人體腸道寄生蟲圖譜 by taiwancdc taiwan

人體腸道寄生蟲圖譜

審閱:李淑英主任攝影主編:許世芬版面設計:林子琦

衛生福利部疾病管制署編印

目錄一、 Helminths ................................................................................................. 1 二、 Intestinal Protozoa .................................................................. 21 三、阿米巴感染症及阿米巴原蟲 .............................................. 56 四、腸道原蟲之形態學及檢驗法 .............................................. 58 五、致病性阿米巴症之鑑別檢驗 .............................................. 76 六、目鏡測微尺校正及顯微測量法........................................ 78 七、 MIF 固定、染色及濃縮法 ...................................................... 83 八、 MIF 染色形態學 ................................................................................ 87 九、 PVA 固定法.............................................................................................. 97 十、 Trichrome Stain 染色步驟 ................................................ 98 十一、 Trichrome Stain 形態學介紹.............................. 101 十二、阿米巴性痢疾相關事項................................................ 108

ႋᙝռ! (Hookworm egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉

Thin, smooth colorless shell

Eggs are colorless, ovoid, thin-shelled, and measure 55-75μm x 36-40μm. The ends are broadly rounded. The embryo is usually in an unembryonated, early clearvage state when passed, with a notable clear space between the embryo and shell. Four cell stage of embryonic cleavage

ܿБЛጕᙝռ! (Trichostrongylus orientalis egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Eggs of Trichostrongylus spp. are thin-shelled, colorless and measure 75-95 μm in length by 40-50 μm in width. Eggs taper at one end and the inner membrane may be wrinkled. Eggs of Trichostrongylus spp. are similar to hookworm eggs, but the eggs of the latter smaller at 60-75 μm long by 35-40 μm wide and have a shorter length : width ratio. Eggs are shed in feces.

Thin shell, elongated, tapered at the end

ᚎᙝռ! (Trichuris trichiura egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Eggs are yellow-brown, ovoid to “barrelshaped”, have a smooth thick shell, and measure 49-65μm x 20-23μm.

Hyaline plug at each pole

They have characteristic mucoid bipolar plugs. Like all roundworm eggs besides pinworm, eggs are unembryonated when shed.

Smooth shell surface Undeveloped unicellular embryo

ᙛᙝռ! (Enterobius vermicularis egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Eggs are colorless, moderately thick shelled, ovoid with a flattened side (so that they resemble the letter “D”), and measure 50-60μm x 20-30μm. Unlike other intestinal nematodes, pinworm eggs are shed partially embryonated, and not infrequently, an infectious larva is visible within.

Flattened on one side

Thick-walled colorless shell

ᕨλఎጕᙝ.ఎ‫ރ‬Ѵᙝ! (Strongyloides stercoralis) -Rhabditifrom larva

Note : All measuring bars = 20μm

Microscopic Morphology烉 Rhabditiform larva has an average size of 220 by 15μm. The larva is equipped with a short buccal cavity and a prominent genital primordium. Prominent genital primordium Short buccal cavity

ຄᙝ‫ڙ‬ᆒռ! (Ascaris lumbricoides egg) (fertile)

(Decorticated egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Eggs are clear to yellow-brown and may be fertilized or unfertilized.

Coarse mammillated albuminous material

Fertilized eggs are round to oval, thick-shelled, measure 55-75μm x 35-50μm, and contain a distinct unembryonated cell mass.

Undeveloped unicellular embryo

ຄᙝ҂‫ڙ‬ᆒռ! (Ascaris lumbricoides egg) (infertile)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Eggs are clear to yellow-brown and may be fertilized or unfertilized.

Amorphous mass of protoplasm

Infertile eggs are elongated and thin-shelled, measure 85-95μm x 43-47μm. Infertile forms have a mammillated surface. when this is lost, the eggs are said to be decorticated. Heavy albuminous coating

඿α֎ᙝռ! (Echinostoma spp. egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 The eggs of Echinostoma are operculate and vary in size, but are typically in the range of 80-135μm × 55-80μm.

Inconspicuous operculum

The eggs have an inconspicuous operculum and the abopercular end is often thickened.

Abopercular end

ᖖТᙝռ! (Fasciolopsis buski egg)

Note : All measuring bars = 20μm

Operculum

Microscopic Morphology烉 Eggs of Fasciolopsis buski are broadly ellipsoidal, operculated and measure 130-150 μm long by 60-90 μm wide. The eggs are unembryonated when passed in feces. The eggs of F. buski can be difficult to distinguish from Fasciola hepatica, although the abopercular end of the latter often has a roughened or irregular area.

Undeveloped miracidium

ФԲ‫֎ط‬ᙝռ! (Fasciola hepatica egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Eggs are among the largest seen in humans, measuring 120-159μm x 80-85μm. Operculum

They are yellow-brown, ovoid, thin-shelled, and have a small indistinct operculum. A roughened area at the opposite end is sometimes seen.

ύ๮‫֎ط‬ᙝռ! (Clonorchis sinensis egg)

Note : All measuring bars = 20μm Thickened rim around operculum

Microscopic Morphology烉 Eggs are among the smallest seen in humans; Clonorchis eggs measure 27-35μm x 12-19μm, while Opisthorchis eggs are slightly smaller, measuring 19-29μm x 12-17μm.

They are yellow-brown with a characteristic “urn” shape, moderately thick shell, operculum with “shoulders” on either side, and small knob at the opposite end.

Operculum Small knob

ી᠌֎ᙝռ! (Eurytrema pancreaticum egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Detailed morphology of the brownish eggs, measuring 38 - 51 μm in length and 25 - 34 μm in width.

Operculum

The egg have an oval shape and are quite small and operculated.

Ovsl shape

ፁМ‫֎ޤ‬ᙝռ! (Paragonimus westermani egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Operculum

Eggs are yellow-brown, ovoid, moderately thick-shelled, measure 80-120μm x 45-70μm.

Terminal shell thickening

They have a shouldered operculum, and the opposite side is thickened.

Smooth, thin shell

ষϷՈ֎ᙝռ! (Schistosoma haematobium egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Schistosoma hematobium eggs measure 112-170μm x 40-70μm and have a prominent narrow terminal spine.

Terminal spine

The egg contains a ciliated miracidium that may exhibit internal motility when alive in fresh specimens. Hatched miracidia may also be seen in urine sediments.

