Common Intestinal Parasites

Parasites are a source of significant illness worldwide. In the United States, giardiasis, cryptosporidiosis, cyclosporiasis, and trichinellosis are nationally notifiable conditions. Pinworm, the most common intestinal parasite in children, is not a locally notifiable infection. Intestinal parasites have a wide range of acute and chronic symptoms but should be suspected in those who present with diarrhea lasting more than seven days. Infections most often occur through a fecal-oral route. Symptoms tend to be worse for children, older adults, or immunocompromised individuals. To diagnose Giardia infection, stool microscopy with direct fluorescent antibody testing is recommended; metronidazole, nitazoxanide, or tinidazole is used for treatment. Microscopy with immunofluorescence is sensitive and specific for diagnosing Cryptosporidium infection. This infection is often self-resolving, but treatment with nitazoxanide is effective for symptoms lasting more than two weeks. Microscopy or polymerase chain reaction assays are recommended to diagnose Cyclospora infections, and sulfamethoxazole/trimethoprim may be used to treat patients with persistent diarrhea. Trichinella infection is diagnosed by serum antibody testing, and severe symptoms are treated with albendazole in patients older than one year. Pinworm infections are diagnosed visually or by a tape test or paddle test; albendazole and pyrantel pamoate are both effective treatments.