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Parasitology Case No 1.Cutenous Larva Migrans.

আগে নিম্নের ছবি গুলি ভালো ভাবে দেখেন, তারপর আর্টিকেল পড়েন..

নিম্নের ১ম ছবিটা দেখেন-

জাহিদ, ১২ বছর এর শিশু, বেলে মাটিতে খালিপায়ে হাঁটাহাঁটি করে, একদিন তার পায়ে চুলকানী শুরু হয়, চুলকানীর ২ দিন পরে পায়ের স্কিনের নিছে একটা পাকানো দড়ির মত skin lesion দেখা যায়,

এই রোগ টা কি হতে পারে?

এই রোগ টা বুঝার জন্য নিম্নের অন্যান্য ছবি গুলিও দেখেন,

প্রতিটি ছবিতে চামড়ার নিছে দড়ির মত বিষয় লক্ষ করা যাচ্ছে..

হাতে এবং পায়ের স্কিনে কিছু লেশন দেখা যাচ্ছে, যা পাকানো দড়ির মত, মনে হচ্ছে চামড়ার নিছে একটা দড়ি পাকিয়ে ডুকিয়ে দেওয়া হয়েছে—

এই রোগের নাম হচ্ছে Cutaneous_Larva_migrans (CLM)

এই রোগ কি দিয়ে হয়?

আমরা সবাই Hookworm এর নাম শুনেছি.. hookworm ফেমিলির একটা প্যারাসাইট আছে, নাম নেমাটোড,

এই Nematode parasite কুকুর/বিড়ালের অন্ত্রে বসবাস করে, এবং মলত্যাগের সাথে এই নেমাটোড সমূহের Egss সমূহ soil বা মাটিতে চলে আসে,

মাটিতে আসার ১-২ সপ্তাহের মধ্যে এই Eggs সমূহ থেকে Infectious agent. larva তৈরি হয়, (লার্ভা, হচ্ছে প্যারাসাইট এর জীবনচক্রের একটা অবস্থা)

Eggs সমূহ পানিতে মিশে water contamination করে পেটে গিয়ে hookworm infection করতে পারে,

আবার যারা খালিপায়ে হাঁটে, কিংবা যারা মাটিতে কাজ করে,

larva সমূহ তাদের স্কিন গর্ত করে স্কিনের ভিতর ডুকে যেতে পারে,

এবং স্কিনের নিছে এরা বড় হতে থাকে, তখন চামড়ার নিছে ফিতাক্রিমির মত একটা দৃশ্য দেখা যায়, ইনফেকশন এর প্রথম কয়েকদিন কেবল চুলকানি থাকে, পরে যখন এই লেশন টা বড় হতে থাকে, তখন পেইন হতে থাকে,

চিকিৎসা – যেহেতু এইটা একটা প্যারাসাইটিক ইনফেকশন, তথা helminthic family এর প্যারাসাইট দিয়ে হয়ে থাকে, তাই

Anti helminthic দিলেই হবে,।

সাথে anti parasitic agent Ivermectin দিবে.

Treatment Management:-

Rx-

Albendazole  

1+0+1 (3-7 days)

Tablet 1:-Alben –DS 400mg (AS A Albendazole AS A Anthelmintic).

Indications of Tablet :-Alben –DS 400mg (AS A Albendazole AS A Anthelmintic).

Alben-DS is indicated in single and mixed infestations of-

  • Hookworm (Ancylostoma, Necator)
  • Roundworm (Ascaris)
  • Threadworm (Enterobius)
  • Whipworm (Trichuris)
  • Strongyloides
  • Tapeworm
  • Opisthorchi
  • Hydatid.

Description of Tablet :-Alben –DS 400mg (AS A Albendazole AS A Anthelmintic).

Alben-DS is a benzimidazole anthelmintic, active against most nematodes and some cestodes. It is used in the treatment of intestinal nematode infections and in higher doses in the treatment of hydatid disease. Alben-DS exhibits vermicidal, ovicidal, and larvicidal activity. The principal mode of action of Alben-DS is its inhibitory effect on tubulin polymerization, which results in the loss of cytoplasmic microtubules.

Pharmacology of Tablet :-Alben –DS 400mg (AS A Albendazole AS A Anthelmintic).

