review questions

review
questions

INSTRUCTIONS Each of the questions or incomplete statements that follows is comprised of four
suggested responses. Select the best answer or completion statement in each case.

1. Enterobius vermicularis infection is usually 4. For which organism is the trophozoite the
diagnosed by finding infective stage for humans?
A. Eggs in perianal specimens A. Endolimax nana
B. Larvae in a stool specimen B. Dientamoeba fragilis
C. Adults in feces C. Entamoeba coli
D. Eggs in the feces D. Giardia duodenalis
2. Which organism infects humans by larval 5. The primary diagnostic specimen for de-
penetration? tecting infection with Naegleria fowleri is a:
A. Enterobius vermicularis A. Thick blood smear
B. Ascaris lumbricoides B. Corneal scraping
C. Necator americanus C. Cerebrospinal fluid sediment
D. Trichuris trichiura D. Skin biopsy
3. Which statement is correct for specimen 6. The host in which sexual reproduction
collection and processing? takes place is called the
A. Stool samples can contain urine. A. Commensal
B. Stools can be frozen without affecting B. Definitive host
parasitic structure. C. Intermediate host
C. Liquid stools are best for detecting D. Vector
ameba and flagellate trophozoites.
D. Unpreserved stools can remain at room
temperature for up to 72 hours.

807
808 ■ CHAPTER 8: PARASITOLOGY

7. The presence of ingested red blood cells 11. A 48-year-old male developed fever and
may be seen in the trophozoite of which weakness 16 days after a safari in northwest
organism? Tanzania. After about 8 days, the patient
A. Giardia duodenalis had a temperature of 38.9°C (102°F), and
B. Entamoeba coli right-sid, anterior cervical lymphadenopa-
C. Dientamoeba fragilis thy. Cerebrospinal fluid contained 12 red
D. Entamoeba histolytica blood cells and 18 mononuclear cells/mL
8. Which of the following is a characteristic and a normal protein level (32 mg/dL).
used in identification of Iodamoeba bütschlii Laboratory tests of peripheral blood
cysts? revealed a hemoglobin level of 12.7 g/dL,
A. A well-defined glycogen mass a white cell count of 2.4 * 109 >L, and a
B. Blunt chromatoidal bars platelet count of 75 * 109 >L. The periph-
C. Four nuclei with large karyosomes eral blood smear demonstrated an extra-
D. Many ingested bacteria erythrocytic, flagellated organism about
18 um long with a prominent nucleus,
9. Which of the following is the most im- and faintly staining undulating membrane.
portant feature in differentiating cysts of Which of the following is the most prob-
Entamoeba histolytica from Entamoeba dispar? able etiologic agent of this infection?
A. Number of nuclei A. Leishmania donovani
B. Size of the cyst B. Trypanosoma brucei
C. Shape and location of the karyosome C. Trypanosoma cruzi
and peripheral chromatin D. Brugia malayi
D. Distinguishing surface antigens by im-
munologic assays 12. Which species of malaria parasite usually
has ameboid trophozoites and produces
10. An egg was found in an iodine wet mount small reddish dots in the red blood cell
of a fecal concentrate. The egg was oval, cytoplasm?
thin shelled, and approximately 55 mm in A. Plasmodium knowlesi
length. The interior showed an embryo in
B. Plasmodium falciparum
the four-cell stage of development. The
C. Plasmodium malariae
most likely identification is:
D. Plasmodium vivax
A. Strongyloides stercoralis
B. Trichuris trichiura 13. Which of the following procedures should
C. Hookworm be used for the accurate, specific diagnosis
D. Enterobius vermicularis of an intestinal amebic infection?
A. Direct saline wet mount
B. Iodine wet mount of concentrated sedi-
ment
C. Permanently stained smear
D. Formalin-ethyl acetate sedimentation
technique
 REVIEW QUESTIONS ■ 809

