Clinical Features and Investigations
WORMS |
CLINICAL FEATURES |
INVESTIGATIONS |
Ascaris Lumbricoides (round worms): Large round, cream coloured worms which live in the small intestines |
• Infection by swallowed embryonated eggs
• Loeffler's syndrome
• Mild bouts of recurrent colic
• The mother has seen the worm in stool or vomits
• Complications such as obstruction, vomiting may occur |
• Stool for ova |
Hookworms |
• "Ground itch"
• Features of anaemia (iron deficiency) |
• Stool for ova
• Haemogram |
Trichuris Trichiura (whip worms) |
• Diarrhoea with blood
• Rectal prolapse
• Anaemia
• Wasting |
• Stool for ova
• Worms may be seen adhering to rectal mucosa |
Strongyloides Stercoralis |
Most infections are asymptomatic but the following may occur:
• larva currens (buttocks)
• Soiling of innerwear with stool
• hyperinfection syndrome
• diarrhoea
• Gram negative septicaemia
• bacterial peritonitis
• encephalitis
|
• Direct stool microscopy (Motile larvae, adult worms |
|
Enterobius Vermicularis oxyuriasis (pin worm)
Synonyms:
Threadworm, pinworm, seatworm.
The worm is 4 mm long and is just visible to the human eye
|
Mode of Spread
Auto-infection:
• Direct anal to mouth transfer through the fingernail
• Retro-infection; eggs may hatch into larvae at the anal-rectal area. Then larvae move retrogradely to the caecum.
Cross infection:
• Contamination of fingers with objects, clothing, toilet seats, etc.
• By inhaling and swallowing eggs in the dust
Main presentation: perianal and perineal itching. Migrating larvae may cause:
• Vaginitis, vulvitis, salpingitis and peritonitis
• Irritation, Insomnia may occur
|
• Stool for ova
• Ova can be obtained from the perianal region by use of adhesive tape.
|
Taenia Saginata (beef tapeworm) |
• Non-specific symptoms, irritability
• Segment may be passed with stools
• Egg in stools
|
• Stool for ova (motile proglottides) |
Management
WORMS |
ADULTS |
CHILDREN |
Ascaris Lumbricoides (round worms) |
Levamisole 2.5 mg/kg as a single dose
OR Mebendazole 100 mg BD × 3 days
OR Albendazole 400 mg STAT
|
Levamisole 2.5 mg/kg as a single dose
OR Mebendazole 100 mg BD × 3 days
OR Albendazole 200 mg STAT for children under 2 yrs
|
Hookworms |
Levamisole 2.5 mg/kg as a single dose
OR Mebendazole 100 mg BD × 3 days
OR Albendazole 400 mg STAT
|
Levamisole 2.5 mg/kg as a single dose
OR Mebendazole 100 mg BD × 3 days
Albendazole 200 mg STAT for children under 2 yrs + ferrous sulphate
|
Trichuris Trichiura (whip worms) |
Mebendazole 100 mg BD × 3 days
Albendazole 400 mg STAT
|
Mebendazole 100 mg BD × 3 days
Albendazole 200 mg STAT for children under 2 yrs
|
Strongyloides Stercoralis |
Albendazole 400 mg BD × 3 days
OR Thiabendazole 25 mg/kg x 3 days
|
Albendazole 200 mg BD × 3 days
OR Thiabendazole 25 mg/kg × 3 days
|
Enterobius Vermicularis (pin worms) |
Mebendazole 100 mg BD × 3 days
Levamisole 2.5 mg/kg as a single dose
REPEAT AFTER 10 days
|
Mebendazole 100 mg BD × 3 days
Levamisole 2.5 mg/kg as a single dose
REPEAT AFTER 10 days
|
Taenia Saginata (beef tapeworms) |
Niclosamide 2 gm; 1 gm before breakfast, 1 gm 1 hr after breakfast |
>6 yrs 1 gm before & 1 gm after breakfast
2 - 6 yrs 500mgs before & 500mgs after breakfast
< 2 yrs 250mgs before & 250mgs after breakfast
|
HOOK WORM - Anaemia develops if iron intake is slow and infection is significant If patient fails to respond to therapy consider other cause e.g. blood loss, poor compliance. |
Deworm children above 2 years at least every 6 months - with mebendazole 500 mg STAT.
Prevention
Appropriate prevention depends on the particular worm. In general:
• Safe water provision
• Hand washing and trimming of fingernails
• Frequent changing of innerwear and sheets
• Use of latrines.