Albendazole is a broad spectrum anthelmintic. Albendazole exhibits vermicidal, ovicidal and larvicidal activities. The drug is thought to exert its anthelmintic effect by blocking glucose uptake in the susceptible helminths, thereby depleting the energy level until it becomes inadequate for survival. Immobilization is followed by the parasite. These events may be a consequence of the binding and subsequent inhibition of parasite tubulin polymerization by Albendazole and its metabolites, although the drug also binds to human tubulin. Albendazole is extensively metabolized, probably in the liver. Albendazole is poorly absorbed from the gastrointestinal tract but rapidly undergoes extensive first-pass metabolism. The principal metabolite albendazole sulphoxide has anthelmintic activity and a plasma half-life of about 8.5 hrs. It is excreted in the urine together with other metabolites.

Dosage & Administration of Tablet :-Alben –DS 400mg (AS A Albendazole AS A Anthelmintic).

Adults & children over 2 years:

  • 400 mg (1 tablet or 10 ml suspension) as a single dose in cases of Enterobius vermicularis, Trichuris trichiura, Ascaris lumbricoides, Ancylostoma duodenale and Necator americanus.
  • In cases of strongyloidiasis or taeniasis, 400 mg (1 tablet or 10 ml suspension) daily should be given for 3 consecutive days. If the patient is not cured on follow-up after three weeks, a second course of treatment is indicated. 

Children of 1-2 years: Recommended dose is a single dose of 200 mg (5 ml suspension).

Children under 1 year: Not recommended.

In Hydatid disease (Echinococcosis):

  • Albendazole is given by mouth with meals in a dose of 400 mg twice daily for 28 days for patients weighing over 60 kg.
  • A dose of 15 mg/kg body weight daily in two divided doses (to a maximum total daily dose of 800 mg) is used for patients weighing less than 60 kg.
  • For cystic echinococcosis, the 28 days course may be repeated after 14 days without treatment, to a total of 3 treatment cycles.
  • For alveolar echinococcosis, cycles of 28 days of treatment followed by 14 days without treatment, may need to continue for months or years.
  • In giardiasis, 400 mg (1 tablet or 10 ml suspension) once daily for five days is used.

Interaction of Tablet :-Alben –DS 400mg (AS A Albendazole AS A Anthelmintic).

No interaction involving Alben-DS, either pharmacodynamic or pharmacokinetic, has been reported.

Contraindications of Tablet :-Alben –DS 400mg (AS A Albendazole AS A Anthelmintic).

Neonates: Albendazole is not normally used in neonates.

Children: Reduction of the dose from 400 mg to 200 mg may be indicated in children weighing less than 10 kg but there are no grounds for a general reduction in dosage to children.

Pregnant woman: Albendazole should not be given during pregnancy or women thought to be pregnant. No information is available on placental transfer.

Concurrent disease: There is no evidence to suggest that dose should be altered in renal, hepatic or cardiac failure.

Side Effects of Tablet :-Alben –DS 400mg (AS A Albendazole AS A Anthelmintic).

Gastrointestinal disturbances, headache, dizziness, changes in liver enzymes, rarely reversible alopecia; rash, fever, blood disorders including leucopenia and pancytopenia reported; allergic shock if cyst leakage; convulsion and meningism in cerebral disease.

Pregnancy & Lactation of Tablet :-Alben –DS 400mg (AS A Albendazole AS A Anthelmintic).

US FDA Pregnancy category of Albendazole is C. So, Albendazole should be avoided in pregnancy and lactation unless the potential benefits to the other outweigh the possible risks to the fetus.

Precautions & Warnings of Tablet :-Alben –DS 400mg (AS A Albendazole AS A Anthelmintic).

Blood counts and liver function tests before treatment and twice during each cycle; breastfeeding; exclude pregnancy before starting treatment. Alben-DS should only be used in the treatment of Echinococcosis if there is constant medical supervision with regular monitoring of serum-transaminase concentrations and of leucocyte and platelet counts

Therapeutic Class of Tablet :-Alben –DS 400mg (AS A Albendazole AS A Anthelmintic).

Anthelmintic

Tablet 2- Ivera 6 mg (AS A Ivermectin Anthelmintic).

2 tab stat

Indications of Tablet:- Ivera 6 mg (AS A Ivermectin Anthelmintic).

