para>The FDA considers certain uses of these drugs investigational. Some may not be available in the United States. DEC is not available in United States; must be obtained through CDC Drug Service, 404-718-4745. ‚
Second Line
- Filariasis (W. bancrofti, B. malayi)
- Ivermectin: 150 Ž ¼g/kg PO once is highly effective against microfilaria but does not kill adult worms.
- Doxycycline 200 mg/day PO for 6 weeks (6)[A]
- Onchocerciasis: doxycycline 200 mg/day PO for 6 weeks plus ivermectin 150 Ž ¼g/kg PO 1 dose 1 week prior (1)[A]
- Toxocariasis: VLM: DEC 3 to 4 mg/kg/day for 21 days or thiabendazole 50 mg/kg/day for 3 to 7 days (5)[A]
SURGERY/OTHER PROCEDURES
- Chronic lymphatic filariasis may require surgical intervention to increase lymphatic drainage.
- Ocular larval migrans may require surgery for retinal detachment or intravitreal fibrovascular membrane proliferation.
ONGOING CARE
FOLLOW-UP RECOMMENDATIONS
Patient Monitoring
Long-term DEC treatment and immunomonitoring of patients with filarial infection are essential in endemic areas to stop spread and avoid comorbidity. ‚
DIET
Avoid contaminated food and water " ”undercooked meats and unwashed raw fruits and vegetables. ‚
PATIENT EDUCATION
- Avoid arthropod bites, use insect repellents and other protective measures (e.g., proper clothing).
- Avoid infected rivers, streams, soil, and foods.
PROGNOSIS
- Good for light to moderate infections
- Depends on organ infected and extent of infection
COMPLICATIONS
- Visceral worms: hepatitis, splenomegaly, pleuritis, peritonitis, eosinophilic granuloma, or other organ damage
- Neurohelminthiasis: CNS migrations and infection (eosinophilic meningitis)
REFERENCES
11 Centers for Disease Control and Prevention. DPDx: laboratory identification of parasitic diseases of public health concern. http://www.cdc.gov/dpdx/22 Gyapong ‚ JO, Kumaraswami ‚ V, Biswas ‚ G, et al. Treatment strategies underpinning the global programme to eliminate lymphatic filariasis. Expert Opin Pharmacother. 2005;6(2):179 " “200.33 Debrah ‚ AW, Specht ‚ S, Klarmann-Schulz ‚ U, et al. Doxycycline leads to sterility and enhanced killing of female Onchocerca volvulus worms in an area with persistent microfilaridermia after repeated ivermectin treatment: a randomized, placebo-controlled, double-blind trial. Clin Infect Dis. 2015;61(4):517 " “526.44 Coulibaly ‚ YI, Dembele ‚ B, Diallo ‚ AA, et al. A randomized trial of doxycycline for Mansonella perstans infection. N Engl J Med. 2009;361(15):1448 " “1458.55 Ahn ‚ SJ, Ryoo ‚ NK, Woo ‚ SJ. Ocular toxocariasis: clinical features, diagnosis, treatment, and prevention. Asia Pac Allergy. 2014;4(3):134 " “141.66 Mand ‚ S, Debrah ‚ AY, Klarmann ‚ U, et al. Doxycycline improves filarial lymphedema independent of active filarial infection: a randomized controlled trial. Clin Infect Dis. 2012;55(5):621 " “630.
ADDITIONAL READING
- Hopkins ‚ DR, Richards ‚ FOJr, Ruiz-Tiben ‚ E, et al. Dracunculiasis, onchocerciasis, schistosomiasis, and trachoma. Ann N Y Acad Sci. 2008;1136:45 " “52.
- Lee ‚ RM, Moore ‚ LB, Bottazzi ‚ ME, et al. Toxocariasis in North America: a systematic review. PLoS Negl Trop Dis. 2014;8(8):e3116.
- Mendoza ‚ N, Li ‚ A, Gill ‚ A, et al. Filariasis: diagnosis and treatment. Dermatol Ther. 2009;22(6):475 " “490.
- Schuster ‚ A, Lesshafft ‚ H, Reichert ‚ F, et al. Hookworm-related cutaneous larva migrans in northern Brazil: resolution of clinical pathology after a single dose of ivermectin. Clin Infect Dis. 2013;57(8):1155 " “1157.
- Winthrop ‚ KL, Furtado ‚ JM, Silva ‚ JC, et al. River blindness: an old disease on the brink of elimination and control. J Glob Infect Dis. 2011;3(2):151 " “155.
- Woodhall ‚ DM, Eberhard ‚ ML, Parise ‚ ME. Neglected parasitic infections in the United States: toxocariasis. Am J Trop Med Hyg. 2014;90(5):810 " “813.
- Woodhall ‚ DM, Fiore ‚ AE. Toxocariasis: a review for pediatricians. J Pediatric Infect Dis Soc. 2014;3(2):154 " “159.
SEE ALSO
Roundworms, Intestinal ‚
CODES
ICD10
- B77.9 Ascariasis, unspecified
- B74.0 Filariasis due to Wuchereria bancrofti
- B74.3 Loiasis
- B74.2 Filariasis due to Brugia timori
- B74.1 Filariasis due to Brugia malayi
- B73.00 Onchocerciasis with eye involvement, unspecified
- B77.89 Ascariasis with other complications
ICD9
- 127.0 Ascariasis
- 125.0 Bancroftian filariasis
- 125.2 Loiasis
- 125.6 Other specified filariasis
- 125.1 Malayan filariasis
- 125.3 Onchocerciasis
SNOMED
- Ascariasis (disorder)
- infection by Wuchereria bancrofti (disorder)
- Infection by Loa loa (disorder)
- Filariasis due to Brugia timori (disorder)
- Infection by Brugia malayi (disorder)
- Timorian filariasis (disorder)
- Ocular onchocerciasis (disorder)
- Larval ascariasis (disorder)
CLINICAL PEARLS
- Roundworms can take up to a year to mature and may survive up to 15 years in human hosts.
- Arthropod vector control and avoiding contaminated water or food are primary means to prevent infection.
- Antigen tests have improved diagnostic capability.
- Weekly DEC 300 mg is effective for prophylaxis against L. loa.
- DEC plus albendazole can be used for prophylaxis against lymphatic filariasis. Ivermectin plus albendazole should be used in areas where onchocerciasis is coendemic.