Abdominal parasitic infection: Difference between revisions

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[[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]]
[[File:Fertilized egg of Ascaris lumbricoides PHIL 410 lores.jpg|300px|center|thumb| +/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=781546]]
*
[[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]]
[[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]]


== 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|abdominal cramps,]] [[bloating]], [[Nausea and vomiting|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 [[ELISA test|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 lamblia|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 examination|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
|Children
|-
|[[Tinidazole]]
|2 g orally, single dose
|Age ≥3 years: 50 mg/kg orally, single dose (maximum dose 2 g)
|-
|[[Nitazoxanide]]
|500 mg orally two times per day for three days
|Age 1 to 3 years: 100 mg orally two times per day for 3 days
Age 4 to 11 years: 200 mg orally two times per day for 3 days
Age ≥12 years: Same as adult dose
|}
[[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 hepatica|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, and  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, [[Hematoma|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 signs|focal neurologic changes]], [[pericarditis]], [[Arrhythmias|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 [[Stools|stool]], [[duodenal]] aspirates, or [[Bile|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 [[Stools|stool]], early cases and ectopic cases.
* Serologic tests include:
* [[Hemagglutination assay|Indirect hemagglutination]]
* [[Complement fixation test|Complement fixation]]
* [[Enzyme linked immunosorbent assay (ELISA)|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 [[Calcification|calcifications]] or tortuous tracks due to migration of the [[Parasites|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 ''[[Schistosoma mansoni|S. mansoni]]'', ''[[Schistosoma japonicum|S. japonicum]]'', and ''[[Schistosoma haematobium|S. haematobium]]''.
* The most common symptoms include chronic or intermittent [[abdominal pain]], [[Appetite loss|poor appetite]], bleeding from [[Colon|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 lobe of [[liver]] 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 [[Schistosoma mansoni|''S. mansoni'',]] ''[[Schistosoma japonicum|S. japonicum]]'', or ''[[Schistosoma haematobium|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 [[Urinary bladder|bladder wal]]<nowiki/>l.
===== '''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:
{| class="wikitable"
!Infection Intensity
!Egss per gram
|-
|Light
|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:
** [[Hemagglutination|Indirect hemagglutination]]
** [[Complement fixation]]
** [[Enzyme-linked immunosorbent assay]]
===== '''Molecular tests''' =====
* [[PCR]] on urine samples noted sensitivity and specificity of 94 and 100 percent, respectively.
* ''[[Schistosoma mansoni|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 [[Strongyloides|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]]
* [[Wheeze|Wheezing]]
* [[Hemoptysis]]
* [[Cough]]
=== '''Diagnosis''' ===
* Aspiration of duodenojejunal fluid is sometimes used to detect ''[[Strongyloidiasis|Strongyloides]]'' larvae in patients with negative [[Stools|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 ''[[Strongyloides stercoralis|S. stercoralis]].''
'''Serology'''
* [[Enzyme linked immunosorbent assay (ELISA)|ELISA]] against ''[[Strongyloidiasis|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 include [[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''.''<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 [[Amoebiasis|amebiasis]] generally has a subacute onset, usually over one to three weeks. 
* Symptoms range from mild [[diarrhea]] to severe [[dysentery]], rarely 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 (tapeworm)|Taenia]];'' ''[[Taenia saginata]]'' (the beef [[Tapeworms|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 and vomiting|nausea]], [[anorexia]], or [[epigastric pain]].
* A peripheral [[eosinophilia]] may be observed.
==== '''Diagnosis''' ====
* The diagnosis is generally established by identifying eggs in the stool.
* [[Enzyme-linked immunosorbent assay]] for the detection of ''T. solium'' [[antigens]] in fecal samples and [[DNA hybridization]] can be used in case of failed eggs detection.
* [[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.
[[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 infection|whipworm]]'' due 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>
* Main symptoms are loose stool which may contain [[mucus]] and [[blood]].
* Nocturnal stooling is common. [[Colitis]] and [[dysentery]] occur most frequently among individuals with >200 worms, and secondary [[anemia]] with pica may occur.
* [[Rectal prolapse]] can occur in heavily infested patients.
* Children who are heavily infected may have impaired growth and cognition.
'''Diagnosis'''
* 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>
* [[Proctoscopy]] can be performed and frequently demonstrates adult worms protruding from the bowel [[Mucous membrane|mucosa]].
* [[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>
* [[Complete blood count|CBC]] shows peripheral [[eosinophilia]] of up to 15 percent and [[anemia]].
'''Treatment'''
* [[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>
* [[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>
[[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]]
== Hymenolepis Nana ==
* [[Hymenolepis infection|Hymenolepis Nana]] is a species most commonly in temperate zones, and is one of the most common [[cestodes]] infecting humans, especially children.
* 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>
* 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.
'''Clinical manifestations'''
* Most infections are asymptomatic.<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>
* Heavy infections with >1000 worms can occur and are often associated with crampy [[abdominal pain]], [[diarrhea]], [[anorexia]], [[fatigue]], and [[pruritus ani]].
'''Diagnosis'''
* The diagnosis is generally established by identifying eggs in the stool.
* The sensitivity of [[Stool examination|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>
* Diagnosis of [[hymenolepiasis]] should prompt family screening or empiric treatment, given the potential for person-to-person spread.
==== Treatment ====
* [[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>
* Dosing for hymenolepiasis is 25 mg/kg orally (single dose), followed by repeat dose 10 days later.<ref name="pmid1980572" />
[[File:H nana LifeCycle.gif|300px|center|thumb|Hymenolepis Nana life cycle , source: Public Domain, https://commons.wikimedia.org/w/index.php?curid=2936828]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 22:24, 15 March 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Abdominal parasitic infection Main page

