John wiley sons medicina bioquimica principles and practice of clinical parasitology

prevention and control 110 see also granulomatous amebic encephalitis bancroftian ®lariasis see lymphatic ®lariasis: bancroftian ®lariasis basic reproductive number R0 22 estimation for

Principles and Practice

of Clinical Parasitology

Edited by S Gillespie & Richard D Pearson Copyright & 2001 John Wiley & Sons Ltd Print ISBN 0-471-97729-2 Online ISBN 0-470-84250-4

Principles and Practice

of Clinical Parasitology

Edited by

Stephen H Gillespie Royal Free Hospital and School of Medicine

and Richard D Pearson University of Virginia Health Sciences Center,

Charlottesville, Virginia, USA

JOHN WILEY& SONS, LTD Chichester  New York  Weinheim  Brisbane  Singapore  Toronto

Edited by S Gillespie & Richard D Pearson Copyright & 2001 John Wiley & Sons Ltd Print ISBN 0-471-97729-2 Online ISBN 0-470-84250-4

Copyright # 2001 by John Wiley & Sons Ltd,

Bans Lane, Chichester, West Sussex PO19 1UD, England National 01243 779777

International (+44) 1243 779777 e-mail (for orders and customer service enquiries): cs-books@wiley.co.uk Visit our Home Page on: http://www.wiley.co.uk

or http://www.wiley.com All Rights Reserved No part of this publication may be reproduced, stored in a retrieval

system, or transmitted, in any form or by any means, electronic, mechanical, photocopying,

recording, scanning or otherwise, except under the terms of the Copyright, Designs and Patents Act

1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham

Court Road, London W1P 0LP, UK, without the permission in writing of the publisher.

Chapter 19b is in the public domain

Other Wiley Editorial Oces

John Wiley & Sons, Inc., 605 Third Avenue,

New York, NY 10158-0012, USA

WILEY-VCH Verlag GmbH, Pappelallee 3,

D-69469 Weinheim, Germany

John Wiley & Sons Australia Ltd, 33 Park Road, Milton,

Queensland 4064, Australia

John Wiley & Sons (Asia) Pte, Ltd, 2 Clementi Loop #02-01,

Jin Xing Distripark, Singapore 129809

John Wiley & Sons (Canada) Ltd, 22 Worcester Road,

Rexdale, Ontario M9W 1L1, Canada

Library of Congress Cataloging-in-Publication Data

Principles and practice of clinical parasitology / edited by Stephen Gillespie, Richard D Pearson.

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN 0-471-97729-2

Typeset in 10/12pt Times from authors' disks by Dobbie Typesetting Limited, Tavistock, Devon

Printed and bound in Great Britain by Antony Rowe Ltd, Chippenham, Wiltshire

This book is printed on acid-free paper responsibly manufactured from sustainable forestry,

in which at least two trees are planted for each one used for paper production.

Edited by S Gillespie & Richard D Pearson Copyright & 2001 John Wiley & Sons Ltd Print ISBN 0-471-97729-2 Online ISBN 0-470-84250-4

6 Cryptosporidiosis and Isosporiasis 139

Cynthia L Sears and

Govinda S Visvesvara

13 Leishmaniasis 287Richard D Pearson,

Selma M B Jeronimo andAnastacio de Q Sousa14a African Trypanosomiasis 315

I Balakrishnan and A Zumla14b American Trypanosomiasis(Chagas' Disease) 335Louis V Kirchho€

Wuchereria bancrofti, Brugia malayi,Brugia timori, Loa loa, Mansonellaperstans and Mansonella ozzardi 433Thomas B Nutman

18b Onchocerciasis 457

J Whitworth

Edited by S Gillespie & Richard D Pearson Copyright & 2001 John Wiley & Sons Ltd Print ISBN 0-471-97729-2 Online ISBN 0-470-84250-4

22 Echinococcosis 585

R C A Thompson

23 Cestodes 613Kaethe Willms and Julio Sotelo

24 Intestinal Trematodes 635Thomas R Hawn and Elaine C Jong

J P Ackers Department of Infections and

Tropical Diseases, London School of Hygiene

and Tropical Medicine, Keppel Street, London

WC1E 7HT, UK

S I Balakrishnan Department of Medical

Microbiology, Royal Free & University College

Medical School, Rowland Hill Street, London

NW3 2PF, UK

B.-A Biggs Division of Infectious Diseases,

Department of Medicine, The Walter and Eliza

Hall Institute of Medical Research, Royal

Melbourne Hospital, Victoria 3050, Australia

R E Boreham PO Box 1246, Toowong,

Queensland 4066, Australia

Graham Brown Division of Infectious Diseases,

Department of Medicine, The Walter and Eliza

Hall Institute of Medical Research, Royal

Melbourne Hospital, Victoria 3050, Australia

D A P Bundy The World Bank, 1818 H Street

NW, Washington, DC 20433, USA

E Canning Department of Biology, Imperial

College of Science, Technology and Medicine,

London SW7 2AZ, UK

G C Cook The Wellcome Trust Centre for the

History of Medicine at UCL, 183 Euston Road,

London NW1 2BE, UK

Srinivasan Dasarathy MetroHealth Medical

Center, Case Western Reserve University, 2500

MetroHealth Drive, Cleveland OH 44109-1998,

USA

Vance Dietz OrganizacioÂn Panamericana de

Salud, Marcelo T de Alvear 684, 4 Piso, 1395

Buenos Aires, Argentina

Je€rey A Gelfand International Medical A€airsPartners, Healthcare System, MassachusettsGeneral Hospital, 50 Stanford Street, Suite 801,Boston, MA 02114-2517, USA

Stephen H Gillespie Department of MedicalMicrobiology, Royal Free and University CollegeHospital Medical School, Pond Street, LondonNW3 2QG, UK

Richard L Guerrant Division of Geographic andInternational Medicine, Box 801379, University ofVirginia School of Medicine, Charlottesville, VA

22908, USAThomas R Hawn Division of Allergy andInfectious Diseases, Department of Medicine,University of Washington Medical Center, TheInstitute for Systems Biology, Suite 200, 4225Roosevelt Way NE, Seattle, WA 98105, USADavid R Hill Division of Infectious Diseases,University of Connecticut Health Center, Farm-ington, CT 06030-3212, USA

Celia V Holland Department of Zoology,Trinity College, Dublin 2, Ireland

Selma M B Jeronimo Department of istry, Universidade Federal do Rio Grande do Norte,Natal, Brazil

Biochem-Elaine C Jong University of Washington, HallHealth Primary Care Center, Box 354410,Seattle, WA 98195-4410, USA

Michael G Lee Department of Medicine, versity of the West Indies, Mona, Kingston 7,Jamaica

Uni-Louis V Kirchho€ University of Iowa, ment of Internal Medicine, 300G EMRB, IowaCity, IA 52242, USA

Depart-Edited by S Gillespie & Richard D Pearson Copyright & 2001 John Wiley & Sons Ltd Print ISBN 0-471-97729-2 Online ISBN 0-470-84250-4

Beth D Kirkpatrick Division of Infectious

Diseases, Department of Medicine, University of

Vermont School of Medicine, Burlington, VT, USA

John F Lindo Department of Microbiology,

University of the West Indies, Mona, Kingston 7,

Jamaica

Augusto Julio MartõÂnez University of Pittsburgh

School of Medicine, Department of Pathology,

Division of Neuropathology, 200 Lothrop Street,

Pittsburgh, PA 15213-2582, USA

E Michael Department of Infectious Disease

Epidemiology, Imperial College School of

Medi-cine, Norfolk Place, London W2 1PG, UK

Ralph Muller International Institute of

Parasi-tology, 22 Cranbrook Drive, St Albans,

Hertfordshire AL4 0SS, UK

Thomas B Nutman Helminth Immunology

Section and Clinical Parasitology Unit,

Lab-oratory of Parasitic Diseases, National Institute

of Allergy and Infectious Diseases, National

Institutes of Health, Building 4, Room B1-03,

Bethesda, MD 20892-0425, USA

G Richard Olds Medical College of Wisconsin,

Department of Medicine, 9200 W Wisconsin

Avenue, Suite 4186, Milwaukee, WI 53226, USA

Richard D Pearson University of Virginia

School of Medicine, Department of Medicine &

Pathology, Box 801379, Charlottesville, VA 22908,

USA

William A Petri Jr University of Virginia

Health Sciences Center, 300 Park Place, MR4

Building, Room 2115, Charlottesville, VA 22908,

USA

Debra D Poutsiaka New England Medical

Center, 750 Washington Street, Boston, MA

02111, USA

Peter M Schantz Division of Parasitic Diseases,

National Center for Infectious Diseases, Centers

for Disease Control and Prevention, 4770 Buford

Highway, Atlanta, GA 30341-3724, USA

Joseph D Schwartzman Department of

Pathol-ogy, Dartmouth-Hitchcock Medical Center, 1

Medical Center Drive, Lebanon, NH 03756, USA

Cynthia L Sears Department of Medicine,Division of Infectious Diseases and Gastroenterol-ogy, Johns Hopkins University School of Medicine,Baltimore, MD 21205, USA

Upinder Singh University of Viginia School ofMedicine, 300 Park Place, Charlottesville, VA

22908, USAAnastacio de Q Sousa Department of InternalMedicine, Universidade Federal do Ceata, Forta-leza, Brazil

Julio Sotelo Instituto Nacional de NeurologõÂa yNeurocirugõÂa, Insurgentes Sur 3877, Mexico City

14269, MexicoTheodore S Steiner Division of Geographic andInternational Medicine, Box 801379, University ofVirginia School of Medicine, Charlottesville, VA

22908, USA

D J Stenzel Analytical Electron MicroscopyFacility, Queensland University of Technology,Garden Point Campus, 2 George Street, GPO Box

2434, Brisbane, Queensland 4001, Australia

M R H Taylor Department of Paediatrics,Trinity College, Dublin 2, and National Children'sHospital, Harcourt Street, Dublin 2, Ireland

R C A Thompson Department of VeterinaryStudies, Murdoch University, Murdoch, WA 6150,Australia

J Whitworth Medical Research Council, UgandaVirus Research Institute, PO Box 49, Entebbe,Uganda

Kaethe Willms Department of Microbiology andParasitology, Facultad de Medicine, UniversidadNacional AutoÂnoma de MeÂxico, Mexico City,Mexico

Govinda S Visvesvara Division of ParasiticDiseases, National Center for Infectious Diseases,Centers for Disease Control and Prevention,Atlanta, GA 30333, USA

A Zumla Centre for Infectious Diseases, versity College London, Royal Free and UniversityCollege Medical School, Rowland Hill Street,London NW3 2PF, UK

In the 1970s and 1980s, in an attempt to focus

world attention on parasitic diseases, the World

Health Organization formed the Tropical

Dis-eases Research Group Their target was six major

infections that damaged the health of individuals

in developing countries, and ®ve of these six were

parasitic diseases The Rockefeller Foundation

also identi®ed parasitic infections as a major

target for health improvement for the world

community They formed a research network to

develop new drugs and vaccines by

understand-ing the pathogenesis of diseases Its title `The

Great Neglected Diseases Network' emphasised

that, in the post-colonial world, parasitic diseases

were no longer identi®ed by governments and

pharmaceutical companies as important subjects

for medical research Despite the success of these

two ventures in developing our understanding of

the immunology, molecular biology and

poten-tial for vaccines and drugs, the position of

parasitic diseases in the world is, if anything,

worse than it was 30 years ago The territories in

which malaria is endemic have expanded and the

number of cases with it Malaria causes more

than a million child deaths in Africa every year

The number of individuals su€ering from

intest-inal helminth infections has more than doubled

in the last 50 years and the prevalence of

schistosomiasis is rising Urbanisation in Brazil,

where more than 80% of the population live in

cities, has resulted in large peri-urban epidemics

of Chagas' disease and epidemics of visceral

leishmaniasis This general global deterioration

has occurred in a context where, for many

countries, endemic parasitic diseases are a thing

of the past In epidemiological terms, parasitic

infections are over-dispersed or, in more

every-day terms, focused in the poorest sector of the

world community

Globalisation has changed the spectrum ofparasitic infection in clinical medical practice.Not only has the incidence of disease world-wide risen, but frequency of travel, migrationand population dispersal due to war hasresulted in individuals presenting with parasiticinfections in locations where these diseaseshave become rare Patients with malaria andintestinal protozoan and helminth infectionsare now an everyday occurrence in familypractice throughout the world The diagnosis

of parasitic diseases has also become an day component of medical laboratory practiceworldwide

every-The HIV pandemic has also had a potentin¯uence on the spectrum of parasitic infections

A number of organisms that cause disease rarelyhave become commonplace The HIV epidemicitself was identi®ed through an apparent epi-demic of Pneumocystis carinii infection, at thattime considered to be a protozoan and nowconsidered to be a fungus Intractable crypto-sporidiosis and isosporiasis, and the recognition

of microsporidium infections and cerebral plasmosis, have all been consequences of severeimmunocompromise secondary to HIV infection.Visceral leishmaniasis, too, has been recognised

toxo-as a major opportunistic disetoxo-ase in HIV-infectedindividuals in Southern France and Italy.New technologies have increased our ability toinvestigate parasitic diseases and to understandthe biology of the organisms and the hosts'immune response to them Developments inimmunology and molecular biology have enableddiagnostic laboratories to improve the diagnosis

of parasitic infections through noassays and DNA ampli®cation techniques.Genome sequence programmes are under wayfor parasites, including malaria, Leishmania and

enzyme-immu-Edited by S Gillespie & Richard D Pearson Copyright & 2001 John Wiley & Sons Ltd Print ISBN 0-471-97729-2 Online ISBN 0-470-84250-4

amoebas and these may lead to the identi®cation

of new virulence determinants, or targets for

chemotherapy or vaccine development Although

new treatments and vaccines have progressed

more slowly than in other infection disciplines,

e€ective chemotherapy is now available for

almost all parasitic infections

An international panel of authors have drawn

together their experience and understanding of

parasitic infections The chapters contain a

clinically orientated overview of all the major

parasitic infections in medical practice Theeditors hope that those who read and use thisbook will develop their clinical diagnostic andtherapeutic skills, and that these skills will beused for the bene®t of those who most needthemÐthe people who are often the poorest inthe world community

Stephen H GillespieRichard D Pearson

Index Numbers in italics indicate ®gures; those in bold indicate tables Plates are denoted by `p'.

in Toxoplasma gondii motility 119

acute dermatolymphangioadenitis (ADLA) 443

acute necrotizing colitis 207

adenolymphangitis (ADL) 436, 437

adenopathy 440

adhesins, Trichomonas vaginalis 247, 249

adventitial layer, Echinococcus granulosus 593, 594, 598

disease suppression 331±2vaccination 332

vector control 331WHO recommendations 315agar plate culture of Strongyloides stercoralis 490age

at ®rst infection related to R0 26optimum for helminth vaccination, mathematicalmodels 27±8, 29

age prevalencescryptosporidiosis 148Entamoeba infections 202, 204intestinal nematode infections 565malaria 68

schistosomiasis 377, 379strongyloidiasis 488±9toxocariasis 508Trichomonas tenax infections 257age-structured dynamic cost±bene®t analysis model34±5

