Demonstration of parasitic infection involved in the respiratory system

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Parasitic infection in respiratory system

Objectives

Pneumocystis jiroveci Paragonimus heterotremus Hydatid cyst of Echinococcus Egg of: - Ascaris lumbricoides Larva of: - Hookworm - Strongyloides stercoralis - Toxocara

Life cycle of Pneumocystis jireveci

Bogitsh BJ et al, 2005: p162

Pneumocystis jiroveci
Disease: PCP, Pneumocystis jiroveci pneumonia or Pneumocystis pneumonia

Cyst 4-8 um

toluidine blue

Pneumocystis jiroveci

- cyst Gomeri methenamine silver (GMS) - - - intracystic body

Morphology of Pneumocystis jireveci

Morphology of Pneumocystis jireveci

Pneumocystis jiroveci

- cyst (bronchoalveolar larvage, BAL) Giemsa - - 4-8 - intracystic bodies 1-8

Pathogenesis of PCP
Fibrosis in septal walls Bilateral-diffused

H&E staining of lung

Radiography by X-ray

biopsy or section

 Paragonimus spp.

Paragonimus spp.
Disease: Pulmonary paragonimiasis Extrapulmonary paragonimiasis

P. heterotremus

P. westermani

2 mm

Paragonimus spp. egg

P. heterotremus

P. westermani

+ NaOH

Pulmonary paragonimiasis

Pulmonary paragonimiasis

CT scan of a patient with paragonimiasis shows Chest roentgenogram of a patient with bilateral pleural effusions and thickening of the paragonimiasis shows bilateral pleural left pleura with possible cystic change (arrow). effusions and an infiltrate in the lower lobe of the left lung (arrow).

Clinical Microbiology Reviews, July 2009, p. 415-446, Vol. 22, No. 3

Pulmonary paragonimiasis

Extrapulmonary paragonimiasis

Life cycle of Echinococus spp.

Echinococcus spp.
Species
E. granulosus

Disease
cystic echinococcosis or unilocular hydatidosis

Host
dog

IH
herbivores

E. multilocularis alveolar or multilocular

echinococcosis

fox

rodent

E. vogeli & E. Oligarthrus

Polycystic echinococcosis

sylvatic animal

rodent

Morphology of Echinococcus spp.

E. multilocularis

E. granulosus

E. multilocularis

E. oligarthrus E. vogeli E. granulosus

Hydatid cyst of E. granulosus

Laminated membrane Germinal layes Laminated membrane

Germinal layes

Brood capsule
Protoscolices Brood capsule Protoscolices

Hydatid sand
Neva FA, & Brown HW, 1994

Hydatid capsule, inner surface,

isolated from lung of a Korean woman

inner surface,

Hydatid sand in human lung H&E, X100

A section of human lung shows multiple protoscoleces

Chest P-A. Hydatid cysts in human lung. Two mass shadows are indicated by arrows.

CT finding of hydatid cyst in human lung shows a distinct cyst wall and a clear fluid in the cyst .

Larva & Egg of Nematode

Ascaris lumbricoides Hookworm Strongyloides stercoralis Toxocara

Disease: Pneumonitis Lffler's syndrome (Eosinophilic pneumonia)

Ascaris lumbricoides
Disease: Ascariasis Ascaris pneumonitis

Ascaris pneumonitis

Pulmonary ascariasis from larval migration of A. lumbricoides

10-30 cm in length

Ascaris pneumonitis

Lffler's syndrome (Eosinophilic pneumonia)

Ascaris lumbricoides egg in stool

Charcot-Leyden crystal

Necator americanus & Ancylostoma duodenale

Life cycle of Necator americanus & Ancylostoma duodenale

Filariform larva of hookworm

Life cycle of Strongyloides stercoralis

Life cycle of Strongyloides stercoralis

cervical alae

Toxocara canis larva

anterior

http://www.dpd.cdc.gov/dpdx/html/imagelibrary/Toxocariasis_il .htm

posterior

Objectives

Pneumocystis jiroveci Paragonimus heterotremus Hydatid cyst of Echinococcus Larva of: - Ascaris lumbricoides - Hookworm - Strongyloides stercoralis - Toxocara

Lab performance
1. Demonstrate - 4 sets / Lab

2. Group Discussion

References
Wilkin A and Feinberg J. Pneumocystis carinii pneumonia: a clinical review. Am Fam Phys 1999;60:1699-1714. John G Bartlett and Stefano Vella. Textbook-Atlast of Intestinal Infections in AIDS Medrano FJ et al. "Pneumocystis jirovecii in General Population". Emerg Infect Dis 2005; 11 (2): 245250 Wazir JF, Ansari NA. Pneumocystis carinii infection. Update and review. Arch Pathol Lab Med 2004; 128:1023-7. Markell EK et al. Medical Parasitology. 1999 www.google.co.th(search image under scientific name/life cycle) www.google.co.th (search under scientific name/lecture, power point or review)

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