Abdominal parasitic infection: Difference between revisions

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__NOTOC__
__NOTOC__


{{CMG}}; {{AE}} {{MAD}}
{{CMG}}; {{AE}} {{MAD}} {{ADG}}
{{Abdominal parasitic infection}}
{{Abdominal parasitic infection}}
==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.


== Main parasitic intestinal infections ==
== Causes ==
* [[Ascaris lumbricoides]]  
* [[Ascaris lumbricoides]]  
* [[Necator americanus]]  
* [[Necator americanus]]  
Line 27: Line 27:
* [[Blastocystis hominis]]'' ''
* [[Blastocystis hominis]]'' ''


== 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 bearing larvae of ''A. suum.''<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 with ascariasis live in Asia (73 percent), Africa (12 percent), and South America (8 percent); some populations have infection rates as high as 95 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 the late phase of infection (six to eight weeks after egg ingestion), symptoms of ascariasis may consist of nonspecific symptoms such as abdominal discomfort, anorexia, nausea, vomiting, and diarrhea. Macroscopic adult worms are passed in the stool.
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
 
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Parasite
==== '''Complications''' ====
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Geographic distrubution
* Intestinal obstruction: In endemic areas, 5 to 35 percent of all bowel obstructions are due to ascariasis. Approximately 85 percent of obstructions due to ascariasis occur in children between one and five years of age. The overall incidence of obstruction associated with ascariasis in children is approximately 1 in 500. Obstruction occurs most commonly at the ileocecal valve.<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>
|-
* Migration of adult ''Ascaris'' worms into the biliary tree can cause biliary colic, biliary strictures, acalculous cholecystitis, ascending cholangitis, obstructive jaundice, liver abscesses, 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>
! style="background:#DCDCDC;" align="center" + |[[Ascariasis]]
 
| style="background:#DCDCDC;" align="center" + |[[Ascaris lumbricoides|''Ascaris lumbricoides'']]
==== '''Laboratory findings''' ====
| style="background:#F5F5F5;" + |
* The diagnosis of ascariasis is generally established via stool microscopy for evaluation of ''Ascaris'' ova (the eggs of ''A. lumbricoides'' and ''A. suum'' are indistinguishable).  
*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>
* Characteristic eggs may be seen on direct examination of stool or following concentration techniques.  
*Ingesting uncooked pig or chicken liver with the larvae.
 
| style="background:#F5F5F5;" + |
* Peripheral eosinophilia may be observed during the late phase of infection but is more likely to be observed during the early phase.<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>
*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>
 
| style="background:#F5F5F5;" + |
==== '''Imaging findings''' ====
*Asia
* Barium swallow may also demonstrate adult ''Ascaris'' worms, which manifest as elongated filling defects of the small bowel. The worms may ingest barium; in such cases, the worm's alimentary canal appears as a white thread bisecting the length of the worm's body.
*Africa
* Computed tomography scanning or magnetic resonance imaging may demonstrate worms in the bowel.
*South America
* Imaging the worm in cross-section demonstrates a "bull's eye" appearance.  
| style="background:#F5F5F5;" + |
* CT or MRI may demonstrate adult ''Ascaris'' worms in the liver or bile ducts. 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>
*[[Abdominal discomfort]]
 
