Soil transmitted helminths

Dr. Madhusudan Swarnkar

Professor, Community Medicine,
JMC, Jhalawar

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Introduction
 Helminths are so called because they possess a “helmia” or
body cavity.
 Helminths affect human health in all parts of the world.
 They differ markedly in their geographical distribution,
prevalence rates and pathogenicity.
 They require special conditions for survival and
transmission.
 The prevalence of helminthic infections is an index of the
level of sanitation in the community.
 Prevention of water, food and soil pollution, with personal
hygiene, will eliminate all helminths
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Soil transmitted helminths(Geohelminths):

 These helminths have a wide distribution and high prevalence.

 Their infective stages develop in the soil.

 Eggs or larvae become infective after a period of incubation in

soil

 The group includes ascaris(roundworm), whipworm,

hookworm and strongyloides.

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 ASCARIS
 Roundworm infestation is
the most common and
most widespread worm
infestation in all tropical
countries,

 It is also most common

intestinal parasite of man.

 Possibly one out of every

4 people in the world is
infected.
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ASCARIASISLUMBRICOIDES (Roundworm)

 The worm is found in any area of the world where there

is no proper disposal of nightsoil and people having poor
hygienic habits.

 transmitted feco-orally through the soil,

 common among children,

 affecting the nutritional status, growth and development

and often causing intestinal obstruction.

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Life cycle
 The adult worm is cylindrical, resembling earth-
worm, lives in upper portion of small intestine.
 It is light brown in color, Life span is one year.
 The female worm lays about 2 lakhs eggs everyday,
 The eggs are elliptical in shape.
 Fertilized eggs-float in saturated salt solution while
Unfertilized eggs-does not float
 The eggs are passed in feces & develop into rhabditiform
larvae in the soil within about 10 to 40 days and become
infective.
 These embroynated eggs can remain viable in soil for many
years under favorable conditions.
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 Life Cycle

 Children while playing in the contaminated soil ingest the

embryonated eggs which pass into the duodenum
where eggshell splits and larvae come out in the intestine
pierce the intestinal wall enter portal circulation and
reach the lungs, passing from pulmonary capillaries to
alveoli and, thence, to bronchi, trachea, esophagus and small
intestine.

 They reach the duodenum, moult once again and grow into
adult males and females in about 10 weeks.

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Host Factors:
 Age incidence:
 It is maximum among children of 2 to 10 years age.
 Sex incidence:
 It is equal in both boys and girls.
 Reservoir
 Human being is the only reservoir of infection.

 Biological incubation period

 from passage of eggs in stools to the development of adults in the
intestine, is 2 to 3 months.

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Mode of Transmission
 It is mainly by feco-oral route, through the contaminated soil,
which is usual among children while playing in the soil.
 The eggs can also be ingested through raw vegetables
cultivated in a sewage irrigated area.
 It is also common among children who develop perversion
of eating mud (pica).
 The infestation can also occur by drinking fecal
contaminated water.
 Insanitary habits, poor food hygiene and repeated
contamination of soil and water by human excreta are
favoring factors for spread.
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 CLINICAL FEATURES
 There are no specific symptoms.
 Children, especially preschoolers, are infected more than
infants and older children, Incidence falls after 15 years of age.

 Urticaria and eosinophilia may occur d/t allergy to larvae and

adults.(The body fluid of the worm contains a substance,
ascaron or ascarase, (protein) which is allergic to man)

 Ascaris infection contributes to malnutrition in children.

 intestinal obstruction is the more common cause of

laparotomy in children, In areas with high prevalence of
ascariasis.
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CONTROL MEASURES
 3 approaches to control ascariasis :
 Treatment of the infected population by piperazine, pyrantel
or mebendazole.
 Measures to prevent environmental contamination with
human feces.
 Education of the public in personal hygiene.
 In the most successful programs, all three measures have
been undertaken simultaneously.
 A unique example of successful control is Japan, where the
prevalence has decreased from 70 % in 1950 to 0.09 % in
1979.
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 Hookworm

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 Hookworm
 Hookworm infection is largely caused by Ankylostoma
duodenale in India.
 Necator americanus infection is common in South India.

