Sandbox spinalcord: Difference between revisions

Latest revision as of 19:19, 1 March 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Lower gastrointestinal bleeding, commonly abbreviated LGIB, refers to any form of bleeding in the lower gastrointestinal tract.

Causes

Coagulopathy - specifically a bleeding diathesis
Colitis
Hemorrhoids
Angiodysplasia
Neoplasm - cancer
Diverticular disease - diverticulosis, diverticulitis

Diagnosis

The following suggest an LGIB:

Melena and a negative oesophagogastroduodenoscopy
Hematochezia
Fecal occult blood

The following may suggest an LGIB:

Anemia

Related Chapter

Blood in stools

Abdominal pain

Yes

No

Fever

Rectal pain

Yes

No

H/O of constipation

No

Yes

No

Yes

Weightloss

Diverticulosis

Hemodynamic status

Diverticulitis

No

Yes

Stable

Unstable

Polyps

Colon cancer

No

Yes

Weight Loss

Anal fissure
External Hemmrhoids

Yes

No

Rectal cancer
Colon cancer

Angiodysplasia
Polyps

Management

Hepatic adenoma

Management of hepatic adenoma depends upon:

Symptoms
Size
Number
Location
Certainty of the diagnosis

Asymptomatic woman on OCPs with a small adenoma

The European Association for Study of the Liver recommends

Discontinuation of contraceptive medication
Close observation of the lesion with repeated imaging and alpha fetoprotein.
- Contrast-enhanced magnetic resonance imaging at a six month interval to determine if there is regression of a large adenoma to less than 5 cm.
Patients with hepatic adenomas that do not resolve or that enlarge after six months of observation should undergo treatment.

Symptomatic patients and those with large adenomas

Surgical resection is recommended for all symptomatic patients with hepatic adenoma and those with large lesions (>5 cm).
Surgical options include :
- Enucleation
- Resection
- Liver transplantation

Nonsurgical interventions include
- Transarterial embolization
- Radiofrequency ablation

Hepatic Hemangioma

Asymptomatic patients
- Patients with lesions <1.5 cm, are reassured and observed.
- Follow-up imaging in patients with hemangiomas ≤5 cm in size is usually not recommended.
- Patients with rapid growth of a hemangioma or with lesions >5 cm it is recommended to repeat imaging in 6 to 12 months.
- It is recommended not perform additional imaging if there is no change in the size of the lesion.
Symptomatic patients
- Patients who have pain or symptoms suggestive of extrinsic compression of adjacent structures should be considered for surgical options.
- Surgical options include
  - Liver resection
  - Enucleation
  - Hepatic artery ligation
  - Liver transplantation
- Non-surgical techniques include
  - Hepatic artery embolization
  - Radiotherapy
  - Interferon alfa-2a

Focal nodular hyperplasia

Due to their benign nature of focal nodular hyperplasia, there is

Follow-up studies at three and six months will often be sufficient to confirm the stability of the lesion and its benign nature, after which no long-term follow-up is required routinely.
Surgery should be reserved for symptomatic FNH lesion.

Parasitic Infection		Mode of infection		Epidemiology	Clinical manifestations	Diagnosis	Treatment
Disease	Parasite	Mode of infection	Incidence	Geographic distrubution	Clinical manifestations	Diagnosis	Treatment
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	Abdominal discomfort Anorexia Nausea and vomiting Diarrhea Intestinal obstruction	Stool microscopy Peripheral eosinophilia Barium swallow	Albendazole Mebendazole Ivermectin
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	Acute ^[4] Nausea and vomiting Diarrhea Epigastric pain Increased flatulence Chronic^[5] Bloody stools Anemia LBW in pregnant women	Stool microscopy^[6] Peripheral eosinophilia	Albendazole Mebendazole^[7] Pyrantel pamoate^[8]
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	Asymptomatic^[11] Acute Diarrhea Malaise Steatorrhea Abdominal cramps Bloating Nausea Weight loss. Chronic Lose stools Malabsorption Steatorrhea Weight loss Fatigue	Antigen detection assays Fluorescein-tagged monoclonal antibodies Immunochromatographic assays^[12] Enzyme-linked immunosorbent assays Nucleic acid amplification^[13]assays (NAAT) Stool microscopy	Tinidazole^[14] Nitazoxanide
Fasciolosis	Fasciola Hepaticum			Central and South America Asia (China, Vietnam, Taiwan, Korea, and Thailand) Europe (Portugal, France, Spain, and Turkey) Africa The Middle East.	Acute liver phase Fever Anorexia Nausea and vomiting Myalgia Cough Right upper quadrant pain Hematomas of the liver Jaundice Hepatomegaly.^[15] Chronic biliary phase Asymptomatic^[16] Common bile duct obstruction Pancreatitis	Microscopy^[17] Stools Bile Duodenal aspiration Peripheral eosinophilia may disappear.^[18] Serology Indirect hemagglutination Complement fixation Enzyme-linked immunosorbent assay	Triclabendazole Bithionol Nitazoxanide
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] Fever and chills Urticaria Angioedema Myalgias Arthralgias Dry cough Diarrhea Abdominal pain Headache.^[21] Chronic schistosomias^[22]^[23]^[24]^[25] Intestinal schistosomiasis Hepatosplenic schistosomiasis^[26]^[27] Pulmonary schistosomiasis^[28] Genitourinary schistosomiasis	Stool microscopy^[29] Serologic tests include: Indirect hemagglutination Complement fixation Enzyme-linked immunosorbent assay PCR	Praziquantel^[30] Oxamniquine
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	Hyperinfection syndrome Fever Nausea and vomiting Anorexia Diarrhea Abdominal pain Dyspnea Wheezing Hemoptysis Cough	Aspiration of duodenojejunal fluid is sometimes used to detect^[31] Stool microscopy PCR, ELISA	Ivermectin^[32] Albendazole^[33]
Amoebiais	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	Asymptomatic Mild diarrhea to severe dysentery. Fulminant amebic colitis. Weight loss Amebic dysentery	Stool microscopy Antigen testing PCR	Metronidazole Tinidazole Paromomycin Diloxanide furoate Iodoquinol
Taeniasis	Taenia saginata (beef tapeworm) Taenia solium, ( pork tapeworm).^[37]	Consumption of undercooked beef	Approximately 50 million human have cysticercosis.	Europe Parts of Asia.	Most human carriers are asymptomatic. Symptoms may include Nausea Anorexia Epigastric pain	Stool microscopy Peripheral eosinophilia ELISA PCR	Albendazole
Trichuriasis	Trichuris trichiura	Ingestion of embryonatedeggs from contaminated drinking water and food.		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	Asymptomatic^[38] Loose stool which may contain mucus and blood Nocturnal stooling Rectal prolapse	Stool microscopy Proctoscopy Demonstrates adult worms protruding from the bowel mucosa. Eosinophilia Polymerase chain reaction	Mebendazole^[39] 500 mg PO q24h X 3 day (or) 100 mg PO q12h x 2 days Albendazole^[40] 400 mg POq24h
Hymenolepiasis	Hymenolepis nana	Ingestion of infected eggs		Most common in temperate zones^[41] South Europe Russia India US Latin America.	Asymptomatic^[42] Heavy infections with >1000 worms can occur Crampy abdominal pain Diarrhea Anorexia Fatigue Pruritus ani	Stool microscopy FLOTAC method^[43]	Praziquantel^[44] Prompt family screening or empiric treatment^[45]

↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Genta RM, Woods KL (1991). "Endoscopic diagnosis of hookworm infection". Gastrointest Endosc. 37 (4): 476–8. PMID 1916173.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Lengerich EJ, Addiss DG, Juranek DD (1994). "Severe giardiasis in the United States". Clin Infect Dis. 18 (5): 760–3. PMID 8075266.
↑ 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.
↑ 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.
↑ Chan CW, Lam SK (1987). "Diseases caused by liver flukes and cholangiocarcinoma". Baillieres Clin Gastroenterol. 1 (2): 297–318. PMID 2822181.
↑ 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.
↑ Prociv P, Walker JC, Whitby M (1992). "Human ectopic fascioliasis in Australia: first case reports". Med J Aust. 156 (5): 349–51. PMID 1588869.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Lucey DR, Maguire JH (1993). "Schistosomiasis". Infect Dis Clin North Am. 7 (3): 635–53. PMID 8254164.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Mahmoud AA (1982). "The ecology of eosinophils in schistosomiasis". J Infect Dis. 145 (5): 613–22. PMID 7042854.
↑ 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.
↑ 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.
↑ 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.
↑ Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR (1993). "Albendazole is effective treatment for chronic strongyloidiasis". Q J Med. 86 (3): 191–5. PMID 8483992.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Rossignol JF, Maisonneuve H (1984). "Benzimidazoles in the treatment of trichuriasis: a review". Ann Trop Med Parasitol. 78 (2): 135–44. PMID 6378109.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Pawłowski ZS (1990). "Efficacy of low doses of praziquantel in taeniasis". Acta Trop. 48 (2): 83–8. PMID 1980572.

[pmid10899534-1] 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.

[pmid24688073-2] 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.

[pmid28098526-3] 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.

[pmid4451228-4] 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.

[pmid28300694-5] 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.

[pmid29016326-6] 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.

[pmid1916173-7] Genta RM, Woods KL (1991). "Endoscopic diagnosis of hookworm infection". Gastrointest Endosc. 37 (4): 476–8. PMID 1916173.

[pmid27032297-8] 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.

[pmid1500757-9] 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.

[pmid23169940-10] 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.

[pmid6707812-11] 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.

[pmid8075266-12] Lengerich EJ, Addiss DG, Juranek DD (1994). "Severe giardiasis in the United States". Clin Infect Dis. 18 (5): 760–3. PMID 8075266.

[pmid23711521-13] 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.

[pmid16507373-14] 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.

[pmid2822181-15] Chan CW, Lam SK (1987). "Diseases caused by liver flukes and cholangiocarcinoma". Baillieres Clin Gastroenterol. 1 (2): 297–318. PMID 2822181.

[pmid18725803-16] 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.

[pmid1588869-17] Prociv P, Walker JC, Whitby M (1992). "Human ectopic fascioliasis in Australia: first case reports". Med J Aust. 156 (5): 349–51. PMID 1588869.

[pmid22171131-18] 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.

[pmid23041540-19] 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.

[pmid17488923-20] 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.

[pmid8599059-21] 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.

[pmid8254164-22] Lucey DR, Maguire JH (1993). "Schistosomiasis". Infect Dis Clin North Am. 7 (3): 635–53. PMID 8254164.

[pmid23465781-23] 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.

[pmid16416239-24] 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.

