Helminthiasis or Worm infestation in Children for Nursing students

Worm
infestation
(Helminthiasis)
Here is where your
presentation begins

01
Round worm
(Ascaris lumbricoides)
02
Pin worm
(Enterobius vermicularis)
04
Tape worm
(Taenia saginata)
03
Hook worm
(Ancylostoma duodenale)
Helminthic infestation in children are a major public health problem caused
by ineffective disposal of human excreta. The common helminths found in
human body are:

Round worm
01
(Ascaris lumbricoides)

Round worm (Ascariasis)
It is common helminthic infestation. It lives in the lumen of
small intestine.
Epidemiology
Agent: Ascaris lumbricoides
 The adult female roundworm measures about 20-40cm
and male 12-30 cms
 Each female round worm produces 2,40,000 eggs per
day.
 The eggs are excreted in the fees and in the external
environment they become infective in favourable
conditions.
 Life span of an adult round worm is between 6-12months

Round worm (Ascariasis)
Epidemiology
Reservoir: Man is the only reservoir
Infective material: is feces containing fertilized eggs.
Mode of transmission: Feco-oral route by ingestion of infective
eggs with food or soil or drink or by contaminated hands and
fingers

Clinical manifestations
The clinical presentations depend upon the worm load,
location or migration of larvae and deprivation of nutrients of the
host.
 Common features: pain abdomen, abdominal distension, nausea,
cough, loss of weight, growth failure, anaemia and vitamin
deficiencies.
 Associated problems: Pica, sleeplessness, irritability, urticaria,
fever, eosinophilia and diarrhea.
 Migration of larvae through lungs may result in ascaris
pneumonia.
 Larvae in the circulation may cause convulsion.
 Retinoblastoma may result from involvement of eye.

Complications
 Intestinal obstruction (by worm mass) or gangrene or perforation.
 Obstructive jaundice (blockage of bile duct)
 Appendicitis.
 Pancreatitis
 Ascaris encephalopathy
 Liver abscess
 Peritonitis
 Kwashiorkor (by protein loss)

Diagnosis
 History of illness and passage of snakelike worm in stool or vomiting.
 Stool examination – for round worm eggs.
 Barium enema.
Management
 Albendazole 15mg/kg or Mebendazole (100mg) twice daily for 3 days.
 Levamisole single dose with 2.5mg/kg
 Pyrantel pamoate 10mg/kg.
 Piperazin citrate is ideal drug for eradication – the drug paralyses the
worms, so the child should pass stools within 12hrs of intake.

Preventive measures
Prevention of round worm infestation can be done by interrupting
its transmission.
 Sanitary disposal of human excreta
 Reduction of fecal contamination of soil.
 Provision of safe drinking water, food hygiene, good personal
hygiene, improving habits of hand washing before eating and
after defecation.
 Health education to the general public about the use of sanitary
latrines.
 Secondary prevention can be done by effective drug therapy of
human reservoir and mass treatment with periodic de-warming
at intervals of 2-3months.

Pin worm
02
(Enterobius vermicularis)

Pin worm or Thread worm
It is very common parasitic infestations of infants and young children.
Epidemiology
Agent: Enterobius vermicularis/Pin worm/Thread worm. Female worms
average 8-13mm in length and male 2-5mm.
The worm does not multiply inside the body. The gravid female travels to
the perianal region at night to lay eggs causing perianal itching.
Reservoir: Man is only natural host
Mode of transmission: Eggs are carried under finger nails contaminated
during perianal scratching or through contaminated clothing, bed linen and
dust to infect host.

Majority of children may have no complaints.
 The infected child may present with poor appetite, loss of
weight, teeth grinding, abdominal pain, nausea, vomiting and
diarrhea.
 Pruritis ani – due to crowding of gravid females at anus.
 Vulvovaginitis in female child.
 Irritability, restlessness, sleep disturbances, enuresis.
Diagnosis
• History of passage of worms in stool.
• Eggs can be demonstrated by examination early morning
perineal swab, before the child has passed stool.
• Eggs can be demonstrated in finger nail dirt in about 1/3rd cases.

Management
 Albendazole 15mg/kg or Mebendazole (100mg) once daily
 Piperazin
 Pyrvinium
 All family members should be investigated and preferably treated
simultaneously to prevent cross infection and reinfection.
Prevention
 Maintenance of personal hygiene – careful hand washing after
defecation and before meal, keeping nails short, laundering of infected
cloths.
 Health education and creating awareness.

Hook worm
03
(Ancylostomiasis)

Hook worm
Hook worm causing intestinal infestation in two species.
Ancylotoma duodenale and Necator americanus. Another species
A.Ceylanicum has been reported from a village near Kolkata.
Epidemiology
Agent: Ancylotoma duodenale and Necator americanus live in the small
intestine remain attached to intestinal villi. Female worms average 9-
13mm in length and male 5-11mm.
Ancylotoma duodenale produces 30000 eggs and Necator americanus
produces 9000 eggs per day.
Reservoir: Man is only natural host
Mode of transmission: of hook worm infective larvae is usually through
skin penetration in barefoot individual. Worm may also transmit by oral
route with direct ingestion of infective larvae via contaminated food.

Clinical manifestation depend upon worm load.
 Adult worm suck blood and cause iron deficiency anaemia, child
also present with loss of appetite, epigastric pain, pica and black
coloured stool.
 At skin penetration ground itching, papulo – vesicular rash or
cutaneous larva migrans.
 Malabsorption, malnutrition, growth retardation,
hypoproteinaemia causing oedema and cardiac failure.
Diagnosis
• Examination of stool for hook worm ova and occult blood.
• Eosinophilia in blood examination.

Management
 Albendazole 10mg/kg in single dose or 5mg/kg daily for 3 days orally.
 Mebendazole (100mg) twice daily for 3 days.
 Correction of anaemia – iron therapy and blood transfusion.
 Nutritious diet with iron rich food.
 Hygienic measures and follow up.
Prevention
 Sanitary disposal of feces.
 Habit of improved personal hygiene, use of footware.
 Community involvement in health education and creating awareness.

Tape worm
Tape worm commonly found in children as pork tapeworm (Taenia
solium) and beef tapeworm (Taenia saginata)
Epidemiology
Agent: T. Solium and T. Saginata pass their life style in two vertebrate
hosts. In man (definitive host). The adult T. Saginata measures 5-12 meters
in length and T. Solium measures 2-6 meters.
The larval stage of T. Saginata mainly occurs in intermediate host cattle.
The larval stage of T. Solium mainly occurs in intermediate host pig.

Clinical manifestation
 Headache, abdominal pain, abdominal distention, recurrent diarrhea, growth
failure and history of passing proglottides in stool.
 Cysticercosis of brain presented with convulsions, neurocysticercosis –
intracranial hypertensive syndrome and alteration of level of consciousness.
Diagnosis
 Stool examination for eggs or proglottids
 Neurocysticercosis is diagnosed by CT Scan and MRI
 CSF and Blood for ELISA

Management
 Praziquental 10mg/kg in a single dose.
 Other drugs – Mepacrine, Niclosamide, Albendazole or Mebendazole.
 Symptomatic and supportive treatment.
Prevention
 Consumption of meat with proper cooking,
 Adequate sewage treatment and disposal of human excreta.
 Washing of raw vegetables and fruit
 Proper housing and feeding of pigs
 Prevention of pollution of food, water and soil with human feces.
 Improving hand washing techniques.

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