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| __NOTOC__ | | __NOTOC__ |
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| {{CMG}}; {{AE}} {{MAD}} | | {{CMG}}; {{AE}} {{MAD}} {{ADG}} |
| {{Abdominal parasitic infection}} | | {{Abdominal parasitic infection}} |
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| ==Overview== | | ==Overview== |
| | An intestinal parasite infection is a condition in which a [[Parasites|parasite]] [[Infect|infects]] the [[Gastrointestinal tract|gastro-intestinal tract]] of humans and other animals. Mode of transmission of infection can be due to [[ingestion]] of undercooked meat, drinking infected water, fecal-oral transmission and skin absorption. There are many types of parasites that can cause abdomial infections but the most common parasites responsible for infection include [[Ascaris lumbricoides]], [[Necator americanus]], [[Fasciola hepatica|Fasciola]], [[Schistosoma]], [[Trichuris trichiura]], [[Strongyloides stercoralis]], [[Taenia solium|Taenia,]] [[Hymenolepis infection|Hymenolepis nana]], and [[Entamoeba histolytica]]. Common symptoms of abdominal parasitic infections include are [[abdominal discomfort]], [[anorexia]], [[Nausea and vomiting|nausea]], [[vomiting]], and [[diarrhea]]. [[Stool examination|Stool microscopy]] is the most common diagnostic tool for evaluation. Common complications include [[Focal neurologic signs|focal neurologic changes]], [[pericarditis]], [[Arrhythmias|arrhythmia]], and right-sided [[pleural effusion]]. [[Serology]] is used as screening mainly because of low sensitivity. [[albendazole]] is the drug of choice for treatment of most parasitic infections. |
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| == Main parasitic intestinal infections == | | == Causes == |
| * [[Ascaris lumbricoides]] | | * [[Ascaris lumbricoides]] |
| * [[Necator americanus]] | | * [[Necator americanus]] |
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| * [[Blastocystis hominis]]'' '' | | * [[Blastocystis hominis]]'' '' |
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| == Ascaris lumbricoides == | | == Abdominal Parasitic infections == |
| | | The following table summarizes all the abdominal parasitic infections. |
| ==== Mode of infection ==== | | {| |
| * Ingestion of eggs secreted in the feces of humans or pigs.
| | ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Parasitic Infection |
| * Ingesting uncooked pig or chicken liver with the larvae.<ref name="pmid10899534">{{cite journal| author=Permin A, Henningsen E, Murrell KD, Roepstorff A, Nansen P| title=Pigs become infected after ingestion of livers and lungs from chickens infected with Ascaris of pig origin. | journal=Int J Parasitol | year= 2000 | volume= 30 | issue= 7 | pages= 867-8 | pmid=10899534 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10899534 }}</ref>
| | ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Mode of infection |
| | | ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Incidence |
| ==== Epidemiology and demographics ==== | | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Epidemiology |
| * Approximately 800 million people are infected.<ref name="pmid24688073">{{cite journal| author=Betson M, Nejsum P, Bendall RP, Deb RM, Stothard JR| title=Molecular epidemiology of ascariasis: a global perspective on the transmission dynamics of Ascaris in people and pigs. | journal=J Infect Dis | year= 2014 | volume= 210 | issue= 6 | pages= 932-41 | pmid=24688073 | doi=10.1093/infdis/jiu193 | pmc=4136802 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24688073 }}</ref> | | ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Clinical manifestations''' |
| * Majority of individuals infected with ascariasis are in Asia (73 percent), Africa (12 percent), and South America (8 percent).<ref name="pmid20934531">{{cite journal| author=Dold C, Holland CV| title=Ascaris and ascariasis. | journal=Microbes Infect | year= 2011 | volume= 13 | issue= 7 | pages= 632-7 | pmid=20934531 | doi=10.1016/j.micinf.2010.09.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20934531 }}</ref> | | ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis |
| | | ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Treatment |
| ==== '''Clinical manifestations''' ====
| | |- |
| * During six to eight weeks after egg ingestion, symptoms of ascariasis are abdominal discomfort, anorexia, nausea, vomiting, and diarrhea. | | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease |
| * Adult worms may be seen in the stool. | | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Parasite |
| * It is called the late phase of infection. | | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Geographic distrubution |
| | | |- |
| ==== '''Complications''' ==== | | ! style="background:#DCDCDC;" align="center" + |[[Ascariasis]] |
| * Intestinal obstruction: In endemic areas, 5 to 35 percent of all bowel obstructions are due to ascariasis.<ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040 }}</ref> | | | style="background:#DCDCDC;" align="center" + |[[Ascaris lumbricoides|''Ascaris lumbricoides'']] |
| * Approximately 85 percent of obstructions occur in children between one and five years of age.
| | | style="background:#F5F5F5;" + | |
| * Obstruction occurs most commonly at the ileocecal valve.
| | *Ingestion of [[Ascaris infection|Ascaris]] eggs secreted in the feces of humans or pigs.<ref name="pmid108995342">{{cite journal| author=Permin A, Henningsen E, Murrell KD, Roepstorff A, Nansen P| title=Pigs become infected after ingestion of livers and lungs from chickens infected with Ascaris of pig origin. | journal=Int J Parasitol | year= 2000 | volume= 30 | issue= 7 | pages= 867-8 | pmid=10899534 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10899534 }}</ref> |
| * Migration of adult ''Ascaris'' worms into the biliary tree can cause biliary colic, biliary strictures, acalculous cholecystitis, ascending cholangitis, and bile duct perforation with peritonitis.<ref name="pmid10501884">{{cite journal| author=Javid G, Wani NA, Gulzar GM, Khan BA, Shah AH, Shah OJ et al.| title=Ascaris-induced liver abscess. | journal=World J Surg | year= 1999 | volume= 23 | issue= 11 | pages= 1191-4 | pmid=10501884 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10501884 }}</ref>
| | *Ingesting uncooked pig or chicken liver with the larvae. |
| | | | style="background:#F5F5F5;" + | |
| ==== '''Laboratory findings''' ==== | | *Ascariasis affects at least 1 billion people worldwide and about 4 million people in the United States.<ref name="pmid246880732">{{cite journal| author=Betson M, Nejsum P, Bendall RP, Deb RM, Stothard JR| title=Molecular epidemiology of ascariasis: a global perspective on the transmission dynamics of Ascaris in people and pigs. | journal=J Infect Dis | year= 2014 | volume= 210 | issue= 6 | pages= 932-41 | pmid=24688073 | doi=10.1093/infdis/jiu193 | pmc=4136802 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24688073 }}</ref> |
| * Stool microscopy is the most common diagnostic tool for evaluation of ''Ascaris'' ova.
| | | style="background:#F5F5F5;" + | |
| * Characteristic eggs may be seen on direct examination of stool.
| | *Asia |
| | | *Africa |
| * Peripheral eosinophilia may be observed.<ref name="pmid1405826">{{cite journal| author=Weller PF| title=Eosinophilia in travelers. | journal=Med Clin North Am | year= 1992 | volume= 76 | issue= 6 | pages= 1413-32 | pmid=1405826 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1405826 }}</ref>
| | *South America |
| | | | style="background:#F5F5F5;" + | |
| ==== '''Imaging findings''' ==== | | *[[Abdominal discomfort]] |
| * Barium swallow may also demonstrate adult ''Ascaris'' worms, which manifest as elongated filling defects of the small bowel making the "bull's eye" appearance. | | *[[Anorexia]] |
| * Computed tomography scanning or magnetic resonance imaging may demonstrate worms in the bowel or in the liver or bile ducts.
| | *[[Nausea and vomiting]] |
| * Magnetic resonance cholangiopancreatography may detect adult worms in bile or pancreatic ducts.<ref name="pmid9516689">{{cite journal| author=Reeder MM| title=The radiological and ultrasound evaluation of ascariasis of the gastrointestinal, biliary, and respiratory tracts. | journal=Semin Roentgenol | year= 1998 | volume= 33 | issue= 1 | pages= 57-78 | pmid=9516689 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9516689 }}</ref>
| | *[[Diarrhea]] |
| | | *[[Intestinal obstruction]] |
| ==== '''Treatment''' ==== | | | style="background:#F5F5F5;" + | |
| {| class="wikitable"
| | *[[Stool examination|Stool microscopy]] |
| |'''Drug''' | | *Peripheral [[eosinophilia]] |
| |'''Dosage''' | | *[[Barium swallow]] |
| | | style="background:#F5F5F5;" + | |
| | *[[Albendazole]] |
| | *[[Mebendazole]] |
| | *[[Ivermectin]] |
| | |- |
| | ! style="background:#DCDCDC;" align="center" + |[[Necatoriasis]] |
| | | style="background:#DCDCDC;" align="center" + |[[Necator americanus|''Necator americanus'']] |
| | | style="background:#F5F5F5;" + | |
| | *Skin contact |
| | | style="background:#F5F5F5;" + | |
| | *Approximately 800 million people are infected with [[hookworms]] worldwide.<ref name="pmid280985262">{{cite journal| author=Bradbury RS, Hii SF, Harrington H, Speare R, Traub R| title=Ancylostoma ceylanicum Hookworm in the Solomon Islands. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 2 | pages= 252-257 | pmid=28098526 | doi=10.3201/eid2302.160822 | pmc=5324822 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28098526 }}</ref> |
| | | style="background:#F5F5F5;" + | |
| | *Brazil |
| | *Texas |
| | *Africa |
| | *China |
| | *Southwest Pacific islands |
| | *India |
| | *Southeast Asia |
| | | style="background:#F5F5F5;" + | |
| | *'''Acute <ref name="pmid44512282">{{cite journal| author=Nawalinski TA, Schad GA| title=Arrested development in Ancylostoma duodenale: course of a self-induced infection in man. | journal=Am J Trop Med Hyg | year= 1974 | volume= 23 | issue= 5 | pages= 895-8 | pmid=4451228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4451228 }}</ref>''' |
| | **[[Nausea and vomiting|Nausea]] and [[Nausea and vomiting|vomiting]] |
| | **[[Diarrhea]] |
| | **Epigastric pain |
| | **Increased [[flatulence]] |
| | *'''Chronic<ref name="pmid283006942">{{cite journal| author=Chhabra P, Bhasin DK| title=Hookworm-Induced Obscure Overt Gastrointestinal Bleeding. | journal=Clin Gastroenterol Hepatol | year= 2017 | volume= 15 | issue= 11 | pages= e161-e162 | pmid=28300694 | doi=10.1016/j.cgh.2017.02.034 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28300694 }}</ref>''' |
| | **[[Bloody stools]] |
| | **[[Anemia]] |
| | **[[Low birth weight|LBW]] in [[pregnant]] women |
| | | style="background:#F5F5F5;" + | |
| | *Stool microscopy<ref name="pmid290163262">{{cite journal| author=McKenna ML, McAtee S, Bryan PE, Jeun R, Ward T, Kraus J et al.| title=Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama. | journal=Am J Trop Med Hyg | year= 2017 | volume= 97 | issue= 5 | pages= 1623-1628 | pmid=29016326 | doi=10.4269/ajtmh.17-0396 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29016326 }}</ref> |
| | *Peripheral [[eosinophilia]] |
| | | style="background:#F5F5F5;" + | |
| | *[[Albendazole]] |
| | *[[Mebendazole]]<ref name="pmid19161732">{{cite journal| author=Genta RM, Woods KL| title=Endoscopic diagnosis of hookworm infection. | journal=Gastrointest Endosc | year= 1991 | volume= 37 | issue= 4 | pages= 476-8 | pmid=1916173 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1916173 }}</ref> |
| | *[[Pyrantel pamoate]]<ref name="pmid27032297">{{cite journal| author=Serre-Delcor N, Treviño B, Monge B, Salvador F, Torrus D, Gutiérrez-Gutiérrez B et al.| title=Eosinophilia prevalence and related factors in travel and immigrants of the network +REDIVI. | journal=Enferm Infecc Microbiol Clin | year= 2017 | volume= 35 | issue= 10 | pages= 617-623 | pmid=27032297 | doi=10.1016/j.eimc.2016.02.024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27032297 }}</ref> |
| | |- |
| | ! style="background:#DCDCDC;" align="center" + |[[Giardiasis]] |
| | | style="background:#DCDCDC;" align="center" + |''[[Giardia lamblia]]'' |
| | | style="background:#F5F5F5;" + | |
| | *Ingestion of raw or undercooked food contaminated with [[cysts]].<ref name="pmid15007572">{{cite journal| author=Quick R, Paugh K, Addiss D, Kobayashi J, Baron R| title=Restaurant-associated outbreak of giardiasis. | journal=J Infect Dis | year= 1992 | volume= 166 | issue= 3 | pages= 673-6 | pmid=1500757 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1500757 }}</ref> |
| | | style="background:#F5F5F5;" + | |
| | *Approximately, 15,223 cases were reported in the United States in 2012.<ref name="pmid231699402">{{cite journal| author=Muhsen K, Levine MM| title=A systematic review and meta-analysis of the association between Giardia lamblia and endemic pediatric diarrhea in developing countries. | journal=Clin Infect Dis | year= 2012 | volume= 55 Suppl 4 | issue= | pages= S271-93 | pmid=23169940 | doi=10.1093/cid/cis762 | pmc=3502312 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23169940 }}</ref> |
| | | style="background:#F5F5F5;" + | |
| | *Worldwide infection |
| | *Among mountains hikers |
| | | style="background:#F5F5F5;" + | |
| | *Asymptomatic<ref name="pmid67078122">{{cite journal| author=Pickering LK, Woodward WE, DuPont HL, Sullivan P| title=Occurrence of Giardia lamblia in children in day care centers. | journal=J Pediatr | year= 1984 | volume= 104 | issue= 4 | pages= 522-6 | pmid=6707812 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6707812 }}</ref> |
| | *Acute |
| | **[[Diarrhea]] |
| | **[[Malaise]] |
| | **[[Steatorrhea]] |
| | **[[Abdominal cramps]] |
| | **[[Bloating]] |
| | **[[Nausea and vomiting|Nausea]] |
| | **[[Weight loss]]. |
| | *Chronic |
| | **Loose stools |
| | **[[Malabsorption]] |
| | **[[Steatorrhea]] |
| | **[[Weight loss]] |
| | **[[Fatigue]] |
| | | style="background:#F5F5F5;" + | |
| | *Antigen detection assays |
| | **[[Fluorescein]]-tagged [[monoclonal antibodies]] |
| | **Immunochromatographic assays<ref name="pmid80752662">{{cite journal| author=Lengerich EJ, Addiss DG, Juranek DD| title=Severe giardiasis in the United States. | journal=Clin Infect Dis | year= 1994 | volume= 18 | issue= 5 | pages= 760-3 | pmid=8075266 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8075266 }}</ref> |
| | **[[ELISA test|Enzyme-linked immunosorbent assays]] |
| | *Nucleic acid amplification<ref name="pmid237115212">{{cite journal| author=Claas EC, Burnham CA, Mazzulli T, Templeton K, Topin F| title=Performance of the xTAG® gastrointestinal pathogen panel, a multiplex molecular assay for simultaneous detection of bacterial, viral, and parasitic causes of infectious gastroenteritis. | journal=J Microbiol Biotechnol | year= 2013 | volume= 23 | issue= 7 | pages= 1041-5 | pmid=23711521 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23711521 }}</ref>assays ([[NAAT]]) |
| | *[[Stool examination|Stool microscopy]] |
| | | style="background:#F5F5F5;" + | |
| | *[[Tinidazole]]<ref name="pmid165073732">{{cite journal| author=Fung HB, Doan TL| title=Tinidazole: a nitroimidazole antiprotozoal agent. | journal=Clin Ther | year= 2005 | volume= 27 | issue= 12 | pages= 1859-84 | pmid=16507373 | doi=10.1016/j.clinthera.2005.12.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16507373 }}</ref> |
| | *[[Nitazoxanide]] |
| | |- |
| | ! style="background:#DCDCDC;" align="center" + | [[Fasciolosis]] |
| | | style="background:#DCDCDC;" align="center" + |''[[Fasciola hepatica|Fasciola Hepaticum]]'' |
| | | style="background:#F5F5F5;" + | |
| | | style="background:#F5F5F5;" + | |
| | | style="background:#F5F5F5;" + | |
| | *Central and South America |
| | *Asia (China, Vietnam, Taiwan, Korea, and Thailand) |
| | *Europe (Portugal, France, Spain, and Turkey) |
| | *Africa |
| | *The Middle East |
| | | style="background:#F5F5F5;" + | |
| | *Acute liver phase |
| | **[[Fever]] |
| | **[[Anorexia]] |
| | **Nausea and [[vomiting]] |
| | **[[Myalgia]] |
| | **[[Cough]] |
| | **Right upper quadrant pain |
| | **[[Hematoma|Hematomas]] of the [[liver]] |
| | **[[Jaundice]] |
| | **[[Hepatomegaly]].<ref name="pmid28221812">{{cite journal| author=Chan CW, Lam SK| title=Diseases caused by liver flukes and cholangiocarcinoma. | journal=Baillieres Clin Gastroenterol | year= 1987 | volume= 1 | issue= 2 | pages= 297-318 | pmid=2822181 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2822181 }}</ref> |
| | *Chronic [[biliary]] phase |
| | **Asymptomatic<ref name="pmid187258032">{{cite journal| author=Marcos LA, Terashima A, Gotuzzo E| title=Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis. | journal=Curr Opin Infect Dis | year= 2008 | volume= 21 | issue= 5 | pages= 523-30 | pmid=18725803 | doi=10.1097/QCO.0b013e32830f9818 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18725803 }}</ref> |
| | **[[Common bile duct]] obstruction |
| | **[[Pancreatitis]] |
| | | style="background:#F5F5F5;" + | |
| | *Microscopy<ref name="pmid15888692">{{cite journal| author=Prociv P, Walker JC, Whitby M| title=Human ectopic fascioliasis in Australia: first case reports. | journal=Med J Aust | year= 1992 | volume= 156 | issue= 5 | pages= 349-51 | pmid=1588869 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1588869 }}</ref> |
| | **Stools |
| | **Bile |
| | **Duodenal aspiration |
| | *Peripheral [[eosinophilia]] may disappear.<ref name="pmid221711313">{{cite journal| author=Kaya M, Beştaş R, Cetin S| title=Clinical presentation and management of Fasciola hepatica infection: single-center experience. | journal=World J Gastroenterol | year= 2011 | volume= 17 | issue= 44 | pages= 4899-904 | pmid=22171131 | doi=10.3748/wjg.v17.i44.4899 | pmc=3235633 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22171131 }}</ref> |
| | *Serology |
| | **[[Hemagglutination assay|Indirect hemagglutination]] |
| | **[[Complement fixation test|Complement fixation]] |
| | **[[Enzyme linked immunosorbent assay (ELISA)|Enzyme-linked immunosorbent assay]] |
| | | style="background:#F5F5F5;" + | |
| | *[[Triclabendazole]] |
| | *[[Bithionol]] |
| | *[[Nitazoxanide]] |
| |- | | |- |
| |Albendazole | | ! style="background:#DCDCDC;" align="center" + |[[Schistosomiasis]] |
| |400 mg orally once | | | style="background:#DCDCDC;" align="center" + | |
| | ''[[Schistosoma mansoni|S. mansoni]]''<br> |
| | ''[[Schistosoma japonicum|S. japonicum]]''<br> |
| | ''[[Schistosoma haematobium|S. haematobium]]'' |
| | | style="background:#F5F5F5;" + | |
| | *Infection can occur by: |
| | **Penetration of the human skin by [[cercaria]] |
| | **Handling of contaminated soil |
| | **Consumption of contaminated water or food sources (e.g, unwashed garden vegetables) |
| | | style="background:#F5F5F5;" + | |
| | *Approximately 200 million people are infected annually with 200,000 deaths per year. |
| | | style="background:#F5F5F5;" + |Sub-Saharan Africa<ref name="pmid230415402">{{cite journal| author=Gower CM, Gouvras AN, Lamberton PH, Deol A, Shrivastava J, Mutombo PN et al.| title=Population genetic structure of Schistosoma mansoni and Schistosoma haematobium from across six sub-Saharan African countries: implications for epidemiology, evolution and control. | journal=Acta Trop | year= 2013 | volume= 128 | issue= 2 | pages= 261-74 | pmid=23041540 | doi=10.1016/j.actatropica.2012.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23041540 }}</ref> |
| | | style="background:#F5F5F5;" + |Acute schistosomiasis syndrome <ref name="pmid174889232">{{cite journal| author=Jauréguiberry S, Ansart S, Perez L, Danis M, Bricaire F, Caumes E| title=Acute neuroschistosomiasis: two cases associated with cerebral vasculitis. | journal=Am J Trop Med Hyg | year= 2007 | volume= 76 | issue= 5 | pages= 964-6 | pmid=17488923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17488923 }}</ref> |
| | *[[Fever]] and [[chills]] |
| | *[[Urticaria]] |
| | *[[Angioedema]] |
| | *[[Myalgias]] |
| | *[[Arthralgias]] |
| | *Dry [[cough]] |
| | *[[Diarrhea]] |
| | *[[Abdominal pain]] |
| | *[[Headache|Headache.]]<ref name="pmid85990592">{{cite journal| author=Rocha MO, Rocha RL, Pedroso ER, Greco DB, Ferreira CS, Lambertucci JR et al.| title=Pulmonary manifestations in the initial phase of schistosomiasis mansoni. | journal=Rev Inst Med Trop Sao Paulo | year= 1995 | volume= 37 | issue= 4 | pages= 311-8 | pmid=8599059 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8599059 }}</ref> |
| | Chronic schistosomias<ref name="pmid82541642">{{cite journal| author=Lucey DR, Maguire JH| title=Schistosomiasis. | journal=Infect Dis Clin North Am | year= 1993 | volume= 7 | issue= 3 | pages= 635-53 | pmid=8254164 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8254164 }}</ref><ref name="pmid234657812">{{cite journal| author=Stothard JR, Sousa-Figueiredo JC, Betson M, Bustinduy A, Reinhard-Rupp J| title=Schistosomiasis in African infants and preschool children: let them now be treated! | journal=Trends Parasitol | year= 2013 | volume= 29 | issue= 4 | pages= 197-205 | pmid=23465781 | doi=10.1016/j.pt.2013.02.001 | pmc=3878762 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23465781 }}</ref><ref name="pmid164162392">{{cite journal| author=Gabbi C, Bertolotti M, Iori R, Rivasi F, Stanzani C, Maurantonio M et al.| title=Acute abdomen associated with schistosomiasis of the appendix. | journal=Dig Dis Sci | year= 2006 | volume= 51 | issue= 1 | pages= 215-7 | pmid=16416239 | doi=10.1007/s10620-006-3111-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16416239 }}</ref><ref name="pmid275214432">{{cite journal| author=Mu A, Fernandes I, Phillips D| title=A 57-Year-Old Woman With a Cecal Mass. | journal=Clin Infect Dis | year= 2016 | volume= 63 | issue= 5 | pages= 703-5 | pmid=27521443 | doi=10.1093/cid/ciw413 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27521443 }}</ref> |
| | *Intestinal schistosomiasis |
| | *Hepatosplenic schistosomiasis<ref name="pmid31246482">{{cite journal| author=Homeida M, Abdel-Gadir AF, Cheever AW, Bennett JL, Arbab BM, Ibrahium SZ et al.| title=Diagnosis of pathologically confirmed Symmers' periportal fibrosis by ultrasonography: a prospective blinded study. | journal=Am J Trop Med Hyg | year= 1988 | volume= 38 | issue= 1 | pages= 86-91 | pmid=3124648 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3124648 }}</ref><ref name="pmid104415772">{{cite journal| author=Dessein AJ, Hillaire D, Elwali NE, Marquet S, Mohamed-Ali Q, Mirghani A et al.| title=Severe hepatic fibrosis in Schistosoma mansoni infection is controlled by a major locus that is closely linked to the interferon-gamma receptor gene. | journal=Am J Hum Genet | year= 1999 | volume= 65 | issue= 3 | pages= 709-21 | pmid=10441577 | doi=10.1086/302526 | pmc=1377977 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10441577 }}</ref> |
| | *Pulmonary schistosomiasis<ref name="pmid37228982">{{cite journal| author=Sarwat AK, Tag el Din MA, Bassiouni M, Ashmawi SS| title=Schistosomiasis of the lung. | journal=J Egypt Soc Parasitol | year= 1986 | volume= 16 | issue= 1 | pages= 359-66 | pmid=3722898 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3722898 }}</ref> |
| | *Genitourinary schistosomiasis |
| | | style="background:#F5F5F5;" + | |
| | *Stool microscopy<ref name="pmid70428542">{{cite journal| author=Mahmoud AA| title=The ecology of eosinophils in schistosomiasis. | journal=J Infect Dis | year= 1982 | volume= 145 | issue= 5 | pages= 613-22 | pmid=7042854 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7042854 }}</ref> |
| | *Serologic tests include: |
| | **[[Hemagglutination|Indirect hemagglutination]] |
| | **[[Complement fixation]] |
| | **[[Enzyme-linked immunosorbent assay]] |
| | **[[PCR]] |
| | | style="background:#F5F5F5;" + | |
| | *[[Praziquantel]]<ref name="pmid249555232">{{cite journal| author=Cioli D, Pica-Mattoccia L, Basso A, Guidi A| title=Schistosomiasis control: praziquantel forever? | journal=Mol Biochem Parasitol | year= 2014 | volume= 195 | issue= 1 | pages= 23-9 | pmid=24955523 | doi=10.1016/j.molbiopara.2014.06.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24955523 }}</ref> |
| | *[[Oxamniquine]] |
| |- | | |- |
| |Mebendazole | | ! style="background:#DCDCDC;" align="center" + |[[Strongyloidiasis]] |
| |100 mg orally twice daily for 3 days or 500 mg orally once | | | style="background:#DCDCDC;" align="center" + |[[Strongyloides|''Strongyloidis Stercoralis'']] |
| | | style="background:#F5F5F5;" + | |
| | *Infection is contracted via direct contact with contaminated soil during agricultural, domestic, and recreational activities |
| | | style="background:#F5F5F5;" + | |
| | *Approximately 30–100 million infected persons worldwide |
| | | style="background:#F5F5F5;" + | |
| | *Tropical and subtropical regions |
| | | style="background:#F5F5F5;" + | |
| | *Hyperinfection syndrome |
| | **[[Fever]] |
| | **[[Nausea and vomiting]] |
| | **[[Anorexia]] |
| | **[[Diarrhea]] |
| | **[[Abdominal pain]] |
| | **[[Dyspnea]] |
| | **[[Wheeze|Wheezing]] |
| | **[[Hemoptysis]] |
| | **[[Cough]] |
| | | style="background:#F5F5F5;" + | |
| | *Aspiration of duodenojejunal fluid is sometimes used to detect<ref name="pmid70364302">{{cite journal| author=Carroll SM, Karthigasu KT, Grove DI| title=Serodiagnosis of human strongyloidiasis by an enzyme-linked immunosorbent assay. | journal=Trans R Soc Trop Med Hyg | year= 1981 | volume= 75 | issue= 5 | pages= 706-9 | pmid=7036430 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7036430 }}</ref> |
| | *Stool microscopy |
| | *PCR, ELISA |
| | | style="background:#F5F5F5;" + | |
| | *[[Ivermectin]]<ref name="pmid119571272">{{cite journal| author=Zaha O, Hirata T, Kinjo F, Saito A, Fukuhara H| title=Efficacy of ivermectin for chronic strongyloidiasis: two single doses given 2 weeks apart. | journal=J Infect Chemother | year= 2002 | volume= 8 | issue= 1 | pages= 94-8 | pmid=11957127 | doi=10.1007/s101560200013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11957127 }}</ref> |
| | *[[Albendazole]]<ref name="pmid84839922">{{cite journal| author=Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR| title=Albendazole is effective treatment for chronic strongyloidiasis. | journal=Q J Med | year= 1993 | volume= 86 | issue= 3 | pages= 191-5 | pmid=8483992 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8483992 }}</ref> |
| |- | | |- |
| |Ivermectin | | ! style="background:#DCDCDC;" align="center" + |[[Amoebiasis]] |
| |150-200 mcg/kg orally once
| | | style="background:#DCDCDC;" align="center" + |''[[Entamoeba histolytica|E. Histolytica]]'' |
| |}
| | | style="background:#F5F5F5;" + | |
| | | *Transmitted by the fecal-oral route through contaminated drinking water or food. |
| [[File:Ascaris lumbricoides adult worms.png|300px|center|thumb|Ascaris lumbricoides adult worms, source: By SuSanA Secretariat - https://www.flickr.com/photos/gtzecosan/15701719491/in/set-72157648708895830, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=37077525]] | | *Direct contact with infected individuals. |
| [[File:Fertilized egg of Ascaris lumbricoides PHIL 410 lores.jpg|300px|center|thumb|Fertilized egg of Ascaris lumbricoides, source: By CDC/ Dr. Mae Melvin - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #410.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=781546]]
| | | style="background:#F5F5F5;" + | |
| == Necator ''americanus'' ==
| | *Annual incidence of amoebiasis is approximately 50 million cases.<ref name="pmid17716437">{{cite journal| author=Valenzuela O, Morán P, Gómez A, Cordova K, Corrales N, Cardoza J et al.| title=Epidemiology of amoebic liver abscess in Mexico: the case of Sonora. | journal=Ann Trop Med Parasitol | year= 2007 | volume= 101 | issue= 6 | pages= 533-8 | pmid=17716437 | doi=10.1179/136485907X193851 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17716437 }}</ref><ref name="pmid17437396">{{cite journal| author=van Hal SJ, Stark DJ, Fotedar R, Marriott D, Ellis JT, Harkness JL| title=Amoebiasis: current status in Australia. | journal=Med J Aust | year= 2007 | volume= 186 | issue= 8 | pages= 412-6 | pmid=17437396 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17437396 }}</ref><ref name="pmid19540361">{{cite journal| author=Ximénez C, Morán P, Rojas L, Valadez A, Gómez A| title=Reassessment of the epidemiology of amebiasis: state of the art. | journal=Infect Genet Evol | year= 2009 | volume= 9 | issue= 6 | pages= 1023-32 | pmid=19540361 | doi=10.1016/j.meegid.2009.06.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19540361 }}</ref> |
| * Approximetly 800 million people are infected with hookworms worldwide.<ref name="pmid28098526">{{cite journal| author=Bradbury RS, Hii SF, Harrington H, Speare R, Traub R| title=Ancylostoma ceylanicum Hookworm in the Solomon Islands. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 2 | pages= 252-257 | pmid=28098526 | doi=10.3201/eid2302.160822 | pmc=5324822 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28098526 }}</ref>
| | | style="background:#F5F5F5;" + | |
| * The prevalence of hookworm infection in rural areas of United States in the early 20th century was high. | | *India |
| '''Acute gastrointestinal symptoms'''
| | *Africa |
| * Nausea, diarrhea, vomiting, epigastric pain, and increased flatulence may be observed.<ref name="pmid4451228">{{cite journal| author=Nawalinski TA, Schad GA| title=Arrested development in Ancylostoma duodenale: course of a self-induced infection in man. | journal=Am J Trop Med Hyg | year= 1974 | volume= 23 | issue= 5 | pages= 895-8 | pmid=4451228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4451228 }}</ref>
| | *Mexico |
| * In patients with recurrent infections, gastrointestinal symptoms become less in the proceeding attacks, mild after the second, and absent after the third and fourth infection. | | *Parts of Central and South America |
| '''Chronic nutritional impairment'''
| | | style="background:#F5F5F5;" + | |
| * Hookworms cause blood loss during attachment to the intestinal mucosa by lacerating capillaries and ingesting extravasated blood.<ref name="pmid28300694">{{cite journal| author=Chhabra P, Bhasin DK| title=Hookworm-Induced Obscure Overt Gastrointestinal Bleeding. | journal=Clin Gastroenterol Hepatol | year= 2017 | volume= 15 | issue= 11 | pages= e161-e162 | pmid=28300694 | doi=10.1016/j.cgh.2017.02.034 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28300694 }}</ref>
| | *Asymptomatic |
| * The daily losses of blood, iron, and albumin can lead to anemia and contribute to impaired nutrition, especially in patients with heavy infection. | | *Mild [[diarrhea]] to severe [[dysentery]]. |
| * Pregnant females with hookworm infection are associated with low birth weight.
| | *Fulminant amebic colitis. |
| '''Stool examination'''
| | *[[Weight loss]] |
| * Stool examination for the eggs of ''N. americanus'' or ''A. duodenale ''is useful for detection of hookworm infection eight weeks after dermal penetration of ''N. americanus'' infection.
| | *[[Amebic dysentery]] |
| * Eosinophilia has been attributed to persistent attachment of adult worms to the intestinal mucosa.<ref name="pmid29016326">{{cite journal| author=McKenna ML, McAtee S, Bryan PE, Jeun R, Ward T, Kraus J et al.| title=Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama. | journal=Am J Trop Med Hyg | year= 2017 | volume= 97 | issue= 5 | pages= 1623-1628 | pmid=29016326 | doi=10.4269/ajtmh.17-0396 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29016326 }}</ref>
| | | style="background:#F5F5F5;" + | |
| | | *Stool microscopy |
| ==== Treatment ====
| | *Antigen testing |
| * Albendazole is the first line of treatment for hookworms.<ref name="pmid1916173">{{cite journal| author=Genta RM, Woods KL| title=Endoscopic diagnosis of hookworm infection. | journal=Gastrointest Endosc | year= 1991 | volume= 37 | issue= 4 | pages= 476-8 | pmid=1916173 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1916173 }}</ref>
| | *PCR |
| * Mebendazole is an alternative therapy; 100 mg twice daily for three days.