 The worms are attached to intestines and cause GI symptoms

like distension and epigastric discomfort.

 Progressive anemia of hypochromic microcytic type due to

sucking of blood by worms is the more common symptom.
 The tendency for anemia is exacerbated b/c worms keep on
shifting in the intestine, leaving behind bleeding points or open
wounds.
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Hookworm
 One-fourth of the world population harbours hookworms.

 It is present in all states in India, the prevalence varying in

different districts depending upon soil, moisture and humidity.

 Soils that retain moisture are very suitable.

 Dry, hot and saline lands are unfavourable.

 presence of more than 500 worms is necessary to produce

anemia.

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 LIFE CYCLE
 The adult worms attach themselves
to the mucous membrane of the
small intestine.
 They are most common in jejunum
> duodenum & rare in ileum.
 The male female ratio is 1:3.
 The eggs are characteristically segmented.
 A rhabditiform larva comes out of the egg in 24 to 48 hours
under favorable soil conditions.
 In another 2 to 5 days, it develops into filariform or infective
larva which is thinner & longer and can survive in soil for year.
 Its usual life is 3 weeks to 2 years.
 It dies in dry soil and sun but lives long in the shade.
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 Life Cycle….

 The filariform larva in soil enters the bare

skin of feet, legs or, sometimes hands.
 It may cause local itch known as ground itch.
 It enters the lymphatics and the blood stream,
reaches the lung capillaries and pierces into
the alveoli of lungs.
 From there it goes to bronchi, trachea and
oropharynx, gets swallowed and reaches the
stomach.
 The larvae develop into adults in the
intestine.
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Life Cycle….

 The life of the adult worm is uncertain but long.

 Frequently, reinfection maintains the infestation.

 Infection may sometimes occur by oral route when

infected larvae are ingested with polluted water,
vegetables or food and pierce through the mucous
membrane of the intestine to complete the biological
cycle.

 Eggs appear in stools 6 to 7 weeks

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 CONTROL MEASURES

 Use of latrines and sanitary disposal of excreta so as to

prevent soil pollution.

 People in endemic zones should wear shoes and should not

wash hands with earth.

 Health education

 Mass treatment with mebendazole or pyrantel pamoate in

areas with high prevalence.

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TRICHURIS TRICHIURA (WHIPWORM)

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TRICHURIS TRICHIURA (WHIPWORM)
 It is prevalent worldwide and, like roundworm and
hookworm, infects nearly 1/4th of the world population.

 As in case of ascaris, the eggs are passed in stools, become

infective in 3 to 4 weeks as the larva develops, and are
swallowed with soil, polluted water, food or vegetables or
through soiled fingers.

 On reaching the intestine, the larva is liberated from the egg

and develops into an adult worm in about a week’s time.

 The worm is 3 to 4 cm long and looks like a

whip, with a coiled handle and a thread.
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 Dracunculus Medinensis
(Guinea Worm)
 Guinea worm is a tissue roundworm.

 The infection with this worm is called dracontiasis.

 It occurs in those villages where water supply is from

stepwells, tanks or ponds.

 There has been a natural decline in incidence of this

disease in India during the last 25 years.

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22 10:13
OCCURRENCE
 In India, the last reported case was in July 1996.
 The VIth Independent Evaluation Program conducted in Jan.
1998 has validated the reported zero guinea worm status in
India and absence of disease transmission.
 After three years of zero incidence, India was declared free of
guineaworm disease in 1999.
 WHO has certified in February, 2000 that guinea worm
infection has been eradicated from India.
 At present only 30 cases reported(2017) from 2 countries
Ethopia and Chad only
 Guinea worm is well on its way to global eradication.

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LIFE CYCLE AND MODE OF SPREAD
 The female worm is thread-like,
about 0.4 mm thick and about
one meter long.
 The male dies after copulation
in the intestine.
 The female worm then passes
through connective tissues and
makes its way to the skin of
hanging parts such as leg, foot,
breast and testes.
 It may be seen as a wavy band
under the skin.
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Life Cycle….

