Worm infestation

it includes etiology, transmission, consequences, management , home made remedies and other preventive measures related to worm infestation.
also helpful for B.Sc.nursing students as it includes nursing care plan as well .

1. Worm Infestation By Charu Sharma B.sc. Nursing 3 rd year

2. Introduction Worm infestation constitutes an important health problem, especially in the children These are not noticed but sometimes lead to significant problems which affect many organ systems It’s a public health problem and include most importantly pinworms, round worms and hookworms

3. Definition Helminthiasis , also known as  worm infection , is any macro parasitic disease of humans and other animals in which a part of the body is infected with  parasitic   worms , known as  helminths . They often live in the  gastrointestinal tract  of their  hosts , but they may also burrow into other  organs , where they induce physiological damage.

4. Causative agents Nematodes – Roundworms – ascariasis : they are round, thin, white/pink worms about 10-20 inches long. Hookworms – ancylostomiasis: they are tiny dark pink in colour, not visible in stool Pinworms or threadworms – enterobiasis: white, small and thin and thread like Whipworm- trichiasis

5. Causative agents Cestodes and trematodes which include flatworms like tapeworm and liver fluke Tapeworms include Taniea saginata/ solium which are flat in appearance .

6. Transmission

7. Prevalance

8. Causes As children are quite dynamic and active, they tend to come in contact with germs easily.  Some of the causes of worm infections include:  Coming in contact with an infected surface such as soil containing eggs or germs at a playground or touching pets infected with worms Consuming infected food or water Improper hygiene Inadequate hand washing Uncooked or raw meat

9. causes Fecal contamination of water •Unsanitary conditions • Eating raw or undercooked meats or fish • Keeping animals in close unsanitary conditions • Rat or insect infestations • Malnourished or diseased persons •Heavy mosquito or fly infestations

10. Symptoms Some common symptoms of worm infections are irritability, weight loss, stomach ache, bed wetting, blood in stools. Besides these, each worm infection has distinct symptoms as listed below: Tapeworm or flatworm infection – Jaundice, nausea, vomiting, loss of appetite, eating too frequently and sometimes even malnutrition Roundworm infection – Diarrhoea, passing worms with stools, dry cough, fever Pinworm or threadworm infection – Itching around the anus, trouble sleeping due to itching, painful urination Hookworm infection – Wheezing, coughing, fatigue, anaemia

11. Roundworms (ascariasis) A few roundworms, in a well fed child usually produce no ill effects and are not noticed until the worms are passed in stool. Sometimes occasional abdominal pain, vomiting and diarrhea may occur In heavy infection intestinal obstruction can occur from tangle ball of round worms becoming stuck at the ileocecal junction where the lumen of intestine is narrowest

12. Clinical manifestations Most patients are asymptomatic Respiratory symptoms.  In the early phase (4-16 d after egg ingestion), respiratory symptoms result from the migration of larvae through the lungs; classically, these symptoms occur in the setting of eosinophilic pneumonia ( Löffler syndrome): fever, nonproductive cough, dyspnea, wheezing. Gastrointestinal symptoms.  In the late phase (6-8 wk after egg ingestion), gastrointestinal symptoms may occur and are more typically related to the mechanical effects of high parasite loads; passage of worms (from mouth, nares, anus), diffuse or epigastric abdominal pain, nausea, vomiting, pharyngeal globus , “tingling throat”, frequent throat clearing, and dry cough are some of the GI symptoms.

13. Management Treatment is divided according to the phases of  infection : early infection (larval migration) and established infection (adult phase). Benzimidazoles.  Benzimidazoles are the mainstay of treatment of symptomatic and asymptomatic infections; they are poorly systemically absorbed and thus have low human toxicity and exert their action directly on worms; the most common members of this family are albendazole and mebendazole. Bowel obstruction.  Treatment of bowel obstruction includes intravenous hydration, nasogastric suctioning, electrolyte monitoring, and laparotomy if conservative measures fail; colonoscopy and esophagogastroduodenoscopy (EGD) may be useful in removing obstructing masses of worms.

14. If not treated…. Complicaation due to migration of roundworms into the bile passage etc may occur Such migration is promoted by fever a very spicy diet, anorexia and improper treatment Acc to an Indian study, round worms were the cause of biliary and pancreatic disease in about 37 percent of patients, so it is important to treat even light or asymptomatic infections

15. Hookworms (ancylostomiasis) Prolonged blood loss may occur Effect of hookworm infection depends on worm load, amount of blood loss and nutrition status of the child Heavy hookworm load during childhood causes slowly increasing anaemia If left untreated it eventually leads to death from heart failure.

