Parasitic infections
Red flags
Consider urgent referral for patients with the following:
- Red flags occur from complications of dehydration from gastroenteritis, from extensive secondary bacterial infection and from the presence of parasites in vital organs
- Dehydration from gastroenteritis
- Marked anaemia
- Deteriorating renal function
- Abnormal LFT
- Extensive crusting and secondary infection of the skin associated with scabies
- Altered conscious level
- Tapeworm cysts in liver, brain, myositis
- Visual problems (toxocara)
- Myocarditis (toxocara)
Features that may lead to more urgent categorisation
- Hepatic cysts
Parasitic infections are common in Australia and simple infections include:
- Skin and hair
- Head and body lice
- Pubic lice
- Scabies
- Gastrointenstinal
- Intestinal helminth (whipworm, threadworm, hookworm, tapeworm)
- Giardia lamblia
- Blastocystis, Dientamoeba fragilis
- Other
- Cysticercosis
- Toxoplasmosis
- Toxocara
Other important information for referring practitioners
Lifestyle changes
- Encourage good personal hygiene habits especially after toileting and food preparation
- Encourage regular worming of pets
Medical management
Pediculosis (head and body lice)
- Use hair conditioner & comb through, immersing the comb in hot water will kill lice and eggs
- If using anti lice shampoo ensure complete treatment of all parts of the scalp and retreat 1 week later. Use nit comb to remove all eggs (nits).
- Main treatment compounds are:
- Pyrethrins
- Perimethrin and bioallethrin
- Organophosphates (malathion or malison)
- Herbal and essential oils
- Main treatment compounds are:
Scabies
- If neglected can lead to extensive secondary infection and serious health consequences, especially in remote communities. Consider urgent referral.
- Consider this diagnosis for unexplained dermatitis of recent onset, recurrent impetigo with itch, unexplained pruritis
- Look for typical burrows, consider skin scrapings
- Used scabicidal cream from neck down and treat all family members, even if asymptomatic
- Use permethrin cream and leave on for 24 hrs. Other treatments are:
- Benzoyl benzoate (irritating)
- Gamma benzene hexachloride (potential neurotoxin)
- Ivermectin (potential side effects in young and very elderly)
- Repeat in 1 week
- Wash all clothes and bedding in hot water and iron or heat dry
- Treat pruritis with emollients and steroid creams and treat secondary infection
- Reassure that pruritis takes up to 4 weeks to settle
Gastrointestinal
- Helminth infection
- Suspect threadworm if unexplained pruritis ani
- A wide range of antihelminthics are available over the counter, these are:
- Mebendazole, Pyrantel, (OTC)
- Albendazole (tapeworm and hydatid) PBS listed
- Ivermectin (strongyloidiasis and onchocerciasis) PBS listed
- Praziquantel (Brachylaima cribbi from snails ingestion) is prescription only not PBS listed
- Giardia, blastocystis, dientamoeba
- Suspect if persistent diarrhoea or intermittent diarrhoea
- Diagnose on stool microscopy or PCR
- The multiplex PCR assay currently available produces many positives for blastocystis and dientamoeba, the significance of which remains unclear
- Treat with Metronidazole or Tinidazole
- Often resolves without treatment
Referral requirements
A referral may be rejected without the following information.
Send referral
Hotline: 1300 364 938
Fax: 1300 364 952
Electronic: eReferral system
Mail: Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
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