| | | style="background:#F5F5F5;" + | |
| * Another alternative therapy is pyrantel pamoate (11 mg/kg per day for three days, not to exceed 1 g/day).<ref name="pmid27032297">{{cite journal| author=Serre-Delcor N, Treviño B, Monge B, Salvador F, Torrus D, Gutiérrez-Gutiérrez B et al.| title=Eosinophilia prevalence and related factors in travel and immigrants of the network +REDIVI. | journal=Enferm Infecc Microbiol Clin | year= 2017 | volume= 35 | issue= 10 | pages= 617-623 | pmid=27032297 | doi=10.1016/j.eimc.2016.02.024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27032297 }}</ref>
| | *[[Metronidazole]] |
| [[File:Necator Americanus1.jpg|300px|center|thumb|Necator Americanus, source: By Jasper Lawrence - I took the photograph using a Nikon E200 Trinocular microscope, an M99 microscope adaptor from the Martin Microscope Company (S/N3734), a D10NLC C-Mount manufactured by Diagnostic Instruments and a Sony HDV-A1U HD digital video camera., GFDL, https://commons.wikimedia.org/w/index.php?curid=4335265]]
| | *[[Tinidazole]] |
| [[File:Hookworm LifeCycle.gif|300px|center|thumb|Hookworm life cycle , source: By The original uploader was Sonett72 at English Wikipedia - CDC - Department of Parasitic Diseaseshttp://www.dpd.cdc.gov/dpdx/HTML/ImageLibrary/Hookworm_il.htmhttp://www.dpd.cdc.gov/dpdx/images/ParasiteImages/G-L/Hookworm/Hookworm_LifeCycle.gifOriginally from en.wikipedia; description page is/was here., Public Domain, https://commons.wikimedia.org/w/index.php?curid=1860052]]
| | *[[Paromomycin]] |
| | | *[[Diloxanide furoate]] |
| | | *[[Iodoquinol]] |
| == Giardia lamblia ==
| |
| * The prevalence of giardiasis is 20 to 40 percent in endemic areas.
| |
| * The highest risk group for infection are children <5 years.<ref name="pmid21233509">{{cite journal| author=Feng Y, Xiao L| title=Zoonotic potential and molecular epidemiology of Giardia species and giardiasis. | journal=Clin Microbiol Rev | year= 2011 | volume= 24 | issue= 1 | pages= 110-40 | pmid=21233509 | doi=10.1128/CMR.00033-10 | pmc=3021202 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21233509 }}</ref>
| |
| * Approximately, 15,223 cases were reported in the United States in 2012.<ref name="pmid23169940">{{cite journal| author=Muhsen K, Levine MM| title=A systematic review and meta-analysis of the association between Giardia lamblia and endemic pediatric diarrhea in developing countries. | journal=Clin Infect Dis | year= 2012 | volume= 55 Suppl 4 | issue= | pages= S271-93 | pmid=23169940 | doi=10.1093/cid/cis762 | pmc=3502312 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23169940 }}</ref>
| |
| * Giardiasis is a major cause of diarrhea among mountains hikers who drink water that has not been boiled.<ref name="pmid7188724">{{cite journal| author=Dykes AC, Juranek DD, Lorenz RA, Sinclair S, Jakubowski W, Davies R| title=Municipal waterborne giardiasis: an epidemilogic investigation. Beavers implicated as a possible reservoir. | journal=Ann Intern Med | year= 1980 | volume= 92 | issue= 2 Pt 1 | pages= 165-70 | pmid=7188724 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7188724 }}</ref>
| |
| * Transmission of giardiasis can occur via ingestion of raw or undercooked food contaminated with cysts.<ref name="pmid1500757">{{cite journal| author=Quick R, Paugh K, Addiss D, Kobayashi J, Baron R| title=Restaurant-associated outbreak of giardiasis. | journal=J Infect Dis | year= 1992 | volume= 166 | issue= 3 | pages= 673-6 | pmid=1500757 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1500757 }}</ref>
| |
| * Giardiasis can be transmitted via anal-oral sexual contact.<ref name="pmid24434784">{{cite journal| author=Escobedo AA, Almirall P, Alfonso M, Cimerman S, Chacín-Bonilla L| title=Sexual transmission of giardiasis: a neglected route of spread? | journal=Acta Trop | year= 2014 | volume= 132 | issue= | pages= 106-11 | pmid=24434784 | doi=10.1016/j.actatropica.2013.12.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24434784 }}</ref>
| |
| | |
| === '''Clinical presentation''' ===
| |
| | |
| ==== '''Asymptomatic infection''' ====
| |
| * Most of the cases are asymptomatic.<ref name="pmid6707812">{{cite journal| author=Pickering LK, Woodward WE, DuPont HL, Sullivan P| title=Occurrence of Giardia lamblia in children in day care centers. | journal=J Pediatr | year= 1984 | volume= 104 | issue= 4 | pages= 522-6 | pmid=6707812 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6707812 }}</ref>
| |
| | |
| ==== '''Acute giardiasis''' ====
| |
| * Symptoms of acute giardiasis include diarrhea, malaise, steatorrhea, abdominal cramps and bloating, nausea, and weight loss. | |
| | |
| ==== '''Chronic giardiasis''' ====
| |
| * Symptoms of chronic giardiasis may include loose stools, malabsorption, steatorrhea, weight loss, and fatigue. | |
| | |
| ==== '''Complications''' ====
| |
| * Persistent infection occur in small number of patients causing malabsorption and weight loss.<ref name="pmid8075266">{{cite journal| author=Lengerich EJ, Addiss DG, Juranek DD| title=Severe giardiasis in the United States. | journal=Clin Infect Dis | year= 1994 | volume= 18 | issue= 5 | pages= 760-3 | pmid=8075266 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8075266 }}</ref>
| |
| | |
| === Laboratory diagnosis ===
| |
| ==== '''Antigen detection assays''' ====
| |
| * Fluorescein-tagged monoclonal antibodies, immunochromatographic assays, and enzyme-linked immunosorbent assays are studies using antibodies against cyst or trophozoite antigens. These methods have greater sensitivity.<ref name="pmid17309026">{{cite journal| author=Al FD, Kuştimur S, Ozekinci T, Balaban N, Ilhan MN| title=The use of enzyme linked immunosorbent assay (ELISA) and direct fluorescent antibody (DFA) methods for diagnosis of Giardia intestinalis. | journal=Turkiye Parazitol Derg | year= 2006 | volume= 30 | issue= 4 | pages= 275-8 | pmid=17309026 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17309026 }}</ref> | |
| | |
| ==== '''Nucleic acid amplification assays''' ====
| |
| * Nucleic acid amplification assays (NAAT) detect ''Giardia'' in stool samples.<ref name="pmid23711521">{{cite journal| author=Claas EC, Burnham CA, Mazzulli T, Templeton K, Topin F| title=Performance of the xTAG® gastrointestinal pathogen panel, a multiplex molecular assay for simultaneous detection of bacterial, viral, and parasitic causes of infectious gastroenteritis. | journal=J Microbiol Biotechnol | year= 2013 | volume= 23 | issue= 7 | pages= 1041-5 | pmid=23711521 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23711521 }}</ref>
| |
| | |
| ==== '''Stool microscopy''' ====
| |
| * Stool microscopy to detect ''Giardia ''can be specific but needs expert to examine the stool and needs intermittent excretion of ''Giardia'' cysts. | |
| | |
| === '''Treatment''' ===
| |
| | |
| ===== '''Preferred agents''' =====
| |
| * Tinidazole and nitazoxanide are the preferred drug for Giardiasis.<ref name="pmid16507373">{{cite journal| author=Fung HB, Doan TL| title=Tinidazole: a nitroimidazole antiprotozoal agent. | journal=Clin Ther | year= 2005 | volume= 27 | issue= 12 | pages= 1859-84 | pmid=16507373 | doi=10.1016/j.clinthera.2005.12.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16507373 }}</ref>
| |
| * Tinidazole has a longer half-life than nitazoxanide and may be administered as a single dose with high efficacy (>90 percent). | |
| {| class="wikitable"
| |
| | rowspan="2" |Drug
| |
| | colspan="2" |Dose
| |
| |- | | |- |
| |Adults | | ! style="background:#DCDCDC;" align="center" + |[[Taeniasis]] |
| |Children | | | style="background:#DCDCDC;" align="center" + | |
| | ''[[Taenia saginata]]'' (beef [[Tapeworms|tapeworm]])<br> |
| | ''[[Taenia solium]]'', ( pork tapeworm)<ref name="pmid97985864">{{cite journal| author=Forrester JE, Bailar JC, Esrey SA, José MV, Castillejos BT, Ocampo G| title=Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children. | journal=Lancet | year= 1998 | volume= 352 | issue= 9134 | pages= 1103-8 | pmid=9798586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798586 }}</ref> |
| | | style="background:#F5F5F5;" + | |
| | *Consumption of undercooked beef |
| | | style="background:#F5F5F5;" + | |
| | *Approximately 50 million human have cysticercosis. |
| | | style="background:#F5F5F5;" + | |
| | *Europe |
| | *Parts of Asia |
| | | style="background:#F5F5F5;" + | |
| | *Most human carriers are asymptomatic. |
| | *Symptoms may include |
| | *[[Nausea and vomiting|Nausea]] |
| | *[[Anorexia]] |
| | *[[Epigastric pain]] |
| | | style="background:#F5F5F5;" + | |
| | *Stool microscopy |
| | *Peripheral [[eosinophilia]] |
| | *ELISA |
| | *PCR |
| | | style="background:#F5F5F5;" + | |
| | *[[Albendazole]] |
| |- | | |- |
| |Tinidazole | | ! style="background:#DCDCDC;" align="center" + |[[Trichuriasis]] |
| |2 g orally, single dose | | | style="background:#DCDCDC;" align="center" + |''Trichuris trichiura'' |
| |Age ≥3 years: 50 mg/kg orally, single dose (maximum dose 2 g) | | | style="background:#F5F5F5;" + | |
| | *Ingestion of [[Fertilised|embryonated]]<nowiki/>eggs from contaminated drinking water and food. |
| | | style="background:#F5F5F5;" + | |
| | * 600-800 million people are infected worldwide. |
| | | style="background:#F5F5F5;" + | |
| | *[[Endemic (epidemiology)|Endemic]] in [[Tropical disease|tropical]] and subtropical countries. |
| | * Southern United States |
| | *Incidence and prevalence rates are highest in children living in |
| | **Sub-Saharan Africa |
| | **Asia |
| | **Latin America |
| | **Caribbean |
| | | style="background:#F5F5F5;" + | |
| | *Asymptomatic<ref name="pmid979858622">{{cite journal| author=Forrester JE, Bailar JC, Esrey SA, José MV, Castillejos BT, Ocampo G| title=Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children. | journal=Lancet | year= 1998 | volume= 352 | issue= 9134 | pages= 1103-8 | pmid=9798586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798586 }}</ref> |
| | *Loose stool which may contain [[mucus]] and [[blood]] |
| | *Nocturnal stooling |
| | *[[Rectal prolapse]] |
| | | style="background:#F5F5F5;" + | |
| | *Stool microscopy |
| | *[[Proctoscopy]] |
| | **Demonstrates adult worms protruding from the bowel [[Mucous membrane|mucosa]]. |
| | *[[Eosinophilia]] |
| | *[[Polymerase chain reaction]] |
| | | style="background:#F5F5F5;" + | |
| | *[[Mebendazole]]<ref name="pmid63781092">{{cite journal| author=Rossignol JF, Maisonneuve H| title=Benzimidazoles in the treatment of trichuriasis: a review. | journal=Ann Trop Med Parasitol | year= 1984 | volume= 78 | issue= 2 | pages= 135-44 | pmid=6378109 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6378109 }}</ref> |
| | **500 mg PO q24h X 3 day '''(or)''' |
| | **100 mg PO q12h x 2 days |
| | *[[Albendazole]]<ref name="pmid219803732">{{cite journal| author=Steinmann P, Utzinger J, Du ZW, Jiang JY, Chen JX, Hattendorf J et al.| title=Efficacy of single-dose and triple-dose albendazole and mebendazole against soil-transmitted helminths and Taenia spp.: a randomized controlled trial. | journal=PLoS One | year= 2011 | volume= 6 | issue= 9 | pages= e25003 | pmid=21980373 | doi=10.1371/journal.pone.0025003 | pmc=3181256 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21980373 }}</ref> |
| | **400 mg POq24h |
