PARA - SPECIMEN OF CHOICE

• B - blood

  U - urine

  S - sputum

  C - Cerebrospinal fluid

  T - tissue impression

  B - biopsy / aspiration

  S - stool
• Freshly - trypanosomes and microfilariae ( Wb at night & Bm at afternoon
• Preserved - thick and thin smear (babesia - ticks & anopheles minimus flavirostris - plasmodium spp.)
• Mosquitos associated with malaria

  • plasmodium falciparum
  • plasmodium ovale
  • plasmodium vivax
  • plasmodium malariae
  • plasmodium knowlesi (monkey)
• Babesia & plasmodium targets RBCs
• Buffy coat film/layer - WBC (leishmania)
• QBC - quantitative buffy coat (plasmodium)

  uses acridine orange that stains the middle of QBC, all parts dyed orange are confirmed plasmodium
• Urine - covered/seen in urinary sediments
• Urine Parasitic ova: schistosoma haematobium
• Urine Chyluria - high fat content in the urine, chylomicron - milky white appearance of urine
• Urine STI PARASITE: Trichomonas vaginalis (jerky motion)
• Sputum - Location and Migration, coughed out mucus not saliva
• Sputum location

  • Pulmonary (lungs): paragonimus westermani
  • Bronchial mucus: entamoeba gingivalis
  • Lung biopsy: cryptosporidium parvum
  • oral contamination: trichomonas tenax
• Sputum Migration

  • Enzymes - cysteine proteinase: entamoeba histolytica
  • Larval: HAS Small intestine: Hookworm, Ascaris, strongyloides
• CSF - trophozoites: protozoan

  • Naegleria fowleri (PAM - primary amoebic meningoencephalitis)

  Severe infection, If associated with blood cell

  (eosinophilic meningitis & eosinophic pleocytis), may cause angiostrongylus cantonensis (rat lungworm)

  humans can be infected through slugs by eating vegetable and fruits.
• Tissue impression

  • lymp node / liver biopsy / bone marrow
  • Parasite: leishmania/ toxoplasma gondii

  uses giemsa/wright stain to ID parasite
• Biopsy/Aspiration - 11 parts
• biopsy

  Leishmania donovani (visceral leishmania)

  1. spleen
  2. liver
  3. bone marrow
• biopsy

  4. cervical lymph nodes - aspiration enlarged posterior - trypanosomes spp.
• biopsy

  5. Corneal scraping (trophozoites/cystic stage)

  Acanthamoeba spp. - in csf or eyes. (GAE: Granulomatous amoebic encephalitis)
• biopsy

  6. brain biopsy (BANET)

  B - balamunthia

  A - acanthamoeba spp.

  N - naegleria fowleri

  E - entamoeba histolytica

  T - Toxoplasma (bradyziote/tachyziote)

  4 MOT

  • Ingestion
  • Inhalation
  • Transplacental
  • Blood transfusion
• biopsy

  7. intestinal

  • Cryptosporidium parvum (merozoite) - Stage of infection
• biopsy

  8. voluntary muscles

  • trichinella spiralis (muscle worm) Encysted larva (IS) Small intestine
• biopsy

  9. Colonic ulcer

  • entamoeba histolytica
• biopsy

  10. mucosa

  • rectal: schistosoma mansoni
  • urinary bladder: schistosma haematobium
• biopsy

  11. skin - snipping or scrapping

  3M-OL ( microfilariae) seen in mucosa/submucosa

  • Mansonella pertans
  • mansonella streptocerca
  • mansonella ozzardi
  • onchocerca volvulus
  • loa loa
• Stool/feces - waste, from undigested food
• 2 major waste products: Urine and stool
• Color (bile) and smell (bacteria)
• 100-200g per defecation
• GI bleeding - color of stool

  Fecal occult blood test - screening blood in stool

  GI obstruction - stool size and shape
• Obstructive jaundice

  bile

  • bilirubin B1 - (pre or post hepatic condition)
  • B2 - urobilin (kidneys)
  • Stercobilin (intestinal)
• Dysentery

  • Blood watery sample (bacterial infection; mucus/blood)
• Ulcerative colitis

  • long term inflammation in the large instestine
  • High WBC count in stool
• steatorrhea

  • more than 6g of fat in stool (malabsorption)
  • Parasite: strongyloides (nematode)
  • Giardia lambia (protozoan)
  • String test or entero test
• Creatorrhea

  • presence of mucus fibers in stool, more than usual (maldigestion)
• Parasitic infection/disease: Cestodes

  Remain: 8-10L digested F/f

  Adult: 100-200g
• Composition of stool (WISH BIBU)

  W - waste residue

  I - intestinal secretion

  S - shedding

  H - h2O and electrolytes

  B - bile secretion

  I - inorganic substance

  B - bacteria

  U - undigested food
• Stool Examination

  Protocol

  • 3 specimens for 10 days to confirm parasitic infection
  • 6 specimens for 14 days to confirm for amoebiasis (amoeba)
• Amoeba

  • Cystic stage (formed stool)
  • Trophozoite stage (watery stool) - mobile & feeding stage