VISCERAL PROTOZOA: RHIZOPODS

Entamoeba histolytica
Risk Behavior
[1] Never or rarely using soap for hand washing
Shahrul Anuar T, M. Al-Mekhlafi H, Abdul Ghani MK, Osman E, Mohd Yasin A, Nordin A.
2012.

Prevalence

and

Risk

Factors

Associated

with

Entamoeba

histolytica/dispar/moshkovskii Infection among Three Orang Asli Ethnic Groups in

Malaysia. PLoS ONE 7(10): e48165. doi:10.1371/journal.pone.0048165
[2] Not washing hands after playing with soil or gardening and eating foods using bare hands
Shahrul Anuar T, M. Al-Mekhlafi H, Abdul Ghani MK, Osman E, Mohd Yasin A, Nordin A.
2012.

Prevalence

and

Risk

Factors

Associated

with

Entamoeba

histolytica/dispar/moshkovskii Infection among Three Orang Asli Ethnic Groups in

Malaysia. PLoS ONE 7(10): e48165. doi:10.1371/journal.pone.0048165
[3] Adults low level of education, contact with soil and livestock, as well as the season were
considered significant risk factors of E. histolytica infection
Kiani, Hamed, Haghighi, Ali, Rostami, Ali, Azargashb, Eznollah, Tabaei, Seyyed Javad
Seyyed, Solgi, Abbas, & Zebardast, Nozhat. (2016). Prevalence, Risk Factors And
Symptoms Associated To Intestinal Parasite Infections Among Patients With
Gastrointestinal Disorders In Nahavand, Western Iran. Revista do Instituto de
Medicina Tropical de So Paulo. Vol. 58. https://dx.doi.org/10.1590/S16789946201658042
[4] Entamoeba histolytica infection is prevalent to children who did not know the reason why
they wash their hands and did not wear protctive shoes and dont know proper hygiene
Ngeiywa, M.M. and Odityo, G.A.,2016. Risk factors for the prevalence of Entamoeba
histolytica in children aged under five years in a slumsettlement in Nairobi,
Kenya. Merit Research Journal of Microbiology and Biological Sciences. 4(5);
068-073. ISSN: 2408-7076

[5] Drinking of contaminated/ untreated water

Lv, S., Tian, L., Liu, Q., Qian, M., Fu, Q., Steinmann, P., Chen, J., Yang Q., Yang K., Zhou
X. 2013. Water-Related Parasitic Diseases in China. Int J Environ Res Public
Health; 10(5): 19772016. doi: 10.3390/ijerph10051977
1 |R i s k F a c t o r s a n d B e h a v i o r s

[6] Ingestion of raw vegetables

Benetton, M.L., Gonalves, A.V., Meneghini, M.E., Silva, E.F., Carneiro, M. 2004. Risk
factors for infection by the Entamoeba histolytica/E. dispar complex: an
epidemiological study conducted in outpatient clinics in the city of Manaus,
Amazon Region, Brazil. Transactions of the Royal Society of Tropical Medicine
and Hygiene 99(7): 532540. DOI: 10.1016/j.trstmh.2004.11.015
[7] Sexual intercourse with various partners causing fallopian tube amebiasis associated with
hydrosalpinx; a very rare case
Calore, E., Calore , N., Cavaliere, M. 2002. Salpingitis due to Entamoeba histolytica.
Brazilian Journal of Infectious Diseases, 6(2). ISSN: 1678-439
[8] The proper hygiene food handlers and vendors is significant for those that consume foods
prepared outside their house
Atu, B.O et al., 2014. Prevalence of pathogenic protozoa infection in humans and their
associated risk factors in Benue State, Nigeria, International Journal of Public
Health and Epidemiology. 3(2); 007-0116. ISSN: 2326-7291
Host Factors
[9] Malnutrition substantially increases susceptibility to amebiasis
Mondal D, et al,. Entamoeba histolytica-associated diarrheal illness is negatively associated
with the growth of preschool children: evidence from a prospective
study. Transaction of the Royal Society on Tropical Medicine and Hygiene. 100
(11): 10321038. Retrieved from: trstmh.oxfordjournals.org on January 12, 2017
Environmental Factors
[10] Absence of toilets/ latrines can determine the prevalence of E. histolytica infection
Braga, L.L., Gomes, M.L., Silva, M.W., Paiva, C., Sales, A., Mann, B.J. 2001. Entamoeba
histolytica and Entamoeba dispar infections as detected by monoclonal antibody
in an urban slum in Fortaleza, Northeastern Brazil. Rev. Soc. Bras. Med.
[11]

Trop.34, 467471
Having close contact with domestic animals presented a greater risk of E. histolytica

infection
Pham, D.P., Nguyen, V.H., Hattendorf, J., Zinsstag, J., Dac, C.P., Odermatt, P.. 2011. Risk
factors for Entamoeba histolytica infection in an agricultural community in

2 |R i s k F a c t o r s a n d B e h a v i o r s

Hanam province, Vietnam. Parasite Vectors. 10;4:102. doi: 10.1186/17563305-4-102.

Parasites Biology
[12]

E. histolytica has amebapores, small peptides that plays a role in lytic and apoptotic

pathways, playing a role in killing intestinal epithelial cells, hepatocytes, and host defense
cells which may result to amebic liver abscess or amebic colitis
Stanley, S.L.J., Red, S.L.. 2001. American Journal of Physiology - Gastrointestinal and
Liver

Physiology.

280

(6);

G1049-G1054.

Retrieved

from:

http://ajpgi.physiology.org/ by 10.220.32.247 on January 11, 2017

Disease Pathogenesis
[13]

Amoebiasis is a human parasitic infection caused by Entamoeba histolytica

WHO, 1997. WHO/PAHO/UNESCO report of a meeting of experts on amebiasis. Mexico
City, Mexico, 28-29 January, 1997.Distributed at the 13th Seminar on Amebiasis.
World Health Organization. Geneva

VISCERAL PROTOZOA: FLAGELLATES

Giardia lamblia syn. Giardia duodenalis and Giardia intestinalis
Environmental factors

3 |R i s k F a c t o r s a n d B e h a v i o r s

[1] The recreational/environmental (except a swimming pool in Malaysia) and effluent water
types from these two countries were contaminated with waterborne parasites
Kumar, T., Onichandran, S., Lim, Y. A., Sawangjaroen, N., Ithoi, I., Andiappan, H.,
Nissapatorn, V. (2014). Comparative Study on Waterborne Parasites between
Malaysia and Thailand: A New Insight. American Journal of Tropical Medicine
and Hygiene, 90(4), 682-689. doi:10.4269/ajtmh.13-0266
[2] We conclude that children wearing nappies could be an important source of giardia
infection in the community.
Hoque, M. E., Hope, V. T., Scragg, R., Kjellstrm, T., & Lay-Yee, R. (2001). Nappy
handling

and

risk

of

giardiasis.

