Practical guide to diagnostic parasitology /
Lynne S. Garcia.
- 3rd edition.
- 1 online resource
Lynne Shore Garcia is the director of LSG & Associates, a firm providing training, teaching, and consultation services for diagnostic medical parasitology and health care administration. A former manager of the UCLA Clinical Microbiology Laboratory, she is a sought-after speaker (nationally and internationally) and author of hundreds of articles, book chapters, and books including two ASM Press books, Clinical Laboratory Management, Second Edition and Diagnostic Medical Parasitology, Sixth Edition
Includes bibliographical references and index.
TABLE OF CONTENTS Preface xix
About the Author xxiii
Section 1 Philosophy and Approach to Diagnostic Parasitology 1
Neglected Tropical Diseases 2
Why Perform Diagnostic Parasitology Testing? 3
Travel 3
Population Movements 3
Control Issues 4
Climate Change 4
Epidemiologic Considerations 4
Compromised Patients; Potential Sex Bias Regarding Infection Susceptibility; Aging 4
Approach to Therapy 5
Who Should Perform Diagnostic Parasitology Testing? 5
Laboratory Personnel 5
Nonlaboratory Personnel 5
Where Should Diagnostic Parasitology Testing Be Performed? 6
Inpatient Setting 6
Outpatient or Referral Setting 6
Decentralized Testing 6
Physician Office Laboratories 6
Over-the-Counter (Home Care) Testing 7
Field Sites 7
What Factors Should Precipitate Testing? 7
Travel and Residence History 7
Immune Status of the Patient 7
Clinical Symptoms 7
Documented Previous Infection 7
Contact with Infected Individuals 8
Potential Outbreak Testing 8
Occupational Testing 8
Therapeutic Failure 8
What Testing Should Be Performed? 8
Routine Tests 8
Special Testing and Reference Laboratories 9
Specialized Referral Test Options—DPDx and Other Sites 9
Other (Nonmicrobiological) Testing 10
What Factors Should Be Considered in Development of Test Menus? 10
Physical Plant 10
Client Base 10
Customer Requirements and Perceived Levels of Service 10
Personnel Availability and Level of Expertise 10
Equipment 10
Budget 11
Risk Management Issues Associated with Stat Testing 11
Primary Amebic Meningoencephalitis 11
Granulomatous Amebic Encephalitis and Amebic Keratitis 14
Request for Blood Films 15
Automated Instrumentation 15
Patient Information 16
Conventional Microscopy 16
Table 1.1 Common features of the neglected tropical diseases 18
Section 2 Parasite Classification and Relevant Body Sites 19
Protozoa (Intestinal) 20
Amebae, Stramenopiles 20
Flagellates 22
Ciliates 22
Apicomplexa (Including Coccidia) 23
Microsporidia (Now Classified with the Fungi) 23
Protozoa (Other Body Sites) 24
Amebae 24
Flagellates 24
Apicomplexa (Including Coccidia) 24
Microsporidia (Now Classified with the Fungi) 25
Protozoa (Blood and Tissue) 26
Apicomplexa (Including Sporozoa) 26
Flagellates 26
Nematodes (Intestinal) 29
Nematodes (Tissue) 29
Nematodes (Blood and Tissue) 30
Cestodes (Intestinal) 31
Cestodes (Tissue) 32
Trematodes (Intestinal) 33
Trematodes (Liver and Lungs) 33
Trematodes (Blood) 35
Pentastomids 35
Acanthocephala 36
Table 2.1 Classification of human parasites 37
Table 2.2 Cosmopolitan distribution of common parasitic infections 39
Table 2.3 Body sites and possible parasites recovered 40
Section 3 Collection Options 43
Safety 44
Collection of Fresh Stool Specimens 44
Collection Method 44
Number of Specimens To Be Collected 45
Collection Times 47
Posttherapy Collection 47
Specimen Type, Stability, and Need for Preservation 47
Single-Vial Collection Systems (Other than SAF) 53
Universal Fixative (Total-Fix) 54
Quality Control for Preservatives 54
Procedure Notes for Use of Preservatives (Stool Fixative Collection Vials) 55
Procedure Limitations for Use of Preservatives (Stool Fixative Collection Vials) 55
Collection of Blood 56
Collection and Processing 56
Stat Test Requests and Risk Management Issues 57
Collection of Specimens from Other Body Sites 57
Table 3.1 Fecal specimens for parasites: options for collection and processing 58
Table 3.2 Approaches to stool parasitology: test ordering 61
Table 3.3 Preservatives and procedures commonly used in diagnostic parasitology (stool specimens) 62
Table 3.4 Advantages of thin and thick blood films 64
Table 3.5 Advantages and disadvantages of buffy coat films 64
Table 3.6 Potential problems of using EDTA anticoagulant for the preparation of thin and thick blood films 65
Table 3.7 Body sites and possible parasites recovered (trophozoites, cysts, oocysts, spores, adults, larvae, eggs, amastigotes, and trypomastigotes) 66
Section 4 Specimen Test Options: Routine Diagnostic Methods and Body Sites 69
Ova and Parasite Examination of Stool Specimens 70
Other Diagnostic Methods for Stool Specimens 72
Culture of Larval-Stage Nematodes 72
Estimation of Worm Burdens through Egg Counts 73
Hatching Test for Schistosome Eggs 73
Screening Stool Samples for Recovery of a Tapeworm Scolex 74
Testing of Other Intestinal Tract Specimens 74
Examination for Pinworm 74
Sigmoidoscopy Material 75
Duodenal Drainage Material 76
Duodenal Capsule Technique (Entero-Test) 76
Urogenital Tract Specimens 77
