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  1. Article: Laboratory-acquired parasitic infections from accidental exposures.

    Herwaldt, B L

    Clinical microbiology reviews

    2001  Volume 14, Issue 4, Page(s) 659–88, table of contents

    Abstract: Parasitic diseases are receiving increasing attention in developed countries in part because of their importance in travelers, immigrants, and immunocompromised persons. The main purpose of this review is to educate laboratorians, the primary readership, ...

    Abstract Parasitic diseases are receiving increasing attention in developed countries in part because of their importance in travelers, immigrants, and immunocompromised persons. The main purpose of this review is to educate laboratorians, the primary readership, and health care workers, the secondary readership, about the potential hazards of handling specimens that contain viable parasites and about the diseases that can result. This is accomplished partly through discussion of the occupationally acquired cases of parasitic infections that have been reported, focusing for each case on the type of accident that resulted in infection, the length of the incubation period, the clinical manifestations that developed, and the means by which infection was detected. The article focuses on the cases of infection with the protozoa that cause leishmaniasis, malaria, toxoplasmosis, Chagas' disease (American trypanosomiasis), and African trypanosomiasis. Data about 164 such cases are discussed, as are data about cases caused by intestinal protozoa and by helminths. Of the 105 case-patients infected with blood and tissue protozoa who either recalled an accident or for whom the likely route of transmission could be presumed, 47 (44.8%) had percutaneous exposure via a contaminated needle or other sharp object. Some accidents were directly linked to poor laboratory practices (e.g., recapping a needle or working barehanded). To decrease the likelihood of accidental exposures, persons who could be exposed to pathogenic parasites must be thoroughly instructed in safety precautions before they begin to work and through ongoing training programs. Protocols should be provided for handling specimens that could contain viable organisms, using protective clothing and equipment, dealing with spills of infectious organisms, and responding to accidents. Special care should be exercised when using needles and other sharp objects.
    MeSH term(s) Accidents, Occupational/statistics & numerical data ; Helminthiasis/epidemiology ; Helminthiasis/parasitology ; Helminthiasis/therapy ; Helminthiasis/transmission ; Humans ; Laboratory Infection/epidemiology ; Laboratory Infection/parasitology ; Laboratory Infection/therapy ; Laboratory Infection/transmission ; Parasitic Diseases/epidemiology ; Parasitic Diseases/parasitology ; Parasitic Diseases/therapy ; Parasitic Diseases/transmission ; Protozoan Infections/epidemiology ; Protozoan Infections/parasitology ; Protozoan Infections/therapy ; Protozoan Infections/transmission ; Risk ; Wounds and Injuries/epidemiology ; Wounds and Injuries/parasitology ; Wounds and Injuries/therapy
    Language English
    Publishing date 2001-10-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 645015-5
    ISSN 1098-6618 ; 0893-8512
    ISSN (online) 1098-6618
    ISSN 0893-8512
    DOI 10.1128/CMR.14.3.659-688.2001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Cyclospora cayetanensis: a review, focusing on the outbreaks of cyclosporiasis in the 1990s.

    Herwaldt, B L

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2000  Volume 31, Issue 4, Page(s) 1040–1057

    Abstract: Cyclospora cayetanensis, a coccidian parasite that causes protracted, relapsing gastroenteritis, has a short recorded history. In retrospect, the first 3 documented human cases of Cyclospora infection were diagnosed in 1977 and 1978. However, not much ... ...

