General issues of Helminths

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Classification of Hosts for helminths

	Obligatory to life cycle	Larvae maturing	Reproduction	Transmission to other hosts
Definitive host	YES	YES	YES	YES
Intermediate host	YES	YES	NO	YES
Paratenic host	NO	NO	NO	YES
Accidental (deadend) host	NO	NO	NO	NO Pathogens die in the host

Medicine for helminths

Mehta, P. N. (2013). Antimicrobials in Clinical Practice Drugs for intestinal helminths. https://doi.org/10.1016/j.pid.2013.03.004

Moser, W., Schindler, C., & Keiser, J. (2017). Efficacy of recommended drugs against soil transmitted helminths: Systematic review and network meta-analysis. BMJ (Online), 358. https://doi.org/10.1136/bmj.j4307

Abbas, A., & Newsholme, W. (2009). Diagnosis and recommended treatment of helminth infections. Prescriber, 20(6), 31–40. https://doi.org/10.1002/psb.488

	Nematode	Trematode	Cestode
Diethylcarbamazine (DEC)	Lymphatic filariasis Loiasis when <8,000MF/mL NEVER for Onchocerciasis and beware of co-infection
Ivermectin	Onchocerciasis but Mazzotti 10% and encephalopathy NEVER for Loiasis and beware of co-infection Strongyloidiasis Ancylostomiasis (hookworm) Gnathostomiasis
Albendazole	Loiasis when >8,000MF/mL Ancylostomiasis (hookworm) Trichuriasis (whipworm) Trichinellosis Toxocariasis Enterobiasis (pinworm) Gnathostomiasis		Echinococcosis
Piperazine	Ascariasis Enterobiasis (pinworm)
Praziquantel	Ascariasis	Adult of schistosoma Clonorchiasis Paragonimiasis	Diphyllobothriasis Taeniasis Echinococcosis
Triclabendazole		Fasciolasis
Doxycycline	Adult of lymphatic filariae for Wolbachia Adult of onchocerca for Wolbachia
Surgical/Mechanical removal	Dracunculiasis (Guinea worm) Anisakiasis		PAIR for Echinococcus granulosus Surgery for Echinococcus multilocularis
Spontaneous resolution/ No effective treatment	Angiostrongyliasis (rat lungworm) Cutaneous larva migrans by ancylostomiasis

Treatment options of Lymphatic filariasis, Onchocerciasis and Loiasis

	Lymphatic filariasis	Onchocerciasis	Loiasis
Diethylcarbamazine (DEC)	1st line	NEVER possibly Mazzotti	<8,000 MF/mL
Ivermectin		1st line but Mazzotti 10%	NEVER possibly encephalopathy
Albendazole			>8,000 MF/mL

	Lymphatic filariasis	LF & Oncho	Onchocerciasis	Oncho & Loiasis	Loiasis
Diethylcarbamazine (DEC)	1st line	NEVER	NEVER	NEVER	<8,000 MF/mL
Ivermectin		Ivermectin + Albendazole may be safe	1st line but Mazzotti 10%	NEVER	NEVER
Albendazole				may be an option	>8,000 MF/mL
Other option				Cytapheresis of oncho MF before DEC

※MF = microfilariae