Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40

Intestinal Flukes 849

tests

■Basic tests: blood: may see eosinophilia

■Basic tests: urine: normal

■Specific tests: Stool O&P exam, finds eggs. It is difficult to distinguish

various fluke eggs; expert help may be needed.

■Other tests: Barium study may show irritability, edema of upper small

bowel.

differential diagnosis

■Peptic ulcer disease, gastritis, giardiasis, other bowel infections

management

What to Do First

■Assess severity.

General Measures

■Determine source of infection, educate patient.

specific therapy

Indications

■All infected patients

Treatment Options

■All 3 flukes: Praziquantel. Cure rate is high.

Side Effects & Complications

■Abdominal pain, diarrhea, probably relating to worm death

■Contraindications to treatment: absolute: Allergy to medication

■Contraindications to treatment: relative: light or asymptomatic

infections due to Fasciolopsis buski. They die off in about 1 year

without treatment.

follow-up

During Treatment

■Monitor side effects.

Routine

■Repeat stool O&P exam 2 or more weeks after treatment.

complications and prognosis

■Metagonimus and Heterophyes worms become encapsulated in

bowel wall, and eggs can enter circulation and embolize to the heart,