PARA-SITE Online

PARA-SITE Online

Hello and welcome to PARA-SITE Online. Thank you for visiting our site.

The purpose of this site is to inform the public about the field of diagnostic medical parasitology. Within this site you will find numerous topics ranging from new and emerging parasitic infections to diagnostic procedure options.

In addition, you will find answers to many of those commonly asked questions as well as discussions about some of the hottest topics within the field of parasitology today.

The content within this site is made possible through the extensive contribution of Lynne S. Garcia, M.S., MT(ASCP), CLS(NCA), BLM(AAB), F(AAM), Director, Consultantation and Training Services (Diagnostic Medical Parasitology and Health Care Administration). For additional information, she can be contacted at [email protected].

Lynne's new book is out! Look for  Garcia, LS, 2016, Diagnostic Medical Parasitology, 6th Ed., ASM  Press, Washington, D.C. within the next few months.

About Medical Parasitology

During the past few years, the field of diagnostic medical parasitology has seen numerous changes including newly recognized parasites, alternative diagnostic techniques required by regulatory requirements, implementation of new immunoassay techniques and an overall increase in awareness of parasitic infections. Pathogens such as the microsporidia and Cyclospora cayetanensis have moved from the category of "unusual organisms" to becoming more widely recognized as causing important human infections, particularly in the compromised patient.

Newer diagnostic methods continue to be developed, with an emphasis on procedures that are not based on microscopic recognition of subtle organism morphologic details. As laboratories reduce the number of personnel and cross-training and cross-coverage become much more common, the number of laboratorians trained to perform and interpret diagnostic parasitology procedures is diminishing. As fewer trained individuals enter the field of diagnostic microbiology, education and consultation for the laboratorian will continue to grow in importance. It will continue to be difficult to maintain well-trained staff in some specialty areas of the laboratory. It becomes even more important to provide well-written laboratory protocols and to standardize laboratory protocols for consistency.

The basic approach to diagnostic parasitology should be no different from that used in other areas of microbiology. There are a number of publications containing guidelines and recommended procedures for this field. If these recommendations and general guidelines are not followed, then there may be questions concerning the qualifications of the laboratory performing the diagnostic work. Not every laboratory will provide the exact same testing in diagnostic parasitology; however. there are a few guidelines that should be common practice. At the very least, the clinician should always be informed as to the limitations of those procedures that are being used. Because it is difficult for the medical staff to maintain expertise in every available diagnostic procedure within microbiology, it is important to establish close communication between the laboratory and clinicians. Complete and frequent communication is important, particularly when related to the clinical relevance of any diagnostic procedure within the context of quality patient care. Therapeutic intervention often depends on the results obtained from these procedures, so the clinician must be aware of the limitations of each test method and the results obtained.

The field of medical parasitology has taken on additional relevance and importance for several reasons. Improved means of travel has made the world a smaller place, with any number of "exotic" pathogens just a plane ride away! An individual's chances of exposure to parasites not endemic to his or her homeland and the possibility of acquiring or transmitting certain infections have been increasing. This situation emphasizes the need for obtaining a correct and complete history from the patient. It is also important to recognize the parasites commonly found within certain areas of the world and the makeup of the patient population being seen in any particular health facility.

We know that patients with immune defects are particularly at risk for a number of parasitic infections, some of which may cause unusual symptoms in this patient population. It is important for the laboratorian and physician to understand these infections and to recognize the most appropriate diagnostic methods.

In other areas of microbiology, therapy is often begun on the basis of patient history and symptoms. This approach is generally not used in cases of parasitic infection. Thus, understanding the geographic range, life cycle, clinical disease, diagnostic methods, therapy, epidemiology and control become very important. Even more important are the use of appropriate diagnostic procedures, accompanied by a complete understanding of the limitations of each. If certain incomplete procedures are used, incomplete information may be provided to the physician, leading to incomplete or inappropriate patient care.

Information that will be presented throughout this web site will address diagnostic methods, newly recognized emerging parasitic infections, and some of the most commonly asked questions in diagnostic medical parasitology. We will also discuss some of the organisms, including diagnostic methods, organism morphology and clinical relevance.

