FINDINGS PDF

FINDINGS Trematodes Cestodes Proglottids para-sitic life cycles, defined as an examination of the vroute a parasite follows throughout its life. example, as increased awareness that parasites were becoming a problem and the realization that they were responsible for invasion in the body (infe...

FINDINGS Trematodes Cestodes Proglottids para-sitic life cycles, defined as an examination of the vroute a parasite follows throughout its life. example, as increased awareness that parasites were becoming a problem and the realization that they were responsible for invasion in the body (infection), invasion on the body (infestation), and disease, defined as a process with characteristic symptoms, emerged, determining an effective means of healing infected persons became a priority. The escalation of disease caused by the presence of parasites (a concept known as para sitic) because of global travel tends to result in higher parasite recovery rates. Which of the following are key discoveries that contributed to current knowledge about parasites? A. Consistent status quo preservation of samples B. Techniques that indicate only the presence or absence of parasites C. Modifications of traditional parasite identification techniques D. Decrease in parasite incidence because of global trave it is important to study and monitor their trends, a field known as epi demiology. Which of the following people may be at risk for contracting a parasitic infection? (Objective 1-5) A. A toddler who attends an all-day preschool or day care center B. A 25- year-old man who lives on his own in an apartment complex C. A 37-year-old South American refugee D. More than one of these: _______________ (specify) The means whereby a parasite gains entry into an unsuspecting host, referred to as mode of transmission, Consum ing contaminated food or water and hand-to mouth transfer are common ways of transmitting select parasites. The primary function of a host in a parasite-host relationship is to: (Objective 1-7) A. Carry on the parasite’s life cycle. B. Provide immunologic protection for the host. C. Carry on the host’s life cycle. D. Provide a food source for the host a parasite infects a host, symbiosis results. The primary function of the host is to carry on the parasite’s life cycle they all have three common components—a mode of transmission, a mor phologic form that invades humans, known as the infective stage, and one (or more) forms that can be detected via laboratory retrieval methods, known as the diagnostic stage. A parasitic life cycle consists of two common phases (Fig. 1-1). One phase involves the route a parasite follows when in or on the human body. d. The other phase, the route a parasite follows independently of the human body, provides crucial information pertinent to epidemiology, prevention, and control. Which of the following key pieces of information may be extracted from the portion of a parasite’s life cycle that occurs outside the body? (Objective 1-11) A. Parasitic disease symptoms and disease processes B. Epidemiology and prevention and control measures C. Appropriate parasite diagnosis methodologies D. Selection of appropriate antiparasitic medication Which of the following groups of symptoms repre sents those most commonly observed in parasitic infections? (Objective 1-13) A. Diarrhea, abdominal cramping, and anemia B. Enlargement of the spleen, fever, and chills C. Skin lesions, abdominal pain, and diarrhea D. Abdominal cramping, abdominal pain, and diarrhea Which of the following represent examples of avail able treatment therapies to combat parasitic infec tions? (Objective 1-14) A. Regulated exercise plan B. Change in diet C. Avoidance of vitamin supplements D. More than one of these: ______________ (specify) Stool is the most commonly submitted sample for such studies. A process to remove fecal debris, which often resembles parasitic forms, is performed on a portion of sample after a preservative is added to it Micro scopic analysis of the resultant processed sample follows. This traditional parasite recov ery method, often referred to as an O&P, in which “O” stands for ova (eggs) and “P” stands for parasites, is still widely used today Stool and blood has different processes Giemsa stain in Blood. Other specimens, such as blood, are traditionally processed differ ently. For example, a Giemsa stain followed by microscopic examination is the procedure of choice for blood samples submitted for parasite study. Cello phane tape preparation, a methodology for recovery of pinworm eggs, and the Enterotest (string test) for recovery of several parasites are among the traditional tests. ultimately reported. Suspicious forms that visu ally resemble parasites in terms of size and mor phology are commonly encountered and are often referred to as artifacts and/or confusers. Entamoeba histolytica cyst (described in detail in Chapter 3), a single-celled eukaryotic animal known as a protozoa, typi cally measures 12 to 18 microns (µm), a mea surement defined as one millionth of a meter (10−6 m). Which of the following specimen type is most often submitted for parasite study? (Objective 