16. Wormload ? Number of worms living in a child is called worm load. To measure a child’s worm load all the ova in a fecal smear are counted Less than 20 ova in a standard fecal smear is light worm load, between 20 to 40 ova Is a moderate load and more than 40 ova is a heavy load.

17. Clinical manifestations Ground or dew itch.  An erythematous, pruritic, papulovesicular rash develops at the site of initial infection on the palms or soles and may persist for 1-2 weeks after initial infection; intense scratching may lead to a secondary bacterial infection, which is quite common. Pulmonary symptoms.  When the worms break through from the venous circulation into the pulmonary air spaces, cough, fever, and a reactive bronchoconstriction may be observed, with wheezing heard on auscultation. GI symptoms.  Migration of the worms into the gastrointestinal (GI) tract may cause GI discomfort secondary to irritation; as the worms mature in the jejunum, patients may experience diarrhea, vague abdominal pain, colic, flatulence, nausea, or anorexia.

18. Clinical manifestations Symptoms of anemia.  Signs of iron-deficiency anemia are often insensitive.; patients may exhibit pallor, chlorosis (greenish-yellow skin discoloration), hypothermia, spooning nails, tachycardia, or signs of high-output cardiac failure.

19. Management Most cases of classic hookworm disease can be managed on an outpatient basis with anthelmintic and iron therapy, complemented by an appropriate diet. Iron therapy.  Patients with anemia and malnutrition may require both iron supplements and nutritional support (including folate supplementation). Antihelmintics .  

20. Management Blood transfusions.  Blood transfusion is indicated in rare cases of acute severe gastrointestinal (GI) hemorrhage; in patients with chronic anemia, blood transfusions ( ie , packed red blood cells [RBCs]) should be administered slowly and are usually followed by a diuretic to prevent rapid fluid overload. Pharmacologic Management Antihelmintics are the drug of choice for hookworm infections.

21. Threadworms ( enterobiasis) Perianal itching for long duration and history of similar complain in family is the hallmark of threadworms Doesn’t cause any serious complication Treatment failures are usually due to reinfection rather than actual failure of treatment

22. Clinical manifestations Perianal itching.  Intense perianal itching is the primary symptom of pinworms. This occurs especially at night when the female worm leaves the anus to deposit ova. Erythema.  Patients often have excoriation or erythema of the perineum, vulvae, or both, but infestation can occur without these signs. Abdominal pain.  Abdominal pain may sometimes be severe and can mimic acute appendicitis. Visual worm sighting.  Visual sighting of a worm by a reliable source (e.g., a parent) is usually accepted as evidence of infestation and grounds for treatment.

23. Trichinosis Trichinella spiralis  is a viviparous nematode parasite, occurring in rodents, pigs, bears, hyenas and humans, and is responsible for the disease  trichinosis . It is sometimes referred to as the "pork worm" due to it being typically encountered in undercooked pork products. Nausea, diarrhea, vomiting, fatigue, fever, and abdominal discomfort are often the first  symptoms of trichinellosis . Headaches, fevers, chills, cough, swelling of the face and eyes, aching joints and muscle pains, itchy skin, diarrhea, or constipation may follow the first  symptoms .

24. Management Treatment of enterobiasis consists of the following: Handwashing.  Thorough and regular handwashing is effective in preventing disease transmission. Personal hygiene.  Changing personal habits such as thumb-sucking or nail-biting may reduce re-infection; The child should also be encouraged to observe other hygiene measures, such as regular bathing and daily change of underclothing; the nurse should teach caregivers to keep the child’s fingernails short and clean. Pharmacologic Management Drug therapy with pyrantel, mebendazole, or  albendazole  is the current standard in treating enterobiasis :

25. Diagnostic evaluations The usual method of diagnosis of threadworm is to use cellophane tape to capture the eggs from around the anus. The cellophane tape test for identifying worms is performed in the early morning, just before or as soon as the child wakens; the tape is then examined microscopically for eggs in the laboratory. Chest radiography.  Chest radiography may reveal patchy infiltrates of eosinophilic pneumonia. Abdominal radiography.  Abdominal radiography may reveal signs of bowel obstruction Complete blood count and blood studies Stool examination CT scan.   Ultrasonography.  