We encourage your comments and suggestions and thank you for your interest.

New Infections

Ova and Parasite (O&P) Examinations

Appendix 10 CPT CODES, PARASITOLOGY

PROCEDURE NAME

CPT

Blood Film (Thick), Blood film stain (includes concentration)

87015 + 87207

Blood Film (Thin), Blood film stain 

87207

Buffy Coat Blood Film (Thick) Blood film stain (includes conc.)

87015 + 87207

Buffy Coat Blood Film (Thin) Blood film stain (includes conc.)

87015 +87207

Calcofluor Stain (direct material, no concentration)

87206 

Calcofluor Stain (Concentrated material)

87015 + 87206

Concentration, Baermann (Plus Wet Mount Examination)

87015 + 87210

Concentration, Blood (Conc, Wet Mts) (may be multiple wet mounts prepared/examined – use additional 87210 with modifier) (will include Knott and Membrane Concentrations using Nuclepore filters)

87015 + 87210

Concentration, Harada-Mori (Plus Wet Mount Examination)

87015 + 87210

Concentration, Iodine Prep (Wet Prep Only)

87015 + 87210

Concentration (Misc)

87015

Concentration, Petri Dish (Plus Wet Mount Examination)

87015 + 87210

Concentration, Saline Prep (Wet Prep Only)

87015 + 87210

Counterimmunoelectrophoresis, each antigen (Ex:  Entamoeba histolytica)

86185

Cryptosporidium Examination (Mod AFB) (Conc. Sediment)

87015 + 87207

Cryptosporidium Examination (FA) (Conc. Sediment)

87015 + 87272

Cryptosporidium Examination (EIA) (Plate/tray)

87328

Cryptosporidium Examination (Cartridge)

87328*

Cryptosporidium/Giardia Examination (FA) (Conc. Sediment)

87015 + 87272 +
87269

Cryptosporidium/Giardia Examination (EIA)
(Screen that detects both, but does not differentiate between the two.) If positive, separate reagents must be used.

87328 + 87329
(Neg)

Cryptosporidium/Giardia/E. histo/E. dispar group, cartridge

87328 + 87329 +
87336

Cyclospora Examination (Mod AFB) (concentrate sediment)

87015 + 87207

Cyclospora Examination (Autofluorescence) (conc. sediment)

87015 + 87210

Culture (Acanthamoeba) (Agar plates) (Screen, Wet Mt, Permanent Stain) (Trichrome, use 87209)

87081 + 87210 +
87207 (Giemsa)

Culture (Intestinal and Blood Protozoa) (Culture, Conc., Wet Mt, Permanent Stain of culture sediment)

87081 + 87215 +
87210 + 87207
(Giemsa) or 87209
(Trichrome)

Culture, Agar Plate (Strongyloides)

87081 + 87210

Culture (Trichomonas) (Pouch) (Screen) (Microscope exam through plastic pouch)

87081

Ectoparasite Identification (Macro) (Arthropod)

87168

Ectoparasite Identification (Wet Mt) (Arthropod)

87210

Ectoparasite Identification (Skin, Scabies)

87220

Entamoeba histolytica/E dispar Group (EIA)

87336

Entamoeba histolytica  (EIA)

87337

Examination, Wet Prep Only (Wet Prep Only)

87210

Examination, Duodenum (Conc, Wet Mts)

87177 

Examination, Duodenum (Permanent Stain)

87209

Examination, EnteroTest (Wet Mts Only)

87210

Examination, EnteroTest (Permanent Stain Only)

87209

Examination, urine (Random) (Conc, Wet Mts) (may be multiple wet mounts prepared/examined – use additional 87210 with modifier)

87015 + 87210

Examination, 24 h Urine (Conc, Wet Mts) (may be multiple wet mounts prepared/examined – use additional 87210 with modifier)

87015 + 87210

Fat, Stool (Qualitative)

82705

Giardia Examination (FA) (Conc. Sediment)

87015 + 87269

Giardia Examination (EIA) (Plate/Tray)