Developed miracidium

ୗМՈ֎ᙝռ! (Schistosoma mansoni egg)

Note : All measuring bars = 20μm Large lateral spine

Microscopic Morphology烉 The eggs of S. mansoni are clear, ovoid, moderately thick-shelled, and measure 114-180μm x 45-70μm. They have a large characteristic lateral spine.

Developed miracidium

ВҁՈ֎ᙝռ! (Schistosoma japonicum egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Developed miracidium

Eggs of S. japonicum are yellowbrown, ovoid, relatively thickshelled, and measure 70-100μm x55-65μm. A small, rudimentary spine may be seen.

Small lateral spine

፜)Ф*Ժ࿻ᙝռ! (Taenia spp. egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Eggs are yellow-brown, round to oval, and have a thick shell with prominent radial striations.

Hexacanth embryo

They measure 31-43μm in diameter and contain a six-hooked embryo. It is not possible to differentiate the eggs of Taenia saginata and T. solium by microscopy alone. Radial striations on yellowbrown embryophore

ᕭλхጢ࿻ᙝռ! (Hymenolepis diminuta egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Eggs are yellow-brown, round to oval, moderately thick-shelled, measure 70-85μm x 60-80μm and contain a six-hooked embryo. The oncosphere is surrounded by a membrane that is separated from the external shell by a large emptyappearing space.

Capsule Polar thickening

Hexacanth embryo

อλхጢ࿻ᙝռ! (Hymenolepis nana egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉

Filament emerge from Eggs are colorless, round to oval, polar thickenings thin-shelled, measure 30-47μm in diameter, and contain a six-hooked embryo. The oncosphere is surrounded by a membrane with two polar thickenings from which four to eight filaments arise and extend into the space between the oncosphere membrane and the external shell.

Hexacanth embryo

ቶ࿯຋ᓐ࿻ᙝռ! (Diphyllobothrium latum egg)

Note : All measuring bars = 20μm

Microscopic Morphology烉 Eggs are ovoid, moderately thickshelled, colorless, measure 58-75μm x 40-50μm, and have an operculum without shoulders.

Operculum

A small knob at the opposite end is often visible. Coracidium Terminal knob

ฟ੯ߓԯЃ0्ථ‫ߓۦ‬ԯЃ.෷Ꭶᡏ! (Entamoeba histolytica/E. dispar) - Trophozoite

Note : All measuring bars = 10μm

Microscopic Morphology烉 Trophozoites measure 10-60μm (usual range 15-20μm ; invasive E. histolytica trophozoites are typically >20μm) and have a single nucleus. The nucleus has a small, usually central karyosome with fine, evenly distributed peripheral chromatin.

Central karyosome Cytoplasm

Even peripheral chromatin

ฟ੯ߓԯЃ0्ථ‫ߓۦ‬ԯЃ.߻៶ᡏ! (Entamoeba histolytica/E. dispar) - Precyst

Note : All measuring bars = 10μm

Microscopic Morphology烉 Precyst is a rounded-up trophozoite in PVA-preserved feces.

Single nucleus

This organism is beginning the encystation process; nuclear division has yet to occur, but a glycogen mass is present in the cytoplasm. Glycogen vacuoles

ฟ੯ߓԯЃ0्ථ‫ߓۦ‬ԯЃ.៶ᡏ! (Entamoeba histolytica/E. dispar) - Cyst

Note : All measuring bars = 10μm

Microscopic Morphology烉 Cysts measure 10-20μm in diameter (usual range 10-15μm) and have one to four nuclei. The nucleus has a small, usually central karyosome with fine, evenly distributed peripheral chromatin. Chromatoid bodies with rounded ends may be present in the cytoplasm.

Even peripheral chromatin

Chromatoid bar Central karyosome

εဉߓԯЃ.෷Ꭶᡏ! (Entamoeba coli) - Trophozoite

Note : All measuring bars = 10μm

Microscopic Morphology烉 Trophozoites measure 15-50μm in greatest dimension (usual range 20-25μm) and have a single nucleus.

Eccentric karyosome

The nucleus has a large, usually eccentric karyosome that may be darkly staining and diffuse. Peripheral chromatin is coarsely clumped Uneven peripheral or ring-like. The cytoplasm is vacuolated, chromatin coarsely granular and often contains Pseudopod engulfed bacteria, yeasts, and debris.

εဉߓԯЃ.៶ᡏ! (Entamoeba coli) - Cyst

Note : All measuring bars = 10μm

Microscopic Morphology烉 Cysts measure 10-35μm in diameter (usual range 15-25μm) and have one to eight nuclei.

Eccentric karyosome

The nucleus has a large, central or eccentric karyosome with irregular, coarsely clumped peripheral chromatin. Cytoplasm

Uneven peripheral chromatin

ࠖМߓԯЃ.෷Ꭶᡏ! (Entamoeba hartmanni) - Trophozoite

Note : All measuring bars = 10μm

Microscopic Morphology烉 Trophozoites measure 5-12μm in greatest dimension (usual range 8-10μm) and have a single nucleus. The nucleus has a small, often eccentric karyosome with fine, evenly distributed peripheral chromatin.

Centric karyosome

Even peripheral chromatin Cytoplasm

ᚈਡߓԯЃ.෷Ꭶᡏ! (Dientamoeba fragilis) - Trophozoite

Note : All measuring bars = 10μm

Microscopic Morphology烉 Trophozoites measure 5-15μm in greatest dimension (usual range 9-12μm) and have 1-2 nuclei. The nucleus has 4-8 granular dots rather than a single discrete karyosome, appearing fragmented. Peripheral chromatin is absent.

Nuclei

༾λߓԯЃ.෷Ꭶᡏ! (Entamoeba nana) - Trophozoite

Note : All measuring bars = 10μm

Microscopic Morphology烉 Trophozoites measure 6-12μm in greatest dimension (usual range 8-10μm) and have a single nucleus. The nucleus has a large, blot-like karyosome that is often red on trichrome stain.

‘’Blotlike’’ karyosome

Pseudopod Cytoplasm

Peripheral chromatin is absent.

微小阿米巴-囊體 (Entamoeba nana) - Cyst

Note : All measuring bars = 10µm

Microscopic Morphology： Cysts measure 5-10µm in diameter (usual range 6-8µm) and usually have four nuclei.

