This page intentionally left blank District Laboratory Practice in Tropical Countries Part Second Edition Monica Cheesbrough CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521676304 © Monica Cheesbrough 1998, 2005, 2009 This publication is in copyright Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press First published in print format 2005 ISBN-13 978-0-511-34935-5 eBook (NetLibrary) ISBN-13 978-0-521-67630-4 paperback Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate Every effort has been made in preparing this book to provide accurate and up-todate information which is in accord with accepted standards and practice at the time of publication Nevertheless, the authors, editors and publisher can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation The authors, editors and publisher therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use Part I Contents Chapter Organization and staffing of district laboratory services 1.1 1.2 1.3 1.4 Importance of laboratory practice in district health care Pages – Structuring of a district laboratory network – Training and continuing education of district laboratory personnel 10 –11 Code of conduct for laboratory personnel and status of medical laboratory practice 11 –12 Chapter Total quality management of district laboratory services 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Ensuring a reliable and quality laboratory service 14 –20 Selection of tests and interpretation of test results 20–28 Financing district laboratory services and controlling costs 28 –31 Quality assurance and sources of error in district laboratory practice 31 –37 SI Units 37–40 Guidelines for preparing stains and reagents 40–47 Communicating effectively 47–48 Chapter Health and safety in district laboratories 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Implementing a laboratory health and safety programme 50–56 Safe laboratory premise and personal safety measures 56–59 Microbial hazards 59–66 Decontamination of infectious material and disposal of laboratory waste 66–74 Chemical and reagent hazards 75–87 Equipment and glassware hazards 87–89 Fire safety 89 –91 Emergency First Aid 91 –95 Chapter Equipping district laboratories 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 Selection, procurement and care of equipment 96 –103 Power supplies in district laboratories 103 –108 Microscope 109 –126 Equipment for purifying water 126 –131 Equipment for weighing 132 –133 Equipment for pipetting and dispensing 134 –138 Centrifuges 139 –143 Laboratory autoclave 143 –148 Incubator, water bath, heat block 148 –152 Colorimeter 152 –157 Mixers 158 –160 General laboratory-ware for district laboratories 160 –175 Chapter Parasitological tests 5.1 5.2 5.3 5.4 Parasitology in district laboratories and quality assurance of tests 178 –183 Features and classification of parasites of medical importance 183 –191 Direct examination of faeces and concentration techniques 191 –200 Identification of faecal protozoan trophozoites, cysts and oocysts 200–208 iii 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 Identification of helminth eggs and larvae found in faeces 209–235 Examination of urine for Schistosoma haematobium eggs 236–239 Examination of blood for malaria parasites 239–258 Examination of blood, lymph fluid, and c.s.f for trypanosomes causing African trypanosomiasis 259–266 Examination of blood for Trypanosoma cruzi 266– 271 Examination of specimens for Leishmania parasites 271– 279 Examination of blood for microfilariae in lymphatic filariasis and loiasis 280–291 Examination of skin for Onchocerca volvulus microfilariae 291– 295 Examination of sputum for Paragonimus eggs 295–297 Less frequently needed tests: Investigation of amoebic liver abscess 298–299 Investigation of primary amoebic meningoencephalitis 299–300 Diagnosis of toxoplasmosis 300–302 Diagnosis of hydatid disease 302–304 Examination of muscle tissue for Trichinella spiralis larvae 304–305 Detection of Dracunculus medinensis (Guinea worm) larvae 305–306 Chapter Clinical chemistry tests 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 Clinical chemistry in district laboratories 310 – 313 Quality assurance of clinical chemistry tests 313 – 333 Measurement of serum or plasma creatinine 333–337 Measurement of serum or plasma urea 337–340 Measurement of blood or plasma glucose 340–349 Measurement of serum or plasma bilirubin 349–355 Measurement of serum albumin 355–358 Measurement of serum or plasma alanine aminotransferase (ALT) activity 358– 361 Measurement of serum or plasma alpha amylase activity 360–364 Measurement of sodium and potassium in serum or plasma 364–369 Urine tests 369–385 Cerebrospinal fluid (c.s.f ) tests 386–389 Faecal tests 389–392 Appendix I Preparation of reagents 398– 412 Appendix II Useful addresses 414 – 420 Appendix III Useful charts and figures 425–428 Supplement Planning a training curriculum for district laboratory personnel 430–435 Index 437–454 iv Preface Since the publication of the first edition of Part District Laboratory Practice in Tropical Countries the essential role of the laboratory in providing a scientific foundation for district health care and improving the quality of health care to communities, has not changed The new challenges faced by health authorities however, have led to changes in laboratory practice and a greater emphasis on the need for reliable well managed district laboratories and their rational use in district health care In deciding the changes to be incorporated in the new edition of Part 1, the author and those who have helped with the revision have been guided by the views and requests of those using the book in their work and training programmes The important chapters covering management, quality assurance, health and safety and equipping of district laboratories have been reviewed and updated where needed For those with internet access and e-mail facilities, the details of equipment manufacturers now include website information and e-mail addresses Information on parasitic diseases and their control has been brought up to date Current knowledge on HIV interaction with parasitic pathogens and new technologies to diagnose parasitic infections have been included Immunochromatographic tests to diagnose malaria have been described, their limitations discussed, and information on the WHO malaria rapid diagnostic tests website included Other parasite-related websites and a list of up to date references and recommended reading are given at the end of the parasitology chapter Within the clinical chemistry chapter, the text covering diabetes mellitus has been revized to include the current WHO classification of diabetes and guidelines for diabetes diagnosis Urine strip tests have also been updated To assist in monitoring HIV/AIDS patients for toxicity to antiretroviral drugs, a colorimetric test kit to measure alanine aminotransferase (ALT) has been included where it is not possible to refer specimens for testing to a regional clinical chemistry laboratory Information is also given for a colorimetric creatinine test kit For many laboratory programmes, the introduction of standard operating procedures for laboratory tests backed by quality assessment schemes has been key to improving the reliability, efficiency and accountability of district laboratory services, motivating laboratory staff and increasing the confidence of laboratory users Safe laboratory practices now followed in many laboratories have reduced work-related accidents and laboratory-acquired infections It is hoped that the new edition of Part will continue to help those involved in training and those working in district laboratories, often in difficult situations It is also hoped that it will encourage health authorities to provide the resources needed to provide a quality laboratory service to the community Monica Cheesbrough May 2005 v Acknowledgements Special thanks are due to all those working in laboratories in tropical and developing countries and those involved in training laboratory personnel who have corresponded and contributed their suggestions for this second edition of Part District Laboratory Practice in Tropical Countries Gratitude is expressed to all those who have helped to prepare the new edition: Mr Malcolm Guy, formerly Scientific Administrator MRC Laboratory in the Gambia, for reading through and commenting on chapters covering the organization, management, safe working practices and equipping of district laboratories Mr John Williams, Clinical Scientist, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, for helping to update the parasitology chapter Mr Anthony Moody, previously Laboratory Manager, Hospital for Tropical Diseases, London, for also assisting in the revision of the parasitology chapter and for contributing text on rapid malaria diagnostic tests Professor Claus C Heuck, University Hospital, Duesseldorf, formerly of the World Health Organization Health Laboratory Technology Unit, for reading through and making suggestions for the clinical chemistry chapter Mr Robert Simpson, Laboratory Manager, Chemical Pathology, St Thomas