Parasitology Practice Questions

Q: A patient on steroids presented with nocturnal cough and chronic urticaria. An intestinal biopsy was done, and the organism shown in the image was identified. What is the most likely organism?

Strongyloides stercoralis. ***Strongyloides stercoralis*** - The image shows a nematode larva in an **intestinal biopsy sample**, consistent with **Strongyloides stercoralis**, which is known for its ability to **autoinfect** and cause chronic infections. - The patient's **steroid use** can lead to **Strongyloides hyperinfection syndrome**, explaining the pulmonary symptoms (**nocturnal cough**) due to larval migration into the lungs and the chronic **urticaria** often associated with strongyloidiasis. *Enterobius vermicularis* - This organism primarily causes **pinworm infection**, characterized by **perianal itching** and is typically identified by the **scotch tape test** for eggs, not usually found in intestinal biopsy or associated with chronic urticaria. - It does not commonly cause significant pulmonary symptoms or hyperinfection syndrome, especially not triggered by steroid use. *Capillaria philippinensis* - This nematode causes **intestinal capillariasis**, characterized by **chronic diarrhea**, **abdominal pain**, and **malabsorption**. - It is not typically associated with pulmonary symptoms like nocturnal cough or chronic urticaria, and is transmitted through fish consumption. *Ancylostoma duodenale* - This is a **hookworm** that causes **iron deficiency anemia**. While it does have a lung migration phase that can cause transient cough, it is not typically associated with chronic urticaria or severe pulmonary disease due to steroid-induced hyperinfection. - The image shows larvae, but the clinical context strongly points to *Strongyloides* due to the steroid use and specific symptoms.

Q: Name the parasite whose microfilariae have a sheath and no nuclei at the tail end.

Wuchereria bancrofti. **Wuchereria bancrofti** - **Wuchereria bancrofti** microfilariae are characterized by the presence of a **sheath** and a **clear tail end** that is devoid of nuclei. - This morphology is a key feature used in the microscopic differentiation of W. bancrofti from other filarial species. *Brugia malayi* - **Brugia malayi** microfilariae also have a **sheath**, but their tail end typically contains **two distinct nuclei** that are spaced apart. - They are generally shorter and have more kinky curves than W. bancrofti. *Loa loa* - **Loa loa** microfilariae possess a **sheath** but are distinguished by their **nuclei extending to the tip** of the tail, often in a more continuous pattern. - They are also known for their diurnal periodicity, which aids in diagnosis. *Onchocerca volvulus* - **Onchocerca volvulus** microfilariae are **unsheathed** and have nuclei that do **not extend to the tail tip**, leaving a distinct clear space. - They are typically found in the skin and subcutaneous tissue, rather than the blood.

Q: On Ziehl-Neelsen (ZN) staining oocysts of size 8-10 µm are visible. Identify the organism.

Cyclospora. ***Cyclospora*** - *Cyclospora cayetanensis* oocysts are **spherical** and measure **8-10 µm** in diameter, exactly matching the size described in the question. - They are **partially acid-fast** on ZN staining and may show **internal structures** or appear **wrinkled**, making them visible under microscopic examination. *Microsporidium* - *Microsporidium* are extremely small (**1-4 µm**) **intracellular obligate parasites**, much smaller than the 8-10 µm oocysts described. - They require **special staining methods** and are not typically visible with standard ZN staining due to their minute size. *Cryptosporidium* - *Cryptosporidium parvum* oocysts are **spherical** and measure **4-6 µm** in diameter, which is smaller than the 8-10 µm described. - While they are **acid-fast** on ZN staining, their smaller size distinguishes them from the oocysts in question. *Isospora belli* - *Isospora belli* oocysts are **elongated or oval** and measure **20-30 µm** in length, making them significantly larger than the 8-10 µm oocysts described. - Although they are **acid-fast** and visible on ZN staining, their larger size and oval morphology do not match the question parameters.

Q: An HIV patient came to the clinic with a history of diarrhea. Stool microscopy showed the oocysts that were 4-6 µm in size. The image is shown below. Identify the organism.

