62  MEDICAL PARASITOLOGY

Diphyllobothrium
latum

Taenia saginata Taenia solium Dipylidium

worms likely to infect a single individual, although intestinal symptoms Infection produces few symptoms and generally causes concern only on
have been reported. Diagnosis is made by the finding in the feces of mod- detection of the actively moving proglottids.
erately thick-shelled, slightly ovoid, yellow-brown eggs measuring 70– Detection is based on the finding of characteristic eggs, egg packets,
85 µm by 60–80 µm (Fig. 62-20, E ). The eggs are most easily confused or proglottids in the feces. Spherical eggs, each containing a six-hooked
with those of H. nana but, unlike in that species, lack polar filaments. embryo, measure from 24–40 µm in diameter and occur singly or in
packets (Fig. 62-20, H). The scolex is somewhat elongate with four suckers
Diphyllobothrium spp. and a small, retractable rostellum. Proglottids are barrel-shaped and
Humans may be infected by one of several species of the fish tapeworm possess two genital pores, one on each lateral margin, which give rise to
Diphyllobothrium, which normally infect piscivorous mammals and possibly the common name double-pored tapeworm (see Fig. 62-21).
birds (Curtis, 1991; Connor, 1997). These parasites are widely distributed
in the temperate zones, especially northern Europe, Scandinavia, the
former USSR, and Japan. Infection also occurs in Canada and in the north
TREMATODES
central states, the Pacific Coast states, and Alaska in the United States. Trematodes, or flukes, are dorsoventrally flattened helminths (platyhel-
Although Diphyllobothrium latum is the most common species known minths) that include both hermaphroditic forms (intestinal, liver, and lung
to infect humans, differentiation cannot be made on the basis of egg flukes) and those with separate sexes (blood flukes or schistosomes). All
morphology. species that infect humans are characterized by the presence of an oral
This parasite inhabits the small intestine, where it can reach a length sucker, through which the digestive tract opens, and a ventral sucker used
of 10 m or longer and can persist for years. Eggs are passed unembryo- for attachment. Adults vary in length from 1 mm (Metagonimus) to 70 mm
nated in the feces and must reach a freshwater stream or lake to continue (Fasciola gigantica).
development. Following several weeks of embryonation, a ciliated larval Eggs reach the environment by being passed in the feces, sputum, or
form, the six-hooked coracidium, hatches and is ingested by a copepod, a urine, depending on the species. Hermaphroditic flukes produce opercu-
type of zooplankton. The coracidium develops into a procercoid larva, late eggs, which are not embryonated (Clonorchis and Opisthorchis being
which is infective for the second intermediate host, a fish. In fish, the exceptions). Schistosome eggs are not operculated, and each contains a
procercoid migrates into the tissues and develops into the plerocercoid mature larva when passed. Trematode larvae, or miracidia, are ciliated
larva. Plerocercoids may be passed up the food chain unchanged and and are capable of penetrating the tissues of a molluscan host. Each
accumulate in larger fish. Humans acquire these larvae through ingestion species of trematode uses a particular species of snail as the first inter-
of raw or incompletely cooked fish that have spent at least part of their life mediate host. A complex asexual multiplication process within the snail
in fresh water. results in the production of numerous free-swimming larvae called cer-
Adult worms mature and initiate egg production in approximately cariae. Schistosome cercariae are capable of penetrating human skin
