A parasitic infection that can turn fatal with administration of corticosteroids - World Health Organization
A parasitic infection that can turn fatal with administration of corticosteroids - World Health Organization |
- A parasitic infection that can turn fatal with administration of corticosteroids - World Health Organization
- What is a parasite cleanse, and does it work? - Medical News Today
- No evidence ivermectin is a miracle drug against COVID-19 - Berkshire Eagle
| Posted: 17 Dec 2020 12:00 AM PST  Healthcare workers in tropical and sub-tropical settings where strongyloidiasis is prevalent or caring for patients who have travelled to such areas, need to maintain a high level of awareness about the use of corticosteroids, including when this class of anti-inflammatories is given to patients suspected of infection with SARS-CoV-2. Strongyloidiasis - a parasitic worm infection – is estimated to affect millions of people and is associated with marginalized communities who often walk barefoot. While it is frequently subclinical, immunosuppression resulting from diseases such as AIDS, lymphoma and leukemia or from continued use of corticosteroids can convert it into a severe and deadly "hyperinfection" syndrome. Risks in an era of COVID-19The current COVID-19 pandemic serves to highlight the risk of using systemic corticosteroids and, to a lesser extent, other immunosuppressive therapy, in populations with significant risk of underlying strongyloidiasis. Cases of strongyloidiasis hyperinfection in the setting of corticosteroid use as COVID-19 therapy have been described1,2 and draw attention to the necessity of addressing the risk of iatrogenic strongyloidiasis hyperinfection syndrome in infected individuals prior to corticosteroid administration. Although this has gained importance in the midst of a pandemic where corticosteroids are one of few therapies shown to improve mortality3, its relevance is much broader given that corticosteroids and other immunosuppressive therapies have become increasingly common in treatment of chronic diseases (e.g. asthma or certain rheumatologic conditions). The risk of strongyloidiasis and corticosteroid use further becomes globally relevant as at-risk populations include not only those residing in endemic areas but also migrant communities in non-endemic areas. The disease and immunosuppressionStrongyloidiasis, most commonly due to Strongyloides stercoralis in humans, is a parasitic (nematode) infection endemic throughout much of the tropical and subtropical regions of the world with an overall global prevalence of 8% and highest burden in South-East Asia, Western Pacific, and African WHO Regions4. Humans acquire the infection via contact with contaminated soil when larvae penetrate the skin and then migrate to the intestine. The eggs (or larvae) are then excreted back into the environment where they may infect a new host. Unlike other nematode intestinal infections, S. stercoralis has a unique ability to auto-inoculate (re-infect) their human host without requiring passage through the soil, giving the parasite the ability to chronically infect the host for decades. Most infections are asymptomatic or subclinical, although they can be associated with abdominal discomfort, skin rashes, cough, constipation or other less common complications. However, the feared complication, hyperinfection syndrome or dissemination, occurs when a patient becomes immunosuppressed, most commonly from corticosteroid treatment5. In addition to pharmacological immunosuppression, co-infection with human T-lymphotropic virus type 1 (HTLV-1), another common tropical/subtropical chronic infection, increases the risk of hyperinfection. Prevention is crucialThe most common clinical presentation of hyperinfection syndrome is the acute decompensation of a patient who is noted to have a gram-negative bacteremia or central nervous system infection (meningitis). In areas of the world without access to dependable diagnostics, including microbiologic cultures, the underlying condition of strongyloidiasis is under-recognized. Even in areas with advanced diagnostics the etiology is frequently overlooked, and when diagnosed, is incidentally found. While eosinophilia can aid in diagnosis of chronic strongyloidiasis, it is frequently absent in cases of hyperinfection which accentuates the importance of high clinical acumen in recognizing this process. Prevention is paramount given that, even in treated cases, mortality far exceeds 50%. TreatmentTreatment of chronic strongyloidiasis with ivermectin 200 µg/kg per day orally x 1-2 days is considered safe with potential contraindications including possible Loa loa infection (endemic in West and Central Africa), pregnancy, and weight <15kg. Given ivermectin's safety profile, the United States has utilized presumptive treatment with ivermectin for strongyloidiasis in refugees resettling from endemic areas, and both Canada and the European Centre for Disease Prevention and Control have issued guidance on presumptive treatment to avoid hyperinfection in at risk populations6–8. Screening and treatment, or where not available, addition of ivermectin to mass drug administration programs should be studied and considered. Presumptive treatmentCorticosteroids are extremely inexpensive, widely available, and effective treatment for a myriad of conditions. The actual risk of hyperinfection syndrome in any given individual placed on corticosteroids is unknown. However, when it occurs, it generally has a devastating outcome. Risk stratification