The

Lancet,

357(9261),

1017-1018.

doi:10.1016/s0140-6736(00)04251-3
Zoonotic factor
[3] Giardiasis was positively associated with the number of household cats
Pereira, M. D., Atwill, E. R., & Barbosa, A. P. (2007). Prevalence and associated risk factors
for Giardia lamblia infection among children hospitalized for diarrhea in Goinia,
Gois State, Brazil. Revista do Instituto de Medicina Tropical de So Paulo,
49(3), 139-145. doi:10.1590/s0036-46652007000300002
Environmental Factors
[4] Of the 10 Giardia-positive samples, 2 (20%) were in dill, 2 (20%) in lettuce, 3 (30%) in
mung bean sprouts, 1 (10%) in radish sprouts, and 2 (20%) in strawberries.
Robertson, L. J., & Gjerde, B. (2001). Occurrence of Parasites on Fruits and Vegetables in
Norway. Journal of Food Protection, 64(11), 1793-1798. doi:10.4315/0362-028x64.11.1793
[5] Giardia duodenalis isolates recovered from humans and dogs living in the same locality in
a remote tea-growing community of northeast India

4 |R i s k F a c t o r s a n d B e h a v i o r s

Traub, R. J., Monis, P. T., Robertson, I., Irwin, P., Mencke, N., & Thompson, R. C. (2004).
Epidemiological and molecular evidence supports the zoonotic transmission
of Giardia among humans and dogs living in the same community.
Parasitology, 128(3), 253-262. doi:10.1017/s0031182003004505
[6] The cluster of G. lamblia infections described here may have been transmitted by
homosexual contact, and suggests that this and other parasitic diseases
Meyers, J. D., Kuharic, H. A., & Holmes, K. K. (1977). Giardia lamblia infection in
homosexual

men.

Sexually

Transmitted

Infections,

53(1),

54-55.

doi:10.1136/sti.53.1.54
[7] Twenty-five other campers had stools examined before and after a subsequent hiking trip in
another area of Utah; none had Giardia cysts before, but 6 (24%) had them after return.
Burtscher, M. (1995). The Risk of Death to Trekkers and Hikers in the Mountains. JAMA:
The

Journal

of

the

American

Medical

Association,

273(6),

460.

doi:10.1001/jama.1995.03520300030031
[8] The risk of diarrhea was greater among those who frequently drank untreated water from
streams or ponds
Boulware, D. R., Forgey, W. W., & Martin, W. J. (2003). Medical risks of wilderness
hiking.

The

American

Journal

of

Medicine,

114(4),

288-293.

doi:10.1016/s0002-9343(02)01494-8
[9] Giardia cysts were detected in both treated and untreated water samples from the
Philippines, Malaysia, Vietnam, and Thailand
Kumar, T., Majid, M. A., Onichandran, S., Jaturas, N., Andiappan, H., Salibay, C. C.,
Nissapatorn, V. (2016). Presence of Cryptosporidium parvum and Giardia
lamblia in water samples from Southeast Asia: towards an integrated water
detection system. Infectious Diseases of Poverty, 5(1). doi:10.1186/s40249016-0095-z

5 |R i s k F a c t o r s a n d B e h a v i o r s

[10]

The occurrence and prevalence of giardiasis varied among the ages the highest risk

was seen in the young children, with a decreasing risk in older children and adults
Abbas, N. F., El-Shaikh, K. A., & Almohammady, M. S. (2011). Prevalence of Giardia
lamblia in diarrheic children in Almadinah Almunawarh, KSA. Journal of
Taibah University for Science, 5, 25-30. doi:10.1016/s1658-3655(12)60035-1
[11]

Study

showed

the

intestinal

parasites E.

histolytica,

G.

lamblia and A.

lumbricoides were found food-handlers

Kheirandish, F., Tarahi, M. J., & Ezatpour, B. (2014). Prevalence Of Intestinal Parasites
Among Food Handlers In Western Iran. Revista do Instituto de Medicina
Tropical

de

So

Paulo,

56(2),

111-114.

doi:10.1590/s0036-

46652014000200004
[12]

Giardia infection is significantly associated with not washing hands before eating,

not boiling water before consumption, bathing in the river, indiscriminate defecation, not
washing vegetables/fruits before consumption, not wearing shoes when outside, not
washing hands after playing with animals and indiscriminate garbage disposal
Choy, S. H., Al-Mekhlafi, H. M., Mahdy, M. A., Nasr, N. N., Sulaiman, M., Lim, Y. A.,
& Surin, J. (2014). Prevalence and Associated Risk Factors of Giardia
Infection among Indigenous Communities in Rural Malaysia. Scientific
Reports, 4, 6909. doi:10.1038/srep06909
[13]

Person-to-person transmission also played a role in causing non- outbreak-related

cases
Birkhead, G., & Vogt, R. L. (1989). Epidemiologic Surveillance For Endemic Giardia
Lamblia Infection In Vermont The Roles Of Waterborne And Person-ToPerson Transmission. American Journal of Epidemiology, 129(4), 762-768.
doi:10.1093/oxfordjournals.aje.a115191)

Trichomonas sp.
Host Factors
6 |R i s k F a c t o r s a n d B e h a v i o r s

[1] HIV-positive women have high risk in acquiring Trichomoniasis.

Sorvillo, F., Kovacs, A., Kerndt, P., Stek, A., Muderspach, L., & Sanchez-Keeland, L.
(1998). Risk factors for trichomoniasis among women with human
immunodeficiency virus (HIV) infection at a public clinic in Los Angeles
County, California: implications for HIV prevention. The American journal of
tropical

medicine

and

hygiene, 58(4),

495-500.

url:http://www.ajtmh.org/content/58/4/495.short
[2] There is a significant association of trichomoniasis with HIV infection and positive
serological test for syphilis.
Shuter, J., Bell, D., Graham, D., Holbrook, K. A., & Bellin, E. Y. (1998). Rates of and risk
factors for trichomoniasis among pregnant inmates in New York
City. Sexually

transmitted

diseases, 25(6),

303-307.

url:

http://journals.lww.com/stdjournal/Abstract/1998/07000/Rates_of_and_Risk_
Factors_for_Trichomoniasis_Among.6.aspx
Sociodemographic Factors
[3] T. vaginalis is associated with older age (3539 years) in women.
Helms, D. J., Mosure, D. J., Metcalf, C. A., Douglas Jr, J. M., Malotte, C. K., Paul, S. M.,
& Peterman, T. A. (2008). Risk factors for prevalent and incident Trichomonas
vaginalis among women attending three sexually transmitted disease
clinics. Sexually transmitted diseases, 35(5), 484-488. doi:
10.1097/OLQ.0b013e3181644b9c
[4] Black race is strongly associated with Trichomonas infection.
Sorvillo, F., Kovacs, A., Kerndt, P., Stek, A., Muderspach, L., & Sanchez-Keeland, L.
(1998). Risk factors for trichomoniasis among women with human
immunodeficiency virus (HIV) infection at a public clinic in Los Angeles
County, California: implications for HIV prevention. The American journal of
tropical

medicine

and

hygiene, 58(4),

http://www.ajtmh.org/content/58/4/495.short
7 |R i s k F a c t o r s a n d B e h a v i o r s

495-500.

url:

Risk Behavior
[5] Having

an

older

sex

partner

and

concurrent Neisseria

gonorrhoeae infection

are significant risk factors for T. vaginalis infection.

