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LAB ORATORY DIAGNOSIS OF PARASITIC DISEASES

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1 LAB ORATORY DIAGNOSIS OF PARASITIC DISEASES
DEPARTEMENT OF PARASITOLOGY FACULTY OF MEDICINE UNIVERSITAS PADJADJARAN

2 DIAGNOSIS FOR PARASITIC INFECTION
INTRODUCTION AN DIAGNOSIS FOR PARASITIC INFECTION Anamnesa – ( The history should include details of the presenting complaint ) Physical examination Laboratory examination espectially Parasitological diagnosis Imunodiagnosis

3 LABORATORY EXAMINATION
INTRODUCTION ANAMNESIS Fever Gastrointestinal symptoms Fever with respiratory system Neurological symptoms Fever and meningitis / Encephalitis Cutaneous symptoms CLINICAL FEATURES (Symptom and Sign) 1 SPESIFIC ASPESIFIC 2 PHYSICAL EXAMINATION 3 LABORATORY EXAMINATION

4 LABORATORY EXAMINATION
INTRODUCTION 3 LABORATORY EXAMINATION DEPEND ON : Habitat Parasite Parasite distribution TYPE OF SPECIMEN : Stool Blood Urine Sputum Vaginal discharge, urethral discharge Skin scrapings Liquor Cerebro Spinal Tissue biopsy Nasal discharge Corneal scrapings IMPORTANT Very important for examination Helminth parasite and Protozoa parasite Repeating of Laboratory examination occasionally be needed *Should be understood about examination technique,morphology of parasite and life cycle of parasite IMUNODIAGNOSIS 4

5 INTRODUCTION FECAL SPECIMENS Immediatelly have to examine :
Liquid specimens should be examined within 30 minute of passage Soft (semiformed) specimens 1 hour Formed specimens 24 hour after passage If this time is not possible, the specimen should be placed in one of the available fixatives : Formalin 10%, MIF (Merthiolate Iodine Formalin), PVA (Polyvinyl Alcohol) Generally Helminthic eggs more endure without preservation than intestinal protozoa

6 INTRODUCTION FECAL SPECIMENS
The specimens should not be contaminated with Water – because water may contain free-living organisms that can be mistaken for human parasites Urine – may destroy motile organisms Prior to examination , fecal specimens should never be incubated or frozen. A chatartic with an oil base should not be used, and a stool softener (taken either orally or as a suppository) is usually inadequate for obtaining a purged specimen.

7 INTRODUCTION FECAL SPECIMENS
Repeating fecal examination after therapy : Ascariasis, 2-3 weeks after therapy Protozoa infection, 3-4 weeks after therapy Taeniasis, 5-6 weeks after therapy

8 EXAMINATION OF HELMINTH PARASITE
SPECIMENS ( most important ) FECAL SPECIMENS & BLOOD AND TISSUE SPECIMENS

9 EXAMINATION OF HELMINTH PARASITE
FECAL SPECIMENS ? For examination of helminth egg Most important for examination intestinal nematode including “Soil Transmitted Helminths” : Ascaris lumbricoides Trichuris trichiura Hook worm : - Necator americanus and Ancylostoma duodenale Strongyloides stercoralis

10 EXAMINATION OF HELMINTH PARASITE
QUALITATIVE EXAMINATION EXAMINATION OF HELMINTH PARASITE FECAL SPECIMENS DIRECT WET SMEAR ANOTHER QUALITATIVE EXAMINATION AND QUANTITATIVE EXAMINATION TO BE STUDIED IN FECAL EXAMINATION

11 LABORATORY TECHNIQUE FOR EXAMINATION OF HELMINTH PARASITE

12 LABORATORY TECHNIQUE FOR EXAMINATION OF HELMINTH PARASITE
INTESTINAL HELMINTH FECAL SPECIMENS LABORATORY TECHNIQUE FOR EXAMINATION HELMINTH PARASITE BLOOD AND TISSUE HELMINTH BLOOD AND TISSUE HELMINTH Click “Esc” button When finished

13 EXAMINATION TECHNIQUE FOR HELMINTH PARASITE IN FAECES
*Consistency (hard,formed,soft,diarrhea) *Colour *Odor *Foreign bodies (blood, mucus,parasite) MACROSCOPIC EXAMINATION MICROSCOPIC EXAMINATION LABORATORY TECHNIQUE FOR EXAMINATION OF INTESTINAL HELMINTH QUALITATIVE QUANTITATIVE Click “Esc” button When finished

