Can children under 5 years old take medicine to treat gnathostomiasis in Vietnam? How to prevent gnathostomiasis in Vietnam effectively?
What methods are there to identify gnathostomiasis in Vietnam?
Pursuant to Section 3, Section 4 of the Guidelines promulgated together with Decision 1574/QD-BYT in 2022 of the Ministry of Health, guiding the methods used to identify gnathostomiasis in Vietnam is as follows:
“3. SUBCLINICAL
3.1. Test
- ELISA: detects IgG antibodies in the patient's serum against antigens of Gnathostoma spp.
- Blood count: usually see an increase in the total white blood cell count, the percentage of eosinophils in the blood is elevated (maybe > 50%).
- Total IgE in the blood is usually elevated.
- Stool test: look for other parasites to diagnose and rule out.
- Biopsy: to determine histopathology of lesions caused by gnathostomiasis larvae.
- Direct examination: identify gnathostomiasis larvae by morphological identification.
- Molecular biology techniques such as PCR, RFLP, gene sequencing to identify species.
3.2. Image analysation
- Chest X-ray: there are pictures of lung parenchyma lesions, lung infiltrates.
- CT Scanner: there is a change in density corresponding to the lesion area.
- MRI scan of suspected lesions: detect signal changes corresponding to damaged areas.
- Abdominal ultrasound, superficial transducer ultrasound: detect damage to intra-abdominal viscera or subcutaneous soft tissue.
- Ophthalmoscopy: detect choroiditis, retinal hemorrhage, light gray iris nodules, even larva images in anterior chamber with bleeding.
4. DIAGNOSIS
4.1. Suspected case
The patient lives in endemic areas with endemic gnathostomiasis, eats foods at risk of larval infection, and has clinical symptoms.
4.2. Identified case
A case of suspected disease and accompanied by the following tests:
- Direct examination found Gnathostoma spp. at sites of injury, or
- ELISA test to detect IgM/IgG antibodies against Gnathostoma spp. positive, or/and:
Elevated eosinophils and/or elevated total IgE.
+ Diagnostic imaging: detect lesions in viscera, corresponding tissues suggestive of larval lesions.
4.3. Differential diagnosis
- Strongyloidiasis S. stercoralis, eosinophilic meningitis caused by A. cantonensis worms, parasites in the central nervous system.
- Dog/cat roundworm larvae.
- Atopic dermatitis, contact dermatitis.
- Large liver fluke, pork tapeworm larvae.
- Infection with other intestinal worms.
Thus, gnathostomiasis in Vietnam will be identified and diagnosed according to the above methods.
Can children under 5 years old take medicine to treat gnathostomiasis in Vietnam? How to prevent gnathostomiasis in Vietnam effectively?
Can children under 5 years of age take medicine to treat gnathostomiasis in Vietnam?
Pursuant to Section 5 of the Guidelines issued together with Decision 1574/QD-BYT in 2022 of the Ministry of Health, there are guidelines on methods of treatment for gnathostomiasis in Vietnam as follows:
“5. TREATMENT
5.1. The principles of treatment
Treatment of specific drugs in combination with symptomatic treatment.
5.2. Specific treatment
Use one of the drugs in the following order of preference:
5.2.1. Regimen 1: albendazole (200mg and 400mg tablets)
a) Dosage
- Adults: 800mg/day, divided into 2 times/day x 21 days.
- Children > 1 year old: 10-15mg/kg/day (maximum 800mg/day), divided into 2 times/day x 21 days.
b) Treatment according to disease type
- For ocular and neurological gnathostomiasis, treatment with albendazole is not recommended, because it may aggravate the clinical condition of the patient. Treat symptomatically and consider corticosteroids.
c) Contraindications of albendazole
- People with a history of hypersensitivity to benzimidazole.
- Pregnant or lactating women.
- Children < 1 year old.
- People with a history of bone marrow toxicity.
d) Notes
- Be careful when using albendazole in patients with liver and kidney failure.
- Undesirable effects of albendazole, including agranulocytosis, agranulocytosis, decreased blood cell types and liver function effects with long-term use. Therefore, complete blood count and liver function tests (transaminases) should be performed at the start of each treatment cycle and at least every 2 weeks during treatment. If liver enzymes are elevated, albendazole should be discontinued. Treatment can then be continued if liver enzymes return to pre-treatment levels, but more frequent testing is required upon re-treatment.
5.2.2. Regimen 2: ivermectin (6mg tablets)
a) Dosage
- Adults and children 5 years old: 0.2mg/kg x 01 dose/day x 2 days
b) Treatment according to disease type
- For ocular and neurological gnathostomiasis, ivermectin is not recommended because it may aggravate the clinical condition of the patient. Treat symptomatically and consider corticosteroids.
c) Contraindications of ivermectin
- Patients with hypersensitivity to any component of the drug.
- Patients with diseases associated with blood-brain barrier disorders.
- Children under 5 years old.
- Pregnant women in the first 3 months.
d) Caution: when used for driving or operating machinery.
5.2.3. Regimen 3: thiabendazole (500 mg tablet)
a) Dosage: 2 times/day x 7 days, according to the patient's weight (see table)
b) Treatment according to disease type: applied to visceral and normal body.
c) Contraindications: hypersensitivity to the components of the drug.
d) Be careful
- People with liver failure, kidney failure;
- Women who are pregnant in the first 3 months and are breastfeeding;
- Do not use drugs when operating machinery, driving trains or vehicles;
- Children under 12 months old or under 13.6 kg body weight.
5.3. Symptomatic treatment
Depending on the clinical symptoms to prescribe the appropriate treatment drugs:
- Itching, urticaria: use antihistamines until the symptoms are gone.
- Fever: when the patient has a fever, combine mechanical antipyretic measures and antipyretic drugs.
- Supportive drugs: digestive enzymes, multivitamins, liver tonic.
- Eye and neurological form: for patients to go to appropriate specialists for coordinated treatment. Consider corticosteroids.
5.4. Surgical treatment
In the case of larval disease moving under the skin, soft tissue close to the skin, in the eye may have surgical indications depending on the case.
5.5. Follow-up after treatment
Patients need to be monitored and re-examined within 6 months at 1 - 3 - 6 months after the first treatment, to prevent recurrence."
Accordingly, depending on the treatment regimen to determine which cases are applicable and contraindicated for specific drugs according to the above guidelines.
How to effectively prevent gnathostomiasis in Vietnam?
According to Section 7 of the Guidelines issued together with Decision 1574/QD-BYT in 2022 of the Ministry of Health, there are guidelines on measures to prevent gnathostomiasis in Vietnam as follows:
“7. PREVENTION
Propaganda, education, and warning among the people about potentially infectious foods, not eating undercooked/undercooked seafood (fish, frogs, frogs, shrimp), using hygienic water sources , don't drink cold water easily get Cyclops."
Accordingly, to prevent gnathostomiasis in Vietnam, you should not eat undercooked, undercooked or raw seafood such as fish, frogs, shrimp, etc. and need to use hygienic water.
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