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Nematodes - ascariasis

Introduction, etiology

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Infection is transmitted by eggs or larvae, which begin their cycle of development within the human host when, depending on the species, they either actively penetrate intact skin or are ingested or, very rarely, inhaled. The larvae of the most widely prevalent species remain dormant but potentially infective for long periods in contaminated soil; the larvae or cysts of other species are ingested when the flesh of reservoir hosts is eaten either raw or undercooked.

Over 1450 million people worldwide are estimated (2002) to be infected with Acaris lumbricoides (roundworm) and of these, an estimated 60 000 die annually (2002). Risk of infection exists wherever faecal disposal is inadequate and the disease remains endemic in many regions of south-east Asia, Africa, and Central and South America.

Recommended treatments

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albendazole
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chewable tablet, 400 mg

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Adults and children over 2 years:
A single dose of 400 mg
levamisole
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tablet, 50 mg, 150 mg (as hydrochloride)

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Adults and children:
Single dose of 2.5 mg/kg is used widely for both individual treatment and community based campaigns.
mebendazole
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chewable tablet, 100 mg, 500 mg

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Adults and children over 2 years:
A single dose of 500 mg or 100 mg twice daily for 3 days
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:
A single dose of 10 mg/kg
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References
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Prevention and control of schistosomiasis and soil-transmitted helminthiasis, Report of a WHO Expert Committee, Geneva 2002, WHO Technical Report Series 912
   http://www.who.int/wormcontrol/documents/en/trs_912.pdf
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Water related diseases; Ascariasis
   http://www.who.int/water_sanitation_health/diseases/ascariasis/en/
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Evaluation of two years of mass chemotherapy against ascariasis in Hamadan, Islamic Republic of Iran, Bulletin of the World Health Organization 2002, 80 (5)
   http://www.who.int/docstore/bulletin/pdf/2002/bul-5-E-2002/80(5)399-402.pdf
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A comparison of the efficacy of single doses of albendazole, ivermectin, and diethylcarbamazine alone or in combinations against Ascaris and Trichuris spp. Bulletin of the World Health Organization 2003, 81 (1)
   http://www.who.int/bulletin/en/Belizario0103.pdf
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Intestinal nematodes, WHO link page
   http://www.who.int/health-topics/intestinal.htm
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Water Quality - Guidelines, Standards and Health: Assessment of Risk and Risk Management for Water-Related Infectious Disease, Edited by Lorna Fewtrell, Centre for Research into Environment and Health, Aberystwyth, Wales and Jamie Bartram, World Health Organization, Geneva, Switzerland. 2001
   http://www.who.int/water_sanitation_health/dwq/whoiwa/en/
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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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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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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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