238.4 📌 章末速蚘

238.4.0.0.1 4 Main STH
  • Ascaris (giant roundworm): eggs ingested; lung migration; Loeffler; intestinal obstruction; albendazole single dose
  • Hookworm (Necator, Ancylostoma): skin penetration + lung migration; iron deficiency anemia from chronic blood loss; albendazole + iron; cutaneous larva migrans (animal hookworm)
  • Strongyloides: skin penetration + autoinfection (chronic decades); larva currens + chronic GI + eosinophilia; hyperinfection in immunocompromise (60-85% mortality); ivermectin
  • Trichuris (Whipworm): eggs ingested; NO lung migration; bloody diarrhea + rectal prolapse pediatric; albendazole × 3 days
238.4.0.0.2 Pinworm
  • Pediatric perianal itching; Scotch tape test; mebendazole / albendazole / pyrantel; treat household
238.4.0.0.3 Toxocara
  • Dog/cat nematode; VLM + OLM in pediatric; albendazole + steroid
238.4.0.0.4 Strongyloides Special Considerations
  • Pre-immunosuppression screening for patients from endemic regions
  • HTLV-1 synergistic for hyperinfection
  • Steroids = #1 trigger for hyperinfection
  • Serology most sensitive
  • Ivermectin treatment + extended course for hyperinfection
238.4.0.0.5 MDA
  • Albendazole / Mebendazole annual / biannual for endemic school-age children
  • WHO global programs
238.4.0.0.6 Eosinophilia + Travel
  • Strongyloides screen essential (most missed)
  • Multiple parasitic workup based on exposure history
238.4.0.0.7 Treatment Drug Summary
  • Albendazole + Mebendazole: most STH (Ascaris, hookworm, Trichuris, pinworm, Toxocara)
  • Ivermectin: Strongyloides (preferred); also cutaneous larva migrans, scabies, filariae
  • Pyrantel pamoate: pinworm (OTC option)
  • Hyperinfection: ivermectin extended + albendazole combination + reduce immunosuppression
238.4.0.0.8 盧醫垫 hint
  • 移民 / 旅遊 endemic + GI sx / eosinophilia → STH workup
  • Pre-corticosteroid / immunosuppression: screen for Strongyloides if endemic origin
  • Pediatric perianal itching: Scotch tape test for pinworm