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Neurocysticercosis

  • Neurocysticercosis treatment
  • 1. Parenchymal neurocysticercosis
  • 1.1 Single lesions[1]
  • Preferred regimen:antiparasitic therapy (eg, albendazole 15 mg/kg/day for 3 to 8 days) and a short course of corticosteroids (eg, prednisone 1 mg/kg/day for 8 to 10 days followed by a taper)
  • 1.2 Multiple cysts
  • Preferred regimen:most favor treatment of multiple viable, parenchymal cysticerci with antiparasitic therapy (albendazole 15 mg/kg/day in two daily doses for 8 to 15 days) administered together with high-dose steroids
  • Preferred regimen:combination therapy with both praziquantel (50 mg/kg/day) and albendazole (15 mg/kg/day).
  • Cysticercal encephalitis [1]
  • Cysticercal encephalitis (diffuse cerebral edema associated with multiple inflamed cysticerci) is a contraindication for antiparasitic therapy, since enhanced parasite killing can exacerbate host inflammatory response and lead to diffuse cerebral edema and potential transtentorial herniation. Most cases of cysticercal encephalitis improve with corticosteroid therapy
  • Calcified cysts
  • Radiographic evidence of parenchymal calcifications is a significant risk factor for recurrent seizure activity; these lesions are present in about 10 percent of individuals in regions where neurocysticercosis is endemic . Seizures in these patients should be treated with antiepileptic therapy. Subarachnoid cysts
  • Extraparenchymal ncc
  • Subarachnoid cysts
  • albendazole (typically 15 mg/kg/day in divided doses for at least 28 days), A reasonable approach is to use prednisone (up to 60 mg per day) ordexamethasone (up to 24 mg per day) along with the antiparasitic therapy. The dose can often be tapered after a few weeks. However, in cases for which more prolonged steroid therapy is required, methotrexate can be used as a steroid-sparing agent
  • Giant cysts
  • giant cysticerci are usually accompanied by cerebral edema and mass effect, which should be managed with high-dose corticosteroids (with or withoutmannitol).
  • Intraventricular cysts
  • undergo emergent management with CSF diversion via a ventriculostomy or placement of a ventriculo-peritoneal shunt
  • Treatment of residual hydrocephalus may be managed with endoscopic foraminotomy and endoscopic third ventriculostomy; this approach may also allow debulking of cisternal cysticerci
  • Ocular cysticercosis

Surgical excision is warranted in the setting of intraocular cysts



Parasites – Ectoparasites

  • Body lice
  • Pediculus humanus, corporis treatment[2]
  • A body lice infestation is treated by improving the personal hygiene of the infested person, including assuring a regular (at least weekly) change of clean clothes.
  • Clothing, bedding, and towels used by the infested person should be laundered using hot water (at least 130°F) and machine dried using the hot cycle.
  • Sometimes the infested person also is treated with a pediculicide Ivermectin Lotion; however, a pediculicide Ivermectin generally is not necessary if hygiene is maintained and items are laundered appropriately at least once a week. A pediculicide Ivermectin should be applied exactly as directed on the bottle or by your physician.
  • Head lice
  • Pediculus humanus, capitis treatment[3]
  • Preferred regimen (1): Permethrin 1% lotion apply to shampooed dried hair for 10 min.; repeat in 9-10 days
  • Preferred regimen (2): Malathion 0.5% lotion (Ovide) apply to dry hair for 8–12hrs, then shampoo. 2 doses 7-9 days apart
  • Alternative regimen: Ivermectin 200 μg/kg PO once; 3 doses at 7 day intervals reported effective.
  • Pubic lice
  • Phthirus pubis treatment[4]
  • Preferred regimen (1): Permethrin 1% cream rinse applied to affected areas and washed off after 10 minutes
  • Preferred regimen (2): Pyrethrins with piperonyl butoxide applied to the affected area and washed off after 10 minutes
  • Alternative regimen (1): Malathion 0.5% lotion applied to affected areas and washed off after 8–12 hours
  • Alternative regimen (2): Ivermectin 250 ug/kg PO, repeated in 2 weeks
  • Preferred regimen: No medications approved by the FDA are available for treatment[5]
  • Note: Fly larvae need to be surgically removed.
  • Fly larvae treatment [6]
  • Preferred treatment (1): Occlude punctum to prevent gas exchange with petrolatum, fingernail polish, makeup cream or bacon.
  • Preferred treatment (2): When larva migrates, manually remove.
  • Note (1): Myiasis is due to larvae of flies.
  • Note (2): Usually cutaneous/subcutaneous nodule with central punctum.

Scabies

  • Scabies
  • Sarcoptes scabiei treatment [7]
  • 1. Adult
  • Preferred regimen (1): Permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours
  • Preferred regimen (2): Ivermectin 200ug/kg PO qd and repeated in 2 weeksAlternative Regimens
  • Alternative regimen: Lindane (1%) 1 oz of lotion or 30 g of cream applied in a thin layer to all areas of the body from the neck down and thoroughly washed off after 8 hours
  • Infants and young children
  • Preferred regimen: Permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours
  • Note: Infants and young children aged< 10 years should not be treated with lindane.
  • Alternative regimen (2): Less effective is Crotamiton 10% cream, apply for 24 hours, rinse off, then reapply for 24 hours.
  • 2. AIDS patients (CD4 <150 per mm3), debilitated or developmentally disabled patients
* preferred regimen (for Norwegian scabies) : Permethrin 5% cream-2 or more applications a week apart may be needed. After each Permethrin dose (days 2-7) apply 6% Sulfur in petrolatum.
Note: Apply entire skin from chin down to and including toes with Permethrin 5% cream. Leave on 8–14hours. Repeat if itching persists for >2-4 wks after treatment or new pustules occur.

Sparganosis

  • Sparganosis (Spirometra mansonoides) treatment [8]
  • Preferred treatment: Surgical resection or ethanol injection of subcutaneous masses
Note: Source for Spirometra mansonoides larval cysts is frogs or snakes
  1. ↑ 1.0 1.1 García HH, Evans CA, Nash TE, Takayanagui OM, White AC, Botero D; et al. (2002). "Current consensus guidelines for treatment of neurocysticercosis". Clin Microbiol Rev. 15 (4): 747–56. PMC 126865. PMID 12364377.
  2. ↑ Template:CDC
  3. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
  4. ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  5. ↑ "Parasites - Myiasis".
  6. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
  7. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
  8. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
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