    Abstract Cyclospora cayetanensis, a coccidian parasite that causes protracted, relapsing gastroenteritis, has a short recorded history. In retrospect, the first 3 documented human cases of Cyclospora infection were diagnosed in 1977 and 1978. However, not much was published about the organism until the 1990s. One of the surprises has been the fact that a parasite that likely requires days to weeks outside the host to become infectious has repeatedly caused foodborne outbreaks, including large multistate outbreaks in the United States and Canada. In this review, I discuss what has been learned about this enigmatic parasite since its discovery and what some of the remaining questions are. My focus is the foodborne and waterborne outbreaks of cyclosporiasis that were documented from 1990 through 1999. The occurrence of the outbreaks highlights the need for health care personnel to consider that seemingly isolated cases of infection could be part of widespread outbreaks and should be reported to public health officials. Health care personnel should also be aware that stool specimens examined for ova and parasites usually are not examined for Cyclospora unless such testing is specifically requested and that Cyclospora infection is treatable with trimethoprim-sulfamethoxazole.
    MeSH term(s) Animals ; Canada/epidemiology ; Cyclospora/isolation & purification ; Cyclosporiasis/diagnosis ; Cyclosporiasis/drug therapy ; Cyclosporiasis/epidemiology ; Disease Outbreaks ; Feces/parasitology ; Food Parasitology ; Foodborne Diseases/epidemiology ; Fruit/parasitology ; Gastroenteritis/diagnosis ; Gastroenteritis/drug therapy ; Gastroenteritis/epidemiology ; Humans ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use ; United States/epidemiology ; Water/parasitology
    Chemical Substances Water (059QF0KO0R) ; Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2)
    Language English
    Publishing date 2000-10
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1086/314051
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Miltefosine--the long-awaited therapy for visceral leishmaniasis?

    Herwaldt, B L

    The New England journal of medicine

    1999  Volume 341, Issue 24, Page(s) 1840–1842

    MeSH term(s) Administration, Oral ; Antiprotozoal Agents/adverse effects ; Antiprotozoal Agents/therapeutic use ; Female ; Gastrointestinal Diseases/chemically induced ; Humans ; Leishmaniasis, Visceral/drug therapy ; Phosphorylcholine/adverse effects ; Phosphorylcholine/analogs & derivatives ; Phosphorylcholine/therapeutic use
    Chemical Substances Antiprotozoal Agents ; Phosphorylcholine (107-73-3) ; miltefosine (53EY29W7EC)
    Language English
    Publishing date 1999-12-09
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJM199912093412411
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Leishmaniasis.

    Herwaldt, B L

    Lancet (London, England)

    1999  Volume 354, Issue 9185, Page(s) 1191–1199

    Abstract: In 1903, Leishman and Donovan separately described the protozoan now called Leishmania donovani in splenic tissue from patients in India with the life-threatening disease now called visceral leishmaniasis. Almost a century later, many features of ... ...

    Abstract In 1903, Leishman and Donovan separately described the protozoan now called Leishmania donovani in splenic tissue from patients in India with the life-threatening disease now called visceral leishmaniasis. Almost a century later, many features of leishmaniasis and its major syndromes (ie, visceral, cutaneous, and mucosal) have remained the same; but also much has changed. As before, epidemics of this sandfly-borne disease occur periodically in India and elsewhere; but leishmaniasis has also emerged in new regions and settings, for example, as an AIDS-associated opportunistic infection. Diagnosis still typically relies on classic microbiological methods, but molecular-based approaches are being tested. Pentavalent antimony compounds have been the mainstay of antileishmanial therapy for half a century, but lipid formulations of amphotericin B (though expensive and administered parenterally) represent a major advance for treating visceral leishmaniasis. A pressing need is for the technological advances in the understanding of the immune response to leishmania and the pathogenesis of leishmaniasis to be translated into field-applicable and affordable methods for diagnosis, treatment, and prevention of this disease.
    MeSH term(s) Amphotericin B/therapeutic use ; Animals ; Antimony/therapeutic use ; Antiprotozoal Agents/therapeutic use ; Drug Administration Schedule ; Female ; HIV Infections/complications ; Humans ; Leishmania/isolation & purification ; Leishmaniasis/diagnosis ; Leishmaniasis/drug therapy ; Leishmaniasis/immunology ; Leishmaniasis/transmission ; Leishmaniasis, Cutaneous/diagnosis ; Leishmaniasis, Cutaneous/drug therapy ; Leishmaniasis, Mucocutaneous/diagnosis ; Leishmaniasis, Mucocutaneous/drug therapy ; Leishmaniasis, Visceral/complications ; Leishmaniasis, Visceral/diagnosis ; Leishmaniasis, Visceral/drug therapy ; Male
    Chemical Substances Antiprotozoal Agents ; Amphotericin B (7XU7A7DROE) ; Antimony (9IT35J3UV3)
    Language English
    Publishing date 1999-10-02
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0140-6736 ; 0023-7507
    ISSN (online) 1474-547X
    ISSN 0140-6736 ; 0023-7507
    DOI 10.1016/S0140-6736(98)10178-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Cryptosporidiosis: an outbreak associated with drinking water despite state-of-the-art water treatment

    Herwaldt, B. L.

