Texas Southern University- Clinical Laboratory Science CLSC 369 - Case Studies I

Question

Texas Southern University- Clinical Laboratory Science CLSC 369 - Case Studies I (1)

Name:
Instructions:
1. What is your diagnosis means give name of the parasite in the image.
2. Based on what criteria means describe the microscopic characteristics of the parasite to include size and any other distinguishing features
3. Answer MUST include the case and image.
Case 1: A 37-year-old homosexual man came to the outpatient clinic with a I-month history of profuse watery diarrhea; right upper quadrant pain, vomiting, intermittent fever, and a 19-lb weight loss. The patient contracted syphilis in 1980 and 1981 and gonorrhea in 1982. He had traveled extensively in Europe and had recently returned from France. The onset of diarrhea had begun with minor episodes of abdominal discomfort and four to five bowel movements per day for 3 days. The physician requested that the stool specimen be screened for Cryptosporidium. On examination of the Formalin concentrated specimen, images below were seen. What is your diagnosis? Based on what criteria?









Case-2: A missionary traveled to various countries in sub-Saharan Africa for one year. He went to his physician complaining of abdominal pain and occasional diarrhea which he experienced since his return to the U.S. He reported he swam in various lakes while he was abroad. An ova and parasite (0 & P) stool examination revealed objects, measuring 135 µm, like the one shown in images below. What is your diagnosis? Based on what criteria?

structions: What is your diagnosis means give name of the parasite in the image. Based on what criteria means describe the microscopic characteristics of the parasite to include size and any other distinguishing features Answer MUST include the case andimage. 1. 2. 3. Case1: A 37-year-old homosexual man came to the outpatient clinic with a I-monthhistory of profuse watery diarrhea; right upper quadrant pain, vomiting, intermittent fever, and a 19-lb weight loss. The patient contracted syphilis in 1980 and 1981 and gonorrhea in 1982. He hacd traveled extensively in Europe and had recently returned from France. The onset of diarrhea had begun with minor episodes ofabdominal discomfort and four to five bowel movements per day for 3 days. The physician requested that the stool specimen be screened for Cryptosporidium. On examination of the Formalin concentrated specimen, images below were seen. What is your diagnosis? Based on what criteria? 10 10 Case-2: went to his physician complaining of abdominal pain and occasional diarrhea which he experienced since his return to the U.S. He reported he swam in various lakes while he was abroad. An ova and parasite (O & P) stool examination revealed objects, measuring 135 m, like the one shown in images below. What is your diagnosis? Based on what criteria? A missionary traveled to various countries in sub-Saharan Africa for one year. He

Explanation / Answer

Case Study 1:

1. Based on the morphology shown in the image and the symptoms experienced by the patient, the disease is Cystoisosporiasis (formerly isosporiasis). It is caused by the organism Cystoisospora belli (or Isospora belli) which causes an intestinal infection. It has similarity with genera Cryptosporidium, Cyclospora, and Toxoplasma. It causes infection in humans. It is generally a self-limited infection. However, patient may have symptoms for 2-3 days. The parasite is spread by ingesting food or water contaminated with feces of infected individual. It is common in tropical and subtropical areas. Common symptoms are watery diarrhea, abdominal pain, cramps, loss of appetite, nausea, weight loss, vomiting, and fever. It is common in individuals with immunocompromised immune system as in HIV. The patient is homosexual with a history of syphilis and gonorrhea.

2. The immature oocyst containing just 1-2 sporoblast is excreted in stool. After excretion, the sporoblast divides into two sporoblast. The sporoblasts secrete a cyst wall and form sporocysts. The sporocysts divide two to form four sporozoites.

When the mature fully sporulated oocysts are ingested, the sporocysts infect the small intestine and release their sporozoites. These sporozoites invade the epithelial cells to initiate schizogony to form schizonts. The schizonts rupture to form merozoites, which invades epithelial cells and divide asexually to form Trophozoites. Trophozoites develop into schizonts, which contain multiple merozoites.

After a week, the male and female gametes are generated from merozoites by sexual reproduction. Fertilization results in oocysts development, which are excreted in stool.

The microscopic features of the different stages:

Oocyst: The oocysts of C. belli are large (25 to 33 µm in length and 10-19 µm in width) with a typical ellipsoidal shape. They have one sporoblast when immature. The second image is of the immature oocyst. Sporocysts are 12 µm by 7 µm to 9 µm.

Mature Oocyst: The mature oocyst has two sporocyst as seen in image 1.

Schizonts: Mature schizonts range in diameter from 10-50µm. They appear as membrane-bound clusters of small basophilic bodies.

Trophozoites are spherical while macrogamonts contain a single large, centrally located nucleus and wall-forming bodies. Microgamonts has multiple nuclei that migrate to the periphery. These nuclei elongate protruding from the surface. They bud into mature flagellated 5-6 mm microgametes

Case Study 2:

1. The image is of the eggs of Schistosoma mansoni. It is a parasitic worm that causes Schistosomiasis or bilharzias. It is present in Africa and South America. It infects the mesenteric venules and large intestine in humans. The miracidium larvae from fresh water habitats infect a snail intermediate host. In the snail headfoot, it transforms into a sporocyst in the headfoot of the snail. Subsequently it moves to the digestive glands or gonads to form Cercariae. The Cercariae exit the sporocyst and are released into fresh water. It then enters the human host. The patient had visited Sub-Saharan region and swam in fresh water, from where the man could have been infected.

2) Microscopic feature of Schistosoma mansoni: This parasitic flatworm has an oral sucker surrounding the mouth of the adult, and a ventral sucker. The ventral sucker is present posterior to the bifurcation of the gut. An esophagus with distinct esophageal glands is present. Paired caeca form a single caecum. Schistosoma mansoni is dioecious and sexually dimorphic.

The adult male (up to 10 mm in length) is more robust than the female. It has a gynaecophoral canal. Female is longer, more slender with a length of 10-14 in length, held within the groove of the male. The male has 6 - 9 testes. Female has a single ovary located in the anterior portion. Uterus can be long or short.

It oval eggs (115-175 x 45-7µm) with a sharp lateral spine. The anterior end is slightly curved. These eggs are seen in the image shown with a 135 mm size. Mature eggs have a miracidium

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