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Microbiology & infectious diseases

Authors: Steven H. Adams, M.D., Maryam Aghighi, M.D., Ayman Al Habeeb, M.D., Megan Amerson-Brown, M.L.S., Ph.D., Jaya Ruth Asirvatham, M.D., Alison Burkett, M.D., Andrey Bychkov, M.D., Ph.D., Rajeshwari Chellappan, M.B.B.S., M.P.H., Thomas Cotter, D.O., Amaro Nunes Duarte-Neto, M.D., Ph.D., Haind Fadel, M.D., George Andy Farr, M.L.S., Ladan Fazlollahi, M.D., M.P.H., Nina J. Gao, Ph.D., Elizabeth M. Garrett, Ph.D., Carlos Graeff-Teixeira, M.D., Ph.D., Veronica Gross, M.D., Ph.D., Hanni Gulwani, M.B.B.S., Christopher S. Hale, M.D., Mowafak Hamodat, M.B.Ch.B., M.Sc., Andrew Handel, M.D., Julie M. Jorns, M.D., Natalie Larsen, M.D., Sixto M. Leal, Jr., M.D., Ph.D., Lili Lee, M.D., Elizabeth Lee, D.O., Joshua A. Lieberman, M.D, Ph.D., Dragos C. Luca, M.D., Blaine A. Mathison, B.S., Nada Mohamed, M.D., Smitha Mruthyunjayappa, M.D., Sharon Nachman, M.D., Valeria Perez, Nat Pernick, M.D., John K.S.S. Philip, M.D., Bobbi S. Pritt, M.D., M.Sc., Meng Pu, Ph.D., Nicole E. Putnam, Ph.D., Andrii Puzyrenko, M.D., Ph.D., Margaret Redpath, M.D., Ryan F. Relich, Ph.D., Ashleigh N. Riegler, Ph.D., Rubens Rodriguez, M.D., Ph.D., Sawanan Saitornuang, B.S., Ziyan T. Salih, M.D., Hasan Samra, M.D., Sakda Sathirareuangchai, M.D., Andrzej Slominski, M.D., Ph.D., Abha Soni, D.O., M.P.H., Arthur H. Totten, Ph.D., Patricia Tsang, M.D., M.B.A., Asad Ullah, M.D., Ateeqa Mujeeb Ullah, M.D., Elliot Weisenberg, M.D., Erika Wheeler, M.D., Samantha C. Wu, B.A.
Editorial Board Members: Hillary Rose Elwood, M.D., Gary Tozbikian, M.D., Patricia Tsang, M.D., M.B.A.
Deputy Editors-in-Chief: Patricia Tsang, M.D., M.B.A., Debra L. Zynger, M.D.
Editor-in-Chiefs: Patricia Tsang, M.D., M.B.A., Debra L. Zynger, M.D.

Copyright: 2008-2024, PathologyOutlines.com, Inc.

Micro / Clin Path related: Jobs, Fellowships, Conferences, CME, Board Review

Editorial Board oversight: Patricia Tsang, M.D., M.B.A. (last reviewed November 2023)
Page views in 2024 to date: 8

Acanthamoeba
Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D. and Heather Arguello

Double walled cyst and trophozoite


Actinomyces
Microscopic (histologic) images

Contributed by Natalie Larsen, M.D. and Sixto M. Leal, Jr., M.D., Ph.D.
Inflammation surrounding filamentous bacteria

Inflammation surrounding filamentous bacteria

Sulfur granule formation in tonsillar tissue

Sulfur granule formation in tonsillar tissue


Anaplasma
Peripheral smear images

Contributed by Patricia Tsang, M.D.

Case of the Month #486



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HGA: inclusions in granulocytes

Left: HGA (HGE)


Angiostrongyliasis
Gross images

Contributed by Rubens Rodriguez, M.D., Ph.D.
Colonic pseudotumor

Colonic pseudotumor

Cecal pseudotumor

Cecal pseudotumor

Small bowel thickening

Small bowel thickening

Small bowel infarction

Small bowel infarction

Small bowel perforation

Small bowel perforation

Microscopic (histologic) images

Contributed by Rubens Rodriguez, M.D., Ph.D.
Arterial thrombosis Arterial thrombosis

Arterial thrombosis

Eosinophilic arteritis

Eosinophilic arteritis

Severe eosinophilic infiltration

Severe eosinophilic infiltration

Vascular granuloma and eosinophils

Vascular granuloma and eosinophils


Vascular granuloma and eosinophils

Vascular granuloma and eosinophils

Granuloma with degenerated egg

Granuloma with degenerated egg

Degenerated egg

Degenerated egg

Eggs and eosinophils

Eggs and eosinophils

Adult worm inside artery

Adult worm inside artery


Adult worm inside artery

Adult worm inside artery

Degenerated worm Degenerated worm

Degenerated worm

Severe eosinophilic infiltration

Severe eosinophilic infiltration

Adult worm

Adult worm


Artifacts
Microscopic (histologic) images

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Epithelial cell in stool

Fungal spore in stool

Fungal element in stool - AFP stain

Pollen grain in stool


Plant hair in stool

Platelets in blood

Nucleated RBC in blood


Ascaris
Gross images

Contributed by Bobbi Pritt, M.D.

