Worm infestation:tape worm and hook worm

PEDIATRIC NURSING

1. WORM INFESTATION (Round Worm And Whip Worm) Presented by Ms Arifa T N, Second year M.Sc Nursing, MIMS CON

2. Worm infestation Helminthic infestation Major public health problem in India Improper disposal of human excreta

3. Common helminths Round worm ( ascaris lumbricoides ) Pin worms or thread worms ( enterbious vermicularis ) Hook worms ( ancylostoma duodenale and necator americanus ) Tape worms ( taenia saginata or taenia solum )

4. In humans Nematodes Round worm Pinworm Hook worm Cestodes Tape worms Trematodes Fish worms or flukes

5. Fluke worm

6. Other helminthic infestations Trichuris trichura (Whip worm) Stronglyoides stercoralis Drancunculus medinensis ( guineaworm ) Schistoma mansoni or S.hematobium (blood fluke) Trichinosis or trichinella spiralis

7. Round worms Most common infestation Lives in the lumen of small intestine Adult round worm measures 20-40 cm (female) and 12-30 cm male Each female round worm produces 240000 eggs per day. The eggs are excreted in the feces they become infective in favorable conditions

8. Life cycle On the ingestion of mature egg by the human host (definitive host), it hatches out in the duodenum to release larvae. The larvae penetrates the intestinal wall and are carried to liver then to the lungs through blood stream. In the lungs they brake through the alveolar walls and migrate into the bronchioles, then coughed up through the trachea and re swallowed to reach the small intestine.

9. Where they become mature into adult worms in60-80 days. The life span of an adult round worm is between 6 and 12 months and maximum 1.5-2 years.

10. Man is the only reservoir of infection The infective material is the feces containing fertilized eggs Infection rates are high in children, they are most important disseminators of infection

11. Soil transmitted helminth . Clay soils are most favorable for development of eggs. Egg remains viable in the soil for months. Soil pollution due to OAD is the most important factor. Ineffective eggs easily reaches children who play on the ground

12. Mode of transmission is feco-oral route The period of communicability continued until all fertile female worms are destroyed and stool are negative of round worm eggs. Incubation period is about 2 months.

13. Clinical features Asymptomatic Depend on the wormload , location or migration of larvae and deprivation of nutrients of the host. Abdominal pain Abdominal distension Nausea Cough Loss of weight Growth failure Anemia Vitamin deficiencies Bruxism and voracious appetite

14. Associated problems are Pica Sleeplessness Irritability Urticaria Fever Eosinophilia Diarrhea May produce Intestinal obstruction Gangrene or perforation Obstructive jaundice Appendicitis Pancreatitis Ascaris encephalopathy Liver abscess Peritonitis Kwashiorkor ( protein loss)

15. Migration of the larvae through the lungs may result in ascaris penumonia ( Loeffler’s syndrome ) Larvae in the circulation may cause convulsions Retinoblastoma Hepatosplenomegaly

16. Diagnosis History of illness and passage of snake like worm in stool or vomiting is important diagnostic criteria Clinical examination and stool examination Round worm eggs

17. Management Antihelminthics Single dose Albendazole 15mg/kg or mebendazole (100 mg) twice daily for 3 days irrespective of patients age Levamisole single dose with 2.5 mg/kg or single dose of pyrantel pavomate 10mg/ kgbody weight may be used Piperazin citrate is ideal drug for eradication of round worm infestations It is given in dose of 100-150 mg/kg for one or two days at night before sleep in the form of syrup or tablet or granules. The drug paralyses the worms, so the child should pass stools within 12 hours of intake of piprazin .

18. Preventive measures Interrupting its transmission Sanitary disposal of human excreta Reduction of fecal contamination of soil Provision of safe drinking water Food hygiene Good personal hygiene Hand washing Avoid OAD Special attention to be taken for foods such as salads and vegetables or raw food items to prevent spread of infestation

19. Avoidance of pica and playing on contaminated soils and dusts Health education Secondary prevention: effective drug therapy, mass treatment periodic dewarming at intervals of 2-3 months

20. Whip worm ( Trichuris Trichiura )

21. Introduction Trichocephalus trichiuris or whipworm, is a parasitic roundworm that causes trichuriasis when it infects a human large intestine. It is commonly known as the whipworm which refers to the shape of the worm; it looks like a whip with wider "handles" at the posterior end.

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