682.

e2 PART I V Parasitology

Chapter Review
_____ Oocysts of Cryptosporidium spp. can be detected in
1. Which of the following is the best technique for stool specimens using the modified acid-fast stain.
identifying Dientamoeba fragilis in stool? _____ Fecal immunoassays for antigen detection have
a. Formalin concentrate become more commonly used to diagnose infections with
b. Trichrome-stained smear Dientamoeba fragilis and Blastocystis spp.
c. Modified acid-fast–stained smear _____ In the United States, sporadic mini-outbreaks of
d. Giemsa stain diarrheal disease have been associated with the ingestion of
e. Fluorescent stain strawberries, raspberries, fresh basil, mesclun (baby lettuce
2. Which of the following protozoan organisms has leaves), and snow peas. The most likely causative agent is
been widely implicated in waterborne and foodborne Cryptosporidium spp.
outbreaks in the United States? _____ Although the pathogenicity of Blastocystis spp.
a. Pentatrichomonas hominis has been controversial, newer information suggests that
b. Dientamoeba fragilis numerous strains and species are included in the name,
c. Giardia duodenalis some of which are pathogenic and some nonpathogenic.
d. Neobalantidium coli 6. Matching: Match each term with the correct description.
e. Entamoeba coli
3. An Entamoeba histolytica trophozoite has which
characteristics? _____ ova and para- a. used for Giardia,
a. Central karyosome in the nucleus and clear site examination Cryptosporidium spp.
pseudopodia _____ Dientamoeba b. immunocompromised
b. Ingested RBCs, clear pseudopodia, and uneven fragilis patients
chromatin on the nuclear membrane _____ Entamoeba c. immediately infective
c. Ingested RBCs, clear pseudopodia, and large histolytica oocysts
glycogen vacuoles in the cytoplasm _____ Giardia d. waterborne; traveler’s
d. Large blotlike karyosome, ingested white blood cells duodenalis diarrhea
(WBCs), and granular pseudopods _____ Microsporidia e. nonpathogenic ameba
e. Uneven karyosome, no peripheral chromatin, _____ Cryptosporidium f. rare in the United
granular pseudopods _____ fecal States
4. Entamoeba dispar is most easily confused immunoassays g. routine examination
morphologically with: _____ Neobalantidium of stool
a. Entamoeba coli coli h. most common
b. Entamoeba hartmanni _____ Entamoeba dispar intestinal parasite
c. Dientamoeba fragilis _____ Blastocystis spp. i. cause of amebiasis
d. Entamoeba histolytica j. cyst and precystic
e. Blastocystis spp. form
5. True or False
_____ Microsporidia can cause intestinal symptoms
and disease in other tissues, particularly in
immunocompromised patients.
Chapter Review
1. Babesia is an organism that has been implicated in dis- _____ The fifth human malaria, Plasmodium knowlesi, is
ease from both splenectomized and nonsplenectomized considered relatively harmless and can be easily iden-
patients. Morphologically, the parasites resemble: tified and differentiated from the other Plasmodium
a. Plasmodium falciparum rings spp.
b. Leishmania donovani amastigotes _____ Of the American trypanosome or African try-
c. Trypanosoma cruzi trypomastigotes panosome infections, those caused by Trypanosoma
d. Plasmodium vivax developing rings brucei spp. are known to cause severe problems in tis-
e. Trypanosoma brucei gambiense trypomastigotes sue transplantation.
2. A 60-year-old Brazilian patient with cardiac irregularities _____ In addition to transmission by insect vectors,
and congestive heart failure suddenly dies. Examination transmission of blood parasites can be caused by
of the myocardium revealed numerous amastigotes, an blood transfusions and shared needles from infected
indication that the cause of death was most likely: individuals.
a. Leishmaniasis with Leishmania donovani 6. Matching: Match each term with the correct description.
b. Leishmaniasis with Leishmania braziliensis
c. Trypanosomiasis with Trypanosoma brucei gambiense
d. Trypanosomiasis with Trypanosoma cruzi _____ “band form” a. Babesia spp.
e. Any of the above trophozoites b. Plasmodium
3. Plasmodium vivax and Plasmodium ovale are similar _____ multiple rings malariae
because they: per RBC, not c. thick, thin blood
a. Exhibit Schüffner dots and have a true relapse in the endemic in United films
life cycle States d. Leishmania spp.
b. Have no malarial pigment and multiple rings _____ endemic within e. Plasmodium vivax
c. Commonly have appliqué forms in the red cells United States f. Plasmodium
d. Have true stippling, do not have a relapse stage, and _____ causes Chagas falciparum
infect old red cells disease g. Trypanosoma cruzi
e. Have a 72-hour periodicity cycle in the RBCs _____ military h. Leishmania skin
4. Diseases caused by Trypanosoma brucei gambiense and returning from lesions
Trypanosoma brucei rhodesiense have distinct differences, Afghanistan and i. Plasmodium knowlesi
which include: Iraq j. insufficient for
a. The morphology of the trypomastigotes, which looks _____ considered a diagnosis
very different STAT procedure
b. The symptoms and severity of the overall illness _____ enlarged
c. The presence or absence of the undulating membrane infected RBC,
in the trypomastigote ameboid
d. The totally different continents in which they appear trophozoites
e. The different staining characteristics on a thin blood _____ mimics both P.
film falciparum and P.
5. True or False malariae
_____ Although Giemsa stain is recommended for stain- _____ one set of
ing thick and thin blood films, any of the bloodstains malaria blood films
can be used. _____ causes
_____ Trypanosoma cruzi and Leishmania spp. are now cutaneous and
endemic within certain areas of the United States. visceral disease