Adult with 3 fleshy lips


Contributed by @acp000 on Twitter
APL with PML-RARA

Biliary ascariasis

Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D. and Institute of Tropical Medicine Antwerp

Ascaris lumbricoides eggs, decorticated

Videos

Creepy Dreadful Wonderful Parasites Case


Babesia
Peripheral smear images

Contributed by Erika Wheeler, M.D. and Bobbi Pritt, M.D.
Thin smear

Intracellular and extracellular Babesia ring forms

Thin smear

Multiple Babesia ring forms

Giemsa stained thick and thin blood films


Giemsa stained thick and thin blood films



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Tetrad form


Balamuthia
Microscopic (histologic) images

Contributed by Sixto M. Leal, Jr., M.D., Ph.D.
B. mandrillaris trophozoite and cysts

B. mandrillaris trophozoite and cysts


Blastocystis
Diagrams / tables

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Life cycle

Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D. and Blaine Mathison

Trichrome stained stool specimen



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4 common forms


Blastomyces
Microscopic (histologic) images

Contributed by Sixto M. Leal, Jr., M.D., Ph.D.
Lollipop-like aleurioconidia

Lollipop-like aleurioconidia

Multinucleated giant cell with yeasts

Multinucleated giant cell with yeasts

GMS stain of yeasts

GMS stain of yeasts

PAS stain of yeasts

PAS stain of yeasts


Borrelia burgdorferi
Clinical images

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Skin rash

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Erythema migrans

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Various rash presentations

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Erythema migrans lesions


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Late stage: osteoarthritis

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Adult deer tick

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Normal and engorged

Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D.

Giemsa stained thin blood films from patient in northwest North America with recurrent fevers: Borrelia, relapsing fever group (not Lyme disease causing Borrelia species), probably Borrelia hermsii



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Perivascular lymphocytic infiltrate

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Darkfield microscopy


Candida auris
Radiology images

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Candida auris pneumonia

Candida auris pneumonia

Candida auris encephalitis

Candida auris encephalitis

Microscopic (histologic) images

Contributed by Amaro Nunes Duarte-Neto, M.D., Ph.D.
Candida auris and inflammatory cells Candida auris and inflammatory cells Candida auris and inflammatory cells

Candida auris and inflammatory cells

Cytology images

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Culture and microscopic images of C. auris

Culture and microscopic images of C. auris

Electron microscopy images

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Candida albicans chlamydospore

Candida albicans chlamydospore

Yeast cells ultrastructure

Yeast cells ultrastructure


Cimex lectularius (bed bug)
Gross images

Contributed by Bobbi Pritt, M.D.

Bed bugs

Bed bugs: Cimex lectularius


Bed bugs: Cimex lectularius

Bed bug: setae shorter than width of eye

Bat / bird bed bug: prominent long setae


Clostridioides difficile
Clinical images

Contributed by Joshua A. Lieberman, M.D, Ph.D.

C. perfringens

Gross images

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Fluorescence under UV light

Microscopic (histologic) images

Contributed by Joshua A. Lieberman, M.D, Ph.D.

C. perfringens

Electron microscopy images

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Spores


Clostridium perfringens / C. septicum
Clinical images

Contributed by Hasan Samra, M.D.
Clostridium perfringens</i> isolated in culture

Clostridium perfringens isolated in culture

Microscopic (histologic) images

Contributed by Hasan Samra, M.D.
<i>Clostridium</i> sp.

Clostridium spp.

Videos

Clostridium perfringens - an osmosis preview


Cordylobia rodhaini (Lund fly)
Gross images

Contributed by Bobbi Pritt, M.D. and Institute of Tropical Medicine Antwerp

Cordylobia rodhaini: third instar larva

C. rodhaini and
C. anthropophaga


COVID-19 (SARS-CoV-2) testing
Diagrams / tables
  • Below is a partial list of commercially available SARS-CoV-2 assays in the U.S. and a comparison of the key features based on manufacturers’ claims gleaned from package inserts and news releases (FDA: Emergency Use Authorizations - In Vitro Diagnostics EUAs [Accessed 24 April 2020])
  • Independent studies are needed to verify the comparative performances of these assays; due to the rapid rollout of these emergency use authorization assays, peer reviewed publications will take time to catch up
  • The analytical sensitivities (limits of detection) vary widely among assays

