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Nematodes - trichinellosis

Introduction, etiology

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The larvae of the nematode worm Trichinella spiralis, which is a parasite of pigs and wild game, constitute and important public health problem in eastern and southern Europe and in the United States. Other endemic foci exist in Africa, South America and southern Asia, notably in Chile, Kenya, Thailand and the United Republic of Tanzania.

Transmission occurs when meat containing infective, encysted larvae are eaten. The larvae burrow beneath the epithelium of the small intestine where they mature into adult worms. Within 5 days, the female worms release another generation of larvae which migrate to striated skeletal muscle and often to the myocardium. These produce intense allergic and inflammatory reactions.

Recommended treatments

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mebendazole
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chewable tablet, 100 mg, 500 mg

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Adults and children over 2 years:
200 mg daily for 5 days
or
albendazole
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chewable tablet, 400 mg

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Adults and children over 2 years:
400 mg daily for 3 days
or
pyrantel
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chewable tablet 250 mg (as embonate)
oral suspension, 50 mg (as embonate)/ml

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Adults and children:
10 mg/kg daily for 5 days

Plus, (to alleviate the allergic and inflammatory symptoms)
prednisolone
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tablet, 5 mg, 25 mg

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Adults:
40-60 mg daily

References
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WHO Model Prescribing Information. Drugs used in parasitic diseases second edition, 1995. 146 pages [E, F, S] ISBN 92 4 140104 4 Sw.fr. 35.-/US $31.50. In developing countries Sw.fr.24.50.
  Sales Information: http://www.who.int/bookorders/index.htm
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Intestinal nematodes; WHO link page
   http://www.who.int/health-topics/intestinal.htm
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Basic Food Safety for Health Workers, M.Adams and Y.Motarjemi, WHO/SDE/PHE/FOS/99.1, See appendix 1, Causative agents of foodborne illness
   http://www.who.int/foodsafety/publications/capacity/healthworkers/en/
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Report of the WHO Informal Consultation on the use of praziquantel during pregnancy/lactation and albendazole/mebendazole in children under 24 months, Geneva, 8-9 April, 2002, WHO/CDS/CPE/PVC/2002.4
   http://www.who.int/wormcontrol/documents/en/pvc_20024full.pdf
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Benzimidazoles: use in children, Essential Medicines, WHO Drug Information, Vol 17, No. 1, 2003
   http://www.who.int/druginformation/vol17num1_2003/vol17-1.pdf

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