Cryptosporidium. ***Cryptosporidium*** - **Cryptosporidium** is a common cause of **diarrhea** in **HIV patients**, and its oocysts are typically **acid-fast** and measure **4-6 µm** in size, consistent with the description. - The organism causes **watery diarrhea**, abdominal cramps, and malabsorption, especially in immunocompromised individuals. *Microsporidium* - **Microsporidium** species cause **diarrhea** in HIV patients, but their spores are much smaller, typically **1-2 µm** in size, and require specialized stains for visualization. - They are obligate intracellular parasites that primarily infect enterocytes, leading to malabsorption. *Cyclospora* - **Cyclospora cayetanensis** also causes **diarrhea** in HIV patients, but its oocysts are larger than **Cryptosporidium**, typically measuring **8-10 µm**, and are also acid-fast. - Infection is often associated with contaminated fresh produce and results in prolonged watery diarrhea. *Isospora* - **Cystoisospora belli** (formerly Isospora belli) oocysts are even larger, ranging from **20-30 µm** in length, and are typically ellipsoidal in shape. - These oocysts are also acid-fast and cause severe, protracted diarrhea in immunocompromised individuals.

Q: Which of the following statements regarding the given image is correct?

Majority of infections are asymptomatic in humans. ***Majority of infections are asymptomatic in humans*** - The image depicts an egg of *Hymenolepis nana*, also known as the **dwarf tapeworm**, identifiable by its characteristic **polar filaments** and **polar thickenings** on the inner membrane. - While heavy infections can cause symptoms, most *Hymenolepis nana* infections are **asymptomatic** or present with only mild, nonspecific gastrointestinal complaints. *Infection is acquired by ingestion of undercooked freshwater fish* - Infection with *Hymenolepis nana* is typically acquired through the **ingestion of eggs** directly from contaminated food or water, or via **fecally-contaminated hands**. - Ingestion of undercooked freshwater fish is associated with trematode (fluke) infections like **Clonorchis sinensis** or **Opisthorchis viverrini**, not *Hymenolepis nana*. *Albendazole is the drug of choice* - The drug of choice for *Hymenolepis nana* infection is **Praziquantel**, given as a single dose. - While albendazole might be used for some helminth infections, it is **less effective** than praziquantel for *Hymenolepis nana*. *It is the largest tapeworm infecting humans* - *Hymenolepis nana* is known as the **dwarf tapeworm** and is generally the **smallest tapeworm** that infects humans, typically measuring a few centimeters in length. - The largest tapeworm infecting humans is *Diphyllobothrium latum* (fish tapeworm), which can reach lengths of several meters.

Q: A person handling cat feces is at risk of transmitting an infection. Which of the following is the infective stage of the organism transmitted through cat feces?

Oocyst. ***Oocyst*** - The **oocyst** is the infective stage of *Toxoplasma gondii* that is shed in cat feces. - Cats are the definitive host where sexual reproduction occurs in the intestinal epithelium, producing oocysts. - Humans can become infected by ingesting these **oocysts** directly from contaminated cat litter or soil, or indirectly through contaminated food or water. - Oocysts become infective (sporulated) after 1-5 days in the environment. *Bradyzoite* - **Bradyzoites** are slow-growing forms of *Toxoplasma gondii* found within tissue cysts, particularly in muscle and brain tissue. - While they can be infective if undercooked meat containing cysts is consumed, they are not present in cat feces. - This represents a different route of transmission (foodborne via tissue cysts). *Tachyzoite* - **Tachyzoites** are rapidly multiplying forms of *Toxoplasma gondii* responsible for acute infection and tissue damage. - They are found within host cells during active infection and are not shed in cat feces. - They can cross the placenta causing congenital toxoplasmosis. *Gametocyte* - While **gametocytes** (sexual stages) do develop in the cat's intestinal epithelium during *Toxoplasma gondii* reproduction, they are not the stage shed in feces. - The product of sexual reproduction—the **oocyst**—is what gets excreted and serves as the infective stage. - In contrast, gametocytes of *Plasmodium* species remain in blood and are relevant for malaria transmission.