[pmid27521443-25] 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.

[pmid3124648-26] 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.

[pmid10441577-27] 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.

[pmid3722898-28] 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.

[pmid7042854-29] Mahmoud AA (1982). "The ecology of eosinophils in schistosomiasis". J Infect Dis. 145 (5): 613–22. PMID 7042854.

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[pmid7036430-31] 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.

[pmid11957127-32] 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.

[pmid8483992-33] Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR (1993). "Albendazole is effective treatment for chronic strongyloidiasis". Q J Med. 86 (3): 191–5. PMID 8483992.

[pmid17716437-34] 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.

[pmid17437396-35] 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.

[pmid19540361-36] 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.

[pmid9798586-37] 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.

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[pmid6378109-39] Rossignol JF, Maisonneuve H (1984). "Benzimidazoles in the treatment of trichuriasis: a review". Ann Trop Med Parasitol. 78 (2): 135–44. PMID 6378109.

[pmid21980373-40] 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.

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-==Causes==
+__NOTOC__
-Common causes of acute spinal cord compression include
-*Trauma is a leading cause of acute spinal cord compression
-*Primary or secondary metastatic spinal tumor
-*Vertebral compression fractures due to osteomalacia, osteoporosis, corticosteroid therapy
-*Intervertebral disk herniation
-*Epidural abscess
-*Epidural hematoma
-==Risk factors==
-Common risk factors in the development of spinal cord compression include
-*Cervical spondylosis
-*Atlantoaxial instability
-*Congenital conditions (tethered cord)
-*Osteoporosis
-*Ankylosing spondylitis
-*Rheumatoid arthritis of the cervical spine
-Less common risk factors
-*IV drug abuse
-*Immunocompromised
-==Pathophysiology==
+{{CMG}}
-===Anatomy===
+==Overview==
-*The spinal cord extends from the foramen magnum down to the level of the first and second lumbar vertebrae.
+'''Lower gastrointestinal bleeding''', commonly abbreviated '''LGIB''', refers to any form of bleeding in the [[lower gastrointestinal tract]].
-*At L2 level spinal cord transforms into spinal roots and forms a cone-shaped structure called conus medullaris.
-*The cord is protected by the vertebral column, which is mobile and allows for movement of the spine.
-*It is enclosed by the dura mater and the vessels supplying it.
-*The cord floats in the cerebrospinal fluid which acts as a buffer to movement and early degrees of compression.
-*The cord substance contains a gray area centrally and is surrounded by white matter communication tracts, both ascending and descending.
-===Pathogenesis===
-*The spinal cord and nerve roots depend on a constant blood supply to perform axonal signaling.
-*Conditions that interfere, either directly or indirectly, with the blood supply will cause malfunction of the transmission pathway.
-*Injury to the spinal cord or nerve roots arises from stretching or from pressure.
-*It initiates a cascade of events in the gray matter and white matter, and results in hypoperfusion and eventually hemorrhagic necrosis.
-*The extent of necrosis depends on the severity of the trauma, concomitant compression, perfusion pressures and blood flow, and administration of pharmacological agents.
-*The tissue responses by gliosis, demyelination, and axonal loss.
-*This results in injury to the white matter (myelinated tracts) and the gray matter (cell bodies) in the cord with loss of sensory reflexes (pinprick, joint position sense, vibration, hot/cold, pressure) and motor function.
-*Rapid compression will result in the collapse of the venous system, resulting in vasogenic edema.
-*Vasogenic edema exacerbates parenchymal pressure and may lead to rapid progression of dysfunction.
-===Dissemination===
+==Causes==
-Hematogenous spread
+*[[Coagulopathy]] - specifically a [[bleeding diathesis]]
-===Genetic Factors===
+*[[Colitis]]
-===Associated conditions===
+**[[ischaemic colitis]]
-Lesions may develop gradually or acutely and be complete or incomplete. Incomplete lesions often present as distinct syndromes  as follows:
+**[[ulcerative colitis]]
-{| class="wikitable"
+**[[infectious colitis]]
-!
+***[[E. coli O157:H7]]
-!Sensory dysfunction
+***[[Shigella]]
-!Motor dysfunction
+***[[C. difficile]]
-!Sphincter dysfunction
+***[[Campylobacter jejuni]]
-|-
+*[[Hemorrhoids]]
-|Central cord syndrome
+*[[Angiodysplasia]]
-|Sensory loss is very rare
+*[[Neoplasm]] - cancer
-|Upper extremity weakness
+*[[Diverticular disease]] - diverticulosis, diverticulitis
-distal muscles are involved  more than proximal
-|
-|-
-|Brown-Séquard syndrome
-|Ipsilateral position and vibration sense loss
-Contralateral pain and temperature sensation loss
-|Motor loss ipsilateral to cord lesion
-|
-|-
-|Anterior cord syndrome
-|Loss of pin and touch sensation
-Vibration, position sense preserved
+==Diagnosis==
-|Motor loss or weakness below the level of compression
+The following suggest an LGIB:
-|
+*[[Melena]] and a negative [[oesophagogastroduodenoscopy]]
-|-
+*[[Hematochezia]]
-|Transverse cord syndrome
