WORM INFESTATION Mr. Pradeep Abothu, M.Sc (N), PhD Scholar, Associate Professor Dept. Of Child Health Nursing ASRAM College Of Nursing DEFINITION Worm infestation refers to presence of worms in child’s body, specifically in intestines and sometimes in other parts of the body. The child gets infested by worms through drinking or eating of contaminated food, water or mud (PICA). The common worm infestations are Threadworm, Round Worm & Hookworm. ROUND WORMS (ASCARIS): They are round, thin, white/pink in color and are about 10-20 inches long HOOK WORMS (ANKYLOSTOMES) They are tiny, 5–15 mm in length, pink in colour, not visible in stools. THREAD WORMS(ENTEROBIUS): Thread worms are also known as pin worms, They are white, small, thin, just like fine threads and measures about 2–13 mm in length and up to 0.5 mm wide. CLINICAL MANIFESTATIONS: Most often, the signs and symptoms are mild and not noticed unless the worm load is heavy. The symptoms include Loss of appetite, nausea and poor digestion. Abdominal discomfort/pain after eating food Abdominal distension and vomiting. Anemia and weakness. Perineal itching(causing disturbed sleep). Sometimes a worm load may cause intestinal obstruction, Worms in the stool, coughing up worms. Unexplained coughing, wheezing or shortness of breath in a non-asthmatic child. DIAGNOSTIC EVALUATION: Stool microscopy is done to find ova or larvae in the stools. 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 a light worm load, between 20 to 40 ova is a moderate load and more than 40 ova is heavy load. MANAGEMENT: DRUG THERAPY: There are about 25 antihelminthic drugs available in the market. Commonly used drugs are: Mebendazole Pyrantel palmoate Piperazine salts Niclosamide MEBONDAZOLE: This drug has a broad spectrum of action and virtually no side effects. It is wormicidal. It inhibits glucose uptake by the worm, immobilizes the worms and kills it. Mebondazole is the drug of choice for roundworms, hookworms and threadworms.  It is available as 100 mg tablet and syrup. The dose is same for adults and children.  For threadworms single 100 mg tablet of Mebendazole is effective.  For roundworms and hookworms, 100 mg is to be given for 3 days.  When there is massive worm infection and expulsion, transient abdominal pain and Diarrhea can occur.  Worm migration through nose and mouth during Mebendazole treatment is a known side effect which occurs due to starvation and slow death of worm.  Very rarely leucopenia has been reported. PYRANTEL PALMOATE: it is a broad spectrum antihelmintic drug with efficacy similar to Mebendazole. It causes sharp contraction of the worm with subsequent cessation of spontaneous activity and paralysis of worms.  Pyrantel is effective in the treatment of round worms and thread worms with a single dose of 10 mg/kg body weight.  Against hookworms, same d

1. INTESTINAL
PARASITES/WORM
INFESTATION
Mr. Pradeep Abothu, M.Sc (N),
PhD Scholar, Associate Professor
Dept. Of Child Health Nursing
ASRAM College Of Nursing

2. DEFINITION
Worm infestation refers to presence of worms in child’s body, specifically in
intestines and sometimes in other parts of the body.
The child gets infested by worms through drinking or eating of contaminated food,
water or mud (PICA).
The common worm infestations are Threadworm, Round Worm & Hookworm.

3. ROUND WORMS (ASCARIS):
 They are round, thin, white/pink in color and are about 10-20 inches long

4. HOOK WORMS (ANKYLOSTOMES)
 They are tiny, 5–15 mm in length, pink in colour, not visible in stools.

5. THREAD WORMS(ENTEROBIUS):
 Thread worms are also known as pin worms, They are white, small, thin, just
like fine threads and measures about 2–13 mm in length and up to 0.5 mm
wide.

6. TAPE WORMS(TAENIA SOLIUM):
 Tapeworms are flat, ribbon-like worms. They are white or cream in color,
segmented, and can grow from 2 meters to 10 meters in length and about
1–2 cm in width.

7. CLINICAL MANIFESTATIONS:
Most often, the signs and symptoms are mild and not noticed unless the worm load is
heavy. The symptoms include
Loss of appetite, nausea and poor digestion.
Abdominal discomfort/pain after eating food
Abdominal distension and vomiting.
Anemia and weakness.
Perineal itching(causing disturbed sleep).
Sometimes a worm load may cause intestinal obstruction,
Worms in the stool, coughing up worms.
Unexplained coughing, wheezing or shortness of breath in a non-asthmatic child​
.