1 month. Infection may be asymptomatic, with passage of a length of directly, resulting in the disease schistosomiasis. Those of hermaphroditic
strobila being the initial complaint. In others, a variable degree of abdomi- flukes encyst on aquatic vegetation or invade the tissues of second inter-
nal discomfort and diarrhea may be present. Rarely, intestinal obstruction mediate hosts such as fish or crabs, depending on the species. Ingestion
occurs. In endemic areas in northern Europe, a small percentage of patients of these encysted larval stages, known as metacercariae, results in human
develop vitamin B12 deficiency and associated megaloblastic anemia. infection.
Diagnosis is made by the finding of typical brown, oval, operculate eggs Human trematode infection may occur in many tropical and subtropi-
in feces using standard recovery techniques. Eggs measure 58–76 µm by cal regions and involves considerably more species (mostly rare and spo-
40–51 µm and, in addition to the operculum, have a small, round, knob- radic intestinal infections) than can be presented here. Its presence depends
like projection on the abopercular end (Fig. 62-20, F ). The presence of on lack of sewage treatment, availability of appropriate intermediate hosts,
the operculum is unique among those cestodes infecting humans, and care and, in the case of hermaphroditic species, dietary customs associated with
must be taken not to confuse these eggs with those of trematodes, espe- ingestion of infective metacercariae. Some of these diseases, especially
cially Paragonimus or Nanophyetus. Identification to the genus level is pos- schistosomiasis, are spreading because of increased use of irrigation in
sible when a length of strobila or an intact worm is passed. The scolex is endemic areas. Symptoms vary depending on the number of worms para-
elongate and displays a pair of longitudinal grooves known as bothria, sitizing the host at a given time, the tissues and organs involved, and host
which replace the usual suckers. Gravid proglottids are wider than they responses. Many infections are asymptomatic.
are long and have their genital pores located midventrally, adjacent to a The diagnosis of trematode infection is made by recovery and identi-
centrally located rosette-shaped uterus (Figs. 62-20, G, and 62-21). fication of the characteristic eggs in stool, sputum, urine, and, occasionally,
tissues. Direct mounts and formalin–ethyl acetate concentration methods
Dipylidium caninum are most useful for recovery of these eggs, whereas zinc sulfate flotation
Dipylidium caninum is a common tapeworm of dogs and cats in most parts methods are less satisfactory.
of the world and not infrequently infects humans, especially children. In
the usual life cycle, tapeworm eggs are ingested by flea larvae, which infest Fasciolopsis buski
areas frequented by dogs or cats. The cysticercoid larvae persist as the flea This intestinal trematode is the largest species to infect humans, varying
undergoes metamorphosis to the adult stage. Accidental ingestion of the from 20–75 mm in length and from 8–20 mm in breadth. It occurs in many
adult flea containing the infectious cysticercoid results in infection. Chil- parts of China, southeast Asia, and India and is frequently found in pigs,
dren are at highest risk for infection because of their close contact with which serve as a natural reservoir. Infection is acquired by ingesting infec-
pets. Worms mature in the small intestine and grow up to 70 cm in length. tious metacercariae on aquatic food plants such as water chestnuts and