14. In an examination of stained blood films, 19. Elephantiasis is a complication associated

Babesia spp. are likely to resemble with which of the following?
A. Leishmania donovani A. Cysticercosis
B. Plasmodium falciparum B. Guinea worm infection
C. Toxoplasma gondii C. Hydatid cyst disease
D. Trypanosoma cruzi D. Filariasis
15. Which of the following is a mercury- 20. A patient with history of human immuno-
containing fixative used to preserve para- deficiency virus infection presents with an
sites in stool specimens? 8-day history of diarrhea and weight loss.
A. Formalin A series of stool specimens is collected
B. Sodium acetate and examined for the presence of ova and
C. Buffered glycerol parasites. An acid-fast stain on direct smear
D. Polyvinyl alcohol reveals pink-stained round structures ap-
16. Examination of a fecal smear following proximately 4 mm in diameter. The most
acid-fast staining reveals round acid-fast- likely pathogen is
positive structures 8–10 mm in diameter. A. Blastocystis hominis
You should suspect what organism? B. Cryptosporidium sp.
A. Cryptosporidium C. Cyclospora sp.
B. Cyclospora D. Microsporidium
C. Cystoisospora 21. A 55-year-old female presents to her physi-
D. Microsporidia cian complaining of a fever that “comes
17. A 22-year-old male presents to his family and goes” and fatigue. A complete blood
physician complaining of fatigue, muscle count reveals decreased red blood cell
pain, periorbital edema, and fever. The count and hemoglobin. There are small,
complete blood count revealed a slightly delicate intracellular ring forms seen on the
elevated white blood count, and 45% eo- peripheral blood smear. History reveals no
sinophilia on the differential. Which of the travel outside the United States. She had
following conditions should be considered been backpacking along the Appalachian
part of the differential diagnosis? Trail and into the Northeast. You should
A. Hydatid cyst disease suspect what condition?
B. Chaga’s disease A. Trypanosomiasis
C. Trichinosis B. Babesiosis
D. Cysticercosis C. Malaria
D. Filariasis
18. An egg measuring 110 mm with a large lat-
eral projection was observed in an iodine 22. Keratitis is often caused by which of these
wet mount of a stool specimen. What is the organisms?
most likely identification? A. Naegleria fowleri
A. Schistosoma haematobium B. Acanthamoeba sp.
B. Fasciolopsis buski C. Loa loa
C. Chistosoma mansoni D. Onchocera volvulus
D. Paragonimus westermani
810 ■ CHAPTER 8: PARASITOLOGY

23. Which of the following would describe the 29. Humans develop cysticercosis by:
appearance of microsporidia in a modified A. Ingesting eggs of Taenia solium
trichrome stain? B. Eating raw meat containing oocysts of
A. Purple spheres, 10–15 mm in diameter Toxoplasma gondii
B. Pink ovals, 1–3 mm in diameter C. Skin penetration by larva of Strongyloides
C. Blue ovals, 4–6 mm in diameter stercoralis
D. Fluorescent spheres, 8–12 mm in diameter D. Ingesting metacercaria of Fasciola hepatica
24. An iodine wet mount from a formalin 30. Which of the following organisms pro-
concentrate of a stool would most likely duces an elongated, barrel-shaped egg
demonstrate which of the following? 1 50 * 22 μm 2 with a colorless polar plug
A. Mature cyst of E. coli at each end?
B. Immature cyst of Dientamoeba fragilis A. Ascaris lumbricoides
C. Trophozoite stage of Endolimax nana B. Hymenolepis nana
D. Oocyst of Cryptosporidium sp. C. Necator americanus
25. Serologic testing is the primary method of D. Trichuris trichiura
diagnosing infection with which organism? 31. Which of the following Plasmodium spp, is
A. Schistosoma japonicum associated with the presence of an intracel-
B. Cyclospora cayetanensis lular crescent-shaped gametocyte?
C. Naegleria fowleri A. P. falciparum
D. Toxoplasma gondii B. P. malariae
26. Pneumonia-like complications due to larval C. P. ovale
migration through the lungs is most likely as- D. P. vivax
sociated with infection by which organism? 32. Which organism below would routinely be
A. Hookworm considered a nonpathogen?
B. Schistosoma japonicum A. Endolimax nana
C. Strongyloides stercoralis B. Entamoeba histolytica
D. Ascaris lumbricoides C. Giardia duodenalis
27. Infection with which organism may result D. Dientamoeba fragilis
in vitamin B12 deficiency and megaloblastic 33. Which of these organisms is characterized
anemia? by a uninuclear trophozoite?
A. Diphyllobothrium latum A. Balantidium coli
B. Hookworm B. Giardia duodenalis
C. Hymenolepis diminuta C. Dientamoeba fragilis
D. Taenia saginata D. Chilomastix mesnili
28. Knowledge of nocturnal or diurnal period-
icity is especially important in the diagnosis
of infections caused by:
A. Babesia
B. Plasmodium
C. Microfilariae
D. Trypanosomes
 REVIEW QUESTIONS ■ 811

