1. Concise review of Lumen-dwelling Parasites Mark K. Huntington, MD PhD FAAFP Sioux Falls Family Medicine Residency Program - Sanford School of Medicine of the University of South Dakota

2. NOTICE:  As presented at AAFP-CIHI 2009, this lecture was amply illustrated with many images – some of whose position in the public domain is not clear. To comply with potential copyright issues, all images have been removed from this online version. Sorry (you should have been here!).  MKH - 12 Sept 2009

3. A Two-Part series:  Lumen-dwelling parasites  Tissue-dwelling parasites

4. Supplemental resources  Despommier’s Parasitic Diseases  Markell & Voge’s Medical Parasitology  Ash et al’s Parasites: A Guide to Laboratory Procedures & Identification  http://tmcr.usuhs.edu/toc.htm

5. PG PRETTY GRUESOME These lectures are amply illustrated with pictures designed to make even calloused surgeons squirm.

6. Categories of Lumen Parasites  Roundworms  Flatworms  Protozoa

7. Categories of Lumen Parasites  Roundworms  Flatworms  Protozoa

8. Nematodes

9. Roundworms  Ascaris  Enterobius  Hookworms (Necator, Ancylostoma)  Trichuris  Anisakiasis (Anisakis, Phocanema)  Strongyloides

10. Ascariasis

12. Prototype geohelminth

13. Ascaris  Main Symptoms: asthma, biliary or colon obstruction  After ingestion, larvae hatch and migrate to the liver, then heart, then lungs, and finally the GI tract.

14. Trichuriasis (whipworm)

15. Trichuriasis  Main symptoms:  diarrhea,  tenesmus,  weight loss,  Rarely, rectal prolapse

16. Hookworms

17. Hookworms  Main symptoms:  Anemia  Ground itch  Prevention: shoes!

18. Strongyloidiasis

19. Strongyloidiasis  Main symptoms:  Diarrhea  Polymicrobial sepsis  Found as larvae, not ova, in stool

20. Enterobiasis (pinworms)

21. Enterobiasis  Main symptoms: pruritis ani  Diagnosed via Scotch TM Tape Test

22. Anisakiasis

23. Anasakiasis  Main symptoms:  Transient GI upset  Eosinophilic granulomas (often misdiagnosed)

24. Categories of Lumen Parasites  Roundworms  Flatworms  Protozoa

25. Categories of Lumen Parasites  Roundworms  Flatworms  Protozoa

26. Flatworms  Tapeworms (cestodes)  Flukes (trematodes)

27. Tapeworms

28. Cestodes  Diphyllobothrium  Dipylidium  Hymenolepsis  Taenia  Echinococcus

29. Prototype cestode TTTTwo hosts, two stages

30. Cestodes  Main symptoms:  Diarrhea / malabsorption  Proglottid escape  (Tissue-dwelling phase symptoms are worse)

31. Cestodes  Diphyllobothrium (fish, B12 deficiency)  Dipylidium (dog)  Hymenolepsi s (rodent/arthropod)  Taenia (beef/pork, cysticercosis)  Echinococcus (dog, hydatid disease)

32. Flukes

33. Trematodes  Liver flukes  Bile flukes  Schistosomes

34. Prototype trematode

35. Categories of Lumen Parasites  Roundworms  Flatworms  Protozoa

36. Categories of Lumen Parasites  Roundworms  Flatworms  Protozoa

37. Protozoa  Amoebae  Flagellates  Others

38. Amoebae  Entamoeba histolytica – the main pathogenic amoebae  E. coli – appearance is similar to E. histolytica  Others  Iodamoeba butschlii  Endolimax nana  (Naegleria covered in Tissue Parasites lecture)

39. Flagellates  Giardia lamblia  Trichomonas  T. hominis – GI parasite  T. vaginalis – GU parasite

40. Giardiasis

41. Giardiasis  Main symptom: malabsorptive diarrhea

42. Trichomoniasis

43. Trichomoniasis  Main symptoms:  Discomfort  Discharge

44. Miscellaneous Protozoa  Cryptosporidium – sporozoan  Balantidium - ciliate

45. Cryptosporidiosis

46. Balantidiasis

47. Balantidium & Cryptosporidium  Main symptoms: Diarrhea

48. Simplistic Antiparasitic Primer  Roundworms:  Mebendazole  Pyratel pamoate  Thiabendazole  Ivermectin  Tapeworms:  Niclosamine  Quinacrine  Praziquantel  Flatworms:  Praziquantel  Amoebae:  Metronidazole  Paromomycin  Balantidium:  Tetracyline  Metronidazole  Cryptosporidium:  Nitazoxanide

49. Disclosures Images utilized in this lecture were wantonly plagiarized from the following sources:  Ash et al, Parasites: A guide to laboratory procedures and identification, ASCP  Halstead et al, Disease of Travelers and Immigrants, Scope Publications  Katz et al, Parasitic Diseases, Springer-Verlag  Markell et al, Medical Parasitology, Saunders  Meyers et al, Pathology of Infectious Diseases, Vol. 1 Helminthiases, AFIP  Peters et al, A Color Atlas of Tropical Medicine and Parasitology, Wolfe  JF Williams, personal collection  Google image search Any reference to commercial trademarks in this lecture likely causes their respective holders to cringe.