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Dientamoeba Fragilis. a Review of a Commonly Detected Yet Poorly Understood Parasite of Man

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Dientamoeba Fragilis. a Review of a Commonly Detected Yet Poorly Understood Parasite of Man Volume 55 Number 2 August 2001 ISSN 117.1-0195 www.nzimls.org.nz Mangement System;"'. ~~i~~~........ proving to be a Wha 8 ISO 17025 of a Job? ISO 9001 -2000 ISO 14001 as 9ooo AS/NZS 4804 Health Standards ---.-::;:.- -=-- ----. _--:- Q-Pulse is a PC application for controlling and adding value to management systems. Including ISO 17025, 9001, 2000, 14001 , QS 9000 AS/NZ4804 and Health Standards Eleven modules addressing customers, suppliers, employees, equipment, problems, audit, and documents provides a mechanism for managing your system. Designed as a practical tool which people can relate to, Q-Pulse enables com panies to achieve, maintain and demonstrate compliance to formal standards, cost effectively, by minimising paperwork and administration overload, at the same time providing a mechanism to encourage ownership of the management system and more importantly proving a cultural shift to continual improvement. User Benefits include * Total control solution for Quality System management. All necessary control actions are "flagged" to the user. * Frees up executive time and thereby saves money, enabling "problem solving" by managers and not just "problem reporting". * Provides objective evidence of compliance to auditors and assessment bodies. * Comprehensive Messaging capability, fully e-mail compatible. * Transforms the burden of bureaucratic record keeping to provide invaluable management information. • An intuitive product - easy to use, requires no computer knowledge to maintain. • Highlights areas requiring attention: acts as an early warning system and helps prevent costly failure. • Compatible with all standard PC networks. • Controlled documents available using your Intranet. , * Global solution, over 4,000 worldwide user sites in 50 countries. * Available for (WAN) Thick server and (LAN) Thin server. For a FREE Q-Pulse demo CD, evaluation copy or on site presentation fax this sheet with your details to: ( 09) 478 9895 Name ................................................... Company........................................... Tei. ....................................... Demo J Evai.J OnSite.J Yes J No --/\ EEl Ltd Tel (09) 478 9800 EMail [email protected] Or Visit our Website www.gaelquality.com Editor Rob Siebers, Wellington New Zealand Journa l of Editorial Board Ross Anderson, Auckla nd Medical Sue Dunca n, Welli ngton Ca rol Green, Lower Hutt Laboratory Geoff Herd, W hanga rei Roge r Linton, Christchurch Steve Soufflot, Hamilton Science John Sterling, Adelaide Volume 55 Number 2 Ann Thornton, Wel lington August 2001 Fran van Til, Rangiora ISSN 1171 - 0195 Trevor Walmsley, Christchurch Tony Woods, Adelaide Statistical Adviser Gordon Purdie, Wel li ngton All ed itorial matter including submitted papers, press releas­ es and books for review should be sent to the Editor: Rob Siebers, Dept. of Medicine, Wellington School of Medicine, PO Box 7343, Welli ngton So uth. Ph one: (04) 385 5999 Ext. 6838. FAX: (04) 389 5725. E- mail : [email protected]. nz. Comprehensive instruc­ tions for authors ca n be found in the N Z J Med Lab Science 2000; 54(3): 108- 10 or on the website (www.nzimls. org. nz). Leading Articl e Submit two copies of the manuscript (and on disk if poss ible) together w ith a covering letter from the corresponding author Asthma in medical laboratory workers stat ing that the w ork is original, is not under consideration for Susan M Tarlo .. ........ ......... ... ... .... ... .. ... .... ... .. ... ..... ..... 34-3 5 publication elsewhere, that all listed authors have co ntributed directly to t he planning, execution, analysis or to the w riting of Fellowship Treatises t he paper, and t hat all cited references have been checked Di entamoeba fragilis. A revi ew of a co mmonly detected yet against t he ori gina l article or appropriate data bases. poorly understood parasite of man Contributors and advertisers are responsible for the scientific Graeme Paltridge ....... .. .... ..... .... ...... ..... ..................... .36-41 content and views. The opinions expressed in the Journal are not necessarily those of the Editor or Council of the NZIMLS An eva luation and comparison between blood film The New Zealand Journal of Medical Laboratory Science is the microscopy services in government hospital laboratories in official publication of the New Zea land Institute of Medical Laboratory Science (NZIMLS) who owns the copyright. No parts the Mid-Western region of Nepal and the Waikato region in of this publication may be reproduced in anyway without the New Zea land written permission of the NZIMLS. The Journal is published three times per year in April, August and November, printing by Vanessa C J Thomson .... ..... .. ..... ..... .. .... .... .. ... ..... ....... .42-55 Centurion Print, PO Box 6344, Wellesley St., Auckland. Letters to the Editor The Journal is abstracted by the Cumulative Index to Nursing International Association of Medical Laboratory and Allied Health Literature (CINAHL), Excerpta Medica/EMBASE, Techno log ists membership Chem ical Abstracts, and the Australian Medical Index. Advertisement bookings and enquiries shou ld be addressed Shirley Ga insford .................... ........... .... ...., ... ....... ........... 