Neglected Parasitic Infections: What Every Family Physician Needs to Know
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Am Fam Physician. 2014 May 15;89(10):803-811.
Author disclosure: No relevant financial affiliations.
Neglected parasitic infections, including Chagas disease, toxocariasis, cysticercosis, and toxoplasmosis, affect millions of persons in the United States. Relatively few resources have been devoted to surveillance, prevention, and treatment of these diseases. Chagas disease primarily affects Latin American immigrants and can cause heart failure and death if not treated. Immediate antiparasitic treatment is indicated for most patients with acute Chagas disease. Treatment is recommended for patients younger than 18 years who have chronic Chagas disease and is generally recommended for adults younger than 50 years who do not have advanced cardiomyopathy; treatment decisions for other patients should be made on an individual basis. Toxocariasis primarily affects children and can cause gastrointestinal, respiratory, and ophthalmologic disease. Treatment options include albendazole and mebendazole. Patients with ocular infection require referral to an ophthalmologist. Neurocysticercosis, a form of cysticercosis, is the most common infectious cause of seizures in some parts of the United States. Initial treatment should focus on symptom control. Humans generally acquire toxoplasmosis by eating undercooked contaminated meat or ingesting things that have been contaminated with cat feces. Congenital infection can result in miscarriage or adverse fetal effects. Treatment is recommended for immunosuppressed persons, pregnant women, and immunocompetent persons with severe symptoms.
Neglected parasitic infections, including Chagas disease, toxocariasis, cysticercosis, and toxoplasmosis, can cause severe illness, but limited resources have been devoted to better understanding their impact and burden. Physicians may not be familiar with these infections because their clinical presentation, diagnosis, and treatment are typically not emphasized during medical training. However, it is crucial for family physicians to understand the basic principles of diagnosis and treatment of these diseases. A summary of the key points about epidemiology, clinical manifestations, diagnostic evaluation, and treatment for each disease is presented in Table 1.
Key Points About Chagas Disease, Toxocariasis, Cysticercosis, and Toxoplasmosis
|Disease||Epidemiology and transmission||Clinical manifestations||Diagnosis||Treatment|
Chagas disease (American trypanosomiasis)
Acute and congenital infections:
Toxocara antibody test (does not differentiate between acute and previous infection); stool examination is not useful because eggs are not excreted by humans
Treatment options include albendazole (Albenza) and meb
DANA WOODHALL, MD, is a medical officer in the Parasitic Diseases Branch of the Centers for Disease Control and Prevention in Atlanta, Ga.
JEFFREY L. JONES, MD, MPH, is a medical officer in the Parasitic Diseases Branch of the Centers for Disease Control and Prevention.
PAUL T. CANTEY, MD, MPH, is a medical officer in the Parasitic Diseases Branch of the Centers for Disease Control and Prevention.
PATRICIA P. WILKINS, PhD, is an associate director for laboratory science in the Parasitic Diseases Branch of the Centers for Disease Control and Prevention.
SUSAN P. MONTGOMERY, DVM, MPH, is a veterinary medical officer in the Parasitic Diseases Branch of the Centers for Disease Control and Prevention.
Address correspondence to Dana Woodhall, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mail Stop D-03, Atlanta, GA 30333 (e-mail: firstname.lastname@example.org). Reprints are not available from the authors.
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