14 EXAMINATION TECHNIQUE OF INTESTINAL HELMINTH
MICROSCOPIC QUALITATIVE QUANTITATIVE DIRECT WET SMEAR METHOD FLOTATION METHOD MODIFICATION MERTHIOLATE IODINE FORMALDEHYDE (MIF) CELLOTAPE TAPE METHOD FORMALDEHYDE ETHER SEDIMENTATION (RITCHIE’S METHOD) METODA KATO STOLL DILLUTION METHOD KATO – KATZ CELLOPHANE THICK SMEAR METHOD Click “Esc” button When finished

15 DIRECT WET SMEAR METHOD
MICROSCOPIC QUALITATIVE DIRECT WET SMEAR METHOD Fast Severe infection Reagens NaCl Physiologis (0,9%), or Eosin 2% Click “Esc” button When finished

16 MICROSCOPIC QUALITATIVE
DIRECT WET SMEAR METHOD Place 2 mg faeces on microscope slide Emulsify 2 mg faeces in NaCl 0.9% drop Place 1-2 drops NaCl 0,9% or Eosin 2% on microscope slide 1-2 drops NaCl 0,9% or eosin 2% Place 2 mg faeces on microscope slide Click “Esc” button When finished

17 MICROSCOPIC QUALITATIVE
SALINE WET SMEAR METHOD Place 2 mg faeces on microscope slide Emulsify 2 mg faeces in NaCl 0,9% drop Emulsify 2mg faeces in the saline drop Place coverslip over suspension Examine using the lower power objective 10x or 40x 1-2 drops NaCl 0,9% Place coverslip over the suspension

18 WITHOUT CENTRIFUGATION
MICROSCOPIC QUALITATIVE FLOATATION METHOD Berdasarkan BJ telur < BJ larutan Berguna untuk infeksi ringan Larutan yang dipergunakan : NaCl jenuh, atau Gula jenuh FLOTATION METHOD WITHOUT CENTRIFUGATION WITH CENTRIFUGATION Click “Esc” button When finished

19 MICROSCOPIC QUALITATIVE FLOATATION METHOD
WITHOUT CENTRIFUGATION Ose 20 minutes Place coverslip over the solution NaCl saturated faeces stirring glass Take down 1-2 drops of Surface layer with Ose and Place on microscope slide 10 gr faeces mixed with 200 ml NaCl saturated until homogenous solution Take down 1-2 drops the surface layer with Ose Place coverslip over microcope slide 10 gr. faeces + 200 cc NaCl saturated Examine under low power objective

20 MICROSCOPIC QUALITATIVE FLOATATION METHOD
WITH CENTRIFUGATION filtered Centrifuge 100 rpm for 5 minutes NaCl saturated faeces Stirring glass Transfer 10 gr faeces and emulsify in 200 ml NaCl saturated until homogenous solution 10 gr. faeces + 200 cc NaCl saturated

21 Filtered with tea filter
MICROSCOPIC QUALITATIVE FLOATATION METHOD WITH CENTRIFUGATION filtered centrifuge 100 x/mnt 5 minutes NaCl saturated faeces stirring glass Filtered with tea filter 10 gr. faeces + 200 cc NaCl saturated

22 Decant into centrifuge tube
MICROSCOPIC QUALITATIVE FLOATATION METHOD WITH CENTRIFUGATION filtered centrifuge 100 rpm For 5 minutes NaCl saturated faeces stirring glass Decant into centrifuge tube 10 gr. faeces + 200 cc NaCl saturated

23 Centrifuge 100 rpm for 5 minutes
MICROSCOPIC QUALITATIVE FLOATATION METHOD WITH CENTRIFUGATION filtered centrifuge 100 rpm For 5 minutes NaCl saturated faeces Stirring glass Centrifuge 100 rpm for 5 minutes 10 gr.faeces + 200 cc NaCl saturated

24 Take down solution from surface layer with Ose
MICROSCOPIC QUALITATIVE FLOATATION METHOD WITH CENTRIFUGATION filtered Centrifuge 100 rpm For 5 minutes NaCl saturated faeces stirring glass Take down solution from surface layer with Ose 10 gr. faeces + 200 cc NaCl saturated

25 Examine under low power objective 10 x or 40 x.
MICROSCOPIC QUALITATIVE FLOATATION METHOD WITH CENTRIFUGATION Place the solution on microscope slide Place coverslip over microscope slide Place solution on microscope slide and Place coverslip over the microscope slide. Examine under low power objective 10 x or 40 x.