Hospital, London, for also assisting in the revision of the clinical chemistry chapter Gratitude is also expressed to Dr Geoffrey V Gill, Reader in Tropical Medicine, Liverpool School of Tropical Medicine, for updating the diabetes mellitus text Thanks are also due to Dr Peter Hill for commenting on quality assurance in clinical chemistry The help of Mr Ray J Wood, Laboratory Manager Mengo Hospital, Uganda, is also acknowledged The author wishes to thank Fakenham Photosetting for their careful and professional preparation of the new edition Acknowledgements for colour artwork: These can be found on page 177 before Chapter Parasitological Tests vi ORGANIZATION AND STAFFING OF DISTRICT LABORATORY SERVICES 1 Organization and staffing of district laboratory services 1.1 Importance of laboratory practice in district health care District laboratory services have an essential role in the surveillance, prevention, control, diagnosis and management of diseases of greatest public health importance In discussing the role of laboratories at district level, the World Health Organization comments that with the scaling up of interventions against HIV/AIDS, tuberculosis and malaria, the need for diagnostic and laboratory services has never been greater.1 Meaning of district as used in this manual The district is designated by the World Health Organization as the key level for the management, growth and consolidation of primary health care (PHC) It is the most peripheral unit of local government and administration that has comprehensive powers and responsibilities Plate 1.1 Typical community-based district hospital in Kenya The growth of district health systems has led to: – essential health services and health decisions being brought closer to where people live and work – communities becoming more aware of health issues and demanding health services that are relevant, accessible, reliable, affordable, and accountable – district health councils being formed to identify and assess community health care needs, develop and manage local health services, and ensure district health resources are used effectively, efficiently and equitably A typical rural district health system consists of: Ⅲ A network of PHC facilities, including village health clinics, maternity centres, health centres and small urban clinics Mobile health units may also provide some outreach PHC services and support for home-based health care Ⅲ A system for the referral of seriously ill patients needing specialist care Ⅲ The district hospital (first referral hospital) Ⅲ Other government health related departments, including social and rehabilitative services, environmental health, nutrition, agriculture, water supply and sanitation Ⅲ Non-government health sector organizations working in the district A district health system is usually administered by a district health management team or health council, consisting of representatives from the community, PHC and hospital services, and health related departments such as water and sanitation Plate 1.2 Health centre in Vietnam Courtesy: RP Marchand, MCNV 1.1 DISTRICT LABORATORY PRACTICE IN TROPICAL COUNTRIES Ⅲ The laboratory is needed to work with others in reducing infection in the community and investigating epidemics rapidly WHY THE LABORATORY IS NEEDED IN DISTRICT HEALTH CARE The laboratory has an important role in improving the: ● quality, ● efficiency, ● cost-effectiveness, ● planning and management of district health care The public health functions of a district health laboratory service include: – detecting the source(s) of infection, identifying carriers, and contact tracing – participating in epidemiological surveys – assisting in disease surveillance and in the selection, application, and evaluation of control methods – helping to control hospital acquired infections – participating in health education – examining designated community water supplies for indicators of faecal and chemical pollution – responding rapidly when an epidemic occurs, including appropriate on-site testing and the collection and despatch of specimens to the Regional or Central Microbiology Laboratory for pathogen identification What difference can the laboratory make to the quality of district health care? Ⅲ Laboratory investigations increase the accuracy of disease diagnosis Many infectious diseases and serious illnesses can only be diagnosed reliably by using the laboratory For example, errors in the diagnosis of malaria have been shown to be particularly high when diagnosis is based on clinical symptoms alone Misdiagnosis or late diagnosis can lead to: – incorrect treatment with misuse and waste of drugs – increased morbidity and mortality – hospitalization and need for specialist care – patient dissatisfaction leading to negative responses to future health interventions – underutilization of health facilities – lack of confidence and motivation of health personnel – increased risk to the community from inappropriate disease management and untreated infectious disease In what ways can the laboratory contribute to achieving efficiency and cost effectiveness in district health care? Ⅲ The laboratory can help to reduce expenditure on drugs When the laboratory is used to improve the accuracy of diagnosis, perform appropriate antimicrobial susceptibility testing, and monitor a patient’s response to treatment: – drugs can be used more selectively and only when needed – patterns of emerging drug resistance can be identified more rapidly and monitored Ⅲ The laboratory has an essential role in screening for ill health and assessing response to treatment At district level the laboratory is needed to: Ⅲ The laboratory can lower health care costs by identifying disease at an early stage Early successful treatment following early correct laboratory diagnosis can help to: – assess a patient’s response to drug therapy – assist in monitoring the condition of a patient and help to decide when it may be necessary to refer for specialist care – screen pregnant women for anaemia, proteinuria, and infections which if not treated may cause disease in the newborn, premature birth, low birth weight, or significant maternal illness – screen the contacts of persons with infectious diseases such as tuberculosis and sexually transmitted diseases – detect inherited abnormalities such as haemoglobin S as part of district family planning health services – screen whole blood and blood products for transfusion transmitted pathogens – reduce the number of times a patient may need to seek medical care for the same illness – prevent complications arising from advanced untreated disease – avoid hospitalization and further costly investigations Ⅲ Significant savings can be made when the laboratory participates in local disease surveillance and control This is because: 1.1 I NDEX 440 Clin-Chek plus, 312–313 Clinistix, 373, 385 Clinitest, 375 Clonorchis sinensis, see Opisthorchis sinensis Clothing, protective, 59, 74 CNS involvement in trypanosomiasis, 260, 266 Coccidia, 184, 185, 205–208 Code of Professional Conduct, 11–13 Code of Safe Laboratory Practice, 54 Coefficient of variation (CV), 325–327, 328 Coenurus, 304 Cole-Palmer block heater, 151–152 Collection of specimens, blood collection equipment, 166 clinical chemistry, 314–315, 317–322 SOP information, 33 system for transporting, 6, 317–322 unsuitable, 35 see also under individual specimens Colorimeter, 152–157 Colorimetry, 152–153 Colour reagent for glucose assay, 344, 402 Colourwave Medical Colorimeter, 153–154 Combur-Test strips, 385 Communication in laboratory work, 47–48, 430 Communication skills, 47–48, 430 Community-based laboratories, 3–5 Compensating eyepiece, 112 Competence of staff, 10–11, 16–17 Competency-based training, 10, 430–435 Concentration of parasites, anion-exchange centrifugation method, 262 faecal parasite techniques, 192, 195–199 filtration for microfilariae, 288–289 filtration for schistosome eggs, 238–239 floatation techniques, 196, 199 formol detergent method, 220–221 formol ether method, 196, 198 glycerol thick smear, 220 haematocrit technique, 263–264, 284 malaria parasites, 251, 255 Paragonimus eggs in sputum, 297 Strongyloides larvae, 214–215 trypanosomes in blood, 263– 264 Condenser, Abbe type, 113, 117 dark-field, 123 flip-top, 113 iris diaphragm, 116 use of, 115 Conductivity meter, 130–131 Conductivity of water, 127, 130–131 Congenital toxoplasmosis, 301 Conjugated (direct) bilirubin, 349, 350, 352, 355, 377 Containers for specimens, 164, 165 Continuing education, 11 Control charts, 327–328 Control sera, 328–329 Cool boxes, 164, 166 Coordinator laboratory, 17–18 Coplin type container, 167, 169 Coracidia, 231 Corrosive chemicals, 75, 78, 87 Cost recovery schemes, 28–29 Costs, laboratory, 15, 22, 28–32 Counting chambers, 162, 163, 173 Counting parasites, eggs in faeces, 199–200, 220–221 malaria parasites, 250–251 microfilariae, 284 Cover glasses, 72, 162 Crab host, 295, 296 Crayfish host, 295, 296 Creatinine clearance test, 335 Creatinine, serum measurement, calibration, 333–334 interfering substances, 333–334 kits, 333 low values, 337 method, 334–335, 336 raised