AIDS/HIV infectioncryptosporidiosis in 140, 147, 148, 150, 153±4cyclosporiasis treatment 168

giardiasis in 225granulomatous amebic encephalitis in 278, 279isosporiasis in 156, 157, 158

microsporidioses in 181, 185, 186, 190, 191toxoplasmosis in 114, 125±6, 132±3trichomoniasis and transmission risk of 248Trypanosoma cruzi brain abscesses in 344visceral leishmaniasis in 293, 294, 303, 307airport malaria 68

Alaria americana 536, 549, 637, 645

Edited by S Gillespie & Richard D Pearson Copyright & 2001 John Wiley & Sons Ltd Print ISBN 0-471-97729-2 Online ISBN 0-470-84250-4

ameboid form, Blastocystis hominis 359

American trypanosomiasis see Chagas' disease

aminosidine see paromomycin

annual transmission potential (ATP) 464Anopheles mosquitoes 55

control 87house screening against 88insecticide resistance 87microsporidia in 187

in Plasmodium life-cycle 56prevention of bites 88variation and malaria transmission 67anticoagulants, hookworm 538, 570antigen detection tests

Angiostrongylus spp 545Echinococcus spp 603, 604Entamoeba histolytica 209±10Giardia lamblia 229

Schistosoma spp 394Strongyloides stercoralis 492Taenia spp 625

Toxocara spp 514Trichomonas vaginalis 254Trypanosoma brucei 329Wuchereria bancrofti 441antigenic variation, mechanisms in Trypanosomabrucei 323, 324±5

antimalarial antibodies 64antimalarial drug resistance 69, 78chloroquine 54, 75, 76±7, p.vicountries a€ected 89, p.vimis-diagnosed babesiosis 106pyrimethamine±sulfadioxine 84quinine 77

tests for 69, 74antimalarial drugs 81±6see also speci®c drugsantimony dimercaptosuccinate 371ants 421

apicoplasts 114appendicitis and Enterobius infections 574arecoline 603

artemesinin 77, 81, 85artemether 81, 85artesunate 77, 81, 85Ascaris lumbricoidesadult 567classi®cation 566±7clinical features of ascariasis 568control program, cost-e€ectiveness analysis 32±4child-targeted treatment 34±5

eggs 567epidemiologygenetic predisposition 568transmission 567±8

history 566

see also intestinal nematodes

asthma and toxocariasis 513

astrocytes 321

atovaquone 109

atovaquone±proguanil 75, 85, 90

autoantibody production in trypanosomiasis 321

autoimmunity in Chagas' disease 339

organisms see Babesia spp

prevention and control 110

see also granulomatous amebic encephalitis

bancroftian ®lariasis see lymphatic ®lariasis: bancroftian

®lariasis

basic reproductive number (R0) 22

estimation for microparasites 24

for macroparasite infections 27

and vaccination levels to eradicate diseases 24±5

benzimidazole treatmentintestinal nematode infections 578±9Trichinella larvae elimination 530±1see also albendazole treatment; mebendazole treat-ment; thiabendazole treatment

benznidazole 347, 348Bignami, Amico 14, 16, 53Bilharz, Theodore 11, 369biliary tract Cryptosporidium infection 150, 152±3Biomphalaria snails 376

birdsmigration and cyclosporiasis outbreaks 167pet, in Encephalitozoon hellem infections 186bis(glucathionyl)spermidine metabolism 317±18bithionol 419, 420, 429, 642

black¯ies as onchocerciasis vectors 458, 459blood meals 466

control 472±3dispersal and migration 466geographical distribution of vector species 465infective density determination 463±4

life-cycle 465±6seasonality 466Blacklock, D.B 458blackwater fever 63bladder cancer and urinary schistosomiasis 383, 391Blastocystis hominis

clinical features of infection 362clinical management of infection 364chemotherapy 364

diet 364±5epidemiology 361history 355immunology 361laboratory diagnosisculture 363microscopy 362±3, p.viiserology, not yet available 363life-cycle 359±60

molecular biology and biochemistry 360morphological forms 356, p.vii

ameboid 359avacuolar 358cyst 358±9granular 357multivacuolar 358vacuolar 356±7pathogenesis 360±1prevention and control 365taxonomy 355±6

Blastocystis spp with animal hosts 356blindness

from onchocerciasis 467, 468from toxocariasis 511±12

blood concentration methods 327±8

blood smears

acute Chagas' disease diagnosis 345

African trypanosomiasis diagnosis 327±8

Chagas' disease transmission 340, 341±2, 349

blood-borne ®larial parasites 433, 434

see also Loa loa; lymphatic ®lariae; Mansonella

ozzardi; Mansonella perstans

blood-stage malarial vaccines 91±2

Borrelia burgdorferi/Babesia microti co-infection 106,

108, 109±10

bottled water, safety 155

bovine anti-Cryptosporidium hyperimmune colostrum

brain calci®cation in neurocysticercosis 623

breast feeding, protective against Giardia 225

broad ®sh tapeworm see Diphyllobothrium latum

brood capsules, Echinococcus spp 590, 591, 592

see also intestinal nematodes

capsule, ®brous of Echinococcus granulosus 593, 594,

ownership and toxocariasis risk 509

Toxocara cati life-cycle in 502, 503, 504

in Toxoplasma gondii transmission 115, 116, 133

CD4+ cells, in Cryptosporidium parvum immunity

146, 150cell detaching factor (CDF) 247cercariae

intestinal trematodes 635, 637, 638, 641, 643Schistosoma spp 372±3, 374, 37 7

cerebral gnathostomiasis 542cerebral infection, microsporidia 176±7, 182, p.iv, p.vcerebral malaria 61±2, 64, 70, 71, 79

cerebrospinal ¯uid (CSF) examinationAfrican trypanosomiasis 328granulomatous amebic encephalitis 280primary amebic meningitis 280cervical cancer and Trichomonas vaginalis 248cestodes 613

history 9±10see also Diphyllobothrium latum; Echinococcus spp;Hymenolepis nana; Taenia spp

Chagas, Carlos 18, 336Chagas' disease

clinical featuresacute disease 342chronic gastrointestinal disease 343±4chronic heart disease 343

in immunosuppressed patients 344indeterminate phase 342±3clinical management 347±8antiparasitic drugs 346±7heart transplantation 348history 18, 335±6

immunology 339±40laboratory diagnosisacute disease 344±5chronic disease 345PCR 346

recombinant assays 346organism see Trypanosoma cruziprevention and control 348±9chagoma 337, 338, 342

chaos in measles epidemics 23chicle ulcers 298

child-targeted treatment, cost-bene®t analysis 34±5Chinese medicinal herbs, Blastocystis hominis treatment364

chlorination of Cryptosporidium oocysts 155chlorination of water

giardiasis prevention 233, 234primary amebic meningoencephalitis prevention 282chlorine resistance

Blastocystis hominis cysts 365Cyclospora oocysts 167Giardia cysts 226chloroquine 54, 76, 82for amebic liver abscesses 211prophylaxis 89, 90

resistance 54, 74±5, 77, p.vi

for severe malaria 81

obstructive biliary disease 412

recurrent pyogenic cholangitis 412±13

Cobbold, Thomas Spencer 3, 5, 11, 369

Cochrane Parasitic Diseases Group 38

cognitive impairment and intestinal nematode

role in Babesia infection 103

complex lymphedema therapy 444

computed tomography (CT) scans

amebic liver abscesses 210, 211

coverage and frequency of treatment 34±5static models 31±2

cost per DALY 35cost±utility analysis 35±6costae 243, 244

covert toxocariasis 502, 512CpABC 144

creeping eruption see cutaneous larva migranscrustaceans see cyclops; snail hosts

cryptosporidiosisclinical features 149±51

in immunocompetent patients 149±50

in immunocompromised patients 150relapsing diarrhea 150

repeated infections 150

in young children 151clinical management 153di€erential diagnosis 151history 139

immunology 145cell-mediated immunity 145±7humoral immunity 147laboratory diagnosis 151PCR 152, 153serology 153stains 152organism see Cryptosporidium parvumprevention and control 154±5treatment 153±4

