What is the treatment for a patient exposed to worms by a dog?

Treatment for Patients Exposed to Worms by Dogs

For patients exposed to worms by dogs, the recommended treatment is albendazole 400mg twice daily with meals for adults weighing over 60kg, or 15mg/kg/day in divided doses twice daily for those under 60kg, typically for 28 days. 1

Types of Worm Infections from Dogs

• Dogs can transmit several types of parasitic worms to humans, with the most common being:
  • Dipylidium caninum (dog tapeworm) - transmitted when humans accidentally ingest infected fleas 2, 3
  • Echinococcus granulosus (dog tapeworm causing hydatid disease) - transmitted through ingestion of eggs 1
  • Toxocara canis (roundworm) - causing toxocariasis through ingestion of eggs 4, 5

Diagnostic Approach

• For suspected tapeworm infections:
  • Look for proglottids (tapeworm segments) in stool 3
  • Perform serological testing for specific antibodies in cases of hydatid disease 1
• For toxocariasis (roundworm infection):
  • Check for eosinophilia (elevated eosinophil count) 4, 6
  • Perform TES-ELISA followed by Western blotting for confirmation 6
  • Consider imaging studies if visceral involvement is suspected 5

Treatment Protocols

For Tapeworm Infections:

• Albendazole is the first-line treatment for hydatid disease and most tapeworm infections 1
  • For adults ≥60kg: 400mg twice daily with meals
  • For adults <60kg: 15mg/kg/day in divided doses twice daily
  • Treatment duration: 28-day cycle followed by a 14-day albendazole-free interval, for a total of 3 cycles 1
• Praziquantel is effective against Dipylidium and Echinococcus species 3

For Toxocara Infections:

• Albendazole is the treatment of choice 5
  • Same dosing as above but typically for a shorter duration (5-10 days)
• For severe manifestations with organ involvement, consider adding corticosteroids 4

Prevention Strategies

• Implement good hygiene practices:
  • Thorough handwashing after handling dogs or potential exposure 2
  • Avoid contact with dog feces 7
• Regular deworming of pet dogs 3
• Control flea infestations in dogs to prevent Dipylidium transmission 2, 3
• Proper disposal of dog feces to prevent environmental contamination 7

Monitoring During Treatment

• Monitor blood counts at the beginning of treatment and every 2 weeks during therapy 1
• Monitor liver enzymes (transaminases) at the beginning of treatment and at least every 2 weeks 1
• For patients with liver disease, more frequent monitoring is warranted due to increased risk of bone marrow suppression 1

Special Considerations

• Discontinue albendazole if clinically significant decreases in blood cell counts occur 1
• Pregnancy test should be obtained in females of reproductive potential prior to therapy due to potential embryo-fetal toxicity 1
• For patients with neurological involvement, anticonvulsant therapy may be required 1, 5
• Cardiovascular manifestations of toxocariasis may require additional supportive care 8

Complications to Watch For

• Bone marrow suppression (monitor for fatigue, unusual bleeding, or infections) 1
• Hepatotoxicity (monitor for jaundice, right upper quadrant pain) 1
• In cases of neurocysticercosis, cerebral hypertensive episodes may occur during the first week of treatment 1