values, 335–336 reagents required, 334 reference (normal) range, 335 specimen, 335 value of, 333, 337 Creatinine working reagent, 334–335 Cryptosporidium parvum, 205–207 c.s.f., see Cerebrospinal fluid Cultura M incubators, 149 Culture techniques, for Leishmania species, 275, 279 for Trypanosoma cruzi, 270 Current, electrical, 108 Curriculum, training, 430–435 Cutaneous leishmaniasis, 271, 273–274, 278–280 Cuts, treatment of, 91–92 Cuvettes, 153, 155, 162, 163 CV, 325–327, 328 Cyclops water fleas, 306 Cyclospora cayetanensis, 205–208 Cylinders, 162, 163 Cysticercoid, 232 Cysticercosis, 230 Cysticercus, 228 Cysts, Balantidium coli, 205 Chilomastix mesnili, 204 concentration of, 196–199 differentiation of, 195, 197 Endolimax nana, 197, 202 Entamoeba coli, 197, 202 Entamoeba dispar, 202 Entamoeba hartmanni, 202 Entamoeba histolytica, 202 Giardia lamblia, 197, 204 lodamoeba buetschlii, 197, 203 iodine cyst, 197, 202 preservation, 182 staining, 195, 197 Cytoadherence P falciparum, 241, 242 Dalys, 186 Dark ground condenser, 123 Dark-field microscopy, 121–123 Dark-field stops, 121–123 DAT for leishmaniasis, 277 Daylight use with microscope, 119 DC power supplies, 104–108 DEAE-52 cellulose column, 262 DEC, 282–283 Decontamination, infectious material, 66–74 Decorticated Ascaris egg, 210 Definitive host, 183 Dehydration (clinical), 365, 367, 368, 383 Deionization, 129–131 Deionizers, 129–130 Deionizing resin, 129–131 Delafield haematoxylin, 288, 402 Deliquescent chemicals, 42 Desiccants, 42 Design of laboratory, 51, 56–58 DHT pipette filters, 136–137 DHT syringe dispensing system, 137–138 Diabetes mellitus, 341, 346, 375 Diabetic ketoacidosis, 375, 376 Diabur-Test 5000, 373, 385 Diacetyl monoxime reagent, 338, 402 I NDEX Diacetyl monoxime urea method, 337–340 Diagnostic kits, see Kits Diarrhoea, 191, 203, 206, 208, 210, 211 Diastix, 373, 385 Diazo reagent, 351, 352 Dichroic filter (mirror), 125 Dicrocoelium dendriticum, 226 Dientamoeba fragilis, 204 Diethylamine, 82 Diethylcarbamazine (DEC), 282–283 Differential white cell counters, 171, 173 Diffuse cutaneous leishmaniasis (DCL), 274 Digenea flukes, 185 Digestion technique for Trichinella larvae, 305 Diluting solutions and fluids, 43–44 DIN standards, 113 Dipetalonema perstans, see Mansonella perstans Dipetalonema streptocerca, see Mansonella streptocerca Diphyllobothriasis, 231–232 Diphyllobothrium latum, 231–232 Dipylidium caninum, 233–234 Direct agglutination test (DAT), 277 Direct bilirubin, 349, 350, 352 Discard containers, 174 Disinfectants, 67–70 Disinfection, boiling, 66, 67 chemical, 67–70 Dispensers, 137–138 Dispensing chemicals, 136–138 Displacement principle, 138 Disposal of specimens, 71–72 Distillation, 127–128 Distilled water, 126, 127–128 District health care, 1, 2–3, District health system, 1, District laboratories, accidents in, 50, 51–58 activities, 2–3, 5–8 communication, 47–48 correct use of, 14–15 costs, 15, 28–31 equipping, 96–175 establishing, 3–9 evaluating work, 15 external quality assessment, 37 financing of, 15, 28–31 functions, 2–3, 5–8 441 importance, 2–3, 5–8 laboratory coordinator, 17–18 management of, 14–37 mobile work, 7, network, 3–4 organization, 3–10 policies of work, 32 power supplies, 103–108 quality assurance, 14, 17, 19, 31–37 record keeping, 24–25, 47, 175 reliability, 14–37 safety, 50–74 SOPs, 32–34, 101–102, 313 staff, 5, 6, 10–11, 16–17, 430–435 structure, 3–9 supplies, 15, 16 workload, 36, 54 District laboratory coordinator, 17–18 District medical officer, role in QA, 18–19 Diurnal periodic microfilariae, 280, 284 Dixon autoclaves, 144–145 DNPH colour reagent, 359 Dobells’ iodine, 180, 195, 402 Dog tapeworm, see Echinococcus granulosus Donated equipment, 97, 101 Dracunculiasis, 305–306 Dracunculus medinensis, 305–306 Draining rack, 168, 170 Dressings, 174 Dri-bath (heat block), 151–152 Drug-resistance of Plasmodium falciparum, 244 Drugs, reducing expenditure, 2–3 Dry block heater, 151–152 Dry reagent technology systems, 312 Duffy blood group antigens, 243 Duodenal aspirates, 187, 222 Dwarf tapeworm, see Vampirolepis nana Dwarf threadworm, see Strongyloides stercoralis Dysenteric specimens, 191, 193, 204, 210, 216 Earth-fault interrupter, 88 Echinococcosis, 302 Echinococcus granulosus, 302 Echinococcus multilocularis, 304 Echinostoma species, 225 EDTA (sequestrene) anticoagulated blood, 165, 175, 251, 402 Egg capsule, 234 Egg granulomata, 216 Eggs of parasites, Ascaris lumbricoides, 194, 210 Capillaria species, 211 characteristics, 428 comparative sizes, 194, 428 concentration of, 196–199 counting of, 199–200, 220 Dicrocoelium dendriticum, 226–227 Diphyllobothrium latum, 232 Dipylidium caninum, 234 Enterobius vermicularis, 235 examination of faeces, 193–195 Fasciola hepatica, 223–224 Fasciolopsis buski, 224–225 Gastrodiscoides hominis, 227 Heterophyes heterophyes, 226 Hookworm, 194, 213 Hymenolepis diminuta, 233 illustrations of, 194, 428 Metagonimus yokagawai, 226 Opisthorchis sinensis, 222 Paragonimus species, 296–297 Schistosoma haematobium, 236–239 Schistosoma intercalatum, 219 Schistosoma japonicum, 218 Schistosoma mansoni, 218 Schistosoma mattheei, 219 Schistosoma mekongi, 219 sizes, 194, 428 Strongyloides füelleborni, 215 Taenia species, 194, 229 Ternidens deminutus, 213 Trichostrongylus species, 213 Trichuris trichiura, 194, 211 Vampirolepis nana, 233 Ehrlich’s reagent, 378, 403 Ehrlich’s test, 378 Electric shock, 53, 94 Electrical equipment, safe use of, 53, 59, 89 Electricity supplies, 103–108 Electrocution, First Aid, 94 Electrode, battery, 106–107 ISE, 366–367 Electrolytes, acid-base disorders, 364 balance, 364 bicarbonate, 318, 364 body fluid losses, 368 chloride in urine, 368–369 chloride shift, 315 collection of blood, 319, 366 distribution and function, 364 disturbances of balance, 368 function of, 364 loss of, 368 I NDEX 442 measurement of, 365–367 potassium, see Potassium, serum or plasma sodium, see Sodium, serum or plasma water balance, 364, 368 Electronic balance, 131, 132 Elephant skin, 292 Elephantiasis, 282 Embryophore, 229 Emergency First Aid, 55, 91–95 Emergency resuscitation, 92–94 Encephalitozoon species, 208 Endolimax nana, 197, 202 Entamoeba coli, 197, 202 Entamoeba dispar, 200, 202 Entamoeba hartmanni, 202 Entamoeba histolytica, amoebae, 197, 201 CAP test, 298–299 chromatoid bodies, 202 clinical features, 200–201 control and prevention, 201 cysts, 202 geographical distribution, 200 laboratory diagnosis, 201–202 life cycle, 201 liver abscess, 200–201, 298–299 rectal scraping, 201 transmission, 201 Enterobiasis, 234 Enterobius vermicularis, 234–235 Enterocytozoon bieneusi, 208 Enterotest, 203 Enzymes, aminotransferases 358 amylase, 362–363 International Unit, 40, 330 Katal unit, 330 kinetic reaction, 313 measurement of, 330 optimum temperature, 330 pH, 330 quality control, 329–330 reporting in SI units, 40 stability, 330 units, 40, 330 Eosin stain, 193, 201, 403 Eosinophilia, fascioliasis, 224 fasciolopsiasis, 225 filariasis, 282, 283 hookworm disease, 212 loiasis, 283 occult filariasis, 282 paragonimiasis, 296 pulmonary eosinophilia, 282 schistosomiasis, 217 strongyloidiasis, 214 trichinosis, 304 Epifluorescence, 124 Epimastigotes, 267, 268 EQA, 37 Equipment, accidents, 53, 87–88 battery-operated, 104, 106, 112, 149, 158–159, 367 care and maintenance of, 88, 101–103 district laboratory, 96 donated, 97, 98, 100, 101, 102 electrical, 88, 103–105 hazards, 53, 87–88 importation, 98, 99, 101 installation of, 87–88 maintenance, 88, 101–103 managing, 15–16, 33, 101–103 microprocessor controlled, 96 ordering and purchasing of, 97–100, 162–175 problems, 15–16 procurement, 97–99 protection (voltage stabilizers), 103–104 safe use of, 87–88 selection of, 96–99, 100 standardization, 96–97 user manual, 98, 101 Erhlich’s reagent, 378, 403 Erhlich’s test, 370 Errors, clerical, 35 correcting, 37 imprecision, 35–36, 323, 325 inaccuracy, 35, 36, 323, 325 reagent, 40 sources, 34–37 Erythrocyte sedimentation rate, raised, African trypanosomiasis, 261 hepatic amoebiasis, 200 leishmaniasis, 275 Erythrocytic schizogony, 241 Espundia, 274 ESR containers, 170 ESR equipment, 170, 172 Estimating costs, 29–30 Ethanol, absolute, 82 Ethanols (alcohols), safe storage, 82 Ether, diethyl, 82, 196 Ethyl acetate, 196 Ethylene glycol, 329 Evaluating laboratory services, 15 Excitation filter, 124 External quality assessment (EQA), 37 Extracellular body fluid, 364, 370 Eye worm, see Loa loa Eyepiece, 109, 111 Eyepiece graticule, 125–126 Eyepiece micrometer, 125–126 Eyewash bottle, 56, 77, 91 Facemasks, 59 Faecal fat, 391–392 Faecal formol detergent technique, 220–221 Faeces, appearance of, 192–193 blood in, 193 collection of, 192, 316, 393 concentration methods, 192, 195–199 container, 165 cysts in, 197, 200–208 eggs in, 194, 208–235, 428 examination for parasites, 192–195, 208–235 fat in, 195, 391–392 formol detergent technique, 220–221 formol ether technique, 196, 198 lactose in, 391 normal structures, 195 occult blood in, 389–391 parasites in, 187, 208–235 pH testing of, 391 preservation of, 182–183 pus in, 193, 195 worms in, 187 Fainting, First Aid, 92–94 Falciparum drug resistance, 244–245 Falciparum malaria, see