INTESTINAL

HELMINTHIASIS
INTESTINAL HELMINTHS
Are worms that live in the
intestines and deprive their
hosts of essential nutrients,
leaving them malnourished and
tired.
Helminthiasis
A general term for any form of
disease that accompanies a helminth
(worm) infection
In most cases the onset and
severity of detectable morbidity
in a person related to the number
of worms present
Morbidity
Children are particularly vulnerable to
infection so they suffer the highest
intensity and therefore experience the
greatest morbidity.
Worms can lead to
impairment of mental and physical
development
make children too sick to attend or to
concentrate at school.
children persistently infected have
significantly lower literacy and earnings as
adults.
 •Overt morbidity (hidden sign)
•Presence of blood in the feces
•Anemia
•Chronic pain or fatigue
•Subtle morbidity
•such as stunted growth
•impeded school or work
performance
•increased susceptibility to other
diseases
•Morbidity control by treatment
Soil-transmitted Helminth Infections
(ascariasis, trichuriasis, hookworm infection)
The Disease
Caused by:
ingestion of eggs from
contaminated soil
(Ascaris and Trichuris) or
skin penetration by larvae
from the soil (hookworms)
Poor environmental sanitation
(open defecation) and poor
personal hygiene (dirty hands)
are major factors for exposure
People dirtying the environment
infect other people…
 Transmission of and exposure to worms

Heavy intensity Ascaris infection = passing out 10 million eggs per day!!!
Eggs remain viable in soil for about 2 years!!!
 Ingestion of worm eggs
from the soil in dirty hands
Entry of hookworm larvae through skin
Mechanical vectors like house flies
carrying worm eggs from the soil
TOILET not utilized (actual
photo in high prevalence
areas)
Actual photo of WS
in high prevalence
areas
SNAIL SITE
Transmission occurs here
• STH infections cause:
• Growth stunting (malnutrition)
• Decreased physical activity
• Poor mental and physical development
that affect school performance
(Easton, 1999)

• Heavy intensity STH infections result in

greater morbidity and complications including
intestinal obstruction, iron-deficiency anemia and
dysentery syndromes
(Bethony, 2006)
ABDOMINAL PAIN IS ONE OF TOP TWO CHIEF COMPLAINTS
OF PUPILS IN ELEMENTARY SCHOOL (DepEd)
Ascaris lumbricoides
GIANT ROUNDWORM

Trichuris trichiura
WHIPWORM

HOOKWORM
Ascaris lumbricoides
GIANT ROUNDWORM

Mouth part (trilobate)

Erratic Ascaris worms

in the liver
Trichuris trichiura
WHIPWORM
Trichuris worms in the colon

Trichuris worms causing

prolapse of the rectum
HOOKWORM

Necator americanus

Ancylostoma duodenale
Hookworm infection, causing chronic blood loss from the small intestine
leading to the development of iron deficiency anemia.
Diagnosis of Intestinal Helminth Infections

Microscopic helminth eggs in stool

indicate intestinal helminth infection/s
Integrated Helminth Control
Program (IHCP) launched
by the DOH in 2006 as
a response to the continuing
challenge posed by STH
infections

Targets:
Cumulative prevalence <50%
(Heavy intensity infections 0%)
Reasons for refusal to be dewormed:
targets for information and education
Lack of parent’s permit
Child has been dewormed
“Wala namang lumabas” (after last deworming)
“Side effects” (worm passing out through the
mouth, abdominal pain, etc.)
“May Pedia kami…”
“Sabi ng Pedia…”
“Umuulan”
“Bilog ang buwan”
 Basic Interventions
for Reducing Helminth Infections

Water and Sanitation Open defecation free (ODF) communities

Hygiene Education Hand washing (before eating)
Deworming Mass drug administration (MDA)
(WASHED)
Dosage and Estimated Effectiveness of Drugs
in Current Use in Intestinal Helminth Infections
(Based on Drugs Used in Parasitic Diseases, WHO, 1990)

Roundworm Whipworm Hookworm

Albendazole1 +++ ++ - +++ +++
(400 mg)
Levimasole1 (2.5 + ++ ++ - +++
mg/kg)
Mebendazole1 +++ ++ - +++2 ++ - +++2
(500 mg)
Pyrantel1 (10 +++ ++ - +++
mg/kg) Any role for antihistamine???
Safe, effective, candy flavored, chewable deworming tablets
MASS TREATMENT 2X/YEAR FOR PREVALENCE >50%
++++ Highly effective
1 In single dose
+++ Effective
2 The usual dose of mebendazole is 100 mg BID for 3 days.
++ Effective in light
A single dose of 500 mg seems less effective.
to moderate infections
Most important results of treatment
 Improved iron stores and hemoglobin
levels

 Improved growth

 Improved food intake

 Improved cognitive performance

 Reduced incidence of clinical

complications
Parasitologic assessment

Orientation of school children Stool specimen collection

Stool processing (Kato-Katz) Stool examination Quality control

Recommendations / action points
Improve access to clean water and sanitation
Hygiene education to reduce transmission (combined
WASHED)
Sanitation – Zero Open Defecation (ZOD)
Community-led total sanitation (CLTS)
Hygiene – Hand washing
 Thank you
Maraming salamat