What to do about intestinal worms

Somali refugee Nunay Mohammed watches as her son Isho is fed with a deworming solution before getting a measles vaccination in southeastern Ethiopia. AFP PHOTO/JENNY VAUGHAN

Somali refugee Nunay Mohammed watches as her son Isho is fed with a deworming solution before getting a measles vaccination in southeastern Ethiopia. AFP PHOTO/JENNY VAUGHAN

Published Apr 17, 2015

Share

QUESTION: I am grossed out by all the horror stories I recently heard about (intestinal) worms and the complications that can occur.

The issue of worms is certainly a big topic at my son’s preschool. My kids love being outside and enjoy sandpits, even tasting the soil. They love digging and building and I simply cannot be a 24-hour watchdog to prevent this.

I have an 18-month-old and a four-year-old who spend lots of time in my garden and visiting friends for play dates. I am becoming increasingly worried that they they may get worms and other infections. I may be a bit paranoid, but is this a rational fear? How will I know early enough if they are infected?

The pictures I have seen on Google are scary, and apparently worms can be life-threatening. My other worry is that other parents at school may not be as careful and that their kids spread the infection. Are my fears warranted?

At home I try my best with the whole handwashing ritual – and we reward for good practices. So much time is spent (by the children) on the floor, so I try to use good household detergents, as well as antiseptic sprays. Is worm infection contagious?

Kindly offer me some help and guidance, as well as additional precautionary measures.

ANSWER: The topic is a very challenging one – for most parents and children alike. Your questions are not unreasonable and I think many parents are just too busy to ask them, or to stop to think about the issue. It’s exactly the same with the topic of head lice – people’s reactions are very dramatic. Remember that an informed parent is a safe parent.

So why all the hype about worms?

It remains a contentious issue due to the dramatic nature of how people can present in extreme cases. Things like worms crawling out of your nose and ears at night time – and then even the surprise in your child’s nappy when you are greeted by a worm protruding from the anus. The sad part is that most people do not know how we contract them.

My first exposure as a clinician was when a parent thoughtfully brought me a gift of a worm in a shopping bag.

It looked like a white cord the length of a full ruler and the mother proudly declared that she caught it and pulled it from her four-year-old son’s nose. I got a bit dizzy at the thought and asked for my own brown paper bag.

What is a parasite?

These are small creatures (animals) which invade and infect (infest) the body. They are dependent on other life forms for survival.

We classify them broadly into external parasites which live on or in the skin, like scabies and sandworms, or internal parasites which live in the body.

These parasites commonly live in the bowel (ie intestinal parasites such as worms). Other parasites live in the blood but are dependent on their host for survival.

Complications of worm infections

* Lung infections.

* Intestinal obstruction.

* Liver congestion.

* Anaemia.

How do we get infected?

More common in children due to their habit of playing on the ground. In this way it is easier to ingest infested soils and faecal material deposited in sand pits and gardens, among others.

Parasites enter the human body through the mouth or nose, as well as through the skin.

Children love playing in close proximity with pets and often are licked by dogs or cats that transfer the larvae or eggs orally.

 

What happens after they enter the body?

Once ingested, they grow and move to other areas where they feed off their host. The most common manifestations involve the intestines, lungs and liver. You can imagine the possibilities of complications when these worms travel to other body systems.

How do these different worms commonly present?

Roundworms: The most common parasite found in the gut of children. The worms are pink and smooth and measure about 25cm in length. They look like pale garden earthworms.

Roundworms produce thousands of eggs a day, which are passed in the child’s stools (faeces). The eggs have a very characteristic shape and can be easily recognised if a sample of stool is examined under a microscope. Roundworms are common in children between the ages of one and five years.

Whipworms: Commonly infect the bowels of children in South Africa. They are short, thin worms (about 4cm) that attach themselves to the mucosa of the large bowel where they cause bleeding, usually in children over five years of age.

If the infection is light, there are usually no symptoms or signs. Heavy infection can cause loose stools containing blood. Rectal prolapse may occur with very heavy infections. With prolapse, the worms may be seen attached to the rectal mucosa. Iron deficiency anaemia due to chronic bleeding can occur.

Pinworms: Pinworm infection is very common. They are small, thin worms (about 4cm long). Pinworms are especially common where children sleep or play together in crowded conditions.

Adult female worms pass out the anus at night to lay eggs on the perineum.

Eggs are swallowed from contaminated fingers, clothing or bed linen. Pinworms are common even where hygiene and sanitation are of a high standard. They are also known as threadworms. Perianal itching and scratching at night may cause loss of sleep.

Secondary infection of the scratched skin is common. In girls the worms may enter the vulva, causing irritation and vaginal discharge (vaginitis). Pinworm infection presents with perianal itching and scratching, especially at night. A piece of sticky tape should be placed against the anus and surrounding skin during the night and then immediately removed. In this way eggs can be collected and identified under a microscope. – www.childhealthcare.co.za

Is it treatable ?

The treatment of choice is Mebendazole or Albenazole. Formulations vary from a simple stat dosage of one tablet to a three-day course. Pets should also be treated every six months.

Cape Argus

* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues. He features on 567CapeTalk.

If have medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen.

The advice in this column does not replace a consultation and clinical evaluation with a doctor.

Related Topics: