1. Interpretation of Medical Parasitology Laboratory

2. Color Range of Fresh Stool Specimens ColorPossible Cause BlackIron or bleeding in the bowel Dark BrownRange of normal colors BrownRange of normal colors Pale BrownRange of normal colors Reddish BrownPresence of blood, ingested material GreenishIngested material, rapid transit through the bowel ClayResidual barium, biliary obstruction Other (Blue, red, purple) Special medications Fecal Examination : Macroscopy

3. Terms Used for Macroscopic Exam of Stool ConsistencyReference HardCannot be punctured with an applicator stick FormedMaintains shape, can be punctured Semi-formedBottom side flattens in the container SoftCan be cut with an applicator stick MushyCan be reshaped with an applicator stick LooseStool shapes to the container DiarrheaStool will flow slowly out of the container WateryFluid-like stool pours out of the container Fecal Examination : Macroscopy

4. Fecal Examination : Microscopy

7. Classification of Worm Infestation by Using Egg Counts LightModerateHeavy Ascaris lumbricoides < 5.000 5.000 - 50.000 > 50.000 Trichuris trichuira < 1.000 1.000 – 10.000 > 10.000 Hook Worm < 2.000 2.000 – 7.000 > 7.000

8. Specimen TypeExamination TechniquePossible Parasites Cellophane Tape PrepDirect ExamEnterobius vermicularis Sigmoidoscopy MaterialDirect Exam Permanent Stain Entamoeba histolytica Intestinal Protozoa Cryptosporidium parvum Aspirates Duodenal Liver or Lung Abscess Liver or Lung Cyst Bronchoscopy Material Direct Exam Permanent Stain Direct Exam Permanent Stain Culture Direct Exam with KOH Centrifuged, Direct Exam Permanent Stain Giardia Iamblia Isospora belli Strongyloides stercoralis Cryptosporidium parvum Entamoeba histolytica Echinococcus species Pneumocystis carinii Toxoplasma gondii Cryptosporidium parvum SputumDirect Exam N-acetyl-cysteine concentrate Paragonimus westermani Strongyloides stercoralis Ascaris lumbercoides Hookworm Entamoeba histolytica Echinococcus species Parasitological Examination

9. Specimen TypeExamination TechniquePossible Parasites Mouth ScrapingsDirect Exam Permanent Stain Entamoeba gingivalis Trichomonas tenax Nasal DischargeDirect Exam Permanent Stain Naegleria fowleri Corneal ScrapingsCulture Calcofluor White Stain Histologic Processing Acanthamoeba species Tissue Biopsy Skin Ulcer Skin Snip Lymph Node Culture Histologic Processing Direct Exam Histologic Processing Leishmania species Onchocerca volvulus Mansonella streptocerca Leishmania species Trypanosoma species Toxoplasma gondii Parasitological Examination

10. Tissue Biopsy (continued) Bone Marrow Muscle Histologic Processing Permanent Stain Histologic Processing Leishmania species Trypanosoma species Toxoplasma gondii Trichinella spiralis UrineCentrifuged Direct ExamSchistosoma haematobium Microfilariae Trichomonas vaginalis Urethral DischargeDirect ExamTrichomonas vaginalis Vaginal DischargeDirect ExamTrichomonas vaginalis Prostatic SecretionsDirect ExamTrichomonas vaginalis BloodDirect Exam Permanent Stain Plasmodium species Babesia species Leishmania species Trypanosoma species Microfilariae Parasitological Examination

12. Malaria diagnosis Laboratory Dx Blood film (microscopic) Blood film (microscopic) – Gold standard – Sensitivity 40 parasites/μl PCR PCR – Sensitivity up to 4 parasites/μl RDT (Rapid Diagnostic Test) RDT (Rapid Diagnostic Test) – Dipstick – Antigen detection: »HRP-2 detection »pLDH Ag »Pan-malaria Ag – Sensitivity ±100 parasites/μl

13. Malaria diagnosis Calculation  Calculation and identification can both derived from thick and thin blood film  Asexual stages (rings, trophozoites, and schizonts) counted together  Sexual stage (gametocytes) counted separately

15. Malaria diagnosis Calculation 1. Semi quantitative: (-)no parasites in 100 fields (+)1-10 parasites in 100 fields (++)11-100 parasites in 100 fields (+++)1-10 parasites in 1 field (++++)>10 parasites in 1 field

16. Malaria diagnosis Calculation 2. Based on leucocytes count – Thick blood film – Number of parasites in ≥200 leucocytes – (n/200) x 8,000 parasites per μl blood – Hyperparasitemia: parasites ≥250,000 parasites per μl blood

17. Malaria diagnosis Calculation 3. Based on erythrocytes count – Thin blood smear – Number of parasites in ≥1000 erythrocytes (n/1,000) x 4,500,000 parasites per μl blood – Hyperparasitemia: parasites ≥5% or 50 parasites in 1,000 erytrocytes

18. Rapid Diagnosis

19. NegativePositive 1.2.3. Results.

20. THE END! Thank You