*[[Anorexia]]
==== '''Treatment''' ====
*[[Nausea and vomiting]]
{| class="wikitable"
*[[Diarrhea]]
|'''Drug'''
*[[Intestinal obstruction]]
|'''Dosage'''
| style="background:#F5F5F5;" + |
*[[Stool examination|Stool microscopy]]
*Peripheral [[eosinophilia]]
*[[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.
== Necator ''americanus'' ==
*Direct contact with infected individuals.
* 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 the southeastern United States in the early 20th century was high; extensive control efforts have diminished the prevalence.
*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>
'''Acute gastrointestinal symptoms'''
| style="background:#F5F5F5;" + |
* Patients may experience gastrointestinal symptoms at the time of larval migration to the small intestine. Nausea, diarrhea, vomiting, midepigastric pain (usually with postprandial accentuation), and increased flatulence have been observed in individuals with naturally acquired infections [6] and in experimentally infected volunteers.<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>
*India
* Initial infections may be associated with gastrointestinal symptoms more frequently than subsequent infections. In one individual who was experimentally infected on four occasions, gastrointestinal symptoms and diarrhea were marked with the first infection, mild after the second, and absent after the third and fourth infectionsx.
*Africa
'''Chronic nutritional impairment'''
*Mexico
* The major impact of hookworm infection is on nutritional status. This is particularly important in endemic areas where children and pregnant women may have limited access to adequate nourishment. In addition, maternal hookworm infection is associated with low birthweight.
*Parts of Central and South America
* Hookworms cause blood loss during attachment to the intestinal mucosa by lacerating capillaries and ingesting extravasated blood. This process is facilitated by the production of anticoagulant peptides that inhibit activated factor X and factor VIIa/tissue factor complex and inhibit platelet activation. Each ''N. americanus'' and ''A. duodenale ''worm consumes about 0.3 mL and 0.5 mL of blood per day, respectively. The daily losses of blood, iron, and albumin can lead to anemia and contribute to impaired nutrition, especially in patients with heavy infection.<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>
| style="background:#F5F5F5;" + |
'''Stool examination'''
*Asymptomatic
* Stool examination for the eggs of ''N. americanus'' or ''A. duodenale ''is useful for detection of clinically significant hookworm infection.
*Mild [[diarrhea]] to severe [[dysentery]].
* Fecal egg excretion becomes detectable about eight weeks after dermal penetration of ''N. americanus'' infection and up to 38 weeks after dermal penetration of ''A. duodenale.''
*Fulminant amebic colitis.
* Stool examination is not helpful prior to established intestinal tract disease, including during early stages of dermal, pulmonary, or intestinal involvement.
*[[Weight loss]]
* Eosinophilia has been attributed to persistent attachment of adult worms to the intestinal mucosa.
*[[Amebic dysentery]]
* In untreated infections, eosinophilia slowly diminishes in magnitude but can remain elevated for several years.<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
* Anthelminthic treatment of hookworm infection consists of albendazole.<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 acceptable alternative therapy; 100 mg twice daily for three days is more effective than a single dose of 500 mg. 
| style="background:#F5F5F5;" + |
* An 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]]
 
*[[Tinidazole]] 
== Giardia lamblia ==
*[[Paromomycin]] 
* High-risk groups include infants, young children, international adoptees, travelers, immunocompromised individuals, and patients with cystic fibrosis.<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>
*[[Diloxanide furoate]] 
* The prevalence of giardiasis has been reported to be as high as 20 to 40 percent. The highest rates of infection in resource-limited areas occur among children <5 years.
*[[Iodoquinol]] 
* Many individuals with ''G. duodenalis'' identified in stool samples are asymptomatic, a point highlighted by studies that identified ''Giardia ''more commonly in the stool of asymptomatic individuals than among individuals with acute diarrhea.<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>
* In the United States in 2012, a total of 15,223 cases were reported.
* Transmission of infectious ''Giardia'' cysts to humans may occur via three routes: waterborne, foodborne, or fecal-oral transmission.
* Water is a major source of giardiasis transmission. ''Giardia'' cysts survive readily in mountain streams, as they are hardy in cold water. Water-dwelling mammals, such as beavers, can become infected and may serve as ongoing sources of water contamination. For these reasons, giardiasis is an important cause of diarrheal illness among hikers in wilderness areas who drink water that has not been adequately filtered, treated, or boiled.
* Deep well water is usually safe because filtration of water through soil removes ''Giardia'' cysts. ''Giardia'' cysts are resistant to chlorination; therefore, bacterial coliform counts are not a reliable measure of ''Giardia'' contamination in chlorinated water sources.<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 or via food that is contaminated after cooking.<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>
* Person-to-person transmission can occur in settings in which there is fecal incontinence and poor hygiene, such as childcare centers [15]. The risk of acquisition and transmission is greatest for young children who are not yet toilet trained; such children can also serve as a source for secondary cases within households.<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>
* Giardiasis can be transmitted via heterosexual or homosexual anal-oral sexual contact.
 
=== '''Clinical presentation''' ===
 
==== '''Asymptomatic infection''' ====
Asymptomatic infection occurs in both children and adults, and asymptomatic cyst shedding can last six months or more.<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.
* Symptoms usually develop after an incubation period of 7 to 14 days. Onset of acute gastrointestinal symptoms within one week of exposure is not likely attributable to infection with ''Giardia''. Symptoms may last two to four weeks.
 