+*[[Fecal occult blood]]
-|Loss of sensation below level of compression
-|Loss of voluntary motor function below the level of compression
-|Sphincter control lost
-|-
-|Conus medullaris syndrome
-| rowspan="2" |Saddle anesthesia
-Sensory loss may range from patchy to complete transverse pattern
+The following may suggest an LGIB:
-| rowspan="2" |Weakness may be of upper motor neuron type
+*[[Anemia]]
-| rowspan="2" |Sphincter control impaired
-|-
-|Cauda equina syndrome
-|}
-==Epidemiology and Demographics==
+==Related Chapter==
-===Epidemiology===
+* [[Fecal occult blood]]
-====Incidence====
+* [[Blood in stool]]
-*The annual incidence of spinal cord compression is estimated to be about 11,000 new cases/yr in the United States
+* [[Rectal bleeding]]
-*The worldwide incidence of spinal cord compression varies from 8 to 246 cases per million inhabitants per year.
+* [[Upper gastrointestinal bleeding]]
-====Prevelance====
+<small>
-*The global prevalence of spinal cord injury (SCI) has been reported to vary from 236 to 1,298 per million inhabitants.
+<div style="width: 55%;">
-*In United States the prevalence is estimated to be 171,000 persons.
+{{familytree/start |summa|ry=Sample 1}}
-===Demographics===
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | | | A01=Blood in stools}}
-====Gender====
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | }}
-Spinal cord compression is more commonly seen in males than females
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | M01 |M01=Abdominal pain }}
-====Age====
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|-|-|^|-|-|-|.| }}
-It is more common in 40's
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | N01 | | | | | | | N02 | | |N01=Yes|N02=No}}
-====Race====
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | |!| | | |}}
-No racial predilection
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | O01 | | | | | | | O02 | |O01=Fever|O02=Rectal pain}}
+{{familytree | | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|.| | | |!| | }}
+{{familytree | | | | | | | | | | | | | | | P01 | | | | | | | | | | | | | | | | P02 | | |!|P01=Yes|P02=No}}
+{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | |!| | | |!| | }}
+{{familytree | | | | | | | | | | | | | | | Q01 | | | | | | | | | | | | | | | | Q02 | | |`|-|-|.|Q01=H/O of constipation|Q02=H/O of constipation}}
+{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| | |!||}}
+{{familytree | | | | | | | | | | |,|-|-|-|-|^|-|-|-|.| | | | | | | | | B01 | | | | | | B02 | |!|B01=No|B02=Yes|}}
+{{familytree | | | | | | | | | | R01 | | | | | | | R02 | | | | | | | | |!| | | | | | | |!| | |!| R01=No|R02=Yes}}
+{{familytree | | | | | | | | | | |!| | | | | | | | |!| | | | | | | | | C01 | | | | | | C02 | |!|C01=Weightloss|C02=Diverticulosis}}
+{{familytree | | | | | | | | | | S01 | | | | | | | S02 | | | | |,|-|-|-|^|-|-|-|.| | | | | | |!|S01=Hemodynamic status|S02=Diverticulitis| }}
+{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | D01 | | | | | | D02 | | | | | |!|D01=No|D02=Yes}}
+{{familytree | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | | | | |!| | | | | | | |!| | | | | | |!|}}
+{{familytree | | | | | | T01 | | | | | | T02 | | | | | | | | | E01 | | | | | | E02 | | | | | |!|T01=Stable|T02=Unstable|E01=Polyps|E02=Colon cancer}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!|}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|-|'|}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|-|^|-|-|-|-|.|}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | |!| |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | X01 | | | | | | | X02 |X01=No|X02=Yes}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | |!| |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | U01 | | | | | | | U02 |U01=Weight Loss|U02=Anal fissure<br> External Hemmrhoids}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|-|-|^|-|-|-|-|.| |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | |!| }}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | C03 | | | | | | | | C04 |C03=Yes|C04=No|}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | |!| | }}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | D01 | | | | | | | | D02 |D01=Rectal cancer<br>Colon cancer|D02=Angiodysplasia<br>Polyps }}
+{{familytree/end}}
+</div>
+</small>
-==Symptoms==
+== Management ==
-Symptoms of spinal cord compression depends on the anatomic level involved in compression and can be discussed as follows
-{| class="wikitable"
-!Type of spinal
-involvement
-!Symptoms
-|-
-|Cervical
-|Headache
-Neck, shoulder or arm pain
-Loss of sensation over the upper extremities
-Motor weakness of neck, shoulder, and arm
-|-
-|Thoracic
-|Pain in the chest and/or back
-Loss of sensation below the level of the compression
-Paralysis of respiratory muscles
-|-
-|Lumbosacral
-|Low back pain that may radiate down the legs
-Weakness in the legs and feet
-Loss of sensation in the legs and feet
-Bladder and bowel problems
+=== Hepatic adenoma ===
+Management of hepatic adenoma depends upon:
+* Symptoms
+* Size
+* Number
+* Location
+* Certainty of the diagnosis
-Sexual dysfunction
+==== '''Asymptomatic woman on OCPs with a small adenoma''' ====
+The European Association for Study of the Liver recommends
+* Discontinuation of contraceptive medication
+* Close observation of the lesion with repeated imaging and alpha fetoprotein.