‘’Blotlike’’ karyosome No peripheral chromatin

Peripheral chromatin is absent (as evidenced by clear nuclear halos). The cytoplasm does not contain chromatoid bodies. Cytoplasm

Cyst wall

༐࿚ߓԯЃ.෷Ꭶᡏ! (Iodamoeba butschlii) - Trophozoite

Note : All measuring bars = 10μm

Microscopic Morphology烉 Trophozoites measure 8-20μm in greatest dimension (usual range 12-15μm) and have a single nucleus. Vacuole

Cytoplasm

The nucleus has a large, central or eccentric, blot-like karyosome that often has poorly stained granules around the karyosome or at one aspect. Large karyosome The karyosome often stains red on trichrome stain. Peripheral chromatin is absent.

༐࿚ߓԯЃ.៶ᡏ! (Iodamoeba butschlii) - Cyst

Note : All measuring bars = 10μm

Microscopic Morphology烉 Cysts measure 5-20μm in diameter (usual range 10-12μm) and have one nucleus. The nucleus has a large, central, or eccentric, blot-like karyosome that often has poorly stained geanules around the karyosome or at one aspect. The karyosome may stain red on trichrome stain. Peripheral chromatin is absent.

Large glycogen vacuole Cytoplasm

Large karyosome

ఛ‫׎‬ᚎЛᙝ.෷Ꭶᡏ! (Giardia lamblia) - Trophozoite

Note : All measuring bars = 10μm

Microscopic Morphology烉 Trophozoites are teardrop shaped, measure 10-20μm in greatest dimension (usual range 12-15μm) and have two nuclei. Axonemes and curved median median bodies are defining features. Flagellae are not easily appreciated on permanently stained preparations.

Flagella

Nuclei

Median bodies Axostyle

ఛ‫׎‬ᚎЛᙝ.៶ᡏ! (Giardia lamblia) - Cyst

Note : All measuring bars = 10μm

Microscopic Morphology烉 Cysts are oval, measure 8-19μm in diameter (usual range 11-12μm) and have four nuclei.

Nuclei

Prominent longitudinal fibers (axonemes) and curved median bodies are defining features. Retracted cytoplasm is commonly seen on permanent smears, producing a ‘’halo” effect.

Cyst wall Median bodies

য‫׎‬ᚎЛᙝ.෷Ꭶᡏ! (Chilomastix mesnili) - Trophozoite

Note : All measuring bars = 10μm

Microscopic Morphology烉 Trophozoites are teardrop shaped with a narrowed posterior end and measure 6-24μm in greatest dimension (usual range 10-15μm).

Flagella Cytostome with fibrils

They have a single nucleus. A cytostome is present along 1/3 to 1/2 of its body. Nucleus Flagellae are not easily appreciated on permanently stained preparations.

Curved posture

য‫׎‬ᚎЛᙝ.៶ᡏ! (Chilomastix mesnili) - Cyst

Note : All measuring bars = 10μm Clear hyaline knob

Microscopic Morphology烉 Cysts are oval with a hyaline knob at the anterior end and measure 6-10μm in diameter (usual range 8-9μm).

Cytostome

They have a single nucleus. A distinct cytostome near the nucleus is characteristic. Nucleus

Γ޵៶চᙝ! (Blastocystis hominis)

Note : All measuring bars = 10μm

Microscopic Morphology烉 Blastocystis hominis (vacuolated forms), also referred to as central-body forms, are round to oval and measure 5-30μm in diameter (usual range 8-10μm) with two to four nuclei at the periphery. A large body, similar to a vacuole, is present centrally.

Nuclei

ᗦझηᙝ.ռ៶! (Crypotosporidium parum) - Oocyst

Note : All measuring bars = 10μm

Microscopic Morphology烉 Oocysts are round to oval and measure 3-6μm in diameter (usual range 4-5μm) and are clear to pink or dark pink/red on modified acid-fast stain. Oocysts contain four sporozoites that may occasionally be seen inside the oocyst.

Sporozoites

εဉᠼЛᙝ.෷Ꭶᡏ! (Balantidium coli) - Trophozoite

Note : All measuring bars = 20μm

Microscopic Morphology烉

Cilia

Trophozoites are ovoid, often tapered at one end, and measure 40-100μm in greatest dimension (usual range 40-50μm).

Macronucleus

They have one kidney bean-shaped macronucleus and one micronucleus, and possess circumferential cilia. Vacuole

Micronucleus

εဉᠼЛᙝ.៶ᡏ! (Balantidium coli) - Cyst

Note : All measuring bars = 20μm

Microscopic Morphology烉 Balantidium coli is the largest protozoan and only ciliated parasite known to infect humans.

Macronucleus

Cysts are round to oval and measure 45-65μm in diameter (usual range 50-55μm). They have a single kidney beanshaped nucleus.

Cyst wall

‫ن‬М฻झηᙝ.ռ៶! (Isospora belli) - Oocyst

Note : All measuring bars = 10μm

Microscopic Morphology烉 The oval transparent oocyst of Isospora belli ranges in size from 25 to 35μm long by 10 to 15μm wide, with an average of 30 by 12μm.

Cyst wall

Throughout its development, the sporoblast and sporocysts are surrounded by a smooth, colorless, two – layered cell wall. Sporocyst

ฟ੯ߓԯЃ0्ථ‫ߓۦ‬ԯЃ.෷Ꭶᡏ! (Entamoeba histolytica/E. dispar)- Trophozoite MIF stained

Note : All measuring bars = 10μm

Microscopic Morphology烉 Trophozoites measure 10-60μm (usual range 15-20μm ; invasive E. histolytica trophozoites are typically >20μm) and have a single nucleus.

Even peripheral chromatin Pseudopod

The nucleus has a small, usually central karyosome with fine, evenly distributed peripheral chromatin.

Central karyosome Cytoplasm

ฟ੯ߓԯЃ0्ථ‫ߓۦ‬ԯЃ.߻៶ᡏ! (Entamoeba histolytica/E. dispar) - Precyst MIF stained

Note : All measuring bars = 10μm

Microscopic Morphology烉 Precyst is a rounded-up trophozoite In MIF-preserved feces.

Single nucleus

This organism is beginning the encystation process; nuclear division has yet to occur, but a glycogen mass is present in the cytoplasm. Glycogen vacuoles

ฟ੯ߓԯЃ0्ථ‫ߓۦ‬ԯЃ.៶ᡏ! (Entamoeba histolytica/E. dispar) - Cyst MIF stained

Note : All measuring bars = 10μm

Microscopic Morphology烉 Cysts measure 10-20μm in diameter (usual range 10-15μm) and have Central karyosome one to four nuclei. Chromatoid bar The nucleus has a small, usually central karyosome with fine, evenly distributed peripheral chromatin. Chromatoid bodies with rounded ends may be present in the cytoplasm. Cyst wall

Cytoplasm

Even peripheral chromatin

εဉߓԯЃ.෷Ꭶᡏ! (Entamoeba coli) - Trophozoite MIF stained

Note : All measuring bars = 10μm

Microscopic Morphology烉

Vacuole containing bacteria

Trophozoites measure 15-50μm In greatest dimension (usual range 20-25μm) and have a single nucleus.