==== '''Chronic giardiasis''' ====
Symptoms of chronic giardiasis may include oose stools, steatorrhea, profound weight loss, malabsorption, malaise, and fatigue.
 
==== '''Complications''' ====
* In a small number of patients, persistent infection is associated with development of malabsorption and weight loss.
* Chronic giardiasis may resemble other diseases associated with malabsorption, including inflammatory bowel disease.<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''' ====
* A number of immunoassays using antibodies against cyst or trophozoite antigens have been developed for stool analysis. Available kits include direct immunofluorescent assays (DFA) that use fluorescein-tagged monoclonal antibodies, immunochromatographic assays, and enzyme-linked immunosorbent assays.
* These methods have greater sensitivity and faster turn-around time than conventional stool microscopy methods. Specificity and cost are usually relatively comparable. Some studies have shown DFA to have the highest 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) have been developed to detect ''Giardia'' in stool samples; some remain research tools.<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 and may also be useful for detecting other potential parasitic causes of gastrointestinal symptoms.
* Limitations include intermittent excretion of ''Giardia'' cysts (necessitating up to three stool exams), cumbersome processing procedures, and technician expertise.
 
=== '''Treatment''' ===
 
===== '''Preferred agents''' =====
* Preferred agents for initial treatment of giardiasis include tinidazole and nitazoxanide. For treatment of patients ≥3 years of age, we favor tinidazole since it has a longer half-life than nitazoxanide and may be administered as a single dose with high efficacy (>90 percent).
* For treatment of patients 12 to 36 months of age, we favor nitazoxanide. Given limited data regarding use of tinidazole and nitazoxanide for patients <12 months of age, we favor metronidazole for these patients.<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>
{| 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>
|}
|}
== Schistosoma ==
* The prevalence of schistosomiasis is highest in sub-Saharan Africa.
* It has been estimated that more than 200 million people are infected, and schistosomiasis may cause up to 200,000 deaths annually [9,10]
=== '''Clinical presentation''' ===
===== '''Acute schistosomiasis syndrome''' =====
* Clinical manifestations of acute schistosomiasis syndrome include sudden onset of fever, urticaria and angioedema, chills, myalgias, arthralgias, dry cough, diarrhea, abdominal pain, and headache [52-56]. Only one or a few of the above symptoms may be observed, and fever is not an essential component of the illness [57]. The symptoms are usually relatively mild and resolve spontaneously over a period of a few days to a few weeks. Occasionally persistent manifestations are observed including weight loss, dyspnea, and chronic diarrhea. In rare cases, neurologic symptoms suggestive of encephalitis can occur [58].
===== '''Chronic infection''' =====
* Chronic infection related to schistosomiasis is most common among individuals in endemic areas with ongoing exposure.
* The severity of disease is related to the number of eggs trapped in tissues, their anatomic distribution, the duration and intensity of infection, and the host immune response [17,63].
'''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. In heavy infection, chronic colonic ulceration may lead to intestinal bleeding and iron deficiency anemia [66-68]. Intestinal polyps and dysplasia can arise due to granulomatous inflammation surrounding eggs deposited in the bowel wall (picture 1) [69,70]. Bowel strictures can also develop. In rare cases, an inflammatory mass can lead to obstruction or acute appendicitis [71,72].
'''Hepatosplenic schistosomiasis'''
* Among adults with chronic infection, the left liver lobe is enlarged with a sharp edge, and splenomegaly may extend below the umbilicus and into the pelvis in some cases [36,73,74].
* The predominant pathological process consists of collagen deposition in the periportal spaces, which causes periportal fibrosis.  [20,74,76,77]
* This leads to occlusion of the portal veins, portal hypertension with splenomegaly, portocaval shunting, and gastrointestinal varices. On physical examination, the liver is firm and nodular. Hepatocellular liver function is not impaired.
'''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'' [82].
* Progression of disease may be associated with cardiac enlargement and pulmonary artery dilatation. These manifestations represent end-stage disease and are generally irreversible.
* Dyspnea is the primary clinical manifestation [84].
* Chest radiography demonstrates fine miliary nodules.
===== '''Genitourinary schistosomiasis''' =====
* In early infection, eggs are excreted in the urine and patients present with microscopic or macroscopic hematuria and/or pyuria [41,92-94]. 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 [17].
* 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. [41,92,93].
'''Laboratory findings'''
* Eosinophilia is observed in 30 to 60 percent of patients [123-125]. Eosinophilia is very common among patients with acute schistosomiasis infection syndrome, a hypersensitivity that occurs most frequently among travelers with new infection [46,57,126].
* Thrombocytopenia may be observed in patients with portal hypertension due to hepatosplenic schistosomiasis secondary to splenic sequestration in an enlarged spleen.
* Liver enzymes are rarely elevated, even in established hepatic fibrosis due to schistosomiasis.