705.e1
CASE STUDY 49.1
A 16-year-old male presented to the physician with a severe organism was identified and how should the young man
headache and nausea and vomiting. When he arrived at the be treated?
emergency department he seemed somewhat confused and
disoriented. He had chills but no fever. The physician noted that
he was wearing swimming trunks under his clothes and, upon
physical examination, had a few bruises on his arms. The young
man said he had been staying at his friend’s house for several
days and, while swimming in his friend’s pool, had slipped on
the diving board.

Questions
1. What are the potential causes for the young man’s
symptoms?
2. What laboratory tests would be the most useful for quick
diagnosis?
3. The physician ruled out bacterial infection because the
young man’s complete blood count was normal, as was
his CT scan result. A spinal tap was completed. Examine • Fig. 49.4 Patient’s specimen. (Photo courtesy Dr. Henry Travers,
the cytospin photograph presented in Fig. 49.4. What Sioux Falls, SD.)

Chapter Review
1. A 12-year-old female is brought to the emergency depart- the plate and identified as Acanthamoeba species, the
ment with meningitis and a history of swimming in a cause of keratitis.
warm-water spring. Motile amoebae that measure 10 µm _____ Toxoplasma gondii can cause severe CNS disease in
in size are seen in the CSF and are most likely patients with AIDS; the cause is often reactivation of
a. Iodamoeba bütschlii trophozoites latent toxoplasmosis.
b. Endolimax nana trophozoites _____ Acanthamoeba keratitis is often linked to swim-
c. Dientamoeba fragilis trophozoites ming in contaminated freshwater lakes and ponds
d. Naegleria fowleri trophozoites where free-living amoebae live in the water and soil.
e. Giardia duodenalis trophozoites _____ Trichomonas vaginalis causes disease and symp-
2. Toxoplasma gondii (toxoplasmosis) is characterized by toms in both males and females; however, the major-
a. Possible congenital infections ity of infected women remain asymptomatic during
b. Infection from ingestion of raw/rare meats or oocysts the infection.
from cat feces _____ PAM is a chronic disease in which the patient may
c. Possible difficulties with interpretation of serologic develop symptoms over a long period, often months.
tests for antibody 6. Matching: Match each term with the correct description.
d. All of the above
e. None of the above
3. Eye infections with Acanthamoeba spp. have most com- _____ Trichomonas a. organism that is
monly been traced to vaginalis transmitted as
a. Use of soft contact lenses _____ Naegleria fowleri congenital infection
b. Use of hard contact lenses _____ Toxoplasma b. chronic CNS
c. Use of contaminated lens care solutions gondii disease, not
d. Failure to remove lenses while swimming _____ trichomoniasis associated with
e. Dust in the eyes _____ Acanthamoeba swimming
4. Which specimen is the least likely to provide recovery of eye infection c. keratitis
Trichomonas vaginalis? _____ GAE d. also causes GAE
a. Vaginal discharge _____ PAM e. swimming in
b. Urethral discharge _____ poor contact freshwater
c. Male urine lens care f. acute, fatal disease
d. Female urine _____ Balamuthia g. serologic testing
e. Stool mandrillaris h. use of outdated
5. True or False _____ toxoplasmosis solutions
_____ A nonnutrient agar plate is seeded with Escherich- i. males are often
ia coli and then is inoculated with a specimen taken asymptomatic
from an eye lesion. Organisms were recovered from j. no known cyst form

