Module 5 Worms
MODULE 5 INTRODUCTION Introduction Worms Worms or helminths are parasites that live on or in human or animal hosts and draw nutrients from their host 1. Worms are multi-cellular, have complex organ systems and can be divided into two groups 1. Flatworms Roundworms Roundworms Roundworms or nematodes are distinguished from tapeworms and flukes by having a body cavity 5. Hundreds of millions of humans are infected with nematodes; the most common are Ascaris, Hookworms, and Trichuris 5. Soil-transmitted Helminths Soil-transmitted helminth (STHs), which includes roundworms, whipworms and hookworms, occur throughout the developing world, but are particularly common in poorer communities 6. Threadworms/Pinworms Humans are the only hosts of threadworms or Enterobius vermicularis 7. Threadworms or pinworms are thin, white roundworms about the length of a staple that usually affect children. In fact, childcare centres are often where children pick up pinworm infections 7. MODULE 5 CAUSES Flatworms Flatworms or platyhelminthes include tapeworms and flukes 2. Tapeworms Fast fact Pinworm or threadworm eggs can survive outside the body for up to 3 weeks at normal room temperatures 8, which is why proper hygiene is so important for stopping the transfer of worms. Tapeworms or cestodes are found primarily in the intestines. Tapeworms that infect humans are named after their intermediate host, such as the fish tapeworm, beef tapeworm and pork tapeworm 2. Causes Flukes Flukes or trematodes infect the blood vessels, gastrointestinal tract, lungs and even the liver. Schistosoma, commonly known as bilharzia, is an infection caused by a type of fluke schistosomes 3, 4. How Flatworms are transmitted People become infected with bilharzia species. Tapeworm larvae develop in this through walking, wading or swimming in host and encyst in the organs. fresh water contaminated by flatworms 2,3. When the meat of the intermediate host is eaten, the parasites are released An adult tapeworm will live in the into the intestines where they develop intestines of its main host where it into adult tapeworms, thus repeating the lays eggs, which are later excreted cycle 2. Humans usually get tapeworms within faeces, and then ingested by from eating undercooked beef or pork an intermediate host, usually another infected with tapeworm cysts 2. Fast fact Over one billion humans are at risk of bilharzia worldwide and approximately 300 million are infected 3. Bilharzia is spread through contact with snails as they are intermediate hosts of blood flukes or schistosomes 4. 18 19
MODULE 5 CAUSES How Roundworms are transmitted Conditions such as lack of access to clean water, overcrowding, poor sanitation and unhygienic food preparation can contribute to the spread of worm infestations 5. Roundworms are transmitted to human hosts through 5,9 : Gardening or playing in sand contaminated with worm eggs Symptoms The symptoms of Flatworms In severe cases, these infestations cause permanent organ damage, anaemia, stunted growth, poor intellectual development and impaired cognitive function 4. MODULE 5 SYMPTOMS Contact with contaminated toys, clothing and blankets Bilharzia 3,4 Playing with dogs and cats that have eggs in their fur Dermatitis Eating unwashed fruit, vegetables and salad grown in contaminated soil Fever and chills Direct transfer from an infected person Nausea Hookworms are transmitted when walking barefoot in contaminated soil where hookworm larvae can penetrate the skin through the feet 5. Abdominal pain, diarrhoea Malaise, and myalgia Pinworm infection occurs after pinworm eggs are swallowed 8,9. The symptoms of Roundworms Eggs develop into larvae in the intestines where they mature within 2 to 6 weeks, 1. The eggs are swallowed 1 Threadworm 5,10 Intense irritation around the anus area especially at night Loss of appetite and weight before they mate Irritability from lack of sleep The adult female worm exits through the anus to lay eggs, which are deposited in a sticky substance The eggs and sticky substance irritate the skin, leading to itching around the anus Once outside, eggs can be transferred to fingernails, clothing, bedding, toys or food A child may re-infect him/herself by transferring eggs from the anus area to the mouth 2. The larvae migrate to the small and large intestine 3. The female worm mates and migrates to the anus 2 4. The female secretes an irritant mucus 3 Enterobius vermicularis life cycle 8. Non-specific abdominal pains, sometimes with accompanying diarrhoea A cough, wheezing or pneumonitis can suggest worm infestation in the lungs Hookworm 5,11 Itchy rash where the larvae penetrated the skin Abdominal pain or other GI symptoms An iron deficiency may develop later due to chronic blood loss In light infestations, especially in the beginning, symptoms can be mild. Symptom severity depends on the age, health and nutritional status of the person. 20 21
MODULE 5 DIAGNOSIS Diagnosis Diagnosing Flatworms Flatworms are visible in stool or are coughed or vomited up. Tapeworm segments are white and particularly distinctive 2. In the case of bilharzia, eggs are identified in stool, urine or biopsy specimens 3,4. Diagnosing Roundworms Different kinds of roundworms are often visible in stool and can be coughed or vomited up 5,11. Treatment MODULE 5 OTC TREATMENT Once diagnosed with carrying flatworms or roundworms, it is advisable that all members of the family be treated unless contraindicated - they are pregnant, breastfeeding or under the age of one 6,10,12. Over the counter (OTC) treatment Tip for pharmacy staff Advise your customers on how to prevent worms Worm infestation can be prevented through taking the following measures 2,5,9 : OTC remedy Effect Ensuring adequate sanitation Frequently washing clothing, bedding and toys Thoroughly cooking meat and fish Regularly de-worming dogs and cats Washing hands before handling food Avoiding unwashed fruits and vegetables Mebendazole 12 Inhibits the uptake of glucose by the worm and depletes it of its glycogen stores, which leads to the death of the worm 12. Mebendazole is an effective treatment against most common worm infestations. 22 23