Sputum 77
Aspirates 78
Biopsy Specimens 78
Blood 79
Thin Blood Films 79
Thick Blood Films 80
Blood Staining Methods 80
Buffy Coat Films 80
QBC Microhematocrit Centrifugation Method 80
Knott Concentration 81
Membrane Filtration Technique 81
Culture Methods 81
Animal Inoculation and Xenodiagnosis 82
Antibody and Antigen Detection 82
Antibody Detection 82
Antigen Detection, Nucleic Acid-Based Tests, and Molecular Panels 84
Intradermal Tests 84
UV Autofluorescence 84
Table 4.1 Body sites, procedures and specimens, recommended methods and relevant parasites, and comments 86
Table 4.2 Serologic, antigen, and probe tests used in the diagnosis of parasitic infections 94
Section 5 Specific Test Procedures and Algorithms 95
RISK MANAGEMENT ISSUES ASSOCIATED WITH BLOOD FILMS 187
USE OF A REFERENCE LABORATORY FOR PARASITE BLOOD DIAGNOSTIC TESTING 188
BLOOD FILM REPORTING WITH ADDITIONAL REPORT COMMENTS 189
BUFFY COAT BLOOD FILMS 189
Blood Stains 190
STAIN OPTIONS 190
GIEMSA STAIN 190
Blood Concentration 194
BUFFY COAT CONCENTRATION 194
KNOTT CONCENTRATION 195
MEMBRANE FILTRATION CONCENTRATION 197
Algorithm 5.1 Procedure for processing fresh stool for the O&P examination 201
Algorithm 5.2 Procedure for processing liquid specimens for the O&P examination 202
Algorithm 5.3 Procedure for processing preserved stool for the O&P examination—two-vial collection kit 203
Algorithm 5.4 Procedure for processing SAF-preserved stool for the O&P examination 204
Algorithm 5.5 Procedure for the use of Total-Fix (universal fixative, single-vial system) (this fixative contains no mercury, no PVA, and no formalin) 205
ALTERNATE METHOD FOR SMEAR PREPARATION DIRECTLY FROM VIAL 206
Algorithm 5.6 Use of various fixatives and their recommended stains 207
Algorithm 5.7 Ordering algorithm for laboratory examination for intestinal parasites 208
Algorithm 5.8 Procedure for processing blood specimens for examination 209
Table 5.1 Body sites, specimens, and recommended stains 210
Table 5.2 Approaches to stool parasitology: test ordering 214
Table 5.3 Laboratory test reports: notes and optional comments 215
Table 9.15 Comparison of Naegleria fowleri, Acanthamoeba spp., Balamuthia mandrillaris, and Sappinia diploidea 506
Table 9.16 Characteristics of Trichomonas vaginalis 507
Table 9.17 Key characteristics of intestinal tract and urogenital system protozoa 508
HELMINTHS 512
Table 9.18 Normal life spans of the most common intestinal nematodes 512
Table 9.19 Characteristics of the most common intestinal nematodes 513
Table 9.20 Tissue nematodes 515
Table 9.21 Trichinella spiralis: life cycle stages and clinical conditions 517
Table 9.22 Characteristics of human microfilariae 518
Table 9.23 Characteristics of cestode parasites (intestinal) 519
Table 9.24 Tissue cestodes 521
Table 9.25 Characteristics of intestinal trematodes 523
Table 9.26 Characteristics of liver and lung trematodes 524
Table 9.27 Human paragonimiasis 526
Table 9.28 Characteristics of blood trematodes 527
Table 9.29 Key characteristics of helminths 528
BLOOD PARASITES 532
Table 9.30 Malaria characteristics with fresh blood or EDTA-blood 532
Table 9.31 Potential problems with using EDTA anticoagulant for the preparation of thin and thick blood films 533
Table 9.32 Plasmodia in Giemsa-stained thin blood smears 534
Table 9.33 Relevant issues for handling requests for identification of infectious blood parasites 537
Table 9.34 Features of human leishmanial infections 540
Table 9.35 Characteristics of American trypanosomiasis 541
Table 9.36 Characteristics of East and West African trypanosomiasis 541
Table 9.37 Key characteristics of blood parasites 541
Index 547
"As we move forward into the 21st century, the field of diagnostic medical parasitology continues to see some dramatic changes, including newly recognized pathogens, changing endemicity of familiar pathogens, disease control challenges, geographic and climate changes that support the spread of parasitic disease, new methodologies, expansion of diagnostic testing, and an ongoing review of the approach to and clinical relevance of this type of diagnostic testing on patient care within the managed care environment, as well as the world as a whole. The third edition of the Practical Guide to Diagnostic Parasitology is organized to provide maximum help to the user, particularly from the bench use perspective. New aspects of the field have been addressed in these sections, and many new figures and plates have been added, including extensive color images. Section 1 on the philosophy and approach to diagnostic parasitology has been expanded to include discussions on neglected tropical diseases, the impact of global climate change, population movements, potential outbreak testing, the development of laboratory test menus, and the risk management issues related to "stat" testing. The Section 2 discussion of organism classification and relevant tables has been expanded and updated to provide the user with current information related to changes in nomenclature and overall importance of the various parasite categories to human infection"--