719.e1
732.e2 PART I V Parasitology

Chapter Review
1. The filariform larva is the infective stage for 7. The intestinal nematode considered capable of vertical
a. Ascaris lumbricoides, Trichostrongylus spp. transmission and the potential cause of congenital infec-
b. A. lumbricoides, Strongyloides stercoralis tions is:
c. Ancylostoma duodenale, S. stercoralis a. A. lumbricoides
d. Trichuris trichiura, Necator americanus b. E. vermicularis
2. Enterobius vermicularis infection is diagnosed by c. T. trichiura
a. Identification of eggs in a concentrated stool specimen d. A. duodenale
b. Wet prep and iodine stain of a fresh stool specimen 8. True or False
c. The Baermann funnel method _____ The severity of clinical signs and symptoms as-
d. Cellophane tape and microscopic slide preparation sociated with intestinal nematode infections is
3. A stool specimen from a patient was collected at 8 p.m. often related to the level of worm burden.
After collection, the specimen was not submitted to the _____ Löffler syndrome is associated only with A. lum-
laboratory until 11 p.m. The laboratory technologist bricoides infections.
found larvae in the fecal sample; each had long buccal _____ S. stercoralis can be differentiated from hookworm
capsule and a small, reduced genital primordium. The by its short buccal capsule and prominent genital
larvae are most likely primordium.
a. A. duodenale _____ T. trichiura, whipworm, is often easily identified
b. S. stercoralis because the adult worm is passed in feces.
c. T. trichiura 9. Matching: Match each term with the correct description.
d. Unable to determine
4. Which of the following intestinal nematodes is transmit-
ted through the ingestion of infective eggs? _____ autoinfection a. asexual reproduction
a. Trichostrongylus spp. _____ whipworm b. no person-to-person
b. A. lumbricoides _____ mammillated transmission
c. Capillaria philippinensis ovum c. A. lumbricoides
d. Strongyloides fuelleborni _____ C. d. egg-producing female
5. Which of the following roundworms is capable of auto- philippinensis e. reinfection from
infection, hyperinfection, and a heavy worm burden _____ sexual endogenous source
with characteristic larval migration required in the life transmission f. S. stercoralis
cycle? _____ attachment by g. culture technique
a. A. duodenale teeth h. concentration
b. E. vermicularis _____ indirect life method
c. S. stercoralis cycle i. T. trichiura
d. A. lumbricoides _____ Harada-Mori j. hookworm
6. A 4-year-old child presents to the physician. The mother _____ A. duodenale k. prominent polar
claims the child has been persistently irritable and has not _____ parthenogenesis plugs
slept well in approximately 2 weeks. The child attends _____ cutting plates l. N. americanus
day care regularly, and the mother states that the day care _____ Baermann m. migration not
provider has claimed there have been no other children funnel required during
complaining of illness. A urine sample was collected. _____ gravid maturation
Upon microscopic analysis, an oval, flat-sided ovum was _____ copulatory n. A. duodenale
identified. The most probable diagnosis is bursa o. seafood
a. Taenia solium _____ T. trichiura
b. E. vermicularis
c. Schistosoma japonicum
d. A. lumbricoides
Chapter Review
1. Removal and gradual retraction of the adult gravid 5. True or False
female worm is recommended in infections with: _____ Anthelmintic therapy results in serious complica-
a. Ancylostoma braziliense tions in all tissue nematode infections.
b. Dracunculus medinensis _____ Larvae located in the eye should always be surgically
c. Trichinella spiralis removed, if possible, to prevent blindness.
d. Toxocara cati _____ Dirofilariasis often results in severe chest pain, pul-
2. The following infection may resemble acute appendicitis: monary embolism, and sudden death.
a. Parastrongylus costaricensis 6. Matching: Match each term with the correct description.
b. Gnathostoma sp.
c. T. cati
d. Parastrongylus caninum _____ Gnathostoma sp. a. ocular larva migrans
3. After ingesting a roast duck, a 52-year-old male began to _____ P. cantonensis b. roundworm
experience inflammation of the skin and a small spidery _____ A. braziliense encephalitis
pruritic rash. Which of the following is most likely the _____ VLM c. creeping eruption
cause of the patient’s discomfort? _____ Toxocara cati d. barber pole
a. D. medinensis _____ trichinosis e. cephalic hooklets
b. T. cati _____ NLM f. 1:32 titer
c. Gnathostoma spinigerum g. calcification
d. T. spiralis
4. This organism is capable of causing severe neurological
damage that often results in death.
a. Trichinella sp.
b. Toxocara spp.
c. Baylisascaris sp.
d. Gnathostoma sp.