* Hematuria and/or leukocyturia are common in the setting of ''S. haematobium'' infection [129-133].
===== '''Microscopy''' =====
* Identification of schistosome eggs in a stool or urine sample via microscopy is the gold standard for the diagnosis of schistosomiasis. It can also be used for species identification and to measure the parasite burden (picture 1). The sensitivity of microscopy is low in light infections and in acute infection.
===== '''Infection intensity''' =====
* Determining the intensity of infection is important in endemic settings, since parasite burden correlates with the likelihood of complications. The intensity of intestinal schistosomiasis is classified as light (up to 100 eggs per gram), moderate (100 to 400 eggs per gram), or severe (>400 eggs per gram). The intensity of urinary schistosomiasis is classified as light to moderate (up to 50 eggs/10 mL) or severe (>50 eggs/10 mL) [22].
===== '''Serology''' =====
* The assays available include ELISA, radioimmunoassay, indirect hemagglutination, Western blot, and complement fixation [27,28]. Serologic tests use a broad array of schistosome antigens including extracts of adult worms, cercarial antigens, or egg extracts such as the ''S. mansoni'' soluble egg antigen (SmSEA). Most commercially produced antibody test assays are not species specific; therefore, these assays are generally used as screening tests for schistosome infection.
===== '''Molecular tests''' =====
* Some PCR assays facilitate species identification [57]. One study of PCR on urine samples noted sensitivity and specificity of 94 and 100 percent, respectively; use of an assay specific for ''S. mansoni'' was notable for sensitivity and specificity of 100 and 90 percent, respectively [49]. Another assay for ''S. haematobium ''is promising for use with serum, urine, or stool [55]. More elaborate schistosome genome sequencing techniques are also used to determine the epidemiology of schistosome hybrids occasionally found in humans [58].
===== '''Biopsy''' =====
* Histopathology of superficial rectal biopsies is more sensitive than stool microscopy and may demonstrate eggs even when multiple stool specimens are negative. In one study of 135 British expatriates with ''S. mansoni'' infection, eggs were detected on rectal biopsy in 61 percent of patients and on stool examination in 39 percent of patients [21].
=== '''Treatment''' ===
'''Praziquantel'''
* Praziquantel alters the tegument structure of adult worms and increases calcium ion permeability. Calcium ions accumulate in the cytosol, leading to muscular contractions and subsequent paralysis. Damage to the tegument membrane also induces a host immune response to parasite antigens [39]. Therefore, the efficacy of praziquantel depends on both the parasite burden of infection and the host immune defense [40].
* Praziquantel is readily absorbed when taken orally with food [9]. Adverse effects of praziquantel occur in approximately one-third of patients and are generally mild. They include dizziness, headache, vomiting, abdominal pain, diarrhea, and pruritus. These symptoms may be attributable to the drug itself and/or to the host immune response to dying parasites.
===== '''Alternative therapies''' =====
* Oxamniquine has been used for refractory schistosomiasis infection and may be as effective as praziquantel; it is contraindicated in pregnancy and in general is not as effective as praziquantel [56,57].
* Mefloquine has limited action on mature worms. The addition of mefloquine or artesunate to praziquantel is not beneficial [59]. Combination praziquantel with artemether may offer some benefit [60].
== Strongyloidis Stercoralis ==
* In tropical and subtropical regions, the overall regional prevalence may exceed 25 percent.
* The highest rates of infection in the United States are among residents of the southeastern states [3,4] and among individuals who have been in endemic areas.
'''Gastrointestinal symptoms'''
Patients may also experience diarrhea, anorexia, nausea, and vomiting. Epigastric pain may mimic a duodenal ulcer, except that food ingestion may aggravate the pain of strongyloidiasis. Chronic enterocolitis and malabsorption can result from a high intestinal worm burden.
'''Hyperinfection syndrome'''
The most common manifestations of the hyperinfection syndrome include [28,34,37]:
●Fever
●Nausea and vomiting
●Anorexia
●Diarrhea
●Abdominal pain
●Dyspnea
●Wheezing
●Hemoptysis
●Cough
=== '''Diagnosis''' ===
* Standard stool examination is notoriously insensitive for detecting ''Strongyloides'' (<50 percent sensitivity) [86].
* Aspiration of duodenojejunal fluid or the use of a string test (Enterotest) is sometimes used to detect ''Strongyloides'' larvae in patients with negative stool samples [85].
* Polymerase chain reaction (PCR) 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 [97,98]. However, PCR tests are not yet widely available.
'''Serology'''
* Diagnosis of strongyloidiasis by enzyme-linked immunosorbent assay (ELISA) has proven useful in immunocompetent individuals, both in symptomatic and asymptomatic strongyloidiasis [99,100]. The ELISA for detecting ''S. stercoralis ''infection detects immunoglobulin (Ig)G to filariform larvae. Negative test results in immunocompetent individuals decrease the likelihood that infection is present; however, some ELISA serologies run by commercial laboratories are of variable reliability. In addition, ELISA results can be falsely negative in immunocompromised hosts [96]. False-positive results may occur in the presence of other helminth infections [90].
'''Endoscopy'''
* Upper endoscopy is not usually needed to establish a diagnosis of strongyloidiasis. However, it may be performed in patients with gastrointestinal symptoms with unsuspected disease. Strongyloidiasis has a broad range of endoscopic features [105]:
