Overview of Common Worm Infestations in Children and Neglected Tropical Diseases (NTDs)
Common worm infestations in children, such as Ascaris lumbricoides and Enterobius vermicularis, are a significant health concern globally. Neglected Tropical Diseases (NTDs) like ascariasis, hookworm, and lymphatic filariasis affect millions of people, particularly those in poverty. For just 50 cents, treatment can be provided against seven NTDs for an entire year. Helminthiasis caused by nematodes, trematodes, and cestodes, including roundworms, flukes, and tapeworms, poses a serious burden on public health. Proper diagnosis and treatment options are essential in managing these parasitic infections in children.
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http://bioweb.uwlax.edu/bio203/s2008/geske_rich/images/OrgBioScolex4.JPGhttp://bioweb.uwlax.edu/bio203/s2008/geske_rich/images/OrgBioScolex4.JPG Common Worm Infestations in Children Dr Nishant Verma Department of Pediatrics
Burden of disease The 7 Most Common NTDs 1. Ascariasis 2. Hookworm 3. Lymphatic Filariasis Neglected Tropical Diseases (NTDs) are the most common diseases of the world s poor. These diseases disable and debilitate one in six people worldwide, including half a billion children. 4. Onchocerciasis 5. Schistosomiasis 6. Trichuriasis 7. Trachoma
For just 50 cents, treatment can be provided to a person against seven NTDs for an entire year The 7 Most Common NTDs 1. Ascariasis 2. Hookworm 3. Lymphatic Filariasis 4. Onchocerciasis 5. Schistosomiasis 6. Trichuriasis 7. Trachoma
Helminthiasis Nematodes Trematodes Cestodes (Round Worms) (Flukes) (Tape worms) Ascaris lumbricoides Enterobius vermicularis Hook worm Trichuris trichiura Brugia malayi Wuchereria bancrofti Schistosoma Clonorchis Fasciola hepatica Taenia solium Taenia saginata Echinococcus Diphyllobothrium latum
Ascaris lumbricoides C/F Abdominal Pain, distension, vomiting Passage of worms in stool/vomitus Obstruction Pulmonary: Loeffler syndrome Growth failure
Ascaris lumbricoides Diagnosis Eggs in stool sample Worms in stool / vomitus Imaging Treatment Albendazole 400 mg Once (Taken with food) Other options Mebendazole Ivermectin Nitazoxanide
Enterobius vermicularis (Pin Worm) Peri-anal itching More at night
Enterobius vermicularis (Pin Worm) Diagnosis Stool microsopy: not useful Eggs can be demonstrated in peri anal swabs collected early morning Sticky tape on a tongue depressor Treatment Albendazole 400 mg Once, repeat in 2wk Other options Mebendazole Pyrantel Treat entire family
Hook worm Ancylostoma duodenale / Necator americanus
Hook worm C/F Ground itch Abdominal pain, anorexia Iron deficiency anemia Hypoproteinemia Dx Stool microscopy Peripheral smear Treatment Albendazole 400 mg Once Other options Mebendazole Pyrantel Oral Iron therapy
Filariasis Wuchereria bancrofti, Brugia malayi, B. timori
Filariasis C/F Most remain asymptomatic IP: 8-16months Episodes of Fever, lymphangitis, lymphadenitis Last for 7-10d 8-10 episodes/yr Tropical Pulmonary Eosinophilia Chronic stage: Lymphatic obstruction > 25yr age Lymphedema / Elephantiasis
Filariasis Dx Mf identified in thick blood film Nocturnal periodicity Adult worm in LN biopsy Treatment Di Ethyl-Carbamazine (DEC) 6mg/kg /day q8hr for 12 days Other options Single dose Ivermectin Ivermectin + Albendazole Prevention
Echinococcosis Echinococcus granulosus, E. multilocularis Alveolar Echinococcosis Cystic Echinococcosis
Echinococcosis C/F Site and mass effect of the cyst Rupture: fever, anaphylaxis
Echinococcosis Diagnosis Imaging Serology: Sensitive, not specific Treatment Surgical Complete removal USG/CT guided Percutaneous Aspiration, Instillation of hypertonic saline, Reaspiration (PAIR) Medical Albendazole 15mg/kg/day for 2wk May require repeated courses Monitor by serial USG
Taeniasis Taenia solium Taenia saginata Tapeworm Tapeworm Pork Beef
Taeniasis C/F Mild epigastric discomfort, nausea, flatulence, diarrhea Dx Microscopic identification of eggs and proglottids in feces Treatment Praziquantel 5-10mg/kg single dose Alternative option Niclosamide 50mg/kg single dose
Neurocysticercosis C/F Depends on site and number of cysts Seizures, headache Cysticercal encephalitis Dx Neuroimaging Diff from tuberculoma
Neurocysticercosis Treatment Anticonvulsants Albendazole If active lesions on imaging 15mg/kg/day for 7-28 days Adjunctive steroids Relative C/I for albendazole Intraocular cysts Intraventricular cysts Spinal cysts Prevention
