Below is an interesting article and the only one I've seen of its kind, on a pathologist. I had it among my collection and forgot that I had it. Finally a doctor speaks out about the problem!


http://www.ascp.org/general/media/compendium/parasitic.asp
parasites Not Just 'Foreign Objects'

Whether you are traveling for business or pleasure, at home or abroad, it is important to guard against parasitic infection. Both domestic and foreign travel can present special infectious hazards warn two experts on parasitic infections, members of the American Society for Clinical Pathology (ASCP). "Many people mistakenly believe that parasitic infections are uncommon in the United States," said Tsieh Sun, MD, chief and professor of clinical pathology at North Shore University Hospital-Cornell University Medical College, Manhasset, NY. "With the onset of AIDS, we have become more aware of a host of parasites that are common in our environment," Dr. Sun said. "The average person, with a normally functioning immune system, can fend off most parasites and does not show any threatening symptoms. However, individuals with weakened immune systems -- such as AIDS sufferers and transplant and chemotherapy recipients -- are unable to ward off intruding parasites and are especially susceptible to infections, particularly pneumocystosis and toxoplasmosis. Infections caused by the microsporidia parasite also are increasingly common."
Pneumocystosis is often the first distinguishing sign of a full-blown case of AIDS in an HIV infected person, Dr. Sun noted. Pneumocystosis is caused by the parasite, Pneumocystis carinii. It infects the lungs and is the leading cause of death in AIDS patients. Anti-pneumocystis drugs destroy the organism, but the AIDS patient must be treated forever in order to prevent a recurrence.

Unfortunately, pathologists are now encountering some parasites that affect everyone, even those with normal immunity. While most of the infections common in the U.S. result in minor, temporary or easily treated symptoms, those prevalent in less developed cultures and brought to the U.S. by foreign travelers or immigrants can cause lifelong disability or even death. The result is a rise in the number of parasitic infections within the general population.

Traveler Beware
"First-time exposure to different types of organisms, a desire to fit into the native culture by adopting local habits and lifestyles, an adventurous palate and lowered immunity -- sometimes combined with fatigue -- can all contribute to parasitic infections," noted Lawrence R. Ash, PhD. Dr. Ash is professor of infectious and tropical diseases at the School of Public Health, University of California, Los Angeles, and co-author of the book, Atlas of Human Parasitology, published by the ASCP Press.

"If you're planning to travel, use caution and common sense," Dr. Ash urged. "First and foremost, take the potential danger seriously and be prepared. Do a little research before you leave to find out what the risks are and what precautions you should take to avoid infection. This can be as simple as talking to your physician or visiting the local library. If traveling within the U.S., local health departments may be able to advise you of any special health problems in the area. If you plan to be outdoors where mosquitoes, ticks or other insects could be a problem, use ample amounts of an effective insect repellent and wear clothing that covers as much of the body as possible."

"Get any special immunizations appropriate for the places you plan to visit before traveling abroad and always keep regular immunizations up-to-date. Unfortunately, vaccines are not available for parasitic infections," Dr. Ash added. "Malaria remains a huge problem in the tropical world. Malaria parasites have developed a resistance to many of the currently available drugs, posing problems in providing preventive therapy and in treating the infection," he said. However, the traveler is not completely vulnerable. Good hygiene is an effective weapon against parasitic infections.

It's What You Eat and Drink...
Travelers are often tempted to try the local cuisine. But, Dr. Ash noted that the interest in dishes made from raw or undercooked meat and fish have increased the number of parasitic infections encountered throughout the world, including the U.S.. Popular dishes such as sushi and sashimi have led to numerous cases of infection by worm parasites among Americans," he added. "Anisakiasis is an infection caused by roundworm larva that infests various types of marine fish and squid while diphyllobothriasis is a Tapeworm infection that results from eating raw or poorly cooked freshwater fish and salmon. Steak tartar, a raw beef dish, and other poorly cooked pork and beef dishes can cause toxoplasmosis, trichinosis and Tapeworm infections," Dr. Ash pointed out.

Dr. Sun concurred, noting that while cases of anisakiasis infection are relatively rare in the U.S., mainly found in Alaska, California and the Eastern seaboard, thousands of cases have occurred in Japan, where the organism is more prevalent. Generally, the only way to kill these parasites is by cooking or freezing the food. Another good recommendation is to eat in restaurants that cater to tourists or personally inspect, purchase and prepare the food.

