Soil-transmitted helminthes
Background
Clinical Features
- Includes Ascaris roundworm, whipworm, and hookworms
- Morbidity is related to number of worms harbored in intestines
- Light infections often asymptomatic
- Heavier infections with variety of manifestations including GI symptoms (abdominal pain, diarrhea, blood in stool, rectal prolapse), malaise, weakness, impaired cognitive / physical development, malnutrition[1]</ref>
- Hookworm and whipworm infestations also cause iron-deficiency anemia
- Adult worms attach to intestinal wall to feed, causing ongoing luminal blood loss
- Löffler’s syndrome
- Result of Ascaris or hookworm larval transit through the lungs
- Characterized by persistent non-productive cough, chest pain, wheezing, rales, pulmonary infiltrates on CXR and marked eosinophilia
Differential Diagnosis
Workup
Management
- Ascaris: albendazole 400 mg x 1 dose OR mebendazole 100 mg BID x 3 days (both high efficacy)
- Whipworm (Trichuris): albendazole 400 mg x 1 dose
- Historically treated with albendazole or mebendazole, but monotherapy has low efficacy against Trichuris especially in heavy infections; higher cure rate achieved with oxantel pamoate-albendazole combination compared to any monotherapy in recent RCT [2]
- Hookworm: albendazole 400 mg x 1 dose (high efficacy) OR mebendazole 500 mg x 1 dose (low to moderate efficacy)
- Iron supplements in anemia