Krashin, J. W., Koumans, E. H., Bradshaw-Sydnor, A. C., Braxton, J. R., Secor, W. E.,
Sawyer, M. K., & Markowitz, L. E. (2010). Trichomonas vaginalis
prevalence, incidence, risk factors and antibiotic-resistance in an adolescent
population. Sexually

transmitted

diseases, 37(7),

440-444.

doi:

10.1097/OLQ.0b013e3181cfcd8c
[6] Being unmarried and having a higher number of sexual partners have high risks of
trichomoniasis.
Gertig, D. M., Kapiga, S. H., Shao, J. F., & Hunter, D. J. (1997). Risk factors for sexually
transmitted diseases among women attending family planning clinics in Dares-Salaam,

Tanzania. Genitourinary

medicine, 73(1),

39-43.

doi:10.1136/sti.73.1.39
[7] There is a significant association of trichomoniasis with crack use or cigarette use and
prostitution.
Shuter, J., Bell, D., Graham, D., Holbrook, K. A., & Bellin, E. Y. (1998). Rates of and risk
factors for trichomoniasis among pregnant inmates in New York
City. Sexually

transmitted

diseases, 25(6),

303-307.

url:

http://journals.lww.com/stdjournal/Abstract/1998/07000/Rates_of_and_Risk_
Factors_for_Trichomoniasis_Among.6.aspx
[8] Risk behavior of T. vaginalis infection in women were daily alcohol consumption.
Klinger, E. V., Kapiga, S. H., Sam, N. E., Aboud, S., Chen, C. Y., Ballard, R. C., & Larsen,
U. (2006). A Community-based study of risk factors for Trichomonas
vaginalis infection among women and their male partners in Moshi urban
district, northern Tanzania. Sexually transmitted diseases, 33(12), 712-718.
doi: 10.1097/01.olq.0000222667.42207.08
[9] Having less than 12 years of education is a risk factor for T. vaginalis infection.
8 |R i s k F a c t o r s a n d B e h a v i o r s

Helms, D. J., Mosure, D. J., Metcalf, C. A., Douglas Jr, J. M., Malotte, C. K., Paul, S. M.,
& Peterman, T. A. (2008). Risk factors for prevalent and incident Trichomonas
vaginalis among women attending three sexually transmitted disease
clinics. Sexually

transmitted

diseases, 35(5),

484-488.

doi:

10.1097/OLQ.0b013e3181644b9c
[10]

Lack of knowledge about STDs and marriage to a businessman is a risk factor for

Trichomoniasis in Chinese women.

Xueqiang, F., Yingzhi, Z., Yanfang, Y., Yutao, D., & Huiqing, L. (2007). Prevalence and
risk factors of trichomoniasis, bacterial vaginosis, and candidiasis for married
women of child-bearing age in rural Shandong. Japanese journal of infectious
diseases, 60(5), 257. url: http://www.nih.go.jp/niid/JJID/60/257.pdf

VISCERAL PROTOZOA: CILIATES

9 |R i s k F a c t o r s a n d B e h a v i o r s

Balantidium coli
Host Factors
[1] Infectious agent for Balantidiasis.
Leber, A. L., & Novak, S. M. (2007). Intestinal and Urogenital Amebae, Flagellates, and
Ciliates. In P. R. Murray, E. J. Baron, J. H. Jorgensen, M. A. Pfaller & M. L.
Landry (Eds.), Manual of Clinical Microbiology (9th ed., pp. 2092-2112).
Washington, DC.: ASM press.
Levine, N. D. (1961). Protozoan parasites of domestic animals and of man.
Murray, P. R., Baron, E. J., Jorgensen, J. H., Landry, M. L., & Pfaller, M. A. (Eds.).
(2007). Manual of Clinical Microbiology (9th ed.) American Society of
Microbiology Press.
Schuster, F. L., & Ramirez-Avila, L. (2008). Current world status of Balantidium
coli. Clinical Microbiology Reviews, 21(4), 626-638.
[2] B. coli is the only ciliated protozoon known to be pathogenic to humans. The most common
sites of B. coli infection (>95%) are the terminal ileum and colon, and specially the
rectosigmoid area.
Krauss, H., Weber, A., Appel, M., Enders, B., Isenberg, H. D., Schiefer, H. G., Slenczka,
W., Graevenitz, A. V., & Zahner, H. (2003). Parasitic zoonoses.Zoonoses:
Infectious Diseases Transmissible from Animals to Humans. (3rd ed., pp. 271273). Washington, DC, USA: ASM press.
Sociodemographic Factors
[3] Severe infections are rare but can sometimes cause death in undernourished and
immunocompromised populations The most severe symptoms of infection include anorexia,
weight loss, tenesmus, bloody stools, intestinal hemorrhage and perforation.
Leber, A. L., & Novak, S. M. (2007). Intestinal and Urogenital Amebae, Flagellates,
and Ciliates. In P. R. Murray, E. J. Baron, J. H. Jorgensen, M. A. Pfaller & M. L.
Landry (Eds.), Manual of Clinical Microbiology (9th ed., pp. 2092-2112).
Washington, DC.: ASM press.
[4] Transfer of balantidiasis between humans is possible by the spread of B. coli cysts through
fecal contamination of food or water supply, but occurrence is rare.
Schuster, F. L., & Visvesvara, G. S. (2004). Amebae and ciliated protozoa as causal
agents of waterborne zoonotic disease. Veterinary Parasitology, Dec 9;126(1-2),
91-120.
10 |R i s k F a c t o r s a n d B e h a v i o r s

Environmental Factors
[5] High prevalence is observed in areas where close contact with pigs or pig feces is common
such as farms and abattoirs.
Owen, I. L. (2005). Parasitic zoonoses in Papua New Guinea. Journal of
Helminthology, 79(1), 1-14.
Esteban, J. G., Aguirre, C., Angles, R., Ash, L. R., & Mas-Coma, S. (1998).
Balantidiasis in Aymara children from the northern Bolivian Altiplano. The
American Journal of Tropical Medicine and Hygiene, 59(6), 922-927.
Oberhuber, G., Karpitschka, G., & and Stolte, M. (1993). Balantidium coli: a rare cause
of colonic ulcer. European Journal of Gastroenterology and Hepatology, 5, 755757.
[6] Water is the primary disseminator of B. coli infections.
Schuster, F. L., & Ramirez-Avila, L. (2008). Current world status of Balantidium
coli. Clinical Microbiology Reviews, 21(4), 626-638.
[7] The protozoa can be inactivated by heat, radiation, low temperature storage and
desiccation.
Sobsey, M. D., & Leland, S. E. J. (2001). Antiprotozoan and Antihelmintic Agents. In
S. S. Block (Ed.), Disinfection, Sterilization and Preservation (5th ed., pp. 641657). Philadelphia, USA: Lippincott Williams and Wilkins.

