General issues of Helminths

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Treatment for helminths

	Virus	Bacteria/ Rickettsia	Protozoa	Fungi	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
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