* 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 [106].
'''Treatment'''
'''Ivermectin'''
Ivermectin is usually administered as two single 200 mcg/kg doses of ivermectin administered on two consecutive days [109,112].
'''Albendazole'''
Albendazole (400 mg by mouth on empty stomach twice daily for three to seven days) also has activity against ''Strongyloides'' [113,114]. the efficacy of albendazole has been lower than that of ivermectin, with a mean of 60 percent effectiveness for three days of albendazole versus 92 percent for ivermectin [115].
== 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 [3].
* Infection with ''E. dispar'' occurs approximately 10 times more frequently than infection with ''E. histolytica'' [3].
==== Clinical presentation ====
* The majority of entamoeba infections are asymptomatic; this includes 90 percent of ''E. histolytica''infections.
* 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. 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 [24]. 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. Among 5193 asymptomatic individuals in Japan undergoing colonoscopy for evaluation of positive fecal occult blood tests, for example, four were found to have amebic ulcerative lesions in the cecum or ascending colon [25].
=== '''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 [29].
'''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 [30]. Antigen detection kits using enzyme-linked immunosorbent assay (ELISA), radioimmunoassay, or immunofluorescence have been developed [31-33].
* 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 (where serology is less useful).
'''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'' [3].
* 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 [32,35,36]. Studies have shown that PCR is significantly more sensitive than microscopy and that it was 100 percent specific for ''E. histolytica'' [37,38].
* PCR is about 100 times more sensitive than fecal antigen tests [39].
'''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 [1,3].
* The goals of antibiotic therapy of intestinal amebiasis are to eliminate the invading trophozoites and to eradicate intestinal carriage of the organism.
== Taeniasis ==
'''Taeniasis'''
* There are two main species of ''Taenia'' for which humans are the only definitive hosts. These are ''Taenia saginata'', the beef tapeworm, and ''Taenia solium'', the pork tapeworm. 
* ''T. saginata ''occurs worldwide but is most common in areas where consumption of undercooked beef is customary, such as Europe and parts of Asia. The third species, ''T. asiatica'', is found among pigs in Taiwan, Korea, China, Vietnam, Indonesia, Thailand, the Philippines, and Japan [1-5].
==== '''Clinical presentation''' ====
* Most human carriers of adult tapeworms are asymptomatic. Intermittently, patients may pass proglottids in the stool (''T. solium'') or spontaneously (''T. saginata'') or may notice segments in their stool or sense the movement of proglottids through the anus. There may be associated symptoms including nausea, anorexia, or epigastric pain. Anxiety, headache, dizziness, and urticaria can also occur. 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 (picture 1); they are round with a double-walled, radially striated membrane and measure 30 to 40 micrometers. ''T. saginata'' eggs have an acid-fast shell; ''T. solium'' eggs are not acid fast.
* The proglottids and scolices of ''T. solium'' and ''T. saginata ''are morphologically distinguishable and can be used to establish a species diagnosis (picture 2 and picture 3). The ''T. saginata'' proglottids have 12 or more primary uterine branches; ''T. solium''proglottids have ≤10. These branches can be seen on direct examination or by injecting India ink into the segment via its lateral genital opening.
* The scolex usually remains in the intestine when proglottids are passed; it is rare for the entire worm to be eliminated spontaneously. Following antiparasitic therapy, however, the scolex of a fully evacuated worm may be identified in the stool. ''T. saginata'' has a scolex with four lateral suckers and no hooks ("unarmed"). ''T. solium'' has a scolex with a well-developed rostellum (crown) that has four suckers and a double row of hooks ("armed").
* The sensitivity of stool examination is limited since elimination of eggs and proglottids is intermittent. To increase the diagnostic yield, repeat specimens should be examined, and concentration techniques can be used. In addition, ''T. saginata'' eggs may be deposited on perianal areas and be detected by anal swabs.
* Laboratory workers must exercise caution when performing stool examinations; ''T. solium'' eggs are infectious if ingested [9,10]. (See "Clinical manifestations and diagnosis of cysticercosis".)
* Immunologic and molecular methods have been developed to improve diagnostic sensitivity, including an enzyme-linked immunosorbent assay (ELISA) for the detection of ''T. solium'' antigens in fecal samples and DNA hybridization techniques for the detection of eggs in stools [11-17]. In addition, several polymerase chain reaction (PCR) assays targeting various genomic regions have been developed for distinguishing between species of human ''Taenia'' infections, including PCR-restriction fragment length polymorphism (RFLP) methods [18,19], species-specific DNA probes [14], loop-mediated isothermal amplification (LAMP) [20-22], and nested/multiplex PCR [23-27]. Primers targeting the mitochondrial cytochrome c oxidase subunit 1 (''cox1'') gene of the three ''Taenia'' species have been developed and show promise for more routine use to distinguish between the three ''Taenia'' species [5]. In general, these assays are not yet suitable for routine diagnosis or field studies and are not widely available.