Zoonotic Factors
[8] Host ranges from pigs, guinea-pigs, wild boars, horses, bovines, insects, fish, amphibians,
rats, chimpanzees, orangutans, dogs, and cats.
Leber, A. L., & Novak, S. M. (2007). Intestinal and Urogenital Amebae, Flagellates,
and Ciliates. In P. R. Murray, E. J. Baron, J. H. Jorgensen, M. A. Pfaller & M.
L. Landry (Eds.), Manual of Clinical Microbiology (9th ed., pp. 2092-2112).
Washington, DC.: ASM press.
Schuster, F. L., & Ramirez-Avila, L. (2008). Current world status of Balantidium
coli. Clinical Microbiology Reviews, 21(4), 626-638.

11 |R i s k F a c t o r s a n d B e h a v i o r s

Krauss, H., Weber, A., Appel, M., Enders, B., Isenberg, H. D., Schiefer, H. G.,
Slenczka, W., Graevenitz, A. V., & Zahner, H. (2003). Parasitic
zoonoses.Zoonoses: Infectious Diseases Transmissible from Animals to
Humans. (3rd ed., pp. 271-273). Washington, DC, USA: ASM press.
Dodd, L. (1991). Balanttidium coli Infestation as a cause of acute appendicitis. The
Journal of Infectious Diseases., 163, p1392.
[9] Rats can be carriers of the pathogen however, it is not clear if transmission to humans is
possible. Cockroachs may serve as a mechanical agent of transmission from feces to food.
Tatfeng, Y. M., Usuanlele, M. U., Orukpe, A., Digban, A. K., Okodua, M., Oviasogie,
F., & Turay, A. A. (2005). Mechanical transmission of pathogenic organisms:
the role of cockroaches. Journal of Vector Borne Diseases, 42(4), 129-134.

PATHOGENIC FREE-LIVING AMOEBA

Naegleria fowleri
Environmental factors
[1] Occurrence in various environmental sources such as warm freshwater (Jacuzzis, spas and
hot springs), soil, biofilms and dust
Ithoi I, AF Ahmad, V Nissapatorn, YL Lau, R Mahmud, JW Mak. 2011. Detection of
Naegleria species in environmental samples from Peninsular Malaysia. PLoS One,
e24327. DOI: 10.1371/journal.pone.0024327.
[2] History of nasal entry of water
12 |R i s k F a c t o r s a n d B e h a v i o r s

Baig AM. 2016. Primary Amoebic Meningoencephalitis: Neurochemotaxis and Neutropic

References of Naegleria fowleri. ACS Chemical Neuroscience; 40(30), 30-34.
DOI:10.1021/acschemneuro.6b00197
[3] Risk factors include recreational activities and religious practices
Siddiqui R, NA Khan. 2014. Primary Amoebic Meningoencephalitis Caused by Naegleria
fowleri: An Old Enemy Presenting New Challenges. PLoS Negl Trop Dis 8(8):
e3017. DOI:10.1371/journal.pntd.0003017
[4] Detected in fish brain
Dykov I, I Kyselov, H Peckov, M Obornk, J Lukes. 2001. Identity of Naegleria strains
isolated from organs of freshwater fishes. Diseases of aquatic organisms, 46, 115
121
[5] Inadequate chlorination of bulk water and biofilm in an operational drinking water
distribution
Miller HC, MJ Morgan, JT Wylie, AH Kaksonen, D Sutton, K Braun, GF Puzon. 2016.
Elimination of Naegleria fowleri from bulk water and biofilm in an operational
drinking water distribution system. Elsevier. Water Research; 110 (2017),15-26.
http://dx.doi.org/10.1016/j.watres.2016.11.061
[6] Presence of Naegleria fowleri amebae in mosque water is alarming. Ablution (Wudhu) is a
ritual performed by Muslims before offering prayers and involves thorough cleaning of
mouth, ears, face, arms, feet, and nasal passages, the latter by inhaling water forcefully up
the nostrils
Naija K, E Khan, A Khan, W. Muhammad, FR Malik, A Zafar. 2016. Naegleria fowleri
Meningoencephalitis associated with public water supply, Pakistan, 2014.
Emerging

Infectious

Diseases;

22

(10),

1835-1837.

http://dx.doi.org/10.3201/eid2210.151236
[7] Occurrence in countries such as Pakistan, temperatures can reach up to 50C, whereas
water temperatures are documented at 30 35C
Ruquiyyah, Siddiqui, KM Ibne. 2016. Biology and Pathogenesis of Naegleria fowleri. Acta
Tropica; 1-68. http://dx.doi.org/10.1016/j.actatropica.2016.09.009
Disease Pathogenesis
[8] Causing brain fatal disease called Primary Amoebic Meningoecephalitis (PAM)
Butt CG. 1966. Primary Amebic Meningioencephalitis. New England. Journal of Medicine,
274, 14731476.
[9] History of fever and eye gaze
13 |R i s k F a c t o r s a n d B e h a v i o r s

Movahedi Z, MR Shokrollahi, M Aghaali, H Heydari. 2012. Primary amoebic

meningoencephalitis in an Iranian infant. Case Reports in Medicine, 2012:782854.
[10]

DOI: 10.1155/2012/782854
Symptoms include positive Brudzinski sign, positive Kernig sign, cardiac rhythm

abnormalities and myocardial necrosis

Grace E, S Asbill, K Virga. 2015. Naegleria fowleri: Pathogenesis, diagnosis and treatment
options. Antimicrobial Agents and Chemotherapy. AAC ASM Org; 59(11), 66776681. DOI:10.1128/AAC.01293-15.
[11] Multiple episodes of vomiting, stiff neck, severe headache and fever
Naija K, E Khan, A Khan, W Muhammad, FR Malik, A Zafar. 2016. Naegleria fowleri
Meningoencephalitis associated with public water supply, Pakistan, 2014.
Emerging
[12]

Infectious

Diseases;

22

(10),

1835-1837.

http://dx.doi.org/10.3201/eid2210.151236
Lower oxygen consumption explains the presence of Naegleria fowleri
Weik RR, DT John.1979. Cell and mitochondria respiration of Naegleria fowleri. Journal of
Parasitology; 65,700-708

Healthcare Status
[13]

Absence of awareness, poor healthcare infrastructure, and unavailability of effective

drugs to counter this disease is a major health risk for these communities
Ruquiyyah, Siddiqui, KM Ibne. 2016. Biology and Pathogenesis of Naegleria fowleri. Acta
Tropica; 1-68. http://dx.doi.org/10.1016/j.actatropica.2016.09.009

Acanthamoeba spp.
Risk Behavior
[1] Improper use and hygiene of contact lenses
Fritsche, T. R., Gautom, R. K., Seyedirashti, S. E. Y. E. D. R. E. Z. A., Bergeron, D. L., &
Lindquist,

T. D.

(1993).

