Clinical Parasitology: A Practical Approach

385 Pages·2012·52.18 MB·English

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Clinical Parasitology

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Clinical Parasitology

A PRACTICAL APPROACH

Elizabeth A. Gockel-Blessing (formerly Zeibig), PhD, MLS(ASCP)CM

Interim Associate Dean for Student and Academic Affairs
Program Director, Master of Science in Health Sciences
Associate Professor, Department of Clinical Laboratory Science
Doisy College for Health Sciences
Saint Louis University
St. Louis, Missouri

Second Edition

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CLINICAL PARASITOLOGY: A PRACTICAL APPROACH
ISBN: 978-1-4160-6044-4

Copyright © 2013, 1997 by Saunders, an imprint of Elsevier Inc.

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Notices

Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in

evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
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on their own experience and knowledge of their patients, to make diagnoses, to determine dosages
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assume any liability for any injury and/or damage to persons or property as a matter of products
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vi

C O N T R I B U T O R S

Charity E. Accurso, PhD, MT(ASCP)
Assistant Professor
Medical Laboratory Science Program
University of Cincinnati
Cincinnati, Ohio

Hassan A. Aziz, PhD, MLS(ASCP)CM

Director and Associate Professor
Biomedical Sciences
Qatar University
Doha, Qatar

Lynda A. Britton, PhD, MLS(ASCP)CM SM
Program Director and Professor
Program in Clinical Laboratory Sciences
Department of Clinical Sciences
School of Allied Health Professions
LSU Health Sciences Center
Shreveport, Louisiana

Janice M. Conway-Klaassen, PhD,
MT(ASCP)SM

Director, Clinical Laboratory Science
University of Minnesota
Minneapolis, Minnesota

Jill Dennis, EdD, MLS(ASCP)CM

Associate Dean of Academic Operations
Assistant Professor of Medical Laboratory
Science
Thomas University
Thomasville, Georgia

Linda J. Graeter, PhD, MT(ASCP)
Associate Professor
Medical Laboratory Science Program
University of Cincinnati
Cincinnati, Ohio

Michelle Mantooth, MSc, MLS(ASCP)CM,
CG(ASCP)CM

MLT Instructor
Trident Technical College
Charleston, South Carolina

Lauren Roberts, MS, MT(ASCP)
Microbiology Laboratory
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona

John P. Seabolt, EdD, MT(ASCP)SM
Senior Academic Coordinator
Department of Biology
University of Kentucky
Lexington, Kentucky

Teresa A. Taff, MA, MT(ASCP)SM
Laboratory Manager and Program Director
School of Clinical Laboratory Science
Mercy Hospital St. Louis
St. Louis, Missouri

TEST BANK WRITER

Janice M. Conway-Klaassen, PhD,
MT(ASCP)SM

Director, Clinical Laboratory Science
University of Minnesota
Minneapolis, Minnesota

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vii

R E V I E W E R S

Thomas Betsy, DC
Professor
Bergen Community College
Paramus, New Jersey
Adjunct Professor
Felician College
Lodi, New Jersey
Adjunct Professor
SUNY Rockland Community College
Suffern, New York

Dorothy M. Boisvert, EdD, MT(ASCP)
Professor
Department of Biology/Chemistry
Fitchburg State College
Fitchburg, Massachusetts

Donna M. Duberg, MA, MS, MT(ASCP)SM
Vice-Chair, Assistant Professor
Clinical Laboratory Science Department
Doisy College of Health Sciences
Saint Louis University
St. Louis, Missouri

Alese M. Furnald, BS, MLS(ASCP)CM

Clinical Laboratory Scientist and
Microbiologist
Harry S. Truman Memorial Veterans Hospital
Columbia, Missouri

Lynne Hamilton, PhD, MT(ASCP)
Assistant Professor
Clinical Laboratory Science Program
School of Allied Health Sciences
Texas Tech University Health Sciences Center
Lubbock, Texas

