Laboratory-acquired parasitic infections from accidental exposures - PubMed (original) (raw)

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Laboratory-acquired parasitic infections from accidental exposures

B L Herwaldt. Clin Microbiol Rev. 2001 Oct.

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.

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Figures

FIG. 1

FIG. 1

Incubation period (i.e., period from accidental exposure until first symptom or clinical sign of infection) for the clinically evident laboratory-acquired cases of infection with various blood and tissue protozoa. The ends of the lines designate the extremes of the ranges, and the short vertical lines designate the medians. The parasites are ordered from the lowest to the highest median incubation period. Factors that presumably affected the data include the virulence of the particular strain of the parasite, the extent to which the laboratorian correctly identified the time of exposure and was attentive to the earliest clinical manifestations of infection, and the frequency of physical examination after the accidental exposure. For malaria, only non-vector-borne cases are included. For toxoplasmosis, only cases related to exposure to tissue stages of the parasite (rather than to oocysts) are included.

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