Occurrence

of

bacterial

endosymbionts

in

Acanthamoeba spp. isolated from corneal and environmental specimens and

contact lenses. Journal of clinical microbiology, 31(5), 1122-1126.
14 |R i s k F a c t o r s a n d B e h a v i o r s

Larkin, D. F., Kilvington, S., & Easty, D. L. (1990). Contamination of contact lens storage
cases by Acanthamoeba and bacteria. British Journal of Ophthalmology, 74(3),
133-135.
Seal, D., Stapleton, F., & Dart, J. (1992). Possible environmental sources of
Acanthamoeba

spp

in

contact

lens

wearers. British

Journal

of

Ophthalmology, 76(7), 424-427.

Ifejika, C. P., McLaughlin-Borlace, L., Lucas, V. J., Roberts, A. D. G., & Walker, J. T.
(2000). Efficacy of a contact lens cleaning device and its enhancement of the
performance

of

contact

lens

care

products. British

journal

of

ophthalmology, 84(5), 539-541.

Environmental Factor
[2] Exposure to organism often through contaminated water.
Ramirez, E., Campoy, E., Matuz, D., & Robles, E. (2006). Acanthamoeba isolated from
contaminated groundwater. Journal of Eukaryotic Microbiology, 53, S10.
Mubareka, S., Alfa, M., Harding, G. K., Booton, G., Ekins, M., & Caeseele, P. V. (2006).
Acanthamoeba species keratitis in a soft contact lens wearer molecularly linked
to well water. Canadian Journal of Infectious Diseases and Medical
Microbiology, 17(2), 120-122.
Legarreta, J. E., Nau, A. C., & Dhaliwal, D. K. (2013). Acanthamoeba keratitis associated
with tap water use during contact lens cleaning: manufacturer guidelines need to
change. Eye & contact lens, 39(2), 158-161.
Kilvington, S., Gray, T., Dart, J., Morlet, N., Beeching, J. R., Frazer, D. G., & Matheson,
M. (2004). Acanthamoeba keratitis: the role of domestic tap water contamination
in the United Kingdom. Investigative ophthalmology & visual science, 45(1),
165-169.
Rumelt, S., Cohen, I., Lefler, E., & Rehany, U. (2001). Corneal co-infection with
Scedosporium apiospermum and Acanthamoeba after sewage-contaminated
ocular injury. Cornea, 20(1), 112-116.
Host Factor
[3] Corneal Trauma
Garg, P., & Rao, G. N. (1999). Corneal ulcer: diagnosis and management. Community eye
health, 12(30), 256-262.
Van Klink, F., Alizadeh, H., He, Y. U. G. U. A. N. G., Mellon, J. A., Silvany, R. E.,
McCulley, J. P., & Niederkorn, J. Y. (1993). The role of contact lenses, trauma,

15 |R i s k F a c t o r s a n d B e h a v i o r s

and Langerhans cells in a Chinese hamster model of Acanthamoeba

keratitis. Investigative ophthalmology & visual science, 34(6), 1937-1944.
[4] History of Acanthamoeba spp.
Radford, C. F., Minassian, D. C., & Dart, J. K. G. (2002). Acanthamoeba keratitis in
England and Wales: incidence, outcome, and risk factors. British Journal of
Ophthalmology, 86(5), 536-542.
Heaselgrave W, Shama G, Andrew

PW,

Kong

MG.

2016.

Inactivation

of Acanthamoeba spp. and other ocular pathogens by application of cold

atmospheric

gas

plasma.

Appl

Environ

Microbiol

82:31433148.

doi:10.1128/AEM.03863-15.

[5] Effect of Low levels of Anti-Acanthamoeba IgA in tears.

Leher, H. F., Alizadeh, H., Taylor, W. M., Shea, A. S., Silvany, R. S., Van Klink, F., ... &
Niederkorn, J. Y. (1998). Role of mucosal IgA in the resistance to Acanthamoeba
keratitis. Investigative ophthalmology & visual science, 39(13), 2666-2673.
Niederkorn, J. Y., Alizadeh, H., Leher, H., Apte, S., El Agha, S., Ling, L., ... & McCulley,
J. P. (2002). Role of tear anti-acanthamoeba IgA in Acanthamoeba keratitis.
In Lacrimal Gland, Tear Film, and Dry Eye Syndromes 3 (pp. 845-850). Springer
US.
Cao, Z., Saravanan, C., Goldstein, M. H., Wu, H. K., Pasricha, G., Sharma, S., &
Panjwani, N. (2008). Effect of human tears on Acanthamoeba-induced cytopathic
effect. Archives of Ophthalmology, 126(3), 348-352.

Balamuthia mandrillaris
Disease Pathology
[1] Balamuthia amoebas (single-celled living organisms) are thought to enter the body when
soil containing Balamuthia comes in contact with skin wounds and cuts, or when dust
containing Balamuthia is breathed in or gets in the mouth. Once inside the body, the amebas
can then travel to the brain and cause Granulomatous Amebic Encephalitis (GAE).

16 |R i s k F a c t o r s a n d B e h a v i o r s

Visvesvara, G., Moura, H., & Schuster, F. (2007). Pathogenic and opportunistic freeliving amoebae:Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri,
and Sappinia diploidea. FEMS Immunology & Medical Microbiology, 50(1), 126. http://dx.doi.org/10.1111/j.1574-695x.2007.00232.x
[2] Balamuthia mandrillaris, was identified as the causal agent of granulomatous encephalitis
in humans and other animals. Initial reports of the disease in humans suggested that
immunosuppression or immunodeficiency was an important risk factor in determining
susceptibility. Most cases of Balamuthia encephalitis are diagnosed postmortem, based on
finding amebas in brain sections with hematoxylin-eosin or immunofluorescence staining.
Bakardjiev, A., Azimi, P., Ashouri, N., Ascher, D., Janner, D., & Schuster, F. et al. (2003).
Amebic encephalitis caused by Balamuthia mandrillaris: report of four cases.
The

Pediatric

Infectious

Disease

Journal,

22(5),

447-452.

