Hookworm [Ancylostoma braziliense] [Ancylostoma caninum] [Ancylostoma duodenale] [Necator americanus] The eggs of Ancylostoma and Necator cannot

be differentiated microscopically. The eggs are thin-shelled, colorless and measure 60-75 m by 35-40 m.

A, B: Eggs of H. nana in an unstained wet mount. Note the presence of hooks in the oncosphere and polar filaments within the space between the oncosphere and outer shell.

A, B: Hookworm eggs in unstained wet mounts, taken at 400 magnification.

C: Egg of H. nana in a wet mount. Image courtesy of the Georgia Department of Public Health. D: Egg of H. nana in an unstained formalin ethyl acetate (FEA) wet mount. In this image, four of the hooks in the oncosphere are clearly visible. Image courtesy of the Oregon State Public Health Laboratory.

C, D: Hookworm eggs in unstained wet mounts.

E, F: Eggs of H. nana in an unstained wet mount. In these two images, the polar filaments in the space between the oncosphere and outer shell are clearly visible.

E: Hookworm egg in a wet mount.

Strongyloidiasis Hymenelolepiasis [Hymenolepis diminuta] [Hymenolepis nana] Eggs of Hymenolepis nana. These eggs are oval and smaller than those of H. diminuta, with a size range of 30 to 50 m. On the inner membrane are two poles, from which 4-8 polar filaments spread out between the two membranes. The oncosphere has six hooks. [Strongyloides stercoralis] The first-stage rhabditoid larvae (L1) of Strongyloides stercoralis are 180-380 m long, with a short buccal canal, a rhabditoid esophagus and a prominent genital primordium. These L1 larvae are usually found in stool, as the eggs embryonate and hatch in the mucosa of the small intestine of the host. They may also be found in soil and cultured feces.

A, B: Rhabdititoid larvae of S. stercoralis in unstained wet mounts of stool. Notice the short buccal canal and the genital primordium (red arrows).

C: Close-up of the anterior end of a rhabditoid larva of S. stercoralis showing the short buccal canal (red arrow) and the rhabditoid esophagus (blue arrow). Image taken at 1000x oil magnification. Egg of T. trichiura in an iodine-stained A: D: Rhabditoid larva of S. stercoralis in an unstained wet mount B: Egg of T. trichiura in an unstained wet mount. of stool. Notice the short buccal canal and the genital primordium (red arrow).

wet

mount.

E: Rhabditoid larva of S. stercoralis in an unstained wet mount C: Egg of of T. trichiura in an unstained wet mount. stool. Notice the rhabditoid esophagus (blue arrow) and prominent Eggs of T. trichiura in a wet mount, showing variability in size in D: genital primordium (red arrow). species. the F: Rhabditoid larva of S. stercoralis in an unstained wet mount of stool. Notice the prominent genital primordium (blue arrow), rhabditoid esophagus (red arrow) and short buccal canal (green arrow). F: Egg of T. trichiura in an unstained wet Chilomastix mesnili [Chilomastix mesnili] Chilomastix mesnili is a flagellated protozoan generally regarded as nonpathogenic in the human host. Cysts are usually lemon-shaped and measure 6-10 m in length. They contain a large single nucleus with an eccentrically-located karyosome. The cystosome may also be visible. Taeniasis [Taenia saginata] [T. solium ] The eggs of Taenia solium and T. saginata are indistinguishable from each other, as well as from other members of the Taeniidae. The eggs measure 30-35 micrometers in diameter and are radially-striated. The internal oncosphere contains six refractile hooks. mount of stool. Notice also the presence of a cyst of Entamoeba coli (arrow).

A, B: Cysts of C. mesnili in a concentrated wet mount of stool, stained with iodine. Images taken at 1000x magnification. Trichuriasis [Trichuris trichiura] Trichuris trichiura eggs are 50-55 micrometers by 20-25 micrometers. They are barrel-shaped, thick-shelled and possess a pair of polar plugs at each end. The eggs are unembryonated when passed in stool.

A, B: Taenia spp. eggs in unstained wet mounts.

C: Iodine-stained wet mount of Taenia sp. egg in a formalinconcentrated stool specimen. Image courtesy of the Kansas State Public Health Laboratory. D: Iodine-stained wet mount of a Taenia sp. egg. Image courtesy of the Oregon State Public Health Laboratory.

A, B: G. intestinalis cysts in a wet mount stained with iodine.

E: Unstained Taenia sp. egg, teased from a proglottid of an adult. Four hooks can easily be seen in this image.

