IM26.28-33 | Parasitic Infections: Amoebiasis, Malaria, Leishmaniasis, Filariasis, and Cysticercosis — Summary & Reflection

KEY TAKEAWAYS

Malaria: P. falciparum = ACT (AS+SP) ×3 days + primaquine single dose; severe = IV artesunate + ICU; P. vivax = chloroquine ×3 days + primaquine 14 days (G6PD mandatory; contraindicated in pregnancy); steroids contraindicated in cerebral malaria.

Amoebiasis: flask-shaped colonic ulcers; dysentery without high fever; ALA = right lobe, anchovy sauce, 10–15% have diarrhoea; diagnose: USS + serology; treat: metronidazole 10 days THEN luminal agent; aspiration for large/left lobe/failure only.

Kala-azar: L. donovani; sandfly Phlebotomus argentipes; massive splenomegaly + pancytopenia + prolonged fever; diagnose: rK39 RDT; treat: L-AmB single dose 10 mg/kg IV (India first-line); miltefosine oral alternative.

Filariasis: W. bancrofti; Culex mosquito; lymphoedema + elephantiasis + nocturnal microfilaraemia; TPE = nocturnal cough + eosinophilia; treat: DEC 6 mg/kg ×12 days; TPE ×21 days.

Neurocysticercosis: T. solium eggs (NOT pork eating) → cysts in brain → seizures (most common cause of acquired epilepsy in India); CT: scolex = pathognomonic; treat: albendazole + dexamethasone ×28 days; anti-epileptics; contraindicated in ocular NCC.

REFLECT

Parasitic diseases disproportionately affect India's poorest and most marginalised populations — tribal agricultural workers, fisherworkers, construction labourers, and subsistence farmers in endemic districts. Kala-azar is targeted for elimination in India because it kills the poor with near-100% mortality when untreated, yet responds to a single-dose liposomal amphotericin B regimen that is provided free under the national programme. Neurocysticercosis is preventable through sanitation, clean water, and proper sewage management — interventions that remain incomplete in many parts of India. As a physician, you will not only treat individual patients but will also encounter the social determinants of parasitic disease in your patient histories: occupational exposure, unsafe water, inadequate sanitation, food preparation practices, and barriers to healthcare access. Reflect on how your future clinical practice might incorporate advocacy for these patients — connecting the bedside treatment decision to the broader public health imperative to eliminate preventable parasitic diseases from India within this generation.