Procedures for referral to a specialist laboratory

There are certain procedures that should be referred to a specialist laboratory in order to fully determine the details of the parasitic infection. For example, it is possible that a case is involved with several strains of Plasmodium and thus this inquiry can not be performed in a regular parasitology laboratory that can only perform routine staining and microscope screening (Shokoples et al. , 2009). It this case, it is necessary to refer the case to a specialist laboratory that could perform diagnostic testing of multiple parasites through the polymerase chain reaction (PCR) assay (Reid, 2009).

This test involves extraction of deoxyribonucleic acid (DNA) from the tissue sample and subjecting this to different temperature gradients that will allow the generation of multiple copies of DNA sequences specific to the parasite. A special DNA polymerase enzyme is also employed in the PCR assay and this enzyme is responsible for creating more DNA strands of the parasite. Referral to a specialist laboratory is also necessary when there is an inquiry with regards with drug resistance of a parasite to a particular treatment.

The only way to determine drug resistance is to submit the parasite to a molecular biology laboratory for testing of drug resistance genes. It is also possible to refer the case to a pharmacological or biochemical laboratory to further analyze for reactivity to specific drugs. It is important to determine sensitivity of a parasite to a drug because it may be possible that the current medication will not be able to kill the parasite that has been detected in the patient.

Case study A In the case that involves a 4-year-old child with diarrhea, it is necessary to submit a stool sample of the child to the parasitology laboratory for screening of parasites such as roundworms and other nematodes. These parasites are commonly found in dogs and cats and thus it is important that these pets are regularly dewormed. However, children frequently touch different things in their immediate environment, as well as put things in their mouths.

Young children also do not understand that they need to wash their hands as frequently as possible and thus it is possible that they have contracted a worm by playing with their pets. In order to fully determine if the child has parasitic worms, the child should be brought to a physician for immediate screening for parasitic tests. Both stool and blood samples should be collected and screened for any parasites that may be present in these samples.

Any cysts, larvae or worms should be checked in the stool sample, while both hematocrit and present of trophozoites should be checked in the blood. Since the child has been experiencing diarrhea for two weeks, it is important to provide rehydration treatment in order to prevent further complications with respect to the diarrhea. Case study B In the case of the 25-year-old aid that has been experiencing diarrhea and fever for three months while working in the remote villages of the Solomon Islands, it is important to take this person to the hospital for screening of parasites.

It is most possible that the individual is suffering from malaria and this can be determined by taking a blood sample and preparing a fresh mount of this sample for staining and viewing under the microscope. If the patient is indeed infected with malaria, the patient will show trophozoites in her blood smear and thus it is important to administer anti-malarial drugs immediately. It is also important to determine whether the parasite that is present in the patient is responsive to currently available drug treatments.

It is also important to know the strain of Plasmodium that is present in the patient. It may be possible that more than one species is present and the appropriate treatment regimen can be designed once this has been established. Another sample specimen could be used to test for these two essential inquiries through the PCR assay. It is also important to administer rehydration solutions to the patient in order to prevent any excessive loss of water in the body. Anti-pyretics should also be given to the patient to control the fever. IV. Notifiable diseases

A parasitic disease should be treated as notifiable is when it has been observed that the parasite is resistant to the current available treatment. An example of this condition is drug-resistance in Plasmodium falciparum, which is associated with malaria. When resistance is determined in this parasite, it is possible that a great number of individuals living in the same area could be infected with the parasite and there will be greater difficulty in controlling the further spread of the parasite because the current drugs are not effective in preventing its further proliferation in the human body (Intapan et al., 2009).

Another condition that should be kept under high vigilance is the emergence of new strains of a parasite, such as that of flatworms or roundworms and that the common anti-helminthic drugs are not capable of exerting its effects of these new strains of nematodes. The presence of these parasites in common food items such as pork and meat should also be considered as notifiable, in order for other agencies to implement safety and precautionary measures that could prevent further spread of the parasite to the rest of the city or state.

References Badiee, P., Kordbacheh, P. , Alborzi, A. , Zakernia, M. and Haddadi, P. (2009). Early detection of systemic candidiasis in the whole blood of patients with hematologic malignancies. Japanese Journal of Infectious Diseases, 62, 1-5. Intapan, P. M. , Thanchomnang, T. , Lulitanond, V. and Maleewong, W. (2009). Rapid detection of Wuchereria bancrofti and Brugia malayi in mosquito vectors (Diptera: Culicidae) Using a real-time fluorescence resonance energy transfer multiplex PCR and melting curve analysis. Journal of Medical Entomology, 46, 158-164.

Pennington, P. M. , Paiz, C. , Grajeda, L. M. and Cordon-Rosales, C. (2009). Short report: Concurrent detection of Trypanosoma cruzi lineages I and II in domestic Triatoma dimidiata from Guatemala. American Journal of Tropical Medicine and Hygiene, 80, 239-241. Reid, A. (2009). PCR detection of potato cyst nematode. Methods in Molecular Biology, 508, 289-294. Shokoples, S. E. , Ndao, M. , Kowalewska-Grochowska, K. and Yanow, S. K. (2009). Multiplexed real-time PCR assay for discrimination of Plasmodium species with improved sensitivity for mixed infections. Journal of Clinical Microbiology, 47, 975-980.

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