C, D: G. intestinalis cysts in a wet mount stained with iodine. Cryptosporidiosis [Cryptosporidium spp.] Cryptosporidium spp. oocysts are rounded and measure 4.2 to 5.4 m in diameter. Sporozoites are sometimes visible inside the oocysts, indicating that sporulation has occurred.

E, F: G. intestinalis cysts in a wet mount stained with iodine. A: Cryptosporidium spp. oocysts (pink arrows) in wet mount. A budding yeast (brown arrow) is in the same field. B: Cryptosporidium parvum oocysts in wet mount, under differential interference contrast (DIC) microscopy. The oocysts are rounded and measure 4.2 m - 5.4 m in diameter. Sporozoites are visible inside the oocysts, indicating that sporulation has occurred. (In comparison, oocysts of Cyclospora cayetanensis, another important coccidian parasite of humans, are twice larger and upon excretion are not sporulated, i.e., do not contain sporocysts.) Giardiasis [Giardia intestinalis (syn. Giardia lamblia)] Giardia intestinalis cysts are oval to ellipsoid and measure 8-19 m (average 10-14 m). Mature cysts have 4 nuclei, while immature cysts have two. Nuclei and fibrils are visible in both iodine-stained wet mounts and trichrome-stained smears. Enterobiasis [Enterobius vermicularis] The eggs of Enterobius vermicularis measure 50-60 m by 20-30 m , are elongate-oval and slightly flattened on one side. They are usually partially-embryonated when shed. Enterobiasis can be diagnosed by applying cellulose tape to the anus of a suspect patient, especially in the morning before the patient's first bowel movement. Eggs will adhere to the tape and can be seen microscopically.

A: Egg of E. vermicularis in an iodine-stained wet mount from a formalin concentrate. Image contributed by the Kansas State Public Health Laboratory. B: Eggs of E. vermicularis in a wet mount.

Ascariasis [Ascaris lumbricoides] Fertilized and unfertilized Ascaris lumbricoides eggs are passed in the stool of the infected host. Fertilized eggs are are rounded and have a thick shell with an external mammillated layer that is often stained brown by bile. In some cases, the outer layer is absent (known as decorticated eggs). Fertile eggs range from 45 to 75 m in length. Unfertilized eggs are elongated and larger than fertile eggs (up to 90 m in length). Their shell is thinner and their mammillated layer is more variable, either with large protuberances or practically none. Unfertile eggs contain mainly a mass of refractile granules. Fertilized egg of A. lumbricoides

A, B: A. lumbricoides decorticated, fertile eggs in wet mounts, 200 magnification.

C: Unfertilized egg of A. lumbricoides in an unstained wet mount of stool. D: Unfertilized egg of A. lumbricoides in a wet mount of stool. Note this specimen lacks the mammillated layer (decorticated). C: A. lumbricoides decorticated, fertile egg in a wet mount, 200 magnification. The embryo has advanced cleavage. D: The same egg as in Image C, but at 400 magnification. Schistosomiasis [Schistosoma haematobium] [Schistosoma intercalatum] Schistosoma japonicum] [Schistosoma mansoni] [Schistosoma mekongi] Schistosoma mansoni

A, B: Fertilized eggs of A. lumbricoides in unstained wet mounts of stool, with embryos in the early stage of development.

A, B: Eggs of S. mansoni in unstained wet mounts. Images courtesy of the Wisconsin State Laboratory of Hygiene. C: Fertilized egg of A. D: Fertilized egg of A. lumbricoides in an unstained wet mount of stool.

C, D: Eggs of S. mansoni in unstained wet mounts. Images courtesy of the Missouri State Public Health Laboratory.

C, D: Eggs of Diphyllobothrium sp. in an unstained wet mount.

Egg of D. latum in an unstained wet mount E, F: Eggs of S. mansoni in unstained wet mounts. Schistosoma haematobium

Intestinal amebae [Endolimax nana] [Entamoeba coli] [Entamoeba gingivalis] [Enta moeba hartmanni] [Entamoeba polecki] [Iodamoeba buetschlii] Endolimax nana Cysts of Endolimax nana are spherical to ellipsoidal in shape and measure 5 to 10 m. Mature cysts possess four nuclei with large, karyosomes and no peripheral chromatin. The nuclei are not visible in unstained wet mounts, but are visible in iodine-stained wet mounts and permanent slides stained with trichrome. The cytoplasm may contain diffuse glycogen, but lacks chromatoid bodies.

