LETTERS 3. Miyoshi T, Uchino K, Matsuo M, Ikeda Echinostoma ova. In addition, a clinical history was Y, Yoshida H, Sibata H, et al. Charac- taken and a complete physical exami- teristics of norovirus outbreaks during malayanum a non-epidemic season. Jpn J Infect Dis. nation was conducted for each patient 2006;59:140–1. Infection, volunteer after stool submission. Eat- 4. Muscatello DJ, Churches T, Kaldor J, the Philippines ing preferences and habits were spe- Zheng W, Chiu C, Correll P, et al. An auto- cifi cally noted. mated, broad-based, near real-time public health surveillance system using presenta- To the Editor: In 2002, the De- The research was approved by tions to hospital emergency departments partment of Health-Provincial Health the Department of Health Center for in New South Wales, Australia. BMC Team (DOH-PHT) of Surigao del Health Development of the Caraga re- Public Health. 2005;5:141. Norte reported 102 cases of fasciol- gion. Informed consent was obtained 5. Widdowson M-A, Cramer EH, Hadley L, Bresee JS, Beard RS, Bulens SN, et id-like infections in the municipality before procedures were done and treat- al. Outbreaks of acute gastroenteritis on of Santa Monica, Siargao Island, the ment was given to infected patients. cruise ships and on land: identifi cation of Philippines. The reports were based Cumulative prevalence for soil- a predominant circulating strain of noro- on characteristic large operculate eggs transmitted helminth infections among virus—United States, 2002. J Infect Dis. 2004;190:27–36. having been found in routine stool ex- the 70 patients was 51.4%. Prevalence 6. Bull RA, Tu ET, McIver CJ, Rawlinson aminations conducted during schisto- according to species was Trichuris WD, White PA. Emergence of a new noro- somiasis surveys. Fasciola hepatica spp. 42.9%, Ascaris spp. 17.1%, and virus genotype II.4 variant associated with infection was the initial diagnosis hookworm spp. 1.4%. Schistosoma global outbreaks of gastroenteritis. J Clin Microbiol. 2006;44:327–33. considered. In 2005, a collaborative japonicum infection rate was 10%. 7. White PA, Hansman GS, Li A, Dable J, team from DOH-PHT, the National Stool samples from 8 (11.4%) patients Isaacs M, Ferson M, et al. Norwalk-like Institutes of Health, the University of had large (120–130 μm × 80–90 μm), virus 95/96-US strain is a major cause gas- the Philippines Manila, and the Local brownish, operculated eggs; 3 had a troenteritis outbreaks in Australia. J Med Virol. 2002;68:113–8. Government Unit/Rural Health Unit total of 13 adult fl ukes. Microscopy 8. Telfer B, Munnoch S. OzFoodnet—en- conducted a fi eld investigation to de- showed small leafl ike fl ukes 8–9 mm hancing foodborne disease surveillance termine the cumulative prevalence long and 2.5–3.5 mm wide. After the across Australia. In: Annual report. Syd- of intestinal helminthic infections in organisms were processed and stained ney (Australia): New South Wales and Hunter Area Health Service; 2005. adult patients whose conditions had with aceto-carmine and fast green 9. Kroneman A, Vennema H, van Duijn- been previously diagnosed as fasciol- stains, diagnostic features of Echinos- hoven Y, Duizer E, Koopmans M. High id-like infection and to determine the toma malayanum (Leiper 1911) were number of norovirus outbreaks associated causative species of trematode. noted. Adult trematodes were within with GGII.4 variant in The Netherlands and elsewhere: does this herald a world- The study group consisted of 70 known species size range (5–10 mm × wide increase? Euro Surveill. 2004;8(52). adult patients from the barangay (lo- 2.5–3.0 mm) and had elongated bodies 10. Bull RA, Hansman GS, Clancy LE, Tana- cal government unit of 50–100 fami- and bluntly rounded ends. The ventral ka MM, Rawlinson WD, White PA. Noro- lies) of Libertad, for whom fasciolid sucker (acetabulum) was prominent virus recombination in ORF1/ORF2 over- lap. Emerg Infect Dis. 2005;11:1079–85. infections had been noted on previous and larger than the anterior oral suck- surveys. Researchers confi rmed infec- er. Paired testes were deeply branched Address for correspondence: Christopher J. tions and collected adult trematodes and positioned high in the posterior McIver, Department of Microbiology, South for species identifi cation. All patients half of the body, extending above the Eastern Area Laboratory Service, Prince of underwent bowel preparation with bi- midplane with a single anterior glob- Wales Hospital, High St, Randwick, New South sacodyl (Dulcolax) 10-mg tablets (2 ular ovary. The uterus was entirely Wales 2031, Australia; email: christopher. tablets taken immediately after a meal anterior to the ovary, and vitellaria [email protected] on night before deworming), followed (glands) were abundant along both lat- by praziquantel (25 mg/kg in 2 doses 4 eral portions of the worm, ending just h apart), and 30-g magnesium sulfate posterior to the esophagus. The oral granules, dissolved in 1 cup of milk, sucker had a horseshoe-shaped ante- given 1 h after the