Q: Identify the organism from the life cycle shown in the image given below

Cryptosporidium. ***Cryptosporidium*** - This life cycle demonstrates **thick-walled, already sporulated oocysts** being passed in feces and are **immediately infective**, which is characteristic of *Cryptosporidium*. - The infection of **intestinal cells** and the development of **trophozoites**, **schizonts**, and **gametes** within the same host also align with the *Cryptosporidium* life cycle. - *Cryptosporidium* oocysts are **immediately infective** upon shedding and contain **four sporozoites** without sporocysts. *Cystoisospora* - While *Cystoisospora* also produces **oocysts**, their oocysts contain **two sporocysts**, each with four sporozoites, whereas *Cryptosporidium* oocysts are immediately infective and contain **four sporozoites** upon shedding. - *Cystoisospora* typically involves a **monoxenous** life cycle (one host), but the distinct oocyst structure differentiates it from *Cryptosporidium*. *Plasmodium knowlesi* - *Plasmodium knowlesi* is a parasite responsible for **malaria** and its life cycle involves an **insect vector** (mosquito) and a **vertebrate host** (human or monkey). - The diagram shows a fecal-oral transmission route with **oocysts**, which is not consistent with the **blood-borne transmission** and liver/blood stage development of *Plasmodium*. *Toxoplasma gondii* - *Toxoplasma gondii* has a complex life cycle with **definitive host** (cats) and **intermediate hosts** (humans, animals), producing **oocysts** in cat feces. - However, *Toxoplasma* oocysts contain **two sporocysts** with **four sporozoites each**, and the parasite forms **tissue cysts** in intermediate hosts, which differs from the *Cryptosporidium* life cycle shown with direct intestinal infection and immediate oocyst infectivity.

Q: A parasitic smear shows 'copper penny' appearance of RBCs. Which morphological feature would confirm Plasmodium falciparum?

Multiple ring forms. ***Multiple ring forms*** - The presence of **multiple ring-stage trophozoites** in a single RBC is the **most specific and definitive feature** of **P. falciparum infection**. - This, along with the "copper penny" appearance (crenation from dehydration during smear preparation) of RBCs, is a strong indicator of **falciparum malaria**. - Multiple rings in a single RBC is considered **pathognomonic** for P. falciparum. *Schüffner's dots* - These are fine stippling dots seen in RBCs infected with **P. vivax** or **P. ovale**, not P. falciparum. - They represent caveolae on the surface of the infected erythrocyte and are vital for nutrient uptake. *Band forms* - **Band forms** are a distinguishing characteristic of **P. malariae**, where the trophozoite stretches across the erythrocyte as a thick band. - They are not observed in **P. falciparum** infections. *Accole forms* - **Accole forms** (appliqué forms) are ring-stage trophozoites that appear to cling to the periphery of the red blood cell. - While they are **characteristic of P. falciparum**, they are less specific for definitive confirmation than multiple ring forms because they can be subtle and occasionally confused with artifacts or early ring stages of other species.

Q: A parasitic smear shows 'double dot' chromatin pattern. Which morphological feature would confirm Babesia infection?

Tetrad formation. ***Tetrad formation*** - The presence of **tetrads** (also known as a **Maltese cross formation**) in red blood cells is a **pathognomonic morphological feature** of *Babesia* infection. - This arrangement is due to the replication process of *Babesia* parasites within erythrocytes, where **four merozoites** are clustered together. *Maurer's clefts* - These are **irregularly shaped clefts** or dots found in red blood cells infected with **_Plasmodium falciparum_**. - They are **not characteristic of Babesia** and differentiate *P. falciparum* from other _Plasmodium_ species. *James' dots* - These are **fine, reddish-purple dots** seen in red blood cells infected with **_Plasmodium ovale_**. - They are **distinct from Babesia** morphology and help in the species identification of malaria parasites. *Schüffner's dots* - These are **fine, stippling dots** that appear in red blood cells infected with **_Plasmodium vivax_** and **_Plasmodium ovale_**. - They are created by caveolae-vesicle complexes and are **not a feature of Babesia** infection.

Q: Most sensitive test for detecting microfilariae?