34. A physician suspects that a 10-year-old boy 39. An iodine-stained fecal wet mount dem-
has contracted primary amebic meningo- onstrates a round structure that is 25 mm
encephalitis. What clinical history would in diameter with a homogenously stained
support this diagnosis? central body surrounded by a thin ring of
A. Swimming in warm stagnant water cytoplasm containing a number of nuclei.
B. Leukemia with chemotherapy This best describes which organism?
C. Hiking in the desert of Southwest A. Blastocystis hominis
United States B. Endolimax nana
D. Visits to Massachusetts and the North- C. Entamoeba dispar
east D. Iodamoeba bütschlii
35. Which of these diseases would least likely 40. An egg 38 mm in diameter with a thick
to be associated with poor sanitation and shell containing radial striations and several
transmission by fecally contaminated water hooklets is seen in a wet mount of a fecal
or food? specimen. What is the most likely identifi-
A. Amebiasis cation of the egg?
B. Ascariasis A. Hymenolepis nana
C. Filariasis B. Taenia sp.
D. Giardiasis C. Schistosoma japonicum
36. Which stage of Taenia saginata is usually D. Hymenolepis diminuta
infective for humans? 41. Which of the following descriptions would
A. Cysticercus larva be associated with a life cycle stage of
B. Embryonated egg Plasmodium malariae?
C. Filariform larva A. Banana-shaped organism in a normal
D. Rhabditiform larva size red blood cell
37. An amebic cyst was seen in an iodine wet B. Compact organism with dark pigment
mount. It is round, approximately 12–15 mm in an enlarged, red blood cell with fim-
and has three visible nuclei with fine uni- briated edges
form granules of peripheral chromatin and C. 18 merozoites in an enlarged red blood
small, central karyosomes. Name the most cell with pink dots in the cytoplasm
likely organism. D. 6 merozoites in a daisy petal arrange-
A. Endolimax nana ment in a normal-sized red blood cell
B. Entamoeba coli 42. Which of the following nuclear characteris-
C. Giardia duodenalis tics are associated with Entamoeba coli?
D. Entamoeba histolytica A. No peripheral chromatin; large karyo-
38. Which stage of Trichuris trichiura is infective some
for humans? B. No peripheral chromatin; irregular
A. Proglottid clump of four to eight chromatin gran-
B. Filariform larva ules
C. Rhabditiform larva C. Coarse, uneven peripheral chromatin;
D. Embryonated egg large eccentric karyosome
D. Fine, even peripheral chromatin; small
central karyosome
812 ■ CHAPTER 8: PARASITOLOGY

43. What is the primary diagnostic stage for 47. Which of the following pairs of helminths
Strongyloides stercoralis? cannot be reliably differentiated by the ap-
A. Adult female in duodenal aspirate pearance of their eggs?
B. Egg in stool specimen A. Ascaris lumbricoides and Fasciola hepatica
C. Rhabditiform larva in stool specimen B. Hymenolepis nana and H. diminuta
feces C. Necator americanus and Ancylostoma
D. Filariform larva in stool specimen or duodenale
sputum D. Diphyllobothrium latum and Paragonimus
44. Which species of Plasmodium is character- westermani
ized by a trophozoite, with dark coarse 48. Oval eggs with a thin shell, flattened side,
pigment, stretching across a normal-sized and containing a curved larva were found
infected red blood cell? in a first-morning urine from a 6-year-old
A. P. falciparum child. They measured approximately 52 mm
B. P. ovale in length. What is the most likely identifica-
C. P. malariae tion?
D. P. cynomolgi A. Hookworm
45. A Giemsa-stained thin blood film showed B. Enterobius vermicularis
many small, delicate intracellular ring C. Schistosoma haematobium
forms, and a number of the rings had D. Infertile Ascaris lumbricoides
double chromatin dots. These findings are 49. Hematuria is a typical sign associated with
characteristic of: infection by:
A. Plasmodium falciparum A. Trypanosoma cruzi
B. Plasmodium vivax B. Trichinella spiralis
C. Plasmodium malariae C. Trichomonas vaginalis
D. Plasmodium ovale D. Schistosoma haematobium
46. Unembryonated eggs with an inconspicu- 50. Which of the following is the vector for
ous operculum, small knob on the end Babesia?
opposite the operculum and a size ranging A. Fleas
from 65 to 75 mm were seen in the stool of B. Lice
a patient who had extensive travel overseas C. Ticks
and often ate raw fish. What is the most D. Mosquitoes
likely identification?
A. Fasciola hepatica
B. Diphyllobothrium latum
C. Paragonimus westermani
D. Clonorchis sinensis
 REVIEW QUESTIONS ■ 813

51. An 8-year-old child from Guatemala was 55. Refer to Color Plate 38■. This is a photo-
seen in the public health clinic. The mother micrograph of a trichrome stain from a fe-
said he was always tired and had difficulty cal smear. The magnification is 1000*. The
breathing when playing. He had low he- parasite is approximately 20 mm long and
moglobin, and examination of a peripheral 15 mm wide. This is most likely the tropho-
blood smear showed the presence of an zoite of what organism?
extracellular organism about 18 mm long A. Chilomastix mesnili
with an anterior flagellum and prominent B. Giardia duodenalis
nucleus. The organism seen is most likely: C. Trichomonas hominis
A. Trypanosoma brucei D. Dientamoeba fragilis
B. Trypanosoma cruzi 56. Refer to Color Plate 39■. This is a pho-
C. Leishmania braziliensis tomicrograph of a trichrome stain from a
D. Dracunculus medinensis fecal smear. The magnification is 1000*.
52. Which of the following is the preferred The parasite is approximately 12 mm in
anticoagulant for preparing blood smears diameter. What is the identification of this
for diagnosing malaria? parasite?
A. EDTA A. Iodamoeba butschlii
B. Heparin B. Entamoeba hartmani
C. Sodium citrate C. Dientamoeba fragilis
D. Sodium fluoride D. Endolimax nana
53. Refer to Color Plate 36■. This is a photo- 57. Refer to Color Plate 40■. This is a photo-
micrograph of a peripheral blood smear micrograph of an iodine wet-mount from
from an individual who had recently trav- a fecal sample. The magnification is 1000*.
eled to Africa. She complained of recurring The parasite is approximately 25 mm in
fevers and chills; magnification is 1000*. diameter. What is the identification of this
What is the most likely identification? cyst?
A. Plasmodium malariae A. Entamoeba histolytica
B. Plasmodium ovale B. Entamoeba hartmanni
C. Plasmodium knowlesi C. Entamoeba coli
D. Plasmodium vivax D. Entamoeba dispar
54. Refer to Color Plate 37■. This is a photo- 58. Refer to Color Plate 41■. This is a photo-
micrograph of an iodine wet prep made micrograph of a trichrome stained fecal
from a stool sample; magnification is 400*. smear. The magnification is 1000*. The or-
The ovum is about 70 * 50 μm. What is ganism is approximately 11 * 9 mm. What
the identification of the parasite? is the identification of this parasite?
A. Hookworm A. Giardia duodenalis cyst
B. Enterobius vermicularis B. Dientamoeba fragilis trophozoite
C. Trichuris trichiura C. Endolimax nana cyst
D. Ascaris lumbricoides D. Entamoeba hartmanni cyst
814 ■ CHAPTER 8: PARASITOLOGY