26 MERTIOLAT IODIN FORMALIN MODIFICATION (MIF MODIFICATION)
MICROSCOPIC QUALITATIVE MERTIOLAT IODIN FORMALIN MODIFICATION (MIF MODIFICATION) For identification eggs from intestinal helminth, Ameba and Giardia lamblia Solution 1 : 250 ml aquadest 200 ml thimerosal (1:1.000) 25 ml formalin 5 ml glycerin Solution 2 : Fresh lugol solution5%

27 MERTHIOLAT IODIN FORMALIN MODIFICATION (MIF MODIFICATION )
MICROSCOPIC QUALITATIVE MERTHIOLAT IODIN FORMALIN MODIFICATION (MIF MODIFICATION ) It’s good for staining and conservation of cyst of intestine protozoa and worm egg

28 MERTHIOLAT IODIN FORMALIN MODIFICATION (MIF MODIFICATION )
MICROSCOPIC QUALITATIVE MERTHIOLAT IODIN FORMALIN MODIFICATION (MIF MODIFICATION ) (+) 7 ml. ether (40 C) filtered Shake until homogenous centrifuge x/mnt 1 minutes Gelas pengaduk 5 ml base solution 1 0,5 ml base solution 2 0,5 gr faeces Add 7 ml ether (40 C) Open the tube, let it 2 minutes, centrifuge for 1 minutes ( rpm) shake until homogenous

29 MICROSCOPIC QUALITATIVE
MERTHIOLAT IODIN FORMALIN MODIFICATION (MIF MODIFICATION ) Place the sediment on microscope slide Place coverslip over microscope slide Throw away the supernatan, take sediment with pipette Examine under low power objective

30 MICROSCOPIC QUALITATIVE
CELLOTAPE METHOD The egg adhere on perianal area, so rarely found in faeces (5 %). To find this parasite we need Scotch Adhesive tape Swab from Graham or Cellotape Method

31 MICROSCOPIC QUALITATIVE
CELLOTAPE METHOD To examine the egg of Enterobius vermicularis Children 1-10 years old Doing in the morning before take a bath or wash the anus with water after defecating Transparent plastic plaster (2 x 1,5 cm)patched to skin around the anus Press the plaster, then lift slowly Patched to the object glass, examine under the microscope

32 MICROSCOPIC QUALITATIVE
CELLOTAPE METHOD

33 MICROSCOPIC QUALITATIVE
Concentration Method practical, simple, for ova examination in stool : 1 gr faeces, put into the reaction tube, add aquadest, mixed until homogenous, put imyo the centrifuge tube Centrifuge with velocity rpm for 1 mnt Throw away the supernatan, take the sediment with pipette Place the sediment on microscope slide, place coverslip on microscope slide

34 Shake until homogenous
MICROSCOPIC QUALITATIVE Concentration Method Put in faeces solution to the centrifuge tube Centrifuge x/mnt, 1 minutes Shake until homogenous 1 gr faeces Stirring glass Aquadest Throw away supernatan, take sediment with pipette

35 Place sediment on microscope slide Examine under the microscope
MICROSCOPIC QUALITATIVE Concentration Method place coverslip on microscope slide Place sediment on microscope slide Examine under the microscope

36 CELLOPHANE THICK SMEAR METHOD (KATO METHOD)
MICROSCOPIC QUALITATIVE CELLOPHANE THICK SMEAR METHOD (KATO METHOD) Practical, simple, and cheap Can be used in mass examination Examination needs more stool, so the eggs can be found much more Morphology of egg is clear

37 CELLOPHANE THICK SMEAR METHOD
MICROSCOPIC QUALITATIVE CELLOPHANE THICK SMEAR METHOD (KATO METHOD) Substance : Solution 100 ml aquadest/fenol 6% 100 ml glycerin (supaya kotoran tinja jadi jernih) 1 ml malachit green solution (supaya mata tidak silau) Cellophane tape, 2,5 x 3 cm, soak in solution for >24 hours