Table 1. Performance Characteristics of Some EUA SARS-CoV-2 Assays
Manufacturer In Vitro Diagnostic EUAs Technology Claimed LoD Sensitivity Specificity
Abbott Abbott RealTime SARS-CoV-2 Assay rRT-PCR 100 copies/mL 100% at 1-2x LoD 100%
Abbott ID NOW COVID-19 Test Isothermal nucleic acid amplification 125 copies/mL 100% at 2-5x LoD 100%
Becton Dickonson BD SARS-CoV-2 Reagents rRT-PCR 40 copies/mL 95% at 1-2x LoD, 100% at 3-5x LoD 100%
Becton Dickonson BioGX SARS-CoV-2 Reagents rRT-PCR 40 copies/mL 95% at 1-2x LoD, 100% at 3-5x LoD 100%
BGI Genomics Real-Time Fluorescent RT-PCR Kit for Detecting SARS-2019-nCoV rRT-PCR Throat: 150 copies/mL; BALF: 100 copies/mL Throat: 95% at 1x LoD; BALF: 100% at 1x LoD 100%
*Bio-Rad Platelia SARS-CoV-2 Total Ab assay ELISA (IgM, IgA, IgG) 100% serum (n=27), 83% plasma (n=24) 99.6%
BioFire BioFire COVID-19 Test rRT-PCR 330 copies/mL 100% at 1x LoD 100%
*Cellex qSARS-CoV-2 IgG/IgM Rapid Test Lateral flow immunoassay (IgM, IgG) 94% (n=128, no symptoms to severe) 95.6%
Cepheid Xpert Xpress SARS-CoV-2 rRT-PCR 250 copies/mL 100% at 2x LoD 100%
Co-Diagnostics Logix Smart Coronavirus Disease 2019 (COVID-19) Kit rRT-PCR 4290 copies/mL of sputum 100% at 1x LoD 100%
DiaCarta QuantiVirus SARS-CoV-2 Test Kit rRT-PCR ABI QuantStudio 5: 200 copies/mL; ABI 7500 Fast Dx: 100 copies/mL ABI QuantStudio: 95% at 1x LoD; ABI 7500 Fast Dx: 100% at 1x LoD 100%
DiaSorin Simplexa COVID-19 Direct Assay rRT-PCR 500 copies/mL 100% at 1x LoD 100%
GenMark ePlex SARS-CoV-2 Test RT-PCR, electrochemical detection 1 x 105 copies/mL 94.4% at 1x LoD 100%
Gnomegen Gnomegen COVID-19 RT-Digital PCR Detection Kit rRT-PCR, digital, nanofluidic chip 60 copies/mL 100% at 1-2x LoD 100%
Hologic Panther Fusion SARS-CoV-2 Assay rRT-PCR 0.01 TCID50/mL 100% at 1-5x LoD 100%
InBios Smart Detect SARS-CoV-2 rRT-PCR Kit rRT-PCR 7500 Fast Dx: 1100 copies/mL; CFX96 Touch: 860 copies/mL 100% at 1x LoD 100%
Ipsum COV-19 IDx Assay rRT-PCR 8.5 x 103 copies/mL 100% at 1x LoD 100%
Luminex NxTAG CoV Extended Panel Assay rRT-PCR 5.0 x 103 copies/mL 95% at 2x LoD 100%
Luminex ARIES SARS-CoV-2 Assay rRT-PCR 7.5 x 104 copies/mL 100% at 1x LoD 100%
Mesa Biotech Accula SARS-CoV-2 rRT-PCR, lateral flow 200 copies/60uL reaction (pooled nasal & throat) 100% at 2-50x LoD 100%
NeuMoDx NeuMoDx SARS-CoV-2 Assay rRT-PCR 150 copies/mL 100% at 1.5x LoD 100%
*Ortho Vitros Anti-SARS-CoV-2 Total Reagent Pack and Total Calibrator Immunometric luminescent reaction (IgG) 92.3% at 1-5 days, 88.9% at 6-15 days, 75% at 16-22 days post-PCR 100%
PerkinElmer PerkinElmer New Coronavirus Nucleic Acid Detection Kit rRT-PCR ORF1ab: 8.3 copies/mL; N: 27.2 copies/mL ORF1ab: 100% at 1.5x LoD; N: 100% at 1.5x LoD 100%
Primerdesign Primerdesign Ltd COVID-19 genesig Real-Time PCR assay rRT-PCR 330 copies/mL 94.7% at 1-2x LoD, 100% at 3-5x LoD 100%
QIAGEN QIAstat-Dx Respiratory SARS-CoV-2 Panel (22 bacterial & viruses) rRT-PCR 500 copies/mL 100% at 1-2x LoD 100%
Quidel Lyra SARS-CoV-2 Assay rRT-PCR 800 copies/mL 100% at 1x LoD 100%
Roche cobas SARS-CoV-2 Assay rRT-PCR 0.007 TCID50/mL 100% at 1.5x LoD 100%
*Roche Elecsys Anti-SARS-CoV-2 Sandwich immunoassay (antibodies) 65.5% at ≤ 6 days, 88.1% at 7-13 days, 100% ≥ 14 days post-PCR 99.8%
Thermo Fisher TaqPath COVID-19 Combo Kit rRT-PCR 10 copies/140uL 100% at 1x LoD 100%
* Serology assay
Abbreviations: LoD = limit of detection; rRT-PCR = real time reverse transcriptase polymerase chain reaction


Table 2. Categories of SARS-CoV-2 EUA Assays and Examples
Category In Vitro Diagnostic EUAs Instruments Throughput Cycle Time
Point of Care Setting
Abbott ID NOW COVID-19 Test ID NOW Nonbatch 5 min (+), 13 min (-)
Cepheid Xpert Xpress SARS-CoV-2 GeneXpert Xpress System Nonbatch modular 45 min per cartridge
Mesa Biotech Accula SARS-CoV-2 Accula/Silaris Dock Nonbatch cassette 30 min
Respiratory Pathogen Panel
Qiagen QIAstat-Dx Respiratory SARS-CoV-2 Panel (22 bacterial & viruses) QIAstat Dx Analyzer System Nonbatch modular About 1 hour per cartridge
Serology
Bio-Rad Platelia SARS-CoV-2 Total Ab None 96 wells per microplate (manual) 1st incubation: 60 min 2nd incubation: 30 min
Cellex qSARS-CoV-2 IgG/IgM Rapid Test None Nonbatch cassette 15-20 min per cassette
Ortho VITROS Immunodiagnostic Anti-SARS-CoV-2 Total Reagent and Calibrator VITROS Eci/EDiQ/3600 or VITROS 5600/XT 7600 Automated 37 min incubation plus 48 min testing
Roche Elecsys Anti-SARS-CoV-2 cobas e411, e601, e602, e801 Automated 18 min
Modular Cartridge / Cassette / Pouch
BioFire COVID-19 Test FilmArray 2.0 or Torch Nonbatch modular 50 min per pouch
Cepheid Xpert Xpress SARS-CoV-2 GeneXpert Dx / Infinity Nonbatch modular 45 min per cartridge
GenMark ePlex SARS-CoV-2 Test ePlex Nonbatch modular cartridge
Luminex ARIES SARS-CoV-2 Assay ARIES System Nonbatch cassette 2 hours per cassette
Qiagen QIAstat-Dx Respiratory SARS-CoV-2 Panel (22 bacterial & viruses) QIAstat Dx Analyzer System Nonbatch modular About 1 hour per cartridge
High Throughput Capability
Abbott RealTime SARS-CoV-2 Assay m2000 RealTime 96 wells per batch
BGI Real-Time Fluorescent RT-PCR Kit for Detecting SARS-2019-nCoV ABI 7500 Real Time PCR 96 wells per batch
DiaCarta QuantiVirus SARS-CoV-2 Test Kit ABI QuantStudio 5 / 7500 Fast Dx Real-Time PCR Batch
DiaSorin Simplexa COVID-19 Direct Assay LIAISON MDX Batch
Hologic Panther Fusion SARS-CoV-2 Assay Panther Fusion 1150 samples per 24 hours < 3 hours
InBios Smart Detect SARS-CoV-2 rRT-PCR Kit ABI 7500 Fast Dx Real-Time PCR / CFX96 Touch Real-Time PCR 96 wells per batch
Luminex NxTAG CoV Extended Panel Assay Luminex MAGPIX & bioMerieux easyMAG / EMAG 96 wells per batch < 2.5 hours thermal cycler run time
NeuMoDx SARS-CoV-2 Assay NeuMoDx 96 and 288 Molecular Systems Random access, modular
Ortho VITROS Immunodiagnostic Anti-SARS-CoV-2 Total Reagent and Calibrator VITROS Eci/EDiQ/3600 or VITROS 5600/XT 7600 100 wells per reagent pack 37 min incubation plus 48 min testing
PerkinElmer New Coronavirus Nucleic Acid Detection Kit ABI 7500 Real-Time PCR 96 wells per batch
Primerdesign Ltd COVID-19 genesig Real-Time PCR Assay ABI 7500 / Bio-Rad CFX Connect / Roche LightCycler 4800 II Batch
Quidel Lyra SARS-CoV-2 Assay ABI 7500 Fast Dx/Standard, Roche LightCycler 480, Qiagen Rotor-Gene Q, BioRad CFX96 Touch, Thermofisher Quantstudio 7 Pro Batch
Roche cobas SARS-CoV-2 Assay cobas 6800/8800 384/960 per 8 hours 3.5 hours
Thermal Fisher TaqPath COVID-19 Combo Kit Applied Biosystems 7500 Fast Dx 96 wells per batch 4 hours (incl. sample prep)

