Worm infestations, also known as helminth infections, are common in children, especially in developing countries.

  • They can be caused by various parasitic worms, common including roundworms (Ascaris Lumbricoides), hookworms( Ancyclostoma duoenale and Nector americanus), tapeworms (Taenia saginata and Taenia solium), Echinococcus and pinworm (Enterobius vermicularis).
  • Worm infections can lead to malnutrition, anemia, and impaired growth and cognitive development in children.

History and Examination

  • Most cases are mild and asymptomatic
  • Children living in or traveling to endemic areas, close contact with infected individuals, suboptimal academic performance
  • Risk factors: Poor hygiene, crowded living conditions, walking barefoot, consuming contaminated food or water
SymptomsSigns
-Abdominal pain
-Diarrhea
-Weight loss
-Fatigue
-Anemia
-Growth retardation
-pallor
-Failure to thrive or poor growth

Differential Diagnosis (D/D) & Complications

D/D

  • Other parasitic infections (giardiasis, amoebiasis)
    • Bacterial or viral gastroenteritis
    • Malabsorption syndromes (celiac disease, lactose intolerance)

Complications

  • Malnutrition
    • Iron-deficiency anemia
    • Vitamin A deficiency
    • Impaired growth and cognitive development

Investigation

  • Investigation of choice: Stool examination for ova and parasites
    • Complete blood count (CBC); eosinophilia, low hemoglobin, microcytic and hypochromic anemia
    • Iron studies (if anemia is suspected)

Admission Criteria

  • Generally not required, as worm infestations are usually managed on an outpatient basis

Management

Medical

  • Anthelmintic therapy for the affected child and close contacts

Rx:

  • Albendazole 400 mg single dose (200 mg below 2 years) (for roundworms, hookworms, and whipworms)
  • Mebendazole 100 mg BID x 3 days (for roundworms and whipworms) or 100 mg BID x 3 days followed by 100 mg BID x 3 days after 2 weeks (for hookworms)
  • Praziquantel 20 mg/kg single dose (for tapeworms)

Advices

  • Educate the family on good hygiene practices (handwashing, wearing shoes, proper disposal of feces)
    • Ensure access to clean water and food
    • Regular deworming in endemic areas

Referral

  • If the infestation persists despite treatment and adherence to hygiene measures
    • Severe anemia or malnutrition

Follow up

  • Schedule a follow-up visit within 4 weeks after treatment completion
    • Assess for resolution of symptoms and signs of reinfection

Additional Points

Biannual deworming tablets distribution in Nepal: Family Welfare Division, DoHS has been implemented biannual deworming tablets distribution to the children aged 12-59 months. Integrated with biannual Vitamin A supplementation to the children aged 6-59 months, which takes place nationally in every ward on first week of Baisakh and Kartik each year.

References

1. World Health Organization. Soil-transmitted helminth infections. Available at: https://www.who.int/news-room/fact-sheets/detail/soil-transmitted-helminth-infections. Accessed October 4, 2021.

2. Jourdan PM, Lamberton PHL, Fenwick A, Addiss DG. Soil-transmitted helminth infections. Lancet. 2018;391(10117):252-265.

3. Bethony J, Brooker S, Albonico M, Geiger SM, Loukas A, Diemert D, et al. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006;367(9521):1521-1532.