    Annals of Internal Medicine

    1996  Volume 124, Issue 5, Page(s) 459–468

    Institution Mailstop F-22, 4770 Buford Highway NE, USA-Atlanta, GA 30341-3724 c/o B.L. Herwaldt, Centers for Disease Control and Prevention, Division of Parasitic Diseases
    Keywords Protozoeninfektion ; Trinkwasser ; Fallkontrollstudie ; HIV-Infektion
    Language English
    Document type Article
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    Database Social Medicine (SOMED)

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  6. Article: The return of Cyclospora in 1997: another outbreak of cyclosporiasis in North America associated with imported raspberries. Cyclospora Working Group.

    Herwaldt, B L / Beach, M J

    Annals of internal medicine

    1999  Volume 130, Issue 3, Page(s) 210–220

    Abstract: Background: In the spring of 1996, an outbreak of cyclosporiasis associated with fresh Guatemalan raspberries occurred in the United States and Canada. Another multistate outbreak of cyclosporiasis occurred in North America in the spring of 1997.: ... ...

    Abstract Background: In the spring of 1996, an outbreak of cyclosporiasis associated with fresh Guatemalan raspberries occurred in the United States and Canada. Another multistate outbreak of cyclosporiasis occurred in North America in the spring of 1997.
    Objective: To identify the vehicle of the outbreak that occurred in the spring of 1997.
    Design: Retrospective cohort studies of clusters of cases associated with events (such as banquets) and traceback investigations of sources of implicated produce.
    Setting: United States and Canada.
    Patients: Persons who attended events associated with clusters of cases of cyclosporiasis.
    Measurements: Identification of clinically defined or laboratory-confirmed cases of cyclosporiasis and risk factors for infection.
    Results: 41 clusters of cases were reported in association with events held from 1 April through 26 May in 13 U.S. states, the District of Columbia, and 1 Canadian province. The clusters comprised 762 cases of cyclosporiasis, 192 (25.2%) of which were laboratory confirmed. In addition, 250 laboratory-confirmed sporadic cases were reported in persons who developed gastrointestinal symptoms from April through 15 June, for a total of 1012 cases. Fresh raspberries were the only food common to all 41 events and were the only type of berry served at 9 events (22.0%). Statistically significant associations between consumption of raspberry-containing items and cyclosporiasis were documented for 15 events (40.5% of 37). For 31 of the 33 events with well-documented traceback data, the raspberries either definitely came from Guatemala (8 events) or could have come from Guatemala (23 events). The mode of contamination of the raspberries remains unknown. The outbreak ended shortly after the exportation of fresh raspberries from Guatemala was voluntarily suspended at the end of May 1997.
    Conclusions: Similar multistate, multicluster outbreaks of cyclosporiasis associated with consumption of Guatemalan raspberries have occurred in consecutive years. These outbreaks highlight the need for better understanding of the biology and epidemiology of Cyclospora cayetanensis and for stronger prevention and control measures to ensure the safety of produce eaten raw.
    MeSH term(s) Animals ; Canada/epidemiology ; Cluster Analysis ; Coccidiosis/epidemiology ; Disease Outbreaks ; Eucoccidiida ; Food Contamination ; Fruit/parasitology ; Guatemala ; Humans ; Retrospective Studies ; United States/epidemiology
    Language English
    Publishing date 1999-02-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/0003-4819-130-3-199902020-00006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Reevaluating the molecular taxonomy: is human-associated Cyclospora a mammalian Eimeria species?

