Worm infestation, also known as helminthiasis, is a major health problem worldwide, especially in developing countries with poor sanitation. The document discusses the most common types of worm infections including roundworm, hookworm, pinworm, and tapeworm. It provides details on the lifecycles, symptoms, and treatment for each type. The highest rates of worm infections are found in children living in tropical areas with lack of clean water and proper hygiene. Preventive measures include washing hands, avoiding contaminated food/water, and practicing safe disposal of human waste.

1. Worm Infestation
Introduction
Infestation is the state of being invaded by pest or parasite. Worm infestation is referred to as
an infestation of the host especially human and animals by helminths. It is one of the major
causes of health and nutritional problems. Poor sanitation and poor hygiene increase the
spread of these worms.
Definition
Worm infestation refers to worms that live as parasites in human body. Intestinal worm
infestation is one of the commonest causes of chronic parasitic infestation in children in the
rural areas of developing countries. It is more common among school aged children (5-15).
Common types of worm infestation
Roundworm
Hook worm
Thread worm
Tape worm
Prevalence rate
More than 1.5 billion people, or 24% of the world`s population are infected with soil-
transmitted helminthes infection worldwide. Infections are widely distributed in tropical and
subtropical areas, with the greatest numbers occurring in sub-Saharan Africa, the Americas,
China and East Asia.
Over 267 million preschool-age children and over 568 million school-age children live in
areas where these parasites are intensively transmitted, and are in need of treatment and
preventive intervention. (WHO 2 march 2020)
The prevalence rate of intestinal parasitic disease was found to be 37.46% in Nepalese
children, 40.17% in school aged children and 35.84% in preschool aged children. Males are
more affected then females.
Collected from;
Epidemiology of Intestinal Parasitic Disease in Nepalese children, European
journal of public health Vol 27 issue -3, November 2017
Causes
 Raw fish and meat
 Contaminated food
 Contaminated water
 Low socio-economic status
 Poor sanitation
 Pet
 Soil contaminated with infective larvae, faeces
 Agricultural community
 Walks with bare foot
 Unhygienic life style

2. Round worm (Ascaris Lumbricoids)
Ascariasis is the most common worm infestation caused by the adult, ascaris lumbricoids.
Preschool children are vulnerable to infection due to their hand to mouth behaviour; Infection
may also be acquired through ingestion of contaminated fruits and vegetables.
Roundworm is one of the largest of the intestinal helminths or nematode parasite reaching a
length of 20-25 cm (10-14 inch).
Ascaris is a soil transmitted helminth. The eggs of the ascaris remain viable in the soil for
months or year under favorable condition. Soil is seeding by ascarisis eggs by the human
habit of open field defecation which is most important factor responsible for the distribution
of ascariasis in the world. It can occur in any age group but most common is in preschool and
early school aged children.
Prevalent in warm climates
Habitat: Roundworms are worms that infest the human digestive tract, specially the small
intestine. Adult worms live in the small intestines (85% in jejunum and 15% in ileum). It can
live inside the small intestine for up to 2 years. Roundworm eggs live in soil that is
contaminated by faeces.
Transmission: faeco-oral route Disease is transmitted by fecal-oral route i.e. by ingestion of
food or drink contaminated with eggs. Other means of spread by finger and hand
contamination with soil or by ingestion of children playing with soil. No person-to-person
transmission but the infection can then spread from person to person through infected faeces.
Life cycle
Ingestion of egg through contaminated food the infective embryonated egg
reach and hatches out in the small intestine (duodenum) releases of larvae
penetrate the gut wall and are carried to liver and then to the lungs via the blood stream. In
the lungs, they moult twice and break through the alveolar walls and migrate into the
bronchioles. They are coughed up through the trachea and then swallowed by the human host
reaching the intestine mature into adult worms in 60-80 days
start to producing egg again reach in the environment through human excreta.
Clinical manifestation
Most infected individuals are asymptomatic due to low worm load.
Clinical manifestations occur due to pulmonary hypersensitivity and intestinal complications.
1. Light infections/asymptomatic: Parent may find roundworm in child's diaper
with/without stool or see roundworms in the toilet
2. Heavy infections: Anorexia, irritability, nervousness, enlarged abdomen, weight loss,
fever, intestinal colic.
3. Severe infections: Intestinal obstruction, appendicitis, perforation of intestine with
peritonitis, obstructive jaundice, pancreatitis, lung involvement (pneumonitis), loeffler
syndrome characterized by fever, cough, dyspnea, wheeze, urticaria, eosinophilia and
lung infiltrates.
Diagnosis
1. History taking and physical examination
2. Stool test to see ova of worms