Uneven peripheral chromatin

The nucleus has a large, usually eccentric karyosome that may be darkly staining and diffuse. Pseudopod Peripheral chromatin is coarsely clumped or ring-like. The cytoplasm is vacuolated, coarsely granular and often contains engulfed bacteria, yeasts, and debris.

Eccentric karyosome

εဉߓԯЃ.៶ᡏ! (Entamoeba coli) - Cyst MIF stained

Note : All measuring bars = 10μm Eccentric karyosome

Microscopic Morphology烉 Cysts measure 10-35μm in diameter (usual range 15-25μm) and have one to eight nuclei. The nucleus has a large, central or eccentric karyosome with irregular, coarsely clumped peripheral chromatin.

Cyst wall Uneven peripheral chromatin

ࠖМߓԯЃ.෷Ꭶᡏ! (Entamoeba hartmanni) - Trophozoite MIF stained

Note : All measuring bars = 10μm

Microscopic Morphology烉 Trophozoites measure 5-12μm in greatest dimension (usual range 8-10μm) and have a single nucleus.

Even peripheral chromatin

The nucleus has a small, often eccentric karyosome with fine, evenly distributed peripheral chromatin. Central karyosome Pseudopod

ࠖМߓԯЃ.៶ᡏ! (Entamoeba hartmanni) - Cyst MIF stained

Note : All measuring bars = 10μm

Microscopic Morphology烉 Cysts measure 5-10μm in diameter (usual range 6-8μm) and have one to four nuclei. The nucleus has a small, generally round and often eccentric karyosome with fine, evenly distributed peripheral chromatin.

Cyst wall Chromatoid bar

Central karyosome Even peripheral chromatin

༐࿚ߓԯЃ.៶ᡏ! (Iodamoeba butschlii) - Cyst MIF stained

Note : All measuring bars = 10μm Large karyosome

Cyst wall Large glycogen vacuole

༾λߓԯЃ.៶ᡏ! (Endolimax nana) - Cyst MIF stained

Note : All measuring bars = 10μm

Microscopic Morphology烉 Cysts measure 5-10μm in diameter (usual range 6-8μm) and usually have four nuclei.

‘’Blotlike’’ karyosome No peripheral chromatin

Peripheral chromatin is absent (as evidenced by clear nuclear halos). The cytoplasm does not contain chromatoid bodies. Cytoplasm

Cyst wall

য‫׎‬ᚎЛᙝ.෷Ꭶᡏ! (Chilomastix mesnili) - Trophozoite MIF stained

Note : All measuring bars = 10μm

Microscopic Morphology烉 Trophozoites are teardrop shaped with a narrowed posterior end and measure 6-24μm in greatest dimension (usual range 10-15μm). They have a single nucleus. A cytostome is present along 1/3 to 1/2 of its body. Flagellae are not easily appreciated on permanently stained preparations.

Cytostome with fibrils Flagella

Nucleus

Curved posture

য‫׎‬ᚎЛᙝ.៶ᡏ! (Chilomastix mesnili) - Cyst MIF stained

Note : All measuring bars = 10μm

Microscopic Morphology烉 Cysts are oval with a hyaline knob at the anterior end and measure 6-10μm in diameter (usual range 8-9μm).

Clear hyaline knob

They have a single nucleus. A distinct cytostome near the nucleus is characteristic. Nucleus Cytostome

ఛ‫׎‬ᚎЛᙝ.෷Ꭶᡏ! (Giardia lamblia) - Trophozoite MIF stained

Note : All measuring bars = 10μm Nuclei

Microscopic Morphology烉

Median bodies

Trophozoites are teardrop shaped, measure 10-20μm in greatest dimension (usual range 12-15μm) and have two nuclei. Axonemes and curved median median bodies are defining features. Flagellae are not easily appreciated on permanently stained preparations.

Axostyle Flagella Axonemes

ఛ‫׎‬ᚎЛᡏ.៶ᡏ! (Giardia lamblia) - Cyst MIF stained

Note : All measuring bars = 10μm

Microscopic Morphology烉 Cysts are oval, measure 8-19μm in diameter (usual range 11-12μm) and have four nuclei.

Nuclei

Median bodies

Prominent longitudinal fibers (axonemes) and curved median bodies are defining features. Retracted cytoplasm is commonly seen on permanent smears, producing a ‘’halo” effect.

Cyst wall

Cytoplasm beginning to retract from cyst wall

人芽囊原蟲 (Blastocystis hominis) MIF stained

Note : All measuring bars = 10µm

Microscopic Morphology： Blastocystis hominis (vacuolated forms), also referred to as central-body forms, are round to oval and measure 5-30µm in diameter (usual range 8-10µm) with two to four nuclei at the periphery. A large body, similar to a vacuole, is present centrally.

Vacuole

Nuclei

қՈౚ):%&*! MIF stained

Note : All measuring bars = 10μm

Microscopic Morphology烉 While white blood cells in stool usually consist of segmented cells (neutrophils and eosinophils) that measure 10-15μm in diameter and have a multilobed nucleus.

Cell membrane

Nucleus

-2-

-3-

-4-

-5-

-6-

-7-

-8-

-9-

-10-

-11-

-12-

-13-

-14-

-15-

-16-

-17-

-18-

-19-

-20-

-21-

-22-

-23-

-24-

-25-

-26-

-27-

MIF 固定、染色及濃縮法 Merthiolate-iodine-formaldehyde concentration method

MIF 目的：供檢查感染腸道寄生蟲患者糞便中蠕蟲蟲卵及原蟲(滋養體及囊體)之固定和染色與鑑定之用 MIF 原理：利用 Merthiolate 可阻斷細胞之代謝作用及原蟲細胞核有嗜碘性之特性而 5%Formalin 可固定細胞並利用 Eosin-Y 的紅色去襯托細胞背景 MIF 配製： MIF 染色液配方為 MF 儲存液：魯氏碘液＝15：1 之比例 (MIF 配製後勿置放超過 24 小時，碘液會揮發而效果遞減)

操作步驟： 1. 1g 糞便 (約拇指頭大小，解出不超過 1hr )放入呈有 10cc MIF 溶液之集卵瓶，利用採便棒充分攪拌均勻後放置室溫 2 小時以上固定&染色，overnight 呈色更好。