59. Refer to Color Plate 42■. This is a pho- 60. Refer to Color Plate 43■. This is a photo-
tomicrograph of a trichrome stain from a micrograph of a blood smear stained with
fecal smear. The magnification is 1000*. Wright’s stain. Identify the parasite.
The parasite is approximately 15 mm in A. Babesia sp.
diameter. What is the identification of this B. Plasmodium malariae
parasite? C. Plasmodium falciparum
A. Entamoeba hartmanni D. Plasmodium vivax
B. Dientamoeba fragilis
C. Iodamoeba bütschlii
D. Blastocystis hominis
 &

answers & rationales

answers
rationales

1. specimens can damage parasite morphology,

as does freezing. Unpreserved stool specimens
A. Because the eggs of E. vermicularis are usu-
should only be left at room temperature up to
ally deposited on the perianal area, cellulose tape
a couple of hours before examining or placing
slides (or sticky paddles) are recommended for
into a preservative.
collecting the eggs. Recovery is best if speci-
mens are collected late in the evening or before
bathing or defecating in the morning. The gravid 4.
female worms usually migrate at night to the
B. Cysts are the infective stage of most intesti-
perianal region to deposit eggs. Because their
nal protozoa. However, D. fragilis does not have
migration is sporadic, several consecutive collec-
a cyst stage, and the trophozoite is considered
tions may be necessary to detect the infection.
the infective stage.

2.
5.
C. Humans becomes infected with Ascaris
C. N. fowleri is the causative agent of primary
lumbricoides, Enterobius vermicularis, and Trichuris
amebic meningoencephalitis. Therefore, the
trichiura by ingesting the egg. Necator americanus
cerebrospinal fluid sediment would be the pri-
(hookworm) infects humans when the skin is
mary specimen used to look for the trophozo-
penetrated by the filariform larva. The larva
ite. Corneal scrapings and skin biopsy may be
migrates through the blood stream and eventu-
used for diagnosing infection with Acantham-
ally matures into an adult in the intestine.
oeba sp. Blood smears would be used for stages
of organisms such as those causing malaria.
3.
C. Fresh liquid stools are more likely to con-
tain motile protozoan trophozoites that can be
detected in saline wet mounts. Urine in stool

815
 816 ■ CHAPTER 8: PARASITOLOGY

6. C-shaped larva. Eggs of Strongyloides may resemble

those of hookworm; however, they are not rou-
answers & rationales

B. In parasites with a sexual and asexual stage of

tinely found in the feces. T. trichiura eggs are barrel
development, the definitive host is the host in which
shaped with polar plugs.
the sexual stage of the parasite occurs. The interme-
diate host is the host in which the asexual stage of
the parasite is found. Vectors are arthropods, like 11.
mosquitoes and ticks that transmit infectious agents.
B. The symptoms and history for this patient are
A commensal is an organism that benefits from an
compatible with trypanosomiasis (African sleep-
existence with a host but does not damage the host.
ing sickness) caused by T. brucei. The trypomasti-
gote form of the parasite was found in peripheral
7. blood smears from this patient. Another key clini-
cal sign is the presence of swollen lymph nodes
D. E. histolytica is a pathogenic organism charac-
at the posterior base of the neck, known as Win-
terized by its ability to ingest red blood cells. No
terbottom’s sign. T. cruzi is the cause of American
other intestinal amoebae or flagellates shares this
trypanosomiasis. B. malayi infection would dem-
characteristic. Giardia and Dientamoeba are also
onstrate presence of a microfilaria in the blood.
considered pathogens; Entamoeba coli is considered
Leishmania spp. would be seen as intracellular
a nonpathogen.
amastigotes in skin or other organs.