for chronic strongyloidiasis places those receiving corticosteroid therapy (or have HTLV-1 infection) at high risk for hyperinfection if they were born, resided, or had long-term travel in Southeast Asia, Oceania, sub-Saharan Africa, South America, or the Caribbean. Similarly, the risk is considered moderate in Central America, Eastern Europe, Mediterranean, Mexico, Middle East, North Africa, Indian sub-continent, or Asia (with low risk being those in Australia, Canada, United States, or Western Europe)8. When initiating corticosteroid therapy, including for COVID-19, presumptive treatment (with or without laboratory screening) with ivermectin is advisable for those at high or moderate risk of hyperinfection9. High level of awareness by cliniciansWhen prescribing corticosteroids, including when treating COVID-19 patients, clinicians need to maintain a high level of awareness for strongyloidiasis which causes chronic, subclinical infections that can become fatal in the setting of hyperinfection from immunosuppression. Due to the high endemicity of S. stercoralis in tropical and subtropical areas of the globe, people with a history of living or extensively traveling in these areas should be considered for presumptive treatment with ivermectin prior to corticosteroid administration to prevent hyperinfection. Further study and data are needed regarding presumptive treatment and the possible addition of ivermectin to other existing mass drug administration programs. Diagnosis and management of suspected or established strongyloidiasis hyperinfection system should be discussed with an expert. References:
 |
| What is a parasite cleanse, and does it work? - Medical News Today Posted: 16 Oct 2019 12:00 AM PDT  A parasite cleanse is any diet, supplement, or other detox product that is intended to eliminate parasites from the body without using prescription medications. Many companies go so far as to recommend these cleanses for just about anyone, without a doctor ever diagnosing them with a parasitic infection. Many natural plants and compounds may help the body clear out parasites. However, in cases where a person does not have a parasite, they will do very little. In this article, learn more about parasite cleanses and what the evidence says about whether they are effective. There is a myth in some natural health circles that argues that the vast majority of people have parasites, and, therefore, need parasite cleanses. This presumption is untrue. However, well-known parasitic infections such as malaria are a global epidemic. Malaria alone kills over 660,000 people each year, according to the Centers for Disease Control and Prevention (CDC). Most of these deaths are young children in sub-Saharan Africa. Many parasitic infections are also possible in the United States. The CDC calls these neglected parasitic infections and include several statistics for their occurrence in the U.S.:
However, some manufacturers of parasite cleanses and other detox products may inflate these numbers. Many makers of parasite cleanse products will go so far as to say everyone should do a parasite cleanse once or twice a year, with or without evidence of them having a parasite. In reality, the only people who need treatment for parasites are the people who have parasitic infections. Anyone who is concerned they have a parasitic infection should speak to a doctor. There is little research on whether commercial parasite cleanses are useful. Many of the people who try these products likely do not have a parasitic infection. However, some parasite cleansers may be effective for people who do have an infection. For example, wormwood is the main ingredient in many parasite cleansing products, and it contains powerful antioxidants and other helpful compounds. A recent study in the Journal of Helminthology showed that wormwood reduced dwarf tapeworm levels in a similar way as a leading antiparasitic medication in animal studies. These results are promising, but the researchers call for more tests before recommending wormwood as a treatment. Another 2018 study in humans found that wormwood could treat schistosomiasis, which occurs in people with a type of parasitic worms, as effectively as the standard medical treatment. In the study, 800 participants with schistosomiasis received either the standard medical treatment (praziquantel) or one of two types of wormwood tea. Those who received the wormwood tea cleared the infection faster and experienced fewer side effects than those who took standard medication. Plants often have natural defense compounds built into them that work to protect the plant from infections, as well as ward off bugs and other invaders. Many plants and herbs contain compounds that may have an antiparasitic effect in laboratory testing and other studies. Therefore, manufacturers of parasite cleanses claim that many plants may kill parasites in the body as well, including: Many natural sources have similar effects to standard medications for parasites and show promise as antiparasitic tools. However, it may be difficult to tell if they are effective when many people using at-home parasite cleanses do not have any underlying infection. Countless anecdotes appear online about people's experiences with parasite cleansing diets and how much better they feel afterward. While people may feel better, the effects may have more to do with the general tips of a cleansing or detoxing diet. Cleansing diets or programs will often require a person eats a supportive diet while taking the product. This