ANTHELMINTICS

Presented by:-Bhavana ZalavadiyaChirag PrajapatiDr.Poonam PatilKavita VankoreM.Sc. CRM (2009-11)(PRIST UNIVERSITY)

Contents• What are the Helminths?• Classification • Disease caused by them• Anthelmintic drugs• Anthelmintic herbs• Recent trials• School deworming programs• Surgeries

Helminths

Helminths (from the Greek Helmins, meaning worm).

Parasitic worms or helminths are a division of eukaryotic parasites that, unlike external parasites such as lice and fleas, live inside their host.They are worm-like organisms that live and feed off living hosts, receiving nourishment and protection while disrupting their hosts' nutrient absorption, causing weakness and disease.

It has been estimated that about Half of country’s population suffers from helminthiasis, and number is on increase.

It is not only limited to tropical & subtropical countries, but is also endemic in many regions because of poor sanitation, poor family hygiene, malnutrition, and crowded living condition.

ClassificationThere are 3 classes of Helminths:Nematodes (roundworms)

Trematodes (flukes)

Cestodes (tapeworms)

Causes Low priority linked to poverty: unsafe water, poor

sanitation, substandard housing, poor education. Common in low income countries.

Infections Deaths

HIV/Aids HIV/Aids

TBTB

MalariaMalaria

Childhood & vaccinepreventable diseases

Childhood & vaccinepreventable diseases

Diarrhoeal diseases Diarrhoeal diseases

Other infectious andparasitic diseases

Other infectious and parasitic diseases

STDs excluding HIV STDs excluding HIV

African trypanosomiasis, Chagas disease, schistosomiasis, leishmaniasis, lymphatic filariasis, onchocerciasis, leprosy, dengue, japanese encephalitis, trachoma, STH

Diseases Causative agent

Signs & symptoms Worms

ONCHOCERClASIS (RIVER BLINDNESS)

Onchocerca volvulus

subcutaneous nodules, a pruritic skin rash and ocular lesions

TRICHURIASIS (WHIPWORM DISEASE)

Trichuris trichiura

abdominal pain,diarrhea, and flatulence can occur

ENTEROBIASIS (PINWORM DISEASE)

Enterobius vermicularis

Causing intense itching around theanus

HOOKWORM DISEASE

Ancylostoma duodenale ,Necator americanus

anorexia, ulcer like symptoms and chronic intestinal blood loss that leads to anemia.

CYSTICERCOSIS Taenia solium Skin: generally no symptomsBrain:cause features of encephalitis, Epilepsy, personality changes

DISEASES CAUSED BY HELMINTHS

Diseases Causative agent Signs & symptoms Worms

ASCARIASIS (ROUNDWORM DISEASE)

Ascaris lumbricoides

intestinal obstruction; roundworms may pass to blood and infect the lungs

STRONGYLOIDIASIS (THREADWORM DISEASE)

Strongyloides stercoralis

relatively benign disease in normal individuals; can progress to fatal outcome In Immunocompromised patients

FILARIASIS Wucheraria bancrofti, Brugia malayi

Local inflammation and fibrosis of lymphatics , the arms, legs, and scrotum fill with fluid causing elephantiasis

TRICHINOSIS Trichinelia spiralis

muscle pain

SCHISTOSOMIASIS S.HaematobiumS.MansoniS.japonicum

Itch,urticaria, fever, muscle aches, abdominal pain, headaches, cough and sweating.

ANTHELMINTIC DRUGS Public health fights to reduce helminth infections in the US

may be traced as far back as 1910, when the Rockefeller Foundation began the fight against hookworm – the so-called “germ of laziness” – in the American South

Are drugs used to eradicate parasitic worms from the human body.

Most anthelmintics in use today are active against specific parasites, and some are toxic. Hence,the worms must be identified before treatment is started,usualy by finding the ova, parasite or larvae in the faeces, urine, blood, sputum or tissue of the host.

ANTHELMINTHIC DRUGS

• May act by causing :

1- paralysis of the worm.2- damaging the worm leading to partial

digestion or rejection by immune mechanisms.

3- interfere with the metabolism of the worm.

