UNDERSTANDING PARASITES IN THE USA by

Dr. Omar Amin

A contribution of

Parasitology Center, Inc. (PCI)

11445 E. Via Linda, # 2-419

Scottsdale, Arizona 85259

Phone: 480-767-2522

Fax: 480-767-5855

www. Parasitetesting.com

E-mail: omaramin@aol.com

For kits call PCI at 480-767-2522

OR order on line

Pre-lecture questions. Page 1

(1) Medical

parasitology in

the USA

What is the level parasitology studies in the USA?

A.Understudied in medical schools

B.Adequately studied in medical schools

C.Overly studied in medical schools

(2) Medical

parasitology in

the USA

How often do MDs recognize parasite infections from patient’s symptoms?

A.Often

B.Rarely

C.Sometimes

(3) Medical

parasitology in

the USA

How many parasitology only testing facilities there found in the USA?

A.One

B.10-15

C.More than 15

(4) Medical

parasitology in

the USA

How often do you order parasitology tests for patients with GI symptoms?

A.Rarely

B.Sometimes

C.often

(5) Medical

parasitology in

the USA

Where else can intestinal parasites cause symptoms?

A.Skin

B.Kidneys

C.No where

Pre-lecture questions. Page 2

(1) How we get

infected with

parasites?

Which of these infections do we get by drinking contaminated water?

A.Giardia lamblia

B.Ascaris lumbricoides

C.Hookworms

(2) How we get

infected with

parasites?

Which of these infections do we get from contaminated food?

A.Giardia lamblia

B.Valley fever

C.Hydatid cyst disease disease (Echinococcus granulosus)

(3) How we get

infected with

parasites?

Which one of these parasites is transmitted by blood sucking insects?

A.Hookworms

B.Lyme disease

C.Hanta virus

(4) How we get

infected with

parasites?

What is the method of transmission of Rocky Mountain spotted fever?

A.Mosquito bite

B.Flea bite

C.Tick bite

(5) How we get

infected with

parasites?

How do we get infected with Cryptosporidium parvum?

A.Contaminated beef

B.Contaminated water

C.Polluted air

Pre-lecture questions. Page 3

(1) Prevalence What is the most common category of parasites in the USA?

A.Helminths (worms)

B.Protozoa (single-celled) organisms

C.Arthropoda (insects and arachnids)

(2) Prevalence II What is the most common species of Protozoa in the USA?

A.Blastocystis hominis

B.Giardia lamblia

C.Cryptosporidium parvum

(3) Prevalence III What is the prevalence of documented parasitic infections in the USA?

A.10%

B.20-30%

C.60-70%

(4) Prevalence IV What is the proportion of sub-clinical cases of common protozoans?

A.10%

B.20-30%

C.60-70%

(5) Prevalence V What is the most common category of parasites in the far east?

A.Helminths (worms)

B.Protozoa (single-celled) organisms

C.Arthropoda (insects and arachnids)

Pre-lecture questions. Page 4

(1) Infection sites I Which of these parasites are confined to the intestinal tract?

A.Entamoeba coli

B.Entamoeba histolytica

C.Ascaris lumbricoides

(2) Infection sites II Which of these parasites goes to the liver and the brain?

A.Entamoeba coli

B.Entamoeba histolytica

C.Ascaris lumbricoides

(3) Infection sites III Which of these parasites encysts in the muscles?

A.Giardia lamblia

B.Trichinella spiralis (agent of trichinosis)

C.Enterobius vermicularis (pinworm)

(4) Infection sites IV Which of these parasites encysts in the body cavity organs & brain?

A.Echinococcus granulosus (hydatid cyst disease)

B.Schistosoma mansoni

C.Blastocystis hominis

(5) Infection sites V Where can adult tapeworms be found?

A.Body cavity

B.Lungs

C.intestine

Pre-lecture questions. Page 5

(1) Parasite ID Which of these parasites has a flagellum?

A.Giardia lamblia

B.Endolimax nana

C.Tapeworm larvae

(2) Parasite ID Which of these parasites has a trophozoite and cyst stage?

A.Giardia lamblia

B.Hook worms (Ancylostoma duodenale or Necator americanus)

C.Cryptosporidium parvum

(3) Parasite ID What is the longest worm in the human intestine?

