Lynne Shore Garcia - Diagnostic Medical Parasitology

Amphotericin B (AmBisome) (Gilead)

Amphotericin B (Fungizone) (X-Gen)

Artemether (Artenam) (Aarenco, Belgium)

Atovaquone (Mepron) (GlaxoSmithKline)

Atovaquone-proguanil (Malarone) (GlaxoSmithKline)

Benznidazole (Rochagan) (Roche, Brazil)

Bithionol (Bitin) (CDC)

Chloroquine phosphate (Aralen) (Sanofi, others)

Crotamiton (Eurax) (Ranbaxy)

Dapsone (Jacobus)

Diethylcarbamazine citrate USP (Hetrazan) (CDC)

Diloxanide furoate (Furamide, Entamide) (Boots, England)

Eflornithine (difluoromethylornithine, Ornidyl) (Sanofi) (CDC)

Fumagillin (Fumidil-B)

Furazolidone (Furoxone)

Iodoquinol/diiodohydroxyquin (Yodoxin) (Glenwood, others)

Ivermectin (Stromectol, Sklice) (Merck, Sanofi)

Lumefantrine/artemether (Coartem, Riamet) (Novartis)

Malathion (Ovide) (Taro Pharmaceuticals)

Mebendazole (generics)

Mefloquine hydrochloride (generics)

Melarsoprol (Mel-B) (CDC)

Metronidazole (Flagyl, IV Flagyl) (Searle/Pfizer, Baxter)

Miltefosine (Impavido, Miltex) (Paladin, Canada) (CDC)

Niclosamide (Yomesan, Niclocide) (Bayer, Germany)

Nifurtimox (Lampit) (Bayer HealthCare) (CDC)

Nitazoxanide (Alinia) (Romark)

Paromomycin (generics) (Sun Pharma)

Pentamidine isethionate (Pentam 300, Nebupent) (APP Pharmaceuticals)

Permethrin (Nix [Insight Pharmaceuticals], Elimite [Prestium Pharma])

Polyhexamethylene biguanide (Baquacil) (Zeneca)

Praziquantel (Biltricide) (Bayer)

Primaquine phosphate (Sanofi-Aventis)

Propamidine isethionate (Brolene) (Aventis, Canada)

Pyrantel pamoate (Pin-X, Reese’s Pinworm Medicine) (Quartz Specialty Pharmaceuticals, Reese)

Pyrethrin with piperonyl butoxide (Rid) (Bayer, others)

Pyrimethamine (Daraprim) (Amedra)

Quinidine gluconate (generics)

Quinine sulfate or quinine dihydrochloride (many manufacturers)

Spiramycin (Rovamycine) (Sanofi-Aventis)

Stibogluconate sodium (Pentostam, Solustibosan) (GlaxoSmithKline) (CDC)

Suramin sodium (Germanin) (Bayer, Germany) (CDC)

Thiabendazole (Mintezol) (Merck)

Tinidazole (Tindamax) (Mission Pharmaceuticals)

Triclabendazole (Egaten) (Novartis)

APPENDIXES

APPENDIX 1 Information Tables

A1.1 Classification of human parasites

A1.2 Distribution of selected parasitic infections in the Americas

A1.3 Distribution of selected parasitic infections in Europe

A1.4 Distribution of selected parasitic infections in Africa

A1.5 Distribution of selected parasitic infections in Asia

A1.6 Distribution of selected parasitic infections in Oceania

A1.7 Cosmopolitan distribution of common parasitic infections (North America, Mexico, Central America, South America, Europe, Africa, Asia, and Oceania)

A1.8 Body sites and specimen collection

A1.9 Body sites and possible parasites recovered (trophozoites, cysts, oocysts, spores, adults, larvae, eggs, amastigotes, and trypomastigotes)

A1.10 Body site, specimen and procedures, recommended methods, relevant parasites, and comments

A1.11 Examination of tissue and body fluids

A1.12 Key characteristics of protozoa of the intestinal tract and urogenital system

A1.13 Key characteristics of tissue protozoa

A1.14 Key characteristics of helminths

A1.15 Key characteristics of most common parasites found in blood

A1.16 Diagnostic laboratory report information that should be relayed to the physician

A1.17 Pros and cons of stool specimen collection and testing options

A1.18 Approaches to stool parasitology: test ordering

A1.19 Pros and cons of ova and parasite examination options

A1.20 Laboratory test reports: optional comments

A1.21 Estimated prevalence of parasitic diseases worldwide

APPENDIX 2 Flowcharts and Staining Tables for Diagnostic Procedures

Flowcharts

A2.1 Procedure for processing fresh stool for the ova and parasite examination

A2.2 Procedure for processing liquid specimens for the ova and parasite examination

A2.3 Procedure for processing preserved stool for the ova and parasite examination by using the traditional two-vial collection kit