 A blister develops on the skin and the uterine end of the

worm appears in the blister, most often on the skin of foot.

 The patient gets a soothing feeling when the blister is

dipped in water.

 When the patients puts his foot in the stepwell or tank

water, the blister, along with the uterus containing the
larvae, bursts and the larvae escape into the water.

 The larva may survive in water up to 16 weeks.

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Life Cycle….
 If there are cyclops (water flea) in the
water, the larvae are swallowed by them.

 The cyclop acts as an intermediate host and

is swallowed by man along with water.

 The cyclop is digested and the infective larva is liberated

in the stomach.

 It passes into the intestine where it develops into adult

male or female, thus completing the life cycle or biological
incubation period.
 The total cycle takes about one year.
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Reservoir of Infection
 It is an infected person harboring a gravid female parasite
(worm). There is no carrier state.

Incubation Period
 Intrinsic incubation period in human being is about one
year and the extrinsic incubation period in the cyclops is
about 3 to 4 weeks (i.e. the period required by the
embryos to grow into larvae in the body of cyclops).

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Host Factors
Age and Sex:

 It is common among adults of both the sexes.

 Males are frequently affected than females.

Social factors:

 Poverty, illiteracy and the traditional dependence of the

people on step wells are important factors in the
epidemiology of this disease.

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Environmental Factors
 Since the disease is linked with contact with water containing
cyclops, the access to water occurs as in step-wells, cisterns,
ponds and small tanks, which is common in rural areas.

 The access to water occurs during washing of feet, taking

bath or to collect the water for drinking.
 This gives an outlet for the embryo to enter water.
 The cyclops takes up them.

 The incidence used to be high during summer, because the

quantity of water becomes less with consequent increase in
concentration of cyclops.
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Pathogenic Effects and Clinical Features
 The symptoms are manifested during parturition of the
female worm and are due to liberation of a toxic substance
causing blister and allergic manifestation such as itching and
burning.

 The blister later bursts open to form an ulcer often

followed by secondary infection.

 If the worm gets trauma while coming out or while it is

removed, severe tissue reaction can occur.

 If worm goes deep inside can result in arthralgia and

arthritis.
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Prevention and Control
 Breaking the link of the chain (Man– Cyclops-Man) by the
following measures.
 Treatment of the infected person with a strict instruction
not to enter water-body like step-wells or ponds. This
prevents the contamination of the water.
 Disinfection (Chlorination) of water for the eradication of
cyclops.
 Drinking the water, which is either strained, filtered or
boiled at house-hold level.
 Conversion of step-wells into sanitary wells.
 Health education of patients and the people.
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Thank you
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 Enterobius Vermicularis
Threadworm or Pinworm
 The infection, called enterobiasis or oxyuriasis, is found worldwide and
is more common in children.
 The male is a quarter cm long and dies after copulation.
 The adult female is one cm long with a thick anterior end like a pin
head, tapering at the back.
 Eggs have a thick, clear, double walled shell.
 The female comes out of the anus onto the perineum of the host to
lay eggs.
 This process causes irritation and itching, causing an urge to scratch
the perineum.
 The eggs are rarely seen in stools.
 The larva develops within a few hours of egg laying.
 After the eggs are swallowed, the larvae are liberated in the small
intestine and develop into adults in about ten days.
 The lifespan of the adult is 2 to 4 weeks.
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 MODE OF TRANSMISSION
 It is of two types:
 1. The child scratches the perineum because of irritation and his
nails become infected with eggs, leading to infection of others
through fecal-oral route as also to autoinfection.
 Thus infection with threadworm may persist for years.
 2. Dust-borne infection may occur in heavily infected households
and institutions for children.
 After coming out of the anus, the worm may enter the genital
tract in women, leading to peritonitis.
Control measures:
 Nails should be kept short and clean.
 Hands should be washed before meals and after going to toilet.
 All members of the family should be treated at the same time.
 Pyrvinium pamoate, pyrantel pamoate,mebendazole and
piperazine are effective drugs.
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