Cryptosporidium parvum 139classi®cation 139±40, 142epidemiology

infection and outbreak potential 148prevalence 148

transmission 147±8, 149future studies 155genotypes 140, 142life-cycle 141, 142pathogenesis 142±5crypts of Lieberkuhn 587, 595, 615culture media

Blastocystis hominis 363free-living amebae 274cutaneous amebiasis 208cutaneous larva migransclinical features 538±9diagnosis 539pathogenesis 538treatment 539

cutaneous leishmaniasis see leishmaniasis, cutaneous

prevention and control 168±9

cyst wall proteins 223, 229

sand ¯y control 308

DEC see diethylcarbamazine citrate (DEC) treatment

DEET see N,N-diethylmetatoluamide

Demarquay, Jean 8

dendritic cells 121

dermatolymphangioadenitis, acute (ADLA) 443

deworming, randomized trial 36±7

dexamethasone 627diarrhea

of Cochin China 479, 480relapsing 150

Dicrocoelium spp 420±1Dientamoeba fragilis 260clinical features of infection 262clinical management of infection 263description 260±1

epidemiology 262history 260immunology 261±2laboratory diagnosisculture 263microscopy 262±3pathogenesis 261prevention and control 263±4see also other trichomonadsdietary management of Blastocystis hominis 364±5diethylcarbamazine citrate (DEC) treatmentloiasis 448

lymphatic ®lariasis 439, 443, 444, 445Mansonella ozzardi infections 450

in the Mazzotti test 470onchocerciasis 471perstans ®lariasis 449N,N-diethylmetatoluamide (DEET) 88, 90, 110, 309di€erential agglutination test 130±1

diiodohydroxyquin 263diloxanide furoate 211, 214Diphyllobothrium latumclinical features of infection 629diagnosis and treatment 630epidemiology 629±30life-cycle 629directly transmitted infections, R0estimation 24Diro®laria spp 536

clinical features of infection 547diagnosis 547±8

life-cycle 547treatment 548disability-adjusted life years (DALYs) 28, 30±1

in cost-utility analyses 35±6

in intestinal nematode infections 564disease mapping see epidemiology: emergingtechnologies

disseminated strongyloidiasis 486, 489±90Distomum buski see Fasciolopsis buskidiurnal temperature di€erence maps 48±9DNA vaccines, malaria 92

dog hookworms see Ancylostoma caninum/A braziliensedogs

Diro®laria immitis infection 547Echinococcus spp hosts 600, 601, 603, 606Encephalitozoon cuniculi transmission 186

in leishmaniasis control 309

Metorchis conjunctus infection 420

Toxocara canis infection 503±4, 509, 510, 515

Toxoplasma gondii transmission 117

organism see Dracunculus medinensis

prevention and control 557±8

metronidazole in Trichomonas vaginalis 255

nitroimidazole in Giardia lamblia 231

organisms see Echinococcus spp

prevention and control 606

life-cycle 587pathogenesisadult tapeworms 595

E granulosus larvae 595±6

E multilocularis larvae 596

E vogeli/E oligarthrus larvae 596strain/species di€erences 596±7taxonomy 586, 588±9

Echinostoma spp 636clinical features of infection 638, 641±2description 639, 640±1

epidemiology 641laboratory diagnosis 642life cycle 637, 641pathogenesis 641prevention and control 643taxonomy 640

treatment of infection 642±3e€ective reproductive number (R) 22, 26e¯ornithine 330

egg granulomas, Schistosoma spp 376, 380, 381

in hepatosplenic pathology 381±2immune responses to 385±7

in intestinal pathology 381

in neuroschistosomiasis 383

in pulmonary ®brosis 382±3eggs

Ascaris lumbricoides 567, 568Capillaria philippinensis 575Diphyllobothrium latum 629, 630Echinococcus spp 587, 590Echinostoma spp 641Enterobius vermicularis 573, 574Fasciola hepatica 408, 415, 418, 419Fasciolopsis buski 638, 640, 641Gnathostoma spinigerum 540, 541Heterophyes heterophyes 643hookworm 535, 537, 569Hymenolepis nana 628, 629identi®cation of intestinal nematode 577±8Metagonimus yokogawai 641, 643

Opisthorchis and Clonorchis spp 408, 409, 410, 413Paragonimus spp 408, 421, 427, 428

Schistosoma spp 372, 373, 374, 37 5detection 392±4

granulomas see egg granulomas, Schistosoma spp.hatching techniques 393

release 376

encystation, Giardia lamblia 223

endemic hemoptysis see paragonimiasis

Dientamoeba fragilis transmission in eggs 262life-cycle 573±4

management of infection 574pathogenesis 574

see also intestinal nematodesEnterocytozoon bieneusi see microsporidia: E bieneusieosinophilic enteritis 538, 539

epidemic dynamics 22±3epidemic malaria 67±8epidemiology

burden of disease estimation 28, 30±1classical

meta-analyses, examples 38±44randomized trials, example 36±7cost±e€ectiveness analysis see cost±e€ectivenessanalysis

emerging technologies 44±5applied to African trypanosomiasis 45±6, p.i,p.ii, p.iii

applied to lymphatic ®lariasis 46±9population dynamics see population dynamicssee also speci®c parasites

epilepsy

in neurocysticercosis 624and Toxocara titres 512, 513epimastigotes

Trypanosoma brucei 318, 319, 320Trypanosoma cruzi 336, 337eradication therapy, malarias 75, 76erythrocytes

Babesia infection 100, 103Plasmodium infection 55, 56, 57, 59, 60espundia 288, 298, 301

estrogen, role in neonatal trichomoniasis 246, 252exchange transfusions 79, 109

excretory±secretory (ES) antigenshookworms 571

Toxocara canis 505, 506Trichuris trichiura 572excystation, Giardia lamblia 223expression sites (ESs) in vsg genes 323eyeworm 446

failure to thrive, giardiasis 228Fairley, Neil Hamilton 16falciparum malaria 70see also Plasmodium falciparumFasciola gigantica 420

Fasciola hepatica 414description 415epidemiology 416, 417

acute hepatic phase 417

chronic obstructive biliary phase 417, 418

Metorchis conjunctus transmission 420

Opisthorchis and Clonorchis spp transmission 408,

free-living forms of Strongyloides stercoralis 481±2,484

Fujii, Y 370fumagillin 189±90fungi, microsporidia related to 174, 184furazolidone 231, 232, 364

GAE see granulomatous amebic encephalitisGal/GalNAc lectin, Entamoeba histolytica 200±1,

202, 204, 210, 212gametocytes, malarial 55, 56, 78, 92Gastrodiscoides hominis 637, 639, 641, 645gastrointestinal disease

Blastocystis hominis 360±1, 362chronic Chagas' disease 339, 341, 343±4strongyloidiasis 489

gelatin particle agglutination test 491gene expression, Entamoeba histolytica 203±4gene sequencing, microsporidia 184

genetic predisposition and Ascaris burden 568genitourinary schistosomiasis 390±1

genome, Entamoeba histolytica 203genotypes of Cryptosporidium parvum 140, 142geographical information systems (GISs) 44±5, 49geophagia 504, 509, 511, 512

Giardia lamblia/giardiasisantigenic variation 222±3clinical features 227±8chronic giardiasis 228description 219±22encystation and excystation 223growth requirements 222history 219

immune response 224±5laboratory diagnosisantigen detection assays 229culture 230

drug sensitivity testing 230±1duodenal sampling 229ova and parasite examination 229serology 230

management 231±3asymptomatic infections 232±3drugs 231±2

in pregnancy 233resistance and relapse 233pathogenesis

cytokine response 224di€erences between isolates 223±4trophozoite adherence to intestinal mucosa 224predisposition to 225

prevention and control 233±4

in day care centres 234

Giardia lamblia/giardiasis (cont.)

