Outcome evaluation

Follow-up in patients with amebiasis should include repeat stool examinations, sero-

logy, colonoscopy (in colitis) or CT on day 7, at the end of therapy, and a month after the end of therapy. Serial liver scans have demonstrated healing of liver abscesses over

20 21

4 to 8 months after adequate therapy. ' helminthic diseases

Helminthic infections include three groups of organisms: roundworms or nematodes, flukes (trematodes), and tapeworms (cestodes). Because of space constraints, only brief descriptions of some of the helminthic infections most commonly seen in North America and their treatments will be provided here. Although helminthic infections may not produce clinical manifestations, they can cause significant pathology. One factor that determines the pathogenicity of helminthic infections is their population density; a high-density population ("worm burden") results in predictable disease presentation. In the United States, these infections are reported most frequently in recent immigrants from Southeast Asia, the Caribbean, Mexico, and Central America.5,6 Populations at risk include institutionalized patients (both young and elderly), preschool children in daycare centers, residents of Native American reservations, 17,24

and homosexuals. Certain conditions and drugs (anesthesia and corticosteroids) can cause atypical localization of worms. Immunocompromised hosts can be overwhelmed by some helminthic infections, such as Strongyloides stercoralis.

nematodes Hookworm Disease

Hookworm infection is caused by Ancylostoma duodenale or Necator americanus. N.

24 26

americanus is found in the southeastern United States. - Infective larvae enter the host in contaminated food or water, or penetrate the skin and migrate to the small in testine. The adult worm attaches to GI mucosa and causes injury by lytic destruction of the tissue. Over a period of time, the adult worm can cause anemia and hypopro-


teinemia in the host.

Treatment n

The drug of choice is mebendazole (Vermox), which is also active against ascari-asis, enterobiasis, trichuriasis, and hookworm.12 The adult and pediatric (age greater than 2 years) oral dose of mebendazole for hookworm is 100 mg twice daily for 3 days. An alternative agent that can be used in both pediatric and adult patients is albendazole (Zentel), 400 mg as a single oral dose. Diagnosis is by detection of eggs or larvae in stool. Stool examination for eggs and the larvae should be repeated in 2 weeks and the patient retreated if necessary.

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Anxiety and Depression 101

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