http://dx.doi.org/10.1097/01.inf.0000066540.18671.f8
[3] B. mandillaris amoebae spread from a primary lesion through the blood and then penetrate
the bloodbrain barrier to gain access to the brain.
Maciver, S. (2007). The threat from Balamuthia mandrillaris. Journal Of Medical
Microbiology, 56(1), 1-3. http://dx.doi.org/10.1099/jmm.0.47011-0
Host Factor
[4] The earliest case descriptions in humans involved immunocompromised individuals,
including those with HIV infection/AIDS, alcohol and drug abusers, and individuals with
concurrent disease.
Verma, A. (2007). Successful Treatment of Balamuthia Amoebic Encephalitis:
Presentation of 2 Cases. Yearbook Of Neurology And Neurosurgery, 2007, 129130. http://dx.doi.org/10.1016/s0513-5117(08)70090-5
[5] Balamuthia amoebic encephalitis (BAE) can occur in healthy individuals, patients suffering
from human immunodeficiency virus infection, immunosuppressive therapy, alcoholism or
intravenous drug users are at risk, however, it is suggested that malnutrition may also be a
contributing factor.
[6] The risk factors for patients suffering from the above may include exposure to contaminated
water, working with garden soil, i.e., amoebae (cysts or trophozoites) enter through a lesion
in the skin or by inhalation and subsequently invade the bloodstream and spread
hematogenously to the brain or through olfactory nerve structures.
17 |R i s k F a c t o r s a n d B e h a v i o r s

Siddiqui, R. & Khan, N. (2008). Balamuthia amoebic encephalitis: An emerging disease

with

fatal

consequences.

Microbial

Pathogenesis,

http://dx.doi.org/10.1016/j.micpath.2007.06.008;

Matin, A.

44(2),

89-97.

et

(2008)

al.

Increasing importance of Balamuthia mandrillaris. Clin. Microbiol. Rev. 21,

435448
[7] B. mandrillaris is capable of causing skin lesions and GAE in individuals with
compromised or competent immune systems, who inhale infective spores or develop indolent,
granulomatous skin lesions in soil-contaminated wounds.
Diaz, J. (2011). Behavioral and Recreational Risk Factors for FreeLiving Amebic
Infections.

Journal

Of

Travel

Medicine,

18(2),

130-137.

http://dx.doi.org/10.1111/j.1708-8305.2011.00493.x
[8] Balamuthia infection might be more common among Hispanic Americans. However, the
cause of this trend is unknown and might be due to differences in exposure, biology, data
collection, or other reasons. More research is needed to understand what factors might be
associated with increased reporting among persons of Hispanic ethnicity.
Schuster, F., Glaser, C., Gilliam, S., & Visvesvara, G. (2001). Survey of Sera from
Encephalitis Patients for Balamuthia mandrillaris Antibody. Journal Of
Eukaryotic

Microbiology,

48,

10s-12s.

http://dx.doi.org/10.1111/j.1550-

7408.2001.tb00435.x
[9] Children and young adults are the most affected population, with the exception of Peruvian
cases, where at least 50% of patients are children.
Bravo, F. & Seas, C. (2012). Balamuthia mandrillaris Amoebic Encephalitis: An
Emerging Parasitic Infection. Current Infectious Disease Reports, 14(4), 391396.
Bravo, F.G. et al. (2011) Balamuthia mandrillaris infection of the skin and central
nervous system: an emerging disease of concern to many specialties in
medicine. Curr. Opin. Infect. Dis. 24, 112117
Bravo, F.G. et al. (2005) Cutaneous manifestations of infection by free living amebas,
with special emphasis on Balamuthia mandrillaris. In Tropical Dermatology
(Tyring, S.K. et al., eds), pp. 4956, Churchill Livingstone

18 |R i s k F a c t o r s a n d B e h a v i o r s

Environmental Factors
[10]

BAE is predominant in rural areas, and men are affected more often by BAE than

women are. It is also noteworthy that there are geographical similarities between the
Peruvian and Californian coastal areas, with alternating dry, sandy beach environments and
green valleys, and both regions have a higher number of reported BAE cases.
Diaz, J.H. (2011) The public health threat from Balamuthia mandrillaris in the southern
United States. J. La. State Med. Soc. 163, 197204; Moser, M.A. (2011) A
descriptive review of Balamuthia and nonkeratitis Acanthamoeba cases in the
United States, 19552009. Public Health Theses Paper 162

Sappinia spp.
Risk Behavior
[1] Only one case of human infection due to handling of grazing animals.
Gelman BB, Rauf SJ, Nader R, et al. (2001). Amoebic encephalitis due to Sappinia
diploidea. JAMA. 285 (19), 24501. doi:10.1001/jama.285.19.2450
Wylezich, C.; Walochnik, J.; Michel, R. (2009). "High genetic diversity of Sappinia-like
strains (Amoebozoa, Thecamoebidae) revealed by SSU rRNA investigations".
Parasitology research. 105 (3): 869873. doi:10.1007/s00436-009-1482-1

19 |R i s k F a c t o r s a n d B e h a v i o r s

Blood and Tissue Protozoa

Toxoplasma gondii
Risk Behavior
[1] Eating raw or undercooked meat contaminated with T. gondii or meats cross contaminated
with raw or undercooked meat
Jones Jeffrey L., Wilson M., McQuillan G., et al (2001) Toxoplasma gondii Infection
in the United States: Seroprevalence and Risk Factors. American Journal of
Epidemiology 154(4):357-365. doi: https://doi.org/10.1093/aje/154.4.357
[2] Ingesting oocyst of T. gondii though contact with soil without proper handwashing or after
gardening
Cook AJ, Gilbert RE, Buffolano W.

(2000) Sources of toxoplasma infection in

pregnant women: European multicentre case-control study. European

Research Network on Congenital Toxoplasmosis. British Medical Journal,
321(7254): 142-147. doi: http://dx.doi.org/10.1136/bmj.321.7254.142
[3] Acquisition of the parasite through eating of unwashed vegetables.
Marchioro Ariella A., Tiyo Bruna T., Colli Cristiane M.et al (2016) First Detection of
Toxoplasma gondii DNA in the fresh leaves of vegetables in south America.
Vector-Borne

and

Zoonotic

Diseases,

16(9):

624-626.

doi:10.1089/vbz.2015.1937.
[4] Owning cats seropositive with T. gondii and cleaning the cats litter box
Baril L, Ancelle T, Goulet V, et al (1999) Risk factors for Toxoplasma infection in
pregnancy: a case control study in France. US National Library of Medicine,
31(3):305-309

retrieved

from

https://www.ncbi.nlm.nih.gov/pubmed/10482062
[5] Consumption of unpasteurized goat milk from goats seropositive with T. gondii
Sacks JJ, Roberto RR, Brooks NF. (1982) Toxoplasmosis infection associated with
goats milk. Journal of American Medical Association. 248(14): 1728-1732
doi:10.1001/jama.1982.03330140038029

Host Factors

20 |R i s k F a c t o r s a n d B e h a v i o r s

[6] Congenital transmission of T. gondii from a pregnant woman to her child through the
placenta.
Saleh, M. M. S., AL-Shamiri, A. H., & Qaed, A. A. (2010). Seroprevalence and
Incidence of Toxoplasma gondii among Apparently Healthy and Visually or
Hearing Disabled Children in Taiz City, Yemen. The Korean Journal of
Parasitology,

48(1),

7173.

Retrieved

from

http://doi.org/10.3347/kjp.2010.48.1.71
[7] Having an immuno deficiency virus that makes the person immunocompromised
Wallace MR, Rossetti RJ, Olson PE. (1993) Cats and Toxoplasmosis risk in HIVinfected adults. Journal of American Medical Association. 269(1): 76-77 doi:
10.1001/jama.1993.03500010086037
Environmental Factors
[8] Seroprevalence on countries where climate favors the survival of T.gondii oocyst
Onadeko MO, Joynson DH, Payne RA. (1992) The prevalence of Toxoplasma
infection among pregnant women in Ibadan, Nigeria. Journal of Tropical
Medicine,

95(2):

143-146

retrieived

from

https://www.ncbi.nlm.nih.gov/pubmed/1560485
[9] Exposure to waters contaminated with T. gondii oocyst
Benenson MW, Takafuji ET, Lemon SM, et al (1982) Oocyst- transmitted
toxoplasmosis associated with ingestion of contaminated water. The new
England

Journal

of

Medicine,

10.1056/NEJM198209093071107

Cryptosporidium spp.
Risk Behaviors

21 |R i s k F a c t o r s a n d B e h a v i o r s

307(11):

665-669

doi:

[1] Children of >2-11 years of age have the greater risk for infection than older individuals
since they are probable surrogate for inadequate hygiene, fecal incontinence, and the need
for more assistance during illness particularly diarrhea.
MacKenzie, W. R., W. L. Schell, K. A. Blair, D. G. Addiss, D. E. Peterson, N. J. Hoxie, J.
J. Kazmierczak, and J. P. Davis. 1995. Massive outbreak of waterborne
Cryptosporidium infection in Milwaukee, Wisconsin: recurrence of illness and
risk of secondary transmission. Clin. Infect. Dis. 21:57-62.
[2] People in contact with infected cattle either by eating its undercooked meat or handling it
may be a risk factor for transmission of Crytosporidia from calves to humans.
Konkle, D. M., K. M. Nelson, and D. P. Lunn. 1997. Nosocomial transmission of
Cryptosporidium in a veterinary hospital. J. Vet. Intern. Med.11:340-343.
Sischo, W. M., E. R. Atwill, L. E. Lanyon, and J. George. 2000. Cryptosporidia on dairy
farms and the role these farms may have in contaminating surface water supplies
in the northeastern United States. Prev. Vet. Med. 43:253-267.
[3] Travel, particularly international travel, is a recognized risk factor for cryptosporidiosis.
Jokipii, L., S. Pohjolo, and A. M. Jokipii. 1985. Cryptosporidiosis associated with
traveling and giardiasis. Gastroenterology 89:838-842.
[4] Swimming in freshwater was a risk for sporadic disease. From 1991 through 2000, 90% of
recreational water cryptosporidiosis outbreaks reported to the CDC were associated with
swimming pools and water parks, whereas only 10% were associated with freshwater
venues.
Centers for Disease Control and Prevention. 1993. Surveillance for waterborne disease
outbreaksUnited States, 1991-1992. Morb. Mortal. Wkly. Rep. 42:1-22.
Centers for Disease Control and Prevention. 1996. Surveillance for waterborne disease
outbreaksUnited States, 1993-1994. Morb. Mortal. Wkly. Rep. 45:1-33
Centers for Disease Control and Prevention. 1998. Surveillance for waterborne disease
outbreaksUnited States, 1995-1996. Morb. Mortal. Wkly. Rep. 47:1-34.
Centers for Disease Control and Prevention. 2000. Surveillance for waterborne disease
outbreaksUnited States, 1997-1998. Morb. Mortal. Wkly. Rep. 49:1-36.
Centers for Disease Control and Prevention. 2002. Surveillance for waterborne disease
outbreaksUnited States, 1999-2000. Morb. Mortal. Wkly. Rep. 51:1-48.)
[5] Developed countries have found sexual behaviour patterns, immigrant status, pet
ownership especially dogs and farm animals, travel outside the country, toileting children
and some ethnic populations to be some of the risk factors associated with
cryptosporidiosis.

22 |R i s k F a c t o r s a n d B e h a v i o r s

Sorvillo F, Beall G, Turner PA, Beer VL, Kovacs AA, Kraus P, et al. Seasonality and
factors associated with cryptosporidiosis among individuals with HIV infection.
Epidemiol Infect. 1998;121:197204.
Sorvillo FJ, Lieb LE, Kerndt PR, Ash LR. Epidemiology of cryptosporidiosis among
persons with acquired immunodeficiency syndrome in Los Angeles County. Am
J Trop Med Hyg. 1994;51:32631.
Hunter PR, Hughes S, Woodhouse S, Syed Q, Verlander NQ, Chalmers RM, et al.
Sporadic cryptosporidiosis case-control study with genotyping. Emerg Infect
Dis. 2004;10:12419.
Environmental Factors
[6] The potential role of tap water in transmission of endemic cryptosporidiosis in
immunocompetent adults predicted a median annual risk of infection of approximately 1 in
1,000.
Perz, J. F., F. K. Ennever, and S. M. Le Blancq. 1998. Cryptosporidium in tap water:
comparison of predicted risks with observed levels of disease. Am. J.
Epidemiol. 147:289-301.
[7] Oocysts found on the surface of vegetables irrigated with waters evidently suggests that
fresh produce consumption is a risk factor, at least in outbreak situations.
Armon, R., D. Gold, M. Brodsky, and G. Oron. 2002. Surface and subsurface irrigation
with effluents of different qualities and presence of Cryptosporidium oocysts in
soil and on crops. Water Sci. Technol. 46:115-122.
Robertson, L. J., and B. Gjerde. 2001. Occurrence of parasites on fruits and vegetables in
Norway. J. Food Prot. 64:1793-1798.)
[8] Strong association of Cryptosporidium with environments was very conducive to human
fecal contamination due to lack of toilet or latrine
Bern C, Ortega Y, Checkley W, Roberts JM, Lescano AG, Cabrera L, Verastegui M,
Black RE, Sterling C, Gilman RH 2002. Epidemiologic differences between
cyclosporiasis and cryptosporidiosis in Peruvian children. Emerg Infect Dis 8:
581-585.
Host Factors

23 |R i s k F a c t o r s a n d B e h a v i o r s

[9] While the most common species associated with human cryptosporidiosis is C. hominis,
several studies indicate that immunocompromised individuals are susceptible to a wider
range of species and genotypes and that host factors may play a role in controlling
susceptibility to these divergent parasites.
Gatei W, Greensill J, Ashford RW, Cuevas LE, Parry CM, Cunliffe NA, et al. Molecular
analysis of the 18S rRNA gene of Cryptosporidium parasites from patients with
or without human immunodeficiency virus infections living in Kenya, Malawi,
Brazil, the United Kingdom, and Vietnam. J Clin Microbiol. 2003;41:145862.
Gatei W, Suputtamongkol Y, Waywa D, Ashford RW, Bailey JW, Greensill J, et al.
Zoonotic species of Cryptosporidium are as prevalent as the anthroponotic in
HIV-infected patients in Thailand. Ann Trop Med Parasitol. 2002;96:79780