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 A B C

D E F

Figure 62-22  A, Egg of Fasciolopsis buski, indistinguishable from that of Fasciola hepatica, in stool (×400). B, Egg of Heterophyes sp. in stool (×400). C, Adult Clonorchis
sinensis in bile duct (H&E; ×100). D, Egg of C. sinensis in stool (×1000). E, Pair of adult Paragonimus sp. in lung tissue with surrounding inflammatory reaction (H&E; ×10).
F, Egg of Paragonimus sp. in stool; note prominent operculum (×100).

water caltrop. Worms attach to the wall of the duodenum and jejunum, are passed in the feces. Cercariae shed from the snail intermediate host
where they mature to egg-laying adults in about 3 months. Symptoms such encyst on aquatic vegetation, where infectious metacercariae then are
as diarrhea, epigastric pain, and nausea may develop if enough worms are available to herbivorous hosts. Humans usually acquire the infection by

PART 7
present to produce ulceration of the superficial mucosa. Eosinophilia may eating watercress. Once ingested, the larvae penetrate the intestinal wall
be present, even in those who are asymptomatic. and migrate through the peritoneal cavity to the liver. They burrow
Diagnosis is made by the finding of large (130–140 µm by 80–85 µm), through the capsule and parenchyma, coming to reside within the bile
brown, oval, and thin-shelled eggs (Fig. 62-22, A). The operculum may be ducts, where egg laying is initiated in about 2 months. Migration of the
inconspicuous, and the eggs are passed unembryonated. Differentiation larvae through the liver elicits a painful inflammatory reaction both in the
from Fasciola eggs generally is not possible, although these infections may tissue and, later, in the bile ducts, which eventually become fibrosed. Clini-
be differentiated on the basis of geographic history and symptoms. Eggs cal manifestations include colic, obstructive jaundice, abdominal pain and
of echinostome trematodes, which occasionally infect humans, are similar tenderness, cholelithiasis, and eosinophilia.
but smaller (Beaver, 1984). Diagnosis is made by the finding of eggs in the stool. The unembryo-
nated, yellowish brown, operculate eggs, 130–150 µm by 63–90 µm,
Heterophyes and Metagonimus cannot be distinguished easily from those of Fasciolopsis (see Fig. 62-22,
These two genera include a number of species of minute (1–3 mm in A). Spurious infection, which occurs by ingesting infected cattle or sheep
length) intestinal worms that infect humans. Heterophyes heterophyes and liver, is diagnosed by obtaining a good history and performing a follow-up
Metagonimus yokogawai are common parasites in Asia but, along with other stool examination to look for elimination of the eggs.
species, are found in other parts of the world as well. Infection is acquired
by ingestion of metacercariae in raw or incompletely cooked freshwater Clonorchis sinensis and Opisthorchis viverrini
fish. Although it is of minor medical importance, infection with these Clonorchis sinensis, the Oriental liver fluke, and a closely related species,
worms may produce diarrhea and abdominal pain. Infection is self-limited Opisthorchis viverrini, inhabit the biliary system of humans and other pisciv-
because the worms have a life span of only a few months. orous animals, including cats and dogs. C. sinensis occurs mainly in China,
Diagnosis is established by the finding of embryonated, operculate eggs Taiwan, Korea, Japan, and Vietnam, whereas O. viverrini is found primarily
that measure 20–30 µm in length by 15–17 µm in width (Fig. 62-22, B). in southeast Asia, especially northern Thailand. Human infection is also
Differentiation of these eggs from those of Clonorchis and Opisthorchis is known to occur with Opisthorchis felineus in Europe and Amphimerus pseu-
difficult, although the operculum is more deeply seated with Opisthorchis. dofelineus (same as Opisthorchis guayaquilensis) in Ecuador.
Such differentiation may be important, however, for medical reasons. All these parasites are acquired by the ingestion of infectious metacer-
cariae in raw or uncooked freshwater fish. Larvae migrate up the common
Nanophyetus salmincola duct into the liver bile ducts, where they live up to 20 years and grow up
Nanophyetus (Troglotrema) salmincola is a small (0.8–1.1 mm) intestinal fluke to 25 mm in length (Fig. 62-22, C). They produce small eggs that are shed
that has been reported in humans in areas of far eastern Siberia and the into the bile and subsequently are passed in stools.
Pacific Northwest Coast of the United States (Eastburn, 1987; Fritsche, Infection is often asymptomatic, although large numbers of flukes
1989b). These worms are acquired by ingesting raw, incompletely cooked, and repeated infection may cause inflammation of the bile ducts and
or home-smoked salmon or trout that contain infectious metacercariae. subsequent hyperplasia, fibrosis, and hepatic cirrhosis. Development
Symptoms are related to the number of worms present and may include of cholangiocarcinoma has been linked epidemiologically with long-
abdominal pain and diarrhea, with or without eosinophilia. Eggs measur- standing infection.
ing 60–80 µm by 34–50 µm are broadly ovoid, operculate, and yellowish Diagnosis is made by recovering the small brown, embryonated,
brown (Eastburn, 1987). Thickening of the shell at the abopercular end operculate eggs from stools (Fig. 62-22, D). Eggs of Clonorchis cannot be
should be differentiated from the knob seen on eggs of Diphyllobothrium. readily differentiated from those of Opisthorchis. Both measure 25–35 µm
This fluke is the vector for a rickettsia that produces a highly lethal infec- by 12–20 µm and have a prominent, seated opercula and a small knob at
tion in canines known as “salmon-poisoning” disease. the abopercular end. These eggs are difficult to differentiate from those
of the Heterophyes/Metagonimus group, although the latter species do not
Fasciola hepatica have prominent, seated opercula or a small knob at the abopercular end.
Cattle, sheep, and goats in many parts of the world are infected with the When specific identification is not possible, the laboratory report should
liver fluke Fasciola hepatica and, less commonly, with the related species reflect this (i.e., should state, “Clonorchis/Opisthorchis/Heterophyes/
Fasciola gigantica. Adult parasites live in the biliary tree and lay eggs that Metagonimus eggs”).