3. Treatment
1. Treat with Albendazole (single dose); or Mebendazole for 3 days; or ivermectin
(children >15 kg) as a single dose; or nitazoxanide for 3 days
2. Albendazole: children 1-2 years 200mg single dose.
3. Older children and adults 400mg single dose
4. Re-examine stool specimen in 2 weeks to establish need for further pharmacologic
therapy
Hookworm
Hookworm is an intestinal infestation caused by two species of nematode (Ancyclosoma
Duodenale or Necator Americanus). This infection is widely prevalent in developing country
like Nepal and India. Man is the only important reservoir of human hookworm infection.
It is leading cause of maternal and child morbidity in the developing countries of the tropics
and subtropics region. This infection is common in all ages and both sex and has high
prevalence in agricultural community. The eggs and larvae of the helminth will survive in the
damp, sandy soil.
The infective material is human feces containing the ova of the hookworm but the immediate
source of infection is the soil contaminated with infective larva penetrates the skin and enter
the body. The period of infectivity as long as the person harbors the parasite and the
incubation period ranging from five weeks to nine months
Mode of Transmission
Hookworm infective larvae penetrate the skin of barefooted individual and enter inside
human body.
Life cycle
Human host is infected by the filariform larvae not the eggs. The infective larvae enter the
body usually via penetrating the skin by walking barefoot areas contaminated with faecal
matter. The larvae are able to penetrate the skin of the foot and once inside the body, they
migrate through the vascular system to the lungs and from there up the trachea and are
swallowed, then they pass down the esophagus and enter the digestive system, lodges in the
intestine, where the larvae mature into adult worms. Some time it may also be transmitted via
the oral route by direct ingestion of infective larvae that is contaminated with fruits and
vegetables.
Once the larva reaches in the small intestine of the host and begin to mature, the infected
individual will suffer from diarrhoea and other gastrointestinal discomfort. Major morbidity
associated with hookworm is caused by intestinal blood loss, iron deficiency anaemia and
protein energy malnutrition.
Clinical features
1. Light infections in well-nourished individuals: No problems
2. Heavier infections: Chronic blood loss due to hookworm infestation causes mild to
moderate iron deficiency anaemia (they stay in small intestine mainly in the jejunum
and remain attached in the intestinal villi and there they suck blood and protein

4. leading to significant blood loss with iron and protein deficiency. It causes hookworm
anemia.)
And, occasionally, hypoproteinemia, Malnutrition; and oedema only heavily infected
children become symptomatic.
3. Infective larvae may produce a pruritic maculopapular eruption known as ground itch;
at the site of skin penetration. Larvae migrating through lungs may also cause
transient lung infiltration, but this is less common than with Ascaris.
4. Nonspecific complaints like abdominal pain, anorexia, and diarrhoea have also been
attributed to the hookworm infection
Diagnosis
The diagnosis is established by identifying the characteristic oval hookworm eggs in the
faeces. Eggs of the two species are indistinguishable. Blood examination reveals microcytic,
hypochromic anaemia, occasionally eosinophilia.
Treatment
1. Specific treatment: Albendazole 10 mg/ kg single dose or 5 mg/ kg daily for 3 days
orally other drugs: Mebendazole 100 mg twice daily for 3 days or pyrantel pamote
single dose of 10 mg/ kg
2. Iron administration (ferrous sulfate oral) 3-6 mg/ kg of body weight in three divided
dose. It may require blood transfusion or packed cell transfusion in severe anaemia.
Pinworm or threadworm (oxyuriasis)
A pinworm infection (enterobiasis or oxyuriasis) is one of the most common types of human
intestinal worm infections caused by enterobius vemicularis. E.vermicularis is a white slender
nematode with a pointed tail. In human, they reside in the caecum, appendix, and ascending
colon. Female pinworm is 8-13 mm long, and males are 2-5 mm long. Pinworm infestation is
most common in children between the ages of 5-10 years.
Pinworm infections are caused by worm-like parasites (Enterobius vermicularis) that infect
humans' intestines and rectal/anal areas.
Young children, school-aged children, and their household members, including adults, are at
risk for pinworm infections. Pinworms are visible. They range in size from 2-13 mm, are
white, and resemble a worm but the pinworm eggs are small.
Life cycle
Pinworm infestation usually results from transfer of ova from the perianal area to fomites
(clothing, bedding, furniture, rugs, toys, toilet seats), from which the ova are picked up by the
new host, transmitted to the mouth, and swallowed. Thumb sucking is a risk factor.
Reinfestation (autoinfestation) easily occurs through finger transfer of ova from the perianal
area to the mouth. Pinworms reach maturity in the lower gastrointestinal tract within 2 to 6
weeks. The female worm migrates out of the anus to the perianal region (usually at night) to
deposit ova. The sticky, gelatinous substance in which the ova are deposited and the
movements of the female worm cause perianal pruritus. The ova can survive on fomites as
long as 3 weeks at normal room temperature.
Sign and symptom
The major signs and symptoms of pinworm infection are discomfort and itching in the
anal/rectal area. Children especially will scratch the rectal/anal area, get eggs on their fingers