Overview

Causes

Ascaris lumbricoides

Necator americanus

Giardia lamblia

Fasciola Hepaticum

Schistosoma

Strongyloidis Stercoralis

E. Histolytica (Amebiasis)

Taeniasis

Trichuris trichiura

Hymenolepis Nana

Overview

An intestinal parasite infection is a condition in which a parasite infects the 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 types are caused by Ascaris lumbricoides, Necator americanus, Fasciola, Schistosoma, Trichuris trichiura, Strongyloides stercoralis, Taenia, Hymenolepis nana, and Entamoeba histolytica. Ascaris lumbricoides is a common in Asia and during six to eight weeks after egg ingestion, symptoms of ascariasis are abdominal discomfort, anorexia, nausea, vomiting, and diarrhea. Stool microscopy is the most common diagnostic tool for evaluation of Ascaris ova and albendazole is the drug of choice for treatment. Necator americanus is common in rural areas of the US and presents with nausea, diarrhea, vomiting, and epigastric pain. Giardiasis is common in children and mountains hikers who drink water that has not been boiled. Most of the cases are asymptomatic but acute giardiasis symptoms include diarrhea, malaise, steatorrhea, abdominal cramps, bloating, nausea, and weight loss. ELISA is sensitive for detection of giardiasis and stool examination is specific. Tinidazole and nitazoxanide are the preferred drug for Giardiasis. Fasciola appears with fever, anorexia, nausea, vomiting, myalgia, cough, right upper quadrant pain, hematomas of the liver, jaundice, and hepatomegaly. Complications include focal neurologic changes, pericarditis, arrhythmia, and right-sided pleural effusion. 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. The treatment of choice is triclabendazole. Dosing consists of 10 mg/kg orally for one or two days. Bithionol and nitazoxanide are alternative choices. Intestinal schistosomiasis is caused by infection due to S. mansoni, S. japonicum, and S. haematobium. The most common symptoms include chronic or intermittent abdominal pain, poor appetite, bleeding from colonic ulcers that may cause anemia if heavily infested. The left lobe of liver is enlarged with splenomegaly that may extend below the umbilicus. Increased portal hypertension is due to high resistance in the hepatic circulation. The predominant pathological process consists of collagen deposition in the periportal spaces causing periportal fibrosis. Identification of schistosome eggs is the gold standard for the diagnosis of schistosomiasis with low sensitivity and high specificity. Serology is used as screening mainly because of low sensitivity. Praziquantel is the drug of choice for schistosomiasis. It increases calcium ion permeability. Calcium accumulate in the cytosol leading to muscular contractions and subsequent paralysis. Hymenolepis Nana is most common in temperate zones, and is one of the most common cestodes infecting humans, especially children. Most infections are asymptomatic. The diagnosis is generally established by identifying eggs in the stool. Praziquantel is the treatment of choice for hymenolepiasis. Most infections with T. trichiura are asymptomatic. Main symptoms are loose stool which may contain mucus and blood. The diagnosis of trichuriasis is made by stool examination for eggs. Mebendazole is the drug of choice for trichuriasis.