Katherine M. Hopper, MS, MT
Vanderbilt University Medical Center
Nashville, Tennessee

Amy R. Kapanka, MS, MT(ASCP)SC
MLT Program Director
Hawkeye Community College
Waterloo, Iowa

Perthena Latchaw, MS, MLS(ASCP)CM

MLT Program Director
Seminole State College
Seminole, Oklahoma

Laura A. Mayer
Office Assistant
Doisy College of Health Sciences
Office of the Dean
Saint Louis University
St. Louis, Missouri

Paula C. Mister, MS, MT, SM(ASCP)
Educational Coordinator and Clinical
Microbiology Instructor
Medical Microbiology
Johns Hopkins Hospital
Instructor, Biology Department
Community Colleges of Baltimore County
Pathogenic Microbiology Laboratory
Instructor
Stevenson University
Baltimore, Maryland

Cynthia Parsons, MS, MT(ASCP)
Program Director, Medical Laboratory
Technology
Northeast Texas Community College
Mt. Pleasant, Texas

Lauren Roberts, MS, MT(ASCP)
Microbiology Laboratory
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona

Anne T. Rodgers, PhD, MT(ASCP)
Retired Professor of Medical Technology
Hendersonville, North Carolina

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REVIEWERS
viii

Wendy Warren Sweatt, MT(ASCP), MS, CLS
Clinical Coordinator
Center for Professional, Career, and Technical
Education
Jefferson State Community College
Birmingham, Alabama

Teresa A. Taff, MA, MT(ASCP)SM
Laboratory Manager and Program Director
School of Clinical Laboratory Science
Mercy Hospital St. Louis
St. Louis, Missouri

Valerie A. Watson, MS
Department of Microbiology, Immunology &
Cell Biology
West Virginia University
Morgantown, West Virginia

Linda Layne Williford Pifer, PhD, SM(ASCP),
GS(ABB)

Professor, Department of Clinical Laboratory
Sciences
University of Tennessee Health Science Center
Memphis, Tennessee

Michele B. Zitzmann, MHS, MLS(ASCP)
Associate Professor
Department of Clinical Laboratory Sciences
Louisiana State University Health Sciences
Center
New Orleans, Louisiana

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ix
PREFACE

ix

P R E F A C E

Parasitology is an important component of
clinical laboratory medicine. The results obtained
through specimen examination for parasites,
provide invaluable information regarding the
diagnosis and treatment of human disease. Track-
ing the epidemiology of such organisms as
well as establishing prevention mechanisms may
be accomplished with the assistance of this
information.
Although numerous advances in technology
have been developed during recent years, the tra-
ditional technique of manually processing and
examining the samples both macroscopically and
microscopically still occurs in select clinical set-
tings. It is critical that well-educated and highly
trained individuals perform these procedures as
well as read and interpret the results. Thus, the
goal of this second edition is to provide such
information for students preparing for a career
in laboratory medicine, for learners in related
disciplines, which include parasitology, and for
clinical practitioners.
This “learner friendly” text is designed to
assist learners in both the didactic and laboratory
components associated with human clinical par-
asitology. Students using this book will have the
opportunity to develop the skills necessary to
become proficient entry-level practitioners. Cur-
rently practicing clinicians may also find this
book of use as both a reference at the bench and
as a mechanism for these individuals to review
and sharpen their skills. In alignment with
Elsevier standards, the term laboratory techni-
cians is used throughout the book when referring
to practicing laboratorians. The term in this
context does not refer to a specific level of prac-
titioner but rather to all practitioners.
In order to accomplish the aforementioned
goal, the primary focus of this text is two-fold.
First is that assurance that proper diagnostic
laboratory techniques are employed when con-
ducting parasitology testing. The major adjust-
ments/new features designed to address this
component of the two-fold focus are as follows.

