneumonitis.
- 74. Stool: direct mountwith iodine 100X
- 75. Bronchial aspirate, viralculture
- 76. Case 8: 7 y/owith anal itching. What does cellulose tape preparation show?
- 78. Case1x: 48 year oldFilipino with portal vein thrombosis/portal HTN presented with massive upper GI bleed.
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