A2.4 Procedure for processing sodium acetate-acetic acid-formalin (SAF)-preserved stool for the ova and parasite examination

A2.5 Use of various fixatives and their recommended stains: fecal specimens preserved using polyvinyl alcohol (PVA)

A2.6 Use of various fixatives and their recommended stains: fecal specimens preserved in the Universal Fixative, TOTAL-FIX

Tables

A2.1 Steps in the trichrome staining procedure (mercuric chloride-based PVA-preserved stool specimens)

A2.2 Steps in the trichrome staining procedure (non-mercuric chloride-based PVA-preserved stool specimens)

A2.3 Steps in the iron hematoxylin staining procedure (mercuric chloride-based PVA-preserved stool specimens) (Spencer-Monroe method)

A2.4 Steps in the iron hematoxylin staining procedure (mercuric chloride-based PVA-preserved stool specimens) (Tompkins-Miller method)

A2.5 Steps in the iron hematoxylin staining procedure (incorporating the carbol fuchsin step)

A2.6 Steps in the trichrome staining procedure (Universal Fixative [no mercury, no formalin, no PVA])

A2.7 Oil-mounted permanent stained smears (no Permount is used)

A2.8 Tips on stool processing and staining

APPENDIX 3 Common Problems in Parasite Identification

Figures

A3.1–A3.26 Paired drawings of “look alikes”

A3.27 Relative sizes of helminth eggs

Tables

A3.1 Entamoeba spp. trophozoites versus macrophages

A3.2 Entamoeba spp. cysts versus polymorphonuclear leukocytes (PMNs)

A3.3 Entamoeba histocolytica versus Entamoeba coli precysts and cysts

A3.4 Endolimax nana versus Dientamoeba fragilis

A3.5 Adult nematodes and/or larvae found in stool specimens: size comparisons

APPENDIX 4 Quality Control Recording Sheets

A4.1 Diagnostic parasitology quality control (QC) (reagents)

A4.2 Diagnostic parasitology quality control (QC) (reagents)—example for multiple reagents

A4.3 Diagnostic parasitology quality control (QC) (culture)—example of a worksheet

A4.4 Equipment maintenance

APPENDIX 5 Commercial Supplies and Suppliers

Tables

A5.1 Sources of commercial reagents and supplies

A5.2 Addresses of suppliers listed in Table A5.1

A5.3 Sources of available reagents for immunodetection of parasitic organisms or antigens

A5.4 Addresses of suppliers listed in Table A5.3

A5.5 Commercial suppliers of diagnostic parasitology products

A5.6 Sources of additional teaching materials, including case histories

A5.7 Sources of parasitologic specimens

APPENDIX 6 Reference Sources

APPENDIX 7 “Late-Breaking” Published Information

APPENDIX 8 Molecular Panels for Parasitology

APPENDIX 9 Frequently Asked Questions about Diagnostic Parasitology

APPENDIX 10 Current Procedural Terminology (CPT) Codes in Parasitology

GLOSSARY

INDEX

Preface

During the past few years, the field of diagnostic medical parasitology has seen dramatic changes, including newly recognized parasites, emerging pathogens in new geographic areas, bioterrorism considerations and requirements, alternative techniques required by new regulatory requirements, reevaluation of diagnostic test options and ordering algorithms, continuing changes in the laboratory test menus, implementation of testing based on molecular techniques, reporting formats and report comments, coding and billing requirements, managed-care relevancy, increased need for consultation and educational initiatives for clients, and an overall increased awareness of parasitic infections from a worldwide perspective. We have seen organisms like the microsporidia change from the status of “unusual parasitic infection” to being widely recognized as among the most important infections in both immunocompetent and compromised patients. With confirmation of the fifth human malaria, Plasmodium knowlesi, this field has expanded dramatically. More sensitive diagnostic methods for organism detection in stool specimens are now commercially available for Entamoeba histolytica, Entamoeba histolytica/E. dispar, Giardia lamblia, Cryptosporidium spp., and Trichomonas vaginalis. Reagents are actively being developed for other organisms such as Dientamoeba fragilis, Blastocystis spp., and the microsporidia. We have seen Cyclospora cayetanensis coccidia become well recognized as the cause of diarrhea in immunocompetent and immunocompromised humans. We continue to see new disease presentations in compromised patients; a good example is granulomatous amebic encephalitis caused by Acanthamoeba spp., Sappinia diploidea, and Balamuthia mandrillaris. With the expansion of transplantation options, many parasites are potential threats to patients who are undergoing immunosuppression, and these must be considered within the context of this patient group. Transfusion transmission of potential parasitic pathogens continues to be problematic. Transfusion in general is becoming more widely recognized as a source of infection, and donors are also more likely to come from many parasite-endemic areas of the world. It is also important to recognize the many neglected parasitic infections seen within the United States; indeed, the world continues to shrink in terms of infectious diseases.