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62  MEDICAL PARASITOLOGY Paragonimus spp. Initiation of egg laying by mature worms 5–7 weeks after infection may
Several species of Paragonimus may parasitize the lungs of cats, dogs, and result in acute schistosomiasis, or Katayama fever, a serum sickness–like
other carnivores, including humans. Paragonimus westermani is problematic syndrome that occurs with heavy primary infection, especially that of
in many areas of Asia, whereas in Central and South America several S. japonicum. The antigenic challenge to the host is thought to result in
species have been implicated, including Paragonimus mexicanus, Paragoni- immune complex formation (Boros, 1989).
mus caliensis, and Paragonimus ecuadoriensis. Paragonimus kellicotti has Chronic infection results in continued deposition of eggs, many of
occasionally been implicated in cases from North America, and other which remain in the body. Granulomas produced around these eggs in the
species have been described from Africa (Pachucki, 1984; Mariano, 1986; intestine and in the bladder are gradually replaced by collagen, resulting
Strickland, 2000; Cook, 2002; Murray, 2007). in fibrosis and scarring. Eggs trapped in the liver may induce pipe-stem
Adult worms measure up to 12 mm by 6 mm and often are found in fibrosis with obstruction to portal blood flow. Occasionally, eggs are depos-
pairs in lung parenchyma, where they reside in a fibrotic capsule produced ited in ectopic sites, such as the spinal cord, lungs, or brain (Cook, 2002;
by the host (Fig. 62-22, E ). The capsule communicates with the bronchi, Garcia, 2007).
through which eggs pass to be eventually expelled in sputa or feces. Diagnosis is established by demonstrating eggs in feces or urine by
Although a specific snail serves as the first intermediate host, freshwater direct wet mount or formalin–ethyl acetate concentration methods. Zinc
crabs and crayfish serve as second intermediates for infectious metacer- sulfate concentration is not satisfactory for recovery of heavy schistosome
cariae. Ingestion of uncooked, or marinated, crustacea may result in infec- eggs. Eggs also may be detected in biopsies of rectal, bladder, and, occa-
tion. Larvae are released in the stomach and migrate through the intestinal sionally, liver tissues by crush preparation or in histologic section (Fig.
wall into the peritoneal cavity, eventually reaching the lungs after penetrat- 62-23). Use of egg hatching methods may occasionally be requested to
ing the diaphragm. Maturation takes approximately 5–6 weeks, and worms determine viability or, less commonly, to detect light infection. Feces
may live for many years. mixed with distilled water are placed in a flask that is covered with foil to
Symptoms, when present, may be caused by larvae migrating through keep out light, with only the neck or a sidearm exposed to bright light.
tissues or by adults established in the lungs. Not infrequently, worms Miracidia, if present, actively swim to the light and can be detected using
develop in ectopic sites, including the peritoneum, subcutaneous tissues, a hand lens.
and brain. The onset of lung infection is usually associated with fever, Serologic tests may be helpful in screening persons who have traveled
chills, and the appearance of eosinophilia. Once established, symptoms to endemic areas and those with negative urine or stool examination who
include chronic coughing with abundant mucous production, along with are at risk for infection, or for monitoring response to therapy. Although
episodes of hemoptysis. Radiographs may show nodular shadows, calcifica- not widely available, a limited number of reference laboratories and the
tions, or patchy infiltrates. Eggs remaining in the lung tissues or in ectopic CDC provide testing. Generally, serologic testing varies with the antigens
sites may cause an extensive granulomatous reaction. used and the test methods employed. The CDC uses the Falcon assay
Diagnosis is made by the finding of typical eggs in stools, sputum, or, screening test in a kinetic enzyme-linked immunosorbent assay (FAST-
occasionally, tissues. Eggs of the different Paragonimus species cannot be ELISA). Sera that are positive by the screening test are further evaluated
readily differentiated, and specific identification may be inferred from the by immunoblot to improve specificity (Wilson, 1995).
area of origin. Operculate, unembryonated eggs measure 80–120 µm by
45–70 µm and have a moderately thick, yellow-brown shell (Fig. 62-22, Schistosoma mansoni
F ). The operculum is flattened and usually is set off from the rest of the Schistosoma mansoni occurs in Africa, especially in the tropical areas and the
shell by prominent shoulders. The abopercular end is somewhat thickened Nile delta, southern Africa, and Madagascar, Brazil, Venezuela, Surinam,
but does not have a knob. Paragonimus eggs may be differentiated from and certain Caribbean islands, including Puerto Rico. Adult S. mansoni live