5. or underneath their fingernails and transport the infective eggs to bedding, toys, other
humans, or back to themselves.
Other signs and symptoms may include:
(i) Discomfort in the anal and/or vaginal area
(ii) Rash or skin irritation around the anus or vagina
(iii)Insomnia or difficulty sleeping and/or restlessness due to irritation of skin
(iv)Pinworms can often be seen on the anal skin or in the stools, sometimes detected in the
vagina and may produce some vaginal discharge
(v) Some infected individuals may have abdominal pain
(vi)Some infected individuals can get secondary bacterial infections from intense skin
scratching.
(vii) Infrequent infection of the ureters and/or bladder may cause dysuria or bladder
discomfort.
Diagnosis
(i) A “cellophane test” or “scotch tape” test is the most reliable method, where a clear
adhesive cellulose tape is applied to the anal area early in the morning before bathing and
defecation.
(ii) Conduct tape test at least three times; on three consecutive mornings to find pinworms
eggs.
(iii)Anal swab may also be used.
Treatment
(i) Albendazole : 1-2 yrs children -200 mg single dose
i. children >2 yrs of age 400mg single dose
(ii) Mebendazole 100mg twice a days for three days irrespective of the child’s age
(iii) One course of medication usually involves in initial dose two to three weeks later. More
than one course may be necessary to fully eliminate the pinworms eggs. Creams or
ointments can soothe itching skin in the area around the anus.
Tapeworm
These looks like white tape and are long, flat worms divided into segment which contain
fertilized eggs; these segments breaks off and are excreted in the stool. If this is passed
outside on the grass, the grass may be eaten by a pig or a cow. The eggs then hatch out in the
stomach of the animal, and the embryo gets into the muscle where it forms a cyst. If this meat
is eaten raw or only partly cooked, these embryos develop into tapeworms in the intestine of
the man. The pig tapeworm is more dangerous to man because he might also develop the
cystic in his muscles or brain.
Types
1. Taenia saginata ( beef tapeworm)
2. Taenia solium (pork tapeworm)
Taenia saginata (Beef tapeworm)

6. Beef tapeworm is a white semi- transparent worm measuring 4-10 m long which when fully
adult may contain 2000 segments. The head (scolex) is 1-2 mm in diameter with four lateral
suckers but no hooks, so it is called unarmed tapeworm. Adult tapeworms can live for up to
25 years.
Taenia solium
Pork tapeworm has a length of 2-3 m with 800-1000 segments. The head is globular, 1 mm in
with a short pigmented hook, so it is called armed tapeworm.
Lifecycle
Eggs and gravid segments are passed out in faeces on the ground. Cows, buffalos and pigs
ingest them. When they reach the small intestine of those animals, eggs rupture and release
ecospheres. With the help of their hooklets, they penetrate wall of intestine and enter the
portal vessels, right side of heart, lungs, and left side of heart and enter the general
circulation. From general circulation ecosphere are filtered out in striated muscles. There they
develop into larval stage (cysticercus). Human acquires infection by eating raw of
undercooked meat containing larval stage of tapeworm. The larva hatch into small intestine
of man and become mature and lay eggs. Eggs pass in the faeces of infected person along
with gravid segments of worm. Then the cycle is repeated.
Sign and symptoms
1. Most infection with adult worms is asymptomatic.
2. Some children may develop non specific complaints:
 Like nausea, abdominal pain & diarrhoea
 Insomnia
 Anorexia
 Weight loss
3. Small, flat, white pieces are found in the faeces.
4. Neurocysticercosis is the most common parasitic infection of CNS and may account
for as high as 20-50% of seizure.
Diagnosis
 Patient may pass motile segment of worms through anus.
 Perianal and stool examination to find out ova and parasites.
 CT, MRI, and /or ultrasonography can assist in determining the number, location,
extent and stage of the cysticercosis infestation and evaluating the surrounding
structure.
Management
 Detection of parasite e.g presence of eggs, worm segments, cysts is essential for
definitive therapy. In addition, management includes symptomatic related to
cysticercosis.
 Praziquantal in single dose of 10 mg/kg is the drug of choice.
 For neurocysticercosis, praziquantal 50mg/kg/day in 3 divided doses for 2 to 3 weeks
or albendazole 15 mg/kg day in three divided dose for 28 days can be administered.
 Symptomatic and supportive treatment for symptoms related to cysticercosis such
antiepiletics if presence of seizure
 Administer parenteral vitamin B-12 if evidence of vitamin-12 deficiency.
Prevention of Worm Infestation
1. Always wash hands and fingernails with soap and water before eating and handling
food and after toileting.