    Pieniazek, N J / Herwaldt, B L

    Emerging infectious diseases

    1997  Volume 3, Issue 3, Page(s) 381–383

    Abstract: Human-associated Cyclospora is a coccidian parasite that causes diarrheal disease. A reevaluation of the parasite's molecular taxonomy that takes into account newly published data for seven Eimeria species shows that Cyclospora belongs to the Eimeria ... ...

    Abstract Human-associated Cyclospora is a coccidian parasite that causes diarrheal disease. A reevaluation of the parasite's molecular taxonomy that takes into account newly published data for seven Eimeria species shows that Cyclospora belongs to the Eimeria clade (Eimeriidae family). The Cyclospora branch on the phylogenetic tree is between the branches of the eight avian and two mammalian Eimeria species that have been evaluated to date. Furthermore, preliminary results indicate that Cyclospora and Isospora belli, another coccidian parasite that causes diarrheal disease in humans, belong to different families. To improve our understanding of the taxonomy of human-associated Cyclospora, molecular evaluation of isolates of additional Cyclospora and Eimeria species is needed.
    MeSH term(s) Animals ; Coccidiosis/parasitology ; Diarrhea/parasitology ; Eimeria/classification ; Eimeria/genetics ; Eimeria/pathogenicity ; Eucoccidiida/classification ; Eucoccidiida/genetics ; Eucoccidiida/pathogenicity ; Humans ; Mammals ; Molecular Sequence Data ; Phylogeny ; RNA, Protozoan/genetics ; RNA, Ribosomal/genetics
    Chemical Substances RNA, Protozoan ; RNA, Ribosomal
    Language English
    Publishing date 1997-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1380686-5
    ISSN 1080-6040
    ISSN 1080-6040
    DOI 10.3201/eid0303.970319
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: An outbreak in 1996 of cyclosporiasis associated with imported raspberries. The Cyclospora Working Group.

    Herwaldt, B L / Ackers, M L

    The New England journal of medicine

    1997  Volume 336, Issue 22, Page(s) 1548–1556

    Abstract: Background: Cyclospora cayetanensis is a parasite that causes gastroenteritis. Until last year most of the documented cases of cyclosporiasis in North America were in overseas travelers. In 1996, a large outbreak of cyclosporiasis occurred in North ... ...

    Abstract Background: Cyclospora cayetanensis is a parasite that causes gastroenteritis. Until last year most of the documented cases of cyclosporiasis in North America were in overseas travelers. In 1996, a large outbreak of cyclosporiasis occurred in North America. We investigated this outbreak.
    Methods: Health departments solicited information from clinicians and laboratories on cases of cyclosporiasis, which were then reported to the Centers for Disease Control and Prevention and to Health Canada. We conducted retrospective cohort studies for the cases associated with events (e.g., luncheons) and attempted to identify the sources of the implicated food.
    Results: A total of 1465 cases of cyclosporiasis were reported by 20 states, the District of Columbia, and 2 provinces. Of these cases, 978 (66.8 percent) were laboratory confirmed and 725 (49.5 percent) were associated with 55 events that were held from May 3 through June 14. Raspberries were definitely served at 50 events and may have been served at 4 events. For 27 of the 41 events for which adequate data were available (65.8 percent), the associations between the consumption of berries (raspberries with or without other berries) and cyclosporiasis were statistically significant (P<0.05). For all 29 events for which there were good data, the raspberries definitely came from Guatemala (21 events, 72.4 percent) or may have come from Guatemala (8 events, 27.6 percent). As few as five Guatemalan farms could have accounted for the 25 events for which the raspberries could be traced to a single exporter per event. The mode of contamination of the raspberries remains unclear.
    Conclusions: This large outbreak of cyclosporiasis in North America in 1996 was associated with the consumption of Guatemalan raspberries. The outbreak illustrates the need to consider that a local cluster of foodborne illness may be part of a widespread outbreak and to pursue investigations to the source of the implicated vehicle.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Animals ; Canada/epidemiology ; Child ; Child, Preschool ; Cluster Analysis ; Coccidiosis/epidemiology ; Coccidiosis/parasitology ; Cohort Studies ; Disease Outbreaks ; Eucoccidiida/isolation & purification ; Female ; Food Parasitology ; Foodborne Diseases/epidemiology ; Fruit/parasitology ; Fruit/poisoning ; Gastroenteritis/epidemiology ; Gastroenteritis/parasitology ; Guatemala ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies ; United States/epidemiology
    Language English
    Publishing date 1997-05-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJM199705293362202
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Transmission of Babesia microti by blood transfusion in Texas.

