George R. Healy

Human babesiosis on Nantucket Island. Evidence for self-limited and subclinical infections.

Between 1969 and 1975, seven patients infected with Babesia microti, a tick-borne intraerythrocytic protozoan parasite, were reported from Nantucket Island, Massachusetts.1 2 3 Although all seven p...

Babesiosis in a Massachusetts resident.

THE babesia or piroplasmas are intracellular red-cell parasites transmitted by ticks that have been identified in a variety of wild and domestic mammals. Although many animal infections are subclin...

Successful Chemotherapy of Transfusion Babesiosis

We describe babesiosis transmitted by transfusion. The infected blood donor was identified and a minimum period of infectivity of the donors blood was established. We report a new modality for chemotherapy consisting of quinine plus clindamycin, and a new endemic focus for this zoonosis on Fire Island, New York. There are insufficient data to establish a reasonably safe period after which visitors and residents of Babesia-endemic foci can become blood donors. Screening of such persons by a rapid serologic test, such as the ELISA or immunofluorescent antibody tests, is suggested.

Amebiasis: Epidemiologic Studies in the United States, 1971-1974

Seven investigations of suspected foci of amebiasis between October 1971 and June 1974 lead to three conclusions. (1) A number of laboratories have vastly overdiagnosed amebiasis and have reported leukocytes in stools as Entamoeba histolytica. Two laboratories found to be in error were in community hospitals, and one was at a teaching hospital associated with a medical school and a school of public health. These three laboratories had been diagnosing more than 1200 cases of amebiasis a year for 20 years. (2) When amebiasis does occur, it is likely to be misdiagnosed. In one outbreak with four cases and three deaths, amebiasis was not diagnosed until two patients had died and another was critically ill. Sporadic cases may be mistakenly diagnosed as ulcerative colitis and inappropriately treated with steroids. (3) Foci of endemic amebiasis continue to exist in the United States, both in institutions and in noninstitutional settings.

A Communitywide Outbreak of Giardiasis with Evidence of Transmission by a Municipal Water Supply

Three hundred fifty residents of Rome, New York, had laboratory-confirmed cases of giardiasis between 1 November 1974 and 7 June 1975. A random household survey showed an overall attack rate for giardiasis (defined as a diarrheal illness of 5 days or more) of 10.6%. A significant association was discovered between having giardiasis and using city water and between having illness and drinking 1 or more glasses of water a day. The presence of human settlements in the Rome watershed area suggested that the water supply could have been contaminated by untreated human waste. The infectivity of municipal water was confirmed by producing giardiasis in specific pathogen-free dogs fed sediment samples of raw water obtained from an inlet of a city reservoir. A microscopic examination of the water sediments uncovered a Giardia lamblia cyst in one sample. This was the first time that a G. lamblia cyst has been found in municipal water in an epidemic and the first time that such water has been shown to infect laboratory animals.

Human babesiosis on Nantucket Island. Clinical features.

Between 20 July and 15 Octoboer 1975, five cases of human infection with Babesia microti were diagnosed on Nantucket Island, Massachusetts. The illness was characterized by fever, drenching sweats, shaking chills, myalgia, arthralgia, extreme fatigue, and a mild-to-moderate hemolytic anemia. None of the patients had a history of splenetomy. Although all patients responded symptomatically to treatment with oral chloroquine phosphate, parasitemia and fatigue frequently persisted for several weeks to months.

An Outbreak of Amebiasis Spread by Colonic Irrigation at a Chiropractic Clinic

From June 1978 through December 1980, at least 36 cases of amebiasis occurred in persons who had had colonic-irrigation therapy at a chiropractic clinic in western Colorado. Of 10 persons who required colectomy, six did. Of 176 persons who had been to the clinic in the last four months of 1980, 80 had received other forms of treatment. Twenty-one per cent of the colonic-irrigation group had bloody diarrhea, as compared with 1 per cent of the non-irrigation group (P = 0.00013). Thirty-seven per cent of the colonic-irrigation group who submitted specimens had evidence of amebic infection on either stool examination or serum titer, as compared with 2.4 per cent in the non-irrigation group (P = 0.00012). Persons who were given colonic irrigation immediately after a person with bloody diarrhea received it were at the highest risk for the development of amebiasis. Tests of the colonic-irrigation machine after routine cleaning showed heavy contamination with fecal coliform bacteria. The severity of disease in this outbreak may have been related to the route of inoculation.

Ophthalmomyiasis Interna Causing Visual Loss

Ophthalmomyiasis interna caused severe intraocular inflammation and loss of vision in two eyes. In the first eye, the organism was found in the vitreous and created a severe uveitis; a second-stage larva of Hypoderma lineatum was later removed from the anterior chamber. Phthisis bulbi ensued with loss of all vision. In a second eye, a subretinal maggot was observed to produce tracks in the pigment epithelium, with subretinal and vitreous hemorrhage. Severe uveitis and traction retinal detachment later developed. Despite successful reattachment of the retina, visual acuity remained only light perception. These cases demonstrate that ophthalmomyiasis interna is not always a benign condition.

Epidemiology of human babesiosis on Nantucket Island.

Between 1969 and 1977, 14 persons with parasitologically confirmed Babesia microti infections and seven persons with antibody titers to B. microti greater than or equal to 1:1,024 were identified on Nantucket Island, Massachusetts. Nineteen of these 21 persons were interviewed. About half were permanent residents of Nantucket; the others spent most of their summers on the island. There were 12 women and seven men. Patients ranged in age from 23 to 86 years; all of those with parasitologically confirmed infections were at least 49 years old. Fifteen patients had illnesses characterized by fever, chills, myalgia and fatigue. Five reported being bitten by a tick from 7 to 28 days before the onset of illness. Most cases occurred during July or August. There appeared to be no association between B. microti infection and direct contact with wild or domestic animals or specific outdoor activities. The unusual age distribution of patients with parasitologically confirmed B. microti infections may result because older persons tend to have more severe illnesses and thus are more likely to come to medical attention.

Prevalence of ascariasis and amebiasis in Cherokee Indian school children.

PIHYSICIANS at the Public Health Service Indian Hospital on the Cherokee North Carolina Indian Reservation diagnosed several cases of severe clinical ascariasis in children in 1964-65 and recorded the death of a child caused by what was believed to be an overwhelming infection with Ascaris lumnricoides. A preliminary survey in one part of the reservation in 1963 indicateld that 50 percent of the, children were infected with Ascaris worms. To determine the prevalence of the roundworm and other intestinal parasites in the Cherokee population, a collaborative study in 1965 between physicians at the hospital and the Parasitology Section of the National Communicable Disease Center, Public Hea.lth Service, was initiated. Because of logistical problems in obtaining specimens from persons living in the mountainous area of the reservation, it was decided to examine stool specimens from children attending the elementary school close to the hospital. Moreover, the 655 children in the elementary school would represent a sample of the approximately 5,000 residents of the reservation. More important, such examinations would indicate the prevalence of intestinal parasites in the group most likely to be affected by any species of clinical importance.