| |- | | |- |
| |Nitazoxanide | | ! style="background:#DCDCDC;" align="center" + |[[Hymenolepiasis]] |
| |500 mg orally two times per day for three days | | | style="background:#DCDCDC;" align="center" + |''Hymenolepis nana'' |
| |Age 1 to 3 years: 100 mg orally two times per day for 3 days | | | style="background:#F5F5F5;" + | |
| | | *Ingestion of infected eggs |
| Age 4 to 11 years: 200 mg orally two times per day for 3 days
| | | style="background:#F5F5F5;" + | |
| Age ≥12 years: Same as adult dose
| | * 50-75 million carriers of ''H. nana.'' |
| | * 5 to 25% prevalence among children worldwide. |
| | | style="background:#F5F5F5;" + |Most common in temperate zones<ref name="pmid194568362">{{cite journal| author=Utzinger J, Botero-Kleiven S, Castelli F, Chiodini PL, Edwards H, Köhler N et al.| title=Microscopic diagnosis of sodium acetate-acetic acid-formalin-fixed stool samples for helminths and intestinal protozoa: a comparison among European reference laboratories. | journal=Clin Microbiol Infect | year= 2010 | volume= 16 | issue= 3 | pages= 267-73 | pmid=19456836 | doi=10.1111/j.1469-0691.2009.02782.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19456836 }}</ref> |
| | *South Europe |
| | *Russia |
| | *India |
| | *US |
| | *Latin America |
| | | style="background:#F5F5F5;" + | |
| | *Asymptomatic<ref name="pmid265355132">{{cite journal| author=Muehlenbachs A, Bhatnagar J, Agudelo CA, Hidron A, Eberhard ML, Mathison BA et al.| title=Malignant Transformation of Hymenolepis nana in a Human Host. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 19 | pages= 1845-52 | pmid=26535513 | doi=10.1056/NEJMoa1505892 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26535513 }}</ref> |
| | *Heavy infections with >1000 worms can occur |
| | **Crampy [[abdominal pain]] |
| | **Diarrhea |
| | **Anorexia |
| | **Fatigue |
| | **Pruritus ani |
| | | style="background:#F5F5F5;" + | |
| | *Stool microscopy |
| | **FLOTAC method<ref name="pmid224610062">{{cite journal| author=Steinmann P, Cringoli G, Bruschi F, Matthys B, Lohourignon LK, Castagna B et al.| title=FLOTAC for the diagnosis of Hymenolepis spp. infection: proof-of-concept and comparing diagnostic accuracy with other methods. | journal=Parasitol Res | year= 2012 | volume= 111 | issue= 2 | pages= 749-54 | pmid=22461006 | doi=10.1007/s00436-012-2895-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22461006 }}</ref> |
| | | style="background:#F5F5F5;" + | |
| | *[[Praziquantel]]<ref name="pmid236187732">{{cite journal| author=Ohnishi K, Sakamoto N, Kobayashi K, Iwabuchi S, Nakamura-Uchiyama F| title=Therapeutic effect of praziquantel against Taeniasis asiatica. | journal=Int J Infect Dis | year= 2013 | volume= 17 | issue= 8 | pages= e656-7 | pmid=23618773 | doi=10.1016/j.ijid.2013.02.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23618773 }}</ref> |
| | *Prompt family screening or empiric treatment<ref name="pmid19805722">{{cite journal| author=Pawłowski ZS| title=Efficacy of low doses of praziquantel in taeniasis. | journal=Acta Trop | year= 1990 | volume= 48 | issue= 2 | pages= 83-8 | pmid=1980572 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1980572 }}</ref> |
| |} | | |} |
|
| |
| [[File:Giardia lamblia cytology.jpg|300px|center|thumb|Giardia lamblia cytology, source: By Jerad M Gardner, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15125058]]
| |
| [[File:Giardia lamblia 11.png|300px|center|thumb|, source: By CDC/Alexander J. da Silva, PhD/Melanie Moser - NIH, or CDC, or CDC PHIL #3394., Public Domain, https://commons.wikimedia.org/w/index.php?curid=3195726]]
| |
|
| |
| == Fasciola Hepaticum ==
| |
| * Fasciola infection is endemic in Central and South America, Asia (China, Vietnam, Taiwan, Korea, and Thailand), Europe (Portugal, France, Spain, and Turkey), Africa, and the Middle East.
| |
| * Children and women are the highest risk groups. It is highly infectious and in some endemic areas to the extent of infecting 100% of the individuals.
| |
| ==== '''Clinical manifestations''' ====
| |
| * Many infections are mild. Forms of infection include two phases; the acute liver phase and chronic biliary phase.<ref name="pmid16258225">{{cite journal| author=Adachi S, Kotani K, Shimizu T, Tanaka K, Shimizu T, Okada K| title=Asymptomatic fascioliasis. | journal=Intern Med | year= 2005 | volume= 44 | issue= 9 | pages= 1013-5 | pmid=16258225 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16258225 }}</ref>
| |
| '''Acute phase'''
| |
| * The early phase is associated with fever, anorexia, nausea, vomiting, myalgia, cough, right upper quadrant pain, hematomas of the liver, jaundice, and hepatomegaly.<ref name="pmid2822181">{{cite journal| author=Chan CW, Lam SK| title=Diseases caused by liver flukes and cholangiocarcinoma. | journal=Baillieres Clin Gastroenterol | year= 1987 | volume= 1 | issue= 2 | pages= 297-318 | pmid=2822181 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2822181 }}</ref>
| |
| * Acute symptoms last for six weeks.
| |
| * Complications include focal neurologic changes, pericarditis, arrhythmia, and right-sided pleural effusion.<ref name="pmid7837967">{{cite journal| author=Arjona R, Riancho JA, Aguado JM, Salesa R, González-Macías J| title=Fascioliasis in developed countries: a review of classic and aberrant forms of the disease. | journal=Medicine (Baltimore) | year= 1995 | volume= 74 | issue= 1 | pages= 13-23 | pmid=7837967 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7837967 }}</ref>
| |
| '''Chronic phase'''
| |
| * This phase is usually asymptomatic.<ref name="pmid18725803">{{cite journal| author=Marcos LA, Terashima A, Gotuzzo E| title=Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis. | journal=Curr Opin Infect Dis | year= 2008 | volume= 21 | issue= 5 | pages= 523-30 | pmid=18725803 | doi=10.1097/QCO.0b013e32830f9818 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18725803 }}</ref>
| |
| * Common bile duct obstruction can develop, and chronic infection can lead to biliary colic, cholangitis, cholelithiasis, and obstructive jaundice.
| |
| * Pancreatitis has been reported in 30 percent of cases. Peripheral eosinophilia may disappear.<ref name="pmid22171131">{{cite journal| author=Kaya M, Beştaş R, Cetin S| title=Clinical presentation and management of Fasciola hepatica infection: single-center experience. | journal=World J Gastroenterol | year= 2011 | volume= 17 | issue= 44 | pages= 4899-904 | pmid=22171131 | doi=10.3748/wjg.v17.i44.4899 | pmc=3235633 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22171131 }}</ref>
| |
| '''Complications'''
| |
| * Ascending cholangitis are biliary obstruction may be developed.<ref name="pmid8781945">{{cite journal| author=Dias LM, Silva R, Viana HL, Palhinhas M, Viana RL| title=Biliary fascioliasis: diagnosis, treatment and follow-up by ERCP. | journal=Gastrointest Endosc | year= 1996 | volume= 43 | issue= 6 | pages= 616-20 | pmid=8781945 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8781945 }}</ref>
| |
| '''Diagnosis'''
| |
| * Diagnosis of fascioliasis should be associated with evaluation of family members.<ref name="pmid221711312">{{cite journal| author=Kaya M, Beştaş R, Cetin S| title=Clinical presentation and management of Fasciola hepatica infection: single-center experience. | journal=World J Gastroenterol | year= 2011 | volume= 17 | issue= 44 | pages= 4899-904 | pmid=22171131 | doi=10.3748/wjg.v17.i44.4899 | pmc=3235633 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22171131 }}</ref>
| |
| '''Microscopy'''
| |
| * The diagnosis can be established by identifying eggs in stool, duodenal aspirates, or bile specimens.<ref name="pmid1588869">{{cite journal| author=Prociv P, Walker JC, Whitby M| title=Human ectopic fascioliasis in Australia: first case reports. | journal=Med J Aust | year= 1992 | volume= 156 | issue= 5 | pages= 349-51 | pmid=1588869 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1588869 }}</ref>
| |
| * Eggs are not detectable in stool during the acute phase of infection.
| |
| * Examination of multiple specimens may be needed or concentration of specimens to facilitate egg identification.<ref name="pmid158874">{{cite journal| author=Acosta-Ferreira W, Vercelli-Retta J, Falconi LM| title=Fasciola hepatica human infection. Histopathological study of sixteen cases. | journal=Virchows Arch A Pathol Anat Histol | year= 1979 | volume= 383 | issue= 3 | pages= 319-27 | pmid=158874 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=158874 }}</ref>
| |
| '''Serology'''
| |
| * It is useful for cases of absent eggs in the stool, early cases and ectopic cases.
| |
| * Serologic tests include:
| |
| * Indirect hemagglutination
| |
| * Complement fixation
| |
| * Enzyme-linked immunosorbent assay
| |
| '''Imaging'''
| |
| * Computed tomography and magnetic resonance imaging radiographic findings in fascioliasis are vmultiple small nodules, thickening of the liver capsule, subcapsular hematoma, or parenchymal calcifications or tortuous tracks due to migration of the parasite through the liver.<ref name="pmid12541122">{{cite journal| author=Cevikol C, Karaali K, Senol U, Kabaalioğlu A, Apaydin A, Saba R et al.| title=Human fascioliasis: MR imaging findings of hepatic lesions. | journal=Eur Radiol | year= 2003 | volume= 13 | issue= 1 | pages= 141-8 | pmid=12541122 | doi=10.1007/s00330-002-1470-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12541122 }}</ref>
| |
| * Necrotic areas may be seen especially in larger lesions. Peri-portal lymphadenopathy and hepatomegaly and/or splenomegaly may be seen, especially in acute fascioliasis.<ref name="pmid25425366">{{cite journal| author=Teke M, Önder H, Çiçek M, Hamidi C, Göya C, Çetinçakmak MG et al.| title=Sonographic findings of hepatobiliary fascioliasis accompanied by extrahepatic expansion and ectopic lesions. | journal=J Ultrasound Med | year= 2014 | volume= 33 | issue= 12 | pages= 2105-11 | pmid=25425366 | doi=10.7863/ultra.33.12.2105 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25425366 }}</ref>
| |
| '''Treatment'''
| |
| * The treatment of choice is triclabendazole. Dosing consists of 10 mg/kg orally for one or two days. Bithionol and nitazoxanide are alternative choices.<ref name="pmid15264986">{{cite journal| author=Keiser J, Utzinger J| title=Chemotherapy for major food-borne trematodes: a review. | journal=Expert Opin Pharmacother | year= 2004 | volume= 5 | issue= 8 | pages= 1711-26 | pmid=15264986 | doi=10.1517/14656566.5.8.1711 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15264986 }}</ref>
| |
|
| |
| == Schistosoma ==
| |
| * The prevalence of schistosomiasis is highest in sub-Saharan Africa.<ref name="pmid23041540">{{cite journal| author=Gower CM, Gouvras AN, Lamberton PH, Deol A, Shrivastava J, Mutombo PN et al.| title=Population genetic structure of Schistosoma mansoni and Schistosoma haematobium from across six sub-Saharan African countries: implications for epidemiology, evolution and control. | journal=Acta Trop | year= 2013 | volume= 128 | issue= 2 | pages= 261-74 | pmid=23041540 | doi=10.1016/j.actatropica.2012.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23041540 }}</ref>
| |
| * Approximately 200 million people are infected annually with 200,000 deaths per year.