second dose of pra- rior collar with 43 circumoral spines, ziquantel. Stools were processed by which differentiates this species from using the Kato-Katz method (1) and E. ilocanum (49–51 collar spines), examined microscopically by medi- another trematode species endemic to cal technologists from the Diagnostic the Philippines. Parasitology Laboratory, College of In terms of eating habits, patients Public Health, University of the Phil- reported that fi sh were commonly ippines Manila, for intestinal helminth eaten raw, after being dipped in a salt 1130 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 7, July 2007 LETTERS and vinegar mixture, locally known as over, a successful control program 6. Radomyos B, Wongsaroj T, Wilairatana kinilaw. Other methods of fi sh prepa- against chronic intestinal parasitoses P, Radomyos P, Praevanich R, Meesom- boon V, et al. Opisthorchiasis and intes- ration were tinola (boiled), ginataan could serve as a paradigm for local tinal fl uke infections in northern Thai- (stewed in coconut milk), and sinugba health system development of effec- land. Southeast Asian J Trop Med Public (charcoal-grilled). All echinostome- tive control measures for other en- Health. 1998;29:123–7. infected patients had a history of hav- demic diseases. 7. Belizario VY, de Leon WU, Bersabe MJ, Baird JK, Bangs MJ. A focus of human in- ing eaten snails, kuhol and kiambu-ay, fection by Haplorchis taichui (Trematoda: prepared raw with coconut milk and Acknowledgments Heterophyidae) in the southern Philip- lime juice (kinilaw), especially when pines. J Parasitol. 2004;90:1165–9. We express sincere gratitude for the found in greater abundance during the support, cooperation, and assistance pro- rainy season. Address for correspondence: Vicente Y. vided by the Local Government Unit/Ru- Human echinostome infection re- Belizario, Jr., National Institutes of Health and ral Health Unit of Santa Monica, Surigao sults from ingestion of metacercariae College of Public Health, University of the del Norte, Provincial Health Offi ce, DOH- that encyst in secondary intermedi- Philippines Manila, Pedro Gil, Ermita, Manila, PHT Surigao del Norte, V.L. Makabali ate hosts, usually freshwater snails, the Philippines; email: [email protected] Memorial General Hospital, and the gen- tadpoles, or fi sh. E. malayanum uses erous residents of Santa Monica. various species of gastropod mollusks for primary and secondary intermedi- ate developmental stages (2–5). Cer- Vicente Y. Belizario,*† tain species of fi sh may also serve Giovanni G. Geronilla,*† as secondary intermediate hosts (2). Marilyn Benedith M. Anastacio,*† Several mollusks that may serve as Winifreda U. de Leon,† primary and secondary intermedi- Adriano P. Suba-an,‡ Zoonotic Pathogens ate hosts have been identifi ed in the Arlene C. Sebastian,§ in Ixodes Philippines, including Lymnaea (Bul- and Michael J. Bangs¶ lastra) cumingiana, Radix quadrasi, *National Institutes of Health, Manila, the scapularis, and Physastra hungerfordiana for E. Philippines; †University of the Philippines Michigan malayanum, and Pila luzonica for E. Manila, Manila, the Philippines; ‡Health ilocanum (6,7). Development, Caraga Region, Butuan City, To the Editor: Ixodes scapularis, To our knowledge, this is the fi rst the Philippines; §Rural Health Unit, Santa the black-legged tick, is the predomi- report of E. malayanum infections in Monica, the Philippines; and ¶Navy Region nant vector of reportable human vec- the southern Philippines. Local eating Northwest, Silverdale, Washington, USA torborne disease in the United States. habits are a strong factor in echino- It transmits agents that cause Lyme stome infections. The general lack of References borreliosis, human anaplasmosis, and awareness by health staff and the com- human babesiosis. I. scapularis–borne munity was a big factor in the poor 1. World Health Organization. Bench aids disease is becoming more frequent as for the diagnosis of intestinal parasites. this tick expands its range from tick- identifi cation of the disease. Clinical Geneva: the Organization; 1994. Plate 3. and laboratory staff and healthcare 2. Monzon RB, Kitikoon V, Thammapalerd endemic foci in the northeastern and providers need training about echino- N, Temcharoen P, Sornmani S, Viyanant upper midwestern United States. stome infections and other intestinal V. Ecological observations on Lymnaea Despite Michigan’s proximity to (Bullastra) cumingiana. Southeast Asian J large tick-endemic areas (Wisconsin foodborne trematode infections. Simi- Trop Med Public Health. 1993;24:563–9. lar environmental, sanitary, and eating 3. Garrison PE. A new intestinal trematode and Minnesota to the west and Indiana practices in the region suggest that the of man. Philippine Journal of Science. to the south), active and passive sur- same parasitoses should be considered 1908;B3:385–93. veillance data indicated that the only 4. Waikagul J. Intestinal fl uke infections in populations of I. scapularis estab- to be widespread in the area.