2. ৾௞໳Յ֨ηǴ໣ռ౟࿼‫ܭ‬ӾۭᚆЈᆅ΢٠ᘈઇᖓጢǴа໣ռ౟ ‫ޑ‬ᘠᆛၸᘠϐǴஒᘠనၸᘠԿӾۭᚆЈᆅϣǴᔈၲ 7~8mlǴ҂ၲ ਔӆံуΕ MIF solution Կ 7-8 ml ջёǶ

3. уΌለΌ✊(Ethyl Acetate) 0.5~1 mlǴҔᇂηᇂՐᆅαǴ΢ΠமΚ ᎜ᕏԿϿ 30 ࣾ(‫ ܈‬15 ԛԿ 30 ԛ)Ƕ

4. ᚆЈ 2000 rpmǴ2 ϩដǴஒ΢మనҧకǴ੮؇෦ऊ 0.5~1 mlǴӆа ා޸෇ᔔ࡬ᆅᏛ‫ڬ‬ൎǴаխ΢ቫనӣࢬǶ 5.

6. а֎ᆅ֎‫ڗ‬؈෦‫᜔ނ‬ᔠϐ

၂ᏊࠔᆅǺ 1. ‫ֿڗ‬؈෦ᆅ(ςዴ‫ޕ‬ϣ֖ WBC ‫ ܈‬Epithelial cell)ऊ 0.6ml ؈෦྽ࠔᆅᔠᡏǶ 2. ஒ MIF 6ml уΕ 0.6ml ֿ؈෦ಒझϣ(10:1)ࢉՅ 3 ϩដǶ 3. ᡉ༾᜔᜔ᔠǴऩಒझࢉԋણआՅջࣁࢉనࠔᆅ೯ၸǶ

-32-

Entamoeba histolytica/E. dispar cyst z 10~20 Pm(த‫ ـ‬12~15 Pm) z Ѧ‫׎‬և༝ౚ‫ރ‬Ƕ z 1~4 ঁਡǴ҂ԋዕ៶ᡏ 1~2 ঁਡǴ όத‫ـ‬Ƕ z PC ᗭಈಒጏǴ೯தελ΋ठЪ ϩѲ֡ϬǶ z ਡϘ(KC)λǴஏჴ‫܈‬ϩණ‫ޑ‬Ǵ z ೯தۚύǴଽԶୃЈǶ z ᜪࢉՅᡏևߏ෇‫׎‬Ǵᜐጔ༝໌Ƕ z ᗐচ༧೯தևණթ‫ރ‬Ǵԃᇸ៶ᡏև༧‫ރ‬Ƕ

10μm

10μm 10μm

Entamoeba histolytica/E. dispar trophozoite z 10~60 Pm(த‫ ـ‬15~20 Pm) z ൂਡ z ਡ‫ࢉڬ‬Յ፦(PC)ᗭಈಒጏǴ ೯தελ΋ठЪϩѲ֡ϬǶ z ਡϘ(KC)λǴஏჴ‫܈‬ϩණ‫ޑ‬Ǵ ೯தۚύǴଽԶୃЈǶ z झ፦Ѧᢀևಒጏᗭಈ‫ރ‬Ǵ ϣ֖ಒ๵‫ ܈‬RBCǶ

z HematophagousǺE. histolytica ੝Ԗ

10μm

10μm 10μm

Entamoeba hartmanni cyst z 5~10 Pm(த‫ ـ‬6~8 Pm) z Ѧ‫׎‬և༝ౚ‫ރ‬ z 1~4 ঁਡǴ҂ԋዕ៶ᡏ 1~2 ঁਡǴ Ψத‫ـ‬Ƕ z PC ᗭಈಒጏǴ೯தελ΋ठЪϩѲ֡ϬǶ z ਡϘ(KC)λǴஏჴ‫܈‬ϩණ‫ޑ‬Ǵ ೯தۚύǴଽԶୃЈǶ z ᜪࢉՅᡏևߏ෇‫׎‬Ǵᜐጔ༝໌Ƕ z ᗐচ༧೯தևණթ‫ރ‬Ǵԃᇸ៶ᡏև༧‫ރ‬Ƕ

10μm

Entamoeba hartmanni trophozoite z 5~12 Pm(த‫ ـ‬8~10 Pm) z ൂਡ z PC ᗭಈಒጏǴ೯தελ΋ठЪϩѲ֡Ϭ z ਡϘ(KC)λǴஏჴ‫܈‬ϩණ‫ޑ‬Ǵ 10μm

೯தۚύǴଽԶୃЈǶ z ಒझ፦ևಒጏᗭಈ‫ރ‬ϣ֖ಒ๵Ƕ

Entamoeba coli cyst z 10~35 Pm(த‫ ـ‬15~25 Pm) z ೯தև༝‫׎‬ǴӢ‫ۓڰ‬నၨᜤ຾ΕǴ ଽԶևռ‫׎‬ǵΟ‫ځ܈׎ف‬д‫ރ׎‬Ƕ 1~16 ਡǴ8 ঁਡத‫ـ‬Ǵଽᅟё‫ـ‬ όԋዕ 2 ਡ៶ᡏǶ z PC ᗭಈಉǴελό΋ЪϩѲ ό֡ϬǴՠၨࢲ୏ᡏϩѲ֡ϬǶ z KC εǴϩණ‫܈‬ஏჴ‫ޑ‬Ǵ ೯தୃЈǴଽԶۚύǶ z ᜪࢉՅᡏၨόதр౜Ǵ೯த ԋ຋Т‫ރ‬ǴӾ‫҃׎‬ᆄǶ

10μm

Entamoeba coli trophozoite z 15~50 Pm(த‫ ـ‬20~25 Pm)ǴൂਡǶ z PC ᗭಈಉǴελό΋ЪϩѲό֡ϬǴ ‫׎܈‬ԋ΋ಉ໵ᕉǶ z KC εǴϩණ‫܈‬ஏჴ‫ޑ‬Ǵ೯தୃЈǴ ଽԶۚύǶ z ಒझ፦ևಉᗭಈ‫ރ‬ϣ֖ಒ๵Ǵத‫ݰޜڀ‬Ƕ

10μm

Iodamoeba bütschlii cyst z 5~20 Pm (த‫ ـ‬10~12 Pm) z ևռ‫׎‬ǵߏᐍ༝‫׎‬ǵΟ‫ځ܈׎ف‬д‫ރ׎‬Ƕ z ൂਡ z ؒԖ PC z KC ࡐεǴ೯தۚύǴԖਔຼᜐൎᙅ๱཮ۙӀϐߚࢉ Յ፦ᗭಈǶ z ᜪࢉՅᡏևᗭಈ‫ރ‬ z ᗐচ༧೯தևమཱϐஏჴ፦༧