| |
|
| |
| === '''Clinical presentation''' ===
| |
|
| |
| ===== '''Acute schistosomiasis syndrome''' =====
| |
| * Clinical manifestations include sudden onset of fever, urticaria, angioedema, chills, myalgias, arthralgias, dry cough, diarrhea, abdominal pain, and headache.<ref name="pmid8599059">{{cite journal| author=Rocha MO, Rocha RL, Pedroso ER, Greco DB, Ferreira CS, Lambertucci JR et al.| title=Pulmonary manifestations in the initial phase of schistosomiasis mansoni. | journal=Rev Inst Med Trop Sao Paulo | year= 1995 | volume= 37 | issue= 4 | pages= 311-8 | pmid=8599059 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8599059 }}</ref>
| |
| * The symptoms are usually relatively mild and resolve spontaneously over a period of a few days to a few weeks.<ref name="pmid17488923">{{cite journal| author=Jauréguiberry S, Ansart S, Perez L, Danis M, Bricaire F, Caumes E| title=Acute neuroschistosomiasis: two cases associated with cerebral vasculitis. | journal=Am J Trop Med Hyg | year= 2007 | volume= 76 | issue= 5 | pages= 964-6 | pmid=17488923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17488923 }}</ref>
| |
|
| |
| ===== '''Chronic infection''' =====
| |
| * Chronic infection related to schistosomiasis is most common among individuals in endemic areas.<ref name="pmid8254164">{{cite journal| author=Lucey DR, Maguire JH| title=Schistosomiasis. | journal=Infect Dis Clin North Am | year= 1993 | volume= 7 | issue= 3 | pages= 635-53 | pmid=8254164 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8254164 }}</ref>
| |
| '''Intestinal schistosomiasis'''
| |
| * Intestinal schistosomiasis is caused by infection due to ''S. mansoni'', ''S. japonicum'', ''S. intercalatum'', ''S. mekongi,'' and, occasionally, ''S. haematobium''.
| |
| * The most common symptoms include chronic or intermittent abdominal pain, poor appetite, and diarrhea, bleeding from colonic ulcers that may cause anemia if heavily infested.<ref name="pmid23465781">{{cite journal| author=Stothard JR, Sousa-Figueiredo JC, Betson M, Bustinduy A, Reinhard-Rupp J| title=Schistosomiasis in African infants and preschool children: let them now be treated! | journal=Trends Parasitol | year= 2013 | volume= 29 | issue= 4 | pages= 197-205 | pmid=23465781 | doi=10.1016/j.pt.2013.02.001 | pmc=3878762 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23465781 }}</ref>
| |
| * Granulomatous chronic inflammation surrounding eggs in the intestine wall is developed making polyps. Dysplasia is uncommon complication of chronic inflammation.<ref name="pmid27521443">{{cite journal| author=Mu A, Fernandes I, Phillips D| title=A 57-Year-Old Woman With a Cecal Mass. | journal=Clin Infect Dis | year= 2016 | volume= 63 | issue= 5 | pages= 703-5 | pmid=27521443 | doi=10.1093/cid/ciw413 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27521443 }}</ref>
| |
| * Intestinal stricture or obstruction is on the commonest complications.<ref name="pmid16416239">{{cite journal| author=Gabbi C, Bertolotti M, Iori R, Rivasi F, Stanzani C, Maurantonio M et al.| title=Acute abdomen associated with schistosomiasis of the appendix. | journal=Dig Dis Sci | year= 2006 | volume= 51 | issue= 1 | pages= 215-7 | pmid=16416239 | doi=10.1007/s10620-006-3111-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16416239 }}</ref>
| |
| '''Hepatosplenic schistosomiasis'''
| |
| * The left liver lobe is enlarged with splenomegy that may extend below the umbilicus. Increased portal hypertension is due to high resistance in the hepatic circulation.<ref name="pmid3124648">{{cite journal| author=Homeida M, Abdel-Gadir AF, Cheever AW, Bennett JL, Arbab BM, Ibrahium SZ et al.| title=Diagnosis of pathologically confirmed Symmers' periportal fibrosis by ultrasonography: a prospective blinded study. | journal=Am J Trop Med Hyg | year= 1988 | volume= 38 | issue= 1 | pages= 86-91 | pmid=3124648 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3124648 }}</ref>
| |
| * The predominant pathological process consists of collagen deposition in the periportal spaces causing periportal fibrosis.<ref name="pmid10441577">{{cite journal| author=Dessein AJ, Hillaire D, Elwali NE, Marquet S, Mohamed-Ali Q, Mirghani A et al.| title=Severe hepatic fibrosis in Schistosoma mansoni infection is controlled by a major locus that is closely linked to the interferon-gamma receptor gene. | journal=Am J Hum Genet | year= 1999 | volume= 65 | issue= 3 | pages= 709-21 | pmid=10441577 | doi=10.1086/302526 | pmc=1377977 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10441577 }}</ref>
| |
| * This leads to occlusion of the portal veins, portal hypertension with splenomegaly, portocaval shunting, and gastrointestinal varices.
| |
| '''Pulmonary complications'''
| |
| * Pulmonary manifestations of schistosomiasis occur most frequently among patients with hepatosplenic disease due to chronic infection with ''S. mansoni'', ''S. japonicum'', or ''S. haematobium.''
| |
| * Dyspnea is the primary clinical manifestation.<ref name="pmid3722898">{{cite journal| author=Sarwat AK, Tag el Din MA, Bassiouni M, Ashmawi SS| title=Schistosomiasis of the lung. | journal=J Egypt Soc Parasitol | year= 1986 | volume= 16 | issue= 1 | pages= 359-66 | pmid=3722898 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3722898 }}</ref>
| |
| * Chest radiography demonstrates fine miliary nodules.<ref name="pmid13627419">{{cite journal| author=FARID Z, GREER JW, ISHAK KG, EL-NAGAH AM, LEGOLVAN PC, MOUSA AH| title=Chronic pulmonary schistosomiasis. | journal=Am Rev Tuberc | year= 1959 | volume= 79 | issue= 2 | pages= 119-33 | pmid=13627419 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13627419 }}</ref>
| |
|
| |
| ===== '''Genitourinary schistosomiasis''' =====
| |
| * In early infection, eggs are excreted in the urine and patients present with microscopic or macroscopic hematuria and/or pyuria.<ref name="pmid16547578">{{cite journal| author=Silva IM, Thiengo R, Conceição MJ, Rey L, Pereira Filho E, Ribeiro PC| title=Cystoscopy in the diagnosis and follow-up of urinary schistosomiasis in Brazilian soldiers returning from Mozambique, Africa. | journal=Rev Inst Med Trop Sao Paulo | year= 2006 | volume= 48 | issue= 1 | pages= 39-42 | pmid=16547578 | doi=/S0036-46652006000100008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16547578 }}</ref>
| |
| * Blood is usually seen at the end of voiding terminal hematuria, although in severe cases hematuria may be observed for the entire duration of voiding.
| |
| * In early chronic infection, the eggs provoke granulomatous inflammation, ulcerations, and development of pseudopolyps in the vesical and ureteral walls, which may be observed on cystoscopy and mimic malignancy.<ref name="pmid16997665">{{cite journal| author=Gryseels B, Polman K, Clerinx J, Kestens L| title=Human schistosomiasis. | journal=Lancet | year= 2006 | volume= 368 | issue= 9541 | pages= 1106-18 | pmid=16997665 | doi=10.1016/S0140-6736(06)69440-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16997665 }}</ref>
| |
| '''Laboratory findings'''
| |
| * Eosinophilia is observed in 30 to 60 percent of patients. Eosinophilia is very common among patients with acute schistosomiasis infection.<ref name="pmid7042854">{{cite journal| author=Mahmoud AA| title=The ecology of eosinophils in schistosomiasis. | journal=J Infect Dis | year= 1982 | volume= 145 | issue= 5 | pages= 613-22 | pmid=7042854 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7042854 }}</ref>
| |
| * Anemia and thrombocytopenia may be observed secondary to splenic sequestration in an enlarged spleen.
| |
| * Liver enzymes are near normal even if hepatic fibrosis occurred in most cases.
| |
| * Hematuria may occur with ''S. haematobium'' infection due to deposition of eggs in the urinary bladder wall.
| |
|
| |
| ===== '''Microscopy''' =====
| |
| * Identification of schistosome eggs in a stool or urine sample via microscopy is the gold standard for the diagnosis of schistosomiasis with low sensitivity and high specificity.
| |
|
| |
| ===== '''Infection intensity''' =====
| |
| * The intensity of intestinal schistosomiasis is classified as:
| |
| * Light: up to 100 eggs per gram
| |
| * Moderate: 100 to 400 eggs per gram
| |
| * Severe: >400 eggs per gram
| |
| * The intensity of urinary schistosomiasis is classified as:
| |
| * Light to moderate: up to 50 eggs/10 mL
| |
| * Severe: >50 eggs/10 mL
| |
|
| |
| ===== '''Serology''' =====
| |
| * Schistosome antigens including extracts of adult worms, cercarial antigens can develop antibodies that may be used in serology test.<ref name="pmid1802520">{{cite journal| author=Tsang VC, Wilkins PP| title=Immunodiagnosis of schistosomiasis. Screen with FAST-ELISA and confirm with immunoblot. | journal=Clin Lab Med | year= 1991 | volume= 11 | issue= 4 | pages= 1029-39 | pmid=1802520 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1802520 }}</ref>
| |
| * Serology is used as screening mainly because of low sensitivity.
| |
| * Serologic tests include:
| |
| * Indirect hemagglutination
| |
| * Complement fixation
| |
| * Enzyme-linked immunosorbent assay
| |
|
| |
| ===== '''Molecular tests''' =====
| |
| * PCR on urine samples noted sensitivity and specificity of 94 and 100 percent, respectively.