1-16) A. Blood B. Sputum C. Urine D. Stool Which of the following correctly represents the three major groups of clinically significant parasites? (Objec tive 1-20) A. Protozoa—worms; Metazoa—single-celled para sites; Arthropods—insects and their allies B. Protozoa—insects and their allies; Metazoa— worms; Arthropods—single-celled parasites C. Protozoa—single-celled parasites; Metazoa— worms; Arthropods—insects and their allies D. Protozoa—single-celled parasites; Metazoa— insects and their allies; Arthropods—worms CHAPTER 1 CASE STUDY 1-1 UNDER THE MICROSCOPE Joe, a third-year medical student, presented to his physi cian complaining of severe diarrhea and abdominal pain and cramping. Patient history revealed that Joe recently returned home after a 3-month medical missionary trip to Haiti. Suspecting that Joe might be suffering from a para sitic infection, his physician ordered a battery of tests, including a stool sample for parasite examination using a traditional O&P technique. Questions and Issues for Consideration 1. What is a parasite? (Objective 1-21B) 2. Indicate where Joe might have come into contact with parasites and identify the factors that likely contributed to this contact. (Objective 1-21D) 3. Name two other populations that are at risk of contract ing parasitic infections. (Objective 1-21D) 4. Name two other symptoms associated with parasitic infections that individuals like Joe may experience. (Objective 1-21D) 5. What are the key components of a traditional O&P examination? (Objective 1-21B) CHAPTER 1 Case Study 1-1: Under the Microscope 1. A parasite is an organism that gains it nour ishment from and lives in or on another organism.  2. Joe most likely came into contact with parasites during his mission trip to Haiti. Increased pop ulation density, poor sanitation, marginal water sources, poor public health practices, and envi ronmental changes are all factors that might have contributed to Joe’s current condition. 3. Other populations at risk for contracting para site infections include the following: (1) indi viduals in underdeveloped areas/countries; (2) refugees; (3) immigrants; (4) visitors from foreign countries; (5) immunocompromised individuals; (6) individuals living in close quar ters; and (7) children attending day care centers. 4. The most likely additional symptoms of indi viduals with intestinal parasitic infections are fever and chills. 5. The key components of a traditional O&P study include direct macroscopic and micro scopic examination and microscopic exami nation of the sample following a fecal debris removal process. Quick test Which of the following are key discoveries that contributed to current knowledge about parasites? (Objective 1-2) A. Consistent status quo preservation of samples B. Techniques that indicate only the presence or absence of parasites C. Modifications of traditional parasite identification techniques D. Decrease in parasite incidence because of global trave Which of the following people may be at risk for contracting a parasitic infection? (Objective 1-5) A. A toddler who attends an all-day preschool or day care center B. A 25-year-old man who lives on his own in an apartment complex C. A 37-year-old South American refugee D. More than one of these: _______________ (specify) D. A AND C The primary function of a host in a parasite-host relationship is to: (Objective 1-7) A. Carry on the parasite’s life cycle. B. Provide immunologic protection for the host. C. Carry on the host’s life cycle. D. Provide a food source for the host Which of the following key pieces of information may be extracted from the portion of a parasite’s life cycle that occurs outside the body? (Objective 1-11) A. Parasitic disease symptoms and disease processes B. Epidemiology and prevention and control measures C. Appropriate parasite diagnosis methodologies D. Selection of appropriate antiparasitic medication Which of the following groups of symptoms repre sents those most commonly observed in parasitic infections? (Objective 1-13) A. Diarrhea, abdominal cramping, and anemia B. Enlargement of the spleen, fever, and chills C. Skin lesions, abdominal pain, and diarrhea D. Abdominal cramping, abdominal pain, and diarrhea Which of the following represent examples of avail able treatment therapies to combat parasitic infec tions? (Objective 1-14) A. Regulated exercise plan B. Change in diet C. Avoidance of vitamin supplements D. More than one of these: ______________ (specify Which of the following are examples of possible parasite prevention and control measures? (Objective 1-15) A. Avoiding the use of insecticides B. Practicing unprotected sex C. Practicing proper sanitation practices D. More than one of these: ________________ (specify Which of the following correctly represents the three major groups of clinically significant parasites? (Objec tive 1-20) A. Protozoa—worms; Metazoa—single-celled para sites; Arthropods—insects and their allies B. Protozoa—insects and their allies; Metazoa— worms; Arthropods—single-celled parasites C. Protozoa—single-celled parasites; Metazoa— worms; Arthropods—insects and their allies D. Protozoa—single-celled