Entamoeba histolytica (Amoebiasis) |
Trophozoites or cysts on stool micro (cannot distinguish between cysts of E histolytica or E. dispar)
May be associated with GIT symptoms
|
FBE/differential
Ferritin
Fresh stool <24 h for ELISA or PCR(if available). If this confirms E dispar, do nothing. If confirms E histolytica, treat.
If ELISA/PCR not available, serology (IHA) for E. histolytica, although baseline positive 30% in endiic areas.
|
Asymptomatic: eliminate intraluminal carriage
Diloxanide 20 mg/kg/day (max 500 mg/dose) in 3 divided doses oral 10 days
Paramomycin 10 mg/kg/dose 8 hourly oral 7 days (SAS medication)
Symptomatic: Discuss with ID. Metronidazole 15 mg/kg/dose (max 750 mg) tds oral 7-10 days followed by luminal agent (as above)
|
Offer screen |
Discuss with ID physicians if symptomatic |
As required for parasite persistence or reinfection |
Ascaris lumbricoides |
Ova on stool micro
History of worms
May be a/w respiratory Sx
|
FBE/differential
Ferritin
|
Albendazole (weight > 10 kg) 400 mg oral stat (200 mg for patient over 6 months, up to 10 kg)
Mebendazole 100 mg oral bd 3 days
|
Offer screen, Rx siblings |
Repeat stool micro at follow-up (not essential) |
As required for parasite persistence or reinfection |
Giardia intestinalis |
Trophozoites or cysts on stool micro
May be associated with GIT symptoms
|
FBE/differential
Ferritin
|
Metronidazole 30 mg/kg/dose oral (max 2 g) daily for 3 days
Tinidazole 50 mg/kg stat dose oral (max 2 g)
|
Screen symptomatic family |
Repeat stool micro at follow-up (not essential) |
As required for parasite persistence or reinfection |
Hookworm (Ancylostoma or Necator) |
Ova on stool micro |
FBE/differential
Ferritin
|
Albendazole (weight > 10 kg) 400 mg oral stat (200 mg for patient over 6 months, up to 10 kg)
Mebendazole 100 mg oral bd 3 d
|
Offer screen |
Repeat stool micro at follow-up |
As required for parasite persistence or reinfection |
Strongyloides stercoralis
(Risk of dissiination if immune suppressed) |
Larvae on stool micro |
byloides serology
FBE/differential
Ferritin
|
Ivermectin (weight >15 kg) 200 mcg/kg dose x 2 doses, day 1 and day 14 (2 weeks apart)
Albendazole (weight > 10 kg) 400 mg oral twice daily for 7 days
(200 mg for patient over 6 months, up to 10 kg) – less effective than ivermectin
|
Offer screen |
If larvae on stool micro then repeat 3 days post treatment
Serology & FBE at 6 months
|
If parasites persist on stool micro repeat Rx at 2 weeks
If serum IgG and eosinophilia persist at 3-6 months
Children < 5 years may require monitoring and treatment with ivermectin once they are 5 years.
|
Clear positive IgG |
Fresh stool micro
FBE/diff/Ferritin |
Pulmonary or GIT symptoms |
Discuss with ID consultant urgently |
Schistosoma spp. (Bilharzia)
also see Schistosomiasis guideline
|
Ova on stool micro |
FBE/differential
Schistosoma serology
|
Praziquantel
- 20 mg/kg/dose x 2 doses orally - 4 hrs apart (no upper limit)
- 40 mg/kg total may be given as a single stat dose in children
|
Offer screen |
Stool/urine micro (x 3 specimens) at 3-6 months. Serology at 6 & 12 months
FBE/diff at 3 months
|
Persistent parasite, increasing IgG titre 6/12 post Rx (esp if eosinophillia)
IgG same at 12mo
|
Clear positive IgG and negative stool micro
|
Midday end urine micro for ova (lab x5738 first)
Renal/bladder US if symptoms
|
Tapeworm (Taenia spp) |
Proglottids or ova in faeces
Nodules
Check for neurological Sx (different Rx)
|
FBE/differential
Ferritin
|
Praziquantel 10 mg/kg/dose stat oral
Rodentolepis nana (prev. Hymenolepis nana; dwarf tapeworm) requires Praziquantal 25 mg/kg/dose stat oral
|
Offer screen |
Repeat stool micro 3/52 - not essential. |
As required for parasite persistence or reinfection |
Whipworm (Trichuris trichiuria) |
Ova stool micro
May be assoc. with bloody diarrhoea, pain
|
FBE/differential
Ferritin
|
Mebendazole 100 mg oral bd 3 days
(200 mg for patient over 6 months, up to 10 kg)
|
Offer screen |
Repeat stool micro 3/52- not essential |
As required for parasite persistence or reinfection |
Note:
- The safety of Praziquantel in children <2 yrs has not been established - Discuss with ID
- Albendazole tabs are chewable and soluble and trials include children 2 years and over. There is limited data on use in children aged > 6 months. Discuss if liver disease
- Ivermectin is used in children >15 kg
- Exclude pregnancy in adolescents; Praziquantal B1, Metronidazole B2, Ivermectin B3, Albendazole D.
|