ANTHELMINTHIC DRUGSDrugs ALBENDAZOLE MEBENDAZOLE

MOA Inhibits mitochondrial reductase causing reduced glucose transport

Blocks the uptake of glucose

Clinical uses Hydatid disease & cysticercosisAlso in ascariasis ,trichuriasis ,hookworm, pin worm infections

Pinworm , trichuriasis, hookworm & ascaris infections

Adverse effects Mild epigastric pain,diarrhea, nausea, headache & insomnia

Mild GI disturbance, nausea, vomiting, diarrhoea

precautions Should not be used in pregnancy

Used with caution under 2ys of age may cause convulsion & contraindicated in pregnancy

Drugs PYRANTEL PAMOATE PIPERAZINE

MOA Paralyze the helminth. Flaccid paralysis

Clinical uses Round worm & pin worm infection

Ascariasis

Adverse effects Anorexia, nausea, headache, drowsiness, rashes

Nausea, vomiting, diarroea and allergic reaction

precautions Should be used with caution in liver dysfunction.Pregnancy, children under 2 years of age

Epilepsy or a history of epilepsyImpaired liver or kidney functionspregnancyChronic neurologic disease

Contd …

Drugs NICLOSAMIDE IVERMECTIN

MOA inhibition of oxidative phosphorylation

Acts on the parasites glutamate-gated Cl- channel receptors

Clinical uses tapeworms infection. cutaneous larva migrans & strongyloidiasis

Adverse effects Mild abdominal pain, nausea Fatigue ,dizziness, GI disturbance

precautions Not indicated in children under 2 years of age or in pregnancy

Concomitant use with other drugs that enhance GABA e.g Barbiturates, bnzodiazepines, valproic acid.Meningitis

Contd …

Anti-Helminthic Ayurvedic Herbs:

These medicinal plants damage the worms in the intestine. They either cause the death of worms or make them unconscious. So some purgatives are used along with these herbs.

• These are of two types. Specific Antihelminthic Herbs: Some herbs act

specifically on particular type of worm. e.g. Chauhar, Palashbeeja, Vidanga for pin worm; Pomegranate bark, Puga for thread worm.

General Antihelminthic Herbs: These herbs affect all the worms. These usually possess bitter, pungent and astringent taste and are with hot active principle

Gmelina arborea Roxb

Latex of Calotropis procera: Latex possesses wormicidal activity and thus, may be useful as an anthelmintic.

Baliospermum montanum :Roots of B. montanum were evaluated for their anthelmintic activity against Pheretima posthuma and Ascardia galli as test worms.

Streblus asper Lour :Antifilarial

Cleome viscosa (wild mustard)

Garlic: It is also used as anthelminthic.

Contd …

Preventive measures

The infective larvae develop and survive in an environment of damp dirt, particularly sandy and loamy soil. The main lines of precaution are those dictated by sanitary science:

o Do not defecate in places other than latrines, toilets etc.o Deworm pet dogs — canine and feline hookworms rarely develop to

adulthood in humans but their invasive larvae can cause an itchy rash called cutaneous larva migrans

o Handwashing before food handling .o Avoiding ingestion of soil by thorough washing of food that may have

been contaminated with egg-containing soil are other preventive measures.

o Improvement of Sewage and Sanitation systems, as well as improved facilities for feces disposal

Recent trials Efficacy of Vaccine Sh28GST in Association With

Praziquantel (PZQ) for Prevention of Clinical Recurrences of Schistosoma Haematobium Pathology (Bilhvax)

Sponsor: Institut National de la Santé Et de la Recherche Médicale, France

Phase 1 Trial of Na-ASP-2 Hookworm Vaccine in Previously Infected Brazilian Adults

Sponsor: Albert B. Sabin Vaccine Institute

Antihelminthic Therapy Combined With Antimony in the Treatment of Cutaneous Leishmaniasis

Sponsor: Hospital Universitário Professor Edgard Santos

School deworming programs

These programs have a number of advantages. On the one hand, they allow health policymakers to take advantage of existing infrastructure and institutions for the dispensation of medical treatment; students already plan to attend school on a somewhat regular basis, and teachers can easily distribute the medication to their students without receiving any medical training.

Surgeries

There are various surgeries to remove worms from the body like colonoscopy , heart surgery, brain surgery, etc.

See videos.