parasites; Metazoa— insects and their allies; Arthropods— worms Column A Column B ___ A. Ectoparasite 1. The form of a parasite that enters a host ___ B. Obligatory parasite 2. Two organisms of different species living together ___ C. Infective stage 3. The official units of parasite measurement ___ D. Commensalism 4. A parasite that cannot survive outside its host ___ E. Disease 5. An insect that transports a parasite from an infected host to an uninfected host ___ F. Microns 6. A parasite that lives on the outside surface of its host ___ G. Transport host 7. Parasite-harboring host that is not affected by its presence but can shed the parasite and infect others ___ H. Vector 8. A destructive process that has characteristic symptoms ___ I. Symbiosis 9. Association of two different species of organisms that is beneficial to one but neutral to the other ___ J. Carrier 10. A host responsible for transferring a parasite from one location to another 1-1. A. 6 B. 4 C. 1 D. 9 E. 8 F. 3 G. 10 H. 5 I. 2 J. 7 1-2. In what parts of the world are parasites endemic, and what factors contribute to their occurrence in these areas? (Objec tive 1-3 1-3. Why is there an increased prevalence of parasites in nonendemic areas of the world (Objective 1-4) 1-4. What are some of the primary modes of parasitic transmission? (Objective 1-6) 1-5. Suppose that you have been asked to design a one-page informational flyer on parasite-host relationships. Identify the types of parasites, hosts, and parasite-host relationships that you should include in your flyer. (Objective 1-8) A. Types of parasites B. Types of hosts C. Types of parasite-host relationships Optional activity: Design the actual flyer and share with classmates. (Objective 1-21) 1-6. Give one example of a parasite defense mechanism that serves to protect it from a host’s immune system. (Objective 1-9) 1-7. What are the two common phases of a parasitic life cycle? (Objective 1-10) 1-8. Refer to question 1-7. What key pieces of information may be extracted from each of the two common phases of a parasitic life cycle? (Objective 1-11) 1-9. Which of the following major body areas may be affected as the result of a parasitic infection? (Objective 1-12) A. Gastrointestinal tract B. Respiratory tract C. Blood and tissue D. Liver and lung E. More than one of these: ___________ (specify) 1-10. Which of the following are examples of newer parasite recovery techniques? (Objec tive 1-18) A. Carbohydrate immunoassays B. RNA hybridization techniques C. PCR D. Immunochromatographic techniques E. More than one of these: _______________ (specify) 1-11. What are the three groups of clinically significant parasites? (Objective 1-19) 1-12. Suppose you are asked to speak to a group of grade school–aged children who are preparing to go on a class picnic. The students are currently learning the basics about parasites in their science class. You have been asked to speak about possible parasite prevention and control strategies for the upcoming class outing. What strat egies would you discuss with these stu dents? (Objective 1-21) 1-13. Refer to question 1-12. The session with the students went so well that the teacher would like you to take this project to the next level. Design an infor mational brochure with these strategies detailed, written at a grade school level. (Objective 1-21) 1-14. Suppose that you and a friend are studying for parasitology class together. Your friend is having great difficulty visualizing the concept of parasite life cycles, including the difference between the two common phases and the information derived from each phase. Your friend has asked you for help. Using Figure 1-1 as a guide, con struct your version of a generic parasite life cycle in a format that is easy to read and follow. (Objective 1-21) 1-3. Parasites are endemic in underdeveloped tropical and subtropical countries and areas around the world. Examples of these places include Guatemala, Myanmar (Burma), and Africa. Factors that con tribute to their presence include the fol lowing: (1) increased population density; (2) poor sanitation; (3) marginal water  sources; (4) poor public health practices; (5) environmental changes affecting vector breeding areas; and (6) habits and customs of the inhabitants. 1-4. 1-3. The increasing prevalence of world travel accounts for the increased incidence of parasitic infections in nonendemic areas of the world. 1-5. 1-4. Primary modes of parasitic transmission include the following: (1) ingestion of con taminated food or drink; (2) hand-to mouth transfer; (3) insect bite; (4) entry via drilling through the skin; (5) unprotected sexual relations; (6) mouth-to-mouth contact; (7) droplet contamination; and (8) eye contact with infected swimming water. 1-6. 1-5. A. Types of parasites: Endoparasites, ectoparasites, obligatory parasites and facultative parasites. B. Types of host: Accidental or inciden tal hosts, definitive hosts, intermedi ate hosts, reservoir hosts, transport hosts, and vectors. C. Types of parasite-host relationships: Symbiosis, commensalisms, mutual ism, and parasitism; in some cases the association may become pathogenic. Optional activity: Any reasonable infor mational flyer is considered acceptable. Follow your instructor’s guidelines and requirements for completion; creativity is encouraged. Keep the audience in mind and use wording that the audience will understand. 