SUMMARY AND EXPLANATION CPHM

1. Background about STH

I. What is STH?
 Soil-transmitted helminthiasis refer to the intestinal worms infecting humans that are
transmitted through contaminated soil, and caused by different species of parasitic
worms.
 STHs infections are among the most common infections worldwide with an estimated
1.5 billion infected people or 24% of the worlds population.
 It is found mainly in area with warm and moist climates
 STHs are considered "Neglected tropical diseases (NTDs)"
 It is the highest prevalence reported from Sub-Saharan Africa, China, South America and
Asia.

EXPLANATION: Soil transmitted helminths (STH), ay tungkol sa parasitic worms na makikita sa soil (Lupa)
which are contaminated through eggs. STH has infected about 1.5 billion people in the world that is
about ¼ population in the world. Mostly prevalent siya sa mga tropical and subtropical regions especially
sa mga warm and moist climates. Commonly nag s-spread ang STH sa mga poor or unsanitary regions na
kung saan prone sa bacteria and can come in contact from stools na may contaminated eggs from an STH
infected individual. Kaya STH’s are considered as the ‘’Neglected Tropical Diseases” kasi mostly nakaka-
affect nga siya sa mga populations with poor communities or those that live in poverty na pwede mag
result ng pag neglect or lack of focus ng global health efforts. Despite sa pag increase ng prevalence at ng
morbidity nito.

II. Transmission

EXPLANATION: Saan ba nagsisimula ang transmission for STH, the transmission starts through the eggs
that are passed to the feces sa taong infected. The transmission of the feces with the contaminated egg
should take place sa soil (Lupa), which would make the egg strive and grow into a parasitic worm. It
commonly takes about a few weeks para mag grow ang egg into a larvae. Meron three main types of
parasitic worms in STH which is the: Roundworms (Ascaris Lumbricoides), Whipworms (Trichuris
Trichuria), Hookworms (Necator americanus and ancylostoma duodenale). These worms can either
enter sa small or large intestine. Yung round worms and whip worms sila yung types of worms na would
need to turn into an infected form such as a larvae. Yung hookworm pupunta muna siya sa blood sa
heart and lungs tyaka siya pupunta sa small intestine. (Blood > Heart> Lungs> Small intestine). While
round worms magiging larvae muna siya bago siya makapunta sa blood, heart, lungs then the small
intestine. (larvae>blood>heart>lungs>small intestine). At yung whipworms naman pagka turn niya as a
larvae pwede na siya dumeretso sa small intestine.

Sa transmission, there are many ways para ma-infect sa STH:

 Enter through the mouth (vegetables enter the mouth uncooked or unwashed)
 Contaminated water
 When people’s hands are contaminated by the soil and not washed before eating
 When the larvae is formed pwede siya mag stick sa paa when you walk barefoot
 III. Types of worms
 Ascaris lumbricoids – Common parasitic worm in humans. This type of parasitic worm
can be asymptomatic kaya it could be harmful and can continue to grow multiple eggs
inside the human body for years. Symptoms could be as vague as presenting only
abdominal pain, nausea, vomiting, bloating and diarrhea.
 Trichuris Trichiura (Whipworm) - It is a common infection that mainly affects children.
Children may become infected if they swallow soil contaminated with whipworm eggs.
When the eggs hatch inside the body, the whipworm sticks inside the wall of the large
intestine
 Ancylostoma Duodenale – or hookworm, siya lng naiiba from the other two worms kasi
siya lng yung parasitic worm na hindi mag eevolve as larvae.

IV. Symptoms
 People with infections of light intensity (few worms) usually do not suffer from the
infection or No symptoms
 Heavier infection can cause a range of symptoms including:
 Intestinal manifestations (diarrhea and abdominal pain)
 Malnutrition
 General malaise
 weakness
 Impaired growth
 physical development

EXPLANATION: There are several types ng symptoms for STH, and mostly sa mga tao na infected ng
onting parasitic worms lng can be asymptomatic or pwede maging vague lang yung symptoms. While
people infected with many manifestations of inside worms sa katawan can suffer from (anemia, loss of
protein, reduced nutrient, absorption, malnutritiom). Which can lead to impaired physical and mental
development and reduced productivity to children.

2. Infective stage

 The infective stage occurs when the eggs of the parasites are passed in the stool of an
infected individual and contaminate the soil. The eggs then hatch into larvae, which can
survive in the soil for several weeks or months and can infect humans when they come into
contact with contaminated soil. Infective stage ng STH is the stage kung saan yung larvae ay
nag develop na from the parasites present sa soil, na pwede na maka infect and mag
spread ng sickness when they come in contact with the contaminated soil.

3. Diagnostic stage
 Infection with STH can be readily diagnosed by detection of helminth eggs in stool samples
using microscopic techniques. The most widely used approach is the Kato-Katz technique,
which is also recommended by the World Health Organization (link is external). However, a
range of methods, including direct microscopy, formol-ether concentration (FEC),
McMaster, FLOTAC, and Mini-FLOTAC, are available and used in the field. All copro-
microscopic methods have variable performance and similar drawbacks, such as low
sensitivity for the detection of light-intensity infection. Sensitivity can be increased by
 examining multiple slides prepared from the same stool sample or, better yet, from
multiple stool samples.