A.Taenia solium

B.Hookworms

C.Diphyllobothrium latum

(4) Parasite ID Which parasite has 2 suckers (oral and ventral)?

A.Tapeworms

B.Round worms

C.Trematodes (flukes)

(5) Parasite ID What is the most commonly used routine method of identifying parasites?

A.PCR

B.Microscopy

C.DNA finger printing

Pre-lecture questions. Page 6

(1) Pathology Which of these parasites causes peritonitis?

A.Blastocystis hominis

B.Ascaris lumbricoides

C.Cryptosporidium parvum

(2) Pathology Which of these parasites causes sub-ingual splinter?

A.Hookworms

B.Ascaris lumbricoides

C.Trichinella spiralis

(3) Pathology Which of these parasites causes mega-colon?

A.Trypanosoma cruzi (Chagas disease)

B.Leishmania tropica (oriental sore)

C.Yersinia pestis (plague)

(4) Pathology Which of these parasites causes prolapsed rectum?

A.Ascaris lumbricoides

B.Taenia solium

C.Trichuris trichura (whipworm)

(5) Pathology Which of these parasites causes hepatomegaly?

A.Ancylostoma duodenale (hookworm)

B.Entamoeba histolytica

C.Entamoeba coli

Pre-lecture questions. Page 7

(1) Distribution The following countries has comparable parasite prevalence to USA:

A.Mexico

B.Canada

C.Kenya

(2) Distribution The prevalence of house-hold infections compared to non-house-hold:

A.About twice as high

B.About half as high

C.About 4 times as high

(3) Distribution The most widely distributed parasite in the USA is:

A.Babesia

B.Malaria

C.Blastocystis hominis

(4) Distribution The New England states are most famous grounds for:

A.Rocky Mountain spotted fever

B.Flea-borne typhus

C.Lyme disease

(5) Distribution Plague is endemic in which region of the USA?

A.Northeast

B.Southeast

C.Southwest

What we do at PCI

Diagnosis and management of:

• Parasitic organisms and agents of medical & public health importance in fecal, blood, skin, etc. specimens.

• Toxicities related to Neuro-cutaneous Syndrome (NCS).

Educational services: workshops, seminars, training & publications provided.

Consultations & protocols for herbal & allopathic treatments.

Research: over 190 publications on parasites from all continents

Why test ? You need to be tested if you have one or more of these symptoms:

GI symptoms

• Diarrhea/constipation.

• Irritable bowel

• Cramps

• Gas & bloating.

• Bleeding.

• Appetite changes.

• Malabsorption.

• Mucus.

• Rectal itching.

• Gut leakage.

• Poor digestion.

Systemic/other symptoms

• Fatigue.

• Skin rash.

• Dry cough.

• Brain fog/memory loss.

• Lymph blockage.

• Allergies.

• Nausea.

• Muscle or joint pain.

• Dermatitis.

• Headaches.

• Insomnia.

How we get infected

1. Drinking water or juice: Giardia, Cryptosporidium.

2. Skin contact with contaminated water:

Schistosomiasis, swimmers itch.

3. Food (fecal-oral infections): most protozoans, ex.,

Blastocystis, Entamoeba spp. & worms: Ascaris.

4. Arthropods: Lyme disease, plague, typhus, etc.

5. Air: Upper respiratory tract infections (viruses,

bacteria), ex., flu, Valley fever, Hanta virus.

6. Pets: Hydatid cyst disease, heart worm, larva

migrans (dogs), Toxoplasma (cats), Taenia (beef,

swine.

7. People (contagious diseases): AIDS, herpes.

8. Soil: hook worms, thread worms.

Transport and laboratory procedures

• Collection kits are available from Parasitology Center, Inc. (PCI).

• We use the new Protofix (fixative) & the CONSED (stain) system.

• The fixative & stain qualities are superior to those of other tests

required by US Government testing agencies, ex. FEA-Lugol’s.

• We detect & identify 50-80% more species & individuals of intestinal

parasites in fecal specimens than found using other standard tests.

*Receiving specimens in transport vials collected in Protofix.

*Specimens lined up for filtration.

*Filtration process.

*Adding the CONSED stain then the Ethyl acetate.

*Centrifugation.

*Supernatant material decanted & debris removed. Fecal plug remains at bottom.

*End product of a run ready for slide preparation.