Cryptococcus neoformans & gattii
Clinical images

Contributed by Sixto M. Leal, Jr., M.D., Ph.D.

Characteristic colony formation of Cryptococcus sp.

Microscopic (histologic) images

Contributed by Sixto M. Leal, Jr., M.D., Ph.D. and @zaalruwai83 on Twitter

Cryptococcus sp. on staining

Characteristic morphology of Cryptococcus with various stains


Cryptococcus neoformans & gatti Cryptococcus neoformans & gatti Cryptococcus neoformans & gatti

Cryptococcus neoformans & C. gattii


Cutibacterium acnes
Clinical images

Contributed by Meredith Schade, M.D. and Elizabeth Garrett, Ph.D.
Shoulder PJI

Shoulder PJI

Colony morphology

Colony morphology

Microscopic (histologic) images

Contributed by Elizabeth Garrett, Ph.D.
<i>C. acnes</i> Gram stain

C. acnes Gram stain

<i>C. acnes</i> Gram stain <i>C. acnes</i> Gram stain

C. acnes in tissue


Cyclospora cayetanensis
Diagrams / tables

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Life cycle

Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D.

Cyclospora cayetanensis oocysts stained by Wright-Giemsa



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Various images


Dematiaceous molds
Clinical images

Contributed by Sixto M. Leal, Jr., M.D., Ph.D.

Dermatiaceous (black) mold

Microscopic (histologic) images

Contributed by Sixto M. Leal, Jr., M.D., Ph.D.

Characteristic fruiting bodies

Evaluation of fungal elements with various stains


Dengue fever
Clinical images

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Typical rash of dengue fever

Aedes aegypti

Microscopic (histologic) images

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Hemophagocytosis

Stars indicate erythrocytes phagocytized by a macrophage

Electron microscopy images

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Dengue virus virions


Dermatophagoides
Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D. and Tara Ness, M.D.

Likely
Dermatophagoides

Dermatophagoides
versus
Sarcoptes scabiei

Videos

Creepy Dreadful Wonderful Parasites Case


Diphyllobothrium latum
Diagrams / tables

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Life cycle - Diphyllobothrium latum

Gross images

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Proglottids

Microscopic (histologic) images

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Eggs in wet mount

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Proglottids and scolex


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Adults and eggs in tissue


Dipylidium caninum
Diagrams / tables

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Life cycle

Gross images

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Adult tapeworm

Microscopic (histologic) images

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Eggs, various images

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Proglottids

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Cross sections


Dirofilaria repens
Diagrams / tables

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Life cycle of D. repens

Gross images

Contributed by Bobbi Pritt, M.D.

10 cm long D. repens removed from conjunctiva

Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D.

470 μm in diameter

Dirofilaria has longitudinal cuticular ridges

Loa loa has irregularly spaced cuticular bosses



Contributed by Bone Moe Win, M.B.B.S.

"Third testes" in infant

Peripheral smear images

Contributed by Bobbi Pritt, M.D.

Knott concentration performed on blood revealed 6 larvae per mm, each ~375 μm long by ~10 μm wide

D. repens versus L. loa


Ehrlichia
Microscopic (histologic) images

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Left: HGA (HGE)

Rhodamine labeled HGE organisms

HGE antigens

Peripheral smear images

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HME

Intracytoplasmic inclusion

Electron microscopy images

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Dense core cells of E. chaffeensis

Several morulae

Bone marrow white blood cell


Enteromonas hominis
Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D., Blaine Mathison and Henry Bishop

Trichrome stained stool specimen shows Enteromonas hominis trophozoites

Diagnostic features


Fasciola
Diagrams / tables

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Life cycle


Gross images

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Adult liver fluke

Microscopic (histologic) images

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Egg with unshouldered operculum


Filariasis
Diagrams / tables

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Life cycle of filarial worms

Life cycle of filarial worms

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Diagnostic features

Radiology images

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Unusual groupings of benign appearing calcifications

