Emerging Need for Parasitology Education: Training to Identify and Diagnose Parasitic Infections

Parasitic diseases are among the most common chronic infections in the world’s poorest persons and have a tremendous impact on global health. According to the World Health Organization parasitic diseases result in tremendous morbidity and mortality worldwide. 1 Even with increased global awareness and increased allocation of resources from governmental and major philanthropic organizations worldwide, the incidence of parasitic diseases continues to increase with the poorest nations disproportionately impacted. The control of parasitic diseases requires healthcare professionals to accurately identify the causative agents and requires them to have sufficient knowledge of parasite life cycles, transmission, and treatment. Without these skills and knowledge, attaining global control of parasitic diseases will continue to remain distant. With the increase in globalization and the breakdown of international barriers through travel and trade, there is an increasing need for healthcare providers who are qualified in the laboratory identification of parasites and clinical diagnosis of their diseases. In spite of the relative availability of funding and educational resources in the United States, parasitic diseases are underdiagnosed and misdiagnosed. Frequently, healthcare providers do not have sufficient knowledge to clinically identify parasitic infections in any or all of their diagnostic stages. Therefore, healthcare providers make presumptive diagnoses rather than relying on definitive laboratory diagnoses. Consequently, patients are often treated for the incorrect parasite or are incorrectly diagnosed as having a parasitic infection. In our laboratory over the past six months, we have identified parasitic infections in four persons that were misdiagnosed. Three of them had a chronic parasitic infection that persisted for more than two years. The first case involved a 28-year-old woman missionary from Mozambique who came to our laboratory with nausea, lower abdominal pain, and frequent bowel movements over the past two years. While in Mozambique, she was diagnosed and treated for malaria and giardiasis without accompanying laboratory diagnosis. However, the treatments exacerbated her chronic symptoms. When she returned to the United States for treatment she was told that she had irritable bowel syndrome (IBS) without having a stool examination or being offered treatment for IBS. Examination in our laboratory of her stool showed chronic and heavy microsporidial enteritis with infection by either Encephalitozoon hellem or Encephalitozoon cuniculi as we reported in this journal.