Intestinal Flukes Follow-up

Updated: Jul 14, 2016
  • Author: Joseph Adrian L Buensalido, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Follow-up

Further Outpatient Care

Health education is essential; proper washing and thorough cooking of vegetables or fish are essential to prevent egg ingestion.

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Further Inpatient Care

Antispasmodics may relieve abdominal pain.

Iron supplements may be used to treat anemia, which may require transfusions in severe cases.

Vitamin C (ascorbic acid) may be administered to facilitate iron absorption.

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Deterrence/Prevention

Eliminating the intermediate host snail is the key to controlling infection with intestinal flukes.

Proper cleaning and processing of raw vegetables by immersing in boiling water for a few seconds, followed by peeling and washing in clean water, is important in preventing infection with intestinal flukes, especially in endemic areas.

Night soil (human excreta) and pig excreta should not be used as fertilizers.

Metacercariae are not necessarily inhibited or destroyed by interventions such as smoking or freezing; and the practice of fish pickling is ineffective. Irradiation practices may be of benefit in managing the burden of metacercariae in the process of food preparation.

Many strategies to control opisthorchiasis have been used in Thailand. The strategies include mass drug administration and education to decrease the consumption of raw fish. Over the last decade, these methods have changed the epidemiology of O viverrini infection in Thailand. In the past, O viverrini infections were characterized as heavy infections that were concentrated in particular villages. Now, because of these strategies, O viverrini infections have become "lighter" but more widespread in terms of geographic distribution. [48]

Parasitic helminths reside in immunologically exposed extracellular locations within their hosts, yet they are capable of surviving for extended periods. To enable this survival, these parasites have developed complex and multifaceted mechanisms to subvert or suppress host immunity. There are studies on the immunomodulation by helminth parasites of ruminants and the parasite-derived molecules involved in driving this modulation. Such immunomodulatory molecules have considerable promise as vaccine targets. [49]

Triclabendazole 10 mg/kg as a single dose is the preventive chemotherapy for fascioliasis and is recommended in subdistricts, villages, or communities with clustering of cases. The WHO recommends that all school-aged children (aged 5-14 years) or all residents should be given the preventive chemotherapy every 12 months. [47]

Praziquantel 40 mg/kg as a single dose is the preventive chemotherapy for clonorchiasis and opisthorchiasis and is recommended in all people residing in areas where the prevalence of infection is 20% and above. Among people who live in areas with less than 20% prevalence, the recommendation is to administer preventive chemotherapy (1) to everyone every 24 months or (2) every 12 months to those who eat raw fish. [47]

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Prognosis

Light infections may resolve spontaneously within one year, even without treatment. The prognosis may be grave in patients with heavy infection.

Immunocompromised hosts may be at an increased risk of complications. For example, G seoi worms were found to penetrate into colonic lymphoid tissue in a patient with colon cancer. [50]

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Patient Education

Instruct patients on proper food preparation to avoid infection with intestinal flukes. Thoroughly cooking fish and mollusks is always recommended.

Educational interventions that emphasize avoidance of fecal contamination of water where fish and aquatic plants thrive are recommended to prevent intestinal trematode infections.

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