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Common Worm Infestations in Children Dr Nishant Verma Department of Pediatrics
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Burden of disease Neglected Tropical Diseases (NTDs) are the most common diseases of the world’s poor. These diseases disable and debilitate one in six people worldwide, including half a billion children. The 7 Most Common NTDs 1.Ascariasis 2.Hookworm 3.Lymphatic Filariasis 4.Onchocerciasis 5.Schistosomiasis 6.Trichuriasis 7.Trachoma
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For just 50 cents, treatment can be provided to a person against seven NTDs for an entire year The 7 Most Common NTDs 1.Ascariasis 2.Hookworm 3.Lymphatic Filariasis 4.Onchocerciasis 5.Schistosomiasis 6.Trichuriasis 7.Trachoma
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Ascaris lumbricoides Enterobius vermicularis Hook worm Trichuris trichiura Brugia malayi Wuchereria bancrofti Schistosoma Clonorchis Fasciola hepatica Taenia solium Taenia saginata Echinococcus Diphyllobothrium latum
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Ascaris lumbricoides – Life cycle
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C/F – Abdominal Pain, distension, vomiting Passage of worms in stool/vomitus Obstruction – Pulmonary: Loeffler syndrome – Growth failure Ascaris lumbricoides
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Diagnosis – Eggs in stool sample – Worms in stool / vomitus – Imaging Treatment Ascaris lumbricoides Albendazole 400 mg Once (Taken with food) Other options Mebendazole Ivermectin Nitazoxanide
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Enterobius vermicularis (Pin Worm) Peri-anal itching More at night
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Diagnosis – Stool microsopy: not useful – Eggs can be demonstrated in peri anal swabs collected early morning – Sticky tape on a tongue depressor Treatment Enterobius vermicularis (Pin Worm) Albendazole 400 mg Once, repeat in 2wk Other options Mebendazole Pyrantel Treat entire family
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Hook worm Ancylostoma duodenale / Necator americanus
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Hook worm C/F – Ground itch – Abdominal pain, anorexia – Iron deficiency anemia – Hypoproteinemia Dx – Stool microscopy – Peripheral smear Treatment Albendazole 400 mg Once Other options Mebendazole Pyrantel Oral Iron therapy
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Filariasis Wuchereria bancrofti, Brugia malayi, B. timori
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Filariasis C/F – Most remain asymptomatic – IP: 8-16months – Episodes of Fever, lymphangitis, lymphadenitis – Last for 7-10d – 8-10 episodes/yr – Tropical Pulmonary Eosinophilia – Chronic stage: Lymphatic obstruction > 25yr age Lymphedema / Elephantiasis
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Filariasis Dx – Mf identified in thick blood film – Nocturnal periodicity – Adult worm in LN biopsy Treatment Prevention Di –Ethyl-Carbamazine (DEC) 6mg/kg /day q8hr for 12 days Other options Single dose Ivermectin Ivermectin + Albendazole
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Echinococcosis Cystic EchinococcosisAlveolar Echinococcosis Echinococcus granulosus, E. multilocularis
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Echinococcosis C/F – Site and mass effect of the cyst – Rupture: fever, anaphylaxis
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Echinococcosis Diagnosis – Imaging – Serology: Sensitive, not specific Treatment Surgical Complete removal USG/CT guided Percutaneous Aspiration, Instillation of hypertonic saline, Reaspiration (PAIR) Medical Albendazole 15mg/kg/day for 2wk May require repeated courses Monitor by serial USG
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Taeniasis Pork Tapeworm Beef Tapeworm Taenia solium Taenia saginata
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Taeniasis
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C/F – Mild epigastric discomfort, nausea, flatulence, diarrhea Dx – Microscopic identification of eggs and proglottids in feces Treatment Praziquantel 5-10mg/kg single dose Alternative option Niclosamide 50mg/kg single dose
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Cysticercosis
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Neurocysticercosis C/F – Depends on site and number of cysts – Seizures, headache – Cysticercal encephalitis Dx – Neuroimaging – Diff from tuberculoma
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Neurocysticercosis Treatment – Anticonvulsants – Albendazole If active lesions on imaging 15mg/kg/day for 7-28 days Adjunctive steroids – Relative C/I for albendazole Intraocular cysts Intraventricular cysts Spinal cysts Prevention
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