87329

Giardia Examination (Cartridge)

87329*

Helminth Egg Hatching (Concentration, Wet Mounts)

87177

Isospora Examination (Mod AFB) (conc. sediment)

87015 + 87207

Leishmania lesion, stained smear

87207

Microsporidia, Special Stain (Modified Trichrome) (on concentration sediment)

87015 + 87207

Microsporidia, Fluorescent Stain (Calcofluor) (on concentration sediment)

87015 + 87206

Occult Blood, Stool

82270

Occult Blood, Gastric

82273

Ova and Parasite Examination (Direct Smears, Concentration and Smears) (Also recommended for Concentration and Wet Mts)

87177

Ova and Parasite Examination (Permanent Stain) (Ex:
trichrome or iron hematoxylin)

87209

Ova and Parasite Examination (Complete Examination) (Direct Smears, Concentration, Permanent Stain)

87177 + 87209

 

 

Petri Dish Culture/Concentration (Plus Examination)

87015 + 87210

pH, Body fluid except blood (Stool)

83986

Pinworm Examination, Cellophane Tape

87172

Plasmodium (Parasitemia Determination) Manual cell count (RBC, WBC OR Platelet) each (slide preparation and stain - add separate codes)

85032

Plasmodium (Rapid Tests – dipstick, etc.)  Infectious agent antigen detection by immunoassay with direct optical
observation, not otherwise specified
T1 = P. falciparum; T2 = Pan-malaria band; T3 = Internal cont.

87899 *x 3

Reducing Substances, Stool (pH)

83986

Referral In (Stool for Ova & Parasite Exam)

87177 + 87209

Tissue homogenization for culture

87176

Trichomonas vaginalis, direct probe  (Ex:  Affirm)

87660

Trichomonas vaginalis, detection immunoassay with direct optical observation (Ex:  Osom)

87808

Trypsin Activity, Stool (Qualitative)

84488

Worm Identification (Macro)

87169

Worm Identification (Wet Mt)

87210

Quizzes

Each Quiz has a two section format: the first section will present the Quiz topic and the second section will provide a discussion of the answer and/or various options in response to the Quiz situation presented to the user. In some situations, there may be more than one correct response.

The content within this site is made possible through the extensive contribution of Lynne S. Garcia, M.S., MT(ASCP), CLS(NCA), BLM(AAB), F(AAM), Director, Consultantation and Training Services (Diagnostic Medical Parasitology and Health Care Administration). For additional information, she can be contacted at [email protected]

Reference: Garcia, L.S. 2015. Diagnostic Medical Parasitology, 6th Ed., ASM Press, Washington, D.C.



Histology

Histology The content within this site is made possible through the extensive contribution of Lynne S. Garcia, M.S., MT(ASCP), CLS(NCA), BLM(AAB), F(AAM), Director, Consultantation and Training Services (Diagnostic Medical Parasitology). For additional information, she can be contacted at [email protected]

Reference: Garcia, L.S. 2016. Diagnostic Medical Parasitology, 6th Ed., ASM Press, Washington, D.C.

  1. Strongyloides
  2. Micro in the eye 
  3. Enterobius
  4. Capillaria
  5. T.solium, Cysticercosis
  6. Leishmania, cutaneous
  7. Schistosoma haematobium
  8. Naegleria fowleri
  9. Trichinella sp.
  10. Pneumocystis
  11. Schistosomiasis
  12. Clonorchis sinensis
  13. Histology Unknown #13
  14. Histology Paragonimus
  15. Histology Unknown #15
  16. Histology Unknown #16
  17. Histology Trichinella sp.
  18. Histology Schistosoma sp.
  19. Histology Echinococcus

Blood Quizzes

The content within this site is made possible through the extensive contribution of Lynne S. Garcia, M.S., MT(ASCP), CLS(NCA), BLM(AAB), F(AAM), Director, Consultantation and Training Services (Diagnostic Medical Parasitology and Health Care Administration). For additional information, she can be contacted at [email protected]

Reference: Garcia, L.S. 2015. Diagnostic Medical Parasitology, 6th Ed., ASM Press, Washington, D.C.

  1. Plasmodium vivax
  2. Babesia sp.
  3. Plasmodium ovale
  4. Trypanosoma sp.
  5. Plasmodium falciparum
  6. Wuchereria bancrofti
  7. Plasmodium ovale
  8. Plasmodium vivax
  9. Blood parasite Unknown #9
  10. Blood parasite Unknown #10
  11. Blood parasite Unknown #11
  12. Blood parasite Unknown #12
  13. Blood parasite Unknown #13
  14. Blood parasite Unknown #14
  15. Blood parasite Unknown #15
  16. Blood parasite Unknown #16

Review Tests

Periodically we will present a review test that will be related to different aspects of diagnostic medical parasitology. Topics will include: organism identification, test ordering, test coding, method selection, technical problem-solving, test result reporting, and client consultations.

Each test will have multiple choice format: the questions will reflect the principles taught in the quizzes which are presented each month.

The content within this site is made possible through the extensive contribution of Lynne S. Garcia, M.S., MT(ASCP), CLS(NCA), BLM(AAB), F(AAM), Director, Consultantation and Training Services (Diagnostic Medical Parasitology and Health Care Administration). For additional information, she can be contacted at [email protected]

Reference: Garcia, L.S. 2015. Diagnostic Medical Parasitology, 6th Ed., ASM Press, Washington, D.C.

Review Test 1 - Methods

Review Test 2 - Protozoa

Review Test 3 - Bloods

Review Test 4 - Helminths

Review Test 5 - Image Review: Permanent Stains

Review Test 6 - Image Review: Wet Mounts

Review Test 7 - Image Review: Blood Parasites

Review Test 8 - Image Review: Helminths

General Parasitology Test 1

Diagnostic Parasitology FAQs (Garcia)

As laboratory personnel become more widely cross-trained, the availability of people who have expertise in diagnostic parasitology will become more limited. Over the years, questions have been raised regarding various aspects of diagnostic medical parasitology. In this section we will attempt to answer many of these questions. We hope this will be helpful for those working in this area of microbiology and provide some “tips of the trade” that are learned through many years of bench experience.

Microsoft Word Document Round Table FAQs.docx

Adobe PDF version Round Table FAQs.pdf

Informational Tables

Infectious diseases, particularly parasitic infections, play a major role in the overall world’s health and economy. As travel increases, we anticipate seeing many more people who may be infected with parasites that may not be endemic to the specific area where they live. During the past few years, the United States has seen a number of outbreaks with Cyclospora cayetanensis, a coccidian parasite that has been linked to the importation of fresh produce (primarily raspberries, fresh basil, and baby lettuce mixtures) into the United States. Continued vector and disease control efforts will remain on the high priority list, especially when seen within the context of global health.

Also, we continue to see the compromised patient population increase, due to age, intentional immunosuppression (transplantation), underlying disease and chemotherapy. As this population grows, we anticipate the identification of additional etiologic agents of disease, some of which will most probably be human parasites.

Recently, two organisms have been linked to human disease and have been categorized as “emerging infections.” These are Cyclospora cayetanensis, a coccidian similar to Cryptosporidium spp. and the Microsporidia. Currently, there are eight genera and 13 species of Microsporidia that have been identified as causing human disease.

Alphabetical Listing of Parasitic Diseases/Organisms

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
A TO Z LIST ENTRIES

A

Acanthamoeba Infection (Free-Living Amebae)
Acanthamoeba Keratitis Infection
African Sleeping Sickness (Trypanosoma brucei ssp., African Trypanosomiasis)
Alveolar Echinococcosis (Echinococcus granulosus, Hydatid Disease)
Amebiasis (Entamoeba histolytica Infection, Pathogenic Intestinal Amebae)
American Trypanosomiasis (Trypanosoma cruzi, Chagas Disease)
Ancylostomiasis (Ancylostoma duodenale, Hookworm Disease)
Angiostrongyliasis, Cerebral (Angiostrongylus cantonensis Infection)
Angiostrongyliasis, Abdominal (Angiostrongylus costaricensis Infection)
Anisakiasis (Anasakis, Pseudoterranova, Phocanema, Contracaecum)
Ascariasis (Ascaris Infection, Intestinal Roundworms/Nematodes)

