Clin Colon Rectal Surg 2007; 20(1): 038-046
DOI: 10.1055/s-2007-970199
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Parasitic Colitides

Joel E. Goldberg1
  • 1Division of General and Gastrointestinal Surgery, Section, Colon and Rectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Further Information

Publication History

Publication Date:
28 February 2007 (online)

ABSTRACT

Parasitic infections are a major worldwide health problem, and they account for millions of infections and deaths each year. Most of the infections as well as the morbidity and mortality from these diseases occur in the developing world in rural regions. However, these diseases have become more common in Western countries and in big cities over the past 25 years. These changing disease patterns can be attributed to emigration from the third world to developed countries and migration of rural populations to the big cities in developing nations. These parasitic infections have protean manifestations and consequences. The medical problems range from chronic asymptomatic carrier to fulminant infections and even death. Several factors such as the host immune status, the infecting organism, and the availability of treatment all play key roles in the outcomes of parasitic colitides. The two major classes of parasites causing these infections are the helminthes (ascariasis, strongyloidiasis, enterobiasis, trichuriasis, and schistosomiasis) and the protozoa (Isospora, Cryptosporidium, Cyclospora, Trypanosoma cruzi, Giardia lamblia, and Balantidium coli). This article summarizes the salient features of each parasite with respect to epidemiology, transmission, pathogenesis, clinical features, diagnosis, and treatment. The vast majority of these infections have a self-limited clinical course or are easily treated with medical management, and surgery is rarely needed.