10μm

Iodamoeba bütschlii trophozoite z 8~20 Pm(த‫ ـ‬12~15 Pm) z ൂਡ z ؒԖ PC z KC ࡐεǴ೯தۚύǴԖਔຼᜐൎᙅ๱཮ ۙӀϐߚࢉՅ፦ᗭಈǶ z ಒझ፦ևಉᗭಈ‫ރ‬ϣ֖ಒ๵Ǵሇ҆๵Ǵё‫ݰޜـ‬Ƕ

Endolimax nana cyst z 5~10 Pm(த‫ ـ‬6~8 Pm) z և༝‫׎‬ǵռ‫ߏ܈׎‬ᐍ༝‫׎‬ z 1~4 ਡǴϿ‫ ܭ‬4 ਡϐόԋዕ៶ᡏϿ‫ـ‬Ƕ z ؒԖ PC z KC ࡐεǴևόೕ߾ϐᏀᗺ‫ރ‬Ǵ೯தۚύǶ z ᜪࢉՅᡏևᗭಈ‫܈ރ‬λռ‫׎‬፦༧ z ᗐচ༧೯தևණթ‫ރ‬

10μm 10μm

Endolimax nana trophozoite z 6~12 Pm(த‫ ـ‬8~10 Pm) z ൂਡ z ؒԖ PC z KC ࡐεǴևόೕ߾ϐᏀᗺ‫ރ‬Ƕ z ಒझ፦ևᗭಈ‫ރ‬ϣ֖ಒ๵Ǵё‫ݰޜـ‬Ƕ

Blastocystis hominis z ғࢲўϝόమཱ z 5~30 Pm(த‫ ـ‬8~10 Pm) z և༝‫׎‬ǵռ‫ߏ܈׎‬ᐍ༝‫׎‬Ƕ z ਡՏ‫ܭ‬ಒझ፦ᜐጔǴ1~4 ਡǴத‫ൂـ‬ਡǴ 2~4 ਡԛϐǶ z ಒझύѧԖ΋ε‫(ݰޜ‬central body)ஒਡ Ϸᗭಈᔒ‫ډ‬ಒझᜐጔ‫׎‬ԋᕉ‫׎‬Ƕ

Dientamoeba fragilis trophozoite z ࣁ΋ᅿᚎЛᙝ z ғࢲўؒԖ៶ᡏ໘ࢤ z 5~15 Pm(த‫ ـ‬9~12 Pm) z ᚎЛόё‫ـ‬ z ᚈਡ‫ൂ܈‬ਡ(ѝэ 20%) z ؒԖ PC z ຋ԋ࿗Тϐ KCǴ‫܈‬և 4~8 ᗭಈϐᘀ໣

Giardia lamblia cyst z 8~19 Pm(த‫ ـ‬11~12 Pm) z ևռ‫ߏ܈׎‬ᐍ༝‫׎‬ z 4 ঁਡǴ೯தՏ‫ܭ‬΋ୁǶ z ᚎЛᕵӛՏ‫៶ܭ‬ᡏύ z ᠼЛதୁӛ‫܈‬௹ӛҬ‫׃‬࿼‫៶ܭ‬ᡏၨե೽Տ z ಒझ፦࿶தவಒझᏛೀ۳ϣᕭ

10μm 10μm

Giardia lamblia trophozoite z 10~20 Pm(த‫ ـ‬12~15 Pm) z ևఛ‫׎‬ z ᚈਡ z ᚎЛ-ୁᚎЛ 4 ਥǵື(ဎ)ᚎЛ 2 ਥǵ‫׀‬ᚎЛ 2 ਥǶ z ֎ዬэဎ೽߄य़ᑈ 1/2~3/4

10μm 10μm

Chilomastix mensnili cyst z 6~10 Pm(த‫ ـ‬8-9 Pm) z ևᘗᘔ‫׎‬Ǵ߻ᆄ஥Ԗ೸ܴౚࠠँр‫ނ‬ z ൂਡ z झᡏ஥ԖЍ࡭ᠼЛ

Chilomastix mensnili trophozoite z 6~24 Pm(த‫ ـ‬10-15Pm) z ևఛ‫׎‬ z ൂਡ z ᚎЛ-߻ୁᚎЛ 3 ਥǵझᡏᚎЛ 1 ਥǶ

10μm

z झᡏϐँрӛΠ‫ۯ‬՜ 1/2~1/3 झᡏߏ z ᖥ௽ࠠྎદᑽຫဎ೽߄य़

Artifact-WBC ( White Blood Cells )

10μm

E. histolytica(cyst) Mimics: WBC

PVA ‫(ݤۓڰ‬Polyvinyl - alcohol fixation) ᏹբ‫؁‬ᡯǺ 1. ‫ڗ‬ᕨߡऊ 0.5g ‫ܫ‬ΕևԖ 1c.c. PVA ‫ۓڰ‬నύ (ᕨߡᆶ PVA Кࣁ 1Ǻ2)Ǵᠳ܏֡Ϭࡕ‫ܫ‬࿼࠻ྕ 2 λਔа΢‫ۓڰ‬ϐǶ

2. ᔠᡏ࿶‫ࡕۓڰ‬Ǵ‫ڗ‬؇ᐘ‫ނ‬ऊ 4~5 ᅀ‫ܭ‬ᘠર΢Ǵ1 ϩដࡕӆ ҔԮ෇‫ڗڊ‬ᕨߡǶ

3. ஒᕨߡ༡‫ܭ‬ၩ࣒Т΢Ǵ࿶႖‫ڹ‬॥ଳࡕջё຾ՉࢉՅǶ

Trichrome Stain ࢉՅ‫؁‬ᡯ ᏹբ‫؁‬ᡯǺ 1. ஒᇙբӳ‫࣒ޑ‬Т‫ܫ‬Ε֖࿚న‫ ޑ‬70%ଚᆒύǴ5~10 ϩដǶ (CAP ෳ၂ᔠᡏόࢂ PVA ‫ۓڰ‬Ǵό໪Ԝ‫؁‬ᡯ౽ନෛϯ؄ǹၩ࣒Т౽ԿΠ΋ ࢉऌ߻Ǵ໪‫ܭ‬રτ΢ᛅଳၸӭࢉᏊǴᗉխ਀஥‫ׯނ‬ᡂ၂ᛰԋϩǶ)