    Cangelosi, J J / Sarvat, B / Sarria, J C / Herwaldt, B L / Indrikovs, A J

    Vox sanguinis

    2008  Volume 95, Issue 4, Page(s) 331–334

    Abstract: In the USA, seasonal tickborne transmission of Babesia microti occurs in the Northeast and upper Midwest. A resident of Texas became infected through a red blood cell transfusion from an asymptomatic local donor who had summered in Massachusetts. The ... ...

    Abstract In the USA, seasonal tickborne transmission of Babesia microti occurs in the Northeast and upper Midwest. A resident of Texas became infected through a red blood cell transfusion from an asymptomatic local donor who had summered in Massachusetts. The patient's infection was diagnosed by blood smear examination in January, 7 weeks post-transfusion. He died 1 week later from variceal haemorrhage complicated by haemolysis. Premortem patient specimens and archived blood from the donor unit tested positive for B. microti antibodies and DNA. Babesiosis should be included in the differential diagnosis of post-transfusion haemolytic anaemia or thrombocytopenia, regardless of the geographical region or season.
    MeSH term(s) Anemia, Hemolytic/etiology ; Animals ; Babesia microti ; Babesiosis/complications ; Babesiosis/diagnosis ; Babesiosis/transmission ; Erythrocyte Transfusion/adverse effects ; Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Texas ; Thrombocytopenia/etiology
    Language English
    Publishing date 2008-11
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 80313-3
    ISSN 1423-0410 ; 0042-9007
    ISSN (online) 1423-0410
    ISSN 0042-9007
    DOI 10.1111/j.1423-0410.2008.01094.x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Laboratory-acquired malaria, leishmaniasis, trypanosomiasis, and toxoplasmosis.

    Herwaldt, B L / Juranek, D D

    The American journal of tropical medicine and hygiene

    1993  Volume 48, Issue 3, Page(s) 313–323

    Abstract: Because of renewed interest in parasitic diseases, increasing numbers of persons in clinical and research laboratories have the potential for exposure to parasites and therefore are at risk for acquiring parasitic infections. In this review of laboratory- ...

    Abstract Because of renewed interest in parasitic diseases, increasing numbers of persons in clinical and research laboratories have the potential for exposure to parasites and therefore are at risk for acquiring parasitic infections. In this review of laboratory-acquired parasitic infections, we concentrate on protozoan diseases that frequently have been reported to be laboratory acquired: malaria, leishmaniasis, trypanosomiasis (American and African), and toxoplasmosis. These diseases can be severe, even fatal, and may be difficult to diagnose. Many laboratorians who have acquired these diseases did not recall having had an accident. Of those with recognized accidents, needlestick injuries were the most common. Laboratories should have established protocols for handling specimens that may contain viable organisms and for responding to laboratory accidents.
    MeSH term(s) Animals ; Cats ; Culicidae ; Female ; Humans ; Insect Vectors ; Laboratory Infection/etiology ; Leishmaniasis/etiology ; Leishmaniasis/transmission ; Malaria/etiology ; Malaria/transmission ; Male ; Mice ; Needlestick Injuries/complications ; Psychodidae ; Rabbits ; Rats ; Toxoplasmosis/etiology ; Toxoplasmosis/transmission ; Triatominae ; Trypanosomiasis/etiology ; Trypanosomiasis/transmission ; Wounds and Injuries/complications
    Language English
    Publishing date 1993-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2942-7
    ISSN 1476-1645 ; 0002-9637
    ISSN (online) 1476-1645
    ISSN 0002-9637
    DOI 10.4269/ajtmh.1993.48.313
    Database MEDical Literature Analysis and Retrieval System OnLINE

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