57 to the Advertising Manager: Trish Re il ly, 48 Towai St., St Heli ers, 57 Auckland 5. Phone: (09) 575 5057 . G Frank Lowrey .. ...... .. ....... ... ......... ..., .. ....... ... ... ... ..... ..... .. En qui ries rega rding subscription and address changes shoul d be addressed to t he Executive Office r of t he NZIM LS: Fra n van Til , Regular Features PO Box 505, Rangiora. Phone: (03) 313 4761 . E-mail : [email protected]. Abstracts, Australian Journal of Medica l Science ............ .58 Advertisers in this issue ................. .. .. ... ... .. .. ..... .... .. .. ........ 66 Instructions for authors .... .. .. ... ...... .... .. .. ..... .. ... ..... .. ...... ... .33 NZIMLS Web-Site ... ... ...... ..... .. ..... ......... ... ..... ......... ........ ... 56 Ob ituary- John Case ................................................... .... 67 Special Interest Groups ..... .. .......... ........ ...... ..... ... .... .... 59-65 NZ J Med lab Soence 200 1 33 Asthma in medical laboratory workers Susan M Tarlo, MB BS, MRCP (UK), FRCP(C) Professor of Medicine and Public Health Sciences, University of Toronto, Canada Occupational asthma describ es asthma caused by a specific workplace Irritant-Induced Asthma or RADS may be induced if the medical exposure and is not due to factors outsid e the workplace. It needs to laboratory worker has an exposure to a very high level of a respiratory be distinguished from asthma which is co incidental to the workplace irritant, such as a spi ll of acetic acid (as reported in a hospital setting by but which may be aggravated by irritant exposu res at work (s imilar to Kern and co ll eagues) (6), or a fire in the laboratory. More commonly, the aggravation which may occur in most asthmatics on exposure to asthma which starts co incidentally to the workplace may be aggravat­ second-hand smoke, paint fumes, dusts or co ld air). Occupational asth­ ed by exposure to respiratory irritants in the medical laboratory, such as ma is most commonly due to an immunologic or presumed immuno­ strong cleaning agents e.g. bleach or other agents, acids, or ammonia logic response to a workplace sensit iser. Thi s may be an lgE mediated (as w hen cleaning an imal cages). Endotoxin exposure may occur from response to a high molecular weight allergen (often a protein), or to an imal feed or an imal cages, and this can aggravate asthma but also in certain chemica ls such as epoxy res ins. However, some workplace sen­ an imal models may act as an adjuvant augmenting sensitisation to sitisers may cause a cl inical response similar to this but w ithout a clear­ natural rubber latex (7). ly identified lgE-mediated response. Less commonly (about 6% of cases of occupational asthma), the mechanism may be a sin gle very high Investigation of workers with suspected occupa­ level irritant airway exposure, resulting in Reactive Airway Dysfunction tional asthma Syndrome (RADS), or Irritant-Induced Asthma (1, 2). Investigation of these workers should be performed as for other patients with sus pected occupational asthma, according to published Medical laboratory causes of occupational asthma guidelines and consensu s statements (8,9). Th e diagnosis should be Th ere are many laboratory settings in w hich occu pational asthma may suspected in any worker w ith new-onset asthma, especially if there is occu r. In most laboratory settings workers wear natural rubber latex worsen ing of symptoms at work and/or improvement on weekends or gloves for protection and/or maintaining sterility. Especially in atopic holidays off work . workers, the use of high protein powdered natural rubber latex gloves An objective diagnosis, of asthma should init ially be confirm ed by w ill expose the worker to a risk of lgE-mediated sensitisation to the pulmonary function testing and/or methacholine chall enge when the gloves and subsequent asthma from natural rubber latex, carri ed in t he patient has been at work. The occupational component to this can be glove powder. The prevalence of natural rubber latex induced occupa­ assessed by evidence of an improvement in serial pea k f low rea dings, tional asthma in hea lthca re work ers has been reported to be 5-17% serial spirometry and/or methacholin e or histamine challenge respo ns­ (3). Among 52 clinica lly sensitised hospital workers from our
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