Causes

Abdominal Parasitic infections

The following table summarizes all the abdominal parasitic infections.

Parasitic Infection Mode of infection Epidemiology Clinical manifestations  Diagnosis Treatment
Disease Parasite Incidence Geographic distrubution
Ascariasis Ascaris lumbricoides
  • Ingestion of Ascaris eggs secreted in the feces of humans or pigs.[1]
  • Ingesting uncooked pig or chicken liver with the larvae.
  • Ascariasis affects at least 1 billion people worldwide and about 4 million people in the United States.[2]
  • Asia
  • Africa
  • South America
Necatoriasis  Necator americanus 
  • Skin contact
  • Approximately 800 million people are infected with hookworms worldwide.[3]
  • Brazil
  • Texas
  • Africa
  • China
  • Southwest Pacific islands
  • India
  • Southeast Asia
Giardiasis Giardia lamblia
  • Ingestion of raw or undercooked food contaminated with cysts.[9]
  • Approximately, 15,223 cases were reported in the United States in 2012.[10]
  • Worldwide infection
  • Among mountains hikers
 Fasciolosis  Fasciola Hepaticum
  • Central and South America
  • Asia (China, Vietnam, Taiwan, Korea, and Thailand)
  • Europe (Portugal, France, Spain, and Turkey)
  • Africa
  • The Middle East.
  • Microscopy[17]
    • Stools
    • Bile
    • Duodenal aspiration
Schistosomiasis 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)
  • Approximately 200 million people are infected annually with 200,000 deaths per year.
 Sub-Saharan Africa.[19] Acute schistosomiasis syndrome [20]

Chronic schistosomias[22][23][24][25]

  • Intestinal schistosomiasis
  • Hepatosplenic schistosomiasis[26][27]
  • Pulmonary schistosomiasis[28]
  • Genitourinary schistosomiasis 
Strongyloidiasis Strongyloidis Stercoralis
  • Infection is contracted via direct contact with contaminated soil during agricultural, domestic, and recreational activities
  • Approximately 30–100 million infected persons worldwide
  • Tropical and subtropical regions
  • Aspiration of duodenojejunal fluid is sometimes used to detect[31] 
  • Stool microscopy
  • PCR, ELISA
Amoebiais E. Histolytica
  • Transmitted by the fecal-oral route through contaminated drinking water or food.
  • Direct contact with infected individuals.
  • Annual incidence of amoebiasis is approximately 50 million cases.[34][35][36]
  • India
  • Africa
  • Mexico
  • Parts of Central and South America
  • Stool microscopy
  • Antigen testing
  • PCR
Taeniasis
  • Consumption of undercooked beef
  • Approximately 50 million human have cysticercosis.
  • Europe
  • Parts of Asia.
  • Stool microscopy
Trichuriasis Trichuris trichiura
  • Ingestion of embryonatedeggs from contaminated drinking water and food.
  • Endemic in tropical and subtropical countries.
  •  Southern United States
  • Incidence and prevalence rates are highest in children living in
    • Sub-Saharan Africa
    • Asia
    • Latin America
    • Caribbean
  • Stool microscopy
  • Proctoscopy
    • Demonstrates adult worms protruding from the bowel mucosa.
Hymenolepiasis Hymenolepis nana
  • Ingestion of infected eggs
 Most common in temperate zones[41]
  • South Europe
  • Russia
  • India
  • US
  • Latin America.
  • Asymptomatic[42]
  • Heavy infections with >1000 worms can occur
  • Stool microscopy


