Post on 28-Dec-2015
ANTHELMINTICS
Presented by:-Bhavana ZalavadiyaChirag PrajapatiDr.Poonam PatilKavita VankoreM.Sc. CRM (2009-11)(PRIST UNIVERSITY)
Contents• What are the Helminths?• Classification • Disease caused by them• Anthelmintic drugs• Anthelmintic herbs• Recent trials• School deworming programs• Surgeries
Helminths
Helminths (from the Greek Helmins, meaning worm).
Parasitic worms or helminths are a division of eukaryotic parasites that, unlike external parasites such as lice and fleas, live inside their host.They are worm-like organisms that live and feed off living hosts, receiving nourishment and protection while disrupting their hosts' nutrient absorption, causing weakness and disease.
It has been estimated that about Half of country’s population suffers from helminthiasis, and number is on increase.
It is not only limited to tropical & subtropical countries, but is also endemic in many regions because of poor sanitation, poor family hygiene, malnutrition, and crowded living condition.
ClassificationThere are 3 classes of Helminths:Nematodes (roundworms)
Trematodes (flukes)
Cestodes (tapeworms)
Causes Low priority linked to poverty: unsafe water, poor
sanitation, substandard housing, poor education. Common in low income countries.
Infections Deaths
HIV/Aids HIV/Aids
TBTB
MalariaMalaria
Childhood & vaccinepreventable diseases
Childhood & vaccinepreventable diseases
Diarrhoeal diseases Diarrhoeal diseases
Other infectious andparasitic diseases
Other infectious and parasitic diseases
STDs excluding HIV STDs excluding HIV
African trypanosomiasis, Chagas disease, schistosomiasis, leishmaniasis, lymphatic filariasis, onchocerciasis, leprosy, dengue, japanese encephalitis, trachoma, STH
Diseases Causative agent
Signs & symptoms Worms
ONCHOCERClASIS (RIVER BLINDNESS)
Onchocerca volvulus
subcutaneous nodules, a pruritic skin rash and ocular lesions
TRICHURIASIS (WHIPWORM DISEASE)
Trichuris trichiura
abdominal pain,diarrhea, and flatulence can occur
ENTEROBIASIS (PINWORM DISEASE)
Enterobius vermicularis
Causing intense itching around theanus
HOOKWORM DISEASE
Ancylostoma duodenale ,Necator americanus
anorexia, ulcer like symptoms and chronic intestinal blood loss that leads to anemia.
CYSTICERCOSIS Taenia solium Skin: generally no symptomsBrain:cause features of encephalitis, Epilepsy, personality changes
DISEASES CAUSED BY HELMINTHS
Diseases Causative agent Signs & symptoms Worms
ASCARIASIS (ROUNDWORM DISEASE)
Ascaris lumbricoides
intestinal obstruction; roundworms may pass to blood and infect the lungs
STRONGYLOIDIASIS (THREADWORM DISEASE)
Strongyloides stercoralis
relatively benign disease in normal individuals; can progress to fatal outcome In Immunocompromised patients
FILARIASIS Wucheraria bancrofti, Brugia malayi
Local inflammation and fibrosis of lymphatics , the arms, legs, and scrotum fill with fluid causing elephantiasis
TRICHINOSIS Trichinelia spiralis
muscle pain
SCHISTOSOMIASIS S.HaematobiumS.MansoniS.japonicum
Itch,urticaria, fever, muscle aches, abdominal pain, headaches, cough and sweating.
ANTHELMINTIC DRUGS Public health fights to reduce helminth infections in the US
may be traced as far back as 1910, when the Rockefeller Foundation began the fight against hookworm – the so-called “germ of laziness” – in the American South
Are drugs used to eradicate parasitic worms from the human body.
Most anthelmintics in use today are active against specific parasites, and some are toxic. Hence,the worms must be identified before treatment is started,usualy by finding the ova, parasite or larvae in the faeces, urine, blood, sputum or tissue of the host.
ANTHELMINTHIC DRUGS
• May act by causing :
1- paralysis of the worm.2- damaging the worm leading to partial
digestion or rejection by immune mechanisms.
3- interfere with the metabolism of the worm.