The location of this chapter has been moved
from the last chapter in the book to the second
chapter of the book right after the introduction
discussion. An updated, where appropriate, lab-
oratory diagnosis section is incorporated under
the discussion of each parasite. Second is that of
accurate organism identification, which is para-
mount to successful parasitology. To enhance
proper organism identification, full-color photo-
micrographs are now embedded within the
corresponding parasite discussions. Full-color
detailed line drawings, many of which are
enlarged to show detail, with structures labelled,
where appropriate and updated “Typical Char-
acteristics at a Glance” tables have been added.
Periodic references to other chapters, without
being redundant, are strategically placed in the
text to assist the reader in quickly finding addi-
tional information.
Several parasites deemed appropriate, primar-
ily in the Arthropod Chapter (Chapter 13) have
been added to this second edition. Under the
individual parasite descriptions concise informa-
tion is incorporated regarding life cycle notes,
epidemiology, clinical symptomatology, treat-
ment, prevention and control, and notes of
interest and new trends, where appropriate.
Features such as side-by-side comparison
drawings and an entire chapter dedicated to
common artifacts and confusers (Chapter 12)
that were placed into the first edition are also
included in this edition with revisions for clarity
made as appropriate. The introduction to each
chapter is now known as a feature called “Focus-
ing In,” whereas the summary of each chapter
constitutes the section entitled “Looking Back.”
A series of chapter review questions and a case
study with questions for consideration comprise
the section at the end of appropriate chapters
entitled “Test Your Knowledge.”
This second edition contains several addi-
tional features worthy of mentioning that pertain
to the book in general, to specific chapters, and/
or to individual parasite discussions. Learning

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PREFACE
x

objectives have been updated as appropriate for
each chapter. A list of key terms is embedded
within each set of appropriate chapter objectives.
Each term is then bolded and defined in the
chapter where it first appears. A comprehensive
alphabetized glossary is located at the back of
the book. The common disease/condition name(s)
associated with each pathogenic parasite appears
below the pronunciation for quick and easy
reference.
This text provides a way of enhancing
problem solving skills through the use of case
studies, each identified as “Case Study: Under
the Microscope,” as these abilities are critical to
the practice of laboratory and primary care
medicine. Each appropriate chapter begins with
a case study based on the chapter content that
follows and contains questions for consider-
ation. A second case study complete with patient
history and symptomatology, pertinent labora-
tory findings, drawings of the organism(s)
present and a series of questions appears at the
end of each appropriate chapter. Periodic self-
assessment questions, each of which is entitled
“Test Your Knowledge” and a set of review
questions have been incorporated into each
chapter. Answers for both the chapter “Quick
Quiz” and review questions are located in the
appendices located in the back of the book.
A new addition to this second edition is an
Evolve website. This Evolve site provides free

material for both students and instructors. Instruc-
tors have access to a test bank, PowerPoint slides,
and an electronic image collection featuring all the
images from the book. Students have access to
interactive quizzes which test them on the content
from individual chapters.
Every attempt has been made to ensure that
this text is as accurate and as up-to-date as pos-
sible. As with every field of study, disagreements
and discrepancies exist about particular facts.
Parasitology is no exception. In select instances
where this was encountered, notations were
made in the text. It is important to point out here
that in all such occurrences appropriate decisions
on how to remedy these situations for the purpose
of this book were reached primarily by consider-
ing views from content experts and my personal
clinical experience.
This text was written to serve as a concise and
practical guide to clinical parasitology. It is not
intended to be exhaustive in nature. It is my
sincere hope that users of this text will find it
to be a positive learning experience as well as
enjoyable and helpful. I welcome comments and
suggestions from students, educators and practi-
tioners. After all, this text has been designed with
you in mind.