*Creating a wet mount slide preparation for microscopic examination.

PCI findings of parasite presence in the USA population

• One third of 5,792 fecal specimens examined from patients in 48 states were infected with 19 species of parasites in the year 2000.

• 72% of infected patients had Blastocystis hominis in single/mixed infections.

• Cyptosporidium parvum was the 2nd most prevalent parasite (13%).

• Entamoeba histolytica/dispar were 3rd in prevalence (7%).

• Up to 31% of infections with pathogenic protozoans were subclinical.

• Prevalence was low (22-27) in winter but increased to 36-43% July-October.

PCI educational publications

• Appeared in EXPLORE Vol. 8 (6), 1998, Addendum.

• Call EXPLORE Publications at 928-541-4614.

• Covers all herbal remedies for parasitic infections since Ancient Egypt and

China to the present by parasite and age groups.

PCI educational videos

HERBAL/NATURAL REMEDIES ALLOPATHIC REMEDIES

Clear/experience/harmony by Awareness Corp

Protozoa, some worms

Albendazole

Round worms, Giardia, Microsporidia

Tricycline by Allergy Research Group

Protozoa

Clindamycin & quinine

Babesia bigemina & B. microti, malaria

Biocidin & Biotonic by Biobotanical Res. Gr.

Protozoa

Metronidazole (flagyl) or iodoquinol

Blastocystis hominis, amebiasis

Tanalbit by Intensive Nutrition

Yeast

Nitazoxanide (illinia) by Romark labs.

Cryptosporidium parvum, other protozoans

Freedom/Cleanse/Restore by Parasitology Ctr

Protozoa, worms, bacteria, fungi

Mebendazole (Vermox)

Worms (trematodes, cestodes, round worms)

Paragone I & II by Renew Life

Parasites and Candida

Praziquantel

Tissue invading worms & invasive amebiasis

Unikey verma-key I & II by Unikey Hlth. Syst.

Protozoa, worms (?)

Tinidazole

Blastocystis & other protozoans

Natural Cleanse I, II, III by AHR, LTD, UK

Protozoa, yeast, fungi

Permethrin or Ivermectin

Skin ectoparasites and some worms

Para-Gard by Tyler

Protozoa

Niclosamide

Tissue invading worms

Common parasite remedies

INTESTINAL PARASITES

Protozoa

Blastocystis hominis (species complex)

Infections caused by fecal-oral contamination & cause typical GI and

extra-intestinal symptoms including skin abnormalities.

Blastocystis hominis

A case of heavy infection with many specimens (left) also showing

extreme levels of mucus reaction (right).

Cryptosporidium parvum An under-diagnosed water-borne infection common throughout the US

• Best known for the 1993 Milwaukee epidemic infecting 400,000 cases, 4000 hospitalized & over 100 deaths.

• Detected in 27% of drinking water samples in households supplied by 66 surface water treatment plants in 14 states.

• Our prevalence rate (13%) is higher than the 0.6-4.3% reported from North America & 2-4% from Europe.

• Runoff water from hillsides where cattle graze infect water reservoirs.

• Typical GI & systemic symptoms.

Cyclospora cayetanensis

• Cyclospora is very similar to Cryptosporidium

morphologically but twice as large (7-12 um).

• Infections are associated with contaminated

berries, fruits & vegetables from S. America.

• Endemicity & water borne transmission in the

US was established by Amin (1998); see below.

Entamoeba histolytica/dispar

The pathogenic (Montezuma’s revenge)/non-pathogenic amoebas; the

third most common protozoan (7%) in the United States.

Cyst (transmission stage) Trophozoite (feeding stage)

Entamoeba histolytica (a classical cyclic parasite)

*Trophozoite actively feeding on host cells, bacteria & white blood cells (left).

*Charcot-Leyden crystal, a by product of eosinophil destruction by trophozoites.

Entamoeba histolytica

* Flask shaped intestinal ulcers from invasive trophozoites spreading

and multiplying at the margins.

* Section in the colon mucosa showing flask-shaped ulceration site.

Entamoeba histolytica

*Rectal muco-cutaneous amoebiasis in a child from Mexico (left).

*Ulcerative amoebic colitis with inflammation and secondary bacterial

infection; from autopsy material (right).

