Candida and parasitic infection: Helminths, trichomoniasis, lice, scabies, and malaria
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Pyrantel pamoate, a pyrimidine derivative, acts by paralyzing nematodes, allowing them to be expelled. Its action is similar to depolarizing neuromuscular blocking agents (41). Pyrantel pamoate is very poorly absorbed, with half remaining in the intestinal tract unabsorbed. This poor absorption is the basis for its recommendation as first-line therapy in pregnancy. Blood levels of pyrantel pamoate are quite low, but it is not known whether it crosses the placenta. Animal teratology studies were negative, and no human malformations have been reported (compatible with pregnancy category B, but never labeled by the FDA). Pyrantel pamoate is considered safe for use while breastfeeding, due to its low absorption. Side effects (gastrointestinal complaints) are generally minimal and are not increased in pregnancy. Pyrantel doses can be calculated from the pamoate form or the free base (1mg base = 2.9mg pamoate form). Anthelmintic doses are 5 to 10 mg/kg pyrantel base or 15 to 30mg/kg pyrantel pamoate (maximum daily dose, 1-g pyrantel base) (41).
Niclosamide
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
In a report prepared by Ofori-Adjei and Dodoo (2004) for the WHO/PSM Expert Committee on the Selection and Use of Essential Medicines meeting in 2005, 84 reports of suspected adverse drug reactions to niclosamide were identified in the WHO database from 1975 until 2004, involving 173 reactions from 16 countries. The most common adverse reactions were those involving skin and appendages (41), gastrointestinal tract (37), and cardiovascular system (28). There were nine reports of anaphylactic shock and anaphylactoid reactions. A recent review of adverse events to anthelmintics in the French national pharmacovigilance database revealed that adverse drug reactions in nine subjects were reported between 1985 and 1999 (Bagheri et al., 2004). These comprised abdominal pain and vomiting (n = 3), dizziness (n = 2), and one each of polymorphic erythema, sweating, and anaphylactoid reaction.
Antihelmintic Properties of Allium sativum L.: Effect on Fecal Egg Count of West African Dwarf (WAD) Rams
Megh R. Goyal, Hafiz Ansar Rasul Suleria, Ademola Olabode Ayeleso, T. Jesse Joel, Sujogya Kumar Panda in The Therapeutic Properties of Medicinal Plants, 2019
Since the 1960s, worm control has relied heavily on the use of synthetic anti-helminths, such as Invermectins, Levamisoles, and Thiabendazole [7]. The continuous and indiscriminate use of antihelmintic drugs has caused growing resistance of the parasite to conventional treatments [12, 13]. Also, the long-term regular uses of these anti-helminths have led to the loss of an animal‘s natural resistance and immunity. It was opined that the increasing resistance of parasites to antihelmintic drugs is a largely known phenomenon, this necessitates the search for several alternatives (nutrition manipulation, use of medicinal plants and rotational grazing) rather than the common chemotherapeutic means, because of the recent consumers concern for safe food [13].
Arctigenin: pharmacology, total synthesis, and progress in structure modification
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2022
Dan Wu, Lili Jin, Xing Huang, Hao Deng, Qing-kun Shen, Zhe-shan Quan, Changhao Zhang, Hong-Yan Guo
To control the parasitism of D. intermedius, Hu et al.144 designed, synthesised, and tested a new series of arctigenin derivatives. The anthelmintic activity of most derivatives was shown in the range 1–10 mg/L. Compared to the conventional drug praziquantel (EC50 = 2.69 mg/L), the ether derivatives 206 and 207 showed slightly higher antiparasitic activity with EC50 values of 2.48 and 1.52 mg/L, respectively. In addition, the arctigenin-imidazole hybrids 194 and 197 were also effective in removing intermediate entomopathogenic nematodes, with EC50 values of 2.13 and 2.07 mg/L, respectively. Structure-activity relationship analysis showed that the four-carbon linker and imidazole substituents can significantly improve the insect repellent activity and reduce the toxicity of the molecule. The above results indicate that 194 and 197 are considered to be promising lead compounds to prevent and control D. intermedius infection.
Intraventricular neurocysticercosis causing obstructing hydrocephalus
Published in Baylor University Medical Center Proceedings, 2022
Alejandro Perez, Gaurav Syngal, Samreen Fathima, Sam Laali, Sadat Shamim
One week after treatment, repeat CSF sampling showed resolution of pleocytosis and xanthochromia. He completed a total of 2 weeks of the antihelminthic therapy. His ventriculostomy was transitioned to a ventriculoperitoneal shunt by neurosurgery with improved headaches, but he did have persistent right-sided ptosis, cranial nerve III palsy, and right-sided hearing loss. He was discharged on a tapering dose of dexamethasone and levetiracetam for seizure prophylaxis. On his follow-up with neurology 6 months later, he was noted to have persistent reduced right-sided hearing loss but denied headaches or seizures; hence, his levetiracetam was discontinued. Follow-up CT of the head a year after hospitalization showed resolution of the subdural collection and no evidence of hydrocephalus. Follow-up MRI of the brain 2 years after hospitalization showed a right frontal ventriculoperitoneal shunt in place without ventriculomegaly and no evidence of intraventricular obstruction or hydrocephalus (Figure 4).
Ivermectin: a mini-review
Published in Clinical Toxicology, 2022
Ivermectin is generally well tolerated after therapeutic oral exposure when used for anthelminthic purposes. Commonly adverse effects associated with therapeutic anthelminthic ivermectin ingestion include headache, nausea, pain, edema, skin rashes, and dizziness [20]. Pain, swelling, and cutaneous reactions are often reported in patients treated with single-dose therapy for treatment of onchocerciasis, but these side effects may be more closely related to the primary disease process than the treatment provided. In a pharmacokinetic study, healthy adult volunteers tolerated up to 2000 mg/kg of ivermectin without serious toxicity [7]. In this study, transient and mild adverse events (including headache, nausea, dizziness, and rash) occurred at similar frequencies in subjects who received placebo or ivermectin. The incidence of adverse events was not dose-dependent. In school-aged pediatric patients, ivermectin has been tolerated at doses up to 600 mcg/kg [21]. In this population, most adverse events, including headache, abdominal pain, photophobia, and pruritus, were mild and resolved within 48 h of drug administration.
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