743.e1
CASE STUDY 52.1 3. The endosymbiont Wolbachia sp. is required for parasite
reproduction in all of the following except:
A 45-year-old male returned to the United States after a
3-week safari in Central Africa. He presented to his physician a. O. volvulus
complaining of a tender area near his groin and discomfort b. B. timori
during urination. In addition, he was having difficulty sleeping c. L. loa
at night because of intermittent periods of fever. A complete d. W. bancrofti
blood count was drawn, and the patient exhibited a mild 4. A 25-year-old female patient residing in the Amazon
eosinophilia. All other results appeared normal. Urinalysis
revealed no abnormal laboratory results. A computed Basin presented to the mobile clinic complaining of
tomography scan of the patient’s lower abdomen and intermittent fever, swollen lymph nodes, and a non-
groin showed an unusual mass in his inguinal region. The productive cough. Her symptoms persisted for several
physician admitted the patient for further observation and months. Laboratory results indicated a normal white
tests. Subsequent testing included additional peripheral blood cell count. Serum protein electrophoresis dem-
blood collection during the periodic fevers. Thick and thin
smears disclosed no unusual organisms. After concentration onstrated an elevated gamma fraction. What additional
of a blood sample and staining with Giemsa, the organism laboratory tests would assist the physician’s diagnosis?
depicted in Fig. 52.6 was identified. a. Serologic assay
b. Serologic assay coupled with PCR for microfilariae
Questions identification
1. Identify the parasite depicted in Fig. 52.7. c. Fractionation of the gamma fraction to identify her
antibody abnormality
d. Nasal aspirate and sputum specimen for viral and bac-
terial culture
5. Treatment for microfilariae can be complicated because
of:
a. Diethylcarbamazine resistance
b. Ivermectin resistance
c. Allergic reactions to dying parasites
d. Drug toxicity
6. True or False
_____ L. loa requires surgical removal from the infected
host.
_____ Heavy microfilaria infections are associated with
• Fig. 52.7 Identified organism from a patient. (Courtesy Dr. Henry the development of onchocerciasis.
Travers, Sioux Falls, SD.) _____ All species of Mansonella contain a sheath and ter-
minal nuclei.
2. What is the recommended treatment for this patient?
3. What additional parasite could be associated with this
_____ The definitive host for dirofilariae causes severe
patient’s symptoms? infection in the lungs and eyes.
7. Matching: Match each term with the correct description.