8.
12.
A. Mature cysts of I. bütschlii are usually ovoid, with
D. The trophozoites of P. vivax are described as
a single nucleus with a large eccentric karyosome.
ameboid and may have large vacuoles; infected red
The cytoplasm contains a compact mass of glyco-
blood cells (RBCs) contain small pink dots called
gen, which appears as a clear, well-defined area in
Shüffner’s dots. P. malariae cytoplasm is much
unstained or permanently stained preparations but
more compact, and infected RBCs lack Shüff-
stains dark brown with iodine. Chromatoidal bars
ner’s dots. P. ovale resembles P. vivax. Shüffner’s
are not present. Ingested bacteria are often seen in
dots are generally found in P. vivax and P. ovale-
the cytoplasm of trophozoites.
infected RBCs; however, P. ovale-infected RBCs
have fimbriated edges. Growing trophozoites of
9. P. falciparum seen in the peripheral blood remain in
the ring form, and infected RBCs lack malarial pig-
D. E. histolytica and E. dispar cannot be morphologically ment. P. knowlesi is rarely a human pathogen.
differentiated. The cyst stage of both organisms has
four nuclei with a centrally located karyosome and fine,
evenly distributed peripheral chromatin. E. histolytica is 13.
a well-recognized intestinal parasite, whereas E. dispar
C. The permanently stained smear is especially
is considered nonpathogenic. Immunologic assays to
recommended for identification of trophozoites,
detect antigens or molecular biology assays are neces-
for confirmation of species, and for keeping a per-
sary to differentiate these two species.
manent record of the organisms found. Species
identification of amebic trophozoites can rarely
10. be made from a single feature; permanent stains
enable one to observe the cytoplasm, cytoplasmic
C. The characteristics describe an egg of hook-
inclusions, and the nuclear morphologic features
worm. Although E. vermicularis also has a thin shell,
of many cells. Iron hematoxylin and trichrome are
it is flattened on one side and usually contains a
commonly used stains.
 ANSWERS & RATIONALES ■ 817

14. 18.

answers & rationales

B. Babesia spp. are sporozoan parasites of RBCs C. Ova of Schistosoma spp. contain a spine.
that have been recognized as causing febrile illness S. haematobium ova have a prominent spine on one
in humans. B. microti has caused a number of tick- end. S. mansoni eggs have a prominent lateral spine,
borne infections in the United States. The parasites whereas the spine of S. japonicum is small and incon-
often appear as small rings within infected RBCs, spicuous. S. mekongi is a rare human pathogen.
resembling P. falciparum trophozoites. The patho-
gnomic form of Babesia is the “Maltese cross,”
four ring forms inside a single RBC. T. cruzi has a 19.
trypomastigote as the diagnostic stage. T. gondii has D. Adult filarial helminths typically inhabit the
intracellular forms found in tissue. lymph vessels. They produce inflammation and
swelling of the lymph vessels, often in the legs and
sometimes the scrotum. This condition is referred
15. to as elephantiasis. The larvae are highly motile
D. Polyvinyl alcohol (PVA) is a commonly used and migrate through the body.
fixative for stool specimens. This preservative
contains mercury and is used to fix fecal samples
for making permanently stained smears. Forma- 20.
lin is commonly used to preserve stool samples in B. Although all these organisms are potential
preparation for concentration procedures. Sodium pathogens of patients who are immunocompro-
acetate is used with formalin to preserve fecal mised, only Cryptosporidium produces acid-fast-posi-
specimens, but it does not contain mercury and tive oocysts about 4–6 mm in diameter. The oocysts
is, therefore, less toxic. Buffered glycerol is some- of Cyclospora measure approximately 8–10 mm. The
times used as a transport medium for stool sam- spores of microsporidia are generally 1–3 mm in
ples when performing a bacterial culture. diameter. Most hospitals today use antigen detec-
tion methods to diagnose Cryptosporidium infection.

16.
B. Although all the organisms listed have some 21.
degree of acid-fast positivity, only Cyclospora forms B. The ring forms of P. falciparum and Babesia sp.
oocysts in the size range of 8–10 mm. The oocysts are similar. In this case the lack of travel out of the
of Cryptosporidium are generally 4–6 mm in diam- country and travel to the Northeast where Babesia
eter and are generally strongly acid-fast positive. infections are endemic suggest babesiosis. Both
Oocysts of Cystoisospora are much larger, approxi- organisms may cause hemolysis of the RBC lead-
mately 25 * 18 mm. Microsporidia are acid-fast ing to a decreased hemoglobin. Trypomastigotes
variable, and this stain is not recommended for and microfilaria are large, extracellular organisms
detecting microsporidia. The spores of microspo- in the blood.
ridia are generally 1–3 mm in diameter.