those of Diphyllobothrium and Fasciola/Fasciolopsis, which they superficially primarily in the portal vein and in the distribution of the inferior mesen-
resemble, by size. teric vein. Initial deposition of eggs in the large intestine may produce
abdominal pain and dysentery, with abundant blood and mucus in the
Schistosoma spp. stool. Eggs may be detected in feces at this time. Chronic infection may
Schistosomiasis, or bilharzia, is among the most important parasitic dis- result in liver fibrosis and portal hypertension, depending on the number
eases worldwide, afflicting 200–300 million individuals. Adult male and of worms present; eggs may be more difficult to find in feces during
female blood flukes inhabit veins of the mesentery or bladder. The most this stage.
important species infecting humans are Schistosoma mansoni, Schistosoma Eggs, which measure 116–180 µm by 45–58 µm, are oval, with a large
japonicum, Schistosoma mekongi, Schistosoma haematobium, and Schistosoma distinctive lateral spine that protrudes from the side of the egg near one
intercalatum; other species infect humans less frequently. end (see Fig. 62-23, A and B). If the spine is not visible, the egg may be
Adult female schistosomes are slender, measuring up to 26 mm by rotated by gently tapping the coverslip. Movement of the miracidium
0.5 mm. Males, which are slightly shorter, enfold a female using the lateral within the egg may be evident in unfixed material if the larva is viable.
margins of the body (the gynecophoral canal) to assist in sperm transfer. Concentration techniques may be required to detect eggs because individu-
When examined in situ, schistosomes are often found in copula. In their als with limited exposure or with chronic infection may pass few of them.
preferred locations, blood flukes elicit little or no inflammatory response.
Eggs are deposited in the smallest venule that can accommodate the female Schistosoma japonicum
worm, where they elicit a strong granulomatous response that results in Schistosoma japonicum, which occurs in China, southeast Asia, and the Phil-
extrusion of the egg into the intestinal lumen or the bladder. Pathology is ippines, causes disease that is clinically similar to that of S. mansoni but
primarily related to the sites of egg deposition, the numbers deposited, and often more serious because many more (up to 10 times as many) eggs are
the host reaction to egg antigens. produced by S. japonicum. The disease has been essentially eliminated from
Eggs are fully embryonated when passed and readily hatch when depos- Japan, although animal reservoirs still exist. Adult worms live primarily in
ited in fresh water. The miracidia penetrate an appropriate species of snail the distribution of the superior mesenteric vein, and eggs readily reach the
host, where they undergo transformation and extensive asexual multiplica- liver, inducing fibrosis and portal hypertension as a common complication
tion. After about 4 weeks, large numbers of fork-tailed cercariae emerge of chronic infection. The smaller size of the eggs predisposes them to
from the mollusk. Cercariae swim actively about for hours and readily dissemination, especially to the brain and spinal cord. The eggs are broadly
penetrate the skin of susceptible hosts, including humans. After penetra- oval, measuring 75–90 µm by 60–68 µm, and have an inconspicuous lateral
tion, the cercariae, now called schistosomules, enter the circulation and spine, which may be difficult to demonstrate (see Fig. 62-23, C and D).
pass through the lungs before reaching the mesenteric-portal vessels.
Symptoms of schistosomiasis result primarily from penetration of cer- Schistosoma mekongi
cariae (cercarial dermatitis), from initiation of egg laying (acute schistoso- This species occurs in humans and animal reservoirs in countries along the
miasis or Katayama fever), and as a late-stage complication of tissue Mekong River, especially Cambodia and Laos (Bruce, 1980). It is similar
proliferation and repair (chronic schistosomiasis). In a matter of hours after to S. japonicum but is differentiated from that species by several biological
cercarial penetration, a papular rash associated with pruritus may develop. characteristics and by smaller eggs (60–70 µm by 52–61 µm), which oth-
This is a sensitization phenomenon resulting from prior exposure to cer- erwise are indistinguishable from those of S. japonicum.
carial antigens. The most severe form of dermatitis occurs in individuals
who are repeatedly exposed to cercariae of nonhuman (primarily avian) Schistosoma haematobium
schistosomes. Cercarial dermatitis or swimmer’s itch occurs worldwide and Urinary schistosomiasis occurs in many parts of Africa, the Middle East,
is a well-recognized entity in the United States (Hoeffler, 1974). and Madagascar. Parasites migrate via the hemorrhoidal veins to the