_____ Knott a. unsheathed, five to

concentration eight subterminal nuclei
Chapter Review _____ chyluria b. shepherd’s crook
1. Periodicities associated with filarial infection are _____ B. timori c. sheathed, four to
a. Periods of increased microfilariae in the peripheral _____ L. loa five subterminal nuclei
circulation _____ B. malayi d. centrifugation
b. Always regular during the nighttime hours between 10 _____ O. volvulus e. dog heart worm
p.m. and 4 a.m. _____ M. streptocerca f. lymph fluid
c. Present in all filarial infections _____ D. immitis g. calabar swelling
d. Correlated directly with the patient’s symptoms h. river blindness
2. Lymphatic vessel involvement within the retroperitoneal
region is associated with infection with
a. M. perstans
b. B. malayi
c. W. bancrofti
d. L. loa

752.e1
CASE STUDY 53.1
A 50-year-old male presented to the physician complaining of samples over the next 12 days. After treatment, the parasite seen
headaches and difficulty maintaining his balance. On physical in Figs. 53.10 and 53.12 was recovered from the man’s stool.
examination, the physician noticed a lump in the man’s left calf.
Initial laboratory results, including a complete blood count and Questions
differential, were normal. The erythrocyte sedimentation rate 1. Identify the parasite to the species level.
(ESR) was slightly elevated, indicating generalized inflammation. 2. Explain the morphologic characteristics that would
The physician asked the man if he had traveled to any areas definitively identify the parasite.
outside of the United States in the past 12 months. The man 3. What, if any, additional treatments are available for this
had recently returned from volunteering in Haiti. The physician patient?
prescribed niclosamide and had the patient collect three stool

Chapter Review
1. Which tapeworm infects cattle as an intermediate host? 6. Which of the following is not an appropriate prevention
a. T. saginata measure for cestodes?
b. D. caninum a. Controlling the flea and rat population
c. H. diminuta b. Avoiding the consumption of raw meat or fish
d. H. nana c. Immunization
2. Which of the following can bypass the need for an inter- d. Practicing good hygiene
mediate host? 7. True or False
a. D. latum _____ Diphyllobothrium latum is the only cestode
b. D. caninum to have an aquatic life cycle.
c. H. diminuta _____ Hymenolepis diminuta, also known as the
d. H. nana dwarf tapeworm, may reach up to 4 cm in
3. Which eggs are passed unembryonated and may have a length.
small knob at the end of the operculum? _____ Food is absorbed from the host through the
a. D. latum worm’s scolex.
b. D. caninum _____ Humans are infected with T. saginata by eat-
c. H. diminuta ing cysticerci in raw or undercooked beef.
d. H. nana _____ All Taenia species are indistinguishable mor-
4. Which tapeworm cannot be identified to the species level phologically requiring detailed genotypic
based on its egg morphology; instead, proglottids must analysis
be examined? 8. Matching: Match each term with the appropriate
a. Diphyllobothrium description.
b. Dipylidium
c. Hymenolepis
d. Taenia _____ cestode a. oncosphere
5. Which of the following are treatment(s) of choice for _____ scolex b. crown of scolex
tapeworm infection? _____ proglottids c. head
a. Praziquantel _____ rostellum d. shallow sucking
b. Niclosamide _____ integument grooves
c. Both A and B _____ hexacanth e. tapeworm
d. None of the above embryo f. outer covering
_____ bothria g. segments

764.e1
CHAPTER 54 Tissue Cestodes 773.e1

CASE STUDY 54.1

A 65-year-old man from Montana was admitted to the Suckers
emergency department in a local hospital. The patient is a
sheepherder and owns dogs. He claims to have no travel
history outside the local area. He enjoys hunting and trapping
in the area and frequently enjoys eating his venison. He was
admitted with upper right quadrant pain and vomiting. An rostellum
abdominal mass was felt and an MRI ordered. MRI showed
a 5-cm mass in the liver. Fluid-filled cysts and a scolex were
surgically removed (Fig. 54.4).

Questions
1. What parasite should be considered?
2. What additional testing should be performed to aid in
diagnosis?
3. Which preventive measures should be used to control the
spread of this parasite? • Fig. 54.4 Scolex collected from patient’s liver biopsy. (Courtesy
Dr. Henry Travers, Sioux Falls, SD.)

