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Trichostrongylus species are nematodes (round worms), which are ubiquitous among herbivores worldwide, including cattle, sheep, donkeys, goats, deer, and rabbits [1][2][3]. At least 10 Trichostrongylus species have been associated with human infections [1]. Infections occur via ingestion of infective larvae from contaminated vegetables or water [1][3]. Epidemiological studies indicate a worldwide distribution of Trichostrongylus infections in humans, with the highest prevalence rates observed in individuals from regions with poor sanitary conditions, in rural areas, or who are farmers / herders [4][5]. Human infections are most prevalent in the Middle East and Asia [3], with a worldwide estimated prevalence of 5.5 million [1].
Clinical Presentation
[edit]The majority of human infections are asymptomatic or associated with mild symptoms. Symptomatic individuals may experience abdominal pain, nausea, diarrhea, flatulence, dizziness, generalized fatigue, and malaise [1][2][3]. Eosinophilia is frequently observed [1][2][6]. Infections with a heavy worm burden can lead to anemia, cholecystitis, and emaciation [1][3].
Diagnosis
[edit]The adult worms live in the small intestine. The diagnosis is based on the observation of eggs in the stool. The eggs are 85 – 115 um, oval, elongated, and pointed at one or both eggs [3]. Trichostrongylus eggs must be differentiated from hookworm eggs which are smaller and do not have pointed ends [1][3].
Prevention and Treatment
[edit]Since the use of herbivore manure as fertilizer is a common practice preceding infection, thorough cleaning and cooking of vegetables is required for prevention of infection [1][3]. Treatment with pyrantel pamoate (11mg/kg base once, max. 1 g) is recommended [7]. Alternative agents include mebendazole (100 mg bid x 3 days) and albendazole (400 mg once) [7]. Successful treatment with ivermectin has also been reported [2].
References
[edit]- ^ a b c d e f g h i Garcia LS, editor. Diagnostic Medical Parasitology. 5 ed. Washington, DC: ASM Press; 2007.
- ^ a b c d Ralph A, O'Sullivan M, Sangster N, Walker J. Abdominal pain and eosinophilia in suburban goat keepers - Trichostrongylosis. Med J Aust. 2006;184(9):467-9.
- ^ a b c d e f g h Strickland GT, editor. Hunter's Tropical Medicine and Emerging Infectious Diseases. 8 ed. Philadelphia, PA: WB Saunders Company; 2000.
- ^ Adams VJ, Markus MB, Adams JF, Jordaan E, Curtis B, Dhansay MA, et al. Paradoxical helminthiasis and giardiasis in Cape Town, South Africa: epidemiology and control. Afr Health Sci. 2005 Sep;5(3):276-80.
- ^ el-Shazly AM, el-Nahas HA, Soliman M, Sultan DM, Abedl Tawab AH, Morsy TA. The reflection of control programs of parasitic diseases upon gastrointestinal helminthiasis in Dakahlia Governorate, Egypt. J Egypt Soc Parasitol. 2006 Aug;36(2):467-80.
- ^ Strickland GT, editor. Hunter's Tropical Medicine and Emerging Infectious Diseases. 8 ed. Philadelphia, PA: WB Saunders Company; 2000.
- ^ a b Drugs for parasitic infections. The Med Lett. 2007;5(Suppl):1-15.