1-7. 1-6. Parasites have the ability to alter their makeup so that the host will not recog nize its presence as being foreign will therefore not mount an immune response against it. This in turn often creates an environment that is conducive for para site establishment. 1-8. 1-7. The two common phases of a parasitic life cycle are the following: (1) occurs when the parasite is in or on the human body and: (2) occurs independently from the human body 1-9. (1) When parasite is in or on the human body: Provides information about the method of diagnosis, symptomatol ogy, pathology and selection of appro priate antiparasitic medication. (2) When parasite is independent of the human body: Provides information about epidemiology, prevention, and control. 1-10. 1-9. E (A, B, C, and D) 1-11. 1-10. E (C and D) 1-12. 1-11. The three groups of clinically significant parasites areas follows: (1) Protozoa, single-celled parasites; (2) Metazoa, mul ticellular worms (helminths); and Anima lia, arthropods. 1-13. 1-12. Possible prevention and control strate gies include the following: (1) practicing good hygiene and sanitation practices; (2) protecting picnic food from flies; (3) proper handling and preparation of food; and (4) educating at-risk individuals regarding the proper use of insecticides and other chemicals. 1-14. 1-13. Any reasonable informational flyer is con sidered acceptable; follow your instruc tor’s guidelines and requirements for completion. Creativity is encouraged. Keep the audience in mind and use wording that the audience will understand. 1-15. 1-14. Any reasonable generic life cycle is con sidered acceptable; the use of illustra tions and key words and phrases is encouraged. Follow your instructor’s guidelines and requirements for comple tion; creativity is encouraged. It is impor tant that two life cycle phases (those that occur when the parasite is in or on the human body and independently from the human body) are clearly distinguished and delineated. Cestodes CASE STUDY 10-1 UNDER THE MICROSCOPE A 14-year-old, severely mentally disabled boy, who was institutionalized in a state facility, was evaluated for epi sodes of chronic diarrhea, anal pruritis, restless nights, and occasional vomiting. Significant laboratory findings were a 10% eosinophilia, an IgE level of 225 IU/mL, and micro scopic examination of a stool concentrate that revealed two thin-shelled, oval-shaped eggs measuring 45 by 35 um in size and containing three pairs of hooklets and polar filaments. Questions and Issues for Consideration 1. What is the most likely identification of the parasite in question? (Objective 10-11A) 2. Why is this organism unique among the intestinal ces todes? (Objective 10-9) 3. What is the preferred treatment for infection caused by this organism? (Objective 10- 11D) Quick Quiz! 10-1 The cestode morphologic form characterized by a segmented appearance that houses male and female reproductive structures is referred to as a(an): (Objec tive 10-1) A. Scolex B. Proglottid C. Egg D. Cyst Quick Quiz! 10-2 Characteristics of the cestodes include all the follow ing except: (Objective 10-9) A. They are hermaphroditic. B. They generally require intermediate host(s). C. Their laboratory diagnosis consists of finding larvae in feces. D. Their anatomic regions include the scolex, neck, and strobila Quick Quiz! 10-3 A persistent cough, localized pain, and liver and lung involvement are associated with an infection with which of the following cestodes? (Objective 10-6) A. Diphyllobothrium latum B. Echinococcus granulosus C. Both A and B D. Neither A nor B Quick Quiz! 10-4 Which of the following are key distinguishing factors in differentiating an infection between T. saginata and T. solium? (Objective 10-9) A. Egg morphology and number of uterine branches in proglottid B. Presence of hooklets on scolex and egg morphology C. Presence of hooklets and number of uterine branches in proglottid D. Egg morphology and presence of suckers on scolex Quick Quiz! 10-5 The primary means of developing an intestinal infec tion with Taenia spp. is via which of the following? (Objective 10-5) A. Skin penetration of larvae B. Ingestion of raw or poorly cooked meat C. Egg consumption D. Drinking contaminated water Quick Quiz! 10-6 Which is the preferred drug for treating intestinal infection by Taenia spp.? (Objective 10-7) A. Praziquantel B. Penicillin C. Nicolasamide D. Pentamidine Quick Quiz! 10-7 Which of the following is characteristic of an H. diminuta egg? (Objective 10-10A) A. Spherical, with radial striations B. Ellipsoid, with terminal polar plugs C. Oval, with thin shell and polar filaments D. Oval, with polar thickenings and no filaments Quick Quiz! 10-8 The infective stage of H. diminuta for humans is which of the following? (Objective 10-5) A. Rhabditiform larva B. Cysticeroid larva C. Embryonated egg D. Encysted form Quick Quiz! 10-9 Prevention and control measures