Parasitic Infections

Worldwide, more than 1 billion people are infested with Ascaris lumbricoides, the causative agent of ascariasis or roundworm. More than 4 million people are estimated to be infected in the United States. Infection occurs predominately in the southeastern states and more commonly in younger children, and it is associated with lower socioeconomic status. The organism is acquired through ingestion of embryonic forms of the worm, which are found in fecally contaminated soil.

The genera Leishmania and Trypanosoma are members of the family Trypanosomatidae. These protozoans cause diseases with widely varied clinical presentations as well as geographic distributions, including leishmaniasis, American trypanosomiasis (Chagas’ disease), and African trypanosomiasis (sleeping sickness).

An estimated 50 million people are at risk for acquiring African trypanosomiasis worldwide, and there are 20,000 reported new cases annually. This is likely an underestimate because reporting in endemic countries is incomplete. There are no natural life cycles of T brucei outside Africa; thus, the only cases seen outside Africa are imported.

T cruzi is found only in the Western Hemisphere, where it ranges from the southern United States to Argentina. An estimated 16 million-18 million people in Latin America have chronic T cruzi infections and ~ 50,000 die of Chagas’ disease each year. In the United States, there has been concern about transmission of the organism via blood transfusion from unsuspected infected donors who are immigrants from endemic zones. Similar concerns arise for organ transplant recipients.

Giardia, a genus of primitive eukaryotes, is a flagellated enteric protozoan of the class Zoomastigophorea. Giardia lamblia, also known as Giardia intestinalis or Giardia duodenalis, is the species known to infect humans. Its name comes from Vilem Lambl, who first reported the organism in 1859.

After ingestion of G lamblia cysts, 5-15% of patients will have asymptomatic cyst passage, and 25-50% of patients will have diarrhea. From 35% to 70% of these patients will have no evidence of infection. The three manifestations of infection include asymptomatic cyst passage, self-limited diarrhea, and chronic diarrhea with associated malabsorption and weight loss. Factors related to each of these manifestations are unknown but are believed to be related to specific host factors, parasite load, and virulence variation among G lamblia isolates.

Within the last decade, the AIDS epidemic has heightened awareness of several gastrointestinal spore-forming protozoan pathogens. The genera Cryptosporidium, Isospora, and Cyclospora are members of the subclass Coccidia and phylum Apicomplexa; the microsporidia are a group of organisms belonging to the phylum Microspora.

Microsporidia were first discovered in 1857, but it was not until 1973 that a human case of microsporidiosis was confirmed from a case described in 1959. Awareness of the diversity of microsporidial infections has heightened, especially in light of the AIDS epidemic. Central nervous system, respiratory, corneal, muscular, and gastrointestinal microsporidial infections have all been identified. Microsporidiosis has been found worldwide.

Isospora infection is endemic in several tropical and subtropical climates in areas of South America, Africa, and southwest Asia. In the United States, Isospora belli infection occurs primarily in patients with AIDS but is still quite rare in this population, accounting for = 0.2% of AIDS-defining illnesses. Isospora infection is more common in patients with AIDS from developing countries in which the prevalence of spore passage is 15% compared with 5% in industrialized nations.

Cyclospora is a coccidian that had been described as a “large cryptosporidium” or “cyanobacterium-like body” before being confirmed as a member of the phylum Apicomplexa in 1993. The life cycle in humans has not been fully detailed.