| |
| * ''S. mansoni'' PCR sensitivity is 100 percent and specificity is 90 percent.<ref name="pmid19646307">{{cite journal| author=Webster BL, Rollinson D, Stothard JR, Huyse T| title=Rapid diagnostic multiplex PCR (RD-PCR) to discriminate Schistosoma haematobium and S. bovis. | journal=J Helminthol | year= 2010 | volume= 84 | issue= 1 | pages= 107-14 | pmid=19646307 | doi=10.1017/S0022149X09990447 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19646307 }}</ref>
| |
|
| |
| ===== '''Biopsy''' =====
| |
| * Histopathology of superficial rectal biopsies is more sensitive than stool microscopy and may demonstrate eggs even when multiple stool specimens are negative.<ref name="pmid2867326">{{cite journal| author=Harries AD, Fryatt R, Walker J, Chiodini PL, Bryceson AD| title=Schistosomiasis in expatriates returning to Britain from the tropics: a controlled study. | journal=Lancet | year= 1986 | volume= 1 | issue= 8472 | pages= 86-8 | pmid=2867326 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2867326 }}</ref>
| |
|
| |
| === '''Treatment''' ===
| |
| * Praziquantel is the drug of choice for schistosomiasis. It increases calcium ion permeability. Calcium ions accumulate in the cytosol, leading to muscular contractions and subsequent paralysis.<ref name="pmid24955523">{{cite journal| author=Cioli D, Pica-Mattoccia L, Basso A, Guidi A| title=Schistosomiasis control: praziquantel forever? | journal=Mol Biochem Parasitol | year= 2014 | volume= 195 | issue= 1 | pages= 23-9 | pmid=24955523 | doi=10.1016/j.molbiopara.2014.06.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24955523 }}</ref>
| |
| * Praziquantel side effects include dizziness, headache, vomiting, abdominal pain, diarrhea, and pruritus.<ref name="pmid1841998">{{cite journal| author=Araújo N, Kohn A, Katz N| title=Activity of the artemether in experimental schistosomiasis mansoni. | journal=Mem Inst Oswaldo Cruz | year= 1991 | volume= 86 Suppl 2 | issue= | pages= 185-8 | pmid=1841998 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1841998 }}</ref>
| |
|
| |
| * Oxamniquine can be used for refractory schistosomiasis infection and may be as effective as praziquantel.
| |
| [[File:Schistosoma mansoni.jpg|300px|center|thumb|Schistosoma mansoni egg, source: By US federal government - Work of US federal government, Public Domain, https://commons.wikimedia.org/w/index.php?curid=218201]]
| |
| [[File:Couple of Schistosoma mansoni.jpg|center|300px|thumb|Couple of Schistosoma mansoni, source: CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=55038168]]
| |
|
| |
| == Strongyloidis Stercoralis ==
| |
| * In tropical and subtropical regions, the prevalence of Strongyloidis Stercoralis infection may exceed 25 percent.<ref name="pmid28882382">{{cite journal| author=Jourdan PM, Lamberton PHL, Fenwick A, Addiss DG| title=Soil-transmitted helminth infections. | journal=Lancet | year= 2017 | volume= | issue= | pages= | pmid=28882382 | doi=10.1016/S0140-6736(17)31930-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28882382 }}</ref>
| |
| * The highest rates of infection in the United States are among residents of the southeastern states and among individuals who have been in endemic areas.
| |
| '''Gastrointestinal symptoms'''
| |
|
| |
| The most common manifestations of the hyperinfection syndrome include:<ref name="pmid362122">{{cite journal| author=Scowden EB, Schaffner W, Stone WJ| title=Overwhelming strongyloidiasis: an unappreciated opportunistic infection. | journal=Medicine (Baltimore) | year= 1978 | volume= 57 | issue= 6 | pages= 527-44 | pmid=362122 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=362122 }}</ref>
| |
| * Fever
| |
| * Nausea and vomiting
| |
| * Anorexia
| |
| * Diarrhea
| |
| * Abdominal pain
| |
| * Dyspnea
| |
| * Wheezing
| |
| * Hemoptysis
| |
| * Cough
| |
|
| |
| === '''Diagnosis''' ===
| |
| * Enterotest: Aspiration of duodenojejunal fluid or the use of a string test is sometimes used to detect ''Strongyloides'' larvae in patients with negative stool samples.<ref name="pmid18589879">{{cite journal| author=Boulware DR, Stauffer WM, Walker PF| title=Hypereosinophilic syndrome and mepolizumab. | journal=N Engl J Med | year= 2008 | volume= 358 | issue= 26 | pages= 2839; author reply 2839-40 | pmid=18589879 | doi= | pmc=2596663 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18589879 }}</ref>
| |
| * Polymerase chain reaction tests have also been developed for detection of ''Strongyloides ''in stool samples and have been found to be more sensitive and more reliable in detection of ''S. stercoralis'' compared with parasitological methods.
| |
| '''Serology'''
| |
| * ELISA against ''strongyloides'' antigens has been proven as useful in diagnosis of immunocompetent individuals.<ref name="pmid7036430">{{cite journal| author=Carroll SM, Karthigasu KT, Grove DI| title=Serodiagnosis of human strongyloidiasis by an enzyme-linked immunosorbent assay. | journal=Trans R Soc Trop Med Hyg | year= 1981 | volume= 75 | issue= 5 | pages= 706-9 | pmid=7036430 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7036430 }}</ref>
| |
| * ELISA results can be falsely negative in immunocompromised hosts.
| |
| '''Endoscopy'''
| |
| * Upper endoscopy is not usual diagnostic test. Strongyloidiasis has a broad range of endoscopic features:<ref name="pmid9248183">{{cite journal| author=Sreenivas DV, Kumar A, Kumar YR, Bharavi C, Sundaram C, Gayathri K| title=Intestinal strongyloidiasis--a rare opportunistic infection. | journal=Indian J Gastroenterol | year= 1997 | volume= 16 | issue= 3 | pages= 105-6 | pmid=9248183 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9248183 }}</ref>
| |
| * In the duodenum, the findings included edema, brown discoloration of the mucosa, erythematous spots, subepithelial hemorrhages, and megaduodenum.
| |
| * In the colon, the findings include loss of vascular pattern, edema, aphthous ulcers, erosions, serpiginous ulcerations, and xanthoma-like lesions.
| |
| * In the stomach, thickened folds and mucosal erosions are seen.<ref name="pmid19144377">{{cite journal| author=Qu Z, Kundu UR, Abadeer RA, Wanger A| title=Strongyloides colitis is a lethal mimic of ulcerative colitis: the key morphologic differential diagnosis. | journal=Hum Pathol | year= 2009 | volume= 40 | issue= 4 | pages= 572-7 | pmid=19144377 | doi=10.1016/j.humpath.2008.10.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19144377 }}</ref>
| |
| '''Treatment'''
| |
| * Ivermectin is the preferred drug for treatment. Administered as two single 200 mcg/kg doses of ivermectin administered on two consecutive days.<ref name="pmid11957127">{{cite journal| author=Zaha O, Hirata T, Kinjo F, Saito A, Fukuhara H| title=Efficacy of ivermectin for chronic strongyloidiasis: two single doses given 2 weeks apart. | journal=J Infect Chemother | year= 2002 | volume= 8 | issue= 1 | pages= 94-8 | pmid=11957127 | doi=10.1007/s101560200013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11957127 }}</ref>
| |
| '''Albendazole'''
| |
| * Albendazole (400 mg by mouth on empty stomach twice daily for three to seven days) also has activity against ''Strongyloides''.<ref name="pmid8483992">{{cite journal| author=Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR| title=Albendazole is effective treatment for chronic strongyloidiasis. | journal=Q J Med | year= 1993 | volume= 86 | issue= 3 | pages= 191-5 | pmid=8483992 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8483992 }}</ref>
| |
| [[File:Strongyloides1.jpg|300px|center|thumb|Strongyloides Stercoralis, source: Public Domain, https://commons.wikimedia.org/w/index.php?curid=219824]]
| |
|
| |
| == E. Histolytica (Amebiasis) ==
| |
| * Areas with high rates of amebic infection include India, Africa, Mexico, and parts of Central and South America. The overall prevalence of amebic infection may be as high as 50 percent in some areas.
| |
| * Infection with ''E. dispar'' occurs approximately 10 times more frequently than infection with ''E. histolytica.''<ref name="pmid2324531">{{cite journal| author=Weinke T, Friedrich-Jänicke B, Hopp P, Janitschke K| title=Prevalence and clinical importance of Entamoeba histolytica in two high-risk groups: travelers returning from the tropics and male homosexuals. | journal=J Infect Dis | year= 1990 | volume= 161 | issue= 5 | pages= 1029-31 | pmid=2324531 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2324531 }}</ref>
| |
| ==== Clinical presentation ====
| |
| * The majority of entamoeba infections are asymptomatic; this includes 90 percent of ''E. histolytica''infections.<ref name="pmid20617021">{{cite journal| author=Ximénez C, Cerritos R, Rojas L, Dolabella S, Morán P, Shibayama M et al.| title=Human amebiasis: breaking the paradigm? | journal=Int J Environ Res Public Health | year= 2010 | volume= 7 | issue= 3 | pages= 1105-20 | pmid=20617021 | doi=10.3390/ijerph7031105 | pmc=2872301 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20617021 }}</ref>
| |
|
| |
| * Clinical amebiasis generally has a subacute onset, usually over one to three weeks. Symptoms range from mild diarrhea to severe dysentery, producing abdominal pain (12 to 80 percent), diarrhea (94 to 100 percent), and bloody stools (94 to 100 percent), to fulminant amebic colitis.
| |
| * Weight loss occurs in about half of patients, and fever occurs in up to 38 percent.<ref name="pmid19370624">{{cite journal| author=Gonzales ML, Dans LF, Martinez EG| title=Antiamoebic drugs for treating amoebic colitis. | journal=Cochrane Database Syst Rev | year= 2009 | volume= | issue= 2 | pages= CD006085 | pmid=19370624 | doi=10.1002/14651858.CD006085.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19370624 }}</ref>
| |
| * Amebic dysentery is diarrhea with visible blood and mucus in stools and the presence of hematophagous trophozoites (trophozoites with ingested red blood cells) in stools or tissues.
| |
| * Fulminant colitis with bowel necrosis leading to perforation, and peritonitis has been observed in approximately 0.5 percent of cases; associated mortality rate is more than 40 percent. Toxic megacolon can also develop.
| |
| * Amebic colitis has been recognized in asymptomatic patients.<ref name="pmid16610001">{{cite journal| author=Misra SP, Misra V, Dwivedi M| title=Ileocecal masses in patients with amebic liver abscess: etiology and management. | journal=World J Gastroenterol | year= 2006 | volume= 12 | issue= 12 | pages= 1933-6 | pmid=16610001 | doi= | pmc=4087520 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16610001 }}</ref>
| |
|
| |
| === '''Diagnosis''' ===
| |
| '''Stool microscopy'''
| |
| * The demonstration of cysts or trophozoites in the stool suggests intestinal amebiasis, but microscopy cannot differentiate between ''E. histolytica'' and ''E. dispar'' or ''E. moshkovskii'' strains. In addition, microscopy requires specialized expertise and is subject to operator error.<ref name="pmid16333901">{{cite journal| author=Rayan HZ| title=Microscopic overdiagnosis of intestinal amoebiasis. | journal=J Egypt Soc Parasitol | year= 2005 | volume= 35 | issue= 3 | pages= 941-51 | pmid=16333901 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16333901 }}</ref>
| |
| '''Antigen testing'''
| |
| * Stool and serum antigen detection assays that use monoclonal antibodies to bind to epitopes present on pathogenic ''E. histolytica'' strains (but not on nonpathogenic ''E. dispar'' strains) are commercially available for diagnosis of ''E. histolytica'' infection.<ref name="pmid1340315">{{cite journal| author=González-Ruíz A, Haque R, Rehman T, Aguirre A, Castañón G, Hall A et al.| title=Further diagnostic use of an invasive-specific monoclonal antibody against Entamoeba histolytica. | journal=Arch Med Res | year= 1992 | volume= 23 | issue= 2 | pages= 281-3 | pmid=1340315 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1340315 }}</ref>
| |
| * Antigen detection kits using enzyme-linked immunosorbent assay (ELISA), radioimmunoassay, or immunofluorescence have been developed.
| |
| * Antigen detection has many advantages, including ease and rapidity of the tests, capacity to differentiate between strains, greater sensitivity than microscopy, and potential for diagnosis in early infection and in endemic areas.
| |
| '''Serology'''
| |
| * Antibodies are detectable within five to seven days of acute infection and may persist for years.
