While most infections are acquired through environmental exposure, intestinal parasitic infections are among the most common infections throughout the world. “These infections are regarded as a serious public health issue as they can lead to iron deficiency anaemia, growth retardation in children, and other physical and mental health conditions. Worm infections are believed to be imposing an unnecessary burden on many South African children and the overall cost of healthcare,” said Nxasana et al.2 

ROUNDWORMS

Roundworms are parasites that need to live in the body. These parasites live in the intestine and are commonly found in soil and stool, entering the body through a patient’s mouth or direct contact with the skin and can live in the human intestine for up to 2 years. Types of roundworms in humans include pinworms and ascariasis.3 Hookworms and whipworms are types of roundworms that can be found in humans and animals. 

PINWORMS

Also called pinworms, threadworms are tiny thin white roundworms called Enterobius vermicularis about 5 millimetres in length. They live in the intestine and rectum. Although patients of any age can be infected, children are more susceptible.4,5 Pinworm infection is spread by the faecal-oral route. Children can get pinworms when they unknowingly get worm eggs on their hands and swallow them. This happens when they put their hands in their mouth or encounter a contaminated surface, toys, clothing, food, or bedding. Once swallowed, the eggs travel into the small intestines, where they hatch and lay more eggs around the anus. 

Pinworm symptoms include itchiness around the anus or vagina, which is usually worse at night, redness around the bottom area, and restlessness.5,6 

When dispensing deworming treatment, always advise patients to wash clothes and bedding in hot water and to disinfect the toilet regularly with an antiseptic cleaner.4 Because pinworms are spread so easily it is best to advise patients to deworm the whole family.5 

ASCARIS

Ascaris eggs thrive in warm, moist soil and children are more likely to develop a roundworm infection than adults because they are more likely to come into contact with contaminated soil when playing. In most patients, a roundworm infection does not cause any noticeable symptoms and it is unclear why some patients are particularly sensitive to the effects of roundworms while most patients are unaffected. According to Cleveland Clinic, the worm looks like the common earthworm. “It’s about [5-33cm] long and about as thick as a pencil. Up to 100 worms could potentially infect a person.”7  

Symptoms may include worms in the patient’s stool, stomach pain, loss of appetite, coughing, fever, wheezing, weight loss, or failure to grow. St. Louis Children's Hospital warned that if the worms cause a blockage of the intestines, a child may develop severe pain and vomiting, with a tender, bloated, and hard belly.8 

Albendazole and mebendazole are the most common treatment, Dr Andrew Whitelaw advised. This treatment is highly effective and is associated with few side effects.9 

WHIPWORM

Whipworm infection is an intestinal infection caused by the roundworm Trichuris trichiura. Dr Richard Pearson explained that with a whipworm infection, larvae hatch in the small intestine, migrate to the large intestine, and embed their heads in the lining of the intestine. “Each larva grows into a worm that is about 11cm long and is estimated to live 1-2 years, although some may live longer. Female whipworms produce eggs, which are then excreted in the stool.”10 As with pinworms and ascaris eggs, whipworm eggs are ingested with soil. 

Whipworms usually infect children over 5 years of age. If the infection is light, there are usually no symptoms or signs, however heavy infection can cause loose stools containing blood, rectal prolapse with very heavy infections and the worms may be seen attached to the rectal mucosa, iron deficiency anaemia due to chronic blood loss in the stool, and malnutrition. 

Advise patients to practice good hand hygiene, wash raw vegetables, and correctly dispose of human faeces. Mebendazole or albendazole, can be given as treatment options, and iron deficiency anaemia should be treated with oral iron.11 

https://www.youtube.com/watch?v=EQz-ozUSenc

HOOKWORMS

Another roundworm, Dr Roger Henderson explained that the hookworm is a parasitic nematode worm that lives in the small intestine of its host. “Two species of hookworms commonly infect humans, Ancylostoma duodenale and Necator americanus.12  

Daniel Wong from the University of Melbourne described how skin penetration by hookworm larvae produces a focal, itchy area at the site of infection known as ‘ground itch’. “This may appear as a localised area of redness and swelling, or papules. As the hookworm larvae travel via the bloodstream to the lungs, they penetrate the lung air sacs and ascend the windpipe to the pharynx and are swallowed. 

“In a minority of patients, this phase is associated with generalised urticaria. Infected patients are often unaware of the larvae travelling through the lungs, but they may have a mild cough and throat discomfort.  