diet may include avoiding greasy, processed foods and eating natural, whole foods. Some parasite cleansing diets ask the person to avoid specific types of foods, such as gluten, dairy, or pork. Diets may also include the use of anti-inflammatory herbs and spices, such as garlic, turmeric, and ginger. These dietary changes alone may be enough to cause a noticeable change in a person's body, as they are moving to a cleaner and more healthful diet. The ingredients in the detox product tend to be very high in antioxidants, and many can easily cause a reaction in the digestive system. People often mistake these effects for what they call "parasitic die-off." After a round of these herbs, some diets will suggest adding supplements to restore the digestive system, such as prebiotics and probiotics. Some research suggests that probiotics may also help reduce the risk of parasitic infections or help treat them. Many parasite cleanse diets may make a person feel better simply by eliminating processed and greasy foods and introducing healthful probiotics and antioxidants. However, some cleanses ask a person to consume only one type of food for a prolonged period. Common symptoms of a parasitic infection include: However, many of these symptoms appear with other digestive health issues. Anyone experiencing these symptoms should see a doctor for a full diagnosis. In some cases, parasites clear up on their own, especially in a person with a healthy immune system. If the parasite causes concerning symptoms or may cause complications, doctors will likely order an antiparasitic medication that kills the parasite. Some people choose natural methods to clear their body of a parasite. Certain ingredients in these products may show promise in clearing parasites. The authors of a 2013 study note that many natural products show promise as antiparasitic treatments. However, there is not enough research to suggest them as cures yet. While individual ingredients may work in laboratory studies, there is little proof that commercial cleansing products kill parasites. A person can have a parasitic infection, even if they do not experience symptoms. However, there is no evidence to show that people self-diagnosing and using parasite cleanses benefit from these products if no parasite is present. The methods behind many cleansing programs typically involve the person switching to a whole foods diet, eating supportive herbs, and improving their digestive health. The switch to a more healthful diet overall may produce many of the positive effects people note when taking parasite cleanses. Anyone concerned about parasites or the possibility that they have a parasitic infection should see a doctor.  |
| No evidence ivermectin is a miracle drug against COVID-19 - Berkshire Eagle Posted: 14 Dec 2020 12:00 AM PST  CLAIM: The anti-parasitic drug ivermectin "has a miraculous effectiveness that obliterates" the transmission of COVID-19 and will prevent people from getting sick. THE FACTS: During a Senate hearing Tuesday, a group of doctors touted alternative COVID-19 treatments, including ivermectin and the anti-malaria medication hydroxychloroquine. Medical experts have cautioned against using either of those drugs to treat COVID-19. Studies have shown that hydroxychloroquine has no benefit against the coronavirus and can have serious side effects. There is no evidence that ivermectin has been proved a safe or effective treatment against COVID-19. Yet, Dr. Pierre Kory, a pulmonary and critical care specialist at Aurora St Luke's Medical Center in Milwaukee, described ivermectin as a "wonder drug" with immensely powerful antiviral and anti-inflammatory agents, at the hearing before the Senate Homeland Security and Governmental Affairs Committee. Clips of Kory's comments on ivermectin during the hearing were shared widely on social media, with one clip receiving more than 1 million views on YouTube. Ivermectin is approved in the U.S. in tablet form to treat parasitic worms, as well as a topical solution to treat external parasites. The drug also is available for animals. The Food and Drug Administration and the National Institutes of Health have said that the drug is not approved for the prevention or treatment of COVID-19. According to the FDA, side effects for the drug include skin rash, nausea and vomiting. Dr. Amesh Adalja, an infectious disease expert at Johns Hopkins University, said most of the research around ivermectin at the moment is made up of anecdotes and studies that are not the gold standard in terms of how to use ivermectin. "We need to get much more data before we can say this is a definitive treatment," he said. "We would like to see more data before I recommend it to my patients." Kory told The Associated Press that he stands by the comments he made at the hearing, saying that he was not trying to promote the drug, but rather, the data around it. In June, Australian researchers published the findings of a study that found that ivermectin inhibited the replication of SARS-CoV-2 in a laboratory setting, which is not the same as testing the drug on humans or animals. After the study, the FDA released a letter out of concern, warning consumers not to self-medicate with ivermectin products intended for animals.  |
| You are subscribed to email updates from "How do you treat parasites" - Google News. To stop receiving these emails, you may unsubscribe now. | Email delivery powered by Google |
| Google, 1600 Amphitheatre Parkway, Mountain View, CA 94043, United States | |
Comments
Post a Comment