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        DPDx - Laboratory Identification of Parasites of Public Health Concern
        DPDx - Laboratory Identification of Parasites of Public Health Concern
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        Case #167 – November, 2005
          Case #167 – November, 2005
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                    A 45-year-old woman went to her physician with complaints of recurring abdominal cramping, bloating, and infrequent diarrhea. Her travel history included a 10-day camping trip in Alaska, and her symptoms had started approximately 2 weeks after her return. Her physician ordered an ova and parasites (O & P) examination. Figures A-D show objects observed on a trichrome stained fecal smear; A-C were found in moderate numbers on the smear, while D was found in very few numbers. The objects shown ranged in size from 5 to 7 micrometers. What is your diagnosis? Based on what criteria?
                    Figure A
                    Figure B
                    Figure C
                    Figure D
                  Case Answer
                        The organisms identified in this case were Entamoeba hartmanni and Endolimax nana. These amoebae are generally considered to be nonpathogenic. Diagnostic features included:
                          * trophozoites of E. hartmanni (Figures A and B). The morphology of E. hartmanni is very similar to that of Entamoeba histolytica; both have a compact, centrally located nuclear karyosome, uniform distribution of peripheral chromatin, and fine, granular cytoplasm. Size of the trophozoites is consistent with the range for E. hartmanni (5 to 12 micrometers, averaging 8 to 10).
                          * a cyst of E. hartmanni (Figure C) with only two nuclei; mature cysts have four nuclei. The number of nuclei is also similar to E. histolytica cysts, but size of the cyst is consistent with E. hartmanni (5 to 10 micrometers) and distinguishes it from E. histolytica.
                          * a trophozoite of Endolimax nana (Figure D). The size range for E. nana trophozoites is 6 to 12 micrometers. The karyosome is generally large and red (when stained with trichrome). The cytoplasm is coarsely granular and can be very vacuolated.
                        More on: Nonpathogenic Amoebae
                Images presented in the DPDx case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.
      DPDx is an educational resource designed for health professionals and laboratory scientists. For an overview including prevention, control, and treatment visit www.cdc.gov/parasites/.
      Last Reviewed: August 24, 2016
        Source: National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Parasitic Diseases and Malaria
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              o Detection of parasite antigens
              o Isolation of organisms
              o Special tests
              o Inactivation of Ebola/Marburg for malaria testing
          + Stool Specimens plus icon
              o Safety
              o Specimen Collection
              o Specimen Processing
              o Shipment
              o Staining
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              o Detection of parasite antigens
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              o Extraction of Parasite DNA from Fecal Specimens
              o Morphologic comparison of intestinal parasites
          + Serum/Plasma Specimens plus icon
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              o Isolation of Leishmania organisms
              o Sputum
              o Aspirates
              o Sputum, induced sputum, and bronchoalveolar avage (BAL)
              o Vaginal swabs for diagnosis
              o Procedure for demonstration of pinworm eggs
              o Urine
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