References

  1. ↑ Permin A, Henningsen E, Murrell KD, Roepstorff A, Nansen P (2000). "Pigs become infected after ingestion of livers and lungs from chickens infected with Ascaris of pig origin". Int J Parasitol. 30 (7): 867–8. PMID 10899534.
  2. ↑ Betson M, Nejsum P, Bendall RP, Deb RM, Stothard JR (2014). "Molecular epidemiology of ascariasis: a global perspective on the transmission dynamics of Ascaris in people and pigs". J Infect Dis. 210 (6): 932–41. doi:10.1093/infdis/jiu193. PMC 4136802. PMID 24688073.
  3. ↑ Bradbury RS, Hii SF, Harrington H, Speare R, Traub R (2017). "Ancylostoma ceylanicum Hookworm in the Solomon Islands". Emerg Infect Dis. 23 (2): 252–257. doi:10.3201/eid2302.160822. PMC 5324822. PMID 28098526.
  4. ↑ Nawalinski TA, Schad GA (1974). "Arrested development in Ancylostoma duodenale: course of a self-induced infection in man". Am J Trop Med Hyg. 23 (5): 895–8. PMID 4451228.
  5. ↑ Chhabra P, Bhasin DK (2017). "Hookworm-Induced Obscure Overt Gastrointestinal Bleeding". Clin Gastroenterol Hepatol. 15 (11): e161–e162. doi:10.1016/j.cgh.2017.02.034. PMID 28300694.
  6. ↑ McKenna ML, McAtee S, Bryan PE, Jeun R, Ward T, Kraus J; et al. (2017). "Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama". Am J Trop Med Hyg. 97 (5): 1623–1628. doi:10.4269/ajtmh.17-0396. PMID 29016326.
  7. ↑ Genta RM, Woods KL (1991). "Endoscopic diagnosis of hookworm infection". Gastrointest Endosc. 37 (4): 476–8. PMID 1916173.
  8. ↑ Serre-Delcor N, Treviño B, Monge B, Salvador F, Torrus D, Gutiérrez-Gutiérrez B; et al. (2017). "Eosinophilia prevalence and related factors in travel and immigrants of the network +REDIVI". Enferm Infecc Microbiol Clin. 35 (10): 617–623. doi:10.1016/j.eimc.2016.02.024. PMID 27032297.
  9. ↑ Quick R, Paugh K, Addiss D, Kobayashi J, Baron R (1992). "Restaurant-associated outbreak of giardiasis". J Infect Dis. 166 (3): 673–6. PMID 1500757.
  10. ↑ Muhsen K, Levine MM (2012). "A systematic review and meta-analysis of the association between Giardia lamblia and endemic pediatric diarrhea in developing countries". Clin Infect Dis. 55 Suppl 4: S271–93. doi:10.1093/cid/cis762. PMC 3502312. PMID 23169940.
  11. ↑ Pickering LK, Woodward WE, DuPont HL, Sullivan P (1984). "Occurrence of Giardia lamblia in children in day care centers". J Pediatr. 104 (4): 522–6. PMID 6707812.
  12. ↑ Lengerich EJ, Addiss DG, Juranek DD (1994). "Severe giardiasis in the United States". Clin Infect Dis. 18 (5): 760–3. PMID 8075266.
  13. ↑ Claas EC, Burnham CA, Mazzulli T, Templeton K, Topin F (2013). "Performance of the xTAG® gastrointestinal pathogen panel, a multiplex molecular assay for simultaneous detection of bacterial, viral, and parasitic causes of infectious gastroenteritis". J Microbiol Biotechnol. 23 (7): 1041–5. PMID 23711521.
  14. ↑ Fung HB, Doan TL (2005). "Tinidazole: a nitroimidazole antiprotozoal agent". Clin Ther. 27 (12): 1859–84. doi:10.1016/j.clinthera.2005.12.012. PMID 16507373.
  15. ↑ Chan CW, Lam SK (1987). "Diseases caused by liver flukes and cholangiocarcinoma". Baillieres Clin Gastroenterol. 1 (2): 297–318. PMID 2822181.
  16. ↑ Marcos LA, Terashima A, Gotuzzo E (2008). "Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis". Curr Opin Infect Dis. 21 (5): 523–30. doi:10.1097/QCO.0b013e32830f9818. PMID 18725803.
