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Nematodes

Nematodes (roundworms) are nonsegmented, tapered, bilaterally symmetrical, cylindrical organisms that have complete digestive tracts and reproduce sexually. Although > 500,000 species of nematodes have been described, only a small number are commonly encountered as human parasites. Most nematodes have complex life cycles, sometimes involving several larval forms and intermediate hosts or free-living stages. The pathogenic nematodes may be categorized as primarily intestinal or extraintestinal tissue parasites (Box 1).

Albendazole: Observational and Comparative studies

Albendazole has been used in the treatment of human hookworm and trichuriasis. In a mass-treatment report from Western Australia 295 individuals in a remote rural area were treated with albendazole 400 mg/day for 5 days because of possible Giardia lamblia and hookworm infections. The 37% prevalence of Giardia fell to 12% between days 6 and 9, but rose again to 28% between days 18 and 30. The effect on hookworms (Ankylostoma duodenale) was more pronounced and more sustained with a reduction of the pretreatment prevalence of hookworm infections from 76% before treatment to 0% after 3^1 weeks.

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Supine and postural tachycardia with postural hypotension can occur; in one large study, such effects were found in three of 40 patients. In another there was hypotension in 13 of 69 cases, but in some series these effects have not been observed at all. A massive community study in Ghana noted hypotension in only 37 of nearly 15 000 patients treated.

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Emesis, ataxia, and mydriasis are cardinal signs of ivermectin toxicity. The safety, tolerability, and pharma-cokinetics of escalating high-dose ivermectin have been studied in 68 healthy subjects in a randomized, double-blind, placebo-controlled study in the following doses: Ivermectin was generally well tolerated. Quantitative pupillometry ruled out any mydriatic effect of ivermectin.

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Nitrofurantoin is a synthetic nitrofuran that belongs to a group of organic substances characterized by a heterocyclic ring consisting of four carbon atoms and one oxygen atom. Its mechanism of action is not understood. Nitrofurans enter bacterial cells and interact with several enzymes; thereby inhibiting bacterial growth. Nitrofurantoin is active against many Gram-positive and Gram-negative bacteria.

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Except for cardiovascular collapse in anaphylactic shock, adverse cardiovascular events seem to be extremely rare with nitrofurantoin. In experimental animals, cardiotoxic effects have been described. Acute respiratory reactions to nitrofurantoin include dyspnea, cough, interstitial pneumonitis, and pleural effusion, while interstitial pneumonitis and fibrosis are common chronic reactions. Nitrofurantoin causes acute lung injury more often than any other drug.

Parasitic Infections

Most infectious agents fulfill the definition of a parasite: an organism that grows, feeds, and shelters on or in a different organism and contributes nothing to the host. However, medical science has created the classification “parasite” to include a complex group of nonfungal eukaryotic human pathogens. Unlike fungi, parasites have no cell wall and are often motile.

Intestinal Helminths

Infections are often asymptomatic. In the immuno-compromised host, Strongyloides can progress to a fatal hyperinfection syndrome. Helminths include the roundworms (nematodes), flukes (trematodes), and tapeworms (cestodes). These parasites are large, ranging in size from 1 cm to 10 m, and they often live in the human gastrointestinal tract without causing symptoms.

Filariasis (Wuchereria Bancrofti And Brugia Malayi)

Microfilaria is less common than many parasites, being estimated to infect approximately 120 million people. Several strains of worm can cause this disease. Wuchereria bancrofii is found throughout the tropics, and Brugia malayi is restricted to the southern regions of Asia. A third strain, Brugia timori is found only in Indonesia.