=== Treatment ===
* Praziquantel is the treatment of choice for all of the tapeworm infections discussed above [41,42]. Dosing depends upon the species [43]. Dosing for taeniasis and diphyllobothriasis 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 [44]. Dosing for hymenolepiasis is 25 mg/kgorally (single dose), followed by repeat dose 10 days later.
* 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. Dosing consists of four tablets (500 mg) in a single dose (2 g) for adults, two tablets (1 g) for children 11 to 34 kg, and three tablets (1.5 g) for children >34 kg.
== Trichuris trichiura ==
''' Clinical manifestations'''
* Most infections with ''T. trichiura ''are asymptomatic. Clinical symptoms are more frequent with moderate to heavy infections. Stools can be loose and often contain mucus and/or blood. Nocturnal stooling is common. Colitis and dysentery occur most frequently among individuals with >200 worms, and secondary anemia may be observed. Infected individuals may have a peripheral eosinophilia of up to 15 percent.
* Rectal prolapse can occur in the setting of heavy infection, and embedded worms may be visualized directly in the mucosa of the inflamed rectum (picture 2). Pica and finger clubbing are other potential clues to the diagnosis.
* Children who are heavily infected may have impaired growth and/or cognition [29,30]. However, it can be difficult to quantify the role of trichuriasis in isolation from comorbidities and other social factors.
'''Diagnosis'''
* The diagnosis of trichuriasis is made by stool examination for eggs. [31,32].
* Proctoscopy or colonoscopy can be performed and frequently demonstrates adult worms protruding from the bowel mucosa (picture 4). The adult worm is shaped like a whip. The posterior part of the worm is wider and looks like the whip handle, and the anterior part is long and thin.
* PCR using next-generation sequencing techniques are increasingly becoming available and are able to detect soil-transmitted helminths including ''T. trichiura''.
'''Treatment'''
* Treatment of trichuriasis consists of anthelminthic therapy with mebendazole (500 mg once daily for three days or 100 mg orally twice daily for three days; 70 to >90 percent cure) [8,35] or albendazole (400 mg orally on empty stomach once daily for three days; 80 percent cure) [36]. Albendazole should be considered second-line treatment as its efficacy is lower [37,38], although albendazole may be used if coinfection with hookworm has not been excluded. A study showed cure rates with a single 400 mg dose of albendazole of 2.6 percent with egg-reduction rates of 45 percent, compared with 11.8 and 75 percent, respectively, for a single 500 mg dose of mebendazole [37].
* Oxantel pamoate has been evaluated for treatment of trichuriasis; data are limited. One study among children in Tanzania noted reasonable efficacy and tolerability with optimum therapeutic dose range of 15 to 30 mg/kg (15 mg/kg: 49 percent cure and 97 percent egg reduction rate; 30 mg/kg: 59 percent cure rate and 99 percent egg reduction rate) [40].
* Albendazole plus oxantel pamoate (in regions where available) may be more efficacious than mebendazole or albendazole alone [37,41]. One study including 450 children with trichuriasis noted that treatment with oxantel pamoate (20 mg/kg single dose) and albendazole (400 mg single dose) resulted in higher cure and egg reduction rates at 3 weeks and 18 weeks after treatment than albendazole or mebendazole alone [37,42].
== Hymenolepis Nana ==
* ''Hymenolepis nana'' differs from most other tapeworms since it can complete its entire life cycle in a single host (figure 3). Its name derives from the fact that the adult parasite is much smaller than most other cestodes, measuring only 30 to 40 mm by 1 mm. ''H. nana'' is the most common human tapeworm infection worldwide. Transmission is associated with poor sanitation and hygiene and can occur between humans in the absence of an intermediate host. It is especially prevalent in warm countries such as Egypt, Sudan, Thailand, India, and Latin American countries. It has been reported to affect 4 percent of schoolchildren in rural southeastern United States [36].
'''Clinical manifestations'''
* Infection with ''H. nana'' is most common in children, since they are more prone to breaches in fecal-oral hygiene. Most infections are asymptomatic, but symptoms become more common as the parasite burden increases. Heavy infections with >1000 worms can occur and are often associated with crampy abdominal pain, diarrhea, anorexia, fatigue, and pruritus ani. Dizziness, irritability, sleep disturbance, and seizures have also been described. A peripheral blood eosinophilia of 5 to 10 percent may be observed.
* Malignant transformation of ''H. nana'' has been described in an HIV-infected patient [37]. Further study of host-parasite interactions is needed to better understand the potential relationships between infection and cancer.
'''Diagnosis'''
* The diagnosis is generally established by identifying eggs or proglottids in the stool (picture 7 and picture 8). 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; four to eight hair-like filaments arise from the even-thicker polar ends of the membrane. Proglottids disintegrate in the intestine and are not found in the feces. The sensitivity of stool microscopy can be increased by using concentration techniques such as the FLOTAC method [38-40].
* Diagnosis of hymenolepiasis should prompt family screening or empiric treatment, given the potential for person-to-person spread.


