General Guidelines For Bilharzia, Intestinal Worms, Lymphatic Filariasis & Blinding Trachoma

General Notes

Zimbabwe is annually instituting Mass Drug (Medicine) Administration (MDA) for bilharzia, intestinal worms, lymphatic filariasis and blinding trachoma to Pre and School Aged Children (Pre-SAC and SAC) as well as adults in endemic districts using WHO guidelines for preventive chemotherapy.

Bilharzia (Schistosoma mansoni & haematobium)

Proper diagnosis can only be made by microscopy of urine and stools. Antibody tests alone are insufficient basis for treatment.

Health Facility without microscopy diagnosis can treat Schistosoma haematobium infection in children and adolescents on the basis of visible haematuria or positive urine strip test for blood and or protein. Refer all suspected cases of Schistosoma mansoni for further investigations, particularly in the older patient.

NB. In female patients exclude haematuria caused by menstruation

S. Mansoni

Most patients with S. Mansoni infection have minimal or no symptoms unless there is heavy infestation. Infection should be suspected in young patients with unexplained iron deficiency anaemia, hepatosplenomegaly or non-resolving chronic salmonella infections.

Occasionally patients may present with dysentery like symptoms when colonic polyps due to S. Mansoni ulcerate and bleed.

Treatment:

S. Haematobium

Medicine	Children and Adult Dose	Frequency	Duration
Praziquantel po	40mg/kg	one dose only	-

S. Mansoni:

Medicine	Adult Dose	Frequency	Duration
Praziquantel po	40mg/kg	one dose only	repeat at 4 weeks

General notes:

Do not give praziquantel in pregnancy. Treat after delivery.
Praziquantel is generally available as a double-scored 600mg tablets. Using a 40mg/kg body weight dose, the patient should be given a dose to the nearest quarter tablet (150mg).
- Example: The dose for a 70 kg person is 2800 mg (70kg x 40mg). The patient should be given four- and three-quarter tablets (2850 mg, the closest convenient dose).
Treatment with praziquantel will also eliminate any roundworm infestation.
In Mass Drug Administration (MDA campaign) a dose pole is used for administration of praziquantel.

Katayama Syndrome

This is a severe immunological reaction to recent heavy infection with Schistosoma mansoni or haematobium causing fever and acute serum sickness. Treat with:

	Medicine	Adult and children Dose	Frequency	Duration
	Praziquantel po	40mg/kg	one dose	repeat after 2 weeks
and	prednisolone po	50mg, once a day, reducing by 5mg per day according to response