Giardia-speci®c antigen 65 (GSA 65) 229

gliding motility, Toxoplasma gondii 118, 119

organism see Gnathostoma spinigerum

prevention and control 543

Golgi, Camillo 14, 53

GoÈze, Johann 2, 9, 10, 585

GP63 293, 297

granular form, Blastocystis hominis 357, 359

granulomas, egg see egg granulomas

granulomatous amebic encephalitis (GAE) 277

growth retardation see stunting

GSA 65 (Giardia-speci®c antigen 65) 229

guinea worm see Dracunculus medinensis

gynecophoral canal, Schistosoma spp 371, 373

population dynamics 27±8sex bias in infection levels, meta analysis 38±41see also speci®c parasites

hematoxylin and eosin stain 187, p.iv, p.vhemoglobin S 64

hemozoin 62, 108hepatitis B vaccine interference 387hepatitis/schistosome co-infections 387, 391hepatobiliary ¯ukes 407, 411

Dicrocoelium spp 420±1Metorchis conjunctus 420see also Fasciola hepatica; Opisthorchis spp; Clonorchissilensis

hepatocellular carcinoma risk in schistosomiasis 382Heterophyes heterophyes 636

description and life cycle 637, 639, 643epidemiology 644

treatment of infection 642, 644heterophyidiasis

clinical features 638, 644laboratory diagnosis 644organisms see Haplorchis spp; Heterophyes hetero-phyes; Metagonimus yokogawai

treatment 644Hippocrates 53history of parasitologybelief in spontaneous generation 1±2chemotherapeutic agents 19

development of protozoology 12establishment of the discipline 19nineteenth century 2±3

Casimir Davaine 3, 6early texts 3, 4Thomas Spencer Cobbold 3, 5origins of the discipline 2see also speci®c organismsHIV/AIDS see AIDS/HIV infectionHLA antigens and cysticercosis 621HMS (hyper-reactive malarial splenomegaly) 61homosexual males, Entamoeba infection 206, 213hookworm platelet inhibitor 571

hookwormsclassi®cation 569clinical features of infection 571di€erentiation from Strongyloides stercoralis 482,483

history 7±8, 568immunology 570±1life-cycle 569skin penetration 569±70pathogenesis 570

see also Ancylostoma caninum/A braziliensehormonal in¯uence on Trichomonas vaginalis 246

IgG response, strongyloidiasis 486±7

IgG4assays, ®larial infections 442, 462

transfusion-associated Chagas' disease in 342see also AIDS/HIV infection

immunotherapy for leishmaniasis 308imported malaria 68, 69

incremental cost±e€ectiveness ratios 33±4in¯ammatory response, cysticercosis 621, 624innate resistance to malaria 64

insecticidal controlblack¯ies 472±3mosquitoes 54, 87impregnated bednets 87±8sand ¯ies 308±9

tsetse ¯ies 331insecticide resistance 473intensity of infection, intestinal nematodes 27, 28, 565±6interferon gamma (IFNg)

in cryptosporidiosis immunity 146

in leishmaniasis immunity 293, 294, 295, 296mediation of Trypanosoma brucei immune suppres-sion 321

in microsporidiosis immunity 183recombinant

Chagas' disease treatment 347leishmaniasis treatment 306±7, 308response to Entamoeba histolytica 202stimulation of trypanosomal growth 321±2

in toxoplasmosis immunity 120, 121

in Trypanosoma cruzi immunity 339interleukin 1 (IL-1) 295

interleukin 2 (IL-2) 295, 296, 339, 462interleukin 4 (IL-4) 295, 296, 462interleukin 5 (IL-5) 295, 296, 462, 463, 524interleukin 6 (IL-6) 462, 470

interleukin 8 (IL-8) 152interleukin 10 (IL-10) 295, 296, 340, 462, 463interleukin 12 (IL-12) 121, 146, 295, 488intestinal ascariasis 568

intestinal disease pathogenesisCryptosporidium parvum 142±5microsporidia 181, p.iv, p.vintestinal nematodes

entry to the host 566epidemiology

global disease burden 564infection intensity and transmission 565±6

intestinal nematodes (cont)

prevention and control 580

species associated with human intestines 562, 563

treatment 578±80

see also speci®c organisms

intestinal obstruction with Ascaris lumbricoides 568

intestinal trematodes 635, 639

infecting humans 636±7, 638

life-cycles 635, 637

see also speci®c organisms

intradermal test for paragonimiasis 427, 428

iodination of water 234

iodoquinol 211, 364

ipecac bark 198

iron

e€ects on Trichomonas vaginalis 247, 249

loss in hookworm infection 570

irradiated cercarial vaccines 387

pathogenesis and immunology 156

prevention and control 158±9

ivermectin treatment

adverse reactions in loiasis 448, 472

cutaneous larva migrans 539

Leishmania spp 288, 289, 297Trypanosoma brucei 316, 318, 322, 330Trypanosoma cruzi 336, 346

kissing bugs see triatomine vectorsknob-associated histidine-rich protein (KAHRP) 62knock-out mice, egg granuloma studies 385, 386lactoferrin 152

lactose malabsorption 228laminated layer, Echinococcus spp 591, 593, 594,

598, 604Landsat Thematic Mapper 45larva currens 489

larvaeDracunculus medinensis 553, 555, 556, 557Echinococcus spp see hydatid cystsGnathostoma spinigerum 541hookworm 537±8, 569intestinal nematode 566, 578lymphatic ®lariae 434Onchocerca volvulus 458, 459Sparganum mansoni 546Strongyloides stercoralis 482±4Taenia spp see metacestodes: Taenia spp

Toxocara spp 502, 503, 504, 505Trichinella spp 522, 523larvicidal control of black¯ies 472±3latent microsporidial infections 183Laveran, Alphonse 14, 53, 479Leeuwenhoek, Anthony van 1±2, 10, 12, 13, 219Leidy, Joseph 19, 521

Leishman, William 19, 287Leishmania spp 288, 289

molecular biology 297morphological forms 288, 289, 291, 292

of the Old World

L (L.) aethiopica 299

leishmanin skin test 305

parasite identi®cation and culture 304±5

organisms see Leishmania spp

post-kala-azar dermal leishmaniasis 304

lung ¯ukes see pulmonary ¯ukesLyme disease concurrent with babesiosis 106, 108,109±10

lymphatic ®lariaeepidemiologyBrugia malayi and B timori 434±5Wucheria bancrofti 435

life-cycle 434lymphatic ®lariasis 433±4acute manifestations 436±7asymptomatic micro®laremia 436bancroftian ®lariasis 434, 436lymphedema of the limbs 438male genital disease 438±9brugian ®lariasis 434, 436, 438chronic manifestations 437±8adenopathy 440

chyluria 439

®larial granulomata 439hydroceles 438±9lymphedema of the genitalia 439lymphedema of the limbs 438tropical pulmonary eosinophilia (TPE) 439diagnosis 440

antigen detection 441imaging studies 442microscopical detection and speciation 440±1PCR 442

serology 441±2disease mapping 46

at global and regional levels 46±8

at village level 48±9history 8±9

micro®laraemia and chronic disease, meta-analysis41±4

in movers to endemic areas 440organisms see lymphatic ®lariaepathology 435

prevention and control 445treatment

acute manifestations 443asymptomatic micro®laremia 442±3chronic manifestations 443±5dosage of DEC 445

lymphoscintigraphy 442macrophage in¯ammatory protein-1a 296

macrophages, in immunity to Leishmania spp.