  17. ↑ Prociv P, Walker JC, Whitby M (1992). "Human ectopic fascioliasis in Australia: first case reports". Med J Aust. 156 (5): 349–51. PMID 1588869.
  18. ↑ Kaya M, Beştaş R, Cetin S (2011). "Clinical presentation and management of Fasciola hepatica infection: single-center experience". World J Gastroenterol. 17 (44): 4899–904. doi:10.3748/wjg.v17.i44.4899. PMC 3235633. PMID 22171131.
  19. ↑ Gower CM, Gouvras AN, Lamberton PH, Deol A, Shrivastava J, Mutombo PN; et al. (2013). "Population genetic structure of Schistosoma mansoni and Schistosoma haematobium from across six sub-Saharan African countries: implications for epidemiology, evolution and control". Acta Trop. 128 (2): 261–74. doi:10.1016/j.actatropica.2012.09.014. PMID 23041540.
  20. ↑ Jauréguiberry S, Ansart S, Perez L, Danis M, Bricaire F, Caumes E (2007). "Acute neuroschistosomiasis: two cases associated with cerebral vasculitis". Am J Trop Med Hyg. 76 (5): 964–6. PMID 17488923.
  21. ↑ Rocha MO, Rocha RL, Pedroso ER, Greco DB, Ferreira CS, Lambertucci JR; et al. (1995). "Pulmonary manifestations in the initial phase of schistosomiasis mansoni". Rev Inst Med Trop Sao Paulo. 37 (4): 311–8. PMID 8599059.
  22. ↑ Lucey DR, Maguire JH (1993). "Schistosomiasis". Infect Dis Clin North Am. 7 (3): 635–53. PMID 8254164.
  23. ↑ Stothard JR, Sousa-Figueiredo JC, Betson M, Bustinduy A, Reinhard-Rupp J (2013). "Schistosomiasis in African infants and preschool children: let them now be treated!". Trends Parasitol. 29 (4): 197–205. doi:10.1016/j.pt.2013.02.001. PMC 3878762. PMID 23465781.
  24. ↑ Gabbi C, Bertolotti M, Iori R, Rivasi F, Stanzani C, Maurantonio M; et al. (2006). "Acute abdomen associated with schistosomiasis of the appendix". Dig Dis Sci. 51 (1): 215–7. doi:10.1007/s10620-006-3111-5. PMID 16416239.
  25. ↑ Mu A, Fernandes I, Phillips D (2016). "A 57-Year-Old Woman With a Cecal Mass". Clin Infect Dis. 63 (5): 703–5. doi:10.1093/cid/ciw413. PMID 27521443.
  26. ↑ Homeida M, Abdel-Gadir AF, Cheever AW, Bennett JL, Arbab BM, Ibrahium SZ; et al. (1988). "Diagnosis of pathologically confirmed Symmers' periportal fibrosis by ultrasonography: a prospective blinded study". Am J Trop Med Hyg. 38 (1): 86–91. PMID 3124648.
  27. ↑ Dessein AJ, Hillaire D, Elwali NE, Marquet S, Mohamed-Ali Q, Mirghani A; et al. (1999). "Severe hepatic fibrosis in Schistosoma mansoni infection is controlled by a major locus that is closely linked to the interferon-gamma receptor gene". Am J Hum Genet. 65 (3): 709–21. doi:10.1086/302526. PMC 1377977. PMID 10441577.
  28. ↑ Sarwat AK, Tag el Din MA, Bassiouni M, Ashmawi SS (1986). "Schistosomiasis of the lung". J Egypt Soc Parasitol. 16 (1): 359–66. PMID 3722898.
  29. ↑ Mahmoud AA (1982). "The ecology of eosinophils in schistosomiasis". J Infect Dis. 145 (5): 613–22. PMID 7042854.
  30. ↑ Cioli D, Pica-Mattoccia L, Basso A, Guidi A (2014). "Schistosomiasis control: praziquantel forever?". Mol Biochem Parasitol. 195 (1): 23–9. doi:10.1016/j.molbiopara.2014.06.002. PMID 24955523.
  31. ↑ Carroll SM, Karthigasu KT, Grove DI (1981). "Serodiagnosis of human strongyloidiasis by an enzyme-linked immunosorbent assay". Trans R Soc Trop Med Hyg. 75 (5): 706–9. PMID 7036430.
