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1. WORM INFESTATIONS
Dr Muhas C
Professor & Head
Dept. of Pharmacy Practice
Moulana College of Pharmacy, Perintalmanna

2. • Worm invasion is referred to usually as infestation and not as an
infection because there won’t be antigen antibody reaction or
destruction of tissues.
• Bacteria, virus and fungus all cause infection, whereas worms are
parasites which infest to keep living with the host/carrier (one or
more) with minimal or even without any symptoms or complaints.
• Worms live as parasites in our digestive tract and injure our
intestinal mucosa to take food from us for their survival.
• They also breed in our digestive tract and pass the eggs in faeces
contaminating the environment (water and soil) for their spread.

3. INCIDENCE
• The worm infestation mainly comes from contamination of
food or water or taking the direct faeco-oral route with
improper cleaning or contaminated fingers.
• Due to the habit of keeping their hand in the mouth/licking
fingers/thumb sucking, children under the age of 5 are most
commonly affected.
• Anyway, it can affect any age group irrespective of sex.
• Poor sanitation, infective environments, warm moist
atmosphere, etc., account for the higher spread / incidences.

4. Types of worms
• Worms are classified mainly into three types according to
their shape:
• Trematodes – flukes – schistosomiasis, liver flukes, etc
• Cestodes - Tapeworms – T. solium, T. saginata, T.
echinococcus (Hydatid cysts), etc
• Nematodes – Ascaris lumbricoides, Enterobius vermicularis,

5. • Flukes are lives in small intestines of man, dogs and pigs. It affects the
digestive system by affecting the biliary ducts and liver causing
jaundice.
• Tape worm infestations occur from eating undercooked beef or pork. It
is one of the long worms (more than a meter) and long living worms in
our body. Severe infestations can lead to intestinal blockage or
malnutrition.

7. Round worm (Ascaris lumbricoides)
• It is called commonly so for its elongated, unsegmented and cylindrical
nature.
• It spreads mainly through faeco-oral route i.e. by excreta contaminated
vegetables or foods.
• The eggs entering our body get hatched in the small intestine. The
larva burrows the intestinal gut to enter the blood stream and reach the
lungs, where it is coughed up to enter the digestive tract again.
• The eggs are passed in faeces which pollute the environment and
spread.

8. Pin worm or thread worm (Enterobius vermicularis)
• It is more commonly seen in children.
• They are tiny and white worms which can be easily seen when passed in faeces.
• They invade through contaminated food or water or with poor hygienic measures.
• Children usually pick up the eggs from the anus while scratching the anus to infect
others or to re-infect themselves.
• The worms grow in the small intestine and finally
live in the large intestines.
• Female worms usually come out in the night and
lays egg around the anus which causes intense night
itching. It may also involve the vagina and cause
violent vaginal itch.

9. Hookworm
• These remain silent in many individuals but it is also one of the worms
that has a disastrous effect on health by causing anaemia.
• It lives in the top layer of the soil of humid warm areas. When any
person walks barefoot in that soil, the larva enters the human body
thro the skin.
• Then it enters the blood circulation to reach the lungs where it is
coughed up and takes the digestive route to reach the small intestine to
live upon.
• It harasses children with abdomen pain and anemia.

11. Causes
The common causes are
• Poor hygiene
• Lack of cleanliness – while handling food, washing hands
especially after using toilet.
• Bare foot walking (hookworm),
• Undercooked non-vegetarian foods(tapeworm),
• Contact with infective environments – moist shady lands
• contaminated with animal or human excreta.

12. Clinical Presentations
Symptoms may vary according to the type of worms, its load of infection and
its affecting site.
• Abdominal pain/discomfort with constipation or diarrhea
• Loose stools with occasional bleeding
• Iron-deficiency anemia and weight loss with tiredness due to chronic blood
loss
• Poor appetite with gas trouble and bloated abdomen
• Eosinophilia, sneezing, cough and asthma
• Headaches and epilepsy in case of egg lodged in brain
• Sleeplessness or restlessness at night
• Lack of concentration and growth retardation or stunted growth
• Bottom (anal) itch and vaginal itch -- more at night
• Skin rashes

13. Diagnosis
• Worms can be identified when they are passed in the faeces.
• Or otherwise, their presence can be diagnosed in the laboratory under a
microscope by examining the collected faeces/vomited samples for
worms, larvae or eggs.
• Pinworms can be identified even by just examining the anus at night
since it is more than 5 mm

14. Preventive Measures
• Proper hygiene will usually preserve health.
• To prevent worm infestations, cleanliness should be followed as a
first principle.
• To prevent or to avoid re-infestation:
• Children should be trained in good habit development.
• Nails should be cut short to avoid pockets of infection.
• Improve hygienic measures and environment with community
services.
• Wash hands with soap - before food, before handling foods and
especially after using toilet and handling pets.
• Avoid indulging more with pets

15. Management
• There are several medicines that may be used to treat worm
infestations, they are called anthelmintics.
Mebendazole is the most commonly prescribed drug for worms.
Usually a single tablet of mebendazole is used for treatment.
This can sometimes be repeated a week later or, if infection
persists, the medication is given again three weeks later.
Another effective medication is Albendazole and Common side
effects include nausea, abdominal pain, and headache.
oPyrantel pamoate is another drug is available over-the-counter for
pinworm after confirmation of the diagnosis by a licensed
healthcare practitioner.

16. • To treat pinworms affecting urinary and genital organs,
combination therapy with oral Mebendazole and Ivermectin for
the worms as well as topical therapy for the eggs may be
required.
• A person with tapeworms is treated with a single oral dose of
Praziquantel.
• Anti-itching creams or ointments applied directly to the area
around the anus may provide relief from itching.
• Other drugs like Levamisole, Niclosamide, Tiabendazole also
used