293±6

magnetic resonance imaging (MRI)

granulomatous amebic encephalitis 281

clinical management, in pregnancy 81

clinical management, severe malaria 78

Plasmodium falciparum malaria 75, 76±7

Plasmodium vivax/P ovale/P malariae malarias

Anopheles mosquito variation 67

drug resistance 69, p.vi

geographic distribution 66±7, p.vi

patterns of clinical disease 68±9

rapid antigen tests 73, 74serology 73, 74

organisms see Plasmodium spp; speci®c Plasmodiapathology of clinical syndromes 61

anemia 62cerebral malaria 61±2hypoglycemia 63pregnancy 63renal failure 62±3respiratory distress 62thrombocytopenia and coagulation 62prevention in travelers 88

chemoprophylaxis 88±90presumptive treatment 90role of the spleen 60, 61splenectomized patients 71vaccine development 25, 91blood stage vaccines 91±2DNA vaccines 92pre-erythrocytic vaccines 91transmission-blocking vaccines 92Malarone1 76, 78, 86, 89, 90

Manson, Patrick 6, 8, 9, 11, 16Mansonella ozzardi 434epidemiology 450life-cycle 441, 450, 461Mansonella perstans 434epidemiology 449life-cycle 441, 449, 461MAP-4 397

mast cells in Trichinella expulsion 524Mazzotti test 470

mebendazole treatmentclonorchiasis and opisthorchiasis 414cystic echinococcosis 605

eosinophilic enteritis 539intestinal nematode infections 578perstans ®lariasis 449

strongyloidiasis 492toxocariasis 515trichinellosis 530me¯oquine treatment 82±3prophylaxis 76, 89, 90severe malaria 81uncomplicated malaria 75, 7 7megadisease 339, 341, 343±4, 347±8meglumine antimonate 306, 307Melanesian ovalocytosis 64melarsoprol 330±1

meningeal cysticercosis 624, 627mepacrine hydrochloride 54merogony, microsporidia 173, 174, 176, 178, 180meronts

Cryptosporidium parvum 141, 142

Blastocystis hominis infections 364

Dientamoeba fragilis infections 263

Entamoeba polecki infections 214

detection and speciation 440±1

killing with DEC 443, 444, 445

serology 187±8organisms see microsporidiapathogenesis 180±3Microsporidium spp 176±7, 178, 181, 182migrating worms 535, 536

see also speci®c speciesmiltefosine 307miracidiaFasciola hepatica 408, 415intestinal trematodes 635, 637, 638, 641, 643Opisthorchis and Clonorchis spp 408, 410Paragonimus spp 408, 421

Schistosoma spp 372, 373, 374miracil 371

molecular karyotypes of microsporidia 184molecular taxonomy see phylogenetic analysismolluscicides 371

monocyte chemoattractant protein-1 296monthly biting rate (MBR)/transmission potential(MTP) calculations 464

mosquitoescontrol 87

in Diro®laria immitis life-cycle 547lymphatic ®lariae transmission 434, 435microsporidia infections in 186±7see also Anopheles mosquitoesmouse models

Giardia infection 224leishmaniasis cell-mediated immunity 294±6schistosomal egg granuloma induction 385±6toxocariasis 510±11, 512

trichinellosis immunity 523±4mucins, colonic 200

mucosal leishmaniasis 301, 302multivacuolar form, Blastocystis hominis 358, 359, p.viimultivesicular/alveolar echinococcosis (MAE)clinical features 602

clinical management 605±6diagnosis 603, 604pathogenesis 596see also Echinococcus spp

muscle biopsy for trichinellosis diagnosis 529muscle cysticercosis 624

myocardial infection, microsporidia 182, p.iv, p.vmyosins 118

Nabarro, David 18

neutral thiol protease (NTP) 423

neutrophil inhibitory factor, hookworm 570

neutrophils in Trichomonas vaginalis infection 249

nutrient malabsorption, chronic giardiasis 228

obstructive biliary disease 412, 417, 418

occupational risk of schistosomiasis 379

odds ratios 41Onchocerca volvuluslife-cycle 458, 459adult worms 458, 459±60micro®lariae 459, 460±1strain di€erences 464taxonomy 458onchocerciasisclinical features 466±8clinical managementamocarzine 472historical 470±1ivermectin 471±2epidemiology 463entomology 465±6geographical variation 464infective vector density 463±4history 457, 458

immunology 462±3laboratory diagnosisMazzotti test 470skin snips 468±70slit lamp examination 470organism see Onchocerca volvuluspathogenesis 461±2

prevention and control 472mass ivermectin treatment 474nodulectomy campaigns 474vaccine development 475vector control 472±3Onchocerciasis Control Programme 473onchocercomata see subcutaneous nodules: in oncho-cerciasis

Oncomelania snails 376oncospheres

Echinococcus spp 587, 590±1, 597Taenia spp 614, 615, 616, 617O'Neill, J 457

oocystsCryptosporidium parvum 139elimination in drinking water 155infection potential 148

in life-cycle 141, 142PCR detection 152, 153viability determination 153virulence 145

visualization 151, 152Cyclospora spp 165, 166, 168

oral rehydration solutions 144, 153

ova see eggs

sputum and stool analysis 427

prevention and control 429

parasitemia estimation, malaria 72, 73

parasitic female form of Strongyloides stercoralis

cryptosporidiosis 152±3cyclosporiasis 168Entamoeba histolytica infection 210lymphatic ®lariasis 442

malaria 73microsporidiosis 188±9toxocariasis 514toxoplasmosis 128Trichomonas vaginalis infection 254pentamidine isethionate treatmentAfrican trypanosomiasis, hemolymphatic stage 330Balamuthia GAE 281±2

leishmaniasis 306, 308Pentatrichomonas hominisclinical features of infection 259clinical management of infection 260description 244, 258

epidemiology 259laboratory diagnosis 259±60pathogenesis 259

pentavalent antimony-containing drugs 305±6pepstatin A 570

periodic acid±Schi€ (PAS) protocol 128periodic fever 69

periodontal disease and Trichomonas tenax 256, 257periorbital edema in trichinellosis 527

permethrin-treated bednets 87±8personal water ®ltration devices 234perstans ®lariasis 448

clinical manifestations 449diagnosis 449

organism see Mansonella perstanstreatment 449±50

performic acid±Schi€ stain 603Peruvian bark 53, 54

Peyer's patches 225phagocytosis of Babesia 105Phaneropsolus bonnei 637, 644phylogenetic analysis