against H. diminuta include all except which of the following? (Objec tive 10-7B) A. Vaccination program B. Effective rodent control C. Inspection of food prior to consumption D. Protection of food from rodents Quick Quiz! 10-10 A primary differential feature between an H. nana egg and H. diminuta egg is which of the following? (Objective 10-9) A. A flattened side for H. diminuta egg B. A thick shell for H. nana egg C. Polar filaments in H. nana egg D. Radial striations in H. diminuta egg Quick Quiz! 10-11 The characteristic of the life cycle of H. nana that differentiates it from the other cestodes is which of the following? (Objective 10-9) A. Lack of an intermediate host. B. Infective larval stage. C. Need for external environment D. Larval passage through the lungs Quick Quiz! 10-12 Which of the following does not apply to H. nana? (Objectives 10-3, 10-6, 10-7A, 10- 7B)  A. Dwarf tapeworm B. Steatorrhea C. Proper hygiene and sanitation procedures D. Praziquantel therapy Quick Quiz! 10-13 A unique characteristic of Dipylidium caninum is which of the following? (Objective 10- 10A) A. Lack of suckers on the scolex B. Formation of egg packets C. Proglottid resemblance to Taenia solium D. Alternation of female and male proglottids Quick Quiz! 10-14 A 2-year-old girl and her pet dog were diagnosed with D. caninum infection. This infection was acquired by which of the following? (Objective 10-5) A. Ingestion of the parasite’s egg B. Penetration of soil larva C. Ingestion of a flea D. Consumption of poorly cooked beef Quick Quiz! 10-15 Prevention and control measures to prevent D. caninum infection include all except which of the following? (Objective 10-7B) A. Treat dog and cat pets to prevent fleas. B. Warn children against dog and cat licks. C. Deworm dog and cat pets, as needed. D. Neuter dog and cat pets Quick Quiz! 10-16 The egg of D. latum is unique among the cestodes in that it contains which of the following? (Objective 10-10A) A. An operculum and terminal knob B. Radial striations and oncosphere C. An operculum and lateral spine D. A ciliated rhabditiform larva Quick Quiz! 10-17 Which of the following associations is correct for D. latum? (Objective 10-5) A. Snail-coracidium B. Copepod-procercoid C. Fish-cysticercus D. Beetle-pleurocercoid Quick Quiz! 10-18 The primary pathology associated with a D. latum infection is which of the following? (Objective 10-6) A. Eosinophilic pneumonitis B. Vitamin D deficiency C. Vitamin B12 deficiency D. Fat malabsorption Quick Quiz! 10-19 Which of the following procedures would not be appropriate for diagnosing an infection with Echino coccus granulosus? (Objective 10-8) A. Serologic procedure, such as ELISA B. O&P examination of stool specimen C. CT scan of suspect organ D. Biopsy of cyst  Quick Quiz! 10-20 In humans, Echinococcus granulosus infection results in which of the following? (Objective 10-5) A. Eggs similar to those of H. nana B. A nutritional deficiency C. A hydatid cyst D. Filariform larva Quick Quiz! 10-21 Which of the following is not a usual site for Echino coccus granulosus infection in humans? (Objective 10-8) A. Brain B. Liver C. Lung D. Genitalia 10-1. Match each of the key terms (column A) with the corresponding definition (column B). (Objective 10-1) Column A Column B ___ A. Hermaphroditic 1. Smaller cyst within a hydatid cyst ___ B. Scolex 2. Series of proglottids ___ C. Zoonotic 3. Contains both male and female organs ___ D. Oncosphere 4. Develops from a procercoid larva ___ E. Cysticerus 5. Segment of a tapeworm ___ F. Brood capsule 6. Free-swimming larva of D. latum ___ G. Strobila 7. Acquired from animals ___ H. Proglottid 8. Hexacanth embryo ___ I. Coracidium 9. Head of a tapeworm ___ J. Sparaganosis 10. Larval form of Taenia spp. 10-2. State the common name of each of the following cestodes. (Objective 10-3) A. Taenia saginata B. Dipylidium caninum C. Hymenolepis nana D. Diphyllobothrium latum E. Taenia solium F. Echinococcus granulosus G. Hymenolepis diminuta 10-3. In what parts of the world is Diphyllo bothrium latum endemic? (Objective 10-2 10-4. Specify the infective stage name for each of the cestodes listed in question 10-2. (Objective 10-5) 10-5. What is the pathology most commonly associated with each of the following? (Objective 10-6) A. Diphyllobothrium latum B. Echinococcus granulosus 10-6. What is the specimen of choice for the laboratory diagnosis of each cestode listed in question 10-2? (Objective 10-8) 10-7. Describe the appearance of the scolex of the cestodes listed in question 10-2. (Objective 10-9). 10-8. Differentiate the proglottids of Taenia sagninata and Taenia solium. (Objec tive 10-9). 