8. DIAGNOSTIC EVALUATION:
Stool microscopy is done to find ova or larvae in the stools.
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 a light worm load, between 20 to 40
ova is a moderate load and more than 40 ova is heavy load.

9. MANAGEMENT:
DRUG THERAPY: There are about 25 antihelminthic drugs available in the
market. Commonly used drugs are:
Mebendazole
Pyrantel palmoate
Piperazine salts
Niclosamide

10. MEBONDAZOLE: This drug has a broad spectrum of action and virtually no side effects. It is
wormicidal. It inhibits glucose uptake by the worm, immobilizes the worms and kills it.
Mebondazole is the drug of choice for roundworms, hookworms and threadworms.
 It is available as 100 mg tablet and syrup. The dose is same for adults and children.
 For threadworms single 100 mg tablet of Mebendazole is effective.
 For roundworms and hookworms, 100 mg is to be given for 3 days.
 Worm migration through nose and mouth during Mebendazole treatment is a known side
effect which occurs due to starvation and slow death of worm.
 Very rarely leucopenia has been reported.

11. PYRANTEL PALMOATE: it is a broad spectrum antihelmintic drug with efficacy similar
to Mebendazole. It causes sharp contraction of the worm with subsequent cessation of
spontaneous activity and paralysis of worms.
 Pyrantel is effective in the treatment of round worms and thread worms with a single
dose of 10 mg/kg body weight.
 Against hookworms, same daily dosage should be repeated for 3 consecutive days.
 The adverse reactions are mild and transitory, in form of headache, gastrointestinal
disturbances, dizziness, rash and fever.
 As there is a possibility of Pyrantel and Piperazine having antagonistic action, these two
drugs should not be used together.

12. PIPERAZINE SALTS: Though highly effective against round worms and threadworms,
due to availability of non-toxic drugs like Mebendazole, its use is declining.
 It acts by worm paralysis. in this way worms lose their ability to retain their position
against intestinal peristalsis. The worms are carried down passively and expelled
out.
 50 mg Piperazine, per kg body weight per day is given for 2 days, in round worm
infestation.
 Maximum dose is 3.5 grams. For threadworms, it is to be given for 7 days.
 Gastrointestinal disturbances, blurred vision, muscle weakness, ataxia, nystagmus, in
coordination, convulsion and utricaria are the reported side effects.

13. NICLOSAMIDE:
 It is particularly useful against all types of tapeworms. Under the effect of
Niclosamide, worm becomes susceptible to the proteolytic action of intestinal
secretions.
 Dose for children is 2 tables (Total 1 gram) to be chewed or swallowed on empty
stomach.
 Due to availability of broad spectrum drugs now it is not necessary to have a precise
diagnosis of individual parasite.

14. HOME REMEDIES FOR WORM INFESTATION:
Onion juice removes thread worms. Dosage: Three drops to one teaspoon twice daily.
Neem powder removes all types of worms. (Dosage: 1 to 4 grams twice daily) .
Pinch of asafoetida wrapped in small piece of jaggery. It must be given half an hour
before meals.
For 7-12 years old Children 20 grams of jaggery in the morning, then after 10 minutes,
celery seeds (ajwain) + salt (2 grams of celery seeds and one gram of salt) must be taken
with warm water. This recipe eliminates all types of worms.

15. NURSING CARE IN WORM INFESTATION:
The nursing management of parasitic infestation focuses on the following:
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.

16. PREVENTIVE METHODS:
Thoroughly wash vegetables.
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.

17. cont….
Nails should be kept short and clean, as the nails are places where ova of the worms
usually reside.
The underclothes should be changed daily and bed linen must be kept clean.
Children should not be allowed to play barefoot in the fields where the soil may be
contaminated with ova of hookworm. The ova of hookworm enter through the foot and
reach the blood stream and grow into adult worms.
Regular deworming done helps in preventing infestation.
Avoid too many sweets and puddings, fried, greasy and fast foods.
More green vegetables and fresh fruits should be eaten.
Personal hygiene should be maintained.
Restrict diet to only homemade foods.

18. Thank you