Invasive Entamoeba histolytica trophozoites

*Invasion of lymph vessels & cerebrum through gut wall (top right).

*Trophozoites migrate intoto to the liver causing hepatomegaly (left).

*Liver abscess in a 2.5 yr old Mexican child shown on left (lower right).

Entamoeba coli

Previously considered non-pathogenic but does cause pathology

(classical GI, dermatological & other systemic symptoms) especially in

children and immune compromised patients. Trophozoite (L) & cyst (R)

Giardia lamblia

• A common but under-reported intestinal parasite in the USA; hard to detect because of its adhesion to gut mucosa with a ventral sucker.

• Trophozoites (left) cause severe GI symptoms including mal-absorption of food as well as of medications.

• Cysts (right) are transmitted via water (including tap water) vegetables or fruits washed in contaminated water. Carriers are important in the cycle.

• Drinking water in over 20% of households supplied by surface water treatment plants were found contaminated with Giardia cysts.

Balantidium coli

B. coli is essentially an intestinal parasite of pigs where it causes no damage.

Accidental infection of humans transforms cysts to invasive trophozoites (left)

causing diarrhea, bowel ulceration & secondary bacterial infections (right).

At least 4 other species of Protozoa previously viewed as harmless are now

recognized as pathogenic especially in immune compromised patients.

Endolimax nana Iodamoeba butschlii

Dientamoeba fragilis Chilomastix mesnili

The pathogenicity of so-called “non-pathogenic” protozoans and the

subclinical cases of pathogenic species. From Amin (2002)

NON-PROTOZOAN ELEMENTS IN STOOL SPECIMENS

CELLS

White blood cells Squamous epithelial cells

Red blood cells columnar epithethial cells

NON-PROTOZOAN ELEMENTS IN STOOL SPECIMENS

FUNGI

Candida albicans Yeast

Geotrichum Alternaria

NON-PROTOZOAN ELEMENTS IN STOOL SPECIMENS

PSEUDOPARASITES

Citrus particles Tomato skin

Bean sprouts Mucus casts

NON-PROTOZOAN ELEMENTS IN STOOL SPECIMENS

Artifacts confused for worm eggs

Morel mushroom spore Pollen grain

Mite egg Plant parasite (Heterodera) egg

NON-PROTOZOAN ELEMENTS IN STOOL ELEMENTS

Artifacts of significance

Antibiotic crystals Fatty acid crystals

Undigested food - potatoes Undigested food – plant hair

FLAGELLATED NON-INTESTINAL PROTOZOANS: Trichomonas vaginalis

Causes non-specific vaginitis. Infects the vagina and male prostate & urogenital

tract. Transmitted via sexual intercourse. Occasionally found in newborn infants

Trophozoite (left). A case of vaginitis as seen through a vaginal speculum.

The typical creamy discharge is often infected with Candida albicans (right).

FLAGELLATED NON-INTESTINAL PROTOZOANS:

New world muco-cutaneous leishmaniasis (Espundia)

Transmission by the bite of sand flies infected from rodent reservoirs.

Infective leptomonad form (right). Infected reservoir & human cases.

FLAGELLATED NON-INTESTINAL PROTOZOANS

Trypanosoma cruzi (Chagas disease)

Reduvid (assasin/kissing) bugs transmit infection from wild reservoirs

(opossums and armadillos) to domestic hosts (dogs & cats) & humans

causing peri-orbital edema, congestive heart disease & mega-colon.

COCCIDIAN NON-INTESTINAL PROTOZOANS

Toxoplasma gondii

Mature oocysts in cat feces cause human infection by inhalation. Infection is

initially asymptomatic (congenital ?) but may later cause cell destruction as it

transforms from acute to chronic cerebral state often noted in AIDS patients.

HELMINTHS (WORMS): NEMATODA (ROUND WORMS)

Ascaris lumbricoides

The most common worm parasite in the USA. Fecal-oral contamination

brings eggs into the oral cavity of a new case. Adults reach 1 foot long.

NEMATODA (ROUND WORMS) Ascaris lumbricoides

The ingested egg excysts & the larvae penetrate the gut wall (leakage) – blood

vessels - lungs (eosinophilia, pneumonitis) – bronchioles – oral cavity - re-

swallowed – adults in gut. May penetrate gut wall to body cavity (peritonitis).