17.
C. The presence of muscle pain and periorbital
edema (swelling around the eyes) in this patient
is suggestive of trichinosis. The highly elevated
eosinophil count is also characteristic of parasitic
infection in the tissues.
 818 ■ CHAPTER 8: PARASITOLOGY

22. life cycle forms that can be detected in stools

(S. japonicum and C. cayetanensis) or cerebrospinal
answers & rationales

B. Acanthamoeba is a free-living ameba rarely caus-

fluid (N. fowleri).
ing human infections. This organism has been
associated with granulomatous infections of the
skin and lung, as well as meningoencephalitis. 26.
However, the most common presentation is kera-
D. All of the listed organisms have a larval stage
titis (infection of the cornea), associated with con-
that migrates through the blood stream. However,
tact lenses. L. loa and O. volvulus are microfilarial
the larval forms of A. lumbricoides are known to
infections. Although L. loa adults may be found
cause a pneumonitis-like reaction, especially after
migrating across the eye, they are not commonly
repeated exposures.
associated with keratitis.

27.
23.
A. D. latum is a tapeworm that has been linked to
B. The small size and variable staining of the
vitamin B12 deficiencies in individuals of Scan-
microsporidia make their detection difficult. Tis-
dinavian descent. T. saginata and H. diminuta are
sue examination by electron microscopy is the
tapeworms that infect the gastrointestinal tract
most specific diagnostic method. In the modified
of humans but have not been linked to vitamin
trichrome stain, one of the stains (chromotrope
B12 deficiencies. Hookworm infections have been
2R) is used at 10 times the normal concentration.
associated with a microcytic, hypochromic anemia.
In addition, the staining time is increased to 90
minutes. Alternatively, 15 minutes in heated stain
can be used. Under these staining conditions, the 28.
spores of microsporidia stain as pinkish ovals,
C. Transmission of filariasis depends on the pres-
1–3 mm.
ence of microfilariae in the bloodstream at the
time the vector bites, and the periodicity of micro-
24. filariae in the peripheral blood varies with the
species and sometimes with the geographic area.
A. A wet mount of a fecal concentrate will not
Nocturnal periodicity is marked in W. bancrofti in
demonstrate trophozoites as they are generally
Africa, Asia, and the western hemisphere, and
destroyed during processing. D. fragilis exists only
thick blood films for detection of these microfi-
in trophozoite form and requires a permanently
lariae should be made between 10 p.m. and mid-
stained smear to demonstrate its presence. Cryp-
night. The other choices do not exhibit nocturnal
tosporidium sp. oocysts are small (4-6 um) and fre-
periodicity.
quently require an acid-fast stain to demonstrate
their presence.
29.
25. A. Ingestion of T. solium eggs by humans results in
individuals becoming the intermediate host in the
D. T. gondii is a protozoan parasite of humans
life cycle. This host is characterized by the pres-
that generally exists in multiple tissues as a cyst-
ence of the cysticerci in tissue. Eating raw meat
like form. In humans, there are no forms excreted
would result in ingesting the cysticerci and becom-
from the body. Therefore, serologic testing for
ing a host to the adult tapeworm. Metacercaria and
either IgM antibodies (acute infection) or IgG
other larva are not stages in the life cycle of the
antibodies (past infection) is the method of choice
pork tapeworm.
for detecting infection. The other organisms have
 ANSWERS & RATIONALES ■ 819

30. of bacterial meningitis and identification of the

organism in spinal fluid is difficult.

answers & rationales

D. Typical eggs of T. trichiura are yellow to brown,
with colorless polar plugs. They are shaped like a
football or a barrel, and they are in the cellular, or 35.
unsegmented stage, when passed in the feces. The
C. Infectious cysts of amebae and G. duodenalis and
usual egg range is 49–65 * 35–45 mm. Necator
eggs of A. lumbricoides may all be ingested in fecally
eggs have a thin shell with a four- to eight-cell
contaminated water or food. These infections are
stage embryo. Ascaris eggs are characterized by a
most prevalent in areas lacking good public sanitation,
thick mammilated shell. H. nana has a double wall
that is, sanitary disposal of human waste and ade-
with the presence of polar filaments.
quately treated and protected drinking water. Filariasis
is transmitted by blood-feeding insects (vectors).
31.
A. The gametocytes of P. vivax, P. malariae, and 36.
P. ovale are round and somewhat similar in appear-
A. Humans are infected with T. saginata by eating
ance. Those of P. falciparum have a typical crescent
beef containing live cysticerci, the infectious lar-
or banana shape. The gametocytes of P. falciparum
val stage of this parasite. Cattle become infected
may remain in the peripheral blood a month or
by ingesting viable eggs from human feces. Unlike
more and are often found with the ring stages.
T. solium, if humans ingest T. saginata ova, infection
with the cysticercus does not develop.
32.
A. E. nana is considered a nonpathogenic ameba. 37.
E. histolytica is a known pathogen associated with
D. Cysts of E. histolytica are round and range from
amebic dysentery. Giardia and D. fragilis are also con-
10 to 20 mm with characteristic nuclei (small cen-
sidered pathogens. Giardia may cause malabsorp-
tral karyosome and even peripheral chromatin).
tion. Dientamoeba is considered a mildly pathogenic
Although E. hartmanni has morphologically identi-
organism that causes diarrhea, especially in children.
cal nuclei, its size range is 5–10 mm, Giardia nuclei
lack peripheral chromatin and have large promi-
33. nent karyosomes. E. coli may have up to eight
nuclei with uneven peripheral chromatin and large,
D. C. mesnili is the only trophozoite which always
eccentric karyosomes.
has a single nucleus. B. coli has a kidney bean–
shaped macronucleus and a small round micronu-
cleus (rarely seen). Giardia has two large nuclei and 38.
Dientamoeba is usually binucleated although there
D. The fertilized ova of T. trichiura are unembryo-
are some uninucleated forms.
nated when released, and embryonic development
occurs outside of the host. In moist, warm, shaded
34. soil, the first-stage larva develops within the egg
in about 2 weeks. This fully embryonated egg is
A. N. fowleri is found in warm freshwater ponds and
infective when ingested by a susceptible host, and
lakes, especially those with disturbed or suspended
it hatches in the small intestine. During develop-
soil. It has caused a number of cases of primary
ment from larva to adult, the worm usually passes
amebic meningoencephalitis in children and adults
to the cecum, where it embeds its slender anterior
who have swum in these bodies of water. Diag-
portion in the intestinal mucosa.
nosis is difficult as the symptoms resemble those
 820 ■ CHAPTER 8: PARASITOLOGY