Ivera tablet is indicated for the treatment of-

  • Strongyloidiasis
  • Onchocerciasis
  • Filariasis
  • Scabies &
  • Head lice.

Strongyloidiasis of the intestinal tract: Ivera is indicated for the treatment of intestinal (i.e., nondisseminated) strongyloidiasis due to the nematode parasite Strongyloides stercoralis. This indication is based on clinical studies of both comparative and open-label designs, in which 64-100% of infected patients were cured following a single 200-mcg/kg dose of Ivera.

Onchocerciasis: Ivera is indicated for the treatment of onchocerciasis due to the nematode parasite Onchocerca volvulus. This indication is based on randomized, double-blind, placebo-controlled and comparative studies conducted in 1427 patients in onchocerciasis-endemic areas of West Africa. The comparative studies used diethylcarbamazine citrate (DEC-C).

Pharmacology of Tablet:- Ivera 6 mg (AS A Ivermectin Anthelmintic).

Ivermectin selectively binds and with high affinity to glutamate-gated chloride ion channels, which occur in invertebrate nerve and muscle cells leading to an increase in the permeability of cell membranes to chloride ions with hyperpolarization of the nerve or muscle cell and, ultimately, death of the parasite.

Dosage & Administration of Tablet:- Ivera 6 mg (AS A Ivermectin Anthelmintic).

For Treatment (If COVIO Positive): 2 Tablets of Ivermectin 6 mg once daily for 5 days. (2+0+0 for 5 days).
For Prophylaxis: Single-dose as mentioned below to be taken on Day 1 & same dose on Day 7.

  • Body Weight 15-24 kg: 1 Tablet of Ivermectin 3 mg
  • Body Weight 25-35 kg: 1 Tablet of Ivermectin 6 mg
  • Body Weight 36-50 kg: 1 Tablet of Ivermectin 6 mg + 1 Tablet of Ivermectin 3 mg
  • Body Weight 51-65 kg: 2 Tablets of Ivermectin 6 mg
  • Body Weight 66-79 kg: 2 Tablets of Ivermectin 6 mg + 1 Tablet of Ivermectin 3 mg
  • Body Weight >80 kg: 3 Tablets of Ivermectin 6 mg


Strongyloidiasis: The recommended dosage of Ivermectin for the treatment of strongyloidiasis is a single oral dose designed to provide approximately 200 mcg/kg of body weight. Patients should take tablets on an empty stomach with water. In general, additional doses are not necessary. However, follow-up stool examinations should be performed to verify eradication of infection.

Dosage Guidelines for Ivermectin for Strongyloidiasis:

  • Body Weight (kg) 15-24: Dose 3 mg/kg
  • Body Weight (kg) 25-35: Dose 6 mg/kg
  • Body Weight (kg) 36-50: Dose 9 mg/kg
  • Body Weight (kg) 51-65: Dose 12 mg/kg
  • Body Weight (kg) 66-79: Dose 15 mg/kg
  • Body Weight (kg) >80: Dose 200 mcg/kg


Onchocerciasis: The recommended dosage of Ivermectin is a single oral dose designed to provide approximately 150 mcg of Ivermectin per kg of body weight on an empty stomach with water, the most commonly used dose interval is 12 months. For the treatment of individual patients, retreatment may be considered at intervals as short as 3 months.

Dosage Guidelines for Ivermectin for Onchocerciasis:

  • Body Weight (kg) 15-25: Dose 3 mg/kg
  • Body Weight (kg) 26-44: Dose 6 mg/kg
  • Body Weight (kg) 45-64: Dose 9 mg/kg
  • Body Weight (kg) 65-84: Dose 12 mg/kg
  • Body Weight (kg) >85: Dose 150 mcg/kg

Interaction of Tablet:- Ivera 6 mg (AS A Ivermectin Anthelmintic).

Post-marketing reports of increased INR (International Normalized Ratio) have been rarely reported when Ivera was co-administered with warfarin.

Contraindications of Tablet:- Ivera 6 mg (AS A Ivermectin Anthelmintic).

It is contraindicated in patients who are hypersensitive to any component of this product.

Side Effects of Tablet:- Ivera 6 mg (AS A Ivermectin Anthelmintic).