38 CELLOPHANE THICK SMEAR METHOD
MICROSCOPIC QUALITATIVE CELLOPHANE THICK SMEAR METHOD (KATO METHOD) Technique : Take mg faeces ( as large as red bean ) Put on object glass, spread out Cover with cellophane, pressing the faeces until flat and spread out under the cellophane Drain the excessive fluid with filter paper Let it minutes Examine under the microscope

39 CELLOPHANE THICK SMEAR METHOD
MICROSCOPIC QUALITATIVE CELLOPHANE THICK SMEAR METHOD (KATO METHOD) 100 part. Aquadest/fenol 6% 100 part. Glycerin 1 part Malachit green solution Cut the cellophane 2,5 x 3 cm Soaked > 24 hours Soaked cellophane faeces 20-50 gr faeces

40 MICROSCOPIC QUANTITATIVE
STOLL METHOD Solution used : NaOH 0,1 N (faeces solvent) or KOH 10% Good for severe and moderate infection Less good for mild infection

41 3-4 hours but shake it longer
MICROSCOPIC QUANTITATIVE STOLL METHOD faeces NaOH solution 0,1N 56 ml 60 ml Shake Let it 1 night or 3-4 hours but shake it longer

42 MICROSCOPIC QUANTITATIVE STOLL METHOD
Shake and take 0,15 ml

43 MICROSCOPIC QUANTITATIVE STOLL METHOD
Formula : amount of egg in 1 gram feces = amount of seen egg (miroscopic) x 100

44 MICROSCOPIC QUANTITATIVE STOLL METHOD
ENUMARATION NaOH = 56 ml, feces 4 ml ~ 4gr 4 gr feces in 60 ml or 1 gr feces in 15 ml In the 0.15 ml of stool solution, can be found y eggs So, in the 15 ml, is found y x 100 eggs(~ 1 gr stool)

45 AMOUNT OF EGG PER-GRAM FAECES
MICROSCOPIC QUANTITATIVE STOLL METHOD Infection level based on amount of egg in each gram feces and amount of helminth AMOUNT OF HELMINTH AMOUNT OF EGG PER-GRAM FAECES INFECTION LEVEL Infectid by MILD MODERATE SEVERE < 7.000 > A. lumbricoides 5 or less 6-25 > 25 MILD MODERATE SEVERE A. duodenale < 3.000 > 20 or less 21-100 > 100 MILD MODERATE SEVERE N. americanus < 2.000 > 7.000 50or less 51-200 > 200 SOURCE : PARASITIC DISEASES PROGRAME. WHO. GENEVA, 1981

46 MICROSCOPIC QUANTITATIVE
KATO-KATZ METHOD Tolls : Object glass cellotape, thick 40 m, size 3 x 3 cm Thick carton, make hole with fixed volume to print faeces as weight as 30 mg Palm leaf rib, oily papper, wire netting

47 MICROSCOPIC QUANTITATIVE
KATO-KATZ METHOD Malachite-Green solution : 100 ml aquadest 100 ml glycerin (in order to make the feces clear) 1 ml malachite green solution Soak the cellotape in solution for > 24 hours

48 MICROSCOPIC QUANTITATIVE KATO-KATZ METHOD
PRINTING FAECES MAKING PREPARAT FILTERING FAECES Put 5 gr faeces on the oily papper, put wire netting on it then press Put the holed carton on the object glass, print the filtered faeces on holed carton Lift the carton Cover the faeces with soaked cellotape Press, spread out Let it 30 mnt Examine under the microscope

49 MICROSCOPIC QUANTITATIVE
KATO-KATZ METHOD Printing faeces Making THE SPECIMEN Filtering faeces Object glass Holed carton Printed faeces EXAMINE UNDER THE MICROSCOPE Object glass Oily papper Wire netting press faeces (5 gr) Soaked cellotape Filtered faeces printed TEKAN Wire netting faeces (5 gr)

50 MICROSCOPIC QUANTITATIVE
KATO-KATZ METHOD WHO (1981) EGG PRODUCTION PER-DAY : A. lumbricoides : A. doudenale : N. americanus : WEIGHT OF FAECES PER-DAY Children : 70 gram Adult : 2 x children

