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Demonstration of parasitic

infection involved in the respiratory system

Parasitic infection in respiratory system

Objectives

Pneumocystis jiroveci

Paragonimus heterotremus

Hydatid cyst of Echinococcus

Egg of:

- Ascaris lumbricoides

Larva of:

- Hookworm

- Strongyloides stercoralis

- Toxocara

เพื่อให้นักศกึษาอธิบายได้เก่ียวกับรูปร่างลักษณะของปรสิตที่เกี่ยวข้องกับระบบหายใจ

Life cycle of Pneumocystis jireveci

Bogitsh BJ et al, 2005: p162

toluidine blue

Pneumocystis jiroveci Disease: PCP, Pneumocystis jiroveci pneumonia or

Pneumocystis pneumonia

Cyst 4-8 um

- ระยะ cyst ในน ้ำล้ำงถงุลมปอด ย้อมด้วยสี Gomeri methenamine silver (GMS) - พบเช้ืออยู่รวมกนัเป็นกลุ่มๆ ผนังซีสตติ์ดสีเทำ หรือด ำ - ซีสตร์ปูร่ำงกลม บำงซีสตอ์ำจเห่ียวย่น หรือ รปูพระจนัทรเ์ส้ียว - ภำยในไม่ติดสี intracystic body

Pneumocystis jiroveci

Morphology of Pneumocystis jireveci

Morphology of Pneumocystis jireveci

- ระยะ cyst ในน ้ำล้ำงถงุลมปอด (bronchoalveolar larvage, BAL) ย้อมสี Giemsa - พบเช้ืออยู่รวมกนัเป็นกลุ่มๆ ผนังซีสตไ์ม่ติดสี - ซีสตร์ปูรำ่งกลม ใส ขนำด 4-8 ไมโครเมตร - ภำยในติดสีม่วงเข้มของ intracystic bodies ขนำดเลก็ๆ จ ำนวน 1-8 เมด็

Pneumocystis jiroveci

Pathogenesis of PCP

Fibrosis in septal walls

H&E staining of lung

biopsy or section

Bilateral-diffused

Radiography by X-ray

วงจรชวีติ Paragonimus spp.

Paragonimus spp. Disease: Pulmonary paragonimiasis

Extrapulmonary paragonimiasis

P. heterotremus P. westermani

2 mm

Paragonimus spp. egg

P. heterotremus P. westermani

เสมหะ+ NaOH

Pulmonary paragonimiasis

CT scan of a patient with paragonimiasis shows

bilateral pleural effusions and thickening of the left pleura with possible cystic change (arrow).

Chest roentgenogram of a patient with

paragonimiasis shows bilateral pleural

effusions and an infiltrate in the lower lobe of the left lung (arrow).

Pulmonary paragonimiasis

Clinical Microbiology Reviews, July 2009, p. 415-446, Vol. 22, No. 3

Pulmonary paragonimiasis

Extrapulmonary paragonimiasis

Life cycle of Echinococus spp.

Echinococcus spp.

Species Disease Host IH E. granulosus cystic echinococcosis or

unilocular hydatidosis

dog herbivores

E. multilocularis alveolar or multilocular

echinococcosis

fox rodent

E. vogeli & E. Oligarthrus

Polycystic echinococcosis

sylvatic animal

rodent

Morphology of Echinococcus spp.

E. granulosus E. multilocularis E. vogeli

E. oligarthrus

E. granulosus

E. multilocularis

Hydatid cyst of E. granulosus

Hydatid sand

Protoscolices

Brood capsule

Germinal layes

Laminated membrane Laminated membrane

Germinal layes

Protoscolices

Brood capsule

Neva FA, & Brown HW, 1994

Hydatid capsule, inner surface, isolated from lung of a Korean woman

inner surface,

Hydatid sand in human lung H&E, X100

A section of human lung shows multiple protoscoleces

Chest P-A. Hydatid cysts in human lung. Two mass shadows are indicated by arrows.

CT finding of hydatid cyst in human lung shows a distinct cyst wall and a clear fluid in the cyst .

Larva & Egg of Nematode

Ascaris lumbricoides

Hookworm

Strongyloides stercoralis

Toxocara

Disease: Pneumonitis Löffler's syndrome (Eosinophilic pneumonia)

Ascaris lumbricoides Disease: Ascariasis Ascaris pneumonitis

Ascaris pneumonitis

Pulmonary ascariasis from larval migration of A. lumbricoides

10-30 cm in length

Ascaris pneumonitis

Löffler's syndrome (Eosinophilic pneumonia)

Ascaris lumbricoides egg in stool

Charcot-Leyden crystal

Necator americanus & Ancylostoma duodenale

Life cycle of

Necator americanus & Ancylostoma duodenale

Filariform larva of hookworm

Life cycle of Strongyloides stercoralis

Life cycle of Strongyloides stercoralis

cervical alae

http://www.dpd.cdc.gov/dpdx/html/imagelibrary/Toxocariasis_il.htm

Toxocara canis larva

anterior

posterior

Objectives

Pneumocystis jiroveci

Paragonimus heterotremus

Hydatid cyst of Echinococcus

Larva of:

- Ascaris lumbricoides

- Hookworm

- Strongyloides stercoralis

- Toxocara

เพื่อให้นักศกึษาอธิบายได้เก่ียวกับรูปร่างลักษณะของปรสิตที่เกี่ยวข้องกับระบบหายใจ

Lab performance

1. Demonstrate

- 4 sets / Lab

2. Group Discussion

References

• Wilkin A and Feinberg J. Pneumocystis carinii pneumonia: a clinical

review. Am Fam Phys 1999;60:1699-1714.

• John G Bartlett and Stefano Vella. Textbook-Atlast of Intestinal Infections

in AIDS

• Medrano FJ et al. "Pneumocystis jirovecii in General Population". Emerg

Infect Dis 2005; 11 (2): 245–250

• Wazir JF, Ansari NA. Pneumocystis carinii infection. Update and review.

Arch Pathol Lab Med 2004; 128:1023-7.

• Markell EK et al. Medical Parasitology. 1999

• www.google.co.th(search image under scientific name/life cycle)

• www.google.co.th (search under scientific name/lecture, power point or

review)

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