PE31.14 | Parasitic Infections — Summary & Reflection

KEY TAKEAWAYS

Parasitic infections in children span protozoa (Giardia, Entamoeba histolytica, Leishmania donovani) and helminths (Ascaris, hookworm, Enterobius, Trichuris, Wuchereria bancrofti, Taenia solium). Key clinical patterns: eosinophilia with transient pulmonary infiltrates = Loeffler syndrome (Ascaris lung migration); microcytic anaemia with pica in an endemic-area child = hookworm; perianal nocturnal itch = Enterobius (diagnose with cellophane-tape test); chronic malabsorption with greasy stools = Giardia; bloody mucoid stools ± right-lobe liver abscess = E. histolytica; prolonged fever + splenomegaly in Bihar/Jharkhand/WB = kala-azar (rK39 RDT); first seizure in a child from a pig-keeping household = NCC (CT ring-enhancing lesion). Treatment keypoints: albendazole 400 mg single dose (200 mg if <2 yr) for STH; metronidazole + luminal agent (diloxanide or paromomycin) for amoebiasis — the two-drug rule; liposomal amphotericin B (first-line, India) or miltefosine (oral) for kala-azar; albendazole 15 mg/kg/day + corticosteroids + antiepileptics for NCC. The National Deworming Day (NDD) — biannual, 1–19 yr — is India's primary prevention strategy for STH. WASH remains the structural intervention upstream of all faeco-orally transmitted parasites.

REFLECT

Consider the 7-year-old boy from Bihar at the opening of this module — microcytic anaemia from hookworm, and his 5-year-old sister with Enterobius. Reflect: How would you counsel their mother differently than you would prescribe for them? What does she need to understand about why the family keeps getting reinfected, and what she can realistically do in a household with a pit toilet and limited access to clean water? How does the National Deworming Day programme address — and where does it fall short of addressing — the structural factors that perpetuate parasitic infection in that household? As a physician, the prescription slip addresses the individual, but the family will return with the same infections unless the environmental reservoir is disrupted. How do you bridge individual treatment and public health action in a 10-minute consultation?