Strongyloidiasis: In four clinical studies involving a total of 109 patients given either one or two doses of 170 to 200 mcg/kg of Ivera, the following adverse reactions were reported as possibly, probably, or definitely related to Ivera.

  • Body as a whole: asthenia/fatigue (0.9%), abdominal pain (0.9%)
  • Gastrointestinal: anorexia (0.9%), constipation (0.9%), diarrhea (1.8%), nausea (1.8%), vomiting (0.9%) Nervous System/Psychiatric: dizziness (2.8%), somnolence (0.9%), vertigo (0.9%), tremor (0.9%)
  • Skin: pruritus (2.8%), rash (0.9%), and urticaria (0.9%).

Onchocerciasis: arthralgia/synovitis (19.3%), axillary lymph node enlargement and tenderness (11.0% and 4.4%, respectively), cervical lymph node enlargement and tenderness (5.3% and 1.2%, respectively), inguinal lymph node enlargement and tenderness (12.6% and 13.9%, respectively), other lymph node enlargement and tenderness (3.0% and 1.9%, respectively), pruritus (27.5%), skin involvement including edema, papular and pustular or frank urticarial rash (22.7%), and fever (22.6%), abnormal sensation in the eyes, eyelid edema, anterior uveitis, conjunctivitis, limbitis, keratitis, and chorioretinitis or choroiditis. These have rarely been severe or associated with loss of vision and have generally resolved without corticosteroid treatment. The following adverse reactions have been reported since the drug was registered overseas: hypotension (mainly orthostatic hypotension), worsening of bronchial asthma, toxic epidermal necrolysis, and Stevens-Johnson syndrome.

Pregnancy & Lactation of Tablet:- Ivera 6 mg (AS A Ivermectin Anthelmintic).

Pregnancy Category C. Ivermectin does not appear to be selectively fetotoxic to the developing fetus. There are, however, no adequate and well-controlled studies in pregnant women. Ivermectin should not be used during pregnancy since safety in pregnancy has not been established.

Nursing Mothers: Ivermectin is excreted in human milk in low concentrations. Treatment of mothers who intend to breast feed should only be undertaken when the risk of delayed treatment to the mother outweighs the possible risk to the newborn

Precautions & Warnings of Tablet:- Ivera 6 mg (AS A Ivermectin Anthelmintic).

Historical data have shown that microfilaricidal drugs, such as diethylcarbamazine citrate (DEC-C), might cause cutaneous and/or systemic reactions of varying severity (the Mazzotti reaction) and ophthalmological reactions in patients with onchocerciasis. These reactions are probably due to allergic and inflammatory responses to the death of microfilariae. Patients treated with Ivera for onchocerciasis may experience these reactions in addition to clinical adverse reactions possibly, probably, or definitely related to the drug itself. The treatment of severe Mazzotti reactions has not been subjected to controlled clinical trials. Oral hydration, recumbency, intravenous normal saline, and/or parenteral corticosteroids have been used to treat postural hypotension. Antihistamines and/or aspirin have been used for most mild to moderate cases. After treatment with microfilaricidal drugs, patients with hyperreactive onchodermatitis (sowda) may be more likely than others to experience severe adverse reactions, especially edema and aggravation of onchodermatitis. Rarely, patients with onchocerciasis who are also heavily infected with Loa loa may develop a serious or even fatal encephalopathy either spontaneously or following treatment with an effective microfilaricide. In these patients, the following adverse experiences have also been reported: back pain, conjunctival hemorrhage, dyspnea, urinary and/or fecal incontinence, difficulty in standing/walking, mental status changes, confusion, lethargy, stupor, or coma.

Use in Special Populations of Tablet:- Ivera 6 mg (AS A Ivermectin Anthelmintic).

Pediatric Use: Safety and effectiveness in pediatric patients weighing less than 15 kg have not been established.

Geriatric Use: Clinical studies of Ivera did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Therapeutic Class of Tablet:- Ivera 6 mg (AS A Ivermectin Anthelmintic).

Anthelmintic

খালি পায়ে হাঁটবেনা,

যেসব জায়গায় কুকুর /বিড়ালের আবাসস্থল, সেখানে কাজ করলে হাতে পায়ে মোজা পরিধান করে কাজ করবে…

Raiyyan Tahsan Date:24-01-2025 Friday Time:12-09-45 PM

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