Parasitic Infection

Aka: Parasitic Infection, Neglected Parasitic Infection, Parasitic Disease, Parasite, Endoparasite, Entozoic Parasite, Ectoparasite, Ectozoic Parasite

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II. Definitions

  1. Entozoic Parasite (Endoparasite)
    1. Parasites that live within the organs or tissues of its host (e.g. intestinal tract)
  2. Ectozoic Parasite (Ectoparasite)
    1. Parasites that infest the outer surface of their hosts

III. History

  1. See History from the Ill Returning Traveler

IV. Pathophysiology

  1. Parasites cause acute disease via two primary mechanisms
    1. Mass Effect
      1. High parasitic load related obstruction (Intestinal Obstruction)
    2. Host Inflammatory Response
      1. TH2 Pattern (release of inflammatory mediators such as Interleukins, Immunoglobulins, Mast Cell activation)
      2. Jarisch-Herheimer Reaction (Antimicrobial Agent induced reaction to dying organisms)

V. Types: Ectoparasites (Ectozoic Parasite)

  1. See Arthropod
  2. Background
    1. Ectozoic Parasites (Ectoparasites) infest the outer surface of their hosts
  3. Organisms
    1. Bedbug
    2. Lice
    3. Scabies
    4. Tick Bite
    5. Flea Bite

VI. Types: Endoparasites (Entozoic Parasite)

  1. Background
    1. Entozoic Parasites (Endoparasites) live within the organs or tissues of its host (e.g. intestinal tract)
  2. Protozoa
    1. Amoebiasis
    2. Babesiosis
    3. Chagas Disease
    4. Cryptosporidiosis
    5. Cyclosporiasis
    6. Giardiasis
    7. Leishmaniasis
    8. Malaria
    9. Toxoplasmosis
    10. Trichomoniasis
  3. Helminths (worms)
    1. Tapeworms (Cestodes)
      1. Echinococcosis
      2. Cysticercosis
    2. Flukes (Trematodes)
      1. Schistosomiasis
      2. Swimmer's Itch
    3. Roundworms (Nematodes)
      1. Enterobius Vermicularis (Pinworm)
      2. Trichinella spiralis (Trichinosis)
      3. Lymphatic Filariasis
      4. Toxocariasis
      5. Soil Transmitted Helminths (STH)
        1. Worldwide the most common intestinal Parasites worldwide (2.6 billion infections/year)
        2. Ascaris Lumbricoides (Roundworm)
        3. Ancylostoma duodenale or Necator americanus (Hookworm)
        4. Trichuris trichiura (Whipworm)

VII. Causes: U.S.

  1. Neglected Parasitic Infections in the U.S. (CDC focus area)
    1. Chagas Disease
    2. Neurocysticercosis
    3. Toxocariasis
    4. Toxoplasmosis
    5. Trichomoniasis
  2. Intestinal Parasites more common to the U.S. (fecal-oral spread)
    1. One-celled intestinal Protozoa
      1. Giardiasis
      2. Cryptosporidiosis
      3. Cyclosporiasis
    2. Soil transmitted Helminths (Roundworms)
      1. Enterobius Vermicularis (Pinworm)
      2. Trichinella spiralis (Hookworm)

VIII. Causes: Neglected tropical diseases (per CDC)

  1. Buruli ulcer
  2. Chagas Disease
  3. Cysticercosis
  4. Dengue Fever
  5. Dracunculiasis (Guinea Worm Disease)
  6. Echinococcosis
  7. Fascioliasis
  8. Human African Trypanosomiasis (African Sleeping Sickness)
  9. Leishmaniasis
  10. Leprosy (Hansen's Disease)
  11. Lymphatic Filariasis
  12. Onchocerciasis
  13. Rabies
  14. Schistosomiasis
  15. Soil-transmitted Helminths (STH)
    1. Ascaris Lumbricoides (Roundworm)
    2. Ancylostoma duodenale or Necator americanus (Hookworm)
    3. Trichuris trichiura (Whipworm)
  16. Trachoma
  17. Yaws

IX. Causes: Waterborne Parasites (common worldwide)

  1. See Waterborne Illness
  2. Amebiasis
  3. Cryptosporidiosis
  4. Giardiasis
  5. Guinea Worm (Dracunculus Medinensis)
  6. Schistosomiasis

X. Differential Diagnosis

  1. See Altered Mental Status in Febrile Returning Traveler
  2. See Cutaneous Conditions in Febrile Returning Traveler
  3. See Dermatologic Manifestations in Returning Traveler
  4. See Fever in the Returning Traveler
  5. See Gastrointestinal Disease in Returning Traveler
  6. See International Medical Concerns

XI. Labs

  1. See specific agents
  2. See Fever in the Returning Traveler (includes lab testing)
  3. Complete Blood Count with differential
    1. May demonstrate Eosinophilia

XII. Complications: Organisms with serious secondary effects

  1. Anaphylaxis
    1. Echinococcus species (Hydatid Disease)
  2. Anemia
    1. Babesia species (Babesiosis)
    2. Diphyllobothirum latum (Fish Tapeworm)
    3. Necator americanus (New World Hookworm)
    4. Plasmodium species (Malaria) - Hemolytic Anemia
    5. Trichuris trichiura (Whipworm)
  3. Acute Respiratory Distress Syndrome
    1. Babesia species (Babesiosis)
    2. Pneumocystis carinii
    3. Plasmodium species (Malaria)
    4. Strongyloides Stercoralis (Threadworm)
  4. Cardiomyopathy
    1. Trypanosoma cruzi (Chagas Disease)
    2. Trichinella species (TrichinosisRoundworm)
    3. Taenia Solium (Cysticercosis)
    4. Entamoeba histolytica (Amoebiasis)
  5. Encephalitis
    1. Taenia Solium (Cysticercosis)
    2. Plasmodium Falciparum (Malaria)
    3. Toxoplasma gondii (Toxoplasmosis)
    4. Trypanosoma cruzi (Chagas Disease)
  6. Gastrointestinal Conditions
    1. See Serious Parasitic Gastrointestinal Complications
  7. Seizure Disorder
    1. Taenia Solium (Neurocysticercosis)
    2. Entamoeba histolytica (Amoebiasis)
    3. Echinococcus species (Hydatid Disease)

XIII. Prevention

  1. See Travel Preparation
  2. See Travel Immunization
  3. See Waterborne Illness Prevention
  4. See Foodborne Illness Prevention
  5. See Prevention of Vector-borne Infection
  6. See Malaria Prophylaxis

XIV. Resources

  1. See Travel Resources
  2. CDC Neglected Parasitic Infections (U.S.)
    1. http://www.cdc.gov/parasites/npi/index.html
  3. CDC Neglected Tropical Diseases (worldwide)
    1. http://www.cdc.gov/globalhealth/ntd/

XV. References

  1. Wang and Nguyen (2017) Crit Dec Emerg Med 31(9):13-8

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