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Upon completion of the chapter, the reader will be able to:

  1. Identify the primary reasons why some parasitic diseases may be more prevalent in the U.S. population.

  2. Describe the treatment algorithm for giardiasis and amebiasis.

  3. List one effective therapy for nematodes and select the drugs of choice for strongyloidiasis and tapeworms.

  4. List three major reasons why travelers are infected with malaria.

  5. Describe the presenting signs and symptoms of malaria.

  6. List some specific toxicities of mefloquine.

  7. Identify the monitoring parameters for quinidine gluconate in severe malaria.

  8. Define the major complications of falciparum malaria.

  9. Discuss the cardiovascular complications of chronic South American trypanosomiasis.

  10. Describe the steps to take to eradicate lice infestation and scabies.




  • Image not available. For treatment of giardiasis (or as empirical treatment), metronidazole 250 mg three times daily for 7 days or tinidazole 2 g as a single dose is recommended.

  • Image not available. Diagnostic tests for amebiasis include stool for ova, antigen detection, or polymerase chain reaction (PCR) testing.

  • Image not available. The drug of choice for nematode infestations (hookworm, enterobiasis, and ascariasis) is mebendazole, whereas ivermectin is indicated for strongyloidiasis and praziquantel is indicated for tapeworms.

  • Image not available. The primary reasons why travelers are infected with malaria are failure to take chemotherapy, inappropriate chemotherapy, and delay in seeking medical care.

  • Image not available. Falciparum malaria must be considered a life-threatening medical emergency.

  • Image not available. Treatment of serious malarial infection requires admission to an acute care service, IV administration of quinidine gluconate, and symptomatic support.

  • Image not available. Complications of falciparum malaria include hypoglycemia, acute renal failure, pulmonary edema, seizure, and coma.

  • Image not available. The chronic presentation of American trypanosomiasis includes cardiovascular, GI, and CNS manifestations.

  • Image not available. Lice infestation should be treated with 1% permethrin followed by treatment of immediate family members and sexual partners. Bedding and clothes should be sterilized by washing in the hot cycle of the washing machine.

  • Image not available. The diagnosis of scabies is made by obtaining skin scrapings and detecting the mite in a wet mount. Topical therapy is 5% permethrin.


Parasitic medicine is an ever-changing field. The increased desire of large segments of the U.S. population to travel to Asia, Africa, and other parts of the world can expose them to parasitic infections that are endemic in those areas. The influx of refugees and new immigrant populations from Asia and other parts of the world have brought new parasitic infections to our shores. Migrant farm workers who work and live in substandard hygienic conditions, the large and growing Central and South American immigrant population, and the presence of immunosuppressed populations (e.g., those with the AIDS and transplant patients) represent other significant sources of parasitic infections in the United States.1,2,3,4,5,6,7,8,9, and 10 Clearly, there is a need for health professionals in the United States to be familiar with the pathophysiology and treatment of parasitic diseases.


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