EXPLANATION: The diagnostic stage ng Soil transmitted helminths (STH) ay yung microscopic and
macroscopic identification ng mga eggs or larvae na nakita sa stool sample ng isang infected individual or
positive to have the illness of STH. There are several microscopic and macroscopic techniques in order to
identify if a person is infected. And most commonly known technique daw po ay yung Kato-Katz
technique. The kato-katz technique po has a type of procedure which follows:

 Take a type of scrap paper/filter paper

 And using an applicator stick, take the stool sample and place on the paper
 Then strain the stool sample using a piece of wire screen to remove the particulate
material
 Then place a glass slide with a small square carboard that has a hole in the middle
 Afterwards use a wooden stick and scrap the stool that has been screened
 Fill the screened tool into a hole made in the center of the cardboard
 Repeat the step until the hole is filled
 Take out the cardboard
 Cover the stool with piece of cellophane which has been soaked in a mixture of malachite
green and glycerin, the slide would appear visible eggs and after 30-60 mts. hookworm
eggs would start to disappear.

Other types of lab tests:

 Fecal Examination: Fecal examination or Stool Analysis is a series of tests done on a stool

EXPLANATION: Fecal examinations and kato-katz are two of the most commonly used tests para
madetect ang presence ng parasitic worms. These are both tests used to determine stool samples pero
they differ in certain aspects. Such as yung fecal examinations are more specific sa pag identify kung
anong type of parasitic worms ang nakuha. Fecal examinations are used with a small amount of sample
while kato-katz need na specific yung amount and it is measured to prepare a fixed amount of sample for
examination. Fecal can be performed quickly while yung kato-katz technique requires more time and
preparation. Mas expensive ang kato-katz than fecal due to its specialized equipment and materials.

https://www.youtube.com/watch?v=QMDBbh5WgQw

 Molecular method testing - Laboratory method that uses a sample of tissue, blood, or
other body fluid to check for certain genes, proteins, or other molecules that may be a
sign of a disease or condition.

EXPLANATION: Molecular method testing can also be used to detect presence ng parasitic worms gamit
ang Polymerase chain reaction (PRC) na commonly used for molecular method in clinical and research
settings. PCR can be able to detect DNA sequences ng patient gamit ang blood, stool or tissue samples.
PCR can be able to detect even low levels of parasite DNA. Ang kinaibahan niya from other laboratory
tests ay kaya niya madetect even smallest presence of parasitic worms and can be taken by blood other
than the other tests na stools sila nag fofocus.
  Direct Microscopic examination of feces - Detect parasitic elements such as the larvae of
Strongyloides stercoralis which are motile.

EXPLANATION: Direct microscopic examination of feces is almost the same method as fecal examination
pero mas short ang procedure and the stool sample is directly placed and observed sa microscope while
the fecal examination includes more techniques and procedures.

 Formalin-ether concentration technique - It is widely used sedimentation technique for

the diagnosis of intestinal protozoa in preserved stool samples.

EXPLANATION: Formalin ether concentration technique is also used by stool samples but mixed with
formalin ether solutions, para mag separate ang parasitic worms from fecal materials. Sa technique na
‘to magiging mas visible ang parasites sa microscope. Ang pinagkaibahan nila from fecal examinations ay
fecal are used for broad detection of illnesses and encompasses different methods para mag analyze ng
stool samples. While yung FECT are specifically used method for the detection of intestinal parasites
only. This method is very specific and sensitive kaya isa din siya sa mga preferred method and procedures
na ginagamit for STH,

4. Prevention and control

 The WHO recommends periodic medicinal treatment like deworming and preventive
chemotherapy, without previous individual diagnosis to all at-risk people living in endemic
area s. The intervention reduces morbidity by reducing the worm burden.
 Deworming can be easily integrated with child health days or vitamin A supplementation
programs for preschool children, Human Papilloma Vaccine (HPV) program for adolescent
girls or integrated with school health programs.

EXPLANATION: To prevent the illness STH would be effective medications or sometimes surgery needed.
but WHO recommended deworming as one of the most effective medicinal treatments especially to
children. WHO can follow a program integrated sa mga pre-school children since they are more prone to
the illness than adults. There are also long term preventive methods that could be effective such as
improving sanitation in the community, clean uncontaminated water, and practice to take care of your
personal hygiene like handwashing and avoid walking barefoot.

5. Medications

In accordance with the WHO, the recommended drugs or treatment for use in public health
interventions , which are drugs specially designed to eliminate parasitic worms or to control STH
infections are:

 Albendazole (400mg) tablets given in a single dose, reduced to 200mg for children
between 12 and 14 months. It is effective against all major types of STH.
 Levamisole (40mg) tablets given in a single dose by weight (2.5 mg/kg). The drug
levamisole at a dose of 80mg has been successfully used in primary school-age children.
 Mebendazole (500mg) tablets given in a single dose of 100 mg twice daily for three
consecutive days.
  Pyrantel pamoate (250mg) tablets given in a single dose by weight (10mg/kg). A combined
preparation of pyrantel-oxantel has been proved to be more effective than pyrantel alone
in treating T. trichiura infection.

6. Removal of ascaris – just incase na maraming parasites na nag manifest sa intestine ng infected
kailangan ng surgery.