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Bed Bugs Chiggers Parasites in the Academy 4 Ectoparasites Parasites in the Academy JAMES R. JACOBS, MD, PHD DIRECTOR, STUDENT HEALTH SERVICES WILCE STUDENT HEALTH CENTER OFFICE OF STUDENT LIFE This slideset was originally presented on 30 May 2013 in Boston at the Annual Meeting of the American College Health Association. Copyright for all photographs remains with the respective copyright holders. Parasites in the Academy 1 Introduction and Pre-Test 2 Helminthic Parasites 3 Protozoal Parasites 4 Ectoparasites 5 Hints 6 Post-Test Parasites in the Academy • Conflict of interest – The presenter has NO actual or potential conflict of interest in relation to this educational activity or presentation – There is no financial or other sponsorship of this presentation Parasites in the Academy • Disclaimers – The presenter is not responsible for errors or omissions or for any consequences from application of the information in this presentation and makes to warranty, expressed or implied, with respect to the currency, accuracy, or completeness of these contents. Application of this information in a particular clinical situation remains the professional responsibility of the practitioner. – Implications and treatments may differ in pediatrics and in pregnancy. – Implications and treatment do differ in immunocompromised persons. Parasites in the Academy • Off-label use of medications – Off-label uses of drugs are included – A best effort has been made to distinguish between approved and off-label uses of medications, but don’t rely on this presentation as legal guidance! • A few explicit photos • Multiple references in the handout Parasites in the Academy Pre-Test Parasites in the Academy PRE-TEST 1. Oral ivermectin can be A. True used to treat scabies B. False and is FDA-approved for this indication. Parasites in the Academy PRE-TEST 2. Tinidazole and A. True metronidazole both B. False carry a warning against concomitant alcohol consumption. Parasites in the Academy PRE-TEST 3. Three weeks ago this A. Nodular scabies student was walking B. Schistosomiasis barefoot on a sandy C. Cutaneous larva beach in a tropical migrans country. The most likely diagnosis is: D. Tungiasis Parasites in the Academy PRE-TEST 4. Two weeks ago this A. Petroleum jelly student was doing B. Broad spectrum field research in Costa antibiotics Rica. Preferred initial C. Oral albendazole intervention is: D. Topical lindane Parasites in the Academy PRE-TEST 5. The parasite causing A. True strongyloidiasis lives B. False primarily in the small intestine of its human host but typically enters the host through the foot. Parasites in the Academy PRE-TEST 6. Oral metronidazole A. True remains the preferred B. False treatment for giardiasis. Parasites in the Academy PRE-TEST 7. Pediculosis is caused A. Mites by: B. Lice C. Chiggers D. Fleas Parasites in the Academy PRE-TEST 8. One day after A. Chigger bites participating in an B. Spider bites outdoor service C. Flea bites project at his southeastern college, D. Contact dermatitis this student’s rash is most likely caused by: Parasites in the Academy PRE-TEST 9. The appearance of this A. Chiggers itchy rash is classic for: B. Pediculosis C. Bedbugs D. Scabies Parasites in the Academy PRE-TEST 10. This rash is described A. Chiggers as generalized, scaly, B. Pediculosis red papules and C. Bedbugs burrows, suggesting: D. Scabies Parasites in the Academy 1 Introduction Parasites in the Academy 1 Introduction Parasites Ectoparasites Protozoa Helminths Parasites in the Academy 1 Introduction Organisms that grow, feed, and are sheltered on or in another organism but contribute nothing to host survival Parasites Ectoparasites Protozoa Helminths Lives on the outer Unicellular eukaryotic Worm-like parasites surface of its host organisms Parasites in the Academy 1 Introduction Organisms that grow, feed, and are sheltered on or in another organism but contribute nothing to host survival Parasites Ectoparasites Protozoa Helminths Lives on the outer Unicellular eukaryotic Worm-like parasites surface of its host organisms Pediculosis Bedbugs Malaria Schistosomiasis Scabies Fleas Chagas disease Clonorchiasis Laelaps Chiggers Giardia Echinococcosis Pyemotes Cryptosporidium Trichinosis Myiasis Entamoeba histolytica Ascariasis Cheyletiella Cyclospora cayetanensis Dracunculiasis House mite Microsporidiosis Onchocerciasis Avian mite Babesiosis Strongloidiasis Demodex Leishmania Cutaneous larva migrans Tungiasis Trichomonas Visceral larva migrans Parasites in the Academy 1 Introduction Organisms that grow, feed, and are sheltered on or in another organism but contribute nothing to host survival Parasites Ectoparasites Protozoa Helminths Lives on the outer Unicellular eukaryotic Worm-like parasites surface of its host organisms E Pediculosis Bedbugs