B

Babesiosis (Babesia Infection)
Balantidiasis (Balantidium coli Infection)
Balamuthia mandrillaris (Free-Living Amebae)
Baylisascariasis Infection (Baylisascaris procyonis, Raccoon Roundworm)
Bed Bugs
Bilharzia (Schistosoma spp., Schistosomiasis)
Blastocystis spp. Infection
Body Lice Infestation (Pediculosis)
Brugia spp. (See Filariasis)

C

Capillariasis (Capillaria Infection)
Capillaria philippinensis
Capillaria hepatica
Cercarial Dermatitis (Swimmer’s Itch, Schistosomiasis)
Chagas Disease (Trypanosoma cruzi, American Trypanosomiasis)
Chilomastix mesnili Infection (Nonpathogenic Intestinal Protozoa)
Clonorchiasis (Clonorchis Infection, Trematode)
“Crabs” (Phthirus pubis, Pubic Lice)
Cryptosporidiosis (Cryptosporidium spp., Coccidian Infection)
Cutaneous Larva Migrans (CLM, Ancylostomiasis, Dog/Cat Hookworm)
Cyclosporiasis (Cyclospora cayetanensis, Coccidian Infection)
Cysticercosis (Taenia solium, Intermediate Stage Infection)
Cystoisosporiasis (Cystoisospora belli Infection, formerly Isospora)

D

Dientamoeba fragilis Infection (Pathogenic Intestinal Protozoa)
Diphyllobothriasis (Diphyllobothrium latum Infection, Cestode)
Dipylidium caninum Infection (Dog or Cat Tapeworm Infection)
Dirofilariasis (Dirofilaria spp., (See Filariasis)
Dracunculiasis (Dracunculus medinensis, Guinea Worm Disease)
Dog Tapeworm (Dipylidium caninum)

E

Echinococcosis (Alveolar Echinococcosis, Hydatid Disease, Echinococcus granulosus)
Echinococcosis (Multilocular Echinococcosis, Echinococcus multilocularis)
Elephantiasis (Filariasis, Lymphatic Filariasis)
Endolimax nana Infection (Nonpathogenic Intestinal Protozoa)
Entamoeba coli Infection (Nonpathogenic Intestinal Protozoa)
Entamoeba dispar Infection (Nonpathogenic Intestinal Protozoa)
Entamoeba histolytica/E. dispar group or complex Infection
Entamoeba hartmanni Infection (Nonpathogenic Intestinal Protozoa)
Entamoeba histolytica Infection (Amebiasis, Pathogenic)
Entamoeba moshkovskii (Nonpathogenic Intestinal Protozoa)
Entamoeba polecki (May Cause Symptoms, Intestinal Protozoa)
Enterobiasis (Pinworm Infection, Enterobius vermicularis)

F
Fascioliasis (Fasciola Infection)

 
 

Fasciolopsiasis (Fasciolopsis Infection) Filariasis (Lymphatic Filariasis, Elephantiasis)

 
 
 
 
 

G
Giardiasis (Giardia lamblia [intestinalis, duodenalis] Infection)
Gnathostomiasis (Gnathostoma Infection)
Guinea Worm Disease (Dracunculiasis, Dracunculus medinensis)

H
Head Lice Infestation (Pediculosis)
Heterophyes heterophyes (Heterophyes Infection, Trematode)
Hydatid Disease (Alveolar Echinococcosis, Echinococcus granulosus) Hymenolepiasis (Hymenolepis Infection, Cestode)

 
 

Hookworm Infection, Human (Necator americanus, Ancylostoma duodenale)

Hookworm Infection, Zoonotic (Ancylostomiasis, Cutaneous Larva Migrans [CLM])