C: Egg of S. haematobium in a wet mount of a urine concentrate. B: Eggs of S. haematobium in wet mounts of urine concentrates, showing the characteristic terminal spine. Diphyllobothriasis [Diphyllobothrium latum] [Diphyllobothrium spp.] Diphyllobothrium spp. eggs are oval or ellipsoidal and range in size from 55 to 75 m by 40 to 50 m. There is an operculum at one end that can be inconspicuous, and at the opposite (abopercular) end is a small knob that can be barely discernible. The eggs are passed in the stool unembryonated.

A, B: Eggs of Diphyllobothrium sp. in an unstained wet mount. Note the open operculum in Figure B.

A, B: Cysts of E. nana stained with trichrome.

more than four nuclei in the cyst stage. The nuclei may be seen in unstained as well as stained specimens. Karyosomes may be compact or diffuse, and are usually eccentrically located. Peripheral chromatin is present and is often coarse and granular, and irregularly arranged along the nuclear membrane, but may be more uniform. The cytoplasm of mature cysts may contain diffuse glycogen. Chromatoid bodies are seen less frequently than in E. histolytica. When present, they are usually splinter like with pointed ends and thus different from the chromatoid bodies of E. histolytica, which have rounded ends.

C, D: Cysts of E. nana stained with trichrome. E. coli Cysts of Entamoeba coli are usually spherical, but may be elongated, and measure 10 to 35 m. Mature cysts typically have 8 nuclei but may have as many as 16 or more. Entamoeba coli is the only species in the genus encountered in humans with more than four nuclei in the cyst stage. The nuclei may be seen in unstained as well as stained specimens. Karyosomes may be compact or diffuse, and are usually eccentrically located. Peripheral chromatin is present and is often coarse and granular, and irregularly arranged along the nuclear membrane, but may be more uniform. The cytoplasm of mature cysts may contain diffuse glycogen. Chromatoid bodies are seen less frequently than in E. histolytica. When present, they are usually splinter like with pointed ends and thus different from the chromatoid bodies of E. histolytica, which have rounded ends.

A: Immature cyst of E. coli, stained with trichrome. Notice the presence of only two nuclei, and a large glycogen vacuole. B: Mature cyst of E. coli, stained with trichrome. Five nuclei are visible in this focal plane.

Mature cysts of E. coli, stained with trichrome. In both of these specimens, at least five nuclei are visible in the shown focal plane.

A: Cyst of E. coli in a unstained concentrated wet mount. Six nuclei are visible in this focal plane. B: Cyst of E. coli in a concentrated wet mount stained with iodine. Five nuclei are visible in this focal plane.

Mature cyst of E. coli, stained with trichrome.

Trophozoites of E. coli stained with trichrome.

Cysts of Entamoeba coli are usually spherical, but may be elongated, and measure 10 to 35 m. Mature cysts typically have 8 nuclei but may have as many as 16 or more. Entamoeba coli is the only species in the genus encountered in humans with

Trophozoites of E. coli stained with trichrome. Entamoeba hartmanni

Cysts of Entamoeba hartmanni are similar to those of E. histolytica but smaller, measuring 5-10 m. Mature cysts contain four nuclei that possess a small, discrete centrallylocated karyosome and evenly-distributed peripheral chromatin. Cysts may not be visible in unstained specimens. The cytoplasm in mature cysts may contain diffuse glycogen and rounded or elongated chromatoid bodies with rounded ends.

Cyst of an E. hartmanni in a wet mount, stained with iodine. Entamoeba polecki Cysts of Entamoeba polecki measure 9 to 25 m and are usually uninucleate, but binucleate forms are seen rarely. The nucleus is often large, measuring up to one-third of the diameter of the cyst.

Iodamoeba buetschlii Cysts of Iodamoeba buetschlii vary from being nearly spherical to ellipsoidal, and measure 5-20 m. Cysts contain a single nucleus that is not visible in either unstained or iodine-stained wet mounts. With permanent stains (such as trichrome), the nucleus contains a large, usually eccentric karyosome. Achromatic granules may or may not be present around the karyosome. An important diagnostic feature for this species is the presence of a large compact mass (vacuole) of glycogen in the cyst stage. Although this mass can be visible in unstained wet mounts, in iodine-stained preparations it takes on a darker, reddish-brown color. The glycogen vacuole does not stain with trichrome, but will still be visible as a well-defined mass.

A, B: Cysts of I. buetschlii in an unstained concentrated wet mount. In these cysts, the glycogen vacuole can be seen as a large, oval refractile body.