NEMATODA (ROUND WORMS) Anisakis

Anisakis spp. and related forms infect humans & marine mammals, ex.

seals and whales, in N. America by eating infected cod & herring, etc.

(sushi and sashimi). Most prevalent infections in Japan and Holland.

• Detail of a 4.2 cm long worm

penetrated the gut & exited the

neck of a 44 year old California

male who also had ALS & Lyme

disease and a history of frequent

diet of sushi & sashimi. He died

shortly after worm removal.

NEMATODA (HOOK WORMS)

Ancylostoma duodenale and Necator americana

Have insatiable appetite for blood (RBC/oxygen) as adults. Larva penetrates

skin – blood circulatory system – lungs – coughed – swallowed – adult in gut.

NEMATODA (THREAD WORMS) Strongyloides stercoralis

Life cycle similar to that of hook worms. Larvae can, however, spend an

additional non-parasitic cycle of generations in the soil (utilizing a different

metabolic pathway) until hosts become available. Self infection also occurs.

NEMATODA (SPIRAL THREADWORMS) Trichinella spiralis

A cosmopolitan parasite of carnivores involving rodents. Infects humans

consuming pork/pork products having infective larvae in muscle tissue. In

humans: ingested larvae – adults in gut – larvae – migrate to muscles causing

sub-orbital edema, sub-ingual splinter, diaphram/breathing difficulties, etc.

NEMATODA (PINWORMS) Enterobius vermicularis

Infects the very young & the very old via fecal – oral contamination directly or

indirectly. Eggs are laid at anal orifice, diagnosis with Scotch tape method.

Worms in the appendix have uncertain relationship with acute appendicitis.

NEMATODA (PINWORMS) Enterobius vermicularis (cont.)

In a 30 year old female, worms entered the vagina (left) – uterus – eggs laid in

uterine wall (upper right) causing necrotic mass - oviduct – peritoneal cavity .

The Scotch tape method (lower right) is now replaced by pinworm paddles.

NEMATODA (WHIPWORMS) Trichuris trichiura

In a life cycle similar to that of pinworms, adult worms embed deeply into the

large intestinal wall with their narrow anterior end destroying the autonomic

nerve ganglia causing prolapsed rectum. Diagnostic eggs shown (below right)

CESTODA (TAPEWORMS) Diphyllobothrium latum (broad fish tapeworm)

Larvae in aquatic crustaceans develop to immatures (plerocercoides) in fish –

ingested – up to 30 foot long adults in human intestine. Depletes vit. B12 – loss

of memory & CNS functions. Very high prolific rate in a life span of 10 years +.

CESTODA (TAPEWORMS) Taenia solium (pork tapeworm) (top left)

As in the beef tapeworm Taeniarhynchus saginatus (top right), adults live in

the human intestine – eggs (lower right) in mobile segments – ground – eaten

by swine/beef – hatch in gut– larvae migrate to animal muscles – eaten by man

– adults. If eggs are freed in upper intestine – cysticercosis in human tissues.

CESTODA (TAPEWORMS) Taenia solium (pork tapeworm) (cont.)

Eggs released from worm segments in the upper human intestine will re-infect

(auto-infection) soft tissues as larvae (cysticerci) causing cysticercosis in brain

(an epilepsy case), eye, subcutaneous tissue and thigh muscle (x-ray), etc.

CESTODA (TAPEWORMS) Echinococcus granulosus (hydatid cyst disease)

Adults in intestine of dogs and other carnivores – eggs exit with feces – eggs

ingested by sheep/other herbivores – hatch – hooked embryos in circulation –

cysts in various tissues. Man is infected when accidentally ingesting eggs.

CESTODA (TAPEWORMS) Echinococcus granulosus (cont.)

Man (child) ingests eggs from dog face which hatch producing hooked larvae

that migrate forming hydatid cysts with generations of daughter cysts and

hydatid sand dissimenating the infection when naturally or surgically raptured.

CESTODA (TAPEWORMS) Hymenolepis nana & Hymenolepis diminuta

The dwarf & rat tapeworms infect humans when the intermediate hosts (grain

beetles in flour & cereals) (top left) containing cysticercoid larvae (top right) are

ingested. Larvae develop to adults in human/rodent intestines causing tissue

damage (lower right) & nutritional deficiencies. Auto-infection occurs.

