Angiostrongyliasis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Treatment
Treatment of angiostrongyliasis is not well defined, but most strategies include a combination of anti-parasitics to kill the worms, steroids to limit inflammation as the worms die, and pain medication to manage the symptoms of meningitis.
Anti-helminthics
Anti-helminthics are often used to kill off the worms, however in some cases this may cause patients to worsen due to toxins released by the dying worms. Albendazole, ivermectin, mebendazol, and pyrantel are all commonly used, though albendazole is usually the drug of choice. Studies have shown that anti-helminthic drugs may shorten the course of the disease and relieve symptoms. Therefore anti-helminthics are generally recommended, but should be administered gradually so as to limit the inflammatory reaction.
Anti-inflammatories
Anti-helminthics should generally be paired with corticosteroids in severe infections to limit the inflammatory reaction to the dying parasites. Studies suggest that a two week regimen of a combination of mebedizole and prednisolone significantly shortened the course of the disease and length of associated headaches without observed harmful side effects.[1] Other studies suggest that albendazole may be more favorable, because it may be less like to incite an inflammatory reaction.[2] The Chinese herbal medicine long-dan-xie-gan-tan (LDGXT) has also been shown to have a similar anti inflammatory effect, and in mild cases may be used alone to relieve symptoms while infection resolves itself.[2]
Symptomatic treatment
Symptomatic treatment is indicated for symptoms such as nausea, vomiting, headache, and in some cases, chronic pain due to nerve damage or muscle atrophy.
Antimicrobial Regimen
- Angiostrongyliasis
- Preferred: Symptomatic therapy, serial lumber puncture, corticosteroids (prednisone 60 mg qd for 2 weeks) and analgesics.[3]
- Note: Albendazole and Mebendazole are generally not recommended due to the risk of exacerbation of neurological symptoms following anthelminthic therapy.[4]
References
- ↑ V Chotmongkol and K Sawadpanitch et al. (2006). “Treatment of Eosiniphilic Meningitis with a Combination of Prednisolone and Mebendazole”. Am. J. Trop. Med. Hyg., 74(6): 1122–1124.
- ↑ 2.0 2.1 SC Lai, KM Chen, YH Chang and HH Lee (2008). “Comparative efficacies of albendazole and the Chinese herbal medicine long-dan-xie-gan-tan, used alone or in combination, in the treatment of experimental eosinophilic meningitis induced by Angiostrongylus cantonensis”. Annals of Tropical Medicine & Parasitology, 102(2): 143–150.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Chotmongkol V, Kittimongkolma S, Niwattayakul K, Intapan PM, Thavornpitak Y (2009). "Comparison of prednisolone plus albendazole with prednisolone alone for treatment of patients with eosinophilic meningitis". Am J Trop Med Hyg. 81 (3): 443–5. PMID 19706911.