health talk:with Dr Johannes Marisa
Ihave witnessed so many patients who pop up at our practice rooms with jars containing worms, which could have been passed in the stool. Some patients end up being admitted because of anaemia, requiring blood for transfusion, which is a costly and arduous process. Despite all this, how many have followed a deworming exercise where anti-worm medication is taken routinely to keep us safe? Today, I want to bring to your attention two types of worms, the roundworm and the hookworm, two of the most notorious worms in the world.
The roundworm
Roundworms are a type of parasitic worm and infections caused by these worms are fairly common. Ascariasis is the most common roundworm infection and is caused by Ascaris Lumbricoides, a species of the roundworm. It is estimated that 10% of the developing world is infected with intestinal worms according to World Health Organisation. People get the parasite through unsafe food and water. This is quite common in our country and in 2002, the government embarked on mass drug administration in schools against bilharzia and intestinal worms.
Hookworm
These are parasites as well. They affect your lungs, skin and small intestines. Humans contract hookworms through larvae found in dirt contaminated by faeces.
According to Centre for Disease Control, hookworm infections occur in estimated 576 to 740 million people worldwide but mainly in developing countries.
How does ascariasis come?
One becomes infected with ascariasis after accidentally ingesting the eggs of Ascaris Lumbricoides roundworm. The eggs can be found in soil contaminated by human faeces or uncooked food contaminated by soil that contains roundworm eggs
Symptoms of ascariasis
People with ascariasis often have no symptoms. Symptoms become more noticeable when the roundworm infestation grows depending on the system that is affected. Roundworms in the lungs can cause:
lCoughing or gagging.
lWheezing or shortness of breath.
lBlood in the mucus
lChest discomfort
lFever
Roundworms in your intestines can cause gastrointestinal symptoms which include:
lWeight loss despite frequent eating.
lBlood in the stool.
lNausea.
lVomiting.
lIrregular stools or diarrhoea.
lLoss of appetite.
lGrowth impairment in children due to malabsorption.
lVisible worms in the stool.
Hookworms has two major types that cause infection and these are Necator Americanus and Ancylostoma duodenale. One can get infected with hookworms by coming into contact with soil that contains their larvae. The larvae enter your skin, travel through your blood stream and enter your lungs. They are carried out to your small intestine when you cough them out of the lung and swallow. These worms can stay in the small intestine for even longer than one year before they are passed through your faeces. Symptoms include:
lThose mentioned above.
lSymptoms and signs of anaemia (In some cases patients can require blood for transfusion).
lItchy rash.
lColic or cramping or excessive crying in children.
Prevention of worms
lWearing shoes when you walk outdoors especially in areas that might have faeces in the soil.
lDrinking safe water including boiling suspicious water.
lProperly cleaning and cooking food.
lPractising proper handwashing.
lAvoid unclean common areas for bathing.
NB** Children who are between three and eight years are most likely to be infected because of their contact with soil while playing. It is, thus, important to make sure these are routinely dewormed, at least getting medication at least once a year.
Investigations
Investigations to be done include:
lStool analysis where stool is taken to look for parasites and ova (eggs).
lFull blood count — Peripheral eosinophilia can be found, especially during the phase of larval migration through the lungs. Check for microcytic anaemia if a suspicion of hookworms is done.
lOnce diagnosed with ascariasis, one may require more tests which may show the number of worms that have grown to maturity and where major groups of worms are in the body. These tests include:
lX-ray
lUltrasound scan — Usually help diagnose hepatobiliary or pancreatic ascariasis.
lCT Scan
lMRI Scan
lEndoscopy
Treatment
These worms are treated with anti-parasitic drugs. In Zimbabwe, some of the drugs are very much affordable and the duration of treatment is very short. Below are some of the used drugs:
lAlbendazole.
lIvermectin.
lMebendazole.
lPiperazine citrate.
lLevamizole.
lPyrantel pamoate.
In short, please de-worm yourself at least once a year with simple drugs like Albendazole 400mg tablets for just a maximum of three days. Allow your children to get school doses if there is a government programme. Just know, no one is spared in our country. Let us stop these worms.
Till we meet again next week!
lDr Johannes Marisa is a private medical practitioner who holds post-graduate qualifications in Public Health, Business Administration, Education Management and Development Studies.