“Once the larvae have been swallowed, they travel to the small intestine where they mature into adult worms and attach to the intestinal wall. At this stage, the patient may experience gastrointestinal symptoms such as nausea, diarrhoea, vomiting, and abdominal pain. 

“The hookworms feed off the patient’s blood and grow larger. For some patients, chronic blood loss causes anaemia and tiredness. Infested children may fail to grow normally.13 

“Diagnosis is normally made by looking for the eggs under a microscope in a stool specimen,” Dr Andrew Whitelaw advised. “Treatment consists of medication (albendazole/mebendazole/thiabendazole) which needs to be taken for up to three days. Iron supplementation may also be needed if the patient is anaemic.”9 

TAPEWORMS

Tapeworms are flat, ribbon-like worms that live in the gut if a patient swallows their eggs or small, newly hatched worms. This usually occurs by ingesting food or water contaminated with tapeworm eggs or larvae.14 Children can also develop tapeworms by eating raw or undercooked meat from animals or fish that are infected with tapeworms. Contaminated food contains tapeworm cysts. A child may have a tapeworm infection without any symptoms. When symptoms are present, they often include nausea, diarrhoea, and stomach pain. 

According to the American Academy of Pediatrics: Fish tapeworm competes with its human host for vitamin B12 in the intestine and, in prolonged cases, can cause pernicious anaemia. Children who ingest pork tapeworm eggs can develop tapeworm cysts (cysticercosis) within their internal organs. If these cysts occur in the brain, they can cause serious symptoms such as seizures, behavioural disturbances, and even death. 

“The diagnosis can be confirmed by observing proglottids or tapeworm eggs in a stool sample,” said Dr Andrew Whitelaw. “Praziquantel is a drug that is used to treat tapeworm infections.”9 Other antiparasitic drugs, including albendazole, are available specifically for treating cysticercosis.15 

REFERENCES 

• Health Direct. ‘Worms in humans.’ Available from: https://www.healthdirect.gov.au/worms-in-humans 
• Nxasana, N. et al. (2013). ‘Prevalence of Intestinal Parasites in Primary School Children of Mthatha, Eastern Cape Province, South Africa.’ Available from: https://www.researchgate.net/publication/259221240_Prevalence_of_Intestinal_Parasites_in_Primary_School_Children_of_Mthatha_Eastern_Cape_Province_South_Africa 
• My Cleveland Clinic. ‘Roundworms.’ Available from: https://my.clevelandclinic.org/health/diseases/15240-roundworms 
• Queensland Health. ‘Worms in Childhood.’ Available from: http://conditions.health.qld.gov.au/HealthCondition/condition/8/121/661/worms-in-childhood 
• Centres for Disease Control and Prevention. Parasites - Enterobiasis (also known as Pinworm Infection).’ Available from:  https://www.cdc.gov/parasites/pinworm/gen_info/faqs.html 
• Raising Children. ‘Worms.’ Available from: https://raisingchildren.net.au/guides/a-z-health-reference/worms 
• My Cleveland Clinic. ‘Ascariasis.’ Available from: https://my.clevelandclinic.org/health/diseases/14071-ascariasis 
• St. Louis Children's Hospital. ‘Roundworm Infections.’ Available from: https://www.stlouischildrens.org/conditions-treatments/roundworm-infections  
• Mediclinic Infohub. ‘Worms.’ Available from: https://www.mediclinicinfohub.co.za/worms/#:~:text=Drugs%20are%20available%20to%20treat,this%20and%20other%20worm%20infections. 
• Pearson, R. (2019). ‘Whipworm Infection.’ Available from: https://www.msdmanuals.com/home/infections/parasitic-infections-nematodes-roundworms/whipworm-infection 
• Better Care. ‘Parasites.’ Available from: https://bettercare.co.za/learn/child-healthcare/text/11.html#roundworms 
• Henderson, R. (2014). ‘Hookworm Infections.’ Available from: https://patient.info/doctor/hookworm-infections 
• Jun Yi Wong, D. (2013). ‘Hookworm Infections.’ Available from: https://dermnetnz.org/topics/hookworm-infections/ 
• MayoClinic. ‘Tapeworm Infection.’ Available from: https://www.mayoclinic.org/diseases-conditions/tapeworm/symptoms-causes/syc-20378174 
• HealthyChildren. ‘Tapeworms.’ Available from: https://www.healthychildren.org/English/health-issues/conditions/from-insects-animals/Pages/Tapeworms.aspx