Abstract

We analyzed results of 216,275 stool specimens examined by the state diagnostic laboratories in 1987; parasites were found in 20.1%. Percentages were highest for protozoans: Giardia lamblia (7.2%), Entamoeba coli and Endolimax nana (4.2% each), Blastocystis hominis (2.6%), Entamoeba histolytica (0.9%), and Cryptosporidium species (0.2%). Identifications of Giardia lamblia increased broadly from the 4.0% average found in 1979, with 40 states reporting increases and seven decreases. Most states that identified Giardia in more than 9% of specimens were located around the Great Lakes or in the Northwest. Seasonally, Giardia identifications increased in the summer and fall, especially in northern states. The most identified helminths were nematodes: hookworm (1.5%), Trichuris trichiura (1.2%), and Ascaris lumbricoides (0.8%). Other less commonly identified helminths included Clonorchis and Opisthorchis species (0.6%), Strongyloides stercoralis (0.4%), Hymenolepis nana (0.4%), Enterobius vermicularis (0.4%), and Taenia species (0.1%). Tape tests for Enterobius, reported for 35 states, were positive for 11.4% of 9,597 specimens. Nine states (California, Colorado, Hawaii, Idaho, New Jersey, Oregon, Rhode Island, Washington, Wisconsin) reported hookworms in more than 2% of specimens; none were states traditionally associated with indigenous transmission. Cryptosporidium diagnoses, reported by 25 of 49 states, were recorded for the first time in a national survey and showed no marked regional clustering. The Giardia data revealed changes in rates of identification and in geographic patterns compared with state laboratory data collected a decade earlier (1976-1978).