Chapter Review
1. Which of the following is a characteristic of Echinococcus? 7. Neurocysticercosis is defined as:
a. Longest tapeworm found in humans a. Cysticerci localized in the liver
b. Vitamin B12 deficiency b. Cysticerci localized in the brain
c. Hydatid cysts c. Cysticerci localized in the eye
d. Cysticercus d. All of the above
2. Which of the following cysts is not encased in a capsule? 8. Definitive diagnosis of cysticercus is made by:
a. T. solium a. Identification of cysticerci in tissue
b. T. multiceps b. CT or MRI
c. Mansonoides c. Immunoblot assay
d. E. multilocularis d. All of the above
3. What is the drug of choice for treating hydatid cysts? 9. The cyst of E. multilocularis:
a. Albendazole and praziquantel a. Grows quickly and produces many clinical
b. Praziquantel symptoms
c. Mebendazole b. Is most commonly found in the southern United
d. Niclosamide States
4. Surgery may be the best course of treatment for which c. Is capable of forming a multicystic structure attrib-
tapeworm? utable to lack of a laminated membrane
a. E. granulosus d. Causes coenurus in humans
b. E. multilocularis 10. Humans become infected with E. multilocularis when
c. T. multiceps they:
d. All of the above a. Ingest an oncosphere from an infected deer
5. Human cysticercosis occurs when: b. Ingest coracidia from an infected copepod
a. T. solium eggs are ingested c. Ingest eggs from an infected fox
b. Reverse peristalsis returns gravid segments into the d. Ingest eggs from human feces
intestine 11. Humans acquire sparganosis by:
c. Humans ingest contaminated pork a. Accidental ingestion of dog feces
d. All of the above b. Handling infected animals
6. Cysticercosis develops: c. Consuming procercoid larvae in undercooked
a. In any organ or tissue in the body fish
b. After ingesting contaminated beef d. Ingesting human feces
c. And will die and calcify in 2 to 3 weeks
d. All of the above
773.e2 PART I V Parasitology

12. True or False 13. Matching: Match each term with the correct description.
_____ Hydatid disease results when humans become
the accidental host of T. solium cysts. _____ neurocysticercosis a. daughter cysts
_____ The presence of a scolex differentiates Spirome- _____ hydatid disease b. many-chambered cysts
tra from T. solium. _____ hydatids c. longitudinal grooves
_____ The rupture of a hydatid cyst may cause ana- _____ brood capsules d. echinococcosis
phylactic shock. _____ hydatid sand e. magnetic resonance imaging
_____ The cyst of T. solium lacks a laminated mem- _____ multilocular f. T. multiceps larval form
brane. _____ coenurus g. cysticerci localized in brain
_____ bothria h. computed tomography
_____ CT i. scolices in hydatid fluid
_____ MRI j. cysts
CASE STUDY 55.1
The husband of a 32-year-old woman is employed in the foreign service, and the couple has recently been on assignment to Africa.
The wife complained of a 2-month history of abdominal pain, vomiting, diarrhea, and weight loss. While in Africa, she had eaten
the locally grown watercress. A stool specimen was collected for culture, ova, and parasite examination. The bacterial culture was
negative. A wet mount made during the parasite examination showed large, oval, operculated, and unembryonated helminth eggs.

Questions
1. What parasite is the probable cause of the patient’s symptoms?
2. Another parasitic worm has indistinguishable eggs. How would the infections caused by these two worms differ?
3. How did the patient most likely acquire this infection?
4. What would be the preferred treatment for this infection?

Chapter Review
1. Fluke eggs are equipped with a lid at the top of the shell 4. Which two of the following are small flukes whose eggs
called a/an: are generally indistinguishable?
a. Egress a. Fasciolopsis
b. Operculum b. Heterophyes
c. Nodule c. Metagonimus
d. Button d. Paragonimus
2. The infective life cycle stage of a fluke is the: 5. What laboratory finding is common in F. buski infections?
a. Miracidium a. Increased levels of vitamin B12
b. Cercariae b. Increased serum bilirubin levels
c. Metacercariae c. Decreased number of red blood cells
d. Pleurocercariae d. Increased number of eosinophilia
3. What intermediate host is required in the life cycle of all 6. The drug of choice for an intestinal trematode infection
trematodes? is:
a. Freshwater snail a. Niclosamide
b. Crayfish b. Praziquantel
c. Aquatic vegetation c. Albendazole
d. Freshwater crab d. Tiabendazole