10-9. A 30-year-old recent immigrant from Mexico, living in Colorado, presented to the Hispanic Health Clinic after experi encing a seizure at his worksite His history revealed numerous headaches for several weeks. The basic neurologic examination was normal; however, fearing a malig nancy, the physician ordered a CT scan. Calcified lesions were noted. A biopsy revealed a parasitic infection. What organism is suspected? (Objective 10-11A) 10-10. A 55-year-old man and his family had returned to the United States after a visit to his native Finland. While there, he enjoyed fishing and cooking the fish over an open fire. After his return, he visited his physician with complaints of diar rhea, abdominal pain, and some cramp ing. Bacterial culture of a stool specimen was negative for enteric pathogens. However, the microscopic O&P exami nation revealed several large, oval, oper culated eggs. With this brief history, which tapeworm is suspected? (Objective 10-11A CASE STUDY 10-2 UNDER THE MICROSCOPE Renota, a 51-year-old Slavic woman, lived in Romania with her family on a pig farm. She routinely slaughtered pigs and cooked pork for family meals. She had a wide variety of recipes that called for pork. A few days after preparing one of her famous pork dishes, Renota experi enced diarrhea, abdominal pain, and chronic indigestion. She went to her family physician and explained her symp toms to him. The physician, who knew the family well and was familiar with the family business, immediately sus pected a bacterial or parasitic infection. A stool sample for routine bacterial culture and O&P study was collected from Renota and submitted to the local diagnostic laboratory. Routine processing procedures were conducted on the stool sample. Gross examination of the stool revealed a portion of the infecting worm (Fig. A). An egg, measuring 36 by 25 um (Fig. B), was seen on the permanent O&P slide. No intestinal bacterial pathogens were isolated. Questions and Issues for Consideration 1. What is the morphologic form of Figure A? (Objective 10-11A) 2. Label the designated structures in Figures A and B. (Objective 10-10A) 3. Which genus of organism do you suspect? Which species? (Objective 10-11A) 4. What is the common name for this parasite? (Objective 10-11A) 5. Which of the figures shown here, A or B, is most helpful for speciating this parasite? Why? (Objective 10-9) 6. Note the differential characteristics of this species compared with those of its closest relative species. CHAPTER 10 Case 10-1: Under the Microscope 1. Hymenolepis nana. 2. No intermediate host is required. 3. Adult worm develops in humans following ingestion of an egg. 4. Praziquantel. Case 10-2: Under the Microscope 1. Proglottid. 2. A, Uterine branches; B, radial striations; C, hexacanth embryo; D, hooklets. 3. Taenia solium. 4. Pork tapeworm. 5. The proglottids of T. solium differ from T. saginata in that the latter has 15 to 30 uterine branches, whereas the former possesses less than 15 uterine branches. Eggs of both organ isms are identical morphologically. 6. See E. Also, the rostellum of T. solium possess hooklets, whereas that of T. saginata pos sesses no hooklets CHAPTER 10 10-1. B 10-2. C 10-3. B 10-4 C 10-5. B 10-6. A 10-7. D 10-8. B 10-9. A 10-10. C 10-11. A 10-12. B 10-13. B 10-14. C 10-15. D 10-16. A 10-17. B 10-18. C 10-19. B 10-20. C 10-21. D 10-1. A. 3 B. 9 C. 7 D. 8 E. 10 F. 1 G. 2 H. 5 I. 6 J. 4 10-2. A. Beef tapeworm. B. Dog and cat tapeworm; pumpkin seed tapeworm. C. Dwarf tapeworm. D. Fish tapeworm E. Pork tapeworm. F. Hydatid tapeworm; dog tapeworm, less commonly. G. Rat tapeworm. 10-3. Great Lakes region; parts of South America, Asia; Central Africa; Baltic region; Finland. 10-4. A. Cysticercus. B. Cysticercoid larva (in flea). C. Egg. D. Plerocercoid. E. Cysticercus. F. Egg. G. Cysticercoid larva (in beetle or flea). 10-5. A. Vitamin B12 deficiency. B. Cyst development in various organs. 10-6. A. Stool. B. Stool. C. Stool. D. Stool. E. Stool. F. Serum specimen for serology or biopsy. G. Stool. 10-7. A. Four suckers and no hooks. B. Four suckers and rows of tiny hook like spines. C. Four suckers and short rostellum with one row of hooks. D. Lateral sucking grooves. E. Four suckers with two rows of hooks. F. Four suckers and up to 36 hooks. G. Four suckers and rostellum with no hooks. 10-8. Taenia saginata proglottids have 15 to 30 lateral uterine branches, whereas Taenia solium has less than 15 lateral uterine branches. 10-9. Taenia solium. 10-10. Diphyllobothrium latum. TREMATODES CASE STUDY 11-1 UNDER THE MICROSCOPE Mr. Park, a 62-year-old Korean man, was seen for fatigue, fever, and abdominal pain. On questioning the patient, it was learned that Mr. Park is a commercial fisherman. His liver function test results were abnormal, showing elevated aspartate aminotransferase (350 IU/liter), alanine amino transferase (352 IU/liter), alkaline phosphatase (204 IU/ liter), and conjugated bilirubin (3.9 mg per deciliter) levels; total bilirubin was 6.4 mg/dL. His white blood cell (WBC) count was 13,000/mm3 and eosinophilia value was 26%. A computed tomography (CT) scan of the abdomen showed dilation of the common bile duct. A tube was inserted into the common bile duct and numerous leaf-shaped worms were aspirated. The patient was given praziquantel and had a quick and uneventful recovery. Questions and Issues for Consideration 1. What parasite(s) do you suspect? Why? (Objective 11-11A) 2. Briefly describe the life cycle of the parasite(s). (Objec tive 11-11C) 3. What is the name of the disease/condition associated with this parasite? (Objective 11-11B) 4. Propose a plan that Mr. Park could follow to prevent future