Elizabeth A. Gockel-Blessing (formerly Zeibig)

xi
ACKNOWLEDGMENTS

xi

A C K N O W L E D G M E N T S

First and foremost, I would like to thank all of
the individuals who helped in the preparing of
the first and second edition manuscript for pub-
lication. Their roles in this project ranged from
typists and photographers, proofreaders, editors,
and content consultants. I would like to extend
a special thanks to each chapter contributor
who took time out of his/her busy schedule to
review the first edition chapters, revise and
update content as appropriate and incorporate
the new features into this second edition. The
dedication, support, and enthusiasm of all of
these individuals were instrumental in produc-
ing both editions of this text. I apologize in
advance for those I may have inadvertently
omitted.

PROJECT CONSULTANTS

Peggy A. Edwards, MA, MT(ASCP)
Assistant Dean of Student and Academic Affairs,
Retired
Department of Clinical Laboratory Science
Saint Louis University
St. Louis, MO

Michael P. Grady, Ph.D.
Professor of Education
Saint Louis University
St. Louis, MO

James A. Taylor, Ed.D.
Director, School of Allied Health Sciences
Northeast Louisiana University
Monroe, LA

Eugene C. Wienke, M.D.
Pathologist/Microbiology Laboratory Director,
Retired
Deaconess Health Systems
St. Louis, MO

PROJECT ASSISTANTS

Steve Fobian
Bill Matthews
Peg Gerrity, Illustrator
Kelly Rhodes
Ryan Gile
Gail Ruhling
Terry Jo Gile
The late David Zeibig
Shirley Gockel

I would like to extend thanks to Deaconess
Health Systems for supplying select samples that
were used to obtain photographs as well as the
required equipment necessary to take all of the
text photography.

STUDENT ASSISTANTS

A sincere thank you to the Saint Louis University
Department of Clinical Laboratory Science
classes of 1994 and 1995 for their encourage-
ment, support, and help. These students, listed
below, were helpful in many ways, including
looking up organism pronunciations and creat-
ing representative parasite drawings upon which
those in this text are based. In addition, informa-
tion from several of their research projects was
incorporated into the manuscript and is cited in
the reference section.

Beatrice Bernhart
Theresa Blattner
Karen Casey
Toni Depue
John Drury
David Fulmer
Deidra Hughes
Tricia Konrad
Luann Linsalata
Laura Murat
Bharat Patel
Tracy Pitzer
Dawn Randles
Jennifer Shelley
Munsok So
Claro Yu

ACKNOWLEDGMENTS
xii

SPECIAL THANK-YOUS

To my colleagues in the Saint Louis University
Department of Clinical Laboratory Science over
the years of undending support throughout the
development and revision process associated
with both editions of this book.

The late Ann Boggiano
Hillary Daniel
Donna Duberg
Peggy Edwards, Retired
Uthay Ezekiel
Mona Hebert
Rita Heuertz
Linda Hoechst
Kathy Humphrey
Tim Randolph
Sharon Smith
Carol Sykora
Mary Lou Vehige, Retired

Special thanks to following individuals who
each in their own way contributed to one or both
editions of this book:
•
To my late grandmother Grace W. Hull, who
spent countless hours teaching me, during
my formative years, the skills necessary to

effectively write sentences, paragraphs and
papers.
•
To my medical technology instructor Avril
Bernsen, who gave me the opportunity to
study Medical Technology (now known as
Clinical Laboratory Science) under her
direction.
•
To Dr. Michael Grady who served as my
advisor and mentor during graduate school
and served as an outside reviewer for the first
edition chapters in this book.
•
To my mother, Shirley Gockel, and brother
and sister-in-law, Fred and Juanita Gockel,
for their unending encouragement and
support.
•
To my husband, Bob Blessing who provided
unending love and support during the editing
and production stages of this second edition.
Thanks to him for taking care of numerous
tasks and in doing so opened up valuable
time blocks for me to work on this project.
Last, but by no means least, thanks to the entire
staff at Elsevier. Special thanks to Selma
Kaszczuk and Rachael Kelly for their support
and patience during the preparation of the first
edition and to Ellen Wurm-Cutter and Marquita
Parker for guidance and assistance during the
second edition process.

