Case Definition

Consider that fecal-oral transmission occurs in tropical, rural communities via larvae in moist soil (walking barefoot), clothes, furniture, towels, and toilets8,15.

The following are consistent with infection with soil-transmitted helminths:

1. Abdominal pain3,8,9,13,15,18and nutritional problems (nausea, bloating, flatulence, poor appetite/growth)3,8,9,13,14,15,18

2. Visible worms3,5,17 and pruritus at sites of larva penetration/migration3,5,15,17

3. Poor intellectual development15

4. Respiratory distress/wheezing5,13in cases of heavy infection13

5. Rectal prolapse and bleeding in cases of whipworm15

Red Flags

No relevant red flags for hospital referral

Management

Non-pharmacologic recommendations

Treat1,5,18 at triage (or send dose home for patients17 and family14, 19), every 3 to 6 months7,8,15if have not received at school dose7, 8,9,19

Pinworms: wash hands after using the toilet, and before and after eating. Launder bedding, clothing, and toys to destroy eggs15

Pharmacologic management2,7,8

Option 1:
Albendazole 400mg once for patients over 2 yrs old1,3,4,5,7,8,9,13,15,17. Tablets may be crushed prior to administration7. Contraindicated if pregnant7, 8,9,14,15,18 or breastfeeding7,9

Pinworms: repeat dose in 2 weeks3
Trichuris (whipworm): 600mg x117

Pediatric dosing:100mg8-200mg in age 1-2 years7,9,15,17, or 300mg for trichuris17

Option 2:
Mebendazole 500mg PO single dose for >2 years of age (or 100mg PO BID x 3 days) 3,5,7, 17 for severe cases1

Other options:
Ivermectin4, piperazine, secnidazol8, pyrantel

Other considerations:
Have candies/crackers available following deworming therapy13

Consider co-treatment with multi-vitamins for iron deficiency19

Consider treating distended/malnourished children for giardia co-infection using metronidazole 250mg tid x 5 days (10 mg/kg/dose given TID if <20kg) 8, 19. Treat only after antiparasitic treatment, due to risk of worm migration8

Avoid anti-diarrheal medicines during parasite treatment8

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1. Organization A

Locations: Nicaragua
Trips per year: 4
Format of trips: Mobile medical clinics and standing clinics
Setting: Rural
Type of Organization: Secular

2. Organization B

Locations: Guatemala
Trips per year: Variable
Format of trips: Clinics
Setting: Rural
Type of Organization: Secular

3. Organization C

Locations: Haiti
Trips per year: Variable
Format of trips: Clinic
Setting: Urban
Type of Organization: Faith-based

4. Organization D

Locations: Dominican Republic
Trips per year: 3
Format of trips: Clinic
Setting: Rural
Type of Organization: Secular

5. Organization E

Locations: Haiti
Trips per year: 7
Format of trips: Not mentioned
Setting: Rural
Type of Organization: Secular

6. Organization F

Locations: Honduras, Ecuador, Belize, Guyana, Guatemala
Trips per year: 5
Format of trips: Mobile brigades
Setting: Rural and Urban
Type of Organization: Faith-based

7. Organization G

Locations: Ecuador, Guatemala, Dominican Republic
Trips per year: 100 (spread over 6 sites)
Format of trips: Mobile brigades
Setting: Rural and Urban
Type of Organization: Secular

8. Organization H

Locations: Ecuador
Trips per year: 3
Format of trips: Mobile brigades in schools/Clinics in health centers
Setting: Rural
Type of Organization: Secular

9. Organization I

Locations: Honduras
Trips per year: 1
Format of trips: Mobile brigades in 20 villages
Setting: Rural
Type of Organization: Faith-based

10. Organization J

Locations: Jamaica, Haiti
Trips per year: 4
Format of trips: Mobile brigades, Permanent clinics/hospital medicine
Setting: Rural and urban
Type of Organization: Secular

11. Organization K

Locations: Haiti
Trips per year: 4
Format of trips: Clinic
Setting: Rural
Type of Organization: Secular

12. Organization L

Locations: Guatemala, Nicaragua
Trips per year: 3
Format of trips: Mobile clinics
Setting: Rural
Type of Organization: Faith-based

13. Organization M

Locations: Nicaragua, Honduras
Trips per year: 51
Format of trips: Mobile brigades, Hospital-based
Setting: Rural
Type of Organization: Faith-based

14. Organization N

Locations: Guatemala
Trips per year: 12
Format of trips: Hospital
Setting: Rural
Type of Organization: Secular

15. Organization O

Locations: Honduras
Trips per year: Up to 50
Format of trips: Mobile brigades in school and churches
Setting: Rural
Type of Organization: Faith-based

16. Organization P

Locations: Haiti
Trips per year: Variable
Format of trips: Mobile brigades and clinics
Setting: Rural and urban
Type of Organization: Secular

17. Organization Q

Locations: Dominican Republic, Haiti
Trips per year: 12 to 15
Format of trips: Mobile brigades
Setting: Rural
Type of Organization: Secular

18. Organization R

Locations: Honduras, Nicaragua, Panama
Trips per year: Hundreds
Format of trips: Mobile brigades in community centre or school
Setting: Rural
Type of Organization: Secular

19. Organization S

Locations: Honduras
Trips per year: 4
Format of trips: Mobile brigades, Specialty hospital services
Setting: Rural
Type of Organization: Secular

20. Organization T

Locations: Haiti
Trips per year: Approximately 40
Format of trips: Mobile clinics in 14 villages and Standing clinic
Setting: Rural
Type of Organization: Faith-based