| |
| * Approximately 10 to 35 percent of uninfected individuals in endemic areas have antiamebic antibodies due to previous infection with ''E. histolytica''.
| |
| * Negative serology is helpful for exclusion of disease, but positive serology cannot distinguish between acute and previous infection.
| |
| '''Molecular methods'''
| |
| * Techniques can detect ''E. histolytica'' in stool specimens.
| |
| * Studies have shown that PCR is significantly more sensitive than microscopy and that it was 100 percent specific for ''E. histolytica.''<ref name="pmid163339012">{{cite journal| author=Rayan HZ| title=Microscopic overdiagnosis of intestinal amoebiasis. | journal=J Egypt Soc Parasitol | year= 2005 | volume= 35 | issue= 3 | pages= 941-51 | pmid=16333901 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16333901 }}</ref>
| |
| * PCR is about 100 times more sensitive than fecal antigen tests.
| |
| '''Treatment'''
| |
| * All ''E. histolytica'' infections should be treated, even in the absence of symptoms, given the potential risk of developing invasive disease and the risk of spread to family members.<ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377 }}</ref>
| |
| * The goals of antibiotic therapy of intestinal amebiasis are to eliminate the invading trophozoites and to eradicate intestinal carriage of the organism.
| |
| [[File:Amebiasis LifeCycle.gif|300px|center|thumb|Amebiasis life cycle , source: By CDC - https://www.cdc.gov/dpdx/amebiasis/index.html, Public Domain, https://commons.wikimedia.org/w/index.php?curid=41751982]]
| |
| [[File:Ehistdisp cyst wtmt.jpg|300px|center|thumb|Amoebic cyst, source: By CDC’s Division of Parasitic Diseases - http://dpd.cdc.gov/DPDx/HTML/ImageLibrary/Amebiasis_il.htm, Public Domain, https://commons.wikimedia.org/w/index.php?curid=5030067 ]]
| |
|
| |
| == Taeniasis ==
| |
| '''Taeniasis'''
| |
| * There are two main species of human ''Taenia;'' ''Taenia saginata'', the beef tapeworm, and ''Taenia solium'', the pork tapeworm.<ref name="pmid9798586">{{cite journal| author=Forrester JE, Bailar JC, Esrey SA, José MV, Castillejos BT, Ocampo G| title=Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children. | journal=Lancet | year= 1998 | volume= 352 | issue= 9134 | pages= 1103-8 | pmid=9798586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798586 }}</ref>
| |
| * ''T. saginata ''occurs worldwide but is most common in areas where consumption of undercooked beef is customary, such as Europe and parts of Asia.
| |
|
| |
| ==== '''Clinical presentation''' ====
| |
| * Most human carriers of adult tapeworms are asymptomatic.
| |
| * Symptoms may include nausea, anorexia, or epigastric pain.
| |
| * A peripheral eosinophilia (up 15 percent) may be observed.
| |
|
| |
| ==== '''Diagnosis''' ====
| |
| * The diagnosis is generally established by identifying eggs or proglottids in the stool. The eggs of ''Taenia'' species are morphologically indistinguishable.
| |
| * Enzyme-linked immunosorbent assay for the detection of ''T. solium'' antigens in fecal samples and DNA hybridization techniques for the detection of eggs in stools can be used in case of failed eggs detection. [11-17].
| |
| * Polymerase chain reaction assays targeting various genomic regions have been developed for distinguishing between species of human ''Taenia'' infections.
| |
|
| |
| === Treatment ===
| |
| * Praziquantel is the treatment of choice for taeniasis.<ref name="pmid23618773" />
| |
| * Dosing for taeniasis is 5 to 10 mg/kg orally (single dose), although excellent efficacy against ''T. saginata'' infections has been reported at doses as low as 2.5 mg/kg.<ref name="pmid1980572">{{cite journal| author=Pawłowski ZS| title=Efficacy of low doses of praziquantel in taeniasis. | journal=Acta Trop | year= 1990 | volume= 48 | issue= 2 | pages= 83-8 | pmid=1980572 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1980572 }}</ref>
| |
| * Niclosamide is an acceptable alternative treatment for tapeworms if praziquantel is not available. Niclosamide comes in 500 mg tablets that need to be chewed; it is not available in the United States.
| |
| [[File:Taenia saginata LifeCycle.gif|300px|center|thumb|Taenia Saginata life cycle , source: By Centers for Disease Control & Prevention, National Center for Infectious Diseases, Division of Parasitic Diseases - Centers for Disease Control & Prevention, National Center for Infectious Diseases, Division of Parasitic DiseasesThe work compiled from original Life cycle of Taenia spp. - http://www.dpd.cdc.gov/dpdx/html/Taeniasis.htm, Public Domain, https://commons.wikimedia.org/w/index.php?curid=26668532]]
| |
|
| |
| == Trichuris trichiura ==
| |
| * Trichuris trichiura is a round worm that causes trichuriasis when it infects a human large intestine.
| |
| * It is commonly known as the ''whipworm'' which refers to the shape of the worm.
| |
| ''' Clinical manifestations'''
| |
| * Most infections with ''T. trichiura ''are asymptomatic.<ref name="pmid97985862">{{cite journal| author=Forrester JE, Bailar JC, Esrey SA, José MV, Castillejos BT, Ocampo G| title=Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children. | journal=Lancet | year= 1998 | volume= 352 | issue= 9134 | pages= 1103-8 | pmid=9798586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798586 }}</ref>
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| * Main symptoms are loose stool which may contain mucus and blood.
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| * Nocturnal stooling is common. Colitis and dysentery occur most frequently among individuals with >200 worms, and secondary anemia with pica may occur.
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| * Rectal prolapse can occur in heavily infested patients.
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| * Children who are heavily infected may have impaired growth and cognition.
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| '''Diagnosis'''
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| * The diagnosis of trichuriasis is made by stool examination for eggs.<ref name="pmid97985863">{{cite journal| author=Forrester JE, Bailar JC, Esrey SA, José MV, Castillejos BT, Ocampo G| title=Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children. | journal=Lancet | year= 1998 | volume= 352 | issue= 9134 | pages= 1103-8 | pmid=9798586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798586 }}</ref>
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| * Proctoscopy can be performed and frequently demonstrates adult worms protruding from the bowel mucosa.
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| * Polymerase chain reaction assays targeting various genomic regions are becoming available and are able to detect''T. trichiura worms''.<ref name="pmid24968666">{{cite journal| author=Phuphisut O, Yoonuan T, Sanguankiat S, Chaisiri K, Maipanich W, Pubampen S et al.| title=Triplex polymerase chain reaction assay for detection of major soil-transmitted helminths, Ascaris lumbricoides, Trichuris trichiura, Necator americanus, in fecal samples. | journal=Southeast Asian J Trop Med Public Health | year= 2014 | volume= 45 | issue= 2 | pages= 267-75 | pmid=24968666 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24968666 }}</ref>
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| * CBC shows peripheral eosinophilia of up to 15 percent and anemia.
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| '''Treatment'''
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| * Mebendazole is the drug of choice for trichuriasis: 500 mg once daily for three days or 100 mg orally twice daily for three days.<ref name="pmid6378109">{{cite journal| author=Rossignol JF, Maisonneuve H| title=Benzimidazoles in the treatment of trichuriasis: a review. | journal=Ann Trop Med Parasitol | year= 1984 | volume= 78 | issue= 2 | pages= 135-44 | pmid=6378109 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6378109 }}</ref>
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| * Albendazole is second-line treatment: 400 mg orally on empty stomach once daily.<ref name="pmid21980373">{{cite journal| author=Steinmann P, Utzinger J, Du ZW, Jiang JY, Chen JX, Hattendorf J et al.| title=Efficacy of single-dose and triple-dose albendazole and mebendazole against soil-transmitted helminths and Taenia spp.: a randomized controlled trial. | journal=PLoS One | year= 2011 | volume= 6 | issue= 9 | pages= e25003 | pmid=21980373 | doi=10.1371/journal.pone.0025003 | pmc=3181256 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21980373 }}</ref>
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| [[File:Trichuris trichiura.jpg|300px|center|thumb|Trichuris Trichiura, source: By Delorieux for Johann Gottfried Bremser - XIX tabulae : Anatomiam entozoorum illustrantes, congestae, nec non explicatione praeditae, Public Domain, https://commons.wikimedia.org/w/index.php?curid=11412733]]
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| == Hymenolepis Nana ==
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| * Hymenolepis Nana is a species though most common in temperate zones, and is one of the most common cestodes infecting humans, especially children.
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| * The prevalence of Hymenolepis Nana is higher in warm parts of South Europe, Russia, India, US and Latin America.<ref name="pmid19456836">{{cite journal| author=Utzinger J, Botero-Kleiven S, Castelli F, Chiodini PL, Edwards H, Köhler N et al.| title=Microscopic diagnosis of sodium acetate-acetic acid-formalin-fixed stool samples for helminths and intestinal protozoa: a comparison among European reference laboratories. | journal=Clin Microbiol Infect | year= 2010 | volume= 16 | issue= 3 | pages= 267-73 | pmid=19456836 | doi=10.1111/j.1469-0691.2009.02782.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19456836 }}</ref>
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| * Prevalence is 97% in Moscow children and 34% in Argentina children. It has been reported to affect 4 percent of schoolchildren in rural southeastern United States.
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| '''Clinical manifestations'''
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| * Most infections are asymptomatic, but symptoms become more common as the parasite burden increases.<ref name="pmid26535513">{{cite journal| author=Muehlenbachs A, Bhatnagar J, Agudelo CA, Hidron A, Eberhard ML, Mathison BA et al.| title=Malignant Transformation of Hymenolepis nana in a Human Host. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 19 | pages= 1845-52 | pmid=26535513 | doi=10.1056/NEJMoa1505892 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26535513 }}</ref>
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| * Heavy infections with >1000 worms can occur and are often associated with crampy abdominal pain, diarrhea, anorexia, fatigue, and pruritus ani.
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| '''Diagnosis'''
| |
| * The diagnosis is generally established by identifying eggs or proglottids in the stool.
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| * Eggs are 30 to 50 mcm in diameter. They contain an oncosphere and are covered with a thin hyaline outer membrane and a thick inner membrane.
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| * The sensitivity of stool microscopy can be increased by using concentration techniques such as the FLOTAC method.<ref name="pmid22461006">{{cite journal| author=Steinmann P, Cringoli G, Bruschi F, Matthys B, Lohourignon LK, Castagna B et al.| title=FLOTAC for the diagnosis of Hymenolepis spp. infection: proof-of-concept and comparing diagnostic accuracy with other methods. | journal=Parasitol Res | year= 2012 | volume= 111 | issue= 2 | pages= 749-54 | pmid=22461006 | doi=10.1007/s00436-012-2895-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22461006 }}</ref>
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| * Diagnosis of hymenolepiasis should prompt family screening or empiric treatment, given the potential for person-to-person spread.
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|
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| ==== Treatment ====
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| * Praziquantel is the treatment of choice for hymenolepiasis.<ref name="pmid23618773">{{cite journal| author=Ohnishi K, Sakamoto N, Kobayashi K, Iwabuchi S, Nakamura-Uchiyama F| title=Therapeutic effect of praziquantel against Taeniasis asiatica. | journal=Int J Infect Dis | year= 2013 | volume= 17 | issue= 8 | pages= e656-7 | pmid=23618773 | doi=10.1016/j.ijid.2013.02.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23618773 }}</ref>
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| * Dosing for hymenolepiasis is 25 mg/kgorally (single dose), followed by repeat dose 10 days later.<ref name="pmid1980572" />
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |