Parasite Consequence if left untreated / Clinical Diagnosis Treatment
The majority of infections with A. lumbricoides are asymptomatic, and symptoms are
largely restricted to individuals with a high worm load
Adult worms do not multiply in the human host, so the number of adult worms per
infected person relates to the degree of continued exposure to infectious eggs over time.
Untreated intestinal obstruction (IO) may lead to bowel necrosis, peritonitis, sepsis, and
single dose seems to have similar results.
In younger children and in those with a heavy worm burden, symptoms may be caused by either partial or total IO.
(11 mg/kg up to a maximum of 1 g) is administered as a
Migrating worms have also been reported to cause intestinal perforation.
single dose. Efficacy varies with worm load, but single dose therapy is approximately 90 % effective in
Migration of a single adult worm may obstruct the biliary tree, leading to biliary colic,
The spectrum of clinical disease includes asymptomatic infection, self-limited acute
giardiasis, and chronic infection. The virulence of the giardial isolate, the parasite load,
divided into three doses for five to seven
the host immune response, and perhaps other host determinants probably all contribute
the manifestations in an individual patient.
semiformed or formed stool probably will contain only
Giardia can be asymptomatic, but acute infection may symptomatic (loose, watery stools,
with a certain foul-smelling greasy, floaty quality, flatulence, cramps, bloating, and
children three years of age or older and
Chronic giardiasis may follow the acute phase of illness or may develop without an
antecedent acute illness. In one study, 84 % of experimentally infected people self-cured
by a mean of 18.4 days after inoculation, whereas the remainder became chronically
children) of tinidazole has an efficacy of
infected. A chronic syndrome that can develop in as many as 30 to 50 % of symptomatic
patients. Chronic giardia may be associated with significant weight loss and failure-to-
side effects]. Tinidazole has been found
thrive. It also can cause secondary lactase deficiency - interfering with the intestine's
but currently is only available in tablet form. Preliminary in vitro data suggest
Acute giardiasis occurs in less than half of people infected with Giardia.
that newer nitroimidazole antibiotics in
Occasionally, hypersensitivity phenomena such as rash, urticaria, aphthous ulceration,
and reactive arthritis or synovitis are seen in giardiasis, although these manifestations
are rare. G. lamblia also can spread uncommonly from the duodenum to the biliary and
pancreatic ducts. Cases of cholecystitis, cholangitis, and granulomatous hepatitis caused
by this pathogen have been reported. Impaired exocrine pancreatic function with
diminished secretion of trypsin and lipase has been noted.
daily for five days) had an efficacy of 97
in Bangladesh ]. It also was as effective
effects, in two other pediatric studies of
suspension. However, there have been conflicting reports about its benefit in
Most infections with E. vermicularis are asymptomatic. Symptoms can be attributed to
mechanical stimulation and irritation, allergic manifestations, or transportation of
results in a mean cure rate of 95 %, but
organisms to sites where they become pathogenic
a second dose is often given after one to two weeks to help prevent recurrences due to reinfection.
Albendazole is given at a dose of 100 mg if the patient is less than two years old or 400 mg if older. A single dose albendazole repeated at two weeks achieves a cure rate close to 100 %.
Most infections with T. trichiura are asymptomatic. Clinical symptoms are more frequent
a single dose) [. However, in heavy infections, a three-day regimen of
Can lead to diarrhea, and rectal prolapse. Those who are heavily infected may also
often have impaired growth and impaired cognition
albendazole (400 mg QD) should be considered instead.
Strongyloides Most infected patients do not experience prominent symptoms. The most common
manifestations are mild waxing and waning gastrointestinal, cutaneous, or pulmonary
symptoms that persist for years; others simply have eosinophilia in the absence of
although clinical experience is limited.
Immune suppression (high dose exogenous steroid administration) may lead to
hyperinfection that has a high case-fatality rate.
examinations can fail to detect Strongyloides.
Highly sensitive and specific ELISA serology has proven valuable in detecting both symptomatic and asymptomatic strongyloides.
Transpulmonary passage (cough during the time larvae are migrating in the airways,
eosinophilic pulmonary infiltrates typical of Ascaris pulmonary involvement are rare;
Acute gastrointestinal symptoms (nausea, diarrhea, vomiting, abdominal pain)
excretion does not become detectable until about two
Chronic nutritional impact — The major impact of hookworm infection is on the nutritional
status of the patient, especially of marginally nourished children and pregnant women.
The daily losses of blood, iron, and albumin, especially in patients with heavy infections,
can lead to hookworm anemia and contribute to impaired nutrition - effecting growth,
examinations are insensitive for detecting hookworm
infections [ and, in such patients, eosinophilia may be the only clue that the patient harbors a parasitic infection. The degree of eosinophilia with hookworm infection is usually mild and varies during the course of the disease.
The anti-parasite drug line-up
(11 mg/kg up to a maximum of 1 g) is administered as a single dose. Adverse effects include gastrointestinal (GI) disturbances, headaches, rash, and fever. It can lead to adverse reactions including anorexia, nausea, vomiting, abdominal cramps, and diarrhea, and is also associated with neurotoxic effects and transient increases in hepatic enzymes. Usually reserved for treatment of strongyloides hyperinfection.
(100 mg BID for 3 days or 500 mg as a single dose) is an alternative. Adverse effects include transient GI discomfort, headache, and rarely leukopenia. The three-day regimen is approximately 95 % effective, and the single dose seems to have similar results.
Albendazole — A single dose of (400 mg) Similar side effects as mebendazole. Metronidazole (30 to 40 mg/kg per day divided into three doses for five to seven days) has an efficacy of 80 to 95 %. Side effects include nausea, headache, and a metallic taste in the mouth; less commonly, dark urine, paresthesias, and dizziness occur.
Overmectin – 200 mcg/kg as a single dose. May cause cutaneous and/or systemic reactions (Mazzoti reaction) of varying severity including ophthalmological reactions in patients with onchocerciasis. Pretreatment assessment for Loa loa infection is recommended in any patient with significant exposure to endemic areas (West and Central Africa); serious and/or fatal encephalopathy has been reported during treatment in patients with loiasis. Safety and efficacy in children <15 kg have not be established.
Review of Studies on Parasite Infections among Immigrant / Refugee Children
Location n Immigrant Prevalence Trichuriasis countries of parasite of origin infection
58% protozoa total 3% kids w multiple helminths 2% ascaris 334% Blastocystis hominis 1% hookworm 9% Entamoeba coli 56% in adults
presence of Strongyloides or Schistosoma.
1% ascariasis Highest in Sudan, Liberia, Somalia, Vietnam, Ethiopia
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