Helminthic Infections Trematodes Flukes

Clonorchis sinensis and Opisthorchis viverrini (Liver flukes)

Clonorchis sinensis (Chinese liver fluke) and Opisthorchis viverrini (Southeast Asian liver fluke) primarily infect the bile ducts. The illness usually is asymptomatic, but mild or severe illness with epigastric or right upper quadrant pain, fever, leukocytosis and eosinophilia may occur in the acute phase. A sclerosing cholangitis or choledocholithiasis can occur in the chronic phase. The diagnosis is usually made by finding eggs in the stool. The drug of choice is praziquantel. Alternatively, albendazole (10 mg/kg for 7 days) can be used for C. sinensis. Fasciola hepatica (sheep liver fluke), similarly can cause acute and chronic infections of the liver and biliary tract. The treatment of choice is bithionol (an investigational drug available from the Centers for Disease Control and Prevention) or triclaben-dazole (10 mg/kg once). But, this drug is only available by special request from its manufacturer, Novartis.

Fasciolopsis buski, Heterophyes heterophyes, Metagonimus yokogawai (Intestinal flukes)

These infections are very rare in the United States. The drug of choice is 1 day of praziquantel (75 mg/kg/d in 3 doses). An alternative is niclosamide (not available in the United States) administered every other day for 3 days.

Schistosoma mansoni and Schistosoma japonicum (Schistosomiasis)

The most common form of intestinal schistosomiasis is due to schistosoma mansoni, which is common in Africa, Arabian peninsula, South America, and the Carribean. S. japonicum is important in East Asia. Up to 35% of infections are asymptomatic. The disease usually causes intestinal symptoms when it is in a chronic stage, which occurs 6 months to several years after infection, presenting as diarrhea, abdominal pain, blood in stool, and hepatosplenomegaly. Treatment should be given only if live ova are identified in stool specimens. The treatment of choice for all schistosomiasis infections is one day of praziquantel, which has cure rates of 80 to 90%. Alternatively, oxamniquine can be used for s. man-soni infections only (see tables for exact doses).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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