7. 2. Avoid placing fingers, pencil etc in mouth and biting nails.
3. Keep nails short and clean.
4. Ensure that prepared food and drinking water do not get contaminated through
unhygienic handling by a person carrying ova in the finger-nails.
5. Discourage children from scratching bare anal area.
6. Use superabsorbent disposable diapers to prevent leakage.
7. Change diapers as soon as soiled and dispose of diapers in closed receptacle out of
children's reach.
8. Do not rinse cloth or disposable diapers in toilet.
9. Disinfect toilet seats and diaper-changing areas; use dilute household bleach (10%
solution) or ammonia (Lysol) and wipe clean with paper towels.
10. Use safe drinking water with filtering and boiling or drink only treated water or
bottled water, especially if camping.
11. Wash all raw fruits and vegetables and food that have fallen on the floor.
12. Avoid growing foods in soil fertilized with human or untreated animal excreta.
13. Teach children to defecate only in a toilet, not on the ground.
14. Keep dogs and cats away from playgrounds and sandboxes.
15. Avoid swimming in pools frequented by diapered children.
16. Wear shoes outside. Avoid playing barefoot in the fields where the soil may be
contaminated with the ova of the hookworm. The ova of with hookworm enter
through the foot and enter the blood stream and grow into adult worms.
17. Ensure regular deworming
18. Consume meat that is well cooked
19. Change underclothes daily and keep bed linen clean.
20. Use of latrines should be encouraged instead of defecation in the open field
21. Treat all infected persons so that they don't continue to pass ova in the stool and act as
source of infection.
Nursing management
Nursing Assessment
 Assess the general condition of the patient.
 Assess the history of wearing open footwear and walking barefoot in such areas.
 Assess the food intake habit of patient.
 Observe the physical assessment of patient.
Nursing Diagnosis
 Acute pain related to mucosal irritation.
 Ineffective tissue perfusion related to blood loss.
 Impaired skin integrity related to persistent scratching of the affected area.
 Deficient knowledge related to the disease process and treatment.
Nursing Interventions
 Reduce or diminish pain.
Provide rest periods to promote relief, sleep, and relaxation; acknowledge reports
of pain immediately; get rid of additional sources of discomfort, and determine the
appropriate pain relief method.
 Improve tissue perfusion.
Submit patient to diagnostic tests as indicated; administer blood transfusion as
indicated.

8.  Protect skin integrity
Monitor site of impaired tissue integrity at least once daily for color changes,
redness, swelling, warmth, pain, or other signs of infection; provide skin care as
needed; keep a sterile dressing technique during wound care; clip the patient’s
nails as necessary; and teach patient and significant others about proper
handwashing, wound cleansing, dressing changes, and application of topical
medications.
 Enforce knowledge about the disease and its treatment
Determine priority of learning needs within the overall care plan; render physical
comfort for the patient; grant a calm and peaceful environment without
interruption; include the patient in creating the teaching plan; help the patient in
integrating information into daily life; and provide clear, thorough, and
understandable explanations and demonstrations.
Reference
 Uprety K, Child Health Nursing, fourth Edition (2071 Bhadra), Tara Books and
Stationery, Chhetrapati, Kathmandu, pg 149-151
 Shrestha T. Essential Child Health Nursing. first Edition 2015,August. Medhavi
Publication; Jamal, Kathmandu Page no.296-299
 Dahal K, Community Health Nursing –II. 5th
edition Makalu Publication House
Dillibajar, Kathmandu, Page no 92-100
 Paul VK, Bagga A, Ghai Essential Pediatrics, eight edition, CBS Publisher and
Distributors Pvt Ltd page 273 to 278
 Gupta B, Manual of basic science-II, Makalu publication, Dillibazar,
Kathmandu,page379-388.