Antihelminthic

Question 1

Diethylcarbamazine

Answer 1

Used in treament of nematode infection
Inhibits the arachidonic acid metabolism in filarial microfilairia–> does not kill but makes it susceptable to host immune system

Drug of choise for flariasis casued by infection with Wuchereria bancrofti and Brugia malyi

Question 2

Adverse Effects of Diethycarbamazine

Answer 2

Fever, nausea, vomiting, arthralgia and headaches

Question 3

Ivermectin

Answer 3

Used against Nematodes
Targets the parasites glutamate-gated chloride channel receptors
-Chloride influx is enhanced and hyperpolarization occurs resulting in paralysis of the worm

Question 4

What is Ivermectin used to treat

Answer 4

DOC for:

Cutaneous larva migrans (CLM) skin disease from hookworm

Strongyloidiasis thread worm

Onchocerciasis (river blindness) caused by onchocerca volvulus
-does not kill adult worm

pediculosis (lice) and scabies

Question 5

What is the Mazzotti reaction

Answer 5

A result of the killing of the microfilaria in onchoceriasis

Immune response to dead microfilaria: Fever headaches, dizziness, somnolence and hypotension
Severiety is related to the parasite load

Antihistamine or steroids may be given to ameliorate symptoms

Question 6

Mebendazole

Answer 6

Inhibits the assembly of the microtubules in the parasite and by irreversibly blocking glucose uptake

Question 7

What would you treat with Mebendazole

Answer 7

Whipworms
Pinworms
Hookworms
Roundworms

Question 8

Pyrantel pamoate

Answer 8

It acts as a depolarizing, neuro-muscular-blocking agent, causing release of acetylcholine and inhibition of cholinesterase, leading to paralysis of the worm
The paralyzed worm releases its hold on the intestinal tract and is expelled worm releases its hold on the intestinal tract and is expelled
Effective in the treatment of infections caused by roundworms, pinworms, and hook-worms

Question 9

Thiabendazole

Answer 9

Potent broad-spectrum anthelmintic agent
Current use of thiabendazole is limited to the topical treatment of cutaneous larva migrans (CLM)
Because of its toxic effects, it has been largely replaced by other agents for many clinical applications

Question 10

Ascariasis

Answer 10

Most common world wide helminthic infection

Heave infestations can result in growth retardation, pneumonitis, intestinal obstruction

Question 11

How would you treat Ascariasis

Answer 11

Albendazole 400 mg orally once
Mebendazole 100 mg orally twice daily for 3 days or 500 mg orally once
Ivermectin 150-200 mcg/kg orally once

Question 12

Enterobiasis

Answer 12

Pinworm Disease (a nematode)
The most common worm infection in the US

Question 13

How you you treat Enterobiasis?

Answer 13

Mebendazole, pyrantel pamoate, and albendazole.
All three of these drugs are to be given in 1 dose at first and then another single dose 2 weeks later.
Pyrantel pamoate is available without prescription
The medications do not reliably kill pinworm eggs
Therefore, the second dose is to prevent re-infection by adult worms that hatch from any eggs not killed by the first treatment

Question 14

Baylisascariasis

Answer 14

Common intestinal worm of raccoons in North America
Rare but can infect human from direct contact with raccoon or indirectly through ingestion of raccoon feces
Typically a unilateral retinitis and or uveitis
Treatment is albendazole, laser, steroids

Question 15

River Blindness (Onchocerca volvulus)

Answer 15

Common intestinal worm of raccoons in North America
Rare but can infect human from direct contact with raccoon or indirectly through ingestion of raccoon feces
Typically a unilateral retinitis and or uveitis
Treatment is albendazole, laser, steroids

Second only to trachoma as infectious cause of blindness

Question 16

What might ocular findings are associated with river blindness

Answer 16

Ocular findings correlate with the location of the microfilariae
Corneal punctate keratitis
Sclerosing keratitis
Iridocyclitis
Chorioretinitis
Optic atrophy

Question 17

How would you treat river blindness

Answer 17

Ivermectin is the chemotherapeutic agent recommended for use against onchocerciasis

Question 18

Toxocariasis

Answer 18

Toxocariasis is an important cause of unilateral visual loss and leukocoria in infants, and as a differential diagnosis of retinoblastoma
Either the dog roundworm (Toxocara canis), the cat roundworm (Toxocara cati) or the fox (Toxocara canis)
Following surgical removal, treatment is with albendazole and topical corticosteroids

Question 19

Ocular Toxocariasis

Answer 19

50 % of all eyes with toxocariasis present as a peripheral granuloma
In the acute form, the lesion appears as a hazy, white mass in the peripheral fundus that may mimic the sort of snowbank seen in patients with pars planitis
Over time, consolidation and contraction of the lesion produces a peripheral, elevated mass, often with posteriorly extending retinal folds

Question 20

Trichinosis

Answer 20

Caused by eating meat that has not been thoroughly cooked and contains cysts (larvae, or immature worms) of Trichinella spiralis
Trichinella spiralis can be found in pork, bear, walrus, fox, rat, horse, and lion.Ocular trichinosis can manifest itself as edema of the face especially around the eyes, conjunctivitis, and exophthalmoses

Question 21

How would you treat Trichinosis

Answer 21

Thiabendazole or Albendazole can eliminate the adult worms in the gastrinointestinal tract

Question 22

What are the ocular features of Trichinosis

Answer 22

Myalgia, periorbital swelling, exophtalmoses, and fever

Question 23

Praziquantel

Answer 23

Drug of choice for the treatment of all forms of schistosomiasis (blood flukes), other trematode infections Fascioliasis (liver fluke), and cestode infections such as taeniasis
Used off-label in the treatment of cysticercosis (caused by Taenia solium larvae
Tapeworm larval cyst (cysticercus) ingested from poorly-cooked infected pork

Question 24

Praziquantel is contraindicated for the treatment of ocular cysticercosis, because destruction of the organism in the eye may cause irreversible damage (Albendazole and corticosteroids)

Answer 24

Free Card

Question 25

Albendazole

Answer 25

Drug of choice for many cestodes (tape worm) as well as other nematode infections
Should not be used during pregnancy (use Pyrantel pamoate)
one 400mg oral dose

Question 26

Niclosamide

Answer 26

Drug of choce for most cestode infections
Inhibits the parasites production of ATP
does not work for other worms

Question 27

Cysticercosis

Answer 27

Larval cysts of the pork tapeworm (Taenia solium)
Infection is often asymptomatic
Neurological symptoms - the most common manifestation
predominantly seizures
Ocular involvement include orbital, intraocular, subretinal, and optic nerve lesions
Can be evident as a free-floating cyst within the vitreous or anterior chamber

Question 28

How would you treat ocular cysticercosis

Answer 28

Albendazole

Question 29

Thelazia calllipaeda eyeworm

Answer 29

Transmitted by a non-biting drosophilid fly that feeds on ocular secretions, tears, and conjunctiva of mammals

Sympotms range from subclinical to a wide range of clinical signs
epiphora, conjunctivitis, keratitis, corneal opacity, and ulcers

Question 30

How would you treat thelazia callipaeda eyeworm

Answer 30

thiabendazole

Question 31

Myiasis

Answer 31

infection from the Dermatobia hominis (primary human bot fly)
Ophthalmomyiasis affects the eyes, orbits, and periorbital tissue