Unusual
groupings of
benign appearing
calcifications

Linear, tortuous, noncalcified opacities (right); serpiginous, linear and discontinuous calcifications (calcified worms, left)

Noncalcified opacities (left); calcified worms (right)

Caption

Linear, tortuous,
noncalcified
opacities

Oval shaped isodense lesion (arrow)

Oval shaped isodense lesion (arrow)

Cyst with few linear echogenic foci (arrow)

Cyst with few linear echogenic foci (arrow)

Dilated tubular channels; filarial worm (white arrows)

Dilated tubular
channels; filarial
worm (white arrows)

Clinical images

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Right breast lump with pigmentation

Right breast lump with pigmentation

Lump in the right breast

Lump in the right breast

Resolved infection after DEC therapy

Resolved infection after DEC therapy

Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D. and AFIP images
Adult female worm Adult female worm Adult female worm Adult female worm

Adult female worm

Gravid female worm of<br><i>Wucheria bancrofti</i><br>surrounded by fibrosis

Gravid female worm of
Wucheria bancrofti
surrounded by fibrosis



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Wuchereria bancrofti

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Microfilaria

Videos

Fusobacterium necrophorum
Diagrams / tables

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Lemierre syndrome pathophysiology

Lemierre syndrome pathophysiology

Clinical characteristics of Lemierre syndrome

Clinical characteristics of Lemierre syndrome

Clinical images

Contributed by Hasan Samra, M.D.
Culture media

Culture media

Microscopic (histologic) images

Contributed by Hasan Samra, M.D.
Gram stain

Gram stain


Histoplasma capsulatum
Microscopic (histologic) images

Contributed by Sixto M. Leal, Jr., M.D., Ph.D.
Uniform clustered yeasts

Uniform clustered yeasts

Uniform clustered yeasts within histiocytes

Uniform clustered yeasts within histiocytes

Lollipop aleurioconidia of Histoplasma

Lollipop aleurioconidia of Histoplasma

Tuberculate macroconidia

Tuberculate macroconidia


Bone marrow with clustered yeasts

Bone marrow with clustered yeasts

GMS showing clustered yeasts

GMS showing clustered yeasts

Necrotizing granulomas

Necrotizing granulomas

GMS small uniform single and clustered yeasts

GMS small uniform single and clustered yeasts


Hookworm
Diagrams / tables

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Global distribution of human hookworm infection

Global distribution of human hookworm infection

Hookworm life cycle

Hookworm life cycle

Clinical images

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Edema from heavy hookworm infection

Edema from heavy hookworm infection

Adult A. caninum hookworms in canine small intestine

Adult A. caninum hookworms in canine small intestine

Gross images

Contributed by Bobbi S. Pritt, M.D., M.Sc.

Female and male Ancycloctoma duodenale

Microscopic (histologic) images

Contributed by Bobbi S. Pritt, M.D., M.Sc.
Multiple spicules of male Ancycloctoma duodenale

Multiple spicules of male Ancycloctoma duodenale

Buccal canal comparison, hookworm and Strongyloides

Buccal canal comparison, hookworm and Strongyloides

Hookworm egg with thin, colorless shell

Hookworm egg with thin, colorless shell

Cutting plates of N. americanus Cutting plates of N. americanus Cutting plates of N. americanus

Cutting plates of N. americanus


Hyaline molds
Clinical images

Contributed by Sixto M. Leal, Jr., M.D., Ph.D.

Colony growth on plate surface and reverse of plate

Microscopic (histologic) images

Contributed by Sixto M. Leal, Jr., M.D., Ph.D.

Broad septate hyphae

Septate hyphae on GMS

Hyphae with fruiting bodies

Septate hyphae


Fruiting bodies of A. fumigatus

Fruiting bodies of A. terreus

Fruiting bodies of A. flavus

Fruiting bodies of A. niger

Macroconidia of Fusarium spp.


Spore forming anelloconidia

Fruiting bodies of Penicllium spp.

Fruiting bodies of Paecilomyces spp.

Fruiting bodies on GMS


Hymenolepis diminuta
Cytology images

Contributed by Bobbi Pritt, M.D. and Institute of Tropical Medicine Antwerp

H. diminuta egg

H. nana and H. diminuta eggs


Hymenolepis nana
Diagrams / tables

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Life cycle: Hymenolepis nana

Clinical images

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Large number of adult worms in colon

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Adults

Cytology images

Contributed by Bobbi Pritt, M.D.

H. nana egg in stool specimen

H. nana and H. diminuta eggs



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Morphological characteristics

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Eggs, various images

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Proglottids, various images

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Adults


Iodamoeba bütschlii
Cytology images

Contributed by Bobbi Pritt, M.D.

Anal Pap smear



Case #402

Anal Pap smear


Klebsiella oxytoca
Clinical images

Contributed by Joshua A. Lieberman, M.D, Ph.D.

K. pneumoniae,
K. oxytoca and
β hemolytic Streptococcus

K. oxytoca on a blood agar plate

Microscopic (histologic) images

Contributed by Joshua A. Lieberman, M.D, Ph.D.

Gram stain of
K. oxytoca


Leishmania
Clinical images

Contributed by Joshua A. Lieberman, M.D, Ph.D.

Skin lesion

Microscopic (histologic) images

Contributed by Joshua A. Lieberman, M.D, Ph.D.