2. 70ʘଚᆒ 5 ϩដǴӆ‫ܫ‬Ε 70ʘଚᆒ 3 ϩដǶ (CAP ෳ၂ᔠᡏ‫ޔ‬ௗҗԜ‫؁‬ᡯ໒‫ ۈ‬70ʘଚᆒ 5 ϩដǴௗ๱‫ܫ‬Ε Trichrome ࢉऌǴ౽Կ trichrome ࢉऌ߻Ǵ໪‫ܭ‬રτ΢ᛅଳၸӭ 70ʘଚᆒǴᗉխ਀஥ ‫ׯނ‬ᡂ၂ᛰԋϩǶ)

3. ‫ܫ‬Ε Trichrome ࢉऌϣǴࢉ 10~15 ϩដǶ (CAP ෳ၂ᔠᡏߚ؄‫ۓڰ‬ၨόܰ΢ՅǴࡌ᝼ Trichrome ࢉ 30 ϩដǹ Trichrome ࢉࡕၩ࣒Т౽ԿΠ΋ࢉऌ߻Ǵ໪‫ܭ‬રτ΢ᛅଳၸӭ Trichrome ࢉ ᏊǴᗉխ Trichrome ࢉᏊԦࢉΠ΋ࢉᏊǶ)

4. 酸性酒精脫色(90%酒精+0.5%醋酸)1~3 秒 (視抹片厚薄度，自行斟酌酸性酒精脫色秒數，CAP 測試檢體抹片較薄，建議 two dips only；酸性酒精退染後不須於紙巾上瀝乾過多染劑，請爭取時間快速移至 100%酒精 rinse，以避免酸性酒精繼續脫色。)

5. 95%酒精 rinse 2 次。 6. 100%酒精 rinse 3 次。 7. 100%酒精 3 分鐘，脫水 2 次。 (載玻片移至 Xylene 前，須於紙巾上瀝乾過多 100%酒精)

8. Xylene 5~10 分鐘，浸潤 2 次。

9. 滴上封片膠蓋上蓋玻片後，置於室溫晾乾 (overnight)或者於 37℃中烘乾 1 小時，顯微鏡下鏡檢（use 100X oil immersion objective）。

ቹៜ Trichrome ࢉՅϐӢન ‫ܓ‬Тϐࠆࡋ ଏࢉਔ໔ϐৡ౦ ঁᡏᕨߡ໔ϐৡ౦

‫ܓ‬ТᇙբϷࢉՅ‫ݙ‬ཀ٣໨ ‫ܓ‬Т‫ࢉܭ‬Յਔಥပ 9 ၩ࣒ТόଳృǴԖ‫ݨ‬ᅄ 9 ‫ܓ‬ТؒԖֹӄଳᔿ 9 ‫ܓ‬Тϼࠆ‫܈‬༡‫ؒ୔ܓ‬Ԗ఼ᇂ‫࣒ډ‬Тᜐጔ ‫ܓ‬Тр౜‫ש‬Ӏ඲ᡏ‫܈‬ᗭಈ 9 ෛϯ؄ѐନόֹӄ ‫ܓ‬Тୃᆘ 9 ࿚ූ੮ ! ่݀ղ᠐;!!!!!!!!!! Nuclear chromatin & chromatoid bodies

Red to purple

Bacteria & ingested RBC’s

Red to purple

Cytoplasm of cysts

Blue/green with purple tinge

Cytoplasm of protozoan trophozoites

Blue/green with purple tinge

Microsporidia spores

Pink/red wall with clear interior

Background

Green

100

Trichrome

Stain ‫׎‬ᄊᏢϟಏ

Entamoeba histolytica/E. dispar cyst 12~15 Pm

10μm

E. histolytica/E. dispar trophozoite 15~20 Pm

10μm

101

Entamoeba coli Cyst 15~25 Pm

10μm

Entamoeba coli Trophozoite 20~25 Pm

10μm

102

Entamoeba hartmanni Cyst 6~8 Pm

10μm 10μm

10μm

Entamoeba hartmanni Trophozoite 8~10 Pm

10μm

103

Endolimax nana Cyst 6~8 Pm

10μm Iron-hematoxylin stained

Endolimax nana Trophozoite 8~10 Pm

10μm

10μm 10μm

104

Iodamoeba butschlii Cyst 10~12 Pm

10μm

Iodamoeba butschlii Trophozoite 12~15 Pm

10μm

105

Dientamoeba fragilis Trophozoite 9~12 Pm

10μm

Blastocystis hominis 8~10 Pm

10μm

Chilomastix mesnili Cyst 8~9 Pm

10μm

106

Giardia lamblia Cyst 11~12 Pm

10μm

Giardia lamblia Trophozoite 12~15 Pm

10μm 10μm 10μm

10μm

107

阿米巴性痢疾(台灣列入法定傳染病第二類)

致病原痢疾阿米巴原蟲（Entamoeba histolytica）為本病之致病原，其生活史有兩個階段：主司代謝繁殖的活動體（trophozoite；又名營養體）及能耐惡劣環境的囊體（cyst），後者具囊壁，隨寄主之排泄物進入環境，經食入後，在下一寄主腸道脫囊（excystation）成為活動體。活動體可侵入組織造成病變，囊體則為具感染力之階段。

流行病學阿米巴性痢疾屬世界性分布，但熱帶、亞熱帶開發中國家之感染較普遍，長期集體生活之孤兒院、教養院、收容所、監獄為易發之場所。臺灣地區調查發現教養院及精神病患收容所，感染情形較為普遍，此與生活習慣、衛生條件，環境污染及群居狀況關係密切。此外，男同性戀者、國人赴疫區返國者、來自疫區外勞及外籍新娘等為高危險族群。

