Tissues Flashcards by Auriol Harford

Brain

Trypanosoma brucei
(Blood protozoa/ Hemoflagellate)
Brucei in Brain

See Morula cells (modified antibody producing B cells, larger than other lymphocytes) - look like mauve berries with clear surround (A)
See perivascular cuffing (B) in otherwise normal brain tissue (no inflammation or haemorrhages)

Lymph gland aspirates can be examined to diagnose African Trypanosomiasis

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Brain

P.falciparum schizonts sequestrated in the capillaries, where phagocytic cells have engulfed the released black malaria pigment (haemozoin).
The surrounding brain tissue is normal

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Muscle

Trypanosoma cruzi

100’s of Amastigotes contained in Pseudocysts (faint ball of reddish/purple dots in Cardiac smooth muscle)

Chagas Disease
Vector: Triatomine bugs (Panstrongylus) transmits Trypanosoma Cruzi (Haemoflaggelate/Blood protozoa)
Tx: benznidazole or nifurtimox

Cardiac smooth muscle as nuclei are in centre of muscle cells

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Muscle

Trypanosoma cruzi

100’s of Amastigotes contained in Pseudocysts (faint ball of reddish/purple dots in Cardiac smooth muscle)

Chagas Disease
Vector: Triatomine bugs (Panstrongylus) transmits Trypanosoma Cruzi (Haemoflaggelate/Blood protozoa)
Tx: benznidazole or nifurtimox

Cardiac smooth muscle as nuclei are in centre of muscle cells

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Muscle

Taenia solium

See large cysticercus or bladder worm (larvae) with inverted scoleces with crown of hooks in horseshoe (looks like celery slice) surrounded by suckers
Seen at x4

Pork Tapeworm
Cysticercosis from ingestion of ova

Skeletal smooth muscle as nuclei are at the side of muscle cells

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Lymph

Filarial Nematodes
Either Wucheria bancrofti or Brugia sp. - cannot speciate in tissues

Thick cuticle surrounding adult worm with double-uterus in cross-section. The adults are in the ducts so appear to be sitting in a space.
See eggs differentiating into early larvae (microfilariae) in the double uteri.

Lymphatic Filariasis

Vector: Culicine mosquitoes

Tx. : DEC (diethylcarbamazine) +/- Doxy

Lymph node tissue ducts

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Lymph

Adult Filarial Nematodes
Either Wucheria bancrofti or Brugia sp. - cannot speciate in tissues

Lymphatic Filariasis

Vector: Culicine mosquitoes

Tx. : DEC (diethylcarbamazine) +/- Doxy

Lymph node tissue ducts

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Skin

Onchocerca volvulus

A = Adult filarial nematode embedded in tissue
B = classic double uterus containing eggs & Mf.
C = microfilariae inside double uterus
D = microfilariae in surrounding tissue

Subcutaneous Filariasis, Onchocerciasis (River Blindness)

Vector: Simulium Black fly/’Buffalo fly’

Tx. Ivermectin +/- Doxy. NOT DEC
(Caution if Loa)

Skin nodule (surrounded by fibrotic capsule)

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Muscle

Trichinella spiralis

Encrusted Spiralled larvae in striated & skeletal muscle, surrounded by cellular infiltrates.
Juvenile: 75-120µm
Fully developed: 1mm

Skeletal smooth muscle as nuclei are at the side of muscle cells

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Muscle

Trichinella spiralis

Encrusted Spiralled larvae in striated & skeletal muscle, surrounded by cellular infiltrates.
Juvenile: 75-120µm
Fully developed: 1mm

Skeletal smooth muscle as nuclei are at the side of muscle cells

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Brain

P.falciparum schizonts sequestrated in the capillaries, which is now blocked, with haemorrhages in the surrounding brain tissue.
Causing Cerebral Malaria

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Liver

P.falciparum schizonts containing malaria pigment (haemozoin), sequestrated in the Kupffer cells (Hepatic phagocytic cells) within the sinusoidal spaces between hepatocytes.

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Liver

Leishmania sp.

(Blood protozoa/ Hemoflagellate)
See purpleLeishmaniasis amastigotes (B) in macrophages/Kupffer cells (D) inbetween the hepatocytes (A)

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Liver

Fasciola hepatica Adult

Large liver fluke (3cm) with multiple guts & rough tegument in the liver tissue
Fasciola migrates through the liver causing acute symptoms, eosinophilia & detectable antibody response. (Facilitate diagnosis before eggs are detectable in the faeces).

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Liver

Fasciola hepatica Adult

Large liver fluke (3cm) with multiple guts & rough tegument in the billiary tree

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Liver

Clonorchis sinensis Adult

Large liver fluke (2cm) with double gut & smooth tegument in the billiary tree

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Liver

Fasciola hepatica Adult

Large liver fluke (3cm) with multiple guts & rough tegument in the billiary tree

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Liver

Clonorchis sinensis Adult

Large liver fluke (2cm) with double gut & smooth tegument in the billiary tree

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Liver

What are the features labelled?

Fasciola hepatica Adult in the billiary tree

A - multilobed gut
B - egg
C - rough spiney tegument

Large liver fluke (3cm)

Liver

What are the features labelled?

Clonorchis sinesis Adult in the billiary tree

A - double branched gut
B - smooth tegument
C - eggs

Large liver fluke (2cm)

Liver

Echinococcus multilocularis

Cysts are characterised by having multiple chambers of protoscolices (larvae) which are separated by thin walls.

Canid Tapeworm
Multilocular hydatid Disease or alveolar echinococcus from ingestion of ova - very invasive.

Liver

Echinococcus multilocularis

Cysts are characterised by having multiple chambers of protoscolices (larvae) which are separated by thin walls.

