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James R Palmieri,1 Susan L Meacham,2 Jenna Warehime,1 Sarah A Stokes,1 Janie Ogle,1 Dezarae Leto,1 Maggie Bax,1 Anca M Dauer,1 Janie Milliron Lozovski1 1Department of Microbiology and Immunology, 2Department of Preventative Medicine and Public Health, Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA Purpose: This study was to investigate weaning practices used by mothers when transitioning infants from breast milk to complementary foods and to determine the role these foods have in the transmission of gastrointestinal parasites. Participants and methods: On average, of the 175 mothers extensively interviewed, 93% said they had breast-fed their infants. Approximately 20.8% of mothers had added some other liquid to their infant’s diet at 3 months, while most mothers had added other liquids at 6 months (39.0%) and >6 months (32.1%). Some mothers expanded food offerings to infants before 3 months. The percentage of mothers who had added other liquids to their infants’ diet was reported by age of the infant: as early as 1 day (2.5%), <1 week (1.9%), first month (3.1%), 3 months (20.8%), 6 months (39.0%), and >6 months (32.1%). These foods included fruit, vegetables, meat, and grains. The maximum age a child was found to be still breastfeeding was 13 years. Results: Forty percent of mothers involved in this survey reported that their children were diagnosed and/or treated for gastrointestinal parasitic infection. Routes of infection of protozoan and helminth parasites likely resulted from contaminated complementary foods and water given to infants while still breast-feeding or from contaminated foods after breast-feeding had been completed. Contaminated water is a likely source of protozoan parasites. Contaminated water was fed to infants, mixed with formula or complementary foods, or used to wash bottles for infant feeding. There was an absence of hand-washing by children and mothers before eating or while preparing

Kristin Anne Geers Childers, James R Palmieri Department of Microbiology, Infectious and Emerging Diseases, Edward Via College of Osteopathic Medicine–Virginia Campus, Blacksburg, VA, USA Abstract: The prevalence of gastrointestinal parasites and the severity of infection have a profound impact on human health and development, affecting approximately one-third of the world's population. Gastrointestinal diseases, most notably caused by a variety of gastrointestinal parasites, are endemic to the Dominican Republic. A previous study demonstrated a 99.2% prevalence rate in children between the ages of 2 years and 15 years. The purpose of this study is to note the critical factors contributing to the high rate of gastrointestinal parasitic infections in children in the Punta Cana region of the Dominican Republic. This report addresses qualitative observations and contributory factors responsible for the high rate of gastrointestinal parasite infection. These factors include the impact of malnutrition, the role of weaning foods and caretaker food preparation in parasite transmission, the effects of contaminated water sources, sewage control, and lack of health education regarding prevention, control, and treatment of diseases. Prevention programs should be directed at both the national and the local levels, particularly in schools, for education in symptom recognition, prevention, and treatment. It is imperative that health care workers be trained in the use of new tools to help in estimating the prevalence of gastrointestinal parasites in both urban and rural settings. Parasitic infections affect growth, intelligence quotient, and nutrition–health and cause diarrhea, fatigue, dyspepsia, and anemia, resulting in high morbidity and mortality in children in this region of the Dominican Republic. Keywords: clean water, Dominican Republic, gastrointestinal parasites, Haitian, nutritional, parasitic, Verón, weaning foods

James R Palmieri,1 Arben Santo,2 Shawn E Johnson1 1Department of Microbiology, Infectious and Emerging Diseases, 2Department of Pathology, Edward Via College of Osteopathic Medicine, Virginia Campus, Blacksburg, VA, USA Abstract: A 45-year-old man complained of pain and swelling on his right wrist after receiving a scratch while playing paintball in a swampy area of eastern Virginia. Two weeks later, he noticed a pimple-like lesion developing, which quickly grew in size and then ulcerated. Because of the severity of his condition, the patient was taken to the emergency room where surgical drainage of the abscess was carried out and the pus was sent for culture and sensitivity testing. Enlarged and tender lymph nodes were palpable going up the arm and surrounding the right axillary area. Three days following culture of pus from his lesion, colonies of Nocardia brasiliensis were isolated. He was successfully treated with an extended regimen of trimethoprim-sulfamethoxazole. Because of its low incidence, nocardiosis is usually not considered in the initial diagnosis. The rapidity with which his infection developed from a pimple-like lesion into an extensive ulcerated area, the involvement of his lymphatic system, the extended time needed to successfully treat his infection, and the potential for infection to rapidly disseminate, reinforces the necessity for laboratory identification and immediate treatment of severe pyogenic cutaneous lesions. Keywords: actinomycetes, cutaneous nocardiosis, immunocompromised, mycetoma, Nocardia brasiliensis, nocardiosis, trimethoprim-sulfamethoxazole

