Several other nonpathogenic Entamoeba species closely resemble E. Commercial immunoassays are available and have much improved sensitivity and specificity compared to microscopy. Cyclosppora cayetanensis is a coccidian organism endemic to Mexico, Haiti, Peru and Nepal. It is likely that it is found in surrounding countries.
It has been found in the United States, typically in imported foods from endemic countries. Clinical features of Cyclospora infections include diarrhoea, anorexia, nausea, flatulence, fatigue, cramping, fevers and weight loss. Diarrhoea can last up to 3 weeks and patients typically have 5—15 bowel motions per day, however, asymptomatic infections are possible. Human immunodeficiency virus patients typically have more severe disease, with increased weight loss and longer duration of diarrhoea.
It has not been found in the family members of those infected, indicating that person to person transmission is unlikely. Restitution of the immune status using antiretroviral therapy may allow clearance of the organisms. Blastocystis hominis is an organism that courts much controversy in terms of its pathogenicity, given that asymptomatic carriage has been widely noted.
Likewise, studies have noted its association with symptoms such as diarrhoea, bloating, abdominal pain and excessive flatus. Its presence in stool is a likely indicator that exposure to other organisms has occurred. Where Blastocystis has been solely isolated and clinical symptoms are present, then a trial of treatment is warranted.
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While not a common cause of persistent diarrhoea, Strongyloides certainly is an organism that has long term consequences in those infected. Risk factors include travel to endemic areas, consuming contaminated water or contact with infected soil, usually through barefoot travel. Acute or chronic infections are usually asymptomatic, but can present with diarrhoea, urticaria and abdominal pain. Chronic infections in patients with a cell mediated immunity defect due to high dose corticosteroid use, organ transplantation and HTLV-1 can potentially result in Strongyloides hyperinfection syndrome, which has a high mortality.
Screening for the presence of Strongyloides in returned travellers with persistent diarrhoea or with eosinophila is warranted given that co-infection is possible. Current screening method includes agar plate culture or serology. Seek specialist advice for the treatment of Strongyloides if an infection is detected.
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It is important to remember that diarrhoea is a common symptom of many other diseases; it may be a coincidence that travel preceded the episode. Patients who have persistent diarrhoea despite negative screening for stool parasites should be further investigated. Further aetiologies to consider are shown in Table 4. Referral for specialist follow up is warranted when the history and examination are suggestive of potential cancer ie.
Table 5 shows advice that can be given before travel. The advice should be memorable and to the point rather than long winded or overly detailed. A brochure or a travelling item such as a bookmark or a post-travel booking card can help reinforce this advice.
Table 6 provides examples of simple messages that can be given to travellers. To open click on the link, your computer or device will try and open the file using compatible software. To save the file right click or option-click the link and choose "Save As Follow the prompts to chose a location. These files will have "PDF" in brackets along with the filesize of the download. If you do not have it you can download Adobe Reader free of charge.
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Unexpected hosts: imaging parasitic diseases
Subscribe to the print edition. Back Issues Older back issues Indices Order back isues. Reproductive health October Parasitic causes of prolonged diarrhoea in travellers Diagnosis and management Volume 41, No. Article Download article Download Citations. Andrew Slack Background Prolonged infectious diarrhoea in the returning traveller is generally caused by protozoal and occasionally by helminth parasites. Discussion A large proportion of disease is caused by Giardia lamblia, Cryptosporidium parvum and Entamoeba histolytica.
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Clinical challenge. Infection rates for ascariasis have not been reported to be higher in patients infected with the human immunodeficiency virus HIV [4,5]. The highest prevalence of ascariasis occurs in tropical countries where warm, wet climates provide environmental conditions that favor year-round transmission of infection. This contrasts to the situation in dry areas where transmission is seasonal, occurring predominantly during the rainy months .
The prevalence is also greatest in areas where suboptimal sanitation practices lead to increased contamination of soil and water. The majority of people with ascariasis live in Asia 73 percent , Africa 12 percent and South America 8 percent , where some populations have infection rates as high as 95 percent [7,8]. In the United States the prevalence of infection decreased dramatically after the introduction of modern sanitation and waste treatment in the early s .
It is estimated that the current prevalence of A. It is also seen in travelers from endemic areas . Ova can survive in the environment for prolonged periods and prefer warm, shady, moist conditions under which they can survive for up to 10 years . The eggs are resistant to usual methods of chemical water purification but are removed by filtration or by boiling. Developing larvae will be destroyed by sunlight and desiccation. There is no significant animal reservoir, but A. Transmission — Transmission occurs mainly via ingestion of water or food raw vegetables or fruit in particular contaminated with A.
Children playing in contaminated soil may acquire the parasite from their hands. Transplacental migration of larvae has also occasionally been reported . Coinfection with other parasitic diseases occurs with some regularity because of similar predisposing factors for transmission [10,13]. They have a life span of 10 months to 2 years and then are passed in the stool. When both female and male worms are present in the intestine, each female worm produces approximately , fertilized ova per day.
When infections with only female worms occurs, infertile eggs that do not develop into the infectious stage are produced. With male-only worm infections, no eggs are formed.