REFERENCES

  • 1 Bern C, Martines J, de Zoysa I, Glass R I. The magnitude of the global problem of diarrhoeal disease: a ten year update.  Bull World Health Organ. 1992;  70 705-714
  • 2 Anonymous . Chagas disease: Interruption of transmission.  Wkly Epidemiol Rec. 1997;  72 1-4
  • 3 WHO-Control of Chagas' Disease .WHO Technical Report Series 905, World Health Organization, Geneva. 2002
  • 4 Grant I H, Gold J WM, Wittner M et al.. Transfusion-associated acute Chagas' disease acquired in the United States.  Ann Intern Med. 1989;  111 849-851
  • 5 Kirchoff L. American trypanosomiasis (Chagas' disease). In: Guerrant R, Walker DH, Weller PF Tropical Infectious Diseases: Principles, Pathogens and Practice, vol 1. Philadelphia; Churchill Livingstone 1999: 85
  • 6 Corman M L. Colon and Rectal Surgery, 5th ed. Philadelphia; Lippincott, Williams and Wilkins 2005: 1663-1664
  • 7 Keighley M RB, Williams N S. Surgery of the Anus, Rectum and Colon. 2nd ed. London; WB Saunders 2001: 2530-2532
  • 8 Brodsky R E, Spencer Jr H C, Schultz M G. Giardiasis in American travelers to the Soviet Union.  J Infect Dis. 1974;  130 319-323
  • 9 Furness B W, Beach M J, Robert J M. Giardiasis surveillance-United States, 1992-1997.  MMWR Morb Mortal Wkly Rep. 2000;  49 1-13
  • 10 Overturf G D. Endemic giardiasis in the United States-role of the daycare center.  Clin Infect Dis. 1994;  18 764-765
  • 11 Moldwin R M. Sexually transmitted protozoal infections: Trichomonas vaginalis, Entamoeba histolytica, and Giardia lamblia .  Urol Clin North Am. 1992;  19 93-101
  • 12 Mintz E D, Hudson-Wragg M, Mshar P et al.. Foodborne giardiasis in a corporate office setting.  J Infect Dis. 1993;  167 250-253
  • 13 Ortega Y R, Adam R D. Giardia: overview and update.  Clin Infect Dis. 1997;  25 545-549
  • 14 Quick R, Paugh K, Addiss D et al.. Restaurant-associated outbreak of giardiasis.  J Infect Dis. 1992;  166 673-676
  • 15 Katz M, Despommier D D, Gwadz R. Parasitic Diseases. 2nd ed. New York; Springer-Verlag 1989: 129-135
  • 16 Katanik M T, Schneider S K, Rosenblatt J E et al.. Evaluation of ColorPAC Giardia/Cryptosporidium rapid assay and ProSpecT Giardia/Cryptosporidium microplate assay for detection of Giardia and Cryptosporidium in fecal specimens.  J Clin Microbiol. 2001;  39 4523-4525
  • 17 Garcia L S, Shimizu R Y. Evaluation of nine immunoassay kits (enzyme immunoassay and direct fluorescence) for detection of Giardia lamblia and Cryptosporidium parvum in human fecal specimens.  J Clin Microbiol. 1997;  35 1526-1529
  • 18 Upcroft J A, Campbell R W, Benakli K et al.. Efficacy of new 5-nitroimidazoles against metronidazole-susceptible and -resistant Giardia, Trichomonas, and Entamoeba spp.  Antimicrob Agents Chemother. 1999;  43 73-76
  • 19 Casemore D P. Epidemiological aspects of human cryptosporidiosis.  Epidemiol Infect. 1990;  104 1-28
  • 20 Musher D M, Musher B L. Contagious acute gastrointestinal infections.  N Engl J Med. 2004;  351 2417-2427
  • 21 Heyworth M F. Parasitic diseases in immunocompromised hosts. Cryptosporidiosis, isosporiasis, and strongyloidiasis.  Gastroenterol Clin North Am. 1996;  25 691-707
  • 22 Petersen C. Cryptosporidium and the food supply.  Lancet. 1995;  345 1128-1129
  • 23 Checkley W, Epstein L D, Gilman R H et al.. Effects of Cryptosporidium parvum infection in Peruvian children: growth faltering and subsequent catch-up growth.  Am J Epidemiol. 1998;  148 497-506
  • 24 Kehl K S, Cicirello H, Havens P L. Comparison of four different methods for detection of Cryptosporidium species.  J Clin Microbiol. 1995;  33 416-418
  • 25 Smith H V, Corcoran G D. New drugs and treatment for cryptosporidiosis.  Curr Opin Infect Dis. 2004;  17 557-564
  • 26 Blanshard C, Jackson A M, Shanson D C et al.. Cryptosporidiosis in HIV-seropositive patients.  Q J Med. 1992;  85 813-823