CESTODA (TAPEWORMS) Dipylidium caninum (dog tapeworm)

Adults (top left) live in the intestine of dogs & cats. Egg clusters (top right) in

worm segments (lower left) are ingested by flea larvae. Worm larvae develop in

adult fleas (lower right) infective to humans when accidentally ingested.

TREMATODA (FLUKES) Schistosoma mansoni (blood fluke; bilharzia)

Now established in Central & South America, this bisexual liver fluke lives in

the hepatic portal system – eggs – invasive migration to gut – exit with fecal –

hatch in water – miracidium in snail – fork-tailed cercaria penetrates human

skin – schistosomule migration (mimicry) – breeding in blood vessels & liver.

TREMATODA (FLUKES) Schistosoma mansoni (cont.) PATHOLOGY

Intradermal test by injecting proper antigen is diagnostic (top left).

Pseudotubercular fibrosis in liver tissue due to eggs/adults. Eggs to lungs, etc.

Hepatospleenomegaly from fibrotic enlargement of liver/spleen & emaciation.

Massive polyposis of colon from egg passage with fatal intestinal haemorrhage.

TREMATODA (FLUKES) Fasciola hepatica and F. gigantica (liver flukes)

Infection with these flukes is cosmopolitan in liver of herbivores that graze in

wet pasturage where the snail intermediate hosts are found. Man is infected by

eating wild watercress on which metacercariae have encysted. Adults in liver.

TREMATODA (FLUKES) Fasciolopsis buski (the large intestinal fluke)

Distribution is limited to the Far East (despite what Hulda Clark makes you

believe) in pig and man. Life cycle: cercaria – snails – metacercariae on aquatic

plants (water caltrop, water chestnut) – ingestion by humans – adults -eggs.

Eggs are similar to those of Fasciola hepatica and Fasciola gigantica.

ARTHROPODS & ARTHROPOD-BORNE DISEASES - INSECTS

FLEAS (SIPHONAPTERA)

In the US, fleas transmit bubonic & pneumonic plague (Yersinia pestis) in the

West & endemic typhus (Rickettsia typhi) in the South East. The reservoirs are

rodents. They also cause mechanical damage & allergies, ex., sticktight fleas

ARTHROPODS & ARTHROPOD-BORNE DISEASES – INSECTS

LICE (ANOPLURA)

In the US, head lice causes pediculosis, ex., in school children and historically

transmitted epidemic typhus (Rickettsia prowazeki); humans: primary reservoirs

ARTHROPODS & ARTHROPOD-BORNE DISEASES – INSECTS

MOSQUITOES (DIPTERA)

In the US, mosquitoes transmit encephalitis (California, St. Louis, equine,

Eastern, Western & Venezuelan viruses), filariasis (dog heartworm; also in

humans) & historically dengue fever, yellow fever and malaria. Yellow fever

distribution, Aedes mosquito vector & black vomit of yellow fever are shown.

ARTHROPODS & ARTHROPOD-BORNE DISEASES – ARACHNIDS

HARD TICKS (IXODIDAE)

Hard ticks transmit 5 major diseases in the US. The reservoir systems are

rodents and larger mammals. Tick larvae, nymphs & adults all feed on blood.

1. Rocky Mountain spotted fever:

Rickettsia rickettsii by Dermacentor

and Amblyomma ticks throughout

the country. Map shown to right.

2. Colorado tick fever virus by western

ticks in the South West.

3. Tularemia (rabbit fever): Rickettsia

tularensis by Haemaphysalis ticks.

4. Lyme disease: Borrelia burgdorfi

now nationwide by Ixodes ticks.

Erythema chronicum (lower right).

5. Babesiosis: Babesia microti by

Ixodes ticks in the North East.

ARTHROPODS & ARTHROPOD-BORNE DISEASES – ARACHNIDS

SOFT TICKS (ARGASIDAE)

In the US, species of the argasid tick Ornithodoros transmit Relapsing fever

(Borrelia recurrentis) in the South West. Feeding Ornithodoros female with

coxal fluid, temperature chart and Borrelia in a blood smear are shown.

ARTHROPODA & ARTHROPOD-BORNE DISEASES – MITES

Liponyssus mites transmit rickettsial pox (Rickettsia acari) in US households.