+** Contrast-enhanced magnetic resonance imaging at a six month interval to determine if there is regression of a large adenoma to less than 5 cm.
+* Patients with hepatic adenomas that do not resolve or that enlarge after six months of observation should undergo treatment.
-Foot drop
+==== Symptomatic patients and those with large adenomas ====
+* Surgical resection is recommended for all symptomatic patients with hepatic adenoma and those with large lesions (>5 cm).
+* Surgical options include :
+** Enucleation
+** Resection
+** Liver transplantation
-Decreased or absent reflexes in the legs
+* Nonsurgical interventions include
-|}
+** Transarterial embolization
+** Radiofrequency ablation
-==Laboratory findings==
+=== Hepatic Hemangioma ===
-Spinal cord compression is diagnosed based on clinical history and imaging studies. Other lab studies like CBC, CSF, clotting studies and electrolyte exam helpful in excluding infection as a cause.
+* '''Asymptomatic patients'''
-*CBC shows increased neutrophil count in cases of infection.
+** Patients with lesions <1.5 cm, are reassured and observed.
-*[[ESR]] and [[CRP]] are elevated
+** Follow-up imaging in patients with hemangiomas ≤5 cm in size is usually not recommended.
-*Blood and CSF cultures are positive in case of an epidural abscess or osteomyelitis.
+** Patients with rapid growth of a hemangioma  or with lesions >5 cm it is recommended to repeat imaging in 6 to 12 months.
-*Tumor biopsy positive for malignant cells if compression of spinal cord is due to malignancy
+** It is recommended not perform additional imaging if there is no change in the size of the lesion.
-*Urodynamic studies reveal reduced bladder contractility and sphincter dysfunction.
+* '''Symptomatic patients'''
-==X-ray spine==
+** Patients who have pain or symptoms suggestive of extrinsic compression of adjacent structures should be considered for surgical options.
-*Plain radiographs are useful in assessing mechanical stability of the spine in trauma cases and has minimal role in acute conditions.
+** Surgical options include
-*CT scans have replaced the role of plain radiographs in the setting of multiple trauma due to their specificity and accuracy.
+*** Liver resection
-*Plain x-ray film is indicated in patients presenting with chronic back pain as an initial symptom
+*** Enucleation
+*** Hepatic artery ligation
+*** Liver transplantation
+** Non-surgical techniques include
+*** Hepatic artery embolization
+*** Radiotherapy
+*** Interferon alfa-2a
-==CT Spine==
+=== Focal nodular hyperplasia ===
-*MRI and CT imaging are preferred diagnostic modalities in confirming the diagnosis
+* Due to their benign nature of focal nodular hyperplasia, there is
-*CT spine is preferred for detection of spinal canal abnormalities.
-*Anteroposterior, lateral, views are required to show the alignment of bone structures.
-*CT guidance is employed in surgical aspiration and diagnosis of infection or drainage of an epidural abscess.
-*CT-guided biopsy of suspected tumors helps in confirmation of the diagnosis.
-==MRI Spine==
+* Follow-up studies at three and six months will often be sufficient to confirm the stability of the lesion and its benign nature, after which no long-term follow-up is required routinely.
-*MRI is the study of choice when there is incomplete paralysis or CT is inconclusive.
+* Surgery should be reserved for symptomatic FNH lesion.
-*MRI is recommended for all patients who have new-onset urinary symptoms with associated back pain.
-*Patients who present with a tumor history should undergo MRI-enhanced imaging.
-*Epidural abscess is best detected by MRI.
-==Treatment==
 {| class="wikitable"
+! colspan="2" |Parasitic Infection
+! rowspan="2" |Mode of infection
 !
-!First line treatment
+!Epidemiology
-!Adjuvant
+! rowspan="2" |'''Clinical manifestations'''
-!
+! rowspan="2" |Diagnosis
+! rowspan="2" |Treatment
+|-
+!Disease
+!Parasite
+!Incidence
+!Geographic distrubution
+|-
+|[[Ascariasis]]
+|[[Ascaris lumbricoides|''Ascaris lumbricoides'']]
+|
+* Ingestion of [[Ascaris infection|Ascaris]] eggs secreted in the feces of humans or pigs.<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>
+* 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.<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>
+|
+* Asia
+* Africa
+* South America
+|
+* [[Abdominal discomfort]]
+* [[Anorexia]]
+* [[Nausea and vomiting]]
+* [[Diarrhea]]
+* [[Intestinal obstruction]]
+|
+* [[Stool examination|Stool microscopy]]
+* Peripheral [[eosinophilia]]
+* [[Barium swallow]]
+|
+* [[Albendazole]]
+* [[Mebendazole]]
+* [[Ivermectin]]
 |-
-|Acute traumatic spinal cord compression
+|[[Necatoriasis]]
+| [[Necator americanus|''Necator americanus'']]
 |
-*Immobilization of the patient along with decompressive surgery
+* Skin contact
-*Maintenance of volume and blood pressure
+|
+* Approximately 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>
+|
+* Brazil
+* Texas
+* Africa
+* China
+* Southwest Pacific islands
+* India
+* Southeast Asia
+|
+* '''Acute <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>'''
+** [[Nausea and vomiting|Nausea]] and  [[Nausea and vomiting|vomiting]]
+** [[Diarrhea]]
+** Epigastric pain
+** Increased [[flatulence]]
+* '''Chronic<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>'''
+** [[Bloody stools]]
+** [[Anemia]]
+** [[Low birth weight|LBW]] in [[pregnant]] women
 |
-* IV corticosteroids
+* Stool microscopy<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>