  • 27 Sorvillo F J, Lieb L E, Seidel J et al.. Epidemiology of isosporiasis among persons with acquired immunodeficiency syndrome in Los Angeles County.  Am J Trop Med Hyg. 1995;  53 656-659
  • 28 Goodgame R W. Understanding intestinal spore-forming protozoa: cryptosporidia, microsporidia, isospora, and cyclospora.  Ann Intern Med. 1996;  124 429-441
  • 29 DeHovitz J A, Pape J W, Boncy M, Johnson Jr W D. Clinical manifestations and therapy of Isospora belli infection in patients with the acquired immunodeficiency syndrome.  N Engl J Med. 1986;  315 87-90
  • 30 Goodgame R. Emerging causes of traveler's diarrhea: Cryptosporidium, Cyclospora, Isospora, and Microsporidia.  Curr Infect Dis Rep. 2003;  5 66-73
  • 31 Pape J W, Verdier R I, Johnson Jr W D. Treatment and prophylaxis of Isospora belli infection in patients with the acquired immunodeficiency syndrome.  N Engl J Med. 1989;  320 1044-1047
  • 32 DeHovitz J A, Pape J W, Boncy M et al.. Clinical manifestations and therapy of Isospora belli infection in patients with the acquired immunodeficiency syndrome.  N Engl J Med. 1986;  315 87-90
  • 33 Ortega Y R, Sterling C R, Gilman R H et al.. Cyclospora species-a new protozoan pathogen of humans.  N Engl J Med. 1993;  328 1308-1312
  • 34 Herwaldt B L, Ackers M L. An outbreak in 1996 of cyclosporiasis associated with imported raspberries. The Cyclospora Working Group.  N Engl J Med. 1997;  336 1548-1556
  • 35 Herwaldt B L. Cyclospora cayetanensis: a review, focusing on the outbreaks of cyclosporiasis in the 1990s.  Clin Infect Dis. 2000;  31 1040-1057
  • 36 Pape J W, Verdier R I, Boncy M et al.. Cyclospora infection in adults infected with HIV. Clinical manifestations, treatment, and prophylaxis.  Ann Intern Med. 1994;  121 654-657
  • 37 Eberhard M L, Pieniazek N J, Arrowood M J. Laboratory diagnosis of Cyclospora infections.  Arch Pathol Lab Med. 1997;  121 792-797
  • 38 Verdier R-I, Fitzgerald D W, Johnson Jr W D, Pape J W. Trimethoprim-sulfamethoxazole compared with ciprofloxacin for treatment and prophylaxis of Isospora belli and Cyclospora cayetanensis infection in HIV-infected patients. A randomized, controlled trial.  Ann Intern Med. 2000;  132 885-888
  • 39 Weiss L M, Keohane E M. The uncommon gastrointestinal protozoa: Microsporidia, Blastocystis, Isospora, Dientamoeba, and Balantidium.  Curr Clin Top Infect Dis. 1997;  17 147-187
  • 40 Esteban J G, Aguirre C, Angles R et al.. Balantidiasis in Aymara children from the northern Bolivian Altiplano.  Am J Trop Med Hyg. 1998;  59 922-927
  • 41 Ferry T, Bouhour D, De Monbrison F et al.. Severe peritonitis due to Balantidium coli acquired in France.  Eur J Clin Microbiol Infect Dis. 2004;  23 393-395
  • 42 Ladas S D, Savva S, Frydas A et al.. Invasive balantidiasis presented as chronic colitis and lung involvement.  Dig Dis Sci. 1989;  34 1621-1623
  • 43 Drugs for Parasitic Infections .Med Lett Drug Ther; August 2004. http://Online at: www.medletter.com/freedocs/parasitic.pdf
  • 44 Elliott D E. Schistosomiasis. Pathophysiology, diagnosis, and treatment.  Gastroenterol Clin North Am. 1996;  25 599-625
  • 45 Lucey D R, Maguire J H. Schistosomiasis.  Infect Dis Clin North Am. 1993;  7 635-653
  • 46 Arnon R. Life span of parasite in schistosomiasis patients.  Isr J Med Sci. 1990;  26 404-405
  • 47 Corachan M. Schistosomiasis and international travel.  Clin Infect Dis. 2002;  35 446-450
  • 48 Strickland G T. Gastrointestinal manifestations of schistosomiasis.  Gut. 1994;  35 1334-1337
  • 49 Stephenson L. The impact of schistosomiasis on human nutrition.  Parasitology. 1993;  107(Suppl) S107-S123
  • 50 Corman M L. Colon and Rectal Surgery, 5th ed. Philadelphia; Lippincott, Williams and Wilkins 2005: 1665-1669
  • 51 Harries A D, Fryatt R, Walker J et al.. Schistosomiasis in expatriates returning to Britain from the tropics: a controlled study.  Lancet. 1986;  1 86-88
