Zoonotic Pathogens in Ixodes scapularis, Michigan

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 7, July 2007 1131 and vinegar mixture, locally known as kinilaw. Other methods of fi sh preparation were tinola (boiled), ginataan (stewed in coconut milk), and sinugba (charcoal-grilled). All echinostomeinfected patients had a history of having eaten snails, kuhol and kiambu-ay, prepared raw with coconut milk and lime juice (kinilaw), especially when found in greater abundance during the rainy season. Human echinostome infection results from ingestion of metacercariae that encyst in secondary intermediate hosts, usually freshwater snails, tadpoles, or fi sh. E. malayanum uses various species of gastropod mollusks for primary and secondary intermediate developmental stages (2–5). Certain species of fi sh may also serve as secondary intermediate hosts (2). Several mollusks that may serve as primary and secondary intermediate hosts have been identifi ed in the Philippines, including Lymnaea (Bullastra) cumingiana, Radix quadrasi, and Physastra hungerfordiana for E. malayanum, and Pila luzonica for E. ilocanum (6,7). To our knowledge, this is the fi rst report of E. malayanum infections in the southern Philippines. Local eating habits are a strong factor in echinostome infections. The general lack of awareness by health staff and the community was a big factor in the poor identifi cation of the disease. Clinical and laboratory staff and healthcare providers need training about echinostome infections and other intestinal foodborne trematode infections. Similar environmental, sanitary, and eating practices in the region suggest that the same parasitoses should be considered to be widespread in the area. Redirecting vital resources of the local health and government units of the Caraga region to the periphery and building local capacity will help empower authorities to provide public health services in rural areas, strengthen public health programs, and further develop public health infrastructure. Moreover, a successful control program against chronic intestinal parasitoses could serve as a paradigm for local health system development of effective control measures for other endemic diseases.