Prepared By Mr Raed Z Ahmed Medical Parasitology

Prepared By: Mr. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Protozoa in wet mount A. Saline wet mount: • In saline wet mount, trophozoites and cyst of amoeba, flagellates and ciliate may be seen. • Cyst will appear as round or oval, refractile structure. • Trophozoite of amoeba may be round or irregular, but trophozoite of flagellate are usually pyriform (elongated, pear- shaped). • In freshly passed feces (the stool must not be more than 1 hour old), motile trophozoites may be seen. • Motility can be seen very helpful in identifying species, especially in case of flagellates. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Continue ……. • Organism may be detected with the low power (10 x) objective, but a high power (40 x) dry objective will be necessary to identify reliable the structure as a cyst or trophozoite. • With the high power dry objective, you can see motility, inclusions like erythrocytes and yeast in amoebic trophozoites, chromatoid bodies in amoebic cyst. • Also, we can see the shape and structural detail (sucking discs, spiral grooves, or filaments) of flagellate trophozoites and cysts. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Continue ……. • However, it’s necessary to regulate carefully the microscope illumination so that the objects appear clearly. • Too much or too little light will interfere with your observations. • It’s also necessary to focus up and down to see all the layer of the specimen. • Remember to examine the whole coverslip area in a systematic manner to reduce the chances of overlooking organisms. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Continue ……. B. Iodine wet mount: • Iodine wet mount are examined for amoebic and flagellate cysts but not trophozoites because it’s killed by iodine. • In the iodine wet mount, cytoplasm of the cyst will stain yellow or light brown, and nuclei will stain dark brown. • Cyst stained with iodine can be detected with 10 x objective, but they are not refractile as in saline mount. 40 x used to see the characteristics of the cysts. • In iodine stained cysts of Entamoeba, the arrangement of peripheral chromatin and the position of karyosome can be seen. If the peripheral chromatin isn’t present, the cyst is not an Entamoeba spp. These peripheral chromatin bodies stain light yellow. • Sometimes, young cysts contain glycogen, this stains dark brown with iodine. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Continue ……. q Buffered Methylene Blue wet mount: • If you see amoebic trophozoites, or structures that resemble trophozoites, you should prepare and examine BMB mount. • After 5 -10 minutes of staining, the trophozoite sometimes remain motile, but often curl up in BMB preparation. For that do not confuse curled trophozoites with cysts do not stain with BMB solution. • In the trophozoites, the nucleus and inclusion (RBC, yeast) will stain dark blue while the cytoplasm will stain light blue. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Continue ……. • Occasionally, some trophozoite will not stain, so you should look for well- stained organisms. • Look for peripheral nuclear granules (granules in membrane around the nucleus), if these are present, the trophozoite is an Entamoeba ssp. and you must identify the species. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Helminthes in wet mount • Eggs may be easily detected and identified in saline mounts. • They should not be stained (stains may interfere with identification). • Most eggs are large enough to be recognized with the low power (10 x) objective, but a few small eggs will require a high power dry lens (40 x) objective. • In saline mounts, larvae may be present, and it’s easily recognized with 10 x objective. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Continue ……. • In saline mounts, larvae of Strongyloides stercoralis may be seen, but Hookworm larvae are not usually present if the sample is fresh. • If the sample is old and contain Hookworm infection, then larvae may be present. • SO, it may be necessary to distinguish between these two species. ACTIVITY FIND THE WAYS TO DIFFERENTIATE BETWEEN SPECIES IN OLD SAMPLES. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Liver Flukes Fasciola spp. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Life cycle Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Fasciola hepatica • Fasciola hepatica lives in the liver of man. • Fasciola spp. have many stages: • Oval eggs have miracidium, cercaria, metcercaria, larvae and adult stage. • Intermediate host: Snail. • Definitive host: Sheep. • Infective stage (human): Metacercaria. • Human infected by ingestion metacercaria from infected sheep. • Diagnosis: – Stool analysis to find Fasciola egg. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Fasciola hepatica Egg Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Fasciola hepatica Miracidium Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Fasciola hepatica cercariae Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Fasciola hepatica rediae larvae Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Fasciola hepatica Adult Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Blood Flukes Schistosoma spp. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Life cycle Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Schistosoma spp. • Also known as bilharzia, cause schistosomiasis or bilhariziasis. • Schistosoma spp. have 4 stages: – Eggs, miracidia, cercaria, and adult stage. • Eggs are passed through urine or feces to fresh water, where larvae stage can infect a new host by penetrating the skin. • Schistosoma eggs are non- operculated but spined and have miracidum. Eggs hatch and release miracidia in water. • Miracidia move in water looking for a special snail, and penetrate a snail tissue and developed to sporocyst. • Cercaria releasaed by snail into water and free swimming, cercaria has a bifid tail and penetrate intact skin • Cercaria lose tail during penetration and become schitosomulae, that circulate in the blood and migrate to portal blood of liver and mature into adult. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Schistosoma spp. (cont…. ) • There are three medically important species: – Schistosoma mansoni, lives in the mesenteric venules of large intestine, and cause intestinal bilharziasis. – Schistosoma japonicum, lives in the mesenteric venules of small intestine. – Schistosoma haematobium, lives in the venous plexus of the urinary bladder and cause schistosomal hematuria or urinary bilhariziasis. • S. mansoni and S. japonicum are produce their eggs in stool, but S. haematobium produce eggs in urine. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Schistosoma spp. (cont…. ) • Intermediate host: snail. • Definitive host: human. • Cercaria is the infective stage but eggs are the diagnostic stage. • Diagnosis: § Depends on finding the characteristic ova in feces or urine. § Three species can be distinguished by the appearance of their eggs under microscope: • S. mansoni eggs have prominent lateral spine. • S. japonicum eggs have a very small round lateral spine. • S. Haematobium eggs have a terminal spine. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Snail for Schistosoma spp. Schistosome species Snails S. haematobium Bulinus spp. S. mansoni Biomphalaria spp. S. japonicum Oncomelania spp. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Snail Biomphalaria spp. Oncomelania spp. Bulinus spp. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Schistosoma spp. Eggs S. mansoni S. haematobium S. japonicum Lateral spine Terminal spine Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013 Rounded spine

Schistosoma miracidium Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Schistosoma cercaria Oval head Bifid tail Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Schistosoma adult male Adult male short, thick and have Gynaecophoric canal Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Schistosoma adult female Adult female longer and thinner than adult male. Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013

Gynaecophoric canal Raed Z. Ahmed, Medical Parasitology Lab. , 2012 -2013