Cryptosporidium spp 140Echinococcus spp 586Plasmodium spp 54Trypanosoma brucei/T cruzi 316pian bois 298

pinworm eggs in Dientamoeba fragilis transmission 262pinworms see Enterobius vermicularis

piperazine 579±80, 642, 644piritrexam 109

piroplasmosis see babesiosis

implications for public health practice 24±6

population genetics of Toxoplasma gondii 115, 116

pork, trichinellosis transmission 522, 524, 525, 526, 531

pork tapeworm see Taenia spp: T solium

portal hypertension in schistosomiasis 382

post-kala-azar dermal leishmaniasis 304

Diphyllobothrium latum infections 631echinostomiasis 642±3

fascioliasis 419, 420Fasciolopsis buski infections 640heterophyidiasis 642, 644Hymenolepis nana infections 629intestinal nematodes 635Nanophyetes salmincola infections 645paragonimiasis 427, 429

schistosomiasis 395±6, 397sparganosis 547

taeniasis 626pre-erythrocytic malarial vaccines 91prednisolone 516

prednisone 132, 531pregnancy

giardiasis 233malaria 63, 71, 81, 90toxoplasmosis 132, 133trichinellosis 528trichomoniasis 248primaquine treatment, malaria 83contraindicated in pregnancy 81, 90eradication therapy 75, 76

prophylaxis 76, 90primary amebic meningoencephalitis (PAM) 276clinical management 281

clinical signs and symptoms 277laboratory diagnosis 280organism see Naegleria fowleripathogenesis 274

pathology 277, 278prevention and control 282primate model, trichomoniasis 249procercoid larvae, Diphyllobothrium latum 629, 630procyclin 316, 322, 323

proglottidsEchinococcus spp 587, 603Hymenolepis nana 628, 629Taenia spp 614, 616, 617detection 624±5, 626Programme for the Elimination of Onchocerciasis inthe Americas (OEPA) 474

proguanil 54, 76, 84, 89proguanil±atovaquone 86, 90promastigotes, Leishmania spp 287, 292culture 290, 291, 304

macrophage infection 293Prosthodendrium molenkampi 637, 644protease activities

Entamoeba histolytica 201

see also Paragonimus spp.

pulmonary migration of Ascaris lumbricoides larvae

568

pulmonary paragonimiasis 423±5

pulmonary toxoplasmosis 126

pulmonary trichinellosis 527

punctate keratitis in onchocerciasis 467

pyogenic liver abscesses 208, 209

R0see basic reproductive number (R0)

racoons, Baylisascaris procyonis infection 548

radical cure, malarias 75, 76

radiography 603±4

radioimmune precipitation assay, Trypanosoma cruzi

antibodies 345

randomized trials, example 36±7

raspberries, Cyclospora outbreaks 165, 167

rebound morbidity 387

recurrent pyogenic cholangitis 412±13

rediae, intestinal trematodes 635, 637, 638, 641

Redi, Francisco 2, 10

relapsing diarrhea 150

remote sensors on satellites 44±5

diurnal temperature di€erence maps 48±9

tsetse ¯y distribution prediction 45±6

renal complications in loiasis 446

renal failure in malaria 62±3, 70, 78

renal infection, microsporidia 181±2, p.iv, p.v

renal lesions in schistosomiasis 383

repeat sequences, Plasmodium falciparum DNA 65

respiratory distress in malaria 62

respiratory infection, microsporidia 176±7, 182

`Roll Back Malaria' campaign 86RomanÄa sign 342

rosetting 59, 60, 61Ross, Ronald 15, 16Rudolphi, Carl 2±3, 10, 585rural/urban di€erences in toxocariasis prevalence 509Sabin±Feldman dye test 129

salmonella infections and schistosomiasis 391salt, forti®ed with DEC 445

sand ¯ies 289, 290, 298, 308±9satellite data see remote sensors on satellites

Sbv-containing drugs 305, 306Schistosoma spp

characteristics 371±2epidemiology

geographical distribution 377, 378, 379in¯uence of control programs 380occupational risk 379

regional variation in morbidity 380transmission 377, 379

hosts 377life-cycle 373, 374cercariae 372±3eggs 372, 375, 376inside the snail 372lifespan 375±6migration in veins 375miracidia 372

schistosomulae 374, 375snail intermediate hosts 376±7worm pairs 375

schistosomal complement-inhibiting protein (SCIP-1)385

schistosome dermatitis 388schistosomiasis

cancer risk 383, 391clinical disease 380, 388acute 388±9

genitourinary 390±1intestinal 389diagnosiscurrent approach 391±2egg-hatching techniques 393liver biopsy 393±4

rectal biopsy 393serology 394stool samples 392ultrasound 393urine 392±3

sclerosing keratitis in onchocerciasis 467

sequestration of Plasmodium falciparum-infected

sex bias in helminth infection levels, meta-analysis38±41

sexual abuse of children 252sexually transmitted infectionsprevalence 250

R0estimation and importance 24, 25±6see also speci®c infections

Shigella and Entamoeba co-infection 205shikimate pathway 114

Simulium spp see black¯iessimvastatin 109

skinchanges in chronic lymphatic ®lariasis 438lesions in onchocerciasis 461, 467, 468manifestations in strongyloidiasis 489penetration by hookworms 569±70see also cutaneous larva migrans; leishmaniasis:cutaneous

skin snips 468, 469, 470sleeping sickness see African trypanosomiasissnail hosts

Angiostrongylus cantonensis 543, 544Fasciola hepatica 408, 415

Fasciolopsis buski 638Opisthorchis and Clonorchis spp 408, 410Paragonimus spp 408, 421

Schistosoma spp 376±7control programs 369role in life-cycle 372, 374snake, raw 645

socioeconomic impact of onchocerciasis 468sodium pentachlorophosphate 371

sodium stibogluconate 306, 307, 308soil levels of Toxocara canis eggs 509±10soluble egg antigens 380, 381, 385Sonsini, Prospero 11

Sowda 462, 467Sparganum mansonidiagnosis 546, 547epidemiology 546life-cycle 546pathogenesis 546±7Spelotrema brevicaeca 637, 645SPf66 92

spiramycin 131, 132spleen, role in malaria 60, 61splenectomized patientsbabesiosis susceptibility 107malaria in 71

treatment 492±3stunting

in Paragonimus skrjabini infections 425sulfadiazine 131, 132, 133

suramin 329, 470±1surgery

cerebral paragonimiasis 429cystic echinococcosis 604gnathosomiasis 542multivesicular/alveolar echinococcosis 605swollen belly disease 494

Symmers's clay pipe stem ®brosis 382synthetic peptide assays 346

systematic reviews see meta-analysestachyzoites 114, 116, 119, 122detection 126, 127, 128, 130Taenia spp

Asian Taenia 620morphologyadults 613±14eggs 614, 616larvae 614, 615

T saginataepidemiology 618, 619life-cycle 615, 616, 617

T soliumepidemiology 619±20life-cycle 616, 617±18taeniasis

diagnosis 625±6prevention 627

T saginata 620

T solium 620, 621treatment 626see also cysticercosisTasmania, Echinococcus granulosus control 606±7teguments

cestodes 614Schistosoma spp 385, 395, 396telomeric vsg genes 322±3temephos 473, 558tetrachloroethylene 640, 642

tissue biopsies, Toxoplasma gondii detection in 127, 128

tissue culture isolation of Toxoplasma gondii 128

TNFa see tumor necrosis factor alpha (TNFa)

T canis in the dog 503±4

T canis in paratenic hosts 504

T cati in the cat 504

learning and behavioural abnormalities 512

ocular larva migrans 511±12

antibody responses 506±7liver trapping 507laboratory diagnosis 511, 513

of ocular larva migrans 514±15PCR 514

serology 513±14organisms see Toxocara spp

prevention 516treatment 515dogs 515ocular larva migrans 515±16visceral larva migrans 515toxoplasmosis

clinical syndromesacute disease in adults 122±3congenital disease 123±4, 125, 132disease in immunocompromised patients 124,125±6

ocular disease 124, 125control 133

diagnosisbrain imaging studies 126, 127, 128isolation in tissue culture 128mouse inoculation 128PCR 128

serology 129, 130±1tissue biopsies 126, 127, 128di€erential diagnosis 129epidemiology 117history 113±14immunology 120, 121therapy and managementcongenital disease 132drugs 131

immunocompetent patients 131±2immunocompromised patients 132±3

in pregnancy 132Toxoplasma gondii 113actin 119

classi®cation 114gliding motility 118, 119inner membrane complex 119, 120interactions with host cells 116, 118, 119, 120life-cycle 114±15, 116

novel myosins 118pathogenesis 121±2plant-like characteristics 114population genetics 115, 116Trachipleistophora spp 174±5, 176, 177, 17 8life-cycle 173