Nasal septum

Skin lesion

Giemsa

Peripheral smear images

Images hosted on other servers:

Leishmania amastigotes in stained smear

Peripheral blood and bone marrow involvement


Leptospira
Radiology images

Contributed by Amaro Nunes Duarte-Neto, M.D., Ph.D.
Bilateral and diffuse alveolar interstitial pattern

Bilateral and diffuse alveolar interstitial pattern

Post-tracheal intubation

Post tracheal intubation

Microscopic (histologic) images

Contributed by Amaro Nunes Duarte-Neto, M.D., Ph.D.
Severe leptospirosis hepatitis Severe leptospirosis hepatitis

Severe leptospirosis hepatitis

Severe leptospirosis hepatitis Severe leptospirosis hepatitis

Severe leptospirosis hepatitis

Severe leptospirosis hepatitis - IHC

Severe leptospirosis hepatitis - IHC


Lung in fatal leptospirosis Lung in fatal leptospirosis

Lung in fatal leptospirosis

Brain in fatal yellow fever

Brain in fatal yellow fever

Heart in fatal yellow fever

Heart in fatal yellow fever

Kidney in fatal yellow fever

Kidney in fatal yellow fever

Renal lesion in leptospirosis (interstitial nephritis) - IHC

Renal lesion in leptospirosis (interstitial nephritis) - IHC

Electron microscopy images

Images hosted on other servers:

Septal capillary


Listeria monocytogenes
Clinical images

Contributed by Elizabeth M. Garrett, Ph.D.
Gram stain

Gram stain

Colonies on blood agar

Colonies on blood agar


Loa loa
Diagrams / tables

Images hosted on other servers:

Life cycle

Clinical images

Images hosted on other servers:

Anterior chamber of eye

Temporal subconjunctival space of eye

Cutaneous infection

Gross images

Contributed by Bobbi Pritt, M.D.

5 cm long Loa loa extracted from eye

Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D.

Irregularly spaced cuticular bosses

In comparison, Dirofilaria has longitudinal cuticular ridges

Peripheral smear images

Contributed by Blaine A. Mathison, B.S.

Loa loa thick film

Loa loa thin film



Contributed by Bobbi Pritt, M.D.

Knott concentration made and stained with Carazzi to show larvae measuring (on average) 280 μm in length

D. repens versus L. loa


M. genitalium
Clinical images

Contributed by Sixto M. Leal Jr., M.D., Ph.D.

SP4 broth for culture of lab adapted M. genitalium

SP4 agar photo of M. genitalium colonies


M. hominis / Ureaplasma spp.
Clinical images

Contributed by Sixto M. Leal Jr., M.D., Ph.D.

SP4 broth for culture of lab adapted M. hominis

10B broth for culture of Ureaplasma species

SP4 agar photo of M. hominis colonies

A8 agar photo of Ureaplasma colonies


M. pneumoniae
Clinical images

Contributed by Sixto M. Leal Jr., M.D., Ph.D.

SP4 broth for culture of M. pneumoniae

Representative colony photo of M. pneumoniae


Macracanthorhynchus
Gross images

Contributed by Bobbi Pritt, M.D.

15 cm long Macracanthorhynchus worm with pseudosegmented body and retracted proboscis

Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D. and Emily Fernholz

Macracanthorhynchus eggs

Histologic sections of anterior end of Macracanthorhynchus worm

Videos

Macracanthorhynchus egg


Mpox / orthopoxvirus
Clinical images

Contributed by Andrew Handel, M.D.
Penile lesions

Penile lesions

Penile shaft lesions

Penile shaft lesions

Electron microscopy images

Contributed by Ryan F. Relich, Ph.D.
Virions in lesion

Virions in lesion

Dumbbell shaped virion

Dumbbell shaped virion


Mycobacteria non-TB
Radiology images

Images hosted on other servers:
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Jejunal loops and extensive lymphadenopathy (MAI)

Clinical images

Images hosted on other servers:
Bright yellow colonies Bright yellow colonies

Bright yellow colonies

Swimming pool granuloma

Swollen, red papules and nodules


Ulcer on the lateral surface of the fifth toe

Microscopic (histologic) images

Contributed by Chaohui L. Zhao, M.D. and Vicente Nazareno
Granulomatous inflammation Granulomatous inflammation Granulomatous inflammation

Granulomatous inflammation

Pink slender rods

Pink slender rods

Pink-red slender rods

Pink-red slender rods

Yellow-green fluorescent rods

Yellow-green fluorescent rods

Videos

Quick revision of nontuberculous mycobacteria with mnemonics


Myiasis
Diagrams / tables

Images hosted on other servers:
Botfly & blowfly life cycles

Botfly & blowfly life cycles

Clinical images

Contributed by Bobbi Pritt, M.D. and Lars Westblade, Ph.D.

Furuncular myiasis



Images hosted on other servers:
Cutaneous (furuncular) myiasis

Cutaneous (furuncular) myiasis

Ocular myiasis following trauma

Ocular myiasis following trauma

Myiasis of breast carcinoma

Myiasis of breast carcinoma

Maggots in the mandible

Maggots in the mandible


Breast myiasis, tumbu fly larvae

Breast myiasis, tumbu fly larvae

Sinuses after larva extraction

Sinuses after larva extraction

Healed skin after 1 week

Healed skin after 1 week

Gross images

Contributed by Bobbi Pritt, M.D.
D. hominis, 3rd instar

D. hominis, third instar

D. hominis, spineless terminal segments

D. hominis, spineless terminal segments

D. hominis, pear shaped body

D. hominis, pear shaped body

C. macellaria, posterior spiracles; prominent slit-walls

C. macellaria,
posterior spiracles;
prominent slit-walls

C. anthropophaga, posterior spiracles; sinuous slits

C. anthropophaga,
posterior spiracles;
sinuous slits

C. rodhaini, posterior spiracles; irregular slits

C. rodhaini, posterior spiracles; irregular slits



Images hosted on other servers:
C. hominivorax versus D. hominis distinguishing features

C. hominivorax
versus D. hominis
distinguishing
features

Larva of D. hominis

Larva of D. hominis

Larva of C. hominivorax

Larva of C. hominivorax

Microscopic (histologic) images

Contributed by Nada Mohamed, M.D., Bobbi Pritt, M.D. and Lars Westblade, Ph.D.
Cutaneous (furuncular) myiasis Cutaneous (furuncular) myiasis Cutaneous (furuncular) myiasis