I

Intestinal Roundworms (Ascariasis, Ascaris Infection)
Iodamoeba bütschlii Infection (Nonpathogenic Intestinal Protozoa)
Isospora Infection (See Cystoisospora Infection)
Itch Mite (See Sarcoptes scabiei)

K

Kala-azar (Leishmaniasis, Leishmania Infection)
Keratitis (Acanthamoeba Infection)

L

Leishmaniasis (Kala-azar, Leishmania Infection, Leishmania spp.) Lice Infestation (Body Lice, Head Lice, or Pubic Lice)
Loiasis (Loa loa Infection)
Lymphatic filariasis (Filariasis, Brugia malayi)

M

Malaria (See Plasmodium Infection)

Microsporidiosis (Encephalitozoon, Enterocytozoon, etc. Infection)
Mite Infestation (Scabies, Sarcoptes scabiei)

Myiasis (Fly Larvae Infestation)

N

Naegleria Infection (Primary Amebic Meningoencephalitis [PAM], Naegleria fowleri)
Neural Larva Migrans (Baylisascaris procyonis, Toxocara cati, T. canis)
Neurocysticercosis (Cysticercosis, Taenia solium)
Neglected Parasitic Infections in the U.S. (Chagas Disease, Cysticercosis, Toxocariasis, Toxoplasmosis, Trichomoniasis)
Neglected Tropical Diseases

O
Ocular Larva Migrans (Toxocariasis, Toxocara Infection, Visceral Larva Migrans)
Onchocerciasis (River Blindness, Onchocerca volvulus) Opisthorchiasis (Opisthorchis Infection)

 
 

P
Paragonimiasis (Paragonimus Infection.) Pediculosis (Head Lice or Body Lice Infestation, Pediculus spp.)
Pthiriasis (Pubic Lice Infestation, Phthirus pubis)
Pinworm Infection (Enterobiasis, Enterobius vermicularis)
Plasmodium Infection (Malaria)

 
 
 
 
 

Pneumocystis jirovecii Pneumonia (Now Classified with the Fungi)
Post-Kala-Azar dermal Leishmaniasis (PKDL)
Pseudoterranova Infection (Anisakiasis, Anisakis Infection)
Pubic Lice Infestation ("Crabs," Pthiriasis, Phthirus pubis)

R

Raccoon Roundworm Infection (Baylisascariasis, Baylisascaris Infection)
River Blindness (Onchocerciasis, Onchocerca volvulus)

S

Sappinia spp. (Pathogenic Free-Living Amebae)
Sarcocystis Infection (Sarcocystis spp.)
Sarcoptes scabiei (Itch Mite Infestation, Scabies)
Schistosomiasis (Bilharzia, Schistosoma spp.)
Sleeping Sickness (Trypanosomiasis, African; African Sleeping Sickness)
Strongyloidiasis (Strongyloides Infection, Strongyloides stercoralis)
Swimmer's Itch (Cercarial Dermatitis, See Schistosoma spp.)

T
Taeniasis (Taenia Infection, Tapeworm Infection)

 
 

Toxocariasis (Toxocara Infection, Ocular Larva Migrans, Visceral Larva Migrans)
Toxoplasmosis (Toxoplasma Infection, Toxoplasma gondii) Trichinellosis (Trichinosis)
Trichinosis (Trichinellosis, Trichinella spp.)
Trichomoniasis (Trichomonas Infection, Trichomonas vaginalis)
Trichuriasis (Whipworm Infection, Trichuris Infection, Trichuris trichiura)
Trypanosomiasis, African (African Sleeping Sickness, Sleeping Sickness, Trypanosoma spp.)
Trypanosomiasis, American (Chagas Disease, Trypanosoma cruzi)

V

Visceral Larva Migrans (Toxocariasis, Toxocara Infection, Ocular Larva Migrans)
Visceral Leishmaniasis (Post-kala-azar dermal leshmaniasis, PKDL)

W

Whipworm Infection (Trichuriasis, Trichuris Infection, Trichuris trichiura)
Wuchereria bancrofti (lympatic filariasis, elephantiasis)

Z
Zoonotic Diseases (Diseases spread from animals to people)