usmlegr
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Please advise. I just can't get these stuff in my head. Maybe because they are too rare, maybe because i haven't seen a sigle patient with these nasty rascals, i dont know. The only thing i know is that its too hard for me to learn even the High Yield one's covered in First Aid (damn, they are a lot!).
PLease advise
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| bactitech
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The most common parasite in the US is Giardia lamblia, which is not a worm but a protozoa. You probably won't see many parasites in your patients unless you treat people who have traveled outside the US in parts of Asia, Africa, and South America.
If medical technologists can learn this stuff, you can too  . Just remember, most of the identification schemes for microscopic protozoa and eggs are based on measurement. For example, Balantidium coli is a HUGE microscopic parasite microscopically, whereas Chilomastix menili is very small. B. coli cannot EVER be small, and Chilomastix can never be huge.
Some of the big parasites you want to know well, as they are clinically significant, are Entamoeba histolytica (causes BIG problems that can present as non-parasitological problems - always take a good history), Schistosoma mansoni, tapeworms, malaria (millions have this worldwide, and it is a killer), gee, the list IS long, isn't it? There's lots more.
Tropical medicine is a specialty on its own. Good luck.
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| AAAAA
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Absolutely wrong !
Giardia lamblia is very common in US.
It is in the Rocky, in the contaminated water
everywhere and you just have to look for it.
Giardia l. is always asked in the exam with a young man presented with chronic diarrhea x 3 weeks and went to the Rocky for vacations.
dude !!
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| whitmer
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Or drank the water in Mexico.
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| mjl1717
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water drinking in mexico most likely gets you an enterotoxigenic strand of E. Coli! (travelers diarrhea)
Back to the topic:3 popular parasites are malaria with the sporagony stage in the mosquito and schizogony stage in humans, actually introduced a disease via natural selection sickle cell. known for causing high fevers and malaise. Taenia solium and cysticercosis have occured here in the U.S. do to undercooked pork. Naegleria is deadly in stagnant lakes. Trypanosome cruzi Rx ed with Nifirtimox can cause heart disease. that was just for starters.
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| whitmer
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Giardia is a major cause of intestinal disease worldwide and the most frequent non-bacterial cause of diarrhea in North America. Nonetheless, the basic biology of this parasite is poorly understood. Infection from giardia can occur from consuming contaminated food or water. It can also be transferred from animal or human feces. Not every person displays symptoms of infection, but they can still serve as a carrier of the disease. Giardia infection is a concern for people camping in the wilderness or swimming in contaminated streams or lakes, especially the artificial lakes formed by beaver dams (hence the popular name for giardiasis, "Beaver Fever"). (2006, From Wikipedia, the free encyclopedia)
Probability of infection from waterborne microorganisms
Microorganism Probability of infection Number of organisms for
from exposure to 1 organism 1% likelihood of infection
Salmonella (bacteria)
Salmonella typhi (bacteria)
Shigella (bacteria)
Vibrio choleraeclassical(bacteria)
Entamoeba histolytica (protozoa)
Giardia lamblia (protozoa)
Source: Adapted from Joan B. Rose and Charles P. Gerba. 1991. "Use of Risk Assessment for Development of Microbial Standards." Water Science Technology, vol. 24. p. 31.
Edited by whitmer on 05/26/06 - 12:21 PM
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| CandyHome
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Hi,
about Giardiasis
what is the diagnostic stage?
and may the infection be caused throug the entrance of the organism throug wounds,
or just throug the oropharynx?
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| tolito
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giardia is diagnosed either as spores or trophozoites in the feces or commercial immunoassay kit to detect giardia lamblia antigenss in aqueous extracts of stool specimens.
the infection is caused solely by ingestion of the cysts and not thro a wound.
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| CandyHome
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aha,
thanks alot 
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| mjl1717
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tolito wrote:
giardia is diagnosed either as spores or trophozoites in the feces or commercial immunoassay kit to detect giardia lamblia antigenss in aqueous extracts of stool specimens.
the infection is caused solely by ingestion of the cysts and not thro a wound.
Great! so we can add that to the spore list which would include clostridum and bacillus.
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| bactitech
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Giardia does not produce spores. One usually sees cysts in O&P preps, but occasionally you will also see trophozoites. Take Giardia off your spore list NOW.
A very sensitive assay is the Giardia Antigen test. This will detect low numbers of Giardia which may not be seen in an O&P concentrate. We are trying to urge doctors to order the Giardia antigen assay FIRST before going to a full O&P exam, especially in patients with no international travel history.
Bottom line - if you're going to bother ordering an O&P examination, PLEASE take a travel history on your patient. We do hundreds of negative examinations a year. Most of these are knee jerk test orders from doctors too lazy to take a decent history on their patient. I have seen O&P's ordered on hard little rabbit pellet type feces. This is ridiculous. Ask your patient their symptoms, and where they've been and what they've eaten lately. The results will surprise you!
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| mjl1717
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got you! actually thank you!
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| tolito
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my mistake. i meant to write cysts and not spores
thanks bacitech. i was listening to someone complaining about american doctors that they are too lazy to listen to patients' histories and order all tests imaginable while british trained doctors talk too much and examine too much and take a long time before ordering any tests.
i suppose as IMG's we should have the best of both worlds...listen and order tests
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| bactitech
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I believe some of the problem may lie in the constraints of our insurance and HMO system. I was on vacation recently and talked to the parents of my son-in-law, who live in California and are enrolled in a large medical plan there. Things are quite different for them than for us in their HMO's apparently. The doctor they have seen was required to see around 100 patients a DAY by the HMO or she got in trouble. Clearly there's not a lot of time for listening. Ordering lab tests and making us in the lab work on a slew of labwork is apparently easier. 100 patients x 3 minutes/patient = 300 minutes = 5 hours. 100 patients x 5 minutes/patient = 500 minutes = 8.2 hours. That's with no lunch or bathroom breaks.
Start talking and taking histories FAST.
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| tolito
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