Items in AFP with MESH term: Antiparasitic Agents
Ivermectin Use in Scabies - Article
ABSTRACT: Oral ivermectin is an effective and cost-comparable alternative to topical agents in the treatment of scabies infection. It may be particularly useful in the treatment of severely crusted scabies lesions in immunocompromised patients or when topical therapy has failed. Oral dosing may be more convenient in institutional outbreaks and in the treatment of mentally impaired patients. Ivermectin has been used extensively and safely in the treatment of other parasitic infections, but the U.S. Food and Drug Administration has not approved the drug for the treatment of scabies infection. The safety of oral ivermectin in pregnant and lactating women and young children has yet to be established.
ABSTRACT: Cysticercosis (i.e., tapeworm infection) is an increasingly common medical problem in the United States, especially in the Southwest and other areas of heavy emigration from endemic areas or in populations with significant travel to these areas. The larval stage of the pork tape-worm, Taenia solium, causes the clinical syndrome of cysticercosis, with humans as dead-end hosts after ingestion of T solium eggs. Its clinical effects vary depending on site of larval lodging, larval burden, and host reaction. These effects include seizures, headaches, focal neurologic symptoms, visual disturbances, and localized skeletal muscle nodules and pain. Cysticercosis should be considered in any patient from an endemic area presenting with these symptoms. Treatment varies with the clinical presentation. Parenchymal neurocysticercosis generally is treated with albendazole in conjunction with steroids to limit edema and with antiepileptic medications for seizure control. Ocular and extraocular muscle cysticercosis generally requires surgical intervention. Skeletal muscle cysts are surgically removed only if painful. Because cysts can lodge in multiple locations, all patients with cysticercosis should have an ophthalmologic examination to rule out ocular involvement, and all patients with extraneurologic cysticercosis should have computed tomography or magnetic resonance imaging of the brain to rule out neurocysticercosis.
ABSTRACT: Pediculosis and scabies are caused by ectoparasites. Pruritus is the most common presenting symptom. Head and pubic lice infestations are diagnosed by visualization of live lice. Finding nits (louse egg shells) alone indicates a historical infestation. A “no nit” policy for schools and day care centers no longer is recommended because nits can persist after successful treatment with no risk of transmission. First-line pharmacologic treatment of pediculosis is permethrin 1% lotion or shampoo. Multiple novel treatments have shown limited evidence of effectiveness superior to permethrin. Wet combing is an effective nonpharmacologic treatment option. Finding pubic lice should prompt an evaluation for other sexually transmitted infections. Body lice infestation should be suspected when a patient with poor hygiene presents with pruritus. Washing affected clothing and bedding is essential if lice infestation is found, but no other environmental decontamination is necessary. Scabies in adults is recognized as a pruritic, papular rash with excoriations in a typical distribution pattern. In infants, children, and immunocompromised adults, the rash also can be vesicular, pustular, or nodular. First-line treatment of scabies is topical permethrin 5% cream. Clothing and bedding of persons with scabies should be washed in hot water and dried in a hot dryer.
ABSTRACT: Neglected parasitic infections, including Chagas disease, toxocariasis, cysticercosis, and toxoplasmosis, affect millions of persons in the United States. Relatively few resources have been devoted to surveillance, prevention, and treatment of these diseases. Chagas disease primarily affects Latin American immigrants and can cause heart failure and death if not treated. Immediate antiparasitic treatment is indicated for most patients with acute Chagas disease. Treatment is recommended for patients younger than 18 years who have chronic Chagas disease and is generally recommended for adults younger than 50 years who do not have advanced cardiomyopathy; treatment decisions for other patients should be made on an individual basis. Toxocariasis primarily affects children and can cause gastrointestinal, respiratory, and ophthalmologic disease. Treatment options include albendazole and mebendazole. Patients with ocular infection require referral to an ophthalmologist. Neurocysticercosis, a form of cysticercosis, is the most common infectious cause of seizures in some parts of the United States. Initial treatment should focus on symptom control. Humans generally acquire toxoplasmosis by eating undercooked contaminated meat or ingesting things that have been contaminated with cat feces. Congenital infection can result in miscarriage or adverse fetal effects. Treatment is recommended for immunosuppressed persons, pregnant women, and immunocompetent persons with severe symptoms.