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

Latest revision as of 16:44, 5 April 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2] Aditya Ganti M.B.B.S. [3]

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 parasites responsible for infection include Ascaris lumbricoides, Necator americanus, Fasciola, Schistosoma, Trichuris trichiura, Strongyloides stercoralis, Taenia, Hymenolepis nana, and Entamoeba histolytica. Common symptoms of abdominal parasitic infections include are abdominal discomfort, anorexia, nausea, vomiting, and diarrhea. Stool microscopy is the most common diagnostic tool for evaluation. Common complications include focal neurologic changes, pericarditis, 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.

Causes

Abdominal Parasitic infections

The following table summarizes all the abdominal parasitic infections.

Parasitic Infection Mode of infection Incidence Epidemiology Clinical manifestations  Diagnosis Treatment
Disease Parasite 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
Schistosomiasis

S. mansoni
S. japonicum
S. haematobium

  • 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
Amoebiasis 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

Taenia saginata (beef tapeworm)
Taenia solium, ( pork tapeworm)[37]

  • Consumption of undercooked beef
  • Approximately 50 million human have cysticercosis.
  • Europe
  • Parts of Asia
Trichuriasis Trichuris trichiura
  • Ingestion of embryonatedeggs from contaminated drinking water and food.
  • 600-800 million people are infected worldwide.
  • 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
Hymenolepiasis Hymenolepis nana
  • Ingestion of infected eggs
  • 50-75 million carriers of H. nana. 
  • 5 to 25% prevalence among children worldwide.
 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.
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  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.
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  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.
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