Plasmodium falciparum Fasciola gigantica, 223–224 Fasciola hepatica, 223–224 Fascioliasis, 223–224 Fasciolopsiasis, 225 Fasciolopsis buski, 224–225 Fasting blood glucose, 342 Fat globules, 391–392 Fat in faeces, 391–392 Fatty acid crystals, 392 Ferric chloride, 83 Fever in malaria, 242 Field’s/haematoxylin staining technique, 288 Field’s method for microsporidia, 208 Field’s stain, A and B, 180–181, 247, 403 Field’s thick film technique, 247–248 Field’s thin film technique, 247 Filarial antigen, 290 Filarial worms, Brugia species, 280, 281, 283–289 I NDEX Loa loa, 280, 281, 283–289 Mansonella species, 283, 286, 287, 294, 295 Onchocerca volvulus, 291–295 Wuchereria bancrofti, 280, 281–282, 283–291 Filariasis filtration technique, 284, 288–289 Filariform larvae, 212 Filter absorption spectrometer, see Colorimeter Filter, Berkfeld, 128–129, 131 Filter paper, 166, 175 Filter, water, 128–129, 131 Filters, colorimeter, 153, 155 Filters, membranes, 238, 288 Filters, microscopical, 111, 124 Filtration of blood for microfilariae, 288–289 Filtration of urine for S haematobium, 238–239 Filtration of water, 128–129 Financing district laboratories, 15, 22, 28–31 Fire, burns, treatment, 94 causes, 51–52, 53 chemical, 52, 76 equipment, 53, 57, 89–90 extinguisher, 57, 90 management, 55, 89–91 prevention, 90 Fire extinguishers, 57, 90 First Aid, 55, 91–95 First Aid box, 91 First Aid Manual, 95 Fixation of blood films, 246–247 Fixation of parasites, 182–183 Fixed costs, 29 Fixed volume pipettes, 135 Flagellates, Chilomastix mesnili, 184, 204 Giardia lamblia, 202–204 Pentatrichomonas hominis, 204 Trichomonas vaginalis, 187, 188 Flame cells, 237 Flame photometer, 365–366 Flammable chemicals, 75–76, 86, 90 Flasks, 162, 163 Flatfield objectives, 112 Floatation (flotation) concentration methods, 196, 199 Flukes, characteristics of, 185 classification of, 184 Dicrocoelium dendriticum, 226 eggs of, 194, 428 Fasciola hepatica, 223–224 443 Fasciolopsis buski, 224–225 Heterophyes heterophyes, 226 Metagonimus yokagawai, 226 Opisthorchis sinensis, 221–222 Opisthorchis viverrini, 222–223 Paragonimus species, 297 Schistosoma haematobium, 236–239 Schistosoma intercalatum, 216, 217, 219 Schistosoma japonicum, 216, 217, 218 Schistosoma mansoni, 216–217, 218 Schistosoma mekongi, 216, 217, 219 Fluorescence microscopy, 123–125, 255 FluoreslenS, 124 Fluoride-oxalate, 166, 315, 403 Fluorochromes, 123 Forceps, 171, 173 Formaldehyde, 70, 82 Formol detergent solution, 403 Formol detergent technique, 220–221 Formol ether technique, 196–198 Formol gel test, 277–278 Formol saline reagent, 404 Formol water, 196 Fouchet’s reagent, 377, 404 Fouchet’s test, 377 Free haemoglobin in urine, 242, 379–380 Free-living amoebae, 299 Fumouze latex test, 298 Funnels, 162, 163 G6PD deficiency, 242, 245, 354 Gambiense sleeping sickness, see Trypanosoma b gambiense Gametocytes, 250, 252, 253 Gas cylinders, safe use, 79 Gas flame photometer, 365–366 Gastrodiscoides hominis, 227 Gaussian distribution graph, 27–28 GFR, 335–336, 369, 375 Giant intestinal fluke, see Fasciolopsis buski Giardia intestinalis, see Giardia lamblia Giardia lamblia, antigen test, 204 clinical features, 203 concentration of cysts, 203 cysts, 197, 204 distribution, 202–203 Enterotest, 203 Field’s staining, 203 flagellates, 197, 203 laboratory diagnosis, 203–204 life cycle, 201 prevention and control, 203 staining of, 203, 204 transmission, 203 Giardiasis, 203 Giemsa, reagent, 82, 180, 247, 404 safe storage, 82 staining, 248–249 Glare in microscopy, 110 Glass breakages, 88–89 Glassware, cleaning, 72–74 hazards, 53, 88–89 purchasing, 88 Glomerular filtration rate (GFR), 335–336, 369, 375 Glomerulonephritis, 337, 372 Glossina tsetse flies, 259, 261 Gluconeogenesis, 341 Glucose, cerebrospinal fluid, 388–389 Glucose cholesterol meters, 343 Glucose metabolism, 340 Glucose meters, 342–343 Glucose oxidase-peroxidase reaction, 343–344 Glucose 6-phosphate, dehydrogenase (G6PD) deficiency, 242, 245, 354 Glucose, plasma measurement, analyte, 340 calibration of oxidase method, 344 diabetes mellitus, 341, 346 glucose meters, 342–343 low levels (hypoglycaemia), 346 method, 341–345, 347 newborn levels, 346 raised levels (hyperglycaemia), 341, 346 reagents required (oxidase method), 344 reference (normal) range, 345 specimen, 342, 345 strip test, 343 Glucose renal threshold, 375 Glucose tolerance test (GTT), 346, 348 Glucose, urine, 372–375 Glutaraldehyde (glutaral), 70, 82 Glycated haemoglobin, 348–349 Glycerol jelly reagent, 404 Glycerol thick smear, 220 Glycogen inclusion in cysts, 197, 202 Glyconeogenesis (gluconeogenesis), 340 I NDEX 444 Glycosal Hblc meter, 348–349 Glycosuria, 375 Glycosylated haemoglobin, 348–349 GOP glucose method, 343–345 GOT, see Aspartate aminotransferase GPT, see Alanine aminotransferase Gram (g), 39 Granulomata, 216 Graph paper, 175 Graticule (stage), 125, 126 Gravid Taenia segments, 229 Gravity filter, 128–129 Griess test, 381 Ground itch, 212 GTT, 346, 348 Guaiac test, 379–380 Guinea worm, see Dracunculus medinensis Gum guaiac, 379, 405 Haematemesis, 389 Haematocrit centrifuge, 140 Haematocrit tubes, 72, 134, 165 Haematoxylin (Delafield) staining technique, 288 Haematuria, 236, 237, 379 Haemocytometer, see Counting chambers Haemoglobin F, 243 Haemoglobin S, 243 Haemoglobinuria, 379–380 Haemolysis of blood specimens, 314 Haemolytic disease of the newborn (HDN), 354 Haemolytic jaundice, 349, 354, 355 Haemoptysis, 296 Halogen lamps, 112, 121 Hand operated centrifuge, 141–142 Hand tally counter, 173 Handy Mains inverter, 104 Hanna meter, 130–131 Harmful chemicals, 75, 77–78, 86 HAZ-TAB granules, 68, 69 Hazard chemical symbols, 75 Hazard labels, 58, 63, 75 Hazard warning symbols, 58, 63, 75 Hazard zoning, 57 Hazards, laboratory, 50–54 Health and Safety, 50–74 Health centre laboratories, 3–5, 29 Health check, 59 Heart compression, First Aid, 92–94 Heart-lung-migration, 185 Heat block, 151–152 Heat test, Bence Jones protein, 372 Helminths, 184, 185 see also under individual species Hema-Combistix, 385 Hema-Screen test, 389–390 Hemastix, 379, 385 Heparin, 315 Hepatic amoebiasis, see Amoebic liver abscess Hepatitis, 349, 354, 355 Hepatocellular jaundice, 349, 354, 355 Hepatoma, 303, 349 Hermaphroditic flukes, 185 Hermle centrifuge, 140–141 Hertz (frequency), 38 Heterophyes heterophyes, 226 High eyepoint eyepieces, 111 HIV, associated parasites, 187–188 inactivation by chlorine, 68 leishmaniasis, 273 microsporidia infections, 208 P falciparum, 243 T cruzi, 268 toxoplasmosis, 301–302 Hoff technique, 270 Holding time, 67, 143 Hookworm disease, 212 Hookworms, anaemia, 212 clinical features, 212 geographical distribution, 212 laboratory diagnosis, 212–213 larvae, 212, 215 life cycle, 212 prevention and control, 212 transmission, 212 Host, parasitic, 183, 188–191 Hot plate, 159–160 HRP antigen, 255 Human immunodeficiency virus (HIV), see HIV Hydatid cyst, 302, 303 Hydatid disease, 302–303 Hydatid sand, 303 Hydrocele, 281, 282 Hydrochloric acid, 44–45, 83 Hydrochloric acid reagents, 380 Hydrogen ion concentration (pH), 46 Hydrogen peroxide solution, 83, 405 Hydrolysis, 45 Hygiene, personal, 58–59 Hygroscopic chemicals, 42 Hymenolepis diminuta, 233 Hymenolepis nana, see Vampirolepis nana Hyperendemic malaria, 240 Hyperglycaemia, 341, 346 Hyperkalaemia, 367 Hypernatraemia, 367 Hyper-reactive malaria splenomegaly, 243 Hypnozoites, 241 Hypoalbuminaemia, 357–358 Hypochlorite solution, 68, 69 Hypoglycaemia, 242, 342, 346 Hypokalaemia, 367–368 Hyponatraemia, 367 ICT Filariasis test, 290–291 Icterus, see Jaundice IgM in c.s.f., 266 Immersion oil, 110, 120 Immunity, African trypanosomiasis, 260 Chagas’ disease, 268 filariasis, 282 leishmaniasis, 273, 274 malaria, 243 schistosomiasis, 221 Immunization, personal protection, 59 Immunochromatographic strip tests, Cryptosporidium, 207 filariasis, 290–291 giardiasis, 204 malaria, 255 Immutrep rotator, 158–159 Imprecision errors, 35–36, 323, 325 In vitro drug sensitivity testing, 244 In vivo testing, 244 Inaccuracy, 35, 36, 323, 325 Incident light fluorescence, 124 Incineration, 70 Incubators (laboratory), 148–150 Indicators, chemical, 46 Indirect bilirubin, 349, 352, 354 Infection, laboratory acquired, 52, 60 Infectious material, decontamination, 66–74 hazards, 59–64 labelling, 65 safe handling, 61–64 swallowing, First Aid, 94 transport of, 65–66 Infectious substance label, 65 Inoculations, personal, 59 Instant View Faecal Occult Blood test, 389 I NDEX Insulin, 341 Interference filter (colorimetric), 124, 125, 153 Intermediate host, 183 International System of Units, see SI units International transport regulations, 66 International Unit (U), 40 Interpretation of test results, 24–28 Intestinal coccidiosis, 206 Intestinal schistosomiasis, 216–217 Intracellular body fluid, 364 Intravascular haemolysis, 380 Invasive amoebiasis, 200, 298 Inverter, Handy Mains, 104 Iodamoeba buetschlii, 197, 202 Iodine, 83 Iodine cyst, 197, 202 Iodine reagent, 180, 195, 362, 406 Ion selective electrode, see ISE analyzers Iris diaphragm of microscope, 113, 116, 117 Iron deficiency anaemia, 212 Iron 111 chloride, 83 ISE, analyzers, 365, 366–367 Isospora belli, 205–207 