Abdominal parasitic infection

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Abdominal parasitic infection Main page

Overview

Causes

Ascaris lumbricoides

Necator americanus

Giardia lamblia

Fasciola Hepaticum

Schistosoma

Strongyloidis Stercoralis

E. Histolytica (Amebiasis)

Taeniasis

Trichuris trichiura

Hymenolepis Nana

Overview

An intestinal parasite infection is a condition in which a parasite infects the gastro-intestinal tract of humans and other animals. Mode of transmission of infection can be due to ingestion of undercooked meat, drinking infected water, fecal-oral transmission and skin absorption. There are many types of parasites that can cause abdomial infections but the most common types are caused by Ascaris lumbricoides, Necator americanus, Fasciola, Schistosoma, Trichuris trichiura, Strongyloides stercoralis, Taenia, Hymenolepis nana, and Entamoeba histolytica. Ascaris lumbricoides is a common in Asia and during six to eight weeks after egg ingestion, symptoms of ascariasis are abdominal discomfort, anorexia, nausea, vomiting, and diarrhea. Stool microscopy is the most common diagnostic tool for evaluation of Ascaris ova and albendazole is the drug of choice for treatment. Necator americanus is common in rural areas of the US and presents with nausea, diarrhea, vomiting, and epigastric pain. Giardiasis is common in children and mountains hikers who drink water that has not been boiled. Most of the cases are asymptomatic but acute giardiasis symptoms include diarrhea, malaise, steatorrhea, abdominal cramps, bloating, nausea, and weight loss. ELISA is sensitive for detection of giardiasis and stool examination is specific. Tinidazole and nitazoxanide are the preferred drug for Giardiasis. Fasciola appears with fever, anorexia, nausea, vomiting, myalgia, cough, right upper quadrant pain, hematomas of the liver, jaundice, and hepatomegaly. Complications include focal neurologic changes, pericarditis, arrhythmia, and right-sided pleural effusion. Computed tomography and magnetic resonance imaging radiographic findings in fascioliasis are vmultiple small nodules, thickening of the liver capsule, subcapsular hematoma, or parenchymal calcifications or tortuous tracks due to migration of the parasite through the liver. The treatment of choice is triclabendazole. Dosing consists of 10 mg/kg orally for one or two days. Bithionol and nitazoxanide are alternative choices. Intestinal schistosomiasis is caused by infection due to S. mansoni, S. japonicum, and S. haematobium. The most common symptoms include chronic or intermittent abdominal pain, poor appetite, bleeding from colonic ulcers that may cause anemia if heavily infested. The left lobe of liver is enlarged with splenomegaly that may extend below the umbilicus. Increased portal hypertension is due to high resistance in the hepatic circulation. The predominant pathological process consists of collagen deposition in the periportal spaces causing periportal fibrosis. Identification of schistosome eggs is the gold standard for the diagnosis of schistosomiasis with low sensitivity and high specificity. Serology is used as screening mainly because of low sensitivity. Praziquantel is the drug of choice for schistosomiasis. It increases calcium ion permeability. Calcium accumulate in the cytosol leading to muscular contractions and subsequent paralysis. Hymenolepis Nana is most common in temperate zones, and is one of the most common cestodes infecting humans, especially children. Most infections are asymptomatic. The diagnosis is generally established by identifying eggs in the stool. Praziquantel is the treatment of choice for hymenolepiasis. Most infections with T. trichiura are asymptomatic. Main symptoms are loose stool which may contain mucus and blood. The diagnosis of trichuriasis is made by stool examination for eggs. Mebendazole is the drug of choice for trichuriasis.

Causes

Abdominal Parasitic infections

The following table summarizes all the abdominal parasitic infections.

Parasitic Infection Mode of infection Epidemiology Clinical manifestations  Diagnosis Treatment
Disease Parasite Incidence Geographic distrubution
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
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
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
 Fasciolosis  Fasciola Hepaticum
  • Central and South America
  • Asia (China, Vietnam, Taiwan, Korea, and Thailand)
  • Europe (Portugal, France, Spain, and Turkey)
  • Africa
  • The Middle East.
  • Microscopy[17]
    • Stools
    • Bile
    • Duodenal aspiration
Schistosomiasis 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]

Chronic schistosomias[22][23][24][25]

  • Intestinal schistosomiasis
  • Hepatosplenic schistosomiasis[26][27]
  • Pulmonary schistosomiasis[28]
  • Genitourinary schistosomiasis 
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
  • Aspiration of duodenojejunal fluid is sometimes used to detect[31] 
  • Stool microscopy
  • PCR, ELISA
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
  • Stool microscopy
  • Antigen testing
  • PCR
Taeniasis
  • Consumption of undercooked beef
  • Approximately 50 million human have cysticercosis.
  • Europe
  • Parts of Asia.
  • Stool microscopy
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
  • Stool microscopy
  • Proctoscopy
    • Demonstrates adult worms protruding from the bowel mucosa.
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
  • Stool microscopy


References

  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.
  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.
  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.
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  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.
  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.
  7. ↑ Genta RM, Woods KL (1991). "Endoscopic diagnosis of hookworm infection". Gastrointest Endosc. 37 (4): 476–8. PMID 1916173.
  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.
  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.
  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.
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  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.
  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.
  15. ↑ Chan CW, Lam SK (1987). "Diseases caused by liver flukes and cholangiocarcinoma". Baillieres Clin Gastroenterol. 1 (2): 297–318. PMID 2822181.
  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.
  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.
  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.
  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.
  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.
  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.
  22. ↑ Lucey DR, Maguire JH (1993). "Schistosomiasis". Infect Dis Clin North Am. 7 (3): 635–53. PMID 8254164.
  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.
  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.
  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.
  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.
  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.
  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.
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  30. ↑ 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.
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  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.
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  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.
  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.
  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.
  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.
  38. ↑ 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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  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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  42. ↑ 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.
  43. ↑ 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.
  44. ↑ 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.
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