Cutaneous (furuncular) myiasis

Larval / maggot cross section

Larval / maggot cross section

Skin biopsy with fly larva

Skin biopsy with fly larva

Larval structures

Larval structures

Molecular / cytogenetics images

Images hosted on other servers:
Dermatobia identification using ITS2

Dermatobia identification using ITS2

Dermatobia identification using COX1 Dermatobia identification using COX1

Dermatobia identification using COX1

Videos

Cutaneous myiasis

Creepy Dreadful Wonderful Parasites Case


Neisseria meningitidis
Clinical images

Contributed by Elizabeth M. Garrett, Ph.D.
Colonies on blood agar

Colonies on blood agar

Microscopic (histologic) images

Contributed by Elizabeth M. Garrett, Ph.D.
Gram negative diplococci

Gram negative diplococci


Nocardia
Clinical images

Contributed by Sixto M. Leal Jr., M.D., Ph.D.
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N. asteroides colonies,
chocolate and sheep
blood agar

Microscopic (histologic) images

Contributed by Sixto M. Leal Jr., M.D., Ph.D.
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Filamentous branching

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Filamentous branching on GMS stain

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Skin nodule with Nocardia growth


Orf
Clinical images

Images hosted on other servers:
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Firm, erythematous papule of the right thumb

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Hand infection

Microscopic (histologic) images

Images hosted on other servers:
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Rare necrotic keratinocytes

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Balloon degeneration and spongiosis

Electron microscopy images

Images hosted on other servers:
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Oval viral particles


Pediculosis (lice)
Diagrams / tables

Images hosted on other servers:

Life cycle of Pediculus humanus capitis

Gross images

Contributed by Bobbi Pritt, M.D.

Male Pediculus humanus

P. h. capitis


Plasmodium falciparum
Diagrams / tables

Images hosted on other servers:
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Fever paroxysm

Missing Image

Life cycle

Clinical images

Images hosted on other servers:
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Adult of Anopheles freeborni

Peripheral smear images

Contributed by Bobbi Pritt, M.D.

P. falciparum malaria, > 10% parasitemia, negative rapid antigen, Giemsa stained thin blood smear

Giemsa stained thick and thin peripheral blood films from a patient with malaria due to P. falciparum; > 20% parasitemia



Contributed by Patricia Tsang, M.D., M.B.A.
Plasmodium falciparum (blood smear) Plasmodium falciparum (blood smear)

Plasmodium falciparum (blood smear)


Case #277
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Blood smear



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Ring form trophozoites of P. falciparum

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Maurer clefts

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Older trophozoites of P. falciparum


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Gametocytes of P. falciparum

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Schizonts of P. falciparum


Plasmodium non-falciparum
Diagrams / tables

Images hosted on other servers:
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Fever paroxysm

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Life cycle

Clinical images

Images hosted on other servers:
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Adult of Anopheles freeborni

Peripheral smear images

Contributed by Monica E. De Baca, M.D. and Bobbi Pritt, M.D.
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Immature trophozoite (ring) forms, P. vivax

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Immature trophozoite (ring) forms, P. vivax


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Gametocyte forms, P. vivax

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Gametocyte forms, P. vivax

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Gametocyte forms, P. vivax


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Gametocyte forms, P. vivax

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Gametocyte forms, P. vivax

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Schizont forms, P. vivax


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Schizont forms, P. vivax

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Schizont forms, P. vivax

Malaria parasites in human red blood cells, P. malariae



Images hosted on other servers:
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Giemsa, P. ovale

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Wright-Giemsa, P. ovale

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P. ovale gametocyte in a thick blood smear

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Microgametocyte of P. ovale in a thin blood smear


Raillietina
Diagrams / tables

Images hosted on other servers:

Egg of Raillietina

Gross images

Contributed by Bobbi Pritt, M.D.

Motile, rice-like object in stool of toddler



Images hosted on other servers:

Raillietina tetragona

Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D.

Egg capsules containing eggs

Eggs with hooklets


Sarcocystis
Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D. and Institute of Tropical Medicine Antwerp

Intestinal sarcocystosis: sporulated oocyst and sporocyst

Carbolfuchsin staining according to Heine


Schistosomiasis
Diagrams / tables

Images hosted on other servers:
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Life cycle

Microscopic (histologic) images

Scroll to see all images:


Contributed by Kiran Alam, M.B.B.S., M.D., Anshu Jain, M.B.B.S., M.D., Veena Maheshwari, M.B.B.S., M.D., Farhan A. Siddiqui, M.B.B.S., M.D. and Ershad ul Haq, M.B.B.S., M.D.
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Transitional
epithelium of
ureter with S.
haematobium
eggs

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Schistosome eggs in submucosa

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Schistosome eggs in muscle layer

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Schistosome eggs in muscle layer - note terminal spine



Contributed by Jennifer Stumph, M.D.
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37 year old woman with S. mansoni eggs in colon biopsy



Contributed by Lisa Cerilli, M.D.
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With colonic mucosa - type not identified



Contributed by Bobbi Pritt, M.D. and Heather Rose

Schistosoma haematobium eggs and uric acid crystals



Contributed by Bobbi Pritt, M.D. and Sarah Jung, M.D.

Schistosoma haematobium miracidium, newly hatched with egg remnant



Images hosted on other servers:
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Subspecies

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Granuloma surrounding egg - type not identified



Schistosoma haematobium - oval eggs with terminal spine:
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Schistosoma haematobium eggs



Schistosoma japonicum - small eggs,
more rounded, no / minute terminal spine:

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Eggs



Schistosoma mansoni - lateral spine:
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Schistosoma mansoni eggs


Serratia species
Clinical images

Contributed by Megan Amerson-Brown, M.L.S., Ph.D. and Sixto M. Leal, Jr., M.D., Ph.D.