  • 52 Drugs for parasitic infections .Medical Lett Drugs Ther; August 2004. http://Online at: www.medletter.com/freedocs/parasitic.pdf
  • 53 Scowden E B, Schaffner W, Stone W J. Overwhelming strongyloidiasis: an unappreciated opportunistic infection.  Medicine (Baltimore). 1978;  57 527-544
  • 54 Berkmen Y M, Rabinowitz J. Gastrointestinal manifestations of the strongyloidiasis.  Am J Roentgenol Radium Ther Nucl Med. 1972;  115 306-311
  • 55 Gill G V, Welch E, Bailey J W et al.. Chronic Strongyloides stercoralis infection in former British Far East prisoners of war.  QJM. 2004;  97 789-795
  • 56 Lim S, Katz K, Krajden S et al.. Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management.  CMAJ. 2004;  171 479-484
  • 57 Khuroo M S. Ascariasis.  Gastroenterol Clin North Am. 1996;  25 553-577
  • 58 Seltzer E. Ascariasis. In: Guerrant RL, Weller PF Tropical Infectious Diseases: Principles, Pathogens and Practice. 1st ed. Philadelphia; Churchill Livingstone 1999: 553
  • 59 Warren K S, Mahmoud A A. Algorithms in the diagnosis and management of exotic diseases. XXII. ascariasis and toxocariasis.  J Infect Dis. 1977;  135 868-872
  • 60 Tietze P E, Tietze P H. The roundworm, Ascaris lumbricoides .  Prim Care. 1991;  18 25-41
  • 61 Haswell-Elkins M, Elkins D, Anderson R M. The influence of individual, social group and household factors on the distribution of Ascaris lumbricoides within a community and implications for control strategies.  Parasitology. 1989;  98(Pt 1) 125-134
  • 62 Lindo J F, Dubon J M, Ager A L et al.. Intestinal parasitic infections in human immunodeficiency virus (HIV)-positive and HIV-negative individuals in San Pedro Sula, Honduras.  Am J Trop Med Hyg. 1998;  58 431-435
  • 63 Katz M, Despommier D D, Gwadz R. Parasitic Diseases, 2nd ed. New York; Springer-Verlag 1989: 11-15
  • 64 Seltzer E. Ascariasis. In: Guerrant RL, Weller PF Tropical Infectious Diseases: Principles, Pathogens and Practice. 1st ed. Philadelphia; Churchill Livingstone 1999: 553
  • 65 de Silva N R, Guyatt H L, Bundy D A. Worm burden in intestinal obstruction caused by Ascaris lumbricoides .  Trop Med Int Health. 1997;  2 189-190
  • 66 Isselbacher K J, Braunwald E, Wilson J D et al.. Harrison's Principles of Internal Medicine, 13th ed. New York; McGraw Hill 1994: 916-918
  • 67 Reeder M M. The radiological and ultrasound evaluation of ascariasis of the gastrointestinal, biliary, and respiratory tracts.  Semin Roentgenol. 1998;  33 57-78
  • 68 Warren K S, Mahmoud A A. Algorithms in the diagnosis and management of exotic diseases. XXII. ascariasis and toxocariasis.  J Infect Dis. 1977;  135 868-872
  • 69 Albonico M, Smith P G, Hall A et al.. A randomized controlled trial comparing mebendazole and albendazole against Ascaris, Trichuris and hookworm infections.  Trans R Soc Trop Med Hyg. 1994;  88 585-589
  • 70 Cooper E. Trichuriasis. In: Guerrant R, Walker DH, Weller PF Tropical Infectious Diseases: Principles, Pathogens and Practice, vol 2. Philadelphia; Churchill Livingstone 1999: 955
  • 71 Bundy D A. Epidemiological aspects of Trichuris and trichuriasis in Caribbean communities.  Trans R Soc Trop Med Hyg. 1986;  80 706-718
  • 72 Russell L J. The pinworm, Enterobius vermicularis .  Prim Care. 1991;  18 13-24
  • 73 Jones J E. Pinworms.  Am Fam Physician. 1988;  38 159-164
  • 74 Grencis R K, Cooper E S. Enterobius, trichuris, capillaria, and hookworm including ancylostoma caninum.  Gastroenterol Clin North Am. 1996;  25 579-597
  • 75 Arca M J, Gates R L, Groner J I et al.. Clinical manifestations of appendiceal pinworms in children: an institutional experience and a review of the literature.  Pediatr Surg Int. 2004;  20 372-375

Joel E GoldbergM.D. 

Division of General and Gastrointestinal Surgery, Section, Colon and Rectal Surgery, Brigham and Women's Hospital, Harvard Medical School

75 Francis St., Boston, MA 02115

Email: jgoldberg1@partners.org

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