779.e1
CASE STUDY 56.1
A 50-year-old male visiting from Japan complained of fever, abdominal pain, and jaundice. A stool specimen was collected for ova
and parasite examination. A blood specimen was also collected and sent to a clinical laboratory for testing. The blood work showed a
slightly increased serum bilirubin level. The parasite examination showed small, oval, operculated eggs (approximately 80 µm × 45 µm),
with opercular shoulders and a knob on the opposite end.

Questions
1. What parasite is the probable cause of this infection?
2. Another parasitic worm has eggs that are almost identical. What fact about the patient can aid in deciding which worm is
responsible for his infection?
3. What other complications might be expected with this infection?
4. What would be the preferred treatment for this infection?

Chapter Review
1. Which of the following flukes has an operculated flask- 5. Infection with Clonorchis or Opisthorchis may result from
shaped egg with prominent shoulders and a knob at the eating raw or undercooked:
opposite end? a. Aquatic vegetation
a. Opisthorchis b. Crabs
b. Paragonimus c. Crayfish
c. Fasciola d. Freshwater fish
d. Fasciolopsis 6. What laboratory finding may be observed in Paragonimus
2. For which one of the following flukes would sputum be infections?
the diagnostic specimen? a. Increased number of eosinophils
a. Opisthorchis b. Decreased serum bilirubin level
b. Paragonimus c. Decreased vitamin B12 level
c. Fasciola d. Increased number of red blood cells
d. Clonorchis 7. The drug of choice for treatment of Fasciola hepatica
3. The eggs of Fasciola hepatica are indistinguishable from infections is:
those of: a. Albendazole
a. Clonorchis sinensis b. Triclabendazole
b. Heterophyes heterophyes c. Niclosamide
c. Opisthorchis viverrini d. Praziquantel
d. Fasciolopsis buski
4. Where might Clonorchis be found that Opisthorchis is
not found?
a. Vietnam
b. Thailand
c. Korea
d. Cambodia

785.e1
CASE STUDY 57.1
An 18-year-old male had recently been on a 1-month long Questions
trip to Brazil with a group of volunteer workers, where he had 1. What parasite is the probable cause of this infection?
enjoyed swimming in a nearby river with the local teenage 2. Where in the human host would the adults of this parasite
volunteers. He complained of crampy abdominal pain and be found?
twice noticed a small amount of blood in his feces. A stool 3. What recent activity of this patient is probably responsible
specimen was collected for ova and parasite examination. for his infection?
A blood specimen was also collected and sent to a clinical 4. What is the drug of choice for treatment of infection with
laboratory for testing. The results of the blood tests showed this parasite?
increased eosinophil and IgE levels. The parasite examination
showed large (115 µm × 75 µm), inoperculate, oval eggs with
large lateral spines.

Chapter Review
1. The mode of transmission of schistosomal infection is 5. Which of the following is a major contributing factor to
by: infection with S. japonicum?
a. Ingestion of contaminated aquatic vegetation a. Absence of animal reservoir hosts
b. Direct penetration of the skin by cercariae b. Easily controlled snail population
c. Ingestion of raw fish c. Easily passed from person-to-person
d. Mosquito bite d. Large number of humans working in rice paddies
2. A diagnostic characteristic of the egg of S. mansoni is: 6. Matching: Match the location in the body with the adult
a. A large lateral spine schistosome worm:
b. No spine
c. A pointed terminal spine
d. A small lateral spine _____ S. mansoni a. veins surrounding
3. Infection with S. haematobium may present with which _____ S. haematobium the bladder
of the following? _____ S. japonicum b. venules of the small
a. Nausea _____ S. mekongi intestine
b. Basophilia _____ S. intercalatum c. venules of the large
c. Hematuria intestine
d. Jaundice d. venules of the colon
4. The drug of choice for treatment of schistosome infec-
tions is:
a. Metrifonate
b. Praziquantel
c. Bilarcil
d. Niclosamide

790.e1