Table 3.

Advantages and disadvantages to static-image teleparasitology as performed by the CDC-DPDx

Advantages	Disadvantages
Rapid identification or screening (usually within an hour or two).	Submission of images may be biased based on the presumptive diagnosis of the submitter (e.g., submitting only images of features that support the presumptive diagnosis and not giving a clear overall picture of the case).
Clinically relevant examples:     • Differential identification of organisms where treatment differs (e.g. differentiating Babesia and Plasmodium)     • Recognize or rule-out acutely life-threatening pathogens (e.g. free-living amoebae)     • Identification of organisms where there may be infection control needs (e.g. nosocomial Sarcoptes scabiei)     • Determination of when follow-up is warranted for further molecular analysis (e.g. discriminating Entamoeba histolytica vs. E. dispar, resolving Cyclospora to species level for outbreak investigations, confirming the presence of amastigotes in suspect cases of leishmaniasis, or characterizing extraintestinal microsporidiosis)     • Investigation of potential infection via transfusion or transplant (e.g. Babesia in a blood recipient)
	Static images do not provide multiple Z-planes, which can impair the quality of the analysis in some cases (e.g. quantifying Entamoeba nuclei, visualizing both the nucleus and kinetoplast in Leishmania or Trypanosoma cruzi amastigotes).
	The quality of the consultant's interpretation can be limited by the poor quality of the submitter's images. Common examples that render images unsatisfactory for analysis include:     • Poor focus     • Poor magnification choice for the suspected organism     • Poor image exposure (e.g. overexposure)     • Poor cropping     • Too few images submitted to give a clear overall picture of the case
Less expensive than traditional specimen submission (i.e. physically mailing slides and/or related materials).	The quality of the consultant's interpretation can be limited by the submitter's omission of important data regarding the submission (e.g. size, magnification, specimen type, stain used, relevant travel history).
No risk of physical damage to the specimen (e.g. slide breakage) or permanent specimen loss (e.g. fluid leakage).
	Some organisms are inherently difficult to image well. For example:     • Amastigotes of Leishmania sp. or T. cruzi in tissue sections     • Microsporidia     • Coccidian protozoa     • Adult (gross) helminths
Avoids shipment of and potential exposure to potentially infectious pathogens.
Diagnoses are reported in accordance with CLIA guidelines.
Facilitates information sharing and training including:     • DPDx image library     • DPDx monthly case studies and other teaching resources     • Publications