-'''Prophylaxis for venous thromboembolism'''
+* Peripheral [[eosinophilia]]
-* First line low-molecular-weight heparin, enoxaparin: 40 mg subcutaneously once daily
-*Second-line unfractionated heparin 5000 units subcutaneously every 8-12 hours
-*Compression stockings or pneumatic intermittent compression
-'''Prevention of stress ulcers'''
-*Omeprazole: 40 mg orally once daily
-*Cimetidine: 300 mg orally/intravenously every 6 hours
-*Famotidine: 40 mg orally once daily; 20 mg intravenously every 12 hours
-'''Supportive therapies'''
-*Nutritional support
-*Bladder catheterization
-*Frequent position changing for the prevention of pressure ulcers every 2 hours.
 |
+* [[Albendazole]]
+* [[Mebendazole]]<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>
+* [[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>
 |-
+|[[Giardiasis]]
+|''[[Giardia lamblia]]''
+|
+* Ingestion of raw or undercooked food contaminated with [[cysts]].<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>
+|
+* Approximately, 15,223 cases were reported in the United States in 2012.<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>
 |
+* Worldwide infection
+* Among mountains hikers
 |
+* Asymptomatic<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
+** [[Diarrhea]]
+** [[Malaise]]
+** [[Steatorrhea]]
+** [[Abdominal cramps]]
+** [[Bloating]]
+** [[Nausea and vomiting|Nausea]]
+** [[Weight loss]].
+* Chronic
+** Lose stools
+** [[Malabsorption]]
+** [[Steatorrhea]]
+** [[Weight loss]]
+** [[Fatigue]]
 |
+* Antigen detection assays
+** [[Fluorescein]]-tagged [[monoclonal antibodies]]
+** Immunochromatographic assays<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>
+** [[ELISA test|Enzyme-linked immunosorbent assays]]
+* Nucleic acid amplification<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>assays ([[NAAT]])
+* [[Stool examination|Stool microscopy]]
 |
+* [[Tinidazole]]<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>
+* [[Nitazoxanide]]
 |-
+| [[Fasciolosis]]
+|''[[Fasciola hepatica|Fasciola Hepaticum]]''
+|
 |
 |
+* Central and South America
+* Asia (China, Vietnam, Taiwan, Korea, and Thailand)
+* Europe (Portugal, France, Spain, and Turkey)
+* Africa
+* The Middle East.
 |
+* Acute liver phase
+** [[Fever]]
+** [[Anorexia]]
+** Nausea and [[vomiting]]
+** [[Myalgia]]
+** [[Cough]]
+** Right upper quadrant pain
+** [[Hematoma|Hematomas]] of the [[liver]]
+** [[Jaundice]]
+** [[Hepatomegaly]].<ref name="pmid2822181">{{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="pmid18725803">{{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]]
 |
-|}
+* Microscopy<ref name="pmid1588869">{{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>
-* Patients with a spinal cord injury should be immobilized first with a cervical collar and backboard/head strap. The choice of treatment options depends upon the cause of the compression.The patient  can be grouped into the following categories for treatment:
+** Stools
-*Acute traumatic spinal cord compression
+** Bile
-*Intervertebral disk compression (cauda equina syndrome)
+** Duodenal aspiration
-*Spinal cord compression due to metastasis
-*Compression of spinal cord due to epidural abscess (infection)
-The goal of treatment is
-*To prevent further deterioration of the disease.
-*To relieve the patient from pain.
-*To restore functional ability.
-==Medical treatment==
-All the patients with acute spinal cord compression must be admitted. The mainstay of treatment includes surgery for most of the cases except for compression caused by metastasis. The treatment in such cases is mostly palliative. Antibiotics are indicated in cases of compression caused by an epidural abscess.
-===Antibiotics===
+* Peripheral [[eosinophilia]] may disappear.<ref name="pmid22171131">{{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>
-*Preferred regimen (1): vancomycin 15-20 mg/kg IV q8-12h '''and''' metronidazole 500 mg IV q6h  '''and''' cefotaxime 2 g IV q6h
-===Maintaince of fluid volume===
-*Goal is to mainatain systotic bp above 100 mmhg and an adequate urine output (0.5 mL/kg/hour) using volume resuscitation, and vasopressors.
-*Preffered regimen: volume resuscitation using fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial treatment of choice.
-*Alternative regimen : Dopamine 1-50 micrograms/kg/minute IV q8h.
-===Corticosteroids===
+* Serology
-*Preferred regimen: Methylprednisone 30 mg/kg intravenously as a bolus given over 15 minutes followed by 5.4 mg/kg/hour intravenous infusion for 24 hours (if <3 hours since injury) or for 48 hours (if 3-8 hours since injury)
+**[[Hemagglutination assay|Indirect hemagglutination]]
+**[[Complement fixation test|Complement fixation]]
-===Prophylaxis for venous thromboembolism===
+**[[Enzyme linked immunosorbent assay (ELISA)|Enzyme-linked immunosorbent assay]]
-*Preferred regimen: Enoxaparin 40 mg subcutaneously q24h
+|
-*Alternative regimen (1): Heparin 5000 units subcutaneously q8-12h
+* [[Triclabendazole]]
-*Alternative regimen (2): IVC filter (in patients with contraindications to anticoagulation)
+* [[Bithionol]]
+* [[Nitazoxanide]]
-===Prevention of stress ulcers===
-*Preferred regimen (1): Omeprazole 40 mg orally q24h
-*Preferred regimen (2): Cimetidine 300 mg orally/intravenously q6h
-*Preferred regimen (3): Famotidine 40 mg orally q24h (or) 20 mg intravenously q12h
-===Supportive therapies===
-*Nutritional support