MODULE 5 VERMOX Vermox offers a range of 4 products that kill a variety of intestinal worms. Need to know The key ingredient in Vermox is mebendazole polymorph C 5 MODULE 5 VERMOX These OTC treatments are available in a variety of choices depending on the type of worm and the severity of the infestation. The Vermox range How to administer treatment For adults and children older than 1 year: Whipworm, hookworm, large roundworm, pinworm: 1 tablet (100 mg) twice daily for 3 consecutive days Vermox 100 mg Tablets Tapeworm: 1 tablet (100 mg) twice daily for 6 consecutive days Threadworm: Adults: 2 tablets (200 mg) twice daily for 3 consecutive days Children: 1 tablet (100 mg) twice daily for 3 consecutive days For adults and children older than 1 year: Whipworm, hookworm, large roundworm, pinworm: The Vermox range How it can help your patients Vermox SD Suspension 10 ml given as a single dose. A second dose may be given to patients who are still infected, but only 3 to 4 weeks after the first dose. Vermox 100 mg Tablets Vermox SD Suspension 3-day dose helps cure whipworm, hookworm, large roundworm, pinworm, tapeworm (6-day dose) and threadworm infestations. Single dosage helps cure whipworm, hookworm, large roundworm and pinworm infestations. In severe cases a second dose may be required 3 4 weeks later. Vermox Suspension For adults and children older than 1 year: Whipworm, hookworm, large roundworm, pinworm: 5 ml twice daily for 3 consecutive days Tapeworm: 5 ml twice daily for 6 consecutive days Threadworm: Adults: 10 ml twice daily for 3 consecutive days Children: 5 ml twice daily for 3 consecutive days 25 ml can be given as a single dose for adults and children older that 1 year for whipworm, hookworm, large roundworm and pinworm. For adults and children older than 1 year: Whipworm, Vermox Suspension 3-day dose takes care of whipworm, hookworm, large roundworm, pinworm, tapeworm (6-day dose) and threadworm infestations. Vermox 500 mg Tablets hookworm, large roundworm, pinworm: 1 tablet (500 mg) given as a single dose - A single dose of Vermox 500 mg may not be sufficient to cure infestations of hookworm and whipworm, although it can dramatically reduce the number of eggs in the body. Vermox 500 mg Tablets Single dosage helps cure whipworm, hookworm, large roundworm and pinworm infestations. For hookworm and whipworm a second dose may be required 3 4 weeks after the first. A second dose may be given to patients who are still infected, but only 3 to 4 weeks after the first dose. 24 25
Quick Question List the different types of roundworms? MODULE 5 REFERENCES References 1. Porter RS (Ed). Infectious Diseases: Approach to Parasite Infections. The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/professional/infectious-diseases/approach-to-parasitic-infections/approach-to-parasitic-infections 2. Porter RS (Ed). Infectious Diseases: Cestodes (Tapeworms). The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/ professional/infectious-diseases/cestodes-tapeworms/overview-of-tapeworm-infections 3. Escargot. Environmental Management: Bilharzia. Available at www.escargot.ch/personel/schisto.htm 4. Porter RS (Ed). Infectious Diseases: Trematodes (Flukes). Schistosomiasis. The Merck Manual of Diagnosis and Therapy. Availableat www.merckmanuals.com/professional/infectious-diseases/trematodes-flukes/schistosomiasis 5. Porter RS (Ed). Infectious Diseases: Nematodes (Roundworms). The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals. com/professional/infectious-diseases/nematodes-roundworms/introduction-to-nematodes 6. WHO Resources. Deworming: The Millennium Development Goals. WHO/HQ Geneva 2005. Available at www.who.int/intestinal_worms/. Accessed on 11 November 2015. 7. Centers for Disease Control and Prevention. Parasites: Enterobiasis. CDC General Information: FAQs. Available at www.cdc.gov/parasites/pinworm/gen_info/faqs.html 8. Porter RS (Ed). Parasitic Infections: Pinworm Infection. The Merck Manual Home Health Handbook. Available at www.merckmanuals.com/home/ infections/parasitic-infections/pinworm-infection 9. De Carvalho IMC, Caudwell R. Worm Infestations. Front Shop Pharmacy Magazine 2012. Available at www.frontshop.co.za/worm-infestations/.accessed on 6 March 2017. 10. Barnard K. The Basics Management of threadworms. GPonline.com June 2011. Available at www.gponline.com/basics-management-threadworms/gi-tract/article/1073433 11. Porter RS (Ed). Infectious Diseases: Nematodes (Roundworms). Hookworms. The Merck Manual of Diagnosis and Therapy. www.merckmanuals. com/professional/infectious-diseases/nematodes-roundworms/hookworm-infection 12. De Silva I. Threadworm infestation in children: diagnosis and management. Prescriber 2009. Available at onlinelibrary.wiley.com/doi/10.1002/ psb.564/epdf S1 S1 VERMOX Suspension. Each 5 ml suspension contains 100 mg Mebendazole ( Polymorph C). Reg. No. K/12/206. VERMOX 100 mg tablets. Each tablet contains 100 mg Mebendazole (Polymorph C). Reg. No. G/12/105. S1 VERMOX SD Suspension. Each bottle (10 ml suspension) contains 500 mg Mebendazole (Polymorph C). Reg. No. 34/12/0058. S1 VERMOX 500 mg tablets. Each tablet contains 500 mg Mebendazole (Polymorph C). Reg. No. W/12/42. 26 27