xiii
CONTENTS

xiii

C O N T E N T S

CHAPTER 1
INTRODUCTION
1

CHAPTER 2
SPECIMEN COLLECTION AND
PROCESSING
14

CHAPTER 3
THE AMEBAS
41

Entamoeba histolytica
45

Entamoeba hartmanni
51

Entamoeba coli
53

Entamoeba polecki
56

Endolimax nana
58

Iodamoeba bütschlii
60

Entamoeba gingivalis
63

Naegleria fowleri
65

Acanthamoeba species
68

CHAPTER 4
THE FLAGELLATES
77

Giardia intestinalis
80

Chilomastix mesnili
86

Dientamoeba fragilis
88

Trichomonas hominis
91

Enteromonas hominis
92

Retortamonas intestinalis
94

Trichomonas tenax
96

Trichomonas vaginalis
97

CHAPTER 5
THE HEMOFLAGELLATES
104

Leishmania braziliensis complex
111

Leishmania donovani complex
113

Leishmania mexicana complex
116

Leishmania tropica complex
117

Trypanosoma brucei gambiense
120

Trypanosoma brucei rhodesiense
121

Trypanosoma cruzi
123

Trypanosoma rangeli
125

CHAPTER 6
SELECT SPOROZOA: PLASMODIUM AND
BABESIA
129

Plasmodium vivax
136

Plasmodium ovale
141

Plasmodium malariae
143

Plasmodium falciparum
147

Plasmodium knowlesi
151

Babesia microti
154

Babesia divergens
154

CHAPTER 7
MISCELLANEOUS PROTOZOA
159

Balantidium coli
162

Isospora belli
165

Sarcocystis species
168

Cryptosporidium parvum
170

Blastocystis hominis
172

Cyclospora cayetanensis
174

Microsporidia
176

Toxoplasma gondii
177

Pneumocystis jiroveci (Pneumocystis
carinii)
182

CHAPTER 8
THE NEMATODES
188

Enterobius vermicularis
192

Trichuris trichiura
195

Ascaris lumbricoides
197

Necator americanus
202

Ancylostoma duodenale
202

Strongyloides stercoralis
207

Trichinella spiralis
210

Dracunculus medinensis
213

CHAPTER 9
THE FILARIAE
222

Wuchereria bancrofti
225

Brugia malayi
227

Loa loa
229

Onchocerca volvulus
231

Mansonella ozzardi
233

Mansonella perstans
235

CONTENTS
xiv

CHAPTER 10
THE CESTODES
239

Taenia saginata
242

Taenia solium
242

Hymenolepis diminuta
247

Hymenolepis nana
249

Dipylidium caninum
251

Diphyllobothrium latum
253

Echinococcus granulosus
256

CHAPTER 11
THE TREMATODES
265

Fasciolopsis buski
269

Fasciola hepatica
269

Clonorchis sinensis
271

Heterophyes heterophyes
273

Metagonimus yokogawai
273

Paragonimus westermani
275

Schistosoma mansoni
277

Schistosoma japonicum
277

Schistosoma haematobium
277

CHAPTER 12
ARTIFACTS AND CONFUSERS
286

CHAPTER 13
THE ARTHROPODS
297

Ticks
301

Mites
303

Spiders
305

Scorpions
307

Fleas
308

Flies
310

Lice
312

Mosquitoes
314

Bugs
316

APPENDIX A
GLOSSARY
323

APPENDIX B
ANSWERS TO CASE STUDIES UNDER
THE MICROSCOPE
333

APPENDIX C
ANSWERS TO QUICK QUIZ
QUESTIONS
339

APPENDIX D
ANSWERS TO TEST YOUR KNOWLEDGE
REVIEW QUESTIONS
343

APPENDIX E
BIBLIOGRAPHY
352

INDEX
355