Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1446 Trichinosis Trichuriasis

➣Prednisone, depending on severity of symptoms, until fever and

allergic signs regress. Start steroids before antihelminthic thrapy.

➣Mebendazole (graduated dose because of occasional herxheimer

reaction)

➣Albendazole (dose not standardized)

■Mild cases: steroids as needed.

Side Effects & Complications

■Prednisone: usual side effects.

■Mebendazole: mild intestinal complaints, rarely leukopenia. Herx-

heimer reaction at onset.

■Albendazole: mild intestinal complaints, liver function abnormal-

ities, leukopenia, alopecia (usually with longer treatment). Herx-

heimer reaction may occur early.

■Contraindications to treatment: absolute: allergy to medication,

pregnancy

■Contraindications to treatment: relative: mild cases.

follow-up

During Treatment

■Watch for herxheimer reaction. Watch for myocarditis: prolonged

tachycardia, any rhythm disturbance, hypotension, pericardial effu-

sion. Have patient monitored in severe case or if significant myo-

carditis suspected.

Routine

■Recovery is the rule, clinical follow-up is adequate

complications and prognosis

■Myocarditis, retinal hemorrhage, CNS invasion with encephalo-

pathic picture. Most cases have full recovery, sometimes prolonged

muscle weakness in severe cases. Main cause of death is myocarditis.

TRICHURIASIS

J. GORDON FRIERSON, MD

history & physical

History

■Life cycle: eggs ofTrichuris trichurapassed in feces, must incubate

in soil at least 10–14 days to be infective. Then ingested through