Membrane filtration technique. ***Membrane filtration technique*** - The **membrane filtration technique** is considered the most sensitive test for detecting **microfilariae** because it concentrates microfilariae from a larger volume of blood (typically 1 mL or more) onto a filter membrane, increasing detection rates, especially in low-parasite density infections. - This method physically traps the microfilariae, allowing for microscopic examination of the concentrated sample after staining, which enhances visualization. *Diethylcarbamazine (DEC) challenge test* - The **DEC challenge test** uses **diethylcarbamazine** to provoke the release of microfilariae into the peripheral blood, especially in cases of occult filariasis or when microfilaria numbers are low. - While it can be useful in certain diagnostic situations, it is **less sensitive** than membrane filtration for directly detecting circulating microfilariae and carries the risk of inducing severe adverse reactions due to rapid parasite killing. *Fluorescence-based immunoassay* - **Fluorescence-based immunoassays** detect **antigens** or **antibodies** related to filarial infection, providing evidence of exposure or active infection. - While valuable for diagnosis, especially in antibody detection for chronic or occult infections, they do not directly detect live microfilariae and thus are not the most sensitive method for *detecting microfilariae themselves*. *Thick blood smear* - A **thick blood smear** is a common and quick method for detecting microfilariae by examining a drop of blood for their presence. - However, it is **less sensitive** than the membrane filtration technique, particularly in persons with low microfilaremia, as it examines a much smaller volume of blood.

Question 1

A patient on steroids presented with nocturnal cough and chronic urticaria. An intestinal biopsy was done, and the organism shown in the image was identified. What is the most likely organism?

Accepted Answer

Strongyloides stercoralis

Answer

Enterobius vermicularis

Answer

Capillaria philippinensis

Answer

Ancylostoma duodenale

Question 2

Name the parasite whose microfilariae have a sheath and no nuclei at the tail end.

Accepted Answer

Wuchereria bancrofti

Answer

Brugia malayi

Answer

Loa loa

Answer

Onchocerca volvulus

Question 3

On Ziehl-Neelsen (ZN) staining oocysts of size 8-10 µm are visible. Identify the organism.

Accepted Answer

Cyclospora

Answer

Microsporidium

Answer

Cryptosporidium

Answer

Isospora belli

Question 4

An HIV patient came to the clinic with a history of diarrhea. Stool microscopy showed the oocysts that were 4-6 µm in size. The image is shown below. Identify the organism.

Accepted Answer

Cryptosporidium

Answer

Microsporidium

Answer

Cyclospora

Answer

Isospora

Question 5

Which of the following statements regarding the given image is correct?

Accepted Answer

Majority of infections are asymptomatic in humans

Answer

Albendazole is the drug of choice

Answer

Infection is acquired by ingestion of undercooked freshwater fish

Answer

It is the largest tapeworm infecting humans

Question 6

A person handling cat feces is at risk of transmitting an infection. Which of the following is the infective stage of the organism transmitted through cat feces?

Accepted Answer

Oocyst

Answer

Bradyzoite

Answer

Tachyzoite

Answer

Gametocyte

Question 7

Identify the organism from the life cycle shown in the image given below

Accepted Answer

Cryptosporidium

Answer

Cystoisospora

Answer

Plasmodium knowlesi

Answer

Toxoplasma gondii

Question 8

A parasitic smear shows 'copper penny' appearance of RBCs. Which morphological feature would confirm Plasmodium falciparum?

Accepted Answer

Multiple ring forms

Answer

Schüffner's dots

Answer

Band forms

Answer

Accole forms

Question 9

A parasitic smear shows 'double dot' chromatin pattern. Which morphological feature would confirm Babesia infection?

Accepted Answer

Tetrad formation

Answer

Maurer's clefts

Answer

James' dots

Answer

Schüffner's dots

Question 10

Most sensitive test for detecting microfilariae?

Accepted Answer

Membrane filtration technique

Answer

Diethylcarbamazine (DEC) challenge test

Answer

Fluorescence-based immunoassay

Answer

Thick blood smear

Parasitology — MCQs

Parasitology — MCQs

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