-*Compression stockings or pneumatic intermittent compression
-*Bladder catheterization
-*Frequent repositioning of the patient for the prevention of pressure ulcers every 2 hours
-==Surgery==
-{| class="wikitable"
-!Cause of compression
-!Prefered treatment
-!Adjuvant therapy
 |-
-|Trauma
+|[[Schistosomiasis]]
-|Decompressive/stabilization surgery of vertebral column
+|
-| +
+* ''[[Schistosoma mansoni|S. mansoni]]''
+* ''[[Schistosoma japonicum|S. japonicum]]''
+* ''[[Schistosoma haematobium|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.<ref name="pmid23041540">{{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>
+|Acute schistosomiasis syndrome <ref name="pmid17488923">{{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="pmid8599059">{{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="pmid8254164">{{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="pmid23465781">{{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="pmid16416239">{{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="pmid27521443">{{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="pmid3124648">{{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="pmid10441577">{{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="pmid3722898">{{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
+|
+* Stool microscopy<ref name="pmid7042854">{{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]]
+|
+* [[Praziquantel]]<ref name="pmid24955523">{{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]]
 |-
-|Disk herniation
+|Strongyloidiasis
-|Laminectomy
+|[[Strongyloides|''Strongyloidis Stercoralis'']]
-| +
+|
-|-
+* Infection is contracted via direct contact with contaminated soil during agricultural, domestic, and recreational activities
-|Metastasis
+|
-|Corticosteroids + radiation therapy
+* Approximately 30–100 million infected persons worldwide
-|<nowiki>+</nowiki>
+|
-|-
+* Tropical and subtropical regions
-|Epidural asbcess
+|
-|CT guided aspiration of  abscess + Antibiotics
+* Hyperinfection syndrome
-| +
+**[[Fever]]
-|}
+**[[Nausea and vomiting]]
+**[[Anorexia]]
-==Differential==
+**[[Diarrhea]]
-{| class="wikitable"
+**[[Abdominal pain]]
-! rowspan="2" |Disease/Condition
+**[[Dyspnea]]
-! rowspan="2" |Differentiating Signs/Symptoms
+**[[Wheeze|Wheezing]]
-! colspan="2" |Differentiating Tests
+**[[Hemoptysis]]
-|-
+**[[Cough]]
-|'''CSF Findings'''
-|Radiological studies
-(MRI/CT)
-|-
-|Transverse myelitis
-|Febrile illness preceding the symptoms
-LE >UE
-|Pleocytosis
-↑Total protein
-|Focal demyelination
-|-
-|Guillain-Barre syndrome (GBS)
-|History of gastroenteritis or influenza-like illness
-Ascending paralysis
-Loss of deep tendon reflexes
-Respiratory muscle weakness requiring ventilation
 |
+* Aspiration of duodenojejunal fluid is sometimes used to detect<ref name="pmid7036430">{{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
 |
+* [[Ivermectin]]<ref name="pmid11957127">{{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="pmid8483992">{{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>
 |-
-|HIV-related myelopathy
+|Amoebiais
+|''[[Entamoeba histolytica|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.<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>
 |
-|-
+* India
-|Amyotrophic lateral sclerosis (ALS)
+* Africa
+* Mexico
+* Parts of Central and South America
 |
+* Asymptomatic
+* Mild [[diarrhea]] to severe [[dysentery]].
+* Fulminant amebic colitis.
+* [[Weight loss]]
+* [[Amebic dysentery]]
 |
+* Stool microscopy
+* Antigen testing
+* PCR
 |
+* [[Metronidazole]]
+* [[Tinidazole]]
+* [[Paromomycin]]
+* [[Diloxanide furoate]]
+* [[Iodoquinol]]
 |-
-|Multiple sclerosis
+|Taeniasis
+|
+* ''[[Taenia saginata]]''  (beef [[Tapeworms|tapeworm]])
+* ''[[Taenia solium]]'', ( pork tapeworm).<ref name="pmid9798586">{{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>
 |
+* Consumption of undercooked beef
 |
+* Approximately 50 million human have cysticercosis.
 |
-|-
+* Europe
-|Diabetic neuropathy
+* Parts of Asia.
 |
+*Most human carriers are asymptomatic.
+*Symptoms may include
+*[[Nausea and vomiting|Nausea]]
+*[[Anorexia]]
+*[[Epigastric pain]]
 |
+* Stool microscopy
+* Peripheral [[eosinophilia]]
+* ELISA
+* PCR
 |
+* [[Albendazole]]
 |-
-|Polymyositis
+|Trichuriasis
+|''Trichuris trichiura''
 |
+* Ingestion of [[Fertilised|embryonated]]<nowiki/>eggs from contaminated drinking water and food.
 |
 |
-|-
+* [[Endemic (epidemiology)|Endemic]] in [[Tropical disease|tropical]] and subtropical countries.
-|Hereditary muscular dystrophy
+*  Southern United States
+* Incidence and prevalence rates are highest in children living in
+** Sub-Saharan Africa
+** Asia
+** Latin America
+** Caribbean
 |
+* Asymptomatic<ref name="pmid97985862">{{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]]
 |
+* Stool microscopy
+* [[Proctoscopy]]
+** Demonstrates adult worms protruding from the bowel [[Mucous membrane|mucosa]].
+* [[Eosinophilia]]
+* [[Polymerase chain reaction]]
 |
+* [[Mebendazole]]<ref name="pmid6378109">{{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="pmid21980373">{{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
 |-
-|Peripheral neuropathy
+|Hymenolepiasis
+|''Hymenolepis nana''
+|
+* Ingestion of infected eggs
+|
+|Most common in temperate zones<ref name="pmid19456836">{{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.
 |
+* Asymptomatic<ref name="pmid26535513">{{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
