Helminth infections

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Background

  • Approximately 2 billion people infected worldwide
  • Many are WHO-designated Neglected Tropical Diseases[1]
  • At-risk populations include impoverished, children, immigrants, tourists, HIV/AIDS patients, refugees [2]
  • Most common in subtropical and tropical areas, moist climates, poor sanitation and hygiene [3]

Transmission:

  • No direct person-to-person transmission
  • Fecal-oral transmission (ingestion of eggs in contaminated soil / vegetables / water)[3]
    • Ascaris and whipworm from human feces
    • Toxocara from dog / cat feces
    • Echinococcus from sheep / cattle feces
    • Taenia eggs from human feces
  • Cutaneous transmission
    • Hookworm eggs hatch in the soil, mature larvae penetrate skin
    • Lymphatic filariasis transmitted via bite from infected mosquito (Anopheles, Aedes, and Culex)
    • Onchocerciasis transmitted via bite from blackflies (Simulium species)
  • Food or waterborne transmission
    • Taenia also transmitted by ingestion of larval cysts in undercooked pork or beef
    • Diphyllobothrium tapeworm transmitted by contaminated freshwater fish
    • Dracunculiasis transmitted by ingestion of infected Cyclops water fleas in contaminated water (adult worm erodes through skin of leg, releases larvae in water when host wades in pond / open well, infecting the water fleas)

Clinical Features

History

  • Parasitic infections can be in the differential diagnosis for nearly every sign/symptom (GI, dermatologic, neurologic, pulmonary, ophthalmologic, hematologic)
  • Obtain a travel history in every patient
    • countries of travel
    • duration of stay
    • activities while traveling (adventure travel, tourism, working, swimming)
    • living arrangements – city / village / hotel / tent
    • drinking water source
    • symptom chronology

Types

Helminth infections

Cestodes (Tapeworms)

Trematodes (Flukes)

Nematodes (Roundworms)

Evaluation

General

  • Stool studies (ova and parasites)
  • CBC to identify peripheral eosinophilia or anemia (not sensitive or specific)
  • Peripheral blood smear to identify microfilariae (e.g. lymphatic filariasis)

Disease/Symptom Specific

  • Pulmonary symptoms: CXR and sputum smear (e.g. Löffler’s syndrome)
  • CNS symptoms
    • Neuroimaging (CT with contrast or MR brain) may reveal ring-enhancing lesions, calcifications, or focal enhancing lesions in neurocysticercosis[4][5]
    • CSF serologies/ELISA for echinococcus, cysticercosis
  • Ultrasound or CT can localize cyst of echinococcus
  • ELISA or biopsy of affected tissue to diagnosis toxocariasis, cysticercosis
  • Identification of adult worm or microscopic larvae in cutaneous ulcer fluid can confirm dracunculiasis

Management

See Also

External Links

References

  1. The 17 Neglected Tropical Diseases." World Health Organization. http://www.who.int/neglected_diseases/diseases/en/. Web. 11 Aug. 2014.
  2. "Parasites." Centers for Disease Control and Prevention. http://www.cdc.gov/parasites/. Web. 11 Aug. 2014.
  3. 3.0 3.1 "Chapter 133 - Parasitic Infections." Rosen's Emergency Medicine: Concepts and Clinical Practice. Ed. John A. Marx, Robert S. Hockberger, and Ron M. Walls. Philadelphia, PA: Mosby Elsevier, 2014. 1768-784.
  4. Del Brutto OH, Rajshekhar V, White A, et al. “Proposed diagnostic criteria for neurocysticercosis.” Neurology, 2001; 57:177-183.
  5. Del Brutto OH. “Diagnostic criteria for neurocysticercosis, revisited.” Pathogens and Global Health, 2012; 106(5):299-304.