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 A B C

D E F

Figure 62-23  A, Egg of Schistosoma mansoni; note prominent lateral spine (×400). B, Eggs of S. mansoni in an intestinal biopsy; note presence of lateral spine (H&E;
×400). C, Egg of Schistosoma japonicum; note presence of small lateral spine (×400). D, Eggs of S. japonicum in a small-bowel biopsy (H&E; ×400). E, Egg of Schistosoma
haematobium found in urine sediment; note presence of a terminal spine (×400). F, Eggs of S. haematobium seen in a vulvar granuloma; note presence of a terminal spine
(H&E; ×400).

venous plexuses of the urinary bladder, prostate, uterus, and vagina. One Species identification is important because pathogenicity varies. Prin-
of the earliest and most common symptoms of infection is hematuria, cipal characteristics used for identification of microfilariae include the

PART 7
especially at the end of micturition. Chronic infection may cause pelvic presence or absence of a sheath and its staining characteristics, the shape
pain and bladder colic, with an increased desire to urinate. Accumulation of the tail and the distribution of cell nuclei within, and the size of the
of eggs in the tissues may result in hypertrophy of the urothelium, cephalic space and the appearance of its nuclear column. Because micro-
squamous metaplasia, and marked fibrosis, which may progress to filariae of Wuchereria and Brugia usually display a nocturnal periodicity,
obstruction and, ultimately, renal failure. Urinary schistosomiasis also blood from patients suspected to be infected with these filaria should be
has been associated with squamous cell carcinoma of the bladder drawn between the hours of 10 pm and 2 am. Loa loa displays diurnal
(Badawi, 1992). periodicity, so blood preferably should be drawn around noon. Mansonella
Eggs are recovered from the urine by examination of spun sediment. ozzardi and Mansonella perstans are characteristically nonperiodic. Microfi-
They are elongate, measuring 112–180 µm by 40–70 µm, and have a lariae of Mansonella streptocerca and Onchocerca volvulus are present in the
characteristic terminal spine (see Fig. 62-23, E and F ). Occasionally, they skin and are detected by examination of skin snips or punch biopsies.
may be detected in feces or in a rectal biopsy. Serologic tests for the diagnosis of lymphatic filariasis may prove
helpful in select patients, especially those who are not native to endemic
Schistosoma intercalatum areas. Such methods are limited in their ability to distinguish between past
This species occurs in many parts of central and western Africa and pro- exposure and current infection, however, and infection with other nema-
duces intestinal schistosomiasis. Eggs have a terminal spine and so resem- tode species may result in the appearance of cross-reacting antibodies.
ble those of S. haematobium, but they occur primarily in the feces and are Antigen detection tests also may be of value in the diagnosis of lymphatic
larger (140–240 µm by 50–85 µm). filariasis but generally are not available (Wilson, 1995).
Wuchereria bancrofti
Tissue Helminths This species, responsible for bancroftian filariasis, is the most common
filarial species to infect humans. Endemic areas include central and north-
NEMATODES ern Africa, India, southeast Asia, certain South Pacific islands, and portions
of Central and South America and the West Indies. Adult worms reside in
Filaria the lymphatic system, where chronic infection and reinfection result in
Filarial nematodes, also known as threadworms, are common arthropod- lymphadenopathy and lymphangitis, which may progress to lymphedema
transmitted parasites of vertebrate animals. Adult male and female worms and obstructive fibrosis (Fig. 62-24, A). Severe involvement of the lower
are long and slender, measuring up to 100 mm in length, and are known extremities and genitalia may result in elephantiasis.
to inhabit a variety of tissues, including subcutaneous tissues, lymphatics, In most areas, microfilariae circulate in peripheral blood with a noc-
blood vessels, peritoneal and pleural cavities, heart, and brain. All species turnal periodicity that corresponds with feeding activities of the usual
produce larvae known as microfilariae, which may be recovered from blood vectors—Culex, Aedes, and Anopheles mosquitoes. Infections originating in
or skin, depending on the species. The microfilariae of some species cir- the South Pacific are essentially without periodicity. The microfilariae are
culate in the blood with a well-defined periodicity (diurnal or nocturnal), sheathed, although this may not always be obvious with Giemsa staining.
whereas others do not. Microfilariae continue their development only in The tail is pointed, and no nuclei are present in the tip. The cephalic space
the appropriate arthropod vector, usually a mosquito or fly, where they is not as long as it is wide, and the nuclei in the nuclear column are distinct
mature to the infective stage. Such larvae then are deposited in the tissues (Figs. 62-24, B, and 62-25). Concentration procedures may be necessary
of a definitive host when the vector takes another blood meal. for recovery because microfilariae may be present in small numbers.
The diagnosis of filariasis usually is made by the finding of microfilariae
in the blood or skin, because adult stages are often sequestered in the Brugia malayi
tissues. Use of Giemsa or hematoxylin-stained thick smears of peripheral This species produces disease similar to that of W. bancrofti, although it is
blood is routine, although more sensitive procedures such as membrane often milder and more frequently involves the lymphatics of the upper
filter, Knott’s concentration, or saponin lysis may also be required (National extremities. The parasite occurs mainly in India, southeast Asia, Korea, the
Committee for Clinical Laboratory Standards, 2000). Microfilariae may Philippines, and Japan. Human infection with related zoonotic species is
be seen moving in direct mounts of blood or tissue fluid. encountered periodically in the United States.

1227