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Chapter 7 : Protozoa and Helminths

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Abstract:

This chapter educates laboratorians, biosafety personnel, and health care workers about the potential hazards of working in settings in which exposures to viable parasites could occur. It provides information about parasites that have caused or could cause accidental infections in laboratorians and health care workers. Factors that influence whether infection and disease develop after accidental exposures are also provided in this chapter. The chapter focuses on the protozoa that cause leishmaniasis, malaria, toxoplasmosis, Chagas’ disease (American trypanosomiasis), and African trypanosomiasis. Summary data about 180 occupationally acquired cases of infection with the protozoa that cause these diseases are provided in this chapter. Blood and tissue protozoa of potential relevance to laboratorians and health care workers are also discussed in this chapter. Few laboratory-acquired helminthic infections have been reported. Even if laboratorians became infected by ingestion of infective eggs or through penetration of skin by infective larvae, they typically would have low worm burdens and few, if any, symptoms because most helminths do not multiply in humans. The fact that some of the persons who acquired parasitic infections did not recall discrete exposures suggests that subtle exposures (e.g., contamination of unrecognized microabrasions and exposure through aerosolization or droplet spread) can result in infection.

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7

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Clinical and Public Health
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Parasitic Diseases
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Trypanosoma brucei gambiense
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Trypanosoma brucei rhodesiense
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FIGURE 1

Incubation period (i.e., period from accidental exposure until first symptom or clinical manifestation attributed to infection) for the clinically evident occupationally acquired cases of infection with various blood and tissue protozoa. The ends of the lines designate the extremes of the ranges, and the short vertical lines designate the medians. For malaria, only non-vector-borne cases with available data were included ( = 20 caused by and = 3 caused by ). For toxoplasmosis, only cases related to exposure to tissue stages of the parasite (rather than oocysts) were included. See text for discussion of general factors that affect incubation periods (e.g., virulence of parasite and accurate recall of timing of relevant exposure and first clinical manifestations) and specific issues about the data for the various parasites.

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
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Tables

Generic image for table
TABLE 1

Natural pathogens of common laboratory animals

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
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TABLE 2

Factors that affect whether accidental exposures to parasites cause infection and disease

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 3

Available data about rates of laboratory accidents and infections with specific parasites

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 4

Criteria for including occupationally acquired (“laboratory-acquired”) cases of parasitic infection in this chapter and examples of types of cases that were and were not included

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 5

Number of reported cases of occupationally acquired parasitic infections

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 6

Antibody and antigen detection tests available in the United States for parasitic diseases

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 7

Examples of practices and occurrences that have resulted in laboratory-acquired parasitic infections

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 8

Number of reported cases of laboratory-acquired infections caused by blood and tissue protozoa, by decade of occurrence (if known) or publication

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 9

Number of reported cases of laboratory-acquired infections caused by blood and tissue protozoa, by country or region of the world where the case occurred

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 10

Number of reported cases of laboratory-acquired infections caused by blood and tissue protozoa, by known or likely route of exposure

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 11

Characteristics of the reported cases of laboratory-acquired infection with spp.

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 12

Characteristics of the reported cases of laboratory-acquired infection with spp.

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 13

Characteristics of the reported cases of laboratory-acquired infection with

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 14

Characteristics of the reported cases of laboratory-acquired infection with

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 15

Clinical and laboratory monitoring for infection after accidental exposures

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 16

Practical guide for detection of circulating trypomastigotes by light microsopy

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7
Generic image for table
TABLE 17

Characteristics of the reported cases of laboratory-acquired infection with subspp.

Citation: Herwaldt B. 2006. Protozoa and Helminths, p 115-161. In Fleming D, Hunt D (ed), Biological Safety. ASM Press, Washington, DC. doi: 10.1128/9781555815899.ch7

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