sites of infection 181

transforming growth factor-b (TGFb) 295, 339±40

transmission typing procedure 601

transmission-blocking malarial vaccines 92

organisms see Trichinella spp

prevention and control 531

treatment 530±1

trichomonads 243

ectopic infections 263±4

see also speci®c species

Trichomonas hominis see Pentatrichomonas hominis

clinical features

in men 253

in women 252±3clinical management 254±5control 256

epidemiologyprevalence 250transmission 250±2laboratory diagnosisantigen tests 254culture 254PCR 254staining techniques 254wet-®lm examination 253±4organism see Trichomonas vaginalisprevention 255±6

transmissionnon-sexual 251±2sexual 250±1

to children 252Trichostrongylus spp 576see also intestinal nematodesTrichuris trichiura

clinical features of infection 572description 571

history 571life-cycle 572see also intestinal nematodestriclabendazole 420, 429trimethoprim±sulfamethoxazole (TXS) treatmentcyclosporiasis 168

isoporiasis 158toxoplasmosis prophylaxis 133trimetrexate 109

trophozoitesAcanthamoeba spp 272, 273, 275, 279, 281Balamuthia mandrillaris 272±3, 275Cryptosporidium parvum 141, 142Entamoeba histolytica 198, 199, 200, 201, 203detection 208, 209, 210

Giardia lamblia 219±21, 222, 224culture and sensitivity testing 230±1Naegleria fowleri 271, 272, 274, 278, 280Plasmodium spp 55, 58, 59, 60

tropical pulmonary eosinophilia (TPE) 435, 439, 444tropical splenomegaly syndrome 61

Trypanosoma bruceibiochemistry 316±18classi®cation 315±16epidemiologyEast African trypanosomiasis 326±7endemic foci 325

Trypanosoma brucei (cont)

epidemiology (cont)

epidemics 325

geographical distribution 325±6

remote sensing and climatic data 45±6

West African trypanosomiasis 326

distribution prediction 45±6, p.i, p.ii, p.iii

Trypanosoma brucei vectors 318, 323, 325, 326±7

amebic liver abscesses 210, 211

clonorchiasis and opisthorchiasis 413

echinococcosis 604

fascioliasis 419

lymphatic ®lariasis 442

schistosomiasis 393

urban/rural di€erences in toxocariasis prevalence 509

urinary bladder lesions in Schistosoma haematobium

impact on helminth population dynamics 27±8, 29

incomplete population coverage 27

schistosomiasis 396±7toxoplasmosis in animals 133vaccines, hepatitis B, interference from schistosomiasis387

vacuolar form, Blastocystis hominis 356±7, 359, p.viivaginal schistosomiasis 390

var genes 59, 65variant speci®c surface proteins (VSP), Giardia lamblia222±3

variant surface glycoprotein (VSG), Trypanosomabrucei 316, 321, 322±3

vector-borne microparasites, R0estimation 24, 25vectors see speci®c vectors

ventricular cysticercosis 623±4, 627vertical transmission of babesiosis 106virulence factors, Trichomonas vaginalis 246±7visceral gnathostomiasis 541±2

visceral larva migransBaylisascaris procyonis infection 548toxocariasis 501, 511, 515

visceral leishmaniasis see leishmaniasis: visceralviscerotropic leishmaniasis 303±4

vitamin A 36, 37Vittaforma corneae 173, 178±80, 181, 187VSG see variant surface glycoprotein (VSG), Trypano-soma brucei

vsg genes 322±3VSP (variant speci®c surface protein), Giardia lamblia222±3

Warthin±Starry stain 187, p.iv, p.vwater treatment

cryptosporidiosis prevention 155dracunculiasis prevention 558giardiasis prevention 233, 234water-borne transmissioncryptosporidiosis 147±8, 149, 153, 155cyclosporiasis 166±7

giardiasis 226microsporidia 185schistosomiasis 377whipworm, see Trichuris trichiuraworld eradication campaign, dracunculiasis 557±8World Health Organization Global Malaria ControlStrategy 86

worm pairs, Schistosoma spp 375wormy individuals 27, 565WR238605 86

Wucherer, Otto 7, 8Wuchereria bancrofti 8±9, 434, 435, 438, 441zoonosis, leishmaniasis 288

Index compiled by Jackie Christophers

I

Figure 8.5M‘ (A) JSporoplasms (arrows) of Nosema sp from the lawn-grass cutworm Spodoptera depravata emerging from polar tubes after germination of spores still within an infected Antheraea eucalypti cell (arrowhead) in vitro Bar = 10.0 µm From Iwano and Ishihara

(1989), © Academic Press, reproduced by permission

(B) JWarthin–Starry stain Brownish-black spores of Encephalitozoon intestinalis lying individually and in groups in enterocytes and lamina

propria of an AIDS patient Original micrograph of Dr A.S Field

(C) JChromotrope stain Spores of Encephalitozoon cuniculi purified from in vitro culture Original micrograph of Dr R Weber

(D) JChromotrope stain Spores of Enterocytozoon bieneusi concentrated from faeces of AIDS patient Original micrograph of Dr R Weber

(E) JUvitex 2B stain Spores of Enterocytozoon bieneusi viewed by fluorescence Original micrograph of Dr T van Gool

(F) JZiehl–Neelsen stain Pinkish-red aggregates of Encephalitozoon cuniculi in paraffin-embedded section of kidney of an AIDS patient.

Original micrograph of Dr D Woodrow

(G) JToluidene blue stain Multiple sporophorous vesicles containing spores of Trachipleistophora anthropophthera in a giant astrocyte.

Resin section of brain tissue from an AIDS patient Original micrograph of Drs J.M Orenstein and A.T Yachnis

(H) JHaematoxylin and eosin stain Partial polarization of spores of Trachipleistophora anthropophthera in a paraffin-embedded section of

thyroid from an AIDS patient Original micrograph of Dr J.M Orenstein

(I) JGiemsa stain Spores of Enterocytozoon bieneusi showing purple nuclei in a smear of a small intestinal biopsy from an AIDS patient.

Original micrograph of Drs W.S Hollister and E.U Canning

(J) J Toluidene blue stain Resin section of skeletal muscle of an AIDS patient showing massive replacement (arrows) of sarcoplasm by

sporophorous vesicles containing spores of Trachipleistophora hominis Other spores have been phagocytised by macrophages (arrowheads) From Field et al (1996), by permission of the American Society for Microbiology

(K) JHaematoxylin and eosin stain Spores of Trachipleistophora anthropophthera replacing the sarcoplasm of myocytes (arrows)

Paraffin-embedded section of heart from an AIDS patient Original micrograph of Dr J.M Orenstein

(L) JGross brain section showing opaque white patches representing sites of infection with Trachipleistophora anthropophthera in cerebral cortex (arrows) and thalamus (arrowhead) of an AIDS patient From Yachnis et al (1996), by permission of the American Journal of

Clinical Pathology

Figur

Figure 15.1MLight micrographs of Blastocystis hominis in trichrome-stained faecal smears

(A) J Small multivacuolar and vacuolar forms, highlighting the difficulty in definitively clarifying which form is present in stained smears Nuclei/mitochondria-like organelles are stained red (indicated by arrowheads)

(B) J Small multivacuolar forms, showing variability in morphology A cyst form, with a green-staining cyst wall, is indicated by double arrowheads

(C) J Multivacuolar form, showing discrete multiple vacuoles

(D) J Cyst form, displaying a ‘vacuolated’ cytoplasm The surrounding cyst wall stains green (indicated by double arrowheads)

(E) J Vacuolar forms, showing variability in cell shape Nuclei/mitochondria-like organelles are indicated by arrowheads