Nonpigmented S. marcescens colonies

Pigmented colonies of S. marcescens

Microscopic (histologic) images

Contributed by Megan Amerson-Brown, M.L.S., Ph.D.

S. marcescens direct Gram stain

S. marcescens Gram stain from colonies


Shigella
Diagrams / tables

Images hosted on other servers:

Histopathology of Shigella colitis

Gross pathology of shigellosis

Clinical images

Contributed by Nicole E. Putnam, Ph.D.

Shigella on SBA

Shigella on MAC

Shigella on Hektoen



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Ulcerative colitis by colonoscopy


Staph aureus
Clinical images

Images hosted on other servers:

Colonies of Staph. aureus

Microscopic (histologic) images

Images hosted on other servers:

Gram positive cocci in clusters


Staph coagulase negative
Clinical images

Contributed by Joshua A. Lieberman, M.D., Ph.D.

Chocolate agar

Microscopic (histologic) images

Contributed by Joshua A. Lieberman, M.D., Ph.D.

Gram stain


Streptococcus pneumoniae
Clinical images

Contributed by Ashleigh N. Riegler, Ph.D.
Dimpled S. pneumoniae colonies

Dimpled S. pneumoniae colonies

Mucoid S. pneumoniae colonies

Mucoid S. pneumoniae colonies

Microscopic (histologic) images

Contributed by Sixto M. Leal, Jr., M.D., Ph.D.
S. pneumoniae in blood

S. pneumoniae in blood

S. pneumoniae in CSF

S. pneumoniae in CSF


Streptococcus-other
Clinical images

Images hosted on other servers:

Various Strep group colonies


Strongyloides
Diagrams / tables

Images hosted on other servers:

Life cycle

Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D.

Adult female and larvae

Prominent genital primordium



Case #133

Duodenal biopsies of a 43 year old Honduran man

Videos

Contributed by Bobbi Pritt, M.D.

Endodoscopy of elderly woman with hematemesis (parasite case #499)


Taenia saginata
Diagrams / tables

Images hosted on other servers:
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Life cycle

Microscopic (histologic) images

Images hosted on other servers:
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Gravid uterus of T. saginata with > 13 lateral branches


Taenia solium (neurocysticercosis)
Diagrams / tables

Contributed by Wikipedia
Taenia solium adult

Taenia solium adult



Images hosted on other servers:
Life cycle

Life cycle

Radiology images

Contributed by Centers for Disease Control and Prevention
MRI

MRI

Microscopic (histologic) images

Contributed by Centers for Disease Control and Prevention and Wikipedia
Brain tissue

Brain tissue

Cysticercus

Cysticercus

Taenia solium scolex

T. solium scolex

Egg of T. solium

Egg of T. solium


Taenia species
Diagrams / tables

Images hosted on other servers:
Missing Image

Life cycle

Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D.

Taenia species eggs


Talaromyces marneffei
Microscopic (histologic) images

Images hosted on other servers:

Penicillium (A / C)
vs. Histoplasma
capsulatum
(B / D)


Tick (Hyalomma)
Clinical images

Images hosted on other servers:

Skin lesion at bite site

Gross images

Images hosted on other servers:

Various images

Dorsal image of male

Ventral image of male


Tick (Ixodes)
Gross images

Contributed by Bobbi Pritt, M.D.

Female Ixodes tick


Toxocara
Gross images

Contributed by Bobbi Pritt, M.D.

T. cati worms

Cytology images

Contributed by Bobbi Pritt, M.D.

T. cati egg

Pollen grain and Toxocara egg


Trichostrongylus
Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D.

Trichostrongylus egg



Images hosted on other servers:

Trichostrongylus egg

Videos

Trichostrongylus egg


Whipworm
Microscopic (histologic) images

Contributed by Bobbi Pritt, M.D.

Colon at autopsy
shows small
worm-like objects
attached to mucosa

Eggs with polar plugs



Contributed by Bobbi Pritt, M.D. and Heather Rose Arguello

Posterior and anterior end of whipworm

Multiple stichocytes

Immature ova in uterus in posterior end


Yellow fever
Radiology images

Images hosted on other servers:

Ultrasound showing hepatic steatosis

Gross images

Images hosted on other servers:

Steatotic liver in YF

Yellowish color due to diffuse steatosis

Microscopic (histologic) images

Contributed by Amaro Nunes Duarte-Neto, M.D., Ph.D.
Severe yellow fever hepatitis

Severe yellow fever hepatitis

Characteristic distribution of damage in yellow fever hepatitis

Characteristic distribution of damage in YF hepatitis

Apoptosis in yellow fever hepatitis

Apoptosis in yellow fever hepatitis

Centrilobular area in yellow fever hepatitis

Centrilobular area in yellow fever hepatitis

Hallmark diagnostic findings for yellow fever hepatitis

Hallmark diagnostic findings for YF hepatitis

Portal tract in yellow fever hepatitis

Portal tract in yellow fever hepatitis


Distribution of YFV antigens in yellow fever hepatitis

Distribution of YFV antigens in yellow fever hepatitis

Diagnostic immuno-histochemistry in YF hepatitis

Diagnostic immuno-histochemistry in YF hepatitis

Renal damage in yellow fever

Renal damage in yellow fever

Lung in fatal yellow fever

Lung in fatal yellow fever

Brain in fatal yellow fever

Brain in fatal yellow fever


Zygomycetes
Microscopic (histologic) images

Contributed by Sixto M. Leal, Jr., M.D., Ph.D.
Mucor species Mucor species

Mucor species

Mucor species fungal elements Mucor species fungal elements

Mucor species fungal elements


Fungal forms Fungal forms

Fungal forms

Mucor species angioinvasion

Mucor species angioinvasion

Back to top
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