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Suggest Treatment For Ascariasis

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Posted on Tue, 13 Oct 2015
Question: I opened a case four days ago and got an answer but I was busy and did not get a chance to follow up on it. Maybe you can look at my previous case for additional information. By my description the doctor on EBIX felt I did have worm over load including the lung symptoms from larvae migration. I did indeed poop out three large amounts of long white worms five years ago and the symptoms all stopped, but I was never properly treated for it and I have been having symptoms again. The doctor here on EBIX suggested that I do no more treatment with Albendazole since it hasn't responded but that I need to have stool examination and get sure determination of what is going on. But the odd thing is that even though I did poop out all those worms, only a month or two before that and in fact on all stool sample tests it is ALWAYS negative for ova. When I took Albendazole for the first time a couple months ago the symptoms were helped that day but it came rushing back and I also had perfectly drawn little curling worm lines under the flesh of my penis glans! but they disappeared by the next day and then the next day a white matter in the shape of a curving line erupted through the surface of the glans! It certainly looked like little worms were birthed and then died under the skin. But with all of this I have never had a positive stool sample my local doctors simply will not entertain that I am struggling with some kind of deeper nematode infection. I will say that I never have been as constantly sick as before I evacuated the large amounts of worms five years ago, but as I said the symptoms have been returning for the last couple years and I seem to go through bought of the "electrical" feeling all over that wakes me up at night and also some of the lung issues. Could I have a worm outside my digestive track because I chased them out with the diatomaceous earth that I used to "cure" me the first time. And outside my digestive track maybe the eggs are not following so successfully the cycle through the lungs and voice box and back to the gut but are kind of floating in my system? NONE of this will my local doctor entertain.
doctor
Answered by Dr. Tushar Kanti Biswas (6 hours later)
Brief Answer:
Ascariasis

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
It seems that you had worm infestation that is Ascariasis (passage of long white worms in stool) and lung symptoms as well as presumably Loeffler's syndrome (larval migration in the lungs )associated with ascariasis. However worms crawling under the skin of shaft or glans penis is unlikely due to ascariasis.
Ascariasis or round worm infestation is curable with albendazole 400 mg at bed-time single dose and you have to repeat 400 mg after 10 days to break the ova-adult worm cycle through Oro-fecal transmission.
Even your stool is negative for ova,you may repeat another course of Albendazole 400 mg single dose and then repeat the same dose after 10 days.Meanwhile you can do your complete blood cont to see if there is any eosinophilia common with worm infestations.
However you seem to be obsessed with fear of getting worms in your system as it has troubled you in the past.







Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Tushar Kanti Biswas (15 minutes later)
Thank you Dr. Biswas. I am so tired of these difficulties and I am open to the approach that I am obsessed as this is what my doctors on this end are telling me. It is hard to square this with the symptoms that I am having, however, I am also moving forward on stress management approach with my doctor and he is having me review two different anti-depressants so we can choose one and also counseling.

..particularly hard to square physical symptoms that i have seen (re the worm lines under glans and then bursting through).... but as I said, I am also moving forward through with stress management approach. Thank you again.

Dr. Biswas, what about visceral larva migrans? My question is why am I having the symptoms that I had before I pooped out the large amount of worms (that is not up for interpretation, that did happen). And what about seeing the clear purple worm lines under my glans flesh that then a day later burst through the flesh?
doctor
Answered by Dr. Tushar Kanti Biswas (50 minutes later)
Brief Answer:
Cutaneous larva migrans

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
It seems that you had Cutaneous larva migrans (“creeping eruption”) ,a serpiginous skin eruption caused by burrowing larvae of animal hookworms, usually the dog and cat hookworm Ancylostoma braziliense.
Humans become infected after skin contact with soil in areas frequented by dogs and cats..After larvae penetrate the skin, erythematous lesions form along the tortuous tracks of their migration through the dermal-epidermal junction; the larvae advance several centimeters in a day.
The lesions may occur anywhere on the body ( in your case glans penis -very uncommon site though but possible ) ,if the patient has lain on the ground.
You might have spent sometime in lawn or park lying on the grass before you developed that curling worm lines underneath the flesh of glans penis,which in any case has long healed up.
The animal hookworm larvae do not mature in humans and, without treatment, will die ( but usually takes weeks but in your case disappeared next day-a bit uncommon), with resolution of skin lesions. The diagnosis is made on clinical grounds.

However you have taken a course of Albendazole (presumably 200 mg bid × 3 days) that is enough to alleviate/cure symptoms .

