e-Table. Clinical presentation, diagnosis, and treatment of major worm diseases (e16–e19).

Pathogen	Clinical symptoms	Eosinophil count*1	Diagnosis	Treatment
Adult nematodes (roundworms) in the intestine
Ascaris lumbricoides(maw worm)	Larval migration causes pulmonary symptoms, rarely ileus, liver abscesses, obstructive jaundice	Greatly increased during larval migration, later slightly increased or normal	Detection of eggs in stool	Mebendazole 2 x 100 mg/d for 3 days
Ancylostoma, Necator (hookworm)	Larval migration causes pulmonary symptoms, abdominal complaints, poss. (iron deficiency) anemia	Greatly increased during larval migration, later slightly increased or normal	Detection of eggs in stool	Mebendazole 2 x 100 mg/d for 3 days
Strongyloides stercoralis (dwarf threadworm)	Larval migration causes pulmonary symptoms, abdominal complaints, severe courses in immunodeficiency	Initially greatly increased, later moderately to slightly increased, in immunodeficiency poss. normal (!)	Detection of larvae in stool (e.g. Baermann test) or duodenal secretion	Albendazole 2 x 400 mg/d or ivermectin*2 1 x 200 µg/kg for 1 to 2 days, repeated after 2 weeks
Trichuris trichiura (whipworm)	Rarely rectal prolapse	Slightly increased to normal	Detection of eggs in stool	Mebendazole2 x 100 mg/d for 3 days
Enterobius vermicularis (pinworm)	Perianal pruritus, rarely vaginitis, appendicitis	Slightly increased to normal	Detection of eggs in perianal swab sample	Mebendazole 1 x 100 mg/d,repeated after 2 and 4 weeks
Trichostrongylus spp.	Diarrhea, abdominal pain	Slightly increased to normal	Detection of eggs in stool	Mebendazole2 x 100 mg/d for 3 days
Adult nematodes (roundworms) in tissue
Onchocera volvulus	Dermatitis, subcutaneous nodules, ocular involvement	Usually increased	Detection of adult worms in skin nodules (poss. by ultrasonography) or of microfilaria in the skin (skin snip)	Ivermectin*2 150 µg/kg,poss. additionally doxycycline*2100 mg/d for 6 weeks
Loa loa	Cutaneous swellings, subconjunctival worm migration	Often greatly increased	Detection of microfilaria in blood	Diethylcarbamazine*2 Caution with high microfilaria counts
Wuchereria bancrofti, Brugia malayi	Lymph vessel obstruction or even elephantiasis, lymphadenitis, lymphangitis	In early stages	Detection of microfilaria in blood	Diethylcarbamazine*2
Nematode larvae
Anisakis spp.	Abdominal pain	Slightly to moderately increased	Clinical and serological	Endoscopically, poss. surgically
Toxocara spp. (visceral larva migrans)	Generalized symptoms, poss. focal neurological signs, ocular symptoms	Moderately to greatly increased	Clinical and serological	Albendazole 2 x 400 mg/d over 2 to 4 weeks
Gnathostoma spp.	Subcutaneous or visceral larva migrans syndrome	Moderately to greatly increased	Clinical and serological	Albendazole 2 x 400 mg/d over3 weeks poss. also surgical removal
Trichinella spp. (trichinosis)	Abdominal complaints, myalgia, periorbital edema, poss. focal neurological signs	Moderately to greatly increased	Clinical, blood test for larvae, serological	Mebendazole 2 x 200 mg/d for 2 weeks or albendazole 400 mg/d over 2 weeks, poss. additionally corticosteroids
Cestodes (tapeworms) in the intestine
Taenia saginata (beef tapeworm)	Abdominal complaints	Normal to slightly increased	Detection of proglottids in stool	Niclosamide 1 x 2 g or praziquantel 1 x 10 mg/kg
Taenia solium (pork tapeworm)	Abdominal complaints	Normal to slightly increased	Detection of proglottids in stool	Niclosamide 1 x 2 g or praziquantel 1 x 10 mg/kg
Diphyllobothrium latum (fish tapeworm)	Poss. megaloblastic anemia with glossitis	Normal to slightly increased	Detection of eggs in stool	Niclosamide 1 x 2 g or praziquantel 1 x 25 mg/kg
Hymenolepsis nana (dwarf tapeworm)	Abdominal complaints, diarrhea	Normal to slightly increased	Detection of eggs in stool	Praziquantel 1 x 25 mg/kg
Tapeworm larvae in tissue
Taenia solium (cysticercosis)	Focal neurological signs, subcutaneous nodules	Normal to slightly increased	Imaging, immunodiagnostics	Albendazole 15 mg/kg/d for 30 days
Echinococcus granulosus and E. multilocularis	Intrahepatic cysts	Normal to slightly increased	Imaging, immunodiagnostics	Albendazole 15 mg/kg/d for 30 days, often several cycles necessary
Trematodes (leeches, flukes)
Schistosoma haematobium	Initially poss. fever ("Katayama fever"), dysuria, hematuria, hydronephrosis	In Katayama fever greatly increased, later slightly increased	Detection of eggs in urine or in rectal biopsies	Praziquantel 40 mg/kg/d for 3 days
Schistosoma mansoni,S. japonicum,S. intercalatum	Initially poss. fever ("Katayama fever"), abdominal complaints, bloody stool, poss. hepatic fibrosis	In Katayama fever greatly increased, later slightly increased	Detection of eggs in stool or in colon biopsies	Praziquantel 40–60 mg/kg/d for 3 days
Fasciolepsis buski (large intestinal fluke)	Nonspecific symptoms	Normal to slightly increased	Detection of eggs in stool	Praziquantel 1 x 15 mg/kg
Fasciola spp.(large liver fluke)	Hepatomegaly (often painful), liver abscesses, biliary tract symptoms	In early infection greatly increased,later slightly increased	Detection of eggs in stool and duodenal secretion, adult worm in ultrasonography	Triclabendazole*2 1 x 10 mg/kg for severe infections up to 20 mg/kg
Clonorchis and Opisthorchis spp.(Chinese and cat liver fluke)	Biliary tract symptoms, pyrogenic cholangitis, cholangiocarcinoma	In early infection greatly increased, later slightly increased	Detection of eggs in stool and duodenal secretion	Praziquantel 3 x 25 mg/kg/d for 2 days
Paragonimus spp.(lung fluke)	Chronic cough, chest pain, hemoptyses or brownish tinged sputum	In early infection greatly increased, later normal	Detection of eggs in stool and sputum, x-ray	Praziquantel 3 x 25 mg/kg/d for 2 days

^*1 Degree of eosinophilia classified according to Brigden (10; modified): mild eosinophilia <1500/µL, moderate to severe eosinophilia >1500/µL

^*2 Off-label use, only after consulting a specialist in tropical medicine