Isotonic (physiological) saline, 180, 408 Jaffe-Slot creatinine method, 333–334 Jaundice, 349, 354–355 Jendrassik and Grof bilirubin method, 350–354 Job-related training, 10, 430–435 Joule (J), 38 K 39 dipstick test, 277 Kala-azar, 273 Katal, 330 Katayama reaction, 217 Katex test, 277 Kato-Katz technique, 220 Kawamoto AO system, 124 Kelvin (K), 38 Kerandel’s sign, 260 Kernicterus, 354 Keto-Diastix, 375, 385 Ketoacidosis, 375, 376 Ketones, in serum or plasma, 376 in urine, 375–376 production of, 375 Ketonuria, 375, 376 Ketostix, 375, 385 Ketur-Diabur-test, 375–376, 385 445 Kilogram (kg), 38, 39 Kinetic technique, 313 Kinetoplast, 184, 262, 270 Kissing bugs, see Triatomine bugs Kits, ALT, 358–360 creatinine, 333 glycated haemoglobin, 348–349 occult blood in faeces, 392–393 purchasing of, 16, 22, 30, 311–312 Krebs urea cycle, 337 Labelling containers, 174, 175 Labmax bottle top dispenser, 138 Laboratory accident book, 55 Laboratory acquired infections, 52, 60 Laboratory coordinator, role of, 17–18 Laboratory costs, 15, 28–31 Laboratory, district, see District Laboratories Laboratory First Aid box, 91 Laboratory safety officer, 56 Laboratory waste, disposal of, 66–74 Laboratory workload unit (LWU), 30 Labstix, 385 Lactase deficiency, 391 Lactophenol solution, 406 Lactose in faeces, 391 Lancets (blood), 73, 166 Large intestinal roundworm, see Ascaris lumbricoides Larvae, Dracunculus medinensis, 306 filariform, 212 hookworm, 215 rhabditiform, 212 Strongyloides, 193, 194, 197, 215 Trichinella spiralis, 304–305 Latex agglutination tests, amoebiasis, 298 IgM in c.s.f., 266 leishmaniasis, 277 toxoplasmosis, 301 trypanosomiasis, 266 LD bodies, see Amastigotes Lead-acid 12V battery, 104–108, 112 Leishman-Donovan bodies, see Amastigotes Leishmania aethiopica, 271, 272, 273–274 Leishmania amazonensis, 271, 272, 274 Leishmania braziliensis, 271, 272, 274, 279 Leishmania chagasi, 271, 272, 273 Leishmania complex, 271 Leishmania donovani, 271, 272, 273, 274, 278 Leishmania guyanensis, 271, 272, 274 Leishmania infantum, 271, 272, 273, 274 Leishmania major, 271, 272, 273, 274 Leishmania mexicana, 271, 272, 274, 279 Leishmania panamensis, 271, 272, 274 Leishmania peruviana, 271, 272, 274 Leishmania tropica, 271, 272, 273, 279 Leishmaniasis, cutaneous, 271, 273, 278–280 diffuse cutaneous, 271, 274, 279 HIV association, 273 laboratory diagnosis, 274–279 mucocutaneous, 271, 274, 278–280 visceral, 271, 273, 274–278 Leishmaniasis recidiva (LR), 273 Leishmanin test, 279 Length measurements, 39 Leucopenia in leishmaniasis, 273, 275 Leukocyte esterase, 380, 381, 385 Life cycles of parasites, 185–186, 188–191 Lightpath of cuvette, 153 Line of best fit, 157 Linear (straight line) calibration, 156, 157 Lithium heparin, 314 Litre, 38–39 Liver, abscess, 298 bilirubin metabolism, 348–349 diseases, 349, 354, 360 hepatocellular damage, 349, 354, 355 obstruction of biliary ducts, 349, 354, 355 parasites in, 187 Liver abscess, 298 Liver aspirate, 187, 298 Liver rot, 223 Loa loa, clinical features, 283 geographical distribution, 280 laboratory diagnosis, 283–289 life cycle, 281 microfilariae, 286, 287, 427 I NDEX 446 prevention and control, 283 transmission, 281 vectors of, 281 Loiasis, 283 Loops, inoculating, 62, 74, 172, 173 Lung fluke, see Paragonimus westermani Lymph gland aspirate, 187, 264–265, 274, 276 Lymphatic filariasis, 281–283 Lymphoedema, 282 Lyophilized QC serum, 329 Lyzed capillary blood technique, 284, 285 MAEC, 262 Magnetic stirrer, 159–160 Magnification of microscope, 109 Mailing of specimens, 66 Maintenance of equipment, 88, 101–103 Malachite green, 206, 406 Malaria, see Plasmodium species Malaria attack, 242 Malaria drugs, 244 Malaria haemoglobinuria, 242 Malaria parasites, antigen tests, 255–258 Binax Now test, 257 blood films, 245–251 buffy coat preparations, 251, 255 collection of blood, 245 colour plates, 252–253 concentration of, 251, 255 control, 244 counting of, 250–251 diagnosis, 244–258 differentiation of species, 252–254 drug resistance, 244 Field’s staining, 247–248 genetic factors, 243 Giemsa staining, 248–249 global situation, 239, 243–244 haemoglobinuria, 242 life cycle, 241 Paracheck Pf tests, 256 pigment, 241, 250 prevention and control, 244 RDTs, 255–258 reporting, 249–250 staining, 247–250 thick blood films, 246, 247–250, 252–254 thin blood films, 247–248, 250–251 Malaria pigment, 241, 250 Malaria RDTs, 255–258 Malaria splenomegaly, 243 Malayan filariasis, see Brugia malayi Malignant tertian malaria, see Plasmodium falciparum Malnutrition-related diabetes, 341 Management, equipment, 15–16, 102 finances, 15, 28–31 staff, 16–17 supplies, 15, 16 total quality management, 19, 14–37 Mansonella ozzardi, 283, 286, 287 Mansonella perstans, 283, 286, 287 Mansonella streptocerca, 294, 295 Mansonia mosquitoes, 280 Manufacturers, addresses of, 414–419 ordering and purchasing from, 97–100 Mass (weight) measurements, 39, 422 Maurer’s dots (clefts), 251, 252 Mean (M) value, 27, 325, 326, 327, 328 Measurements of objects by microscopy, 125–126 Measuring eyepiece, 125–126 Mechanical balances, 131–133 Mechanical stage of microscope, 114, 116 Median bodies, 203 Medina worm, see Dracunculus medinensis Megacolon, 268 Megaloblastic anaemia, 231 Mega-oesophagus, 268 Mekong schistosome, see Schistosoma mekongi Melaena, 389 Membrane filter technique, filariasis, 288–289 urinary schistosomiasis, 238–239 Meningitis, 391, 392 Meningoencephalitis, 260, 299, 391 Meniscus of a fluid, 41 Mercury, 83 Mercury II chloride, 83 Mercury II nitrate, 83 Mercury vapour lamp, 123 Merit water still, 127 Merogony, see Schizogony Merozoites, 250, 252, 253 Metacercaria, 221, 223, 225, 296 Metacyclic trypanosomes, 260 Metagonimus yokagawai, 326 Methanol, 83, 180 Methylene blue saline, 285, 406 Metre (m), 38, 39 Microalbuminuria, 372 Microbial hazards, 52, 59–66 Microfilariae, blood examination, 283–289 Brugia malayi, 286, 287 Brugia timori, 286, 287 collection times, 284 concentration of, 284, 288–289 counting, 284, 285, 295 differentiation chart, 286, 427 filtration, 288–289 geographical distribution, 284 Loa loa, 286, 287 Mansonella ozzardi, 286, 287 Mansonella perstans, 286, 287 Mansonella streptocerca, 294, 295 Onchocerca volvulus, 293–294 periodicity of, 280, 284 skin examination, 293–294 staining of, 288 urine examination, 289–290 Wuchereria bancrofti, 286, 287 Microhaematocrit centrifuge, 140 Microhaematocrit concentration, microfilariae, 284 trypanosomes, 263–264, 269 Micrometer (eyepiece), 125 Micrometry, 125–126 Micro-organisms, risk groups, 60–61 Microprocessor equipment, 96 Microscope, achromatic objectives (achromats), 110 apochromatic objectives, 110 battery-operated, 112 binocular, 111, 115, 116 care and cleaning of, 120–121 chromatic aberration, 110 compensating eyepiece, 111 condenser, 113, 114, 115, 117 dark-field, 121–123 daylight use, 119 DIN standards, 113 district laboratory microscope, 111–114, 116 eyepiece, 109, 111 eyepiece scale, 125 filters, 111 flatfield objectives, 112 fluorescence, 123–125 focus stop, 113 focus tension, 113, 116 focusing, 115 glare, 110 high eyepoint eyepieces, 111 I NDEX illumination, 110–111, 112, 118–119 immersion oil, 110, 120 infinity corrected system, 112 iris diaphragm, 113, 116, 117 magnification, 109 measuring, 125–126 mechanical stage, 115, 116 micrometry, 125–126 mirror, 116, 118–119 monocular, 111, 119 numerical aperture (NA), 109 objectives, 109, 112–113, 115, 118 oil immersion objective, 109–110 operation, 114–120 quality control, 120–121, 181 resolving power, 109–110 routine use, 114–121 spherical aberration, 110 trinocular head, 111 Tropical Health Technology, 114, 116 tube, 109 useful magnification, 109 working distance, 115 working principle, 109–111 Microscopy, dark-field, 121–123 fluorescence, 123–125 quality control, 120–121, 181 routine use, 114–121 Microsporidia, 185, 208 Millipore polycarbonate membranes, 238, 288 Miniature anion exchange centrifugation (MAEC) technique, 262 Miracidium, 217, 223, 225, 238 Mirror of microscope, 116, 118–119 Mixers, 158–159 Mobile laboratory work, 7, Molar (M) solutions, 40 Mole (mol), 38, 39, 42–43 Mole per litre solutions, 40, 42–43 Molecular mass, 43 Molecular weight, see Molecular mass Molluscicides, 217 Monocular microscope, 111, 119 Montenegro reaction, see Leishmanin test Morula cells, 265–266 Mosquito vectors, 240, 244, 280–281, 282 Mott cells, 265–266 Mouth-pipetting, 63, 77 Mouth-to-mouth respiration, 92–94 447 M.T malaria, see Falciparum malaria Mucocutaneous leishmaniasis, 271, 274, 278–279 Multiceps species, 304 Multistix strips, 385 Muscle biopsy for Trichinella, 304–305 Mutagen, 77 Myeloma, 372 Myocardial infarction, 360 Myoglobin, 370, 380 NaDCC, 68, 69 Naegleria amoebae, 299 Necator americanus, 212 Needles, disposal, 73 ordering/purchasing, 166 safe use, 63 Needlestick injury, 52, 63, 91 Nematodes (roundworms), Ascaris lumbricoides, 209–210 Brugia species, 280, 281, 283–289 Capillaria, 211 characteristics, 185 classification, 184 Dracunculus medinensis, 305–306 eggs of, 194, 428 Enterobius vermicularis, 234–235 Hookworms, 212–213 Loa loa, 280, 281, 283–289 Mansonella species, 283, 286, 287, 294, 295 Onchocerca volvulus, 