Canid Tapeworm
Multilocular hydatid Disease or alveolar echinococcus from ingestion of ova - very invasive.

Liver

Echinococcus granulosus

See single hydatid cyst characterised by having a single triple walled chamber containing daughter cysts, containing brood capsules containing protoscolices (larvae).

Canid Tapeworm
Unilocular hydatid Disease or cystic echinococcus from ingestion of ova.

Liver

What is this structure and what are the names of the 3 layers?

Hydatid cyst caused by ingestion of Echinococcus granulosus ova

See single hydatid cyst characterised by having a single triple walled chamber containing daughter cysts, containing brood capsules, containing protoscolices (larvae).

Outer granular layer
Middle laminated layer
Inner germinal layer

Canid Tapeworm
Unilocular hydatid Disease or cystic echinococcus

# Brain

***P.falciparum*** schizonts containing black pigment (haemozoin), sequestrated in the capillaries, with ring haemorrhages. Causing **cerebral malaria**

# Brain

**Reactivated** ***Toxoplasma gondii*** Tissue shows **perivascular cuffing** with surrounding **haemorrhages** and adjacent tissue **necrosis** On closer inspection would see tachycysts consisting of loosely packed tachyzoites (active) (~5x3µm)

# Brain

**Reactivated** ***Toxoplasma gondii*** Tissue shows **perivascular cuffing** with surrounding **haemorrhages** and adjacent tissue **necrosis** (pale pink) Commonly seen in AIDS patients On closer inspection would see tachycysts consisting of loosely packed tachyzoites (active) (~5x3µm)

# Brain

Dormant ***Toxoplasma gondii*** Shows **bradycyst** - a discreet body which is tightly packed with the **bradyzoites** No surrounding tissue inflammation, haemorrhage or necrosis

# Brain

Dormant ***Toxoplasma gondii*** Shows **bradycyst** - a discreet body which is tightly packed with the **bradyzoites** No surrounding tissue inflammation, haemorrhage or necrosis

# Brain

***P.falciparum*** schizonts containing black pigment (haemozoin), sequestrated in multiple capillaries, with surrouding ring haemorrhages. Seen in **Cerebral malaria**

# Brain

***P.falciparum*** schizonts containing black pigment (haemozoin), sequestrated in multiple capillaries, with ring haemorrhage surrounding transverse section of capilliary. Seen in **Cerebral malaria**

# Liver

***P.falciparum*** schizonts containing malaria pigment (haemozoin), sequestrated in the Kupffer cells (Hepatic phagocytic cells) within the sinusoidal spaces between hepatocytes.

# Bowel

***Entamoeba histolytica*** 'Flask shaped' ulcer in mucosal surface caused by *Entamoeba histolytica* trophozoites invading healthy tissues at base of the ulcer | Large bowel with flattened villae

# Bowel

***Schistosomiasis sp.*** Paired adults in copula in mesenteric veins (A) containing black pigment of ingested RBCs. See eggs (C) in the surrouding tissues surrounded by granulomas (B) (**Sh**isto **Sh**nuggles) | Large bowel with flattened villae

# Bowel

***Enterobius vermicularis*** adult worm See adult worm free-floating in gut lumen with characteristic lateral alae along entire length of body. Usually found in appendix. May also see double-bulbed oesophagus & eggs in lumen. Thread or pin worm (Intestinal Nematode) Perianal puritis - can be collected with “Scotch-tape to skin” | Large bowel with flattened villae

# Liver

***Schistosomiasis japonicum or mansonai*** See eggs (A) surrounded by granulomas (discrete reaction of surrounding eosinophils/neutrophils) and pale pink fibrosis (C) within hepatocytes. Trematode/Blood fluke

# Bowel

***Strongyloides*** See ALL STAGES: Free-living adults in cross-section - dark purple bubble with multiple compartments & double bulbed oesophagus, embedded in mucosa Larvae - small, curved with uniform appearance (look like slender tubes with dots) Eggs - look like hookworm but smaller with yellowish refractile wall | Small bowel with multiple villae and deep crypts

# Bowel

***Entamoeba histolytica*** **trophozoite** (foamy pink bodies with single nuclei - middle arrow) Seen in healthy tissue adjecent to necrotic tissue at base of 'Flask shaped' ulcer in mucosal surface | This is zoomed in but would indentifiy as Large bowel due to flattened v

# Bowel

***Entamoeba histolytica*** **trophozoite** Foamy pink bodies with single nuclei surrounded by clear space Seen in healthy tissue adjacent to necrotic tissue at base of 'Flask shaped' ulcer in mucosal surface | Zoomed in but would indentifiy as Large bowel due to flattened villae

# Bowel

***Entamoeba histolytica*** **trophozoite** (foamy pink bodies with single nuclei - arrows) Seen in healthy tissue adjecent to necrotic tissue at base of 'Flask shaped' ulcer in mucosal surface | Large bowel due to flattened villae

# Lung

***Pneumocystis jirovecii*** in a lung section Silver in stain binds to the pneumocysts staining them black, encased in foamy exudate within the alveolus | Grocott stained section of lung with pale green/teal lung tissue

# Lung

***Pneumocystis jirovecii*** in a lung section Silver in stain binds to the pneumocysts staining them black, encased in pale foamy exudate within the alveolus | Grocott stained section of lung with pale green/teal lung tissue

# Bowel

# Spleen

***Leishmania donovani*** **amastigotes** in Phagocytic cells Haemoflaggelate Visceral Leishmaniasis or Kala-azar – usually Indian subcontinent, East Africa and South America (see massive splenomegaly) Vector: Female Sandfly **Phlebotomus** genus Old World **Lutozmyia** genus New World Tx: Liposomal amphotericin B

Tissues Flashcards

Selection of tissues with protozoal & helminth infections