51 FORMOL ETHER SEDIMENTATION METHOD
MICROSCOPIC QUALITATIVE FORMOL ETHER SEDIMENTATION METHOD (RITCHIE) (0,5 ml faeces) + (1-2 ml aquadest), shake, + (10-12 ml aquadest), shake Filter Centrifuge rpm, 1 mnt + (1 ml formalin 10%) + (formalin 10% sampai volume 8 ml), let it 10 mnt + (3ml ether), shake second Centrifuge rpm, 1-2 mnt Throw away the supernatan, place the sediment on microscope slide, examine under the microscope

52 FORMOL ETHER SEDIMENTATION METHOD
Saring MICROSCOPIC QUALITATIVE FORMOL ETHER SEDIMENTATION METHOD (RITCHIE) 0,5 ml. faeces 1-2 ml. aquadest 10-12 ml. aquadest filter centrifuge 1.000 rpm, 1 minute shake shake centrifuge rpm, 1 minute

53 MICROSCOPIC QUALITATIVE
FORMOL ETHER SEDIMENTATION METHOD (RITCHIE) 1 ml. Formalin 10% + Formalin 10% until volume 8 ml 3 ml. ether CENTRIFUGE 2.000 rpm, 1-2 minutes LET IT (10 minutes) SHAKE (15-20 seconds) + (1 ml formalin 10%) + (formalin 10% until volume 8 ml), let it 10 minutes Throw away the supernatan, place the sediment on microscope slide, examine under the microscope

54 CONSERVATION AND STORAGE METHOD
EGG AND ADULT WORM IN FAECES USING FORMALIN SOLUTION 3,5 % OR 4% Making formalin solution 3,5 % Or 4% : 1 part of formalin solution 35% or 40% mixed with 9 part of running water, then put into closed bottle Put the faeces into the bottle and closed tightly For organ that attacked by parasite, wash cleanly before put into the bottle

55 BLOOD AND TISSUE NEMATODE
(Blood specimens) Laboratory tecknique for examination of Filaria sp. DIRECT METHOD Blood taken of from finger tip Thin blood smear Qualitative Determine microfilariae in peripheral blood vessels Not for species identification Thick blood smear Quantitative Measured blood releasefrom finger tip with mikropipet (160 m), make thick blood smear. CONCENTRATION METHOD Take blood vein More sensitive than direct method Click “esc” button When finished

56 SUBJECT MATERIAL HOW TO EXAMINE AND INTERPRET INTESTINAL PROTOZOA
- Direct wet mount - Modified Merthiolate-Iodine -Formalin (MIF) HOW TO EXAMINE AND INTERPRET BLOOD PROTOZOA - Thin Blood smear with Giemsa staining - Thick Blood smear with Giemsa staining EXAMINATION FOR Trichomonas vaginalis HOW TO PREPARE PERMANENT (FIXED) MOUNT - Blood parasites - Trichomonas vaginalis - Ameba, using Heidenhein method and staining METHODS FOR PREPARING COLOR STAININGS

57 (1). Direct wet mount exam
LAB METHODS FOR INTESTINAL PROTOZOA (1). Direct wet mount exam Purpose : For quick and simple examination - For trophozoite form of ameba, use 2% eosin solution - For cyst and nucleus of amoeba use lugol solution (2% of Iodine + 3% potasssium Iodine)

58 (1). Direct wet mount examination
LAB METHODS FOR INTESTINAL PROTOZOA (1). Direct wet mount examination Preparation : Using a small stick, add small amount of feces on top of an object glass Add few drops of physiological saline solution NaCl/lugol/eosin 2% on top Distribute/spread evenly and cover with coverglass Examine under low power microscope

59 Purpose : LAB METHOD FOR INTESTINAL PROTOZOA
(2). Modified Method Merthiolate-Iodine-Formaline (MIF) Purpose : Good for diagnosis of Ameba and Giardia in feces Click “Esc”button When finished

60 LAB METHOD FOR INTESTINAL PROTOZOA
Modified Method Merthiolate-Iodine-Formaline (MIF) Ingredients used : Basic solution (1) : 250 ml aquadest 200 ml tincture of merthiolate 25 ml formaldehyde Basic solution (2) : lugol 5 % (not to be kept > 3 weeks) Both basic solutions should be kept in brown colored bottle Click “Esc”button When finished

61 CHARACTERISTIC OF FECES WITH AMEBA
MACROSCOPIC Acidic in character Foul smelling Produce less mucus compared to bacillary dysentery, less sticky With or without blood (blood may be found in solid feces) In some cases mucosal wall may come out