傳染方式經糞口途徑傳染，主要藉由糞便中之囊體污染的飲用水、食物或病媒（如：蟑螂、蠅）傳染；亦可能由口對肛門的接觸行為造成。

108

ႣٛБ‫ݤ‬ Ȑ΋ȑ ‫ݙ‬ཀঁΓፁғಞᄍǵ໯१ፁғǵЋ೽మዅϷৎ৥ቲНϐִ๓ ೀ౛ǴёٛЗགࢉǶ ȐΒȑ ஥ᙝ‫ޣ‬ନ‫ݯ‬ᕍѦǴᔈ‫ݙ‬ཀ໭߻ǵߡࡕࢱЋǶ ȐΟȑ ᕨߡִ๓ೀ౛Ǵനӳ٬ҔஏഈԄ‫ܜ‬НଭఏǶ ȐѤȑ ϦҔНྍϐִ๓੃ࢥǴᗉխᕨߡԦࢉНྍǶ Ȑϖȑ ᗉխӞғ๼Ϸฆ‫ݦ‬໯ҔНǶ ȐϤȑ ᔠࢗ‫ݯک‬ᕍவ٣໯१཰‫ޑ‬஥ᙝ‫ޣ‬Ϸᄌ‫܄‬஻‫ޣ‬Ƕ ȐΎȑ Нྍ‫܈‬ᆽН೛ࡼᆶԦࢉྍȐӵ൵‫܌‬ǵϯᕨԣ฻ȑᔈ‫ڀ‬႖Н‫܄‬ ٠ԿϿຯᚆ 15 ϦЁа΢Ƕ ȐΖȑ થ࿽႖ᚆ१‫܈ނ‬গҜН݀Ǵᗉխ೏ੰ൞ȐӵǺᛳǵᖟጶȑௗ ᝻ԦࢉǶ Ȑΐȑ ᗉխαჹ‫ޑߐع‬ௗ᝻ՉࣁǶ

ᖏ‫ރੱ׉‬ ੱ‫ރ‬ёவᇸ༾‫ډ‬ᄌ‫܄‬ဎᘞำࡋό฻Ǵ‫ځ‬дத‫ރੱـ‬хࡴǺᕨߡύ஥ᗹ నϷՈํǵဎภǵ㚊࡚ࡕख़ǵ໔ྂ‫܄‬Πฟǵ⧋ЈǵჍӗϷวᐨ฻Ƕ

109

ᔠᡏ௦ᔠଌᡍ٣໨ ᙴଣ೯ൔਔȐ֖Ѧമ଼ᔠȑ࿶ᚆЈᐚᕭ‫ݤ‬ᡉ༾᜔ᔠࢗ ่݀Ϸղ‫ۓ‬চ߾ϩձӵԛǺ

Ȑ΋ȑΓ޵៶চᙝȐBlastocystis hominisȑϷߓԯЃচᙝᜪǴӵǺࠖ МߓԯЃȐEntamoeba hartmanniȑǵεဉߓԯЃȐEntamoeba coliȑǵ ༾λߓԯЃȐEndolimax nanaȑǵ༐࿚ߓԯЃȐIodamoeba butschliiȑǵ ᚈਡߓԯЃȐDientamoeba fragilisȑǵয‫׎‬ᚎЛᙝ(Chilomastix mesnili) ฻Ǵёόϒ‫ݯ‬ᕍǴຎࣁȨӝ਱ȩǶ

ȐΒȑ Ȩᅪ՟ฟ੯ߓԯЃচᙝȩȐEntamoeba histolytica/E. disparǴ х֖៶ᡏ‫୏ࢲ܈‬ᡏȑǴࡰ‫ۓ‬ᙴଣѸ໪‫ܭ‬ΒΜѤλਔϣ೯ൔ‫܌‬ӧӦፁғ ЬᆅᐒᜢǴ٠ӕਔ೯‫ޕ‬໤ЬǴЪ‫ܭ‬೯‫ޕ‬ϐВଆΎВϣԿচᙴଣख़ཥ௦ ‫ڗ‬ΟԛȐ‫؂‬Ϻ΋ԛȑϐཥᗲᕨߡᔠᡏȐԿϿ‫ࡰܠ‬ελϐໆǹϮуΕҺ Ֆ‫ۓڰ‬నǹ4 ʚߥӸȑǴ‫ٳ‬ӕচ‫ۈ‬ς‫ࢉۓڰ‬ՅϐᔠᡏϷଌᡍൂ‫؂ܭ‬ԛ ௦ᔠࡕΒΜѤλਔϣȐӇᝊհᙒၮଌȑଌύѧፁғЬᆅᐒᜢ‫܌‬ឦ੯ੰ ᆅ‫ڋ‬࿿຾Չዴᇡᔠࢗǹ࿶ዴᇡᔠࢗऩឦ्ථ‫ߓۦ‬ԯЃচᙝȐEntamoeba disparȑਔղࣁȨӝ਱ȩ ǹऩឦฟ੯ߓԯЃচᙝȐEntamoeba histolyticaȑ ߾ࣁȨόӝ਱ȩǶՠள٩ҁᒤ‫ݤ‬ಃΎచಃΒ໨ಃѤීᒤ౛ӆᔠࢗǴ҂ ٩ೕ‫ۓ‬௦ᔠ຾Չዴᇡᔠࢗ‫ޣ‬ǴҭࣁȨόӝ਱ȩǶ

ȐΟȑ ဉၰ᝸ᙝᙝռ‫ځ܈‬дচᙝᜪӵǺᚎЛচᙝᜪǴᠼЛচᙝᜪ Ϸ᪐ηᙝᜪ‫ࣁޣ‬Ȩόӝ਱ȩǶՠள٩ҁᒤ‫ݤ‬ಃΎచಃΒ໨ಃѤීᒤ౛ ӆᔠࢗǶ

110

Reference 1. Parasitology benchtop reference guide Cap/College of American Pathologistis 2. Clinical Parasitology A paractical approach 3. Centers for Disease Control and Prevention web 4. Atlas of Human Parasitology/Ash Orihel’s

კ᛼໒‫ܫ‬୯ϣᙴᕍଣ‫܌‬ǵᏢਠΠၩୖԵ‫܈‬௲ᏢᔈҔ z ੯ᆅ࿿ࣁΑගܹᙴᕍΓ঩ჹ‫ܭ‬ဉၰ஌ғᙝϐບᘐᆶᔠᡍૈΚǴ ੝ձ༼໣ဉၰচᙝǵ᝸ᙝϐᙝռϷѴᙝறՅྣТǴጓुȨΓᡏ ဉၰ஌ғᙝკ᛼ȩǶ z კ᛼ႝηᔞςࡌ࿼‫ܭ‬੯ᆅ࿿ӄౚၗૻᆛȐhttp://www.cdc.gov.twǹ २। > ೯ൔᆶᔠᡍ > ᔠᡍၗૻ > ᔠᡏ௦ᔠȑ Ǵග‫ٮ‬ᙴᕍΓ঩ ΢ᆛᘤំ‫܈‬ΠၩǶ

஌ғᙝჴᡍ࠻( ฟ੯ߓԯЃচᙝ )၌ୢႝ၉ : (02) 33935050 ೚Ш޹

111