Informational Tables

- 1.1 Parasite Classification | - 1.2 Body Site, Specimens, Procedures, Parasites, Comments | - 1.3 STAT Testing in Parasitology | - 1.4 Test Issues and Reports: Computer Report Comments| - 1.5 Rapid Diagnostic Testing
- 2.1 Stool Testing Order Recommendations | - 2.2 Fecal specimens for parasites: options for collection and processinga² | - 2.3 Preservatives used for Stool Specimens
- 3.1 Body Sites and Specimen Collection | - 3.2 Body sites and the most common parasites recovered | - 3.3 Body Site, Specimens and Recommended Stain | - 3.4 Examination of tissues and body fluids | - 3.5 Parasitic Infections: Clinical Findings Healthy/Compromised Hosts | - 3.6 Microscope Calibration | - 3.7 Serologic, Antigen, and Probe Tests for Parasite Diagnosis
- 4.1 Protozoa: Intestinal Tract, Urogenital System: Key Characteristics | - 4.2 Tissue Protozoa: Characteristics | - 4.3 Tips on Performance of Fecal Immunoassays for Intestinal Protozoa
5.1 Helminths: Key Characteristics | 5.2 Helminth Parasites Associated with Eosinophilia
6.1 Reference Laboratory for Parasite Blood Testing | 6.2 Parasites Found in Blood: Characteristics
7.1 Malaria (5 Species) (2 P. ovale subspecies) | 7.2 Malaria (5 Species, Images) | 7.3 Rapid Malaria Testing (BinaxNOW Malaria Test) | 7.4 Malaria Parasitemia Method | 7.5 Malaria Parasitemia Interpretation
- USE OF A REFERENCE LABORATORY FOR PARASITE BLOOD DIAGNOSTIC TESTING (Including the Binax Rapid Test and Report Comments)
- HELMINTH PARASITES ASSOCIATED WITH EOSINOPHILIA | - Histology: Staining Characteristics - Table 1 | - Histological Identification of Parasites - Table 2 | - Microscope Calibration | - Figures for Histology Identification Table 2 |

TAB LE 7.5 PARASITEMIA DETERMINED FROM CONVENTIONAL LIGHT MICROSCOPY: CLINICAL CORRELATION AND INTERPRETATION

Parasitemia (%)	No. of Parasites/µl	Clinical correlation^a
0.0001-0.0004	5-20	Number of organisms required for positive thick film (sensitivity) Examination of 100 thick-blood-film (TBF) fields (0.25 µl) may miss up to 20% of infections (sensitivity 80-90%); at least 300 fields should be examined before reporting a negative result Examination of 100 thin-blood-film fields (THBF) (0.005 µl); at least 300 fields should be examined before reporting a negative result; both thick and thin blood films should be examined for every specimen submitted for a suspect malaria case (report final results using 100 x oil immersion objective) BinaxNOW® rapid lateral flow method (dipstick) (0-100 = 53.9% sensitivity for P. falciparum) BinaxNOW® rapid lateral flow method (dipstick) (0-100 = 6.2% sensitivity for P.vivax)) One set (TBF + THBF) of negative blood films does not rule out a malaria infection
0.002	100	Patients may be symptomatic below this level, particularly if they are immunologically naïve (no prior exposure to malaria) (Example: travelers) BinaxNOW® rapid lateral flow method (dipstick) (100-500 = 89.2% sensitivity for P. falciparum) BinaxNOW® rapid lateral flow method (dipstick) (100-500 = 23.6% sensitivity for P. vivax)
0.02	1,000	Level often seen in travelers (immunologically naïve) – results may also be lower than this BinaxNOW® rapid lateral flow method (dipstick) (1000-5000 = 99.2% sensitivity for P. falciparum) (500-1000 = 92.6% sensitivity for P.falciparum) BinaxNOW® rapid lateral flow method (dipstick) (1000-5000 = 81.0% sensitivity for P. vivax) (500-1000 = 47.4% sensitivity for P. vivax)
0.1	5,000	BinaxNOW® rapid lateral flow method (dipstick)(>5000 = 99.7% sensitivity for P. falciparum) BinaxNOW® rapid lateral flow method (dipstick) (>5000 = 93.5% sensitivity for P. vivax)
0.2	10,000	Level above which immune patients will exhibit symptoms
2	100,000	Maximum parasitemia of P. vivax and P. ovale (which infect young RBCs only)
2-5	100,000 - 250,000	Hyperparasitemia, severe malariab; increased mortality
10	50,000	Exchange transfusion may be considered; high mortality

^aThe BinaxNOW® malaria test (Alere) is FDA approved. The test detects antigen (viable and non-viable) organisms, including gametocytes and sequestered P. falciparum parasites. Performance depends on antigen load and may not directly correlate with microscopy. Positive rheumatoid factor titers may give false positives. The pan malarial test line is capable of detecting all five species. However, insufficient data is present to support claims for the detection of P. malariae, P. ovale, or P. knowlesi. Claims are made for P. falciparum and P. vivax only. The test is not intended for use in screening asymptomatic populations.

^bWorld Health Organization criteria for severe malaria are parasitemia of >10,000/µl and severe anemia (hemoglobin, <5 g/liter). Prognosis is poor if >20% of parasites are pigment-containing trophozoites and schizonts and/or if >5% of neutrophils contain visible pigment.