62 CHARACTERISTIC OF FECES WITH AMEBA
MACROSCOPIC Source :A Colour Atlas of Clinical Parasitology. Tomio Yamaguchi. Alih Bahasa : Lesmana Padmasutra, dkk. Feces of amebic dysenteric patient, plenty of trophozoite stage

63 CHARACTERISTICS OF FECES WITH AMEBA
MACROSCOPIC Source : Color Atlas of Medicine and Parasitology W. Peters & H.M. Gillers Feces of amebic dysenteric patient, loose, slimy and bloody feces

64 CHARACTERISTICS OF FECES WITH AMEBA
MICROSCOPIC Plenty of bacteria Entamoeba histolytica (+) containing erythrocytes Erythrocytes in reuleaux (chain) formation Charcot-Leyden crystals (unspecific for ameba dysentery, can be found also in other parasitic infection e.g. Strongyloides stercoralis) – from eosinophil desintegration Pus less abundant compared to bacillary dysentery, if no secondary infection Macrophages in bacillary dysentery mimics Entamoeba histolytica but nucleus and pseudopods differs Cyst found in carrier patients and cases with light infection

65 CHARACTERISTIC OF FECES WITH AMEBA
microscopic Charcot-Leyden crystals (From eosinophil desintegration) Source;Color Atlas of Medical Parasitology. Prayong Radomyos, dkk.

66 Purpose : Prepared in two stages :
EXAMINATION METHODS FOR BLOOD PROTOZOA Blood slides with Giemsa staining Purpose : For the examination of blood protozoa, e.g. : Plasmodium, Trypanosoma, Babesia etc. Prepared in two stages : (1). Prepare the blood smear (2). Do the color staining

67 EXAMINATION METHOD FOR BLOOD PROTOZOA
Blood slides with Giemsa staining Preparation of thin blood film Place blood slide in upright position, allow to dry, keep away from dust or small insects.

68 EXAMINATION METHOD FOR BLOOD PROTOZOA
Blood slides with Giemsa staining Staining procedure Wash slowly with tap water Fix with methyl alcohol (3-5) minutes Stain with standard Giemsa for 45 minutes ALLOW TO DRY

69 Purpose : Conducted in two stages :
EXAMINATION METHOD FOR BLOOD PROTOZOA Thick blood smear with Giemsa stain Purpose : Rapid examination of blood protozoa (for mass survey and screening ) Conducted in two stages : (1). Prepare thick blood film (2). Staining the blood film

70 Thick blood smear with Giemsa stain
EXAMINATION METHOD FOR BLOOD PROTOZOA Thick blood smear with Giemsa stain (1). Preparation of thick blood smear Blood is prepared similar to thin blood smear Place 1-2 drops of blood on a glass slide Spread evenly, forming a circle of 1 - 1,5 cm in diameter Allow to dry, keep away from dust or insect

71 Thick blood smear with Giemsa stain
EXAMINATION METHOD FOR BLOOD PROTOZOA Thick blood smear with Giemsa stain (2). Staining procedure Rinse slowly with tap water NO FIXATION !!! Stain with standard Giemsa for 45 minutes ALLOW TO DRY

72 COMPARISON OF THIN AND THICK BLOOD SMEAR
EXAMINATION METHOD FOR BLOOD PROTOZOA COMPARISON OF THIN AND THICK BLOOD SMEAR THIN BLOOD SMEAR Morphology and stages of Plasmodium clearly defined Erythrocytes are intact (due to fixation) Slow to prepare Used for examination of moderate and heavy infection THICK BLOOD SMEAR Morphology and stages of Plasmodium not clearly defined Erythrocytes are lysed, only stroma from erythrocytes are seen Preparation and staining are faster (can be used for mass survey examination) Commonly used for light infection

73 EXAMINATION OF Trichomonas vaginalis Methods of examination :
(1). Direct examination (2). Culture Direct method : (1). Direct wet mount (2). Staining

74 EXAMINATION OF Trichomonas vaginalis
Sample for examination : (1). Women : vaginal, or urethral discharge (using vaginal spiculum) (2). Men : discharge from urethra or prostate, and centrifugated urine sample

75 Examination for Trichomonas vaginalis
DIRECT EXAMINATION Cotton bulb Glucose 5% Materials used : Test tube containing 5% glucose (in physiological saline solution) - Cotton bulb

76 Terima kasih atas perhatiannya ......
April 2005


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