Fresh fruits and vegetables grown in areas where parasitic infections are common also can lead to distress, Dr. Ash pointed out. Again, cooking or freezing usually will kill the parasites. Soaking fruits and vegetables in Iodine solutions commonly used to purify water is effective in killing some types of parasitic organisms. Drinking impure water is another frequent cause of infection, he continued. Boil water used for drinking and cooking at least three minutes to purify. If this is impossible, use bottled water or processed bottled beverages for drinking and brushing your teeth. Be cautious about using ice, which may be made from contaminated water.

...Swim and Bathe In
Bathing in hot tubs and Jacuzzis can be potentially dangerous, Dr. Sun noted. The hot water provides an excellent breeding ground for parasites like the one that causes amebic kerititis -- an infection that invades the cornea and can eventually cause blindness. Victims of this infection feel irritation or have secretions in their eyes. "You can enjoy the bath," he said, "but avoid getting the water in your eyes."
The U.S. has an especially large number of amebic kerititis infections because so many people wear contact lenses, and cleansing solutions and homemade saline solutions may contain the ameba. Dr. Sun stresses that proper lens cleaning and sterilization are crucial to prevent infection. "More public education is needed because an infected patient may only need simple surgery if the condition is discovered early," he said. If not treated early enough, the infection will spread throughout the eye requiring its removal.

Simply bathing in lakes and streams also can be hazardous in places where Schistosoma parasites, a species of blood fluke, are found. This includes Africa, the Middle East, Cyprus, certain West Indies islands, and some parts of South America and the Far East.

Imported Parasites
Increased immigration from Latin America has led to the importation of several parasitic infections. Cysticercosis, an infection caused by the larval stage of the pork tapeworm, Taenia solium, is a major problem in Mexico and cases are being found with increasing regularity in immigrants and long-time U.S. residents.
"The changing political scene is having an impact on the types and numbers of parasitic infections we see," said Dr. Sun. "Eastern Europe and the Far East have their share of parasites and often lack the sanitation methods needed to control infection. Improved political relations with China, Vietnam and the former Soviet Union have increased tourism to these areas and it will probably continue to rise."
Dogs, cats and other pets, as well as wild animals, are other sources of parasitic infections known as zoonotic infections. Giardiasis is the most frequently reported human intestinal protozoan in the U.S., Dr. Ash noted. Wild animals are often infected with the same or similar species of parasite and transmit their infection to campers and hikers who drink contaminated water from pristine-looking lakes and streams. This has become so common that Giardia lamblia infection is often referred to as "backpackers' disease." Furthermore, the Centers for Disease Control in Atlanta have linked this parasite to large outbreaks of human disease in many communities having inadequate chlorination and water filtration procedures.

Visceral larva migrans is a common disease acquired by children who accidentally eat dirt containing the eggs of the dog intestinal roundworm," Dr. Ash added. "Creeping eruption is a skin condition occurring in people infected by contact with sandy soil contaminated by the hookworm larvae of dogs and cats." In the last few years other intestinal protozoa have been responsible for outbreaks of water-borne diarrheal disease. The most notable instance was the outbreak of cryptosporidiosis (Cryptosporidium) in Milwaukee in April 1993, which affected more than 300,000 individuals. A related parasite, Cyclospora, also has recently been implicated in diarrheal disease in travelers.

Dirofilariasis, or dog heartworm, is transmitted among dogs by mosquitoes; and humans bitten by infected mosquitoes can acquire the infection, too. Dirofilariasis is seen with increasing frequency in the East, Southeast, Midwest and occasionally in the Western U.S.. "Because the disease is spread from dogs to man by mosquitoes, it's not surprising that the peak of infection in man tends to follow a peak of infection in dogs within a geographic area," Dr. Sun explained. "Consequently, as dirofilariasis becomes more prevalent in the dog population, we can expect it to become more common in humans as well."

Most patients show no symptoms but discover dirofilariasis by a chest x-ray, Dr. Sun continued. It causes a "coin" lesion in the lung which resembles lung cancer. Surgery is necessary to diagnose this lesion. If diagnosed as dog heartworm, rather than cancer, the patient is saved time, money, discomfort and fear.

Finally, Drs. Sun and Ash urge anyone suspecting a parasitic infection to seek medical help immediately since consequences can be painful, inconvenient or deadly. "If you've been traveling and experience such symptoms as diarrhea, abdominal pain and other gastrointestinal disturbances, headache, fever, sweating, chills, cough, loss of appetite, fatigue, inflamed tissue beneath the skin and weight loss, see your physician. Let the doctor know where you visited and when you were there," said Dr. Ash. Early diagnosis and treatment are usually the best defense against a parasitic infection.

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