1. TechLab GIARDIA TEST Cryptosporidium TEST E.histolytica II TEST Parasitology

2. Giardia lamblia Background Morphology and life cycle Incidence Symptoms Available Tests for diagnosis

3. Background First described by Leeuwenhoek in 1681 First report of Giardiasis credited to Lambl in 1859 The most commonly diagnosed flagellate in the intestinal tract Three groups have been described: Giardia muris - rodents, birds, reptiles. Giardia agilis - amphibians Giardia intestinalis (lamblia) - mammals

4. SEM Giardia lamblia

5. Incidence The most commonly isolated intestinal parasite worldwide Especially prevalent in children - outbreaks in daycare centers and within families Giardia cysts have been detected in 81% of raw water samples and 17% of filtered Waterborne transmission is a cause of Giardiasis in travelers and backpackers Can be sexually transmitted

6. Symptoms Incubation period is usually 1-2 weeks Low grade fever, chills, nausea and anorexia can be early symptoms Subsequently - explosive, watery, foul smelling diarrhea; marked abdominal gurgling; flatulence; abdominal distension and belching with a foul taste. The acute stage can resemble travelers diarrhea and is often not recognized as giardiasis

7. A common symptom of Giardiasis is flatulence

8. Available Tests Iodine Wet Mount Immunofluorescent antibody Test Enzyme Immunoassays Rapid assays - gold conjugates

9. GIARDIA TEST Monoclonal antibody based Detects a cyst wall protein (CWP1) Variable first incubation time (results available in as little as 40mins) 3 wash steps Sensitivity:97 - 100% Specificity:100%

10. Giardia Tests TechLab GIARDIA TEST Alexon Trend ProspecT (both micorplate & flow through) Seradyn Color Vue Giardia (subsidiary of Alexon-Trend) Remel RIM (subisidiary of Alexon-Trend) Biosite Triage Parasite Panel BD ColorPac

11. Available Tests for Giardia

12. TechLab GIARDIA TEST Monoclonal antibody based The only test available where the protein detected has been fully characterized Detects the same protein as the other monoclonal antibody based tests Using a 10min first incubation, it is the most rapid microtiter EIA available Can be run in the same format as the Cryptosporidium TEST

13. Cryptosporidium Background Morphology and life cycle Incidence Symptoms Available Tests for diagnosis

14. Background First description of an organism resembling Cryptosporidia was by Clark in 1895 In 1910 Tyzzer proposed the genus name Cryptosporidium for the protozoan parasite 1976 - first human case of Cryptosporidiosis described 1980s the onset of AIDs in the US brought attention to the association of Cryptosporidium with diarrheal illness Only species infectious to humans is C.parvum

15. Incidence The prevalence rate in North America and Europe is 1 - 3% It can reach up to 20% in underdeveloped countries Children are the most susceptible Several nosocomial infections have been reported Patients with late stage AIDs are very susceptible and develop life threatening diarrhea

16. Incidence continued…. Waterborne outbreaks continue to be a problem as the organism is resistant to chlorine and passes through filters of both filtration plants and public swimming pools In 1993, 400,000 people in Milwaukee Wisconsin were exposed & over 100 died. Swimming pools are a source of infection due to babies in diapers and AFR (accidental fecal release) Can be foodborne

17. Symptoms Incubation period is 5 to 28 days Diarrhea is profuse and watery with as many as 71 stools per day and up to 17 liters per day May be accompanied by low grade fever, nausea and vomiting Symptoms wax and wane and may correlate with oocyst shedding

18. Available Tests Microscopy Immunofluorescent Test EIA Lateral Flow Immunochromatographic Tests

19. Microscopy for Cryptosporidium is insensitive due to the small size of the organism - it is very difficult to see!

20. Cryptosporidium Tests TechLab Cryptosporidium TEST Alexon Trend ProspecT Cryptosporidium (in both microplate and flow through format) Seradyn Color Vue Cryptosporidium (subsidiary of Alexon Trend) Alexon Trend Giardia/Cryptosporidium Assay Biosite Triage Parasite Panel BD ColorPac Giardia/Cryptosporidium

21. Available Tests for Cryptosporidium

22. TechLab Cryptosporidium TEST Monoclonal Antibody based 2 wash steps Sensitivity:97% Specificity:97.7 - 100% Crypto and Giardia Tests can be run in the same format (Crypto format)

23. Entamoeba histolytica Background Morphology and life cycle Incidence Symptoms Available Tests

24. Background Presence of organism was first described in a woodworker in Northern Russia in 1875 In 1925 Brumpt differentiated a pathogenic invasive form from a non pathogenic form Recently Clark and Diamond verified the existence of both pathogenic and non pathogenic strains

25. Incidence Infections occur worldwide and it has been suggested that 12% of the world’s population may be infected 10% develop clinical symptoms causing between 40,000 to 120,000 deaths per year Transmission by water is common in developing countries and does occur in this country Serious outbreaks have occurred in the USA, however, are not well documented Can be sexually transmitted and foodborne

26. Symptoms Incubation period varies from a few days to months asymptomatic colonization acute amebic colitis - abdominal pain, bloody stools, fever fulminant colitis - abdominal pain, profuse bloody diarrhea, fever ameboma - asymptomatic lesion or a tender mass accompanied by dysentery

27. Available Tests Microscopy Culture and zymodeme analysis TechLab E.histolytica Test Alexon Trend Entamoeba histolytica Test Biosite Triage Parasite Panel