291–295 Strongyloides füelleborni, 215 Strongyloides stercoralis, 214–215 Trichinella spiralis, 304–305 Trichostrongylus species, 215 Trichuris trichiura, 210–211 Wuchereria bancrofti, 280, 281–282, 283–291 Neonatal hypoglycaemia, 242, 346 Neonatal jaundice, 354–355 Nephrotic syndrome, 243, 358, 372 Neutral fat globules, 391 Neutralization reactions, 45 Newsletter for laboratory workers, 11, 13 Newton (N), 38 Nickel cadmium (NiCd) batteries, 108 Nickel electro centrifuge, 140 Nickel electro water bath, 150 Nigrosin stain, 298, 406 Nitrate reducing bacteria, 381 Nitric acid, 45, 83 Nitrite in urine, 380, 381 Nitroprusside ketone test, 376 Nitroprusside reagent, 376, 407 Nocturnal periodic microfilariae, 280, 284 Non-linear calibration, 156, 157 Normal ranges, see Reference ranges Normal (N) solutions, 40, 43 Normality of solution, 40, 43 Nose-bleed, First Aid, 91–92 NOW ICT Filariasis test, 290–291 NOW Malaria test, 257 Nuclepore membrane technique, filariasis, 288–289 urinary schistosomiasis, 238–239 Numerical aperture (NA), 109 Nylon coated wire racks, 168, 169–170 Nytrel filter, 238 Objectives of microscope, 109, 112–113, 115, 118 Obstructive jaundice, 349, 354, 355 Occult blood in faeces, 389–391 Occult filariasis, 282 OD (optical density), 153 Oesophagostum species, 213–214 Ohaus balances, 131–133 Oil immersion objective, 109–110 Oliguria, 370 Onchocerca volvulus, clinical features, 291–292 geographical distribution, 291 laboratory diagnosis, 292–295 life cycle, 291–292 microfilariae, 293–294 prevention and control, 292 vectors of, 291, 292 Onchocerciasis, 291–292 Onchocercomas, 292 Oocysts, Cryptosporidium, 196, 198, 207 Cyclospora, 196, 198, 208 Isospora, 196, 207 Toxoplasma, 300 Opisthorchis felineus, 223 Opisthorchis sinensis, 221–222 Opisthorchis viverrini, 222–223 Orbital mixer, 158–159 Ordering chemicals and reagents, 46–47 Ordering equipment, 97–100, 162–175 Oriental liver fluke, see Opisthorchis sinensis Oriental lung fluke, see Paragonimus westermani I NDEX 448 Oriental sore, 273 Osmolality of urine, 383 Ova of parasites, see Eggs Oval red cells in malaria, 250, 253 Ovale tertian malaria, see Plasmodium ovale Ovalocytosis gene, 243 Oviparous worms, 185 Oxidizing chemicals, 75, 76, 86 Pancreatitis, 360, 364 Pandy’s test, 387–388 Paracheck Pf tests, 256 Paragonimiasis, 296 Paragonimus africanus, 295 Paragonimus uterobilateralis, 295 Paragonimus westermani, 295 Paralens, 255 Paraproteins, 358, 372 Parasites, characteristics, 183–185 classification, 184 DALYs, 186 diseases caused by, 186, 187, 188–191 HIV associated, 187–188 hosts of, 183 life cycles, 185–186, 188–191 obligatory, 185 preservation of, 182–183 quality assurance, 178–182 reporting, 181–182 specimens, 178–179, 187 transmission of, 181, 188–191 zoonoses, 183 Parasitic disease, 186, 187, 188–191 Parasitism, 183, 188–191 Pascal (Pa), 38, 40, 143, 422 Pastettes, 136 Patient confidentiality, 24 PBS, see Phosphate buffered saline PE schizont, 241 Pentatrichomonas hominis, 204 Percentage solutions, 43 Perianal skin sampling, 234–235 Periodicity of microfilariae, 280, 284 Permanent mounts, 182 Peroxidase reaction, 343–344 Peroxygen compounds, 69 Petri dishes, 164, 165 pH, blood, 394 importance in enzyme assays, 330 meaning of, 45–46 measurement of, 171, 173 papers, 174 testing of faeces, 391 testing of urine, 370 pH meter, 171, 173–174 pH papers, 174 Phase (electrical), 109 Phenol, 78, 84 Phenol saturated solution, 387, 407 Phenolic agents, 68 Phenyl-ketonuria, 376 Phlebotomus sandflies, 272 Phosphate borate buffer, 334, 407 Phosphate buffer for glucose colour reagent, 407 Phosphate buffer solution A and B, 400 Phosphate buffered saline (PBS), pH 7.0–7.1, 298, 407 pH 7.2, 408 Phosphoric acid, 84 Photoelectric colorimeter, see Colorimeter Physiological (neonatal) jaundice, 354–355 Physiological saline, 180, 408 Picric acid, 78, 84 Picric acid reagent, 334, 408 Pigment, malarial, 241, 250 Pinworm, see Enterobius vermicularis Pipette fillers, 136–137 Pipettes, air displacement, 134–136 automatic, 134–136 capillary micropipette filler, 134 cleaning, 72 fillers, 137 fixed volume, 135 graduated, 165 plastic bulb, 136 positive displacement, 134–135 safe pipetting, 63, 134–137 variable volume, 135 Westergren, 170 Pipetting safely, 63, 133–138 Pipettors, 134–136 Pi-pump 2500, 137 pK of acids and bases, 45 Plasmodium falciparum, antigen tests, 255–258 blackwater fever, 242 blood films, 245–251 cerebral malaria, 242 clinical features, 242–243 counting of parasites, 250–251 distribution, 240 drug resistance, 244 endemicity, 240 fever, 242 haemoglobinuria, 242 HIV co-infection, 243 hypoglycaemia, 242 laboratory diagnosis, 244–258 life cycle, 240–242 parasitic density, 250–251 pregnancy, infection in , 242, 243 RDTs, 255–258 recrudescence, 244 severe falciparum malaria, 242, 245 sickle cell gene (Hb S), 243 splenomegaly, 243 transmission, 240–241 vaccines, 244 Plasmodium malariae, 240, 241, 243, 252 Plasmodium ovale, 240, 241, 243, 253 Plasmodium vivax, 240, 241, 243, 253 Plastic bulb pipettes, 136 Plastics, chemical resistance table, 160–161 Plastic-ware, 160–161, 162, 163, 165, 166, 168, 169 pLDH antigen, 255 Pleomorphic trypanosomes, 262 Plerocercoid, 231 Pneumocystis jiroveci (formerly carinii), 188 Poisoning, First Aid, 94 Polar filaments, 233, 248 Policies of work, 32 Polycarbonate filter membranes, filtering blood, 288–289 filtering urine, 238–239 reuse, 238 Polycarbonate (PC) properties, 176–177 Polyethylene (LDPE, HDPE) properties, 160–161 Polypropylene (PP) properties, 160–161 Polyuria, 369 Polyvinyl, alcohol (PVA), 183 Pork tapeworm, see Taenia solium Porphobilinogen in urine, 378 Positive displacement pipettor, 134–135 Post-analytical stage, 181–182, 330–331 Post-hepatic jaundice, see Obstructive jaundice Post kalar-azar dermal leishmaniasis (PKDL), 273 Post prandial specimen, 342 Postal regulations, 66, 323 Posting of specimens, 66, 323 I NDEX Potassium cyanide, 84 Potassium dichromate, 84 Potassium hydroxide, 84 Potassium permanganate, 84 Potassium, serum or plasma, analyte, 364 collection of blood, 319, 366 flame photometry, 365, 366 ISE analyzers, 366–367 low values (hypokalaemia), 367 measurement, 365–367 quality control, 366–367 raised values (hyperkalaemia), 367 reference (normal) range, 367 stability, 319 Power supplies, 103–108 Pre-analytical stage, 178–179, 313 Precision of test methods, 35–36, 323, 325 Predictive value of tests, 26 Pre-erythrocytic (PE) schizonts, 241 Pregnancy and diabetes, 341 Pregnancy and malaria, 242 Prehepatic jaundice, see Haemolytic jaundice Preparation of solutions, 41–43 Preservation of parasites, 182–183 Preservatives, blood, 315 faecal parasites, 182–183 urine, 316 Pressure cooker, 147 Pressure measurements, 40, 143, 422 Prestige Classic autoclave, 145 Prevalence, 26 Primary amoebic meningoencephalitis, 299 Primary filter, 123 Primary health care laboratories, 3–5 Private laboratory practice, 31 Problem-solving, 429 Procercoid, 231 Professional Code of Conduct, 11–13 Proglottids, see Segments of tapeworms Promastigotes, 272 Protective clothing, 59, 74 Protein, plasma/serum, 358, 384 c.s.f 386–388 urine, 371–372 Protein, cerebrospinal fluid (c.s.f.), 386–388 Protein diluent, 355, 408 Protein precipitant reagent, 344, 408 449 Protein standards, 387 Protein, total, 358 Protein, urine, 371–372 Proteinuria, causes of, 371, 372 strip tests, 371, 385 testing for, 371–372, 385 Protoscoleces, 303 Protozoa, 184–185 Pseudocysts, 267 Pseudopodia, 201 PTFE, properties, 160–161 Pulmonary eosinophilia, 282 Pulmonary paragonimiasis, 296 Purchasing of equipment, 97–100, 162–175 Purchasing supplies, 28–29, 162–175 Purified water, 126–131 Purolite deionizing resin, 129–130 Pus cells, 193, 195 Pus from amoebic abscess, 200–201 PVA, 183 Pyelonephritis, 337 Pyrogen, 127 Pyruvate standard, 359 QBC system, 255 Quality assurance (QA), clinical chemistry, 313–333 definition, 31 external (EQA), 37 implementation, 31–37 importance of, 17 improvement in quality, 20 meaning of, 14, 17, 19, 20, 31–37 parasitology, 178–182 Quality control (QC), charts, 327–328 clinical chemistry tests, 313–331 coefficient of variation, 325–327 control sera, 328–329 definition, 31 enzyme tests, 329–330 imprecision, 35, 323, 325 inaccuracy, 36, 323, 325 mean (M) value, 27, 325, 326, 327 microscopy, 120–121 need for, 31 parasitology tests, 178–182 part of TQM, 19, 31–37 quality control day, 19 standard deviation (SD), 325, 326, 327 urine strip tests, 386 Quality management, 14–37 Quartan malaria see Plasmodium malariae Quartz-iodine lamp, see Halogen lamps Racks, 168, 169–170 Rainwater, 128 Random blood glucose, 342 Rapid diagnostic test, malaria, 255–258 RCD, 104 RCF see Relative centrifugal force RDTs, 255–258 Reader variability, 26–27 Reagent blank solution, 153 Reagent strip tests, Bayer, 385 blood glucose, 341–343 quality control of, 384 Roche, 385 selection, 385 storage of, 384 urine, 385 use of, 384 Reagents, containers, 166, 167, 169 dispensing, 136–138 essential reagents list, 16 hazards, 75–87 ordering of, 46–47 pipetting and dispensing safely, 63, 136–138 preparation of, 42–44 purchasing, 46–47 SOP appendix, 34 See also Appendix 