encounters with this parasite. (Objective 11-11D) Eosinophilia is a condition in which there is an increase in the number of eosinophils (a type of white blood cell) in the blood. Eosinophils are part of the body's immune system and play a role in responding to infections, especially those caused by parasites, as well as in allergic reactions and inflammation. The first intermediate host for all the trematodes is which of the following? (Objective 11-5) A. Fish B. Snail C. Shrimp D. Water plant Adult trematodes are readily recoverable in clinical samples. (Objective 11-5) A. True B. False Individuals suffering from trematode infections expe rience a variety of species-dependent symptoms. (Objective 11-6) A. True B. False Fasciolopsis buski infects which organ in humans? (Objective 11-5) A. Bile ducts B. Liver C. Colon D. Small intestine Quick Quiz! 11-5 The determination of Fasciolopsis versus Fasciola can only be accomplished in the laboratory by the recov ery of which of the following? (Objective 11-5) A. Eggs B. Larvae C. Adults D. Sporocysts Quick Quiz! 11-6 The eggs of Fasciolopsis and Fasciola possess a caplike structure from which their contents are released under the appropriate conditions; this is called a (an): (Objective 11-1) A. Operculum B. Shoulder C. Coracidium D. Digenea Quick Quiz! 11-7 The number of Clonorchis cases has tripled in which country because of aquaculture? (Objective 11-2) A. Japan B. Vietnam C. China D. Korea Quick Quiz! 11-8 What procedures must be done to recover the adult form of Clonorchis sinensis? (Objective 11-8) A. Direct examination of stool and after autopsy B. Direct and concentration examinations of stool C. Following surgery and after autopsy D. Following surgery and duodenal aspiration Quick Quiz! 11-9 Which of the following is a recommended prevention and control strategy designed to halt the spread of Clonorchis? (Objective 11-7B) A. Consuming raw, pickled, freshwater fish B. Protecting food from flies C. Avoidance of swimming in fresh water D. Proper human and reservoir host fecal disposal Quick Quiz! 11-10 The key feature that distinguishes Heterophyes from Clonorchis is which of the following? (Objective 11-9) A. Size B. Shape C. Appearance of shoulders D. Location of operculum Quick Quiz! 11-11 The treatment of choice for Heterophyes and Meta gonimus is which of the following? (Objective 11-7A) A. Niclosamide B. Praziquantel C. Pyrantel pamoate D. Metronidazole Quick Quiz! 11-12 The specimen of choice for the recovery of Hetero phyes and Metagonimus is which of the following? (Objective 11-8) A. Stool B. Duodenal contents C. Urine D. Sputum Quick Quiz! 11-13 In addition to its typical location, Paragonimus eggs are also known to cause serious complications when recovered in which of the following? (Objective 11-8) A. Bile B. Cerebrospinal fluid C. Brain tissue D. Feces  Quick Quiz! 11-14 A key feature that distinguishes Paragonimus from the other trematode eggs is which of the following? (Objective 11-9) A. Prominent operculum B. Obvious terminal shell thickening C. Discrete shoulders D. Three pairs of hooklets Quick Quiz! 11-15 The typical transmission route of Paragonimus to humans consists of which of the following? (Objec tive 11-5) A. Consumption of contaminated crayfish or crabs B. Swimming in contaminated water C. Hand-to-mouth contamination D. Walking barefoot on contaminated sandy soil Quick Quiz! 11-16 The adults of this species of Schistosoma dwell in the veins surrounding the urinary bladder: (Objec tive 11-5) A. S. haematobium B. S. mansoni C. S. japonicum D. All of the above Quick Quiz! 11-17 The specimen of choice for the recovery of Schisto soma japonicum is which of the following? (Objec tive 11-8) A. Tissue biopsy B. Urine C. Sputum D. Stool Quick Quiz! 11-18 A systemic hypersensitivity reaction caused by the presence of Schistosoma is called which of the fol lowing? (Objective 1-1) A. Bilharziasis B. Katayama fever C. Swamp fever D. Schistosomiasis 11-1. Trematodes that mature in the lung and produce eggs that appear in the sputum are most probably which of the follow ing? (Objective 11-5) A. Fasciolopsis buski B. Schistosoma japonicum C. Paragonimus westermani D. Clonorchis sinensis 11-2. Consumption of the infective larval stage encysted on aquatic plants that have not been cooked results in infection with: (Objective 11-5) A. Clonorchis sinensis B. Fasciola hepatica C. Heterophyes heterophyes D. Paragonimus westermani 11-3. The largest fluke infecting humans mea suring as much as 5 cm in length is which of the following? (Objective 11-9) A. Fasciolopsis buski B. Fasciola hepatica C. Paragonimus westermani D. Clonorchis sinensis 11-4. A schistosoma egg with a terminal spine would be most likely found in which of the following? (Objective 11-9) A. Feces B. Bile C. Sputum D. Urine 11-5. The infective form of Schistosoma mansoni is which of the following? (Objective 11-5) A. Cercaria swimming in water B. Metacercaria on or in fish C. Metacercaria encysted on water chestnuts or vegetables D. Cercaria on water chestnuts, bamboo shoots, or vegetables 11-6. In the life cycle of hermaphroditic flukes, the infective stage