  32. ↑ Zaha O, Hirata T, Kinjo F, Saito A, Fukuhara H (2002). "Efficacy of ivermectin for chronic strongyloidiasis: two single doses given 2 weeks apart". J Infect Chemother. 8 (1): 94–8. doi:10.1007/s101560200013. PMID 11957127.
  33. ↑ Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR (1993). "Albendazole is effective treatment for chronic strongyloidiasis". Q J Med. 86 (3): 191–5. PMID 8483992.
  34. ↑ Valenzuela O, Morán P, Gómez A, Cordova K, Corrales N, Cardoza J; et al. (2007). "Epidemiology of amoebic liver abscess in Mexico: the case of Sonora". Ann Trop Med Parasitol. 101 (6): 533–8. doi:10.1179/136485907X193851. PMID 17716437.
  35. ↑ van Hal SJ, Stark DJ, Fotedar R, Marriott D, Ellis JT, Harkness JL (2007). "Amoebiasis: current status in Australia". Med J Aust. 186 (8): 412–6. PMID 17437396.
  36. ↑ Ximénez C, Morán P, Rojas L, Valadez A, Gómez A (2009). "Reassessment of the epidemiology of amebiasis: state of the art". Infect Genet Evol. 9 (6): 1023–32. doi:10.1016/j.meegid.2009.06.008. PMID 19540361.
  37. ↑ Forrester JE, Bailar JC, Esrey SA, José MV, Castillejos BT, Ocampo G (1998). "Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children". Lancet. 352 (9134): 1103–8. PMID 9798586.
  38. ↑ Forrester JE, Bailar JC, Esrey SA, José MV, Castillejos BT, Ocampo G (1998). "Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children". Lancet. 352 (9134): 1103–8. PMID 9798586.
  39. ↑ Rossignol JF, Maisonneuve H (1984). "Benzimidazoles in the treatment of trichuriasis: a review". Ann Trop Med Parasitol. 78 (2): 135–44. PMID 6378109.
  40. ↑ Steinmann P, Utzinger J, Du ZW, Jiang JY, Chen JX, Hattendorf J; et al. (2011). "Efficacy of single-dose and triple-dose albendazole and mebendazole against soil-transmitted helminths and Taenia spp.: a randomized controlled trial". PLoS One. 6 (9): e25003. doi:10.1371/journal.pone.0025003. PMC 3181256. PMID 21980373.
  41. ↑ Utzinger J, Botero-Kleiven S, Castelli F, Chiodini PL, Edwards H, Köhler N; et al. (2010). "Microscopic diagnosis of sodium acetate-acetic acid-formalin-fixed stool samples for helminths and intestinal protozoa: a comparison among European reference laboratories". Clin Microbiol Infect. 16 (3): 267–73. doi:10.1111/j.1469-0691.2009.02782.x. PMID 19456836.
  42. ↑ Muehlenbachs A, Bhatnagar J, Agudelo CA, Hidron A, Eberhard ML, Mathison BA; et al. (2015). "Malignant Transformation of Hymenolepis nana in a Human Host". N Engl J Med. 373 (19): 1845–52. doi:10.1056/NEJMoa1505892. PMID 26535513.
  43. ↑ Steinmann P, Cringoli G, Bruschi F, Matthys B, Lohourignon LK, Castagna B; et al. (2012). "FLOTAC for the diagnosis of Hymenolepis spp. infection: proof-of-concept and comparing diagnostic accuracy with other methods". Parasitol Res. 111 (2): 749–54. doi:10.1007/s00436-012-2895-9. PMID 22461006.
  44. ↑ Ohnishi K, Sakamoto N, Kobayashi K, Iwabuchi S, Nakamura-Uchiyama F (2013). "Therapeutic effect of praziquantel against Taeniasis asiatica". Int J Infect Dis. 17 (8): e656–7. doi:10.1016/j.ijid.2013.02.028. PMID 23618773.
  45. ↑ Pawłowski ZS (1990). "Efficacy of low doses of praziquantel in taeniasis". Acta Trop. 48 (2): 83–8. PMID 1980572.
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