 |
+* Stool microscopy
+** FLOTAC method<ref name="pmid22461006">{{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>
 |
+* [[Praziquantel]]<ref name="pmid23618773">{{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="pmid1980572">{{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>
 |}
+<references />
-Approximately one third of patients report a. Most have leg weakness of varying degrees of severity. The arms are involved in a minority of cases.
-Associated illnesses include multiple sclerosis, rheumatoid arthritis, HIV infection, and sarcoidosis.
-CSF analysis shows with a modest number of lymphocytes and increase in .
-MRI shows with possible enhancement at the appropriate level. Lyme titers are occasionally found to be high. [41]
-Two-thirds have aweeks before onset of neurologic symptoms. It is frequently severe and presents with features which are similar to those of spinal cord compression (SCC), as an  initially with weakness in the legs that spreads to the upper limbs and the face, along with complete . Autonomic signs may be present in some variations. May develop progressive .
-Typical CSF findings include , that is, an elevated protein level (100-1000 mg/dL) without an accompanying increased cell count. A sustained increased WBC count may indicate an alternative diagnosis such as infection.
-Electrodiagnostics (EMG and nerve conduction studies) may show prolonged distal latencies, conduction slowing, conduction block, and temporal dispersion of compound action potential in demyelinating cases. In primary axonal damage, the findings include reduced amplitude of the action potentials without conduction slowing. [42]
-Nearly 40% of patients are seropositive for Campylobacter jejuni. [43]
-History of HIV infection or high-risk behaviors (IV drug use, HIV-infected blood transfusion, unprotected sex).
-Signs and symptoms referable to the spinal cord lesions, including paraparesis, often accompanied by spasticity or ataxia (or both) coupled with dementia.
-ELISA testing should be ordered when HIV testing is indicated. False-negatives may occur during window period immediately after infection and before antibodies to HIV have developed. A positive result should be confirmed with a Western blot or second ELISA. The window period can be reduced to 2 to 4 weeks by using fourth-generation tests and those that include IgM antibodies to HIV.
-CSF, microbiologic, and spinal imaging studies may be inconclusive or nonspecific. [44] [45]
-Presents as a combination of upper motor neuron (UMN) and lower motor neuron (LMN) symptoms and signs.
-Approximately 60% of ALS patients experience muscle weakness and stiffness as the initial symptoms. The neurologic exam usually shows evidence of muscle weakness (localized or widespread, depending on the extent of the disease). The exam also reveals muscle atrophy. The muscles may be so stiff that, when the neurologist moves them, they continue to move abnormally afterward. When the neurologist tests the knee jerk reaction, the movement is abnormally quick (hyperreflexia).
-EMG testing is a significant part of the diagnosis. The current criteria define a positive EMG when signs of active denervation include fibrillation potentials and positive sharp waves, with fasciculation potentials. [46]
-Can mimic clinical symptoms of SCC. However, in almost all cases of multiple sclerosis there are also brain lesions.
-Has a variable presentation with multiple episodes separated by space (i.e., neurologic symptoms result from lesions in different CNS sites) and time. Common symptoms include progressive limb weakness, gait difficulty, ataxia, loss of balance, and paroxysmal vertigo.
-In the setting of acute paraparesis, visual symptoms (visual loss) may be present. This is neuromyelitis optica (NMO). NMO is thought to be a distinct entity from MS by many neurologists. It has a relapsing course (80% to 90%), and predominantly affects females. [47]
-Brain MRI typically shows areas of demyelination.
-CSF exam shows raised IgG and oligoclonal banding.
-If NMO suspected (optic neuritis, myelitis, longitudinal cord lesion on MRI), NMO-IgG seropositivity. [47]
-History of diabetes mellitus. Pain and loss of sensation in the feet in a glove-and-stocking distribution. Bladder dysfunction may be present due to autonomic neuropathy.
-Nerve conduction studies show reduction in sensory nerve conduction velocity and a decrease in amplitude.
-Symmetrical weakness of shoulder and pelvic girdles.
-Elevated muscle enzyme levels (e.g., CK), often with a positive ANA titer.
-Characteristic changes in EMG include increased needle insertional activity, spontaneous fibrillations, low-amplitude short-duration polyphasic motor potentials, and complex repetitive discharges.
-Diagnosis is confirmed with muscle biopsy, indicating immune cell infiltration and destruction of muscle fibers.
-Severe proximal and distal muscle weakness without sensory changes from an early age.
-MRI and EMG/nerve conduction studies will show only myopathic changes and no SCC.
-Peripheral neuropathy and neuropathies due to diabetes or thyroid disease may be difficult to differentiate from neurologic symptoms of compression neuropathies.
-Nerve conduction studies and EMG are helpful in confirming neuropathy and characterizing the neuropathy, that is, demyelinating, axonal, polyneuropathy, mononeuropathy multiplex, radiculopathy, or plexopathy.