Parsitosis en alimentos

Diagnosis and Management of Foodborne Illnesses
A Primer for Physicians and Other Health Care Professionals
Foodborne Illnesses Table: Parasitic Agents

Foodborne Illnesses Table: Parasitic Agents
American Medical Association American Nurses Association-American Nurses Foundation Centers for Disease Control and Prevention Center for Food Safety and Applied Nutrition Food and DrugAdministration Food Safety and Inspection Service, US Department of Agriculture

February 2004

Foodborne Illnesses (Parasitic)
Etiology
Angiostrongylus cantonensis

Incubation Signs and Symptoms Period
1 week to ≥ 1 month Severe headaches, nausea, vomiting, neck stiffness, paresthesias, hyperesthesias, seizures, and other neurologic abnormalities.

Duration of Illness
Several weeks to severalmonths

Associated Foods
Raw or undercooked intermediate hosts (eg, snails or slugs), infected paratenic (transport) hosts (eg, crabs, fresh water shrimp), fresh produce contaminated with intermediate or transport hosts. Any uncooked food or food contaminated by an ill food handler after cooking, drinking water.

Laboratory Testing
Examination of CSF for elevated pressure, protein,leukocytes, and eosinophils; serologic testing using ELISA to detect antibodies to Angiostrongylus cantonensis.

Treatment
Supportive care. Repeat lumbar punctures and use of corticosteroid therapy may be used for more severely ill patients.

Cryptosporidium

2-10 days

Diarrhea (usually watery), stomach cramps, upset stomach, slight fever.

May be remitting and relapsing over weeks to months Maybe remitting and relapsing over weeks to months May be protracted (several weeks to several months) Days to weeks

Request specific examination of the stool for Cryptosporidium. May need to examine water or food.

Supportive care, self-limited. If severe consider paromomycin for 7 days. For children aged 1-11 years, consider nitazoxanide for 3 days.

Cyclospora cayetanensis

1-14 days,usually at least 1 week

Diarrhea (usually watery), loss of appetite, substantial loss of weight, stomach cramps, nausea, vomiting, fatigue. Diarrhea (often bloody), frequent bowel movements, lower abdominal pain.

Various types of fresh produce (imported berries, lettuce).

Request specific examination of the stool for Cyclospora. May need to examine water or food.

TMP/SMX for 7 days.Entamoeba histolytica

2-3 days to 1-4 weeks

Any uncooked food or food contaminated by an ill food handler after cooking, drinking water.

Examination of stool for cysts and parasites – may need at least 3 samples. Serology for long-term infections.

Metronidazole and a luminal agent (iodoquinol or paromomycin).

Giardia lamblia

1-2 weeks

Diarrhea, stomach cramps, gas.

Anyuncooked food or food contaminated by an ill food handler after cooking, drinking water. Accidental ingestion of contaminated substances (eg, soil contaminated with cat feces on fruits and vegetables), raw or partly cooked meat (especially pork, lamb, or venison). Passed from mother (who acquired acute infection during pregnancy) to child.

Examination of stool for ova and parasites – may need atleast 3 samples. Isolation of parasites from blood or other body fluids; observation of parasites in patient specimens via microscopy or histology. Detection of organisms is rare; serology (reference laboratory needed) can be a useful adjunct in diagnosing toxoplasmosis. However, IgM antibodies may persist for 6-18 months and thus may not necessarily indicate recent infection. PCR of bodily fluids.For congenital infection: isolation of T. gondii from placenta, umbilical cord, or infant blood. PCR of white blood cells, CSF, or amniotic fluid, or IgM and IgA serology, performed by a reference laboratory.

Metronidazole.

Toxoplasma gondii

5-23 days

Generally asymptomatic, Months 20% may develop cervical lymphadenopathy and/or a flu-like illness. In immunocompromised patients:...