39. cal cavity and a prominent, ovoid, genital primor-

dium midway along the ventral wall of the body.
answers & rationales

A. The most common form of B. hominis seen

The infective stage is the filariform larva, which
in human feces is called the “classic form.”
differs from the hookworm filariform larva by
This form contains a central body that was
having a notched tail tip and a long esophagus.
previously thought to be a vacuole. The central
body can take up to 90% of the volume of the
cell, displacing the nuclei to the outer edge of 44.
the cell. The other organisms will show nuclei
C. P. malariae is characterized by the band form
distributed throughout the cytoplasm.
trophozoite. Pigment is often dark brown to
black and is large and coarse. Infected RBCs
40. are not enlarged. Cells infected with P. ovale are
enlarged and oval and have fimbriated edges. P.
B. Taenia sp. eggs are characteristically round
falciparum has small delicate ring-form tropho-
with a thick shell with radial striations. H. nana
zoites. P. cynomolgi is found in primates.
and H. diminuta also have a hexacanth embryo
but the shells are thin and H. nana will have
polar filaments present. D. latum lacks a hexa- 45.
canth embryo. S. japonicum will have a thin shell
A. P. falciparum infections tend to produce a large
with a small curved inconspicuous spine.
number of rings that frequently have double
chromatin, which is only occasionally found in
41. other species. P. falciparum differs from other plas-
modia of humans in that only early trophozoites
D. The description fits that of a schizont of
(ring forms) and gametocytes are found in periph-
P. malariae. P. vivax will have between 12 and
eral blood except in severe cases. Sex differentia-
24 merozoites in an enlarged RBC. P. ovale tro-
tion of the gametes, when present, is difficult.
phozoites are compact and in an enlarged, oval
RBC that will show fimbriated edges. P. falci-
parum demonstrates a banana-shaped gameto- 46.
cyte.
B. The description fits that of eggs of D. latum.
This is also supported by the patient’s history of
42. travel and ingesting raw fish. Eggs of F. hepatica
have an inconspicuous operculum but are much
C. The nuclear description fits that of E. coli.
larger in size. P. westermani has a flattened, shoul-
E. nana lacks peripheral chromatin around the
dered operculum and lacks the knob. C. sinensis
karyosome. D. fragilis nuclei also lack peripheral
does have a knob opposite the operculum but the
chromatin and have a clump of chromatin gran-
operculum is domed and the egg is much smaller.
ules forming the karyosome. E. histolytica nuclei
will have even peripheral chromatin and a small
central karyosome. 47.
C. N. americanus and A. duodenale are two spe-
43. cies of hookworms infecting humans. Their
eggs are so similar when found in stool speci-
C. The rhabditiform larvae of S. stercoralis are the
mens that they are reported as “hookworm
diagnostic stage typically passed in the feces of
ova.” The two hookworms can be differenti-
infected persons. The larvae measure up to 380 m
ated by the morphologic characteristics of the
m long * 20 mm wide. They have a short buc-
adult worms, which are intestinal parasites.
 ANSWERS & RATIONALES ■ 821