Plasmodium sp.
Host factors
[1] Pregnant women are more susceptible to malaria, which is associated with serious adverse
effects on pregnancy. The presentation of malaria during pregnancy varies according to the
level of transmission in the area.
Adam, I., Khamis, A. H., and Elbashir, M.I. (2005). Prevalence and risk factors for
Plasmodium falciparum malaria in pregnant women of eastern Sudan. Malaria
Journal, 4(18). doi: 10.1186/1475-2875-4-18

24 |R i s k F a c t o r s a n d B e h a v i o r s

[2] The age of the patient directly influences the risk of severe manifestations with younger
ones capable of surviving from the disease.
Buffet,P.A., Safeukui, I., Deplaine, G., Brousse,V., Prendki,V., Thellier,M., Turner, G.D.,
and Puijalon, O.M. (2011). The pathogenesis of Plasmodium falciparum malaria
in humans: insights from splenic physiology. Blood, 117, 381-392. url:
https://doi.org/10.1182/blood-2010-04-202911
Hermentin, P. (1987). Malaria invasion of human erythrocytes. Parasitology Today, 3, 5255. url: http://dx.doi.org/10.1016/0169-4758(87)90214-6
Schwartz, E., Sadetzki, S., Murad, H., and Raveh, D. (2001). Age as a Risk Factor for
Severe Plasmodium falciparum Malaria in Nonimmune Patients. Clin Infect
Dis., 33(10), 1774-1777. doi: 10.1086/322522
[3] Prevalence of anaemia is significantly associated with Plasmodium vivax infection during
pregnancy and in delivering women.
Sohail,M., Shakeel, S., Kumari, S., Bharti, A., Zahid, F., Anwar, S., Singh, K.P., Islam,
M., Sharma, A.K., Lata, S., Ali, V., Adak, T., Das, P., and Raziuddin, M.
(2015). Prevalence of Malaria Infection and Risk Factors Associated with
Anaemia among Pregnant Women in Semiurban Community of Hazaribag,
Jharkhand,

India.

BioMed

Research

International

2015.

url:

http://dx.doi.org/10.1155/2015/740512
[4] The protective effect of HbAS was remarkably specific for falciparum malaria, having no
significant impact on any other disease. HbAS had no effect on the prevalence of
symptomless parasitemia but was 50% protective against mild clinical malaria, 75%
protective against admission to the hospital for malaria, and almost 90% protective against
severe or complicated malaria.
Williams, T.N., Mwangi, T.W., Wambua, S., Alexander, N.D., Kortok, M., Snow, R.W.,
and Marsh, K. (2005). Sickle Cell Trait and the Risk of Plasmodium
falciparum Malaria and Other Childhood Diseases. J Infect Dis. 192(1), 178186. doi: 10.1086/430744
Zoonotic Factor
[5] Anopheles sp. mosquitoes carry Plasmodium spp.
Luchavez, J., Espino,F., Curameng,P., Espina,R., Bell,D., Chiodini,P., Nolder,D.,
Sutherland,C., Lee,K.S., and Singh,B. (2008). Human Infections with
25 |R i s k F a c t o r s a n d B e h a v i o r s

Plasmodium knowlesi, the Philippines. Emerg Infect Dis., 14(5), 811813. url:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600254/
Russell, P.F.(1936). Epidemiology of Malaria in the Philippines. American Journal of
Public Health and the Nations Health, 26(1), 1-7. doi: 10.2105/AJPH.26.1.1
Salim, N., Knopp,S., Lweno, O., Abdul, U., Mohamed,A., Schindler, T., Rothen,J.,
Masimba, J., Kwaba,D., Mohammed, A.S., Althaus, F., Abdulla, S., Tanner, M.,
Daubenberger,C., and Genton, B. (2015). Distribution and Risk Factors for
Plasmodium and Helminth Co-infections: A Cross-Sectional Survey among
Children in Bagamoyo District, Coastal Region of Tanzania. PLoS Negl Trop
Dis., 9(4). doi: 10.1371/journal.pntd.0003660
Environmental factors
[6] Education towards Plasmodium spp. infection and breeding grounds is crucial in terms of
lessening the malaria cases
Habibi, M., Yudhastuti, R., Basuki, S. (2015). Risk Factor of Plasmodium Infection in
Endemic Area. International Journal of Advanced Engineering Research and
Science

(IJAERS),

2(7),

url:

http://www.academia.edu/14489967/Risk_Factor_of_Plasmodium_Infection_in
_Endemic_Area
Dacuma, M.G., Dimalibot, J., Yadao, F., Yasaa, A., Bona, E., Notario, W., and Hallett, R.
(2012). Estimating malaria transmission in Sarangani Province, the Philippines
using serological markers of infection. Malaria Journal, 11(1), P20. url:
http://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-11-S1P20
Disease Pathology
[7] Clinical illness develops during the blood-stage, and the great majority of drugs target this
developmental stage. An important feature of Plasmodium vivax, which differs from
Plasmodium falciparum, is the occurrence of dormant hypnozoites in the liver that can
reactivate weeks, months or years later to initiate new episodes of blood-stage infection,
presenting a major challenge to treatment, control and elimination.
Ashley, E.A. and White, N.J. (2014). The duration of Plasmodium falciparum infections.
Malaria Journal, I. doi: 10.1186/1475-2875-13-500
26 |R i s k F a c t o r s a n d B e h a v i o r s

Beeson, J. G. Chu, C.S., Richards, J.S., Nosten, F., Fowkes, F.J.I. (2015). Plasmodium
vivax Malaria: Challenges in diagnosis, treatment and elimination. Pediatric
Infectious

Disease

Journal,

34(5),

529531.

url:

http://journals.lww.com/pidj/Fulltext/2015/05000/Plasmodium_vivax_Malaria
__Challenges_in_diagnosis,.19.aspx
Mackintosh, C. L., Beeson, J. G., & Marsh, K. (2004). Clinical features and pathogenesis
of

severe

malaria.

Trends

in

Parasitology,

20,

597-603.

url:

http://dx.doi.org/10.1016/j.pt.2004.09.006
Pinsent, A., Read, J.M., Griffin, J.T., Smith, V., Gething, P.W., Ghani, A.Z., Pasvol, G.,
and Hollingsworth, T.D. (2014) . Risk factors for UK Plasmodium falciparum
cases. Malaria Journal, 13(298). doi: 10.1186/1475-2875-13-298

27 |R i s k F a c t o r s a n d B e h a v i o r s