26. Pharmacological therapy Anthelmintics are indicated for the following medical conditions: Albendazole  for the treatment of active lesions caused by pork tapeworm and cystic disease of the liver, lungs, and peritoneum caused by dog tapeworm. Ivermectin  is used for the treatment of threadworm disease or strongyloidiasis Mebendazole  is for the treatment of diseases caused by pinworms, roundworms, whipworms, and hookworms. Praziquantel  is for treatment of a wide number of schistosomes or flukes. Pyrantel  is for treatment caused by pinworms and roundworms.

27. Pharmacological therapy In Children Culture of the suspected worm is important before beginning any drug therapy. Albendazole, ivermectin, and praziquantel are more toxic so they are avoided in children. Instead, a chewable preparation of mebendazole is usually given. Children may develop serious GI effects during therapy so nurse’s focus must be on nutritional status and hydration.

28. Home remedies for worm infestation Onion juice removes the thread worm : three drops to one teaspoon twice daily Neem powder removes all types of worms : 1-4 gm twice daily Pinch of asafetida wrapped in small piece of jaggery. It must be given half an hour before meals For 7-12years old children 20 grams of jaggery in the morning, then after 10 minutes , celery seeds( ajwain ) 2gm + salt 1gm must be taken with the warm water . It can eliminate all types of worms

29. Nursing responsibility Assisting in identifying the parasite Administering antihelminthic drugs Providing emotional and psychological support to child and parents Educating the family members about prevention of infection and reinfection.

30. Nursing diagnosis Fluid volume deficit  related to fluid loss secondary to diarrhea. Impaired sense of comfort: pain  related to smooth muscle spasm secondary to migration of parasites in the stomach. Imbalanced Nutrition: less than body requirements  related to anorexia and vomiting. Hyperthermia  related to decrease in circulation secondary to dehydration. Risk for impaired skin integrity  related to intense perianal scratching. Acute pain  related to mucosal irritation. Ineffective tissue perfusion  related to blood loss. Deficient knowledge  related to the disease process and treatment.

31. Nursing interventions Reduce or diminish pain.  Provide rest periods to promote relief, sleep, and relaxation; Improve tissue perfusion.  Submit patient to diagnostic tests as indicated; administer blood transfusion as indicated. Protect skin integrity.  Monitor site of impaired tissue integrity at least once daily for color changes, redness, swelling, warmth, pain, or other signs of infection Administer medications as ordered.  Drug therapy with pyrantel, mebendazole, or albendazole to destroy the causative parasites. Effective eradication requires treatment of the patient’s family or members of the household.

32. Nursing interventions Inform patient of the side effects of pyrantel.  Stool may be bright red and may cause vomiting. The tablet form of this drug is coated with aspirin and shouldn’t be given to aspirin-sensitive patients. Improve hygienic status.  Avoid scratching the area and nail-biting because this is a cause of autoinfection; thorough handwashing should be done before and after meals. Tell family not to shake bed linens to avoid aerosolization of eggs that may be found on linens. Diminish increase in temperature.  Administer antipyretics as prescribed; tepid sponge baths may also be given.

33. Health education 10 February Deworm all children aged 1-19 at schools and aanganwadi for improved child health, nutritional status, access to education and quality of life

34. Preventive methods Thoroughly wash vegetables like carrots, radish, onion and salad leaves or any food eaten raw this is necessary because the soil adhering to these foods may be contaminated with the ova or cysts of the parasites Drinking water should be filtered and boiled. Care should be taken that prepared food and drinking water do not get contaminated through unhygienic handling by a person carrying ova in the finger nails. Child having worm infestation should be cleaned properly after passing the stool and his stool must be disposed off properly. Washing of the hands after passing stool and before eating food is mandatory. Nails should be kept short and clean, as the nails are places where ova of the worms usually reside. In case of threadworm infection where anal itching is present, it is advisable to apply a suitable cream.

35. Preventive methods The under clothes should be changed daily and bed linen must be kept clean. Children should not be allowed to play barefoot in the field where the soil may be contaminated with ova of hookworm. The ova of hookworm enter through foot and reach the blood stream and grow into adult worms. Regular deworming done helps in preventing infestation. Avoid too many sweets and puddings, very fried, greasy and fast foods. More green vegetables and fresh fruits should be eaten. Personal hygiene must be maintained. Restrict diet to only homemade foods.