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Case Study in Parasitology


Case 4: geohelminths. 36-year old womanHistory of travel to Puerto RicoSubmitted routine stool specimen. Wet Mount Examination of the Concentrate from the Stool Specimen. Fertile (infective) Ascaris eggsbile stained thick, warty, albuminous coatthick transparent inner shell Crescent-shaped spa

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Case Study in Parasitology

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Case Study in Parasitology

温锦娣 0456208

3 November 2006


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Case 4: geohelminths

  • 36-year old woman

  • History of travel to Puerto Rico

  • Submitted routine stool specimen


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Wet Mount Examination of the Concentrate from the Stool Specimen

  • Fertile (infective) Ascaris eggs

    • bile stained

    • thick, warty, albuminous coat

    • thick transparent inner shell

    • Crescent-shaped spaces

    • 45~75 x 35~50 mm in length

  • Resistant: chemicals, temperature, pH, irradiation


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  • Infertile egg

    • elongated and larger than fertile egg

    • thin shelled

    • shell ranges from irregular mammillations to smooth

    • internal contents: a mass of disorganized, highly refractive granules

    • 85-95 mm x 43-47 mm


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Diagnosis

Disease Ascariasis

Transmission fecal-oral route (soil, water, foodborne)

Occurrence 1.5 billion (25%) infections worldwide

Detection direct microscopic observation


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Symptoms

  • Vague intestinal pain, nausea, diarrhea, malnutrition

  • Intestinal obstruction

  • Larva migrans: allergic hypersensitivity reactions such as asthmatic attacks, pulmonary infiltration and urticaria and oedema of the lips


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Wet Mount Examination of the Concentrate from the Stool Specimen

  • Trichuris trichiura (Whipworm)

    • characteristic opercular plugs at each end of the egg

    • Barrel-shaped

    • yellow-brown, thick smooth shell

    • 50-55 mm x 22-24 mm


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Diagnosis

Disease Trichuriasis

Transmission fecal-oral route (soil-borne, contaminated vegetables)

Diagnosis direct microscopic observation of the egg from stool specimen: smear, sedimentation


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Symptoms

  • Chronic dysentery, bloody stools

  • Iron-deficiency anemia

  • Rectal prolapse


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Wet Mount Examination of the Concentrate from the Stool Specimen

  • Enterobius vermicularis (Pinworm)

    • elongated and flattened on one side

    • thick colorless shell

    • 50-60 mm x 20-30 mm

  • Found in feces: unembryonated

  • Cellulose tape preparation: embryonated (infective)


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Diagnosis

Disease Enterobiasis

Transmission anal-oral route, airborne

Detection cellophane tape


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Symptoms

  • majority of infections are asymptomatic

  • irritation of the perianal region

  • Appendicitis

  • Pelvic inflammation


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Treatment

  • administration of an anti-helminthic drug

    • Mebendazole

    • Albendazole


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Association between Multiple Geohelminth Species Infection

  • Infection intensities of different species were positively correlated

  • Individuals with single-species infections had generally lower species-specific egg counts than individuals with multiple-species infections.


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Association between Multiple Geohelminth Species Infection

  • individuals with multiple species infections are likely to be at highest risk of geohelminth-related morbidity

    • number of infections they harbour

    • carry heavier infections of each species