Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish...
Transcript of Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish...
![Page 1: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/1.jpg)
Clinical Parasitology Update
Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow
![Page 2: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/2.jpg)
•Sixteen Cyclospora species
•Only Cyclospora cayetanensis
found in humans.
• “high risk regions”
- the Caribbean, Central and
South America, Turkey, Indian
subcontinent and South East
Asia.
Cyclospora
8 -10µm
![Page 3: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/3.jpg)
Transmission
![Page 4: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/4.jpg)
Symptoms include;
- diarrhoea (5 to 62 days; mean 18 days)
- nausea / vomiting
- lethargy
- abdominal cramping
- satiety
Cotrimoxazole
(sulfamethoxazole and trimethoprim)
![Page 5: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/5.jpg)
• Cyclospora oocysts = 8um – 10um
• Do not stain well with auramine phenol (used for Cryptosporidium)
Laboratory Diagnosis
![Page 6: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/6.jpg)
Pre-2015 1-2 cases per year
2015 79 cases reported in the UK;
21 from Scotland
2016 440 cases reported in the UK;
175 from Scotland
2017 104 cases reported in the UK;
51 from Scotland
![Page 7: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/7.jpg)
Resorts visited by US cases in red, by UK ones in blue
![Page 8: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/8.jpg)
Sunday 3rd June 2018………….
![Page 9: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/9.jpg)
• SMVN Notification
- Sent 30th May 2018
- reminder to raise awareness of Cyclospora
- laboratories are NOT requested to forward all
Cyclospora-positive stools to the SPDRL.
- Only send if unsure of the identity
• Communications continue with authorities in Mexico
and other bodies
Next Steps
![Page 10: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/10.jpg)
Cyclospora Developments
- UK-wide collaborations with CDC Atlanta
for molecular profiling of Cyclospora
![Page 11: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/11.jpg)
Scottish Health Protection Network
Giardia Working Group
“seen animalcules a-moving very prettily….”
“Their bodies were somewhat longer than
broad, and their belly was flat-like, furnisht
with sundry little paws….”
![Page 12: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/12.jpg)
• 150 - 280 lab-confirmed
Giardia per year
• 400 – 800 lab-confirmed
Cryptosporidium
![Page 13: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/13.jpg)
Laboratory reports Rate per 100,000
AA 9 2.4
BR 11 9.6
DG 0 0
FF 3 0.8
FV 3 1.0
GR 112 19.2
GGC 20 1.8
HG 4 1.2
LN 15 2.3
LO 84 9.8
TY 6 1.4
Scotland 269 5.0
Scottish Giardia Reports 2017
![Page 14: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/14.jpg)
- twice as many males than females
(177 males, 92 females)
- evident in all age bands
Scottish Giardia Reports 2017
![Page 15: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/15.jpg)
- No clear seasonal pattern for Giardia
- Slight increase in cases around weeks 30-36
![Page 16: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/16.jpg)
Scottish Data
Study 1
• 13/47 (28%) of samples were negative by microscopy but positive for Giardia antigen
• 34/47 (72%) of Giardia positive samples would have been missed if traditional criteria were used.
![Page 17: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/17.jpg)
- 28 laboratory confirmed microscopy
positive cases
- 26 cases (93%) would have been
excluded from Giardia testing if traditional
clinical information criteria had been
applied.
- Nine cases stated foreign travel - only
two from 'high risk‘ regions
Study 2
![Page 18: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/18.jpg)
Scottish Health Protection Network
Giardia Working Group
• Consider the public health implications of the
changes in laboratory testing across Scotland
• Review information collected by Health
Protection teams and current management of
Giardia across Scotland.
- Giardia surveillance with NHS Grampian
- UK Standards for Microbiology
Investigations
- Treatment resistance
![Page 19: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/19.jpg)
Identify gaps in the current knowledge;
Giardia “Special Interest” Group
- explore the molecular epidemiology of Giardia
in humans and companion animals
- resistance testing
Make recommendations for consideration; -National Gastrointestinal Zoonoses Group
- UK Enteric Protozoa Group
![Page 20: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/20.jpg)
Giardia Nomenclature
![Page 21: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/21.jpg)
Scottish laboratories report;
•Giardia species
•Giardia intestinalis
•Giardia lamblia
•Giardia duodenalis
![Page 22: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/22.jpg)
Antony van Leeuwenhoek
(1632 –1723)
• 1681
- Examined his own faeces
![Page 23: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/23.jpg)
Vilem Lambl
(1824–1895)
• 1859 Describe the parasite
from stools of children
• Cercomonas intestinalis
• Deemed “commensal”
![Page 24: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/24.jpg)
• 1875 Devaine
- a flagellate in rabbits Hexamita duodenalis
• 1882 Kunstler
- genus “Giardia” in tadpoles Giardia agilis
• 1888 Blanchard
- Lamblia intestinalis in commemoration of the
first description by Lambl
• 1914 Alexeieff showed the parasite infecting
humans was the same genus as that observed
by Kunstler i.e. Giardia intestinalis
![Page 25: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/25.jpg)
Charles Wardell Stiles
1867 –1941
Secretary of the
International Commission
on Zoological Nomenclature
1915 - Giardia lamblia
(commemorate Professor A.
Giard and Dr. Lambl)
![Page 26: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/26.jpg)
By 1950’s, 50 species of Giardia
were described…………
one host = one species
![Page 27: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/27.jpg)
G. duodenalis G. muris G.agilis
G. microti G. ardeae
G.psittaci
1952 Francis Pasquale Filice
![Page 28: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/28.jpg)
Filice proposed Giardia duodenalis
for humans and mammals
75% of reports from Scotland state
Giardia lamblia
![Page 29: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/29.jpg)
•Rules of Zoological Nomenclature
Giardia duodenalis has priority (in use by CDC
Atlanta)
•World Health Organisation uses G.intestinalis
•PHE notifiable diseases report uses G.lamblia
https://www.gov.uk/guidance/notifiable-
diseases-and-causative-organisms-how-to-
report
![Page 30: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/30.jpg)
Schistosomiasis National Advisory
Investigation and Liaison Group
S.N.A.I.L Group
![Page 31: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/31.jpg)
![Page 32: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/32.jpg)
![Page 33: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/33.jpg)
•Health Protection Scotland
•Public Health
•Healthcare Scientists
•Infectious Diseases Consultants
•Microbiologists
•General Practitioners
•Travel Nurses
•Travel Companies?
S.N.A.I.L Group
![Page 34: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/34.jpg)
• national clinical guidance on best
practice in screening, diagnosis and
management
• enhanced surveillance system
• diagnostic research
• raise awareness of schistosomiasis
![Page 35: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/35.jpg)
“Making a Microbe” Glasgow Science Festival "Science Sunday"
10th June 2018
![Page 36: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/36.jpg)
Brief Updates
![Page 37: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/37.jpg)
Microscopy - report as;
Entamoeba histolytica / Entamoeba dispar
Molecular speciation assay - Available at the SPDRL, Glasgow
- Replaces antigen testing
- No need to freeze samples
- Samples do not need to be <48 hours old
12 - 15μm
Entamoeba histolytica
![Page 38: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/38.jpg)
Teaching
Webinars on;
-Protozoa
-Helminths
-Ecto-parasites
-Malaria
-Blood Parasies
![Page 39: Clinical Parasitology Update · Clinical Parasitology Update Dr. Claire Alexander Scottish Microbiology Reference Laboratories, Glasgow ... • Consider the public health implications](https://reader035.fdocuments.in/reader035/viewer/2022081505/5f1dacddd6965956303d806d/html5/thumbnails/39.jpg)
10th June 2018
Open Farm Sunday