48. detection of malaria. When a venipuncture is

performed, the preferred anticoagulant for

answers & rationales

B. The description matches that of E. vermicu-
malarial blood smears is EDTA (ethylenedi-
laris eggs. Because the eggs are laid in the peri-
aminetetraacetic acid). Heparin can be used,
anal area at night, it is possible to find some
but it may cause distortion of some parasite
that may have dropped off the body in a first-
forms.
morning urine. S. haematobium eggs are found
in urine but they are larger and have a terminal
spine. Hookworm eggs also have a thin shell 53.
but have a four- to eight-cell embryo and are
found in feces. Eggs of A. lumbricoides are larger D. The trophozoite, seen in Color Plate 36■,
and have a brown bumpy (mamillated) coating. is that of P. vivax. The shape is ameboid; the
infected RBC is enlarged. There are faint
Schüffners dots. P. malariae would show com-
49. pact trophozoites in normal-sized RBCs.
D. A common sign of S. haematobium infection P. ovale would demonstrate a compact tropho-
is the presence of blood in the urine. This is due zoite and the infected RBC would be enlarged
to the damage caused when the eggs break out and oval and possibly have fimbriated edges.
of the blood vessels of the vesicular plexus into P. knowlesi is considered a primate malaria but
the bladder. Falciparum malaria may also cause may infect humans. Trophozoites of P. knowlesi
severe hemoglobinuria or “blackwater fever.” are morphologically similar to those of P. falci-
parum.

50.
C. B. microti is a sporozoan parasite commonly 54.
found in voles and field mice. The vector is D. Color Plate 37■ demonstrates a fertilized
the tick Ixodes, normally a parasite of deer. egg of A. lumbricoides. Eggs measure 45–75 *
Humans are accidental hosts when bitten by an 35–50 mm. The thick, brown, mamillated coat-
infected tick. Many B. microti infections within ing is typical of Ascaris. Although the size range
the United States occur in the Northeast. It is of all eggs overlap, hookworm eggs and the
important to differentiate this parasite from eggs of E. vermicularis have thin shells. T. trichiura
Plasmodium in a stained blood film. Antimalarial has a barrel shape, thick shell, and polar plugs.
drugs are not effective in babesiosis.
55.
51. B. Color Plate 38■ demonstrates a G. duodenalis
B. Chagas disease is found throughout the Amer-trophozoite; notice the two prominent nuclei.
ican continents. The infectious agent, T. cruzi, is
Trophozoites of C. mesnili are approximately
transmitted to humans by reduviid bugs, primar-6–24 mm in length but have a single nucleus,
whereas G. duodenalis trophozoites have two
ily the triatomids. Chagas disease can be acute or
chronic. The trypomastigote is found in blood nuclei. Trophozoites of Trichomonas are about
during the acute phase. T. brucei is associated with
the same size as G. duodenalis, but they are
African sleeping sickness. rounder than the pear-shaped trophozoites
of G. duodenalis and C. mesnili. Trichomonas spp.
have a single nucleus. D. fragilis would demon-
52. strate an ameboid shape and have two nuclei
A. Collection of blood by finger stick is pre- that are composed of four to eight chromatin
ferred for preparing blood smears for the granules.
 822 ■ CHAPTER 8: PARASITOLOGY

56. and presence of curved median bodies are keys

to identification. D. fragilis lacks a cyst form, and
answers & rationales

C. Color Plate 39■ demonstrates a D. fragilis tro- trophozoites frequently demonstrate two nuclei
phozoite. Although this organism lacks a flagel- with four to eight chromatin granules inside the
lum and morphologically resembles the ameba, nuclear membrane. Both E. nana and E. hartmanni
based on its ultrastructure and molecular biol- cysts would have up to four nuclei; those of E.
ogy studies, it is classified as a flagellate. Like hartmanni would demonstrate peripheral chro-
the trichomonads, D. fragilis does not have a cyst matin. Cysts of E. nana would show large karyo-
stage. Most trophozoites of D. fragilis have two somes but no median bodies would be present.
nuclei; none of the other organisms are binucle-
ated. E. hartmanni would demonstrate periph-
eral chromatin on the nuclear membrane. Both 59.
I. butschlii and E. nana have large karyosomes
D. Color Plate 42■ demonstrates the “classic
with no peripheral chromatin.
form” of B. hominis., rRNA studies indicate it
is related to algae and water molds. The classic
57. form usually seen in human feces varies in size
from 6 to 40 mm in diameter. It contains a large
C. Color Plate 40■ demonstrates an E. coli cyst. central body, resembling a vacuole that pushes
These cysts may resemble E. histolytica and E. dis- several nuclei to the periphery of the cell.
par. The key distinguishing feature is that E. coli
cysts contain up to eight nuclei, whereas E. his-
tolytica and E. dispar have up to four nuclei. E. coli 60.
cysts are larger than those of E. histolytica and E. A. Color Plate 43■ demonstrates multiple
dispar. Although nuclear detail is difficult to deter- RBCs infected with Babesia sp. There are small
mine in an iodine prep, the presence of eccentric single ring forms in several RBCs of nor-
karyosomes and irregular coarse peripheral chro- mal size. There is also a “Maltese cross” form
matin may be seen in several nuclei. It is often present which helps to distinguish it from
necessary to use the fine adjustment to see all the P. falciparum. There is no pigment present. A
nuclei. In this image, six nuclei can be seen. trophozoite stretching across the infected RBC,
called a band form would be characteristic of
P. malariae. Trophozoites of P. vivax would be
58.
ameboid and the infected RBCs would be en-
A. Color Plate 41■ demonstrates a cyst of larged.
G. duodenalis. The oval shape, large karyosomes,

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