Other mites cause allergies & irritation, ex., mange, dust and itch mites.

The burrowing mite Sarcoptes scabei The follicle mite Demodex folliculorum

ARTHROPODS & ARTHROPOD-BORNE DISEASES – SPIDERS

In the US, only the bites of the black widow spider Latrodectes mactans (top

left) and the brown recluse spider Loxosceles reclusa (all other photos) can be

fatal to humans. Hemorrhagic necrosis is a common early symptom.

Post-lecture questions. Page 1

(1) Medical

parasitology in

the USA

What is the level parasitology studies in the USA?

A. Understudied in medical schools

B. Adequately studied in medical schools

C. Overly studied in medical schools

(2) Medical

parasitology in

the USA

How often do MDs recognize parasite infections from patient’s symptoms?

A. Often

B. Sometimes

C. Rarely

(3) Medical

parasitology in

the USA

How many parasitology only testing facilities there found in the USA?

A. One

B. 10-15

C. More than 15

(4) Medical

parasitology in

the USA

How often do you order parasitology tests for patients with GI symptoms?

A. Sometimes

B. Rarely

C. Often

(5) Medical

parasitology in

the USA

Where else can intestinal parasites cause symptoms?

A. Kidneys

B. Skin

C. No where

Post-lecture questions. Page 2

(1) How we get

infected with

parasites?

Which of these infections do we get by drinking contaminated water?

A. Hookworms

B. Ascaris lumbricoides

C. Giardia lamblia

(2) How we get

infected with

parasites?

Which of these infections do we get from contaminated food?

A. Valley fever

B. Giardia lamblia

C. Hydatid cyst disease disease (Echinococcus granulosus)

(3) How we get

infected with

parasites?

Which one of these parasites is transmitted by blood sucking insects?

A. Hookworms

B. Lyme disease

C. Hanta virus

(4) How we get

infected with

parasites?

What is the method of transmission of Rocky Mountain spotted fever?

A. Mosquito bite

B. Tick bite

C. Flea bite

(5) How we get

infected with

parasites?

How do we get infected with Cryptosporidium parvum?

A. Contaminated water

B. Contaminated beef

C. Polluted air

Post-lecture questions. Page 3

(1) Prevalence What is the most common category of parasites in the USA?

A. Helminths (worms)

B. Protozoa (single-celled organisms)

C. Arthropoda (insects and arachnids)

(2) Prevalence II What is the most common species of Protozoa in the USA?

A. Giardia lamblia

B. Blastocystis hominis

C. Cryptosporidium parvum

(3) Prevalence III What is the prevalence of documented parasitic infections in the USA?

A. 10%

B. 20-30%

C. 60-70%

(4) Prevalence IV What is the proportion of sub-clinical cases of common protozoans?

A. 10%

B. 20-30%

C. 60-70%

(5) Prevalence V What is the most common category of parasites in the far east?

A. Protozoa (single-celled orgnisms)

B. Helminths (worms: trematodes, nematodes, cestodes)

C. Arthropoda (insects and arachnids)

Post-lecture questions. Page 4

(1) Infection sites I Which of these parasites are confined to the intestinal tract?

A. Entamoeba coli

B. Entamoeba histolytica

C. Ascaris lumbricoides

(2) Infection sites II Which of these parasites goes to the liver and the brain?

A. Entamoeba histolytica

B. Entamoeba coli

C. Ascaris lumbricoides

(3) Infection sites III Which of these parasites encysts in the muscles?

A. Giardia lamblia

B. Trichinella spiralis (agent of trichinosis)

C. Enterobius vermicularis (pinworm)

(4) Infection sites IV Which of these parasites encysts in the body cavity organs & brain?

A. Echinococcus granulosus (hydatid cyst disease)

B. Blastocystis hominis

C. Schistosoma mansoni

(5) Infection sites V Where can adult tapeworms be found?

A. Body cavity

B. Intestine

C. lungs

Post-lecture questions. Page 5

(1) Parasite ID Which of these parasites has a flagellum?

A. Endolimax nana

B. Giardia lamblia

C. Tapeworm larvae

(2) Parasite ID Which of these parasites has a trophozoite and cyst stage?

A. Cryptosporidium parvum

B. Hook worms (Ancylostoma duodenale or Necator americanus)

C. Giardia lamblia

(3) Parasite ID What is the longest worm in the human intestine?

A. Hookworms

B. Taenia solium

C. Diphyllobothrium latum

(4) Parasite ID Which parasite has 2 suckers (oral and ventral)?

A. Tapeworms

B. Round worms

C. Trematodes (flukes)

(5) Parasite ID What is the most commonly used routine method of identifying parasites?

A. PCR

B. Microscopy

C. DNA finger printing

Post-lecture questions. Page 6

(1) Pathology Which of these parasites causes peritonitis?

A. Ascaris lumbricoides

B. Blastocystis hominis

C. Cryptosporidium parvum

(2) Pathology Which of these parasites causes sub-ingual splinter?

A. Trichinella spiralis

B. Ascaris lumbricoides

C. Hookworms

(3) Pathology Which of these parasites causes mega-colon?

A. Trypanosoma cruzi (Chagas disease)

B. Leishmania tropica (oriental sore)

C. Yersinia pestis (plague)

(4) Pathology Which of these parasites causes prolapsed rectum?

A. Taenia solium

B. Ascaris lumbricoides

C. Trichuris trichura (whipworm)

(5) Pathology Which of these parasites causes hepatomegaly?

A. Ancylostoma duodenale (hookworm)

B. Entamoeba coli

C. Entamoeba histolytica

Post-lecture questions. Page 7

(1) Distribution The following countries has comparable parasite prevalence to USA:

A. Kenya

B. Canada

C. Mexico

(2) Distribution The prevalence of house-hold infections compared to non-house-hold:

A. About twice as high

B. About half as high

C. About 4 times as high

(3) Distribution The most widely distributed parasite in the USA is:

A. Blastocystis hominis

B. Malaria (Plasmodium spp.)

C. Babesia

(4) Distribution The New England states are most famous grounds for:

A. Rocky Mountain spotted fever

B. Flea-borne typhus

C. Lyme disease

(5) Distribution Plague is endemic in which region of the USA?

A. Northeast

B. Southwest

C. Southeast

Cited and related references

• Amin, O. M. 1994. Relationships in parasitology. Parts I & II. Explore 5: 5-8 & 6: 19-22.

• Amin, O. M. 1997. Prevalence and host relationships of intestinal protozoan infections during the summer of 1996. Explore 2: 29-35

• Amin, O. M. 1998. Seasonal prevalence and host relationships of Cyclospora cayetenensis in North America during 1996. Parasitol. Intern. 47: 53-58.

• Amin, O. M. 1999. Understanding parasites. Explore 9: 11-13.

• Amin, O. M. 2000. An unusual case of anisakiasis in California, U.S.A. Comp. Parasitol. 67: 71-75

• Amin, O. M. 2000. Evaluation of a new system for the fixation, concentration, and staining of intestinal parasites in fecal specimens, with critical observations on the Trichrome stain. J. Microbiol. Methods 39: 127-132.

• Amin, O. M. 2002. Seasonal prevalence of intestinal parasites in the United States during 2000. Am. J. Trop. Med. Hyg. 66: 799-803.

• Amin, O. M. 2003. Evaluation of Trichrome-plus stain. A new permanent stain and procedure for intestinal parasites in fecal specimens. Explore 12: 4-9.

• Amin, O. M. 2005. The epidemiology of Blastocystis hominins in the United States. Res. J. Parasitol. 1: 1-11.

• Amin, O. M. 2006. Prevalence, distribution, and host relationships of Cryptosporidium parvum (Protozoa) infections in the United States, 2003-2005. Explore 16: 1-7.

• Amin, O. M. 2011. The contribution of pathogenic bacteria to GI symptoms in parasite-free patients. J. Bacteriol. Parasitol. 2: 109-112.

• Amin, O. M. 2011. The significance of biomarkers in the interpretation of comprehensive stool analysis for parasite diagnosis. Parasitol. United J. 4: 231-234.

UNDERSTANDING PARASITES IN THE USA

THIS PRESENTATION

WAS A CONTRIBUTION OF

PARASITOLOGY CENTER, INC.

SCOTTSDALE, ARIZONA

BY

DR. OMAR M. AMIN

480-767-2522

480-767-5855 (FAX)

WWW.PARASITETESTING.COM

THANK YOU