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TREATMENTS-Helminths, Protozoa - Coggle Diagram

- - - - Benznidazole S/E: Allergic dermatitis, peripheral neuropathy, anorexia & weight loss, insomnia
      - Nifurtimox S/E: Anorexia, weight loss, Polyneuropathy, Nausea, Vomiting, Vertigo/Dizziness, Headache
  - - - T.Gambiense Stage 1: Pentamidine generally well-tolerated but may cause hypotension, hypoglycemia, injection site pain, nausea, D&V
      - T.Gambiense Stage 2: NECT (nifurtimox-eflornithine combination therapy). The combination regimen more effective and less toxic than eflornithine monotherapy. S/E Efnoflorine: fever, pruritus, HTN, nausea, D&V, abdominal pain, headaches, myelosuppression, rarely seizures.
      - 2019 WHO interim guidelines for HAT.
        Fexinidazole, a recently approved new medicine!!
    - - T.b. Rhodesiense Stage 1:SuRamin ( would for both species but we don't use it for gambiense because of the risk of severe adverse reactions in patients co-infected with onchocerciasis, which can occur in T. b. gambiense-endemic areas). Adverse reactions to suramin in T. b. rhodesiense are frequent, but usually mild / reversible: drug rash, nephrotoxicity, peripheral neuropathy. In rare instances, suramin administration results in a hypersensitivity reaction, and, for this reason, a small test dose is usually given prior to the full first dose.
      - T.b.Rhodesiense Stage 2: MelarsoPRol, an organoarsenic compound. Adverse reactions can be severe and life-threatening. 5-10% - Encephalopathic reaction (50% case fatality) Prednisolone to reduce the risk of encephalopathy. Other S/E: GI + skin reactions, pyrexia, peripheral neuropathy. IV injections of melarsoprol are painful and can cause phlebitis.
  - - - Visceral leishmaniasis (VL), also known as kala-azar, is fatal if left untreated in over 95% of cases. It is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia. Most cases occur in Brazil, east Africa and India
      - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862432/
      - https://www.cdc.gov/parasites/leishmaniasis/health_professionals/index.html#:~:text=Liposomal%20amphotericin%20B%20is%20FDA,treatment%20of%20choice%20for%20U.S.
      - liposomal amphotericin B (AmBisome®), which is administered by IV infusion, is FDA-approved for treatment of visceral leishmaniasis
      - , FDA approved the oral agent miltefosine for treatment of cutaneous, mucosal, and visceral leishmaniasis caused by particular Leishmania species
    - - , FDA approved the oral agent miltefosine for treatment of cutaneous, mucosal, and visceral leishmaniasis caused by particular Leishmania species
    - - oral MiLtefosine for treatment of cutaneous, mucosal, and visceral leishmaniasis caused by particular Leishmania species
- - - - , Triclabendazole. 1 dose. In severe cases, 2 doses, 12 hours apart. Triclabendazole effective against both adult and immature worm
    - - Praziquantel 10-20 mg/kg as a single dose or 25 mg/kg TDS
    - - Praziquantel 25 mg/kg orally TDS for 2/7. Cerebral disease, a short course of corticosteroids may be given with the praziquantel to help reduce the inflammatory response around dying flukes.
    - - Praziquantel for 1-2/7 for all schistosome species.
  - - - Praziquantel
    - - Praziquantel. Niclosamide can also be used. If needed, B12 injections or supplements.
    - - Active Taeniasis Praziquantel 5-10 mg/kg orally 1x
      - Neurocysticercosis --Praziquantel or albendazole.
    - - ????????
  - - - Albendazole , mebendazole
    - - Mebendazole or Albendazole
    - - Albendazole, mebendazole, pyrantel pamoate
    - - Albendazole , mebendazole
    - - Mebendazole or Albendazole
    - - Lymphatic filariasis
        (Wuchereria bancrofti, Brugia spp.)
        
        Diethylcarbamazine (DEC), is both microfilaricidal and active against the adult worm.
      - Eyeworm (Loa loa)
        
        diethylcarbamazine (DEC) kills the MF and adultS. Albendazole is sometimes used in patients who are not cured with multiple DEC treatments. It is thought to kill adult worms. heavy infections are at risk of brain inflammation when treated with DEC.
      - River Blindness (Onchocerca Volvulus)
        
        Ivermectin, every 6 months for the life span of the adult worms (i.e., 10–15 years) or for as long as the infected person has evidence of skin or eye infection. IVM kills the larvae and prevents them from causing damage but it does not kill the adults.
      - Guinea worm (Dracunculus medinensis)
        
        No drug. Slow extraction.
    - - Ivermectin, 200 µg/kg per day orally until stool and/or sputum exams are negative for 2 weeks.
    - - Visceral toxocariasis -- Albendazole or mebendazole.
        Ocular toxocariasis -- difficult; measures to prevent progressive eye damage.