for the snail is which of the following? (Objective 11-5) A. Cercaria B. Miracidium C. Metacercaria D. Redia  11-7. The adult form of the sheep liver fluke produces large, ovoid, unembryonated eggs with a yellowish-brown shell and an inconspicuous operculum. These eggs are morphologically most similar to which of the following? Objective 10-9) A. Fasciola hepatica B. Fasciolopsis buski C. Clonorchis sinensis D. Paragonimus westermani 11-8. The incidence of small, yellowish, oval, operculated eggs with a short, comma like extension of the shell opposite the operculum increased markedly in stools examined in the United States with the influx of refugees from Vietnam and nearby countries. Although not transmit ted in the United States, human infection in endemic areas is acquired by which of the following? (Objective 11-5) A. Consumption of infected water vegetation B. Direct larval penetration of human skin C. Eating infected crabs or crayfish D. Ingestion of infected fresh water fish 11-9. A child visited his grandparents in rural Egypt for a summer. While there, he played in irrigation ditches and devel oped salmonellosis. Blood cultures were positive for Salmonella and a stool examination revealed eggs of a parasite common to that part of the world. The egg would appear as which of the follow ing? (Objective 11-10A) A. Large (80 × 140 µm), with an operculum B. Oval (40 × 48 µm), with a mammil lated coat C. Small (12 × 30 µm), with an operculum D. Large (60 × 150 µm), with a large lateral spine 11-10. Match the host for metacercariae with the parasite. Answers can be used more than once. (Objective 11-5) Column A Column B A. Fish B. Water plants C. Crawfish 1. Fasciolopsis buski 2. Fasciola hepatica 3. Clonorchis sinensis 4. Paragonimus westermani 5. Metagonimus yokogawai 6. Heterophyes heterophyes CASE STUDY 11-2 UNDER THE MICROSCOPE Anthony, a 30-year-old Italian man, worked as an archeolo gist in the Nile Valley. Anthony and his team recently made an important historical discovery, the Providence Stone. This stone allows a person’s mind and soul on his or her death to be transferred into another person’s body. To cel ebrate this find, the team went out to a local pub for champagne and escargot (snails). The team members became somewhat rowdy and insisted on ending the evening with a dip in the Nile. Approximately 1 month later, Anthony experienced increased urination with spots of blood. He was also fre quently tired and complained of a slight fever. Anthony explained his symptoms to a local physician and was asked if he had eaten or done anything unusual lately. Embar rassed, Anthony admitted only to an early morning swim in the Nile. On examination, the physician ordered a com plete blood count (CBC), Chem 6 (a battery of chemistry tests for Na+ , K+ , Cl− , CO2, glucose, and BUN-blood urea nitrogen), and urinalysis (UA). The samples were sent to a laboratory. The CBC revealed eosinophilia. The Chem 6 results were normal. The UA showed a trace of blood. Microscopic examination of the concentrated urine showed a yellowish-brown ovoid organism that measured approximately 115 by 50 µm. Questions and Issues for Consideration 1. What parasite, including its morphologic form, is sus pected? (Objective 11-11A) 2. Name the disease caused by this parasite. (Objective 11-11B) 3. What is the first intermediate host associated with the life cycle of this parasite? (Objective 11-11C) 4. What is the mode of transmission for this parasite? (Objective 11-11C) CHAPTER 11 11-1. B 11-2. B 11-3. A 11-4. D 11-5. C 11-6. A 11-7. C 11-8. C 11-9. D 11-10. C 11-11. B 11-12. A 11-13. C 11-14. B 11-15. A 11-16. A 11-17. D 11-18. B CHAPTER 11 11-1. C 11-2. B 11-3. A 11-4. D 11-5. A 11-6. B 11-7. B 11-8. C 11-9. D 11-10. 1. B 2. B 3. A 4. C 5. A 6. A CHAPTER 11 Case Study 11-1: Under the Microscope 1. Clonorchis sinensis. The other trematodes that cause infections from eating raw fish, metagonimiasis and heterophyiasis, live in the intestine, not the liver 2. Human infection occurs following the inges tion of undercooked fish contaminated with encysted metacercariae. Maturation of the immature flukes takes place in the liver. The adult worms take up residence in the bile duct. Eggs are passed in bile to the intestine, where they can be identified in feces. On contact with fresh water, the miracidium emerges from each egg. Specific species of snails serve as the first intermediate host. The miracidium penetrates into the snail, where a sporocyst develops. Numerous rediae result and ultimately produce many cercariae. The cercariae emerge from the snail and enter a fish, where they encyst. 3. Clonorchiasis. 4. Appropriate strategies in a prevention plan include practicing proper sanitation proce dures, especially the practice of proper human and reservoir host feces disposal, and avoiding the practice of consuming raw, undercooked, or freshly pickled freshwater fish and shrimp. Case Study 11-2: Under the Microscope 1. Eggs of Schistosoma haematobium. 2. Schistosomiasis, bilharziasis. 3. Snail. 4. Penetration of cercariae through the skin that takes place when unsuspecting humans swim in contaminated fresh water