11, p 398–412 Records of laboratory work, 24–25, 47, 175 Recovery position, 93 Recrudescence, 244 Rectal biopsy for schistosome eggs, 219 Rectal prolapse, 210 Rectal scrapings, 187 Red cells, changes in malaria, 250 ingested, 201 rouleaux, 262 Rediae, 221, 223, 225 Reducing substances in urine, 374 Reduviid bugs, see Triatomine bugs Reference range, clinical chemistry tests, 331–333 meaning, 27–28 Referral of specimens, 6–7, 317–322 Reflectance meters, 312, 342 Reflectance photometry, 312 Reflotron system, 312 I NDEX 450 Refractometer, 382–383 Regional hospital laboratories, Reitman-Frankel ALT method, 358–360 Relapses, 241, 243 Relative centrifugal force (RCF), 139 Relative mass density (urine), 370, 381–383 Renal failure, 335, 337 Renal function tests, 333, 337, 340 Renal glycosuria, 372, 375 Renal threshold for glucose, 372, 373 Reports (laboratory), 24–25, 47, 181–182, 330–331 Request forms, 23–24, 316 Reservoir host, 183 Residual current device (RCD), 104 Resin, deionizing, 129–131 Resistance genes, 243 Resistance of malaria parasites to drugs, 244–245 Resolving power of microscope, 109–110 Respirator, personal, 59 Results of tests, 24–28, 47, 181–182, 330–331 Resuscitation, 92–94 Retroinfection, 234 Rhabditiform larvae, 212 Rhodesiense sleeping sickness, see Trypanosoma b rhodesiense Rhodnius prolixus, 267, 268 Ridley faecal concentration method, 196 Rigor in malaria, 242 Risk groups of organisms, 60–64 River blindness, 291 Riverine tsetse flies, 259 Roche urine strips, 385 Roller mixer, 158 Romana’s sign, 268 Romanowsky stain, 180, 247–249 Rotators, 158–159 Roundworms, see Nematodes RPR rotator, 158–159 Rubber stamps, 24–25, 47 Sabin Feldman dye test, 301 SAF, 183 Safe Code of Practice, 54 Safety, causes of accidents, 50, 51–56 chemical hazards, 52 Code of safe laboratory practice, 54 electric shock, 53, 94 equipment hazards, 53, 59, 89 explosion hazards, 53 fire, 51–52, 53, 89–91 First Aid, 55, 57, 91–95 glassware hazards, 53 infestation, 54 laboratory acquired infections, 52, 60 laboratory premise, 51, 56–58 microbial hazards, 52, 59–66 officer, duties, 56 parasitology work, 181 personal hygiene, 58–59 programme, 50–56 protective clothing, 59 risk assessment, 50 safety equipment, 56, 59, 62, 77, 89–90 signs, 58, 63 working environment, 54–55 working practices, 55 Safety cabinets, 64–65 Safety equipment, 56, 59, 62, 77, 89–90 Safety in the laboratory, 50–74 Safety officer, 56 Safety signs, 58, 63, 75 Salicylic acid, 84 Saline examination of faeces, 193–195 Saline (isotonic), buffered, 298, 407, 408 Saline, physiological (isotonic), 180, 408 Salt depletion, 369 Sandflies, 272, 274 Saponin powder, 84 Saponin-saline solution, 285, 409 Sargeant stain, 202, 409 Saturated sodium chloride, concentration, 199 Scatter errors, 35–36, 323, 325 Schistosoma haematobium, clinical features, 236 eggs, 238–239 geographical distribution, 236 laboratory diagnosis, 236–239 life cycle, 217 preservation of eggs, 183 prevention and control, 236 transmission, 236 urine filtration technique, 238–239 viable and non-viable eggs, 238–239 Schistosoma intercalatum, 216, 219 Schistosoma japonicum, clinical features, 217 eggs, 218, 248 geographical distribution, 216 laboratory diagnosis, 218 life cycle, 217 prevention and control, 217 transmission, 216, 217 Schistosoma malayensis, 216 Schistosoma mansoni, clinical features, 216–217 eggs, 218, 219, 248 geographical distribution, 216 laboratory diagnosis, 218 life cycle, 217 prevention and control, 217 rectal biopsy, 219 transmission, 216, 217 Schistosoma mattheei, 218, 219 Schistosoma mekongi, 216, 217, 219 Schistosomiasis, intestinal, 216–217, 221 urinary, 236 Schizogony (merogony), intestinal coccidia, 206 malaria parasites, 241 Schizonts, 250, 252, 253 Schlesinger test, 380 Schuffner’s dots, 250, 252, 253 Scolex, Taenia saginata, 230 Taenia solium, 230, 231 Sealed centrifuge buckets, 141 Segments of tapeworms, Dipylidium caninum, 234 gravid, 185 Taenia saginata, 229 Taenia solium, 230 Sensitivity of tests, 25 Sequencing of genomes, 187 Sequestration of malaria parasites, 241, 242 Sequestrene anticoagulant, see EDTA Sera, control, 328–329 Serological diagnosis, amoebiasis (liver abscess), 298–299 Chagas’ disease, 271 cysticercosis, 231 filariasis, 290 gambiense trypanosomiasis, 266 hydatid disease, 304 leishmaniasis, 277 malaria, 255–258 schistosomiasis, 221 toxoplasmosis, 301 trypanosomiasis (African), 266 Seronorm Bilirubin control serum, 350 Servicing of equipment, 101–103 Severe falciparum malaria, 242, 245 I NDEX SGOT, see Aspartate aminotransferase SGPT, see Alanine aminotransferase Sheath of microfilariae, 285, 286, 287, 288, 427 SI units, 37–40, 331–333, 422 Sickle cell heterozygotes (HbAS), 243 Siemen (S), 127, 131 Signs, safety, 58, 63, 75 Silica gel, 121 Silver nitrate, 85 Silver nitrate acidified reagent, 368, 398 Simulium flies, 291, 292 Skin, amastigotes in, 278–279 Dracunculus larvae in, 306 microfilariae in, 292–294 parasites in, 187 Skin snips for O volvulus, 293 Sleeping sickness, 259–266 Slide box, 170, 171 Slide draining rack, 168, 170 Slide mailer, 164, 166 Slide staining equipment, 167, 169 Slides, microscope, 72, 162 Slot creatinine method, 333–334 SM 2716 inverter, 104 Snail hosts, 216, 217, 221, 223, 225, 295, 296 Soapy fats, 392 Sodium acetate formalin (SAF), 183 Sodium azide, 85 Sodium chloride floatation technique, 199 Sodium chloride standards, 368 Sodium citrate anticoagulant, 288, 409 Sodium dichloroisocyanurate (NaDCC), 68, 69 Sodium dithionite, 85 Sodium dodecyl sulphate reagent, 334, 409 Sodium fluoride, 85 Sodium hydroxide, 45, 85 Sodium hydroxide reagents, 359, 409, 410 Sodium hypochlorite solutions, 68, 69, 85 Sodium nitrite, 85 Sodium nitrite reagent, 351, 410 Sodium nitroprusside, 85 Sodium, serum or plasma, analyte, 364 collection of blood, 319, 366 flame photometry, 365, 366 ISE analyzer, 366–367 451 low values (hyponatraemia), 367 measurement of, 365–367 quality control, 366, 367 raised values (hypernatraemia), 367 reference (normal) range, 367 stability, 319 water balance role, 364 Soil-transmitted helminths, 185 Solar power, 107–108 Solutions, accurate, 41 buffer, 46 diluting of, 43–44 molar (M), 40 mole per litre, 40, 42–43 normal (N), 43 percentage, 43 pH, 45–46 preparation, 41–43 Somogyi amylase units, 362 SOPs, 32–34, 101–102 South American trypanosomiasis, 266–271 Sowda, 292 Spatula, 171, 173 Specific gravity of urine, see Relative mass density Specific gravity strip test, 385 Specific ion electrode, see ISE analyzer Specificity of tests, 25, 26 Specimen containers, 164, 165 Specimens, abnormal appearances, 317 collection of, 6, 21, 33, 35, 166, 178–179, 317–323 containers for, 164, 165, 314–315 disposal of, 71–72 parasites found in, 187 patient considerations, 21 pipetting safely, 134–136 postal regulations, 66, 323 quality control, 33, 35, 178–179, 313–317 referral of, 6–7, 317–322 SOP, 33 stability, 315, 317–323 transporting of, 6–7, 65–66, 166, 175, 323 unsuitable, 35, 316 urgent, 24 Spectrophotometer, 153 Spectrum, visible, 153 Spencer Well’s forceps, 166, 167 Sphygmomanometer, 166, 167 Spillages, safe handling, 63, 68, 69, 79 Spirit burner, 170, 172 Spleen, enlarged, 243, 273 parasites in, 187, 274 Spleen aspirate, 187, 274, 276 Splenomegaly, 243, 273 Sporocysts, 21, 221, 225 Sporogony, intestinal coccidia, 206 malaria parasites, 241 Sporozoites, 241 Sputum, container, 165 examination for Paragonimus eggs, 296–297 parasites in, 187 Square root tables, 425–426 ST malaria, see Falciparum malaria Stable malaria, 240 Staff, laboratory, 5, 6, 10–11, 16–17, 430–435 Stage graticule, 125–126 Stain dispensers, 167, 168, 169 Staining equipment, 167, 168, 169 Staining rods, 167, 169 Stains, acridine orange, 125 Delafield’s haematoxylin, 288, 402 dispensing containers, 167, 168, 169 Dobell’s iodine, 180, 195, 402 eosin, 193, 201, 403 equipment for staining, 167, 168, 169 Field’s, 180–181, 208, 247, 403 Giemsa, 180, 248, 404 haematoxylin, 288, 402 ordering of, 47 preparation, 42 purchasing, 47 quality control, 180–181 Ziehl Neelsen, 206, 401, 406 Standard deviation (SD), 325, 326, 327 Standard operation procedures (SOPs), 32–34, 101–102, 313 Standard solutions (calibrating), 41 Standardization, equipment, 96–97 performance standards, 325–327 standard operating procedures (SOPs), 32–34, 101–102, 313 test reports, 24–34 Starch iodine amylase method, 362–363 Starch substrate, 362, 410 I NDEX 452 Stationery, 174–175 Steam sterilizer, 147 Steatorrhoea, 391 Sterasyl filter, 128 Stercobilinogen, 349 Sterilization, 66, 143–148 Sterilizing cycle (autoclave), 143 Still (water), 127 Stoll’s counting method, 199–200 Stool specimens, see Faeces Stop watch, 172, 173 Straight line calibration, see Linear calibration String capsule test, see Enterotest Strip tests, urine, 384–385 Strongyloides füelleborni, 215 Strongyloides stercoralis, 214–215 Strongyloidiasis, 214 Strout technique, 269–270 Stuart roller mixer, 158 Subperiodic microfilariae, 280, 284 Substrate, enzyme, 331 Sub-tertian malaria, see Plasmodium falciparum Succinate buffer, 410 Sucrose solution, 410 Sudan III fat stain, 391 Sugar, urine, see Urine, glucose Sulphanilic acid, 85 Sulphanilic acid reagent, 351, 352, 411 Sulphosalicylic acid reagent, 371, 411 Sulphosalicylic acid test, 371–372 Sulphuric acid, 44, 85 Supplies, laboratory, 16 Suramin, 261 Swabs, 72, 175 Swimmer’s itch, 216 Swinnex filter holder, 238, 288 Swollen Belly illness, 215 Symbols, hazard, 58, 63, 75 Syringe dispensing system, 137–138 Syringes, cleaning, 73 measuring, 135–136 purchasing, 166 safe use, 63 System of International Units, see SI units Tabanid flies, 281 Tachyzoites, 302 Taenia saginata, 227–229 Taenia saginata asiatica, 227 Taenia solium, 230–231 Taeniasis, 228, 230 Tally counter, 173 Tapeworms, classification, 184, 185 Diphyllobothrium latum, 231–232 Dipylidium caninum, 233–234 Echinococcus granulosus, 302–303 Echinococcus multilocularis, 305 eggs, 194, 428 Hymenolepis sp 232–233 Multiceps species, 304 Taenia saginata, 227–229 Taenia solium, 230–231 transmission, 190 Vampirolepis nana, 232–233 TDR Programme, 187, 419 Teaching methods, 432–434 Temperature, conversion from °C to °F, 40 S1 unit, 38, 40 thermometer, 173 Ternidens deminutus, 213 Tests, clinical chemistry, 310–311 costs, 22, 29–30 interpreting results, 24–28 kits, 16, 22, 30, 311–312 parasitological, 178 priority tests, 21, 22–23 reference ranges for, 27–28, 331–333 referral, 6–7 relevance, 20–23, 24 reliability of results, see Quality assurance reporting, 24, 34 request form, 23–24, 316 selection, 20–23, 178, 310 SI units, 331–333 standardization of methods, see SOPs standardization of reports, 24 strip tests, see Reagent strip tests urgent, 24 urine, 369–385 Thalassaemia genes and malaria, 243 Thermometer, 173 Thick blood films, 246, 247–250, 252–254, 262 Thin blood films, 247–248, 250–251 Threadworm, see Enterobius vermicularis Thrombocytopenia in leishmaniasis, 273, 275 Thymol, urine preservative, 316 Timers, 172, 173 TK container, 167, 169 Tolidine, 86 Toluene, 86 Toluidine, 86 Total bilirubin, 349, 351–352, 355 Total magnification, 109 Total protein, serum/plasma, 358 Total quality management (TQM), 14–37 Total solids meter, see Refractometer Tourniquet, 164, 166 Toxic chemicals, 75, 76–78, 86 Toxoplasma encephalitis, 301 Toxoplasma gondii, 300–302 Toxoplasmosis, 300–301 TQM, see Total quality management Training, 10–11, 428–433 Training curriculum, 430–435 Training laboratory staff, 10–11, 430–435 Transmission of parasites, 186, 188–191 Transporting specimens, 6–7, 65–66, 166, 175, 317–323 Trematodes, see Flukes Triatomine bugs, 267, 268 Trichinella nativa, 304 Trichinella nelsoni, 304 Trichinella spiralis, 304–305 Trichinellosis, 304 Trichloroacetic acid, 86 Trichloroacetic acid c.s.f protein test, 386–388 Trichloroacetic acid reagent, 386, 390, 411 Trichomonas hominis, see Pentatrichomonas hominis Trichomonas vaginalis, 188 Trichostrongylus species, 213 Trichuriasis, 210–211 Trichuris trichiura, 210–211 Trinocular head, 111 Trip balance, 133 Triple centrifugation technique, 264 Tripod, 170, 172 Tropical pulmonary eosinophilia, 282 Trypan blue preparation, 239 Trypanosoma brucei complex, 259 Trypanosoma b gambiense, clinical features, 260 concentration of, 263–264 early infection, 260 geographical distribution, 259 immunity, 260 in blood, 262–264 in cerebrospinal fluid, 265–266 I NDEX in chancre fluid, 264 in lymph, 264–265 laboratory diagnosis, 261–266 late infection, 260 life cycle, 259–260 morphology, 263 prevention and control, 261 screening donor blood, 261–262 serological (CATT), 266 transmission, 259–260 vectors, 259 Trypanosoma b rhodesiense, clinical features, 260 concentration of, 263–264 early disease, 260 geographical distribution, 259 immunity, 260 in blood, 262–264 in cerebrospinal fluid, 265–266 in chancre fluid, 264 in lymph, 264–265 laboratory diagnosis, 261–266 late stage infection, 260 life cycle, 259–260 morphology, 263 prevention and control, 261 serological test, 266 transmission, 259–260 vectors, 259 zoonosis, 259 Trypanosoma cruzi, acute disease, 268, 269 chronic disease, 268, 270–271 clinical features, 268 complex, 266–267 concentration, 269–270 culture, 270 differentiation from T rangeli, 270 epimastigotes, 267, 270 geographical distribution, 267 HIV association, 268 immunity, 268 laboratory diagnosis, 269–271 life cycle, 267–268 morphology, 270 prevention and control, 268 screening donor blood, 271 serological diagnosis, 271 transmission, 267–268 vectors, 267 xenodiagnosis, 270 Trypanosoma rangeli, 270 Trypanosomiasis, African, 259–266 South American, 266–271 Trypanosomiasis meningoencephalitis, 260, 388 453 Tsetse flies, 259, 261 TST control strips, 147–148 Tube racks, 168, 169 Tubelength of microscope, 109 Tubes, cleaning, 73 ordering/purchasing, 169 Tubular reabsorption, 369 Tubular secretion, 369 Tubules, kidney, 369 Type diabetes, 341 Type diabetes, 341 Ulcer material culture, 279 Ulcer smear for amastigotes, 279 Unconjugated (indirect) bilirubin, 349, 354 Uninterruptible power supply (UPS), 103 Universal bottle, 169 Unstable malaria, 240 Uraemia, 337 Urea, 337 Urea acid reagent, 338, 411 Urea colour reagent, 338 Urea, serum measurement, calibration, 337–338 kits, 337 low values, 340 method, 338–340 raised values, 340 reagents required, 338 reference (normal) range, 340 specimen, 321, 338 stability, 331 standards, 337–338 Urgent specimens, 24 Urinary chloride, 368–369 Urinary schistosomiasis, see Schistosoma haematobium Urine, acetone in, 375 appearance, 370 Bence Jones protein in, 372 bilirubin in, 355, 376–377 blackwater fever, 242, 370 blood in, 372, 379–380 chloride in, 368–369 chyle in, 282, 289 collection of, 315, 321–322 composition, 370 container, 164, 165 disposal, 71 filtration for schistosome eggs, 238–239 galactose in, 374 glucose in, 372–375 haemoglobin in, 379–380 ketones in, 375–376 leukocyte esterase in, 380–381 microfilariae in, 289–290 nitrite in, 380, 381 parasites in, 187, 289 pH of, 370 porphobilinogen in, 378 preservatives, 316 production of, 369 protein in, 371–372 relative mass density (sp g.) of, 370, 381–383 schistosome eggs in, 236–238 specific gravity, 370, 381–383 stability, 316, 321–322 strip tests, 384, 385 urobilinogen in, 355, 377–379 volume, 369–370 Urine strip tests, 384, 385 Urinometer, 381–382 Uristix, 371, 385 Urobilin, 377 Urobilinogon, 349, 355, 377–379 Useful magnification, 109 User Service Manual, 96, 101 Vaginal discharge, 187 Valence, 40, 423 Value of tests, 20–23 Vampirolepis nana, 232–233 Variable costs, 29 Variant surface glycoproteins (VSG’s), 260 Vectors, blackflies, 291, 292 mosquitoes, 240, 244, 280, 281, 282 sandflies, 272, 274 tabanid flies, 281 triatomine bugs, 267, 268 tsetse flies, 259, 261 Venepuncture technique, 314 Venous blood filtration technique, 288–289 Verbal communication, 47–48 Viability of schistosome eggs, 238–239 Viral hepatitis, 349, 354, 355 Virkon, 69, 72, 73 Visceral leishmaniasis, 271, 273, 274–278 Visible light spectrum, 152 Vivax malaria, see Plasmodium vivax Viviparous worms, 185, 281 Volac pipettors, 135 Voltage, 38, 103, 104, 108 Voltage, instability, 103–104 Voltage protection devices, 103–104 Voltage stabilizer, 103 I NDEX 454 Volume measurements, 38–39, 41 Volumetric preparation of a solution, 41 Vortex mixer, 63, 159 Wash bottles, 168, 169 Water, chemically pure, 126, 127 deionization, 129–131 distillation, 127–128 filtration, 128–129, 131 purification, 126–131 supply to laboratory, 54, 126, 127 Water bath, 150–151 Water conductivity meter, 130–131 Water container, 162, 164 Water deionizers, 129–131 Water depletion in body, 368 Water emergence technique for Strongyloides, 214–215 Water filter, 128–129, 131 Water purification, 126–131 Water-soluble (unconjugated) bilirubin, 349, 354 Water stills, 127–128 Water storage container, 162, 164 Watt (W), 38, 105, 108 Wavelength, 153, 154, 156 Weighing, 39, 131–133 Weighing equipment, 131–133 Whipworm, see Trichuris trichiura White cell (WBC) counting equipment, 170, 171 Winterbottom’s sign, 260 Wire loops, 62, 74, 172, 173 Wolbachia bacteria, 292 Work policies, 32 Workload of laboratory, 36, 54 Workload units, 30 Worms, see Helminths Worms, preservation of, 183 Written communication, 47 Wuchereria bancrofti, chyluria, 282, 289–290 clinical features, 280 geographical distribution, 280 laboratory diagnosis, 283–291 life cycle, 280, 281 microfilariae, 286–287, 427 NOW ICT filariasis test, 290–291 prevention and control, 282–283 serological diagnosis, 290–291 transmission, 280, 281 vectors, 280–281 Xenodiagnosis, 270 Xylene, 86 Yeast cells, 195 Ziehl-Neelsen modified technique, 206–207 Zinc sulphate concentration method, 199 Zinc sulphate solution, 199, 412 Zoonosis, 183, 259 ... Chapter Clinical chemistry tests 6 .1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6 .10 6 .11 6 .12 6 .13 Clinical chemistry in district laboratories 310 – 313 Quality... learning and assessment Students and tutors need to be assured of progress during training Becoming aware of learning problems or teaching inadequacies at the end of training is too late 1. 3 Training... procedures Continuing education and updating of district laboratory staff is best provided on-site by the district laboratory coordinator during regular visits (see subunit 2 .1) On-going training in the