Case Definition

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

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

1. Abdominal painC,H,I,M,O,Rand nutritional problems (nausea, bloating, flatulence, poor appetite/growth)C,H,I,M,N,O,R

2. Visible wormsC,E,Q and pruritus at sites of larva penetration/migrationC,E,O,Q

3. Poor intellectual developmentO

4. Respiratory distress/wheezingE,Min cases of heavy infectionM

5. Rectal prolapse and bleeding in cases of whipwormO

Red Flags

No relevant red flags for hospital referral

Management

Non-pharmacologic recommendations

TreatA,E,R at triage (or send dose home for patientsQ and familyN, S), every 3 to 6 monthsG,H,Oif have not received at school doseG, H,I,S

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

Pharmacologic managementB,G,H

Option 1:
Albendazole 400mg once for patients over 2 yrs oldA,C,D,E,G,H,I,M,O,Q. Tablets may be crushed prior to administrationG. Contraindicated if pregnantG, H,I,N,O,R or breastfeedingG,I

Pinworms: repeat dose in 2 weeksC
Trichuris (whipworm): 600mg x1Q

Pediatric dosing:100mgH-200mg in age 1-2 yearsG,I,O,Q, or 300mg for trichurisQ

Option 2:
Mebendazole 500mg PO single dose for >2 years of age (or 100mg PO BID x 3 days) C,E,G, Q for severe casesA

Other options:
IvermectinD, piperazine, secnidazolH, pyrantel

Other considerations:
Have candies/crackers available following deworming therapyM

Consider co-treatment with multi-vitamins for iron deficiencyS

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

Avoid anti-diarrheal medicines during parasite treatmentH

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Organization A

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

Organization B

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

Organization C

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

Organization D

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

Organization E

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

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

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

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

Organization I

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

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

Organization K

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

Organization L

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

Organization M

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

Organization N

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

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

Organization P

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

Organization Q

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

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

Organization S

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

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