Kristin A Geers Childers, James R Palmieri, Mindy Sampson, Danielle Brunet Department of Microbiology, Infectious and Emerging Diseases, Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA Abstract: Gastrointestinal infections impose a great and often silent burden of morbidity and mortality on poor populations in developing countries. The Dominican Republic (DR) is a nation on the island of Hispaniola in the Caribbean Sea. Verón is located in La Alta Grácia province in the southeastern corner of the DR. Dominican and Haitian migrant workers come to Verón to work in Punta Cana, a tourist resort area. Few definitive or comprehensive studies of the prevalence of gastrointestinal parasitic infections have been published in the DR. Historically, most of the definitive studies of water-borne or soil-transmitted parasites in the DR were published more than 30 years ago. Presently, there is a high prevalence of gastrointestinal parasitic infections throughout the poorest areas of the DR and Haiti. In this study we report the prevalence of gastrointestinal protozoan and helminth parasites from children recruited from the Clínica Rural de Verón during 2008 through 2011. Each participant was asked to provide a fecal sample which was promptly examined microscopically for protozoan and helminth parasites using the Centers for Disease Control and Prevention (CDC) fecal flotation technique to concentrate and isolate helminth ova and protozoan cysts. Of the 128 fecal samples examined, 127 were positive for one or more parasites. The age of the infected children ranged from 2–15 years; 61 were males and 66 were females. The only uninfected child was a 9 year old female. Percent infection rates were 43.8% for Ascaris lumbricoides, 8.5% for Enterobius vermicularis, 21.1% for Entamoeba histolytica, and 22.7% for Giardia duodenalis. Of the children examined, 7.8% had double infections. Any plan of action to re

James R Palmieri,1 Dwayne North,1 Arben Santo2 1Department of Microbiology, Infectious and Emerging Diseases-Edward Via College of Osteopathic Medicine–Virginia Campus, Blacksburg, Virginia, USA; 2Department of Pathology-Edward Via College of Osteopathic Medicine–Virginia Campus, Blacksburg, Virginia, USA Abstract: Cutaneous myiasis in humans is a temporary parasitic infestation of the skin by fly larvae or maggots of a variety of Dipteran families. In the United States, autochthonous cases of myiasis are infrequently seen. Most cases of cutaneous myiasis are acquired when traveling to tropical areas of Africa, Central America or South America. This case report involves a 26-year-old male medical student who visited Tanzania on a medical mission trip. Three weeks following his return to the United States he developed a furuncular lesion on the side of the fifth digit on his right foot, which contained the larva of the tumbu fly, Cordylobia anthropophaga. Keywords: Cordylobia anthropophaga, furuncular myiasis, phenylacetaldehyde, phenylacetic acid, Tanzania, tumbu fly

James R Palmieri,1 Scott King,1 Matthew Case,1 Arben Santo21Department of Microbiology, Infectious and Emerging Diseases, 2Department of Pathology, Edward Via College of Osteopathic Medicine, Blacksburg, VA, USAAbstract: A 50-year-old woman from Pulaski, Virginia, presented to a local clinic with headaches, fever, generalized joint pain, excessive thirst and fluid intake, and a progressing rash on her back. On physical examination, she had a large circular red rash on her back with a bull's-eye appearance, 16 × 18 cm in diameter. Serologic tests confirmed a diagnosis of Lyme disease. The patient could recall a walk through the woods 3 weeks prior, although she never noticed a tick on her body. Following a prolonged course of antibiotics, this case report presents a patient with ongoing symptoms consistent with post-treatment Lyme disease.Keywords: arthritis, chronic Lyme disease (CLD), ELISA, erythema migrans, ixodid ticks, Lyme disease, post-treatment Lyme disease syndrome (PTLDS), Western blotting

Microsporidiosis often occurs in immunocompromised persons but may also occur in those who are immunocompetent. Infection by Microsporidia involves a variety of organs and systems, most notably, intestine, lung, kidney, brain, sinuses, muscle, and eyes. Enterocytozoon bieneusi and Encephalitozoon intestinalis are associated with gastroenteritis, and Enterocytozoon hellem and Encephalitozoon cuniculi are associated with keratoconjunctivitis. We report a case of chronic microsporidiosis in a 28-year-old woman missionary from Mozambique who came to our diagnostic laboratory with nausea, lower abdominal pain, and frequent bowel movements. Over two years, the patient was clinically assessed and treated for malaria and giardiasis without laboratory diagnosis while in Mozambique. Identification of the causative agent of her condition was not attempted during the course of her illness in Mozambique. Furthermore, adverse effects of malaria and giardiasis medications may have exacerbated the chronic illness in this patient and mimicked chronic microsporidiosis.