Malaria Schistosomiasis E Scabies Fleas Chagas disease Clonorchiasis X X Laelaps Chiggers Giardia Echinococcosis A Pyemotes Cryptosporidium Trichinosis A M Myiasis Entamoeba histolytica Ascariasis M P Cheyletiella Cyclospora cayetanensis Dracunculiasis P L House mite Microsporidiosis Onchocerciasis L Avian mite Babesiosis Strongloidiasis E E Demodex Leishmania Cutaneous larva migrans S Tungiasis Trichomonas Visceral larva migrans S Parasites in the Academy 1 Introduction Organisms that grow, feed, and are sheltered on or in another organism but contribute nothing to host survival Parasites Ectoparasites Protozoa Helminths Lives on the outer Unicellular eukaryotic Worm-like parasites surface of its host organisms E Pediculosis Bedbugs Malaria Schistosomiasis E Scabies Fleas Chagas disease Clonorchiasis X X Laelaps Chiggers Giardia Echinococcosis A Pyemotes Cryptosporidium Trichinosis A M Myiasis Entamoeba histolytica Ascariasis M P Cheyletiella Cyclospora cayetanensis Dracunculiasis P L House mite Microsporidiosis Onchocerciasis L Avian mite Babesiosis Strongloidiasis E E Demodex Leishmania Cutaneous larva migrans S S Tungiasis Trichomonas Visceral larva migrans Parasites in the Academy 1 Introduction • Approach – What is the parasite? – What is the disease? – Doing something about it. Parasites in the Academy 1 Introduction Source: N Engl J Med 2013;368:1817-25 Parasites in the Academy 2 Helminthic Parasites Parasites in the Academy 2 Helminthic Parasites Strongyloidiasis Echinococcosis Schistosomiasis Cutaneous larva migrans Parasites in the Academy 2 Helminthic Parasites Strongyloidiasis Parasites in the Academy 2 Helminthic Parasites What is the parasite? • Strongyloides stercoralis Strongyloidiasis – Transmission occurs mainly in tropical and subtropical regions – Current geographic distribution is poorly defined • Southeast Asia, Africa, Middle East, Caribbean, tropical Brazil, temperate Spain, Appalachia • Very dependent on sewage management • Estimated 30–100 million people are infected worldwide Parasites in the Academy 2 Helminthic Parasites What is the parasite? (continued) • Strongyloidiasis Strongyloides stercoralis – Acquired through direct contact with contaminated soil during agricultural, domestic, and recreational activities Image: emedicine.com Parasites in the Academy 2 Helminthic Parasites What is the parasite? (continued) • Strongyloidiasis Strongyloides stercoralis – Known for ability to persist and replicate within a host for decades while producing few if any symptoms – Without appropriate therapy, the infection does not resolve and may persist for life – No evidence for human-to- human transmission • Organ transplantation? Parasites in the Academy 2 Helminthic Parasites What is the disease? Strongyloidiasis • Strongyloidiasis Image: cdc.gov – Immunocompetent host • Many are asymptomatic • Mild intermittent symptoms – GI » Watery diarrhea (can be chronic), cramping – Pulmonary » Cough, wheeze, chronic bronchitis – Skin » Larva currens - “creeping” urticaria (photos) and pruritus Image: accessmedicine.com Parasites in the Academy 2 Helminthic Parasites What is the disease? (continued) Strongyloidiasis • Strongyloidiasis – Immunocompromised host • Disseminated disease • Life-threatening (50%) • In US most deaths are iatrogenic when an unknown asymptomatic carrier is treated with immunosuppressants Parasites in the Academy 2 Helminthic Parasites What is the disease? (continued) • Strongyloidiasis Strongyloidiasis – Be suspicious • Persistent watery diarrhea • History of foot wounds then GI • Diarrhea + Cough + Rash • Travel to endemic areas – Eeven decades prior – Diagnosis is not standardized • Most frequent procedure entails direct examination of stool Image: cdc.gov specimens – Often does not yield positive results even when the disease is present • Alternative tests (serology and polymerase chain reaction) are Image: www.nhm.ac.uk more efficient Parasites in the Academy 2 Helminthic Parasites Doing something about it. Off Severity Strongyloidiasis Label Mild or asymptomatic disease ivermectin 200 mcg/kg po times 1-2 days Disseminated disease Hospitalization/ ICU Parasites in the Academy 2 Helminthic Parasites Echinococcosis Parasites in the Academy 2 Helminthic Parasites What is the parasite? • Echinococcus granulosus Echinococcosis – 2-7 mm tapeworm – Endemic to sheep-raising areas worldwide – Definitive hosts: dogs Echinococcus granulosus – Human infection through fecal-oral Source: cdc.gov route • Echinococcus multilocularis – 1-4 mm tapeworm – Central and Eastern Europe, Russia, China, Alaska, others – Definitive hosts: foxes, coyotes, dogs – Hunting, trapping, and contact with dogs in endemic areas Parasites in the Academy 2 Helminthic Parasites What is the disease? • Echinococcus granulosus Echinococcosis
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