You did not have any evidence of Visceral larva migrans (toxocariasis ) .For your information Visceral larva migrans ( caused by nematode Toxocara larvae) is normally parasitic for nonhuman host species (dogs & cats). Humans can acquire toxocariasis accidentally eating soil contaminated by puppy feces that contains infective T. canis eggs. Even then vast majority of Toxocara infections are self-limited and resolve without any specific therapy.

I feel that you have been treated adequately for Ascaraisis and Ancylostoma braziliense infestations if any in the past as albendazole is effective for both the conditions and cured.


Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Tushar Kanti Biswas (21 hours later)
Thank you Dr. Biswas. Your information has been helpful. I will let the clock run some before closing this in case I have another question, but if I do not I will close it in the next day or two. Thank you.
doctor
Answered by Dr. Tushar Kanti Biswas (1 minute later)
Brief Answer:
Helminthic infestations

Detailed Answer:
You are most welcome.


Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Tushar Kanti Biswas (22 hours later)
Dear Dr. Biswas: Worms that came into my toilet were never properly diagnosed, so it is probably wrong for me to state that I had ascariasis. They were however long ribbons, white, and each time they were in the toilet in succession in one week I foolishly flushed them downtime toilet because I was angry at finally seeing real evidence of the symptoms I had suffered for so long, even shortly after I had negative stool samples with an infectious disease doctor. But there was no mistakin that they were worms, they were clean white and very visible each time ribboning back and forth locked in a little piece of fecal matter and they acted dead.
The striking matters in this case are that: I suffered from cyclical symptoms for more than 20 years that no doctor would recognize. It went on and on so long that I became self determined that it was worms. I found online diatomaceous earth, food grade, and ate it until I was literally "shitting bricks" of sand for almost five weeks. On the third week my symptoms and constitution cleared miraculously and on the 4th week I passed all those worms. All this after NEVER having a positive stool sample. My good health and cessation of all the symptoms and including the constant lung and throat sickness ALL cleared up. I continued to take lower dose regularly of diatomaceous earth which with also not properly treating may have chased any remaining infestation deeper into hiding or out of my gut and into elsewhere because after 2.5 years I started to have the symptoms start slowly back. Now five years later I am suffering again, again negative stool samples. The attacks are different though in that the horrible gripping feeling is not so centered around my lungs, heart and the constant colds have not returned. But the night attacks with the same very distinct weird numbing electrical feeling all over is back and the ear ringing, and it's always worse at night. I feel that I need an infectious disease doctor to sit down and truly talk to me and hear my story that started with severe sexual addiction in San Francisco and New York City in the 1970's and 80's and then my consequential health problem that has lasted all this time. But in XXXXXXX the infectious disease doctors will not do this. They will not listen to me to tell my story, they just review my medical record and refuse to see me...
doctor
Answered by Dr. Tushar Kanti Biswas (12 hours later)
Brief Answer:
Tape worm infestations and panic disorders

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
As per your description what you passed in the stool years back are tape-worms ((e.g., Taenia solium, T. saginata).The diagnosis is made by the detection of eggs or proglottids in the stool.
A single dose of praziquantel (10 mg/kg) is highly effective against both the tapeworms or cestodes.
Medical-grade diatomite has been studied for its efficacy as a de-worming agent in cattle; in both studies cited the groups being treated with diatomaceous earth did not fare any better than control groups.
Hence prolonged use of diatomaceous earth, food grade as deworming agent is not justified since praziquantel in stated dose is much more effective. If you are still using it,you can discontinue it straight away.

All you need to do now is repeat stool microscopic examination to exclude any re-infestation,since available serological tests are not helpful diagnostically.

All your night symptoms are more due to panic attacks and you are likely to be benefited by clonazepam which is however a prescription drug.





Regards

Dr. T.K. Biswas M.D. XXXXXXX
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
Answered by
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Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1920 Questions

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Suggest Treatment For Ascariasis

Brief Answer: Ascariasis Detailed Answer: Hi, Thank you for your query. I can understand your concerns. It seems that you had worm infestation that is Ascariasis (passage of long white worms in stool) and lung symptoms as well as presumably Loeffler's syndrome (larval migration in the lungs )associated with ascariasis. However worms crawling under the skin of shaft or glans penis is unlikely due to ascariasis. Ascariasis or round worm infestation is curable with albendazole 400 mg at bed-time single dose and you have to repeat 400 mg after 10 days to break the ova-adult worm cycle through Oro-fecal transmission. Even your stool is negative for ova,you may repeat another course of Albendazole 400 mg single dose and then repeat the same dose after 10 days.Meanwhile you can do your complete blood cont to see if there is any eosinophilia common with worm infestations. However you seem to be obsessed with fear of getting worms in your system as it has troubled you in the past. Regards Dr. T.K. Biswas M.D. XXXXXXX