ANTHELMINTHIC DRUGSDrugs ALBENDAZOLE MEBENDAZOLE
MOA Inhibits mitochondrial reductase causing reduced glucose transport
Blocks the uptake of glucose
Clinical uses Hydatid disease & cysticercosisAlso in ascariasis ,trichuriasis ,hookworm, pin worm infections
Pinworm , trichuriasis, hookworm & ascaris infections
Adverse effects Mild epigastric pain,diarrhea, nausea, headache & insomnia
Mild GI disturbance, nausea, vomiting, diarrhoea
precautions Should not be used in pregnancy
Used with caution under 2ys of age may cause convulsion & contraindicated in pregnancy
Drugs PYRANTEL PAMOATE PIPERAZINE
MOA Paralyze the helminth. Flaccid paralysis
Clinical uses Round worm & pin worm infection
Ascariasis
Adverse effects Anorexia, nausea, headache, drowsiness, rashes
Nausea, vomiting, diarroea and allergic reaction
precautions Should be used with caution in liver dysfunction.Pregnancy, children under 2 years of age
Epilepsy or a history of epilepsyImpaired liver or kidney functionspregnancyChronic neurologic disease
Contd …
Drugs NICLOSAMIDE IVERMECTIN
MOA inhibition of oxidative phosphorylation
Acts on the parasites glutamate-gated Cl- channel receptors
Clinical uses tapeworms infection. cutaneous larva migrans & strongyloidiasis
Adverse effects Mild abdominal pain, nausea Fatigue ,dizziness, GI disturbance
precautions Not indicated in children under 2 years of age or in pregnancy
Concomitant use with other drugs that enhance GABA e.g Barbiturates, bnzodiazepines, valproic acid.Meningitis
Contd …
Anti-Helminthic Ayurvedic Herbs:
These medicinal plants damage the worms in the intestine. They either cause the death of worms or make them unconscious. So some purgatives are used along with these herbs.
• These are of two types. Specific Antihelminthic Herbs: Some herbs act
specifically on particular type of worm. e.g. Chauhar, Palashbeeja, Vidanga for pin worm; Pomegranate bark, Puga for thread worm.
General Antihelminthic Herbs: These herbs affect all the worms. These usually possess bitter, pungent and astringent taste and are with hot active principle
Gmelina arborea Roxb
Latex of Calotropis procera: Latex possesses wormicidal activity and thus, may be useful as an anthelmintic.
Baliospermum montanum :Roots of B. montanum were evaluated for their anthelmintic activity against Pheretima posthuma and Ascardia galli as test worms.
Streblus asper Lour :Antifilarial
Cleome viscosa (wild mustard)
Garlic: It is also used as anthelminthic.
Contd …
Preventive measures
The infective larvae develop and survive in an environment of damp dirt, particularly sandy and loamy soil. The main lines of precaution are those dictated by sanitary science:
o Do not defecate in places other than latrines, toilets etc.o Deworm pet dogs — canine and feline hookworms rarely develop to
adulthood in humans but their invasive larvae can cause an itchy rash called cutaneous larva migrans
o Handwashing before food handling .o Avoiding ingestion of soil by thorough washing of food that may have
been contaminated with egg-containing soil are other preventive measures.
o Improvement of Sewage and Sanitation systems, as well as improved facilities for feces disposal
Recent trials Efficacy of Vaccine Sh28GST in Association With
Praziquantel (PZQ) for Prevention of Clinical Recurrences of Schistosoma Haematobium Pathology (Bilhvax)
Sponsor: Institut National de la Santé Et de la Recherche Médicale, France
Phase 1 Trial of Na-ASP-2 Hookworm Vaccine in Previously Infected Brazilian Adults
Sponsor: Albert B. Sabin Vaccine Institute
Antihelminthic Therapy Combined With Antimony in the Treatment of Cutaneous Leishmaniasis
Sponsor: Hospital Universitário Professor Edgard Santos
School deworming programs
These programs have a number of advantages. On the one hand, they allow health policymakers to take advantage of existing infrastructure and institutions for the dispensation of medical treatment; students already plan to attend school on a somewhat regular basis, and teachers can easily distribute the medication to their students without receiving any medical training.
Surgeries
There are various surgeries to remove worms from the body like colonoscopy , heart surgery, brain surgery, etc.
See videos.