Helminthiasis (worm infestation)

Worm infections are found worldwide, although in warmer moister areas, especially where standards of hygiene are low, the prevalence is greater. In such areas infection with more than one variety is the rule. One billion children in the world are said to be affected. It is commoner in children than in adults because they tend to live closely with nature and with their pets. Worm infections are not necessarily confined to the tropical poor countries and the increase of travel and refugee movements in recent years has led to an increasing awareness in the industrialized world of the dangers of 'imported' diseases.

Worm infections differ in most cases from other micro-organisms in that the clinical effects exhibited by the host are mostly related to the worm load carried and the latter in turn is usually related to the degree of infection. The following principles are utilized either alone or in combination depending on the species to control worm infection.
1.Treatment of infected persons
2. Control of animal reservoirs
3. Hygiene, which includes education and provision of adequate and acceptable toilet facilities
4. Control of carriers
5. The wearing of shoes where infection occurs from the soil through the skin
6. Instruction in food preparation and cooking
7. Improved personal hygiene.

Round Worm (Ascariasis)

It thrives in moist climate and condition of over-crowding. They live in the small intestine. The gravid female lays 200,000 eggs a day and the newly excreted eggs remain dormant out of the body for a long period. If conditions are favourable they develop into an infective stage in two weeks in which condition they remain viable for months or years. The hosts of these worms are humans.

In 80% of cases, the only manifestation in man is asymptomatic passage of eggs and adult worms in the stool. Symptoms are due to invasion of larvae, presence of a large adult worm load or migration of adult worm from the normal habitat. The initial migration into the lungs causes a dry persistent cough, with tweezing and breathlessness. There may be fever with abdominal pain and urticarial rashes. Presence of a few worms in the infestine of a child does not produce symptoms in a child.

A large worm load will take away the nutrition from the child and also digestion and absorption of sugar. In a heavy infection the mass of worms can be felt to the hand can cause intestinal obstruction.

Hook Worm (Necator Americamus)

Hook worm sucks blood from the intestinal wall and is a very common cause of anaemia. The worm lives in the intestine and lays eggs which are excreted in damp shady conditions and hatch out in about two days, liberating the larva. The larva penetrates the skin and enters the instestine after traversing through the lungs. There may be abdominal discomfort especially after meals, loss of apppetite, debility and tiredness. The children are stunted, mal nourished and anaemic.

Thread Worm (Enterobius)

It is common in highly populated areas, institutional groups and members of the same family. The absence of developmental stage outside man favours reinfection and transmission from child to child. Thread worm generally causes no symptoms it produces characteristic scratching or the perianal area due to the migration of worms from the intestine where eggs are deposited. Hands are contaminated by scratching the perianal area and by contact with soiled underclothing, night clothing and bedding.

Infection is also acquired by inhalation of dust containing the eggs. The child is restless, nightmares, grinding of teeth and perhaps bed wetting occur. In about 20% of girls vulval irritation and vaginal discharge occurs. Nail biting, nose picking, masturbation and other behavioural changes have been wrongly attributed to thread worm infection. In general treatment for most cases is unnecessary especially as re-infection inevitably occur. However if treatment is given the whole family should be treated.

Whip Worm (Trichuris Trichiura)

The infection is often asymptomatic but should not be underrated as a disease in humans. Heavy infection can cause abdominal pain, bloody diarrhea may occur with pain around the anal orifice. Excessive loads can cause anaemia and weight loss. Prolapse of the rectum is a well known complication.

Filariasis (Wuchereria Bancrofti and Brugia Malyi)

It is transmitted by a mosquito. First infection may occur in children but the full clinical picture takes many years to develop. As with other filarial diseases, the early phase may be entirely asymptomatic or associated with alergic manifestations. The commonest manifestation is the acute and recurring inflammation of lymph nodes and their vessels where the lymphatic fluid flows usually in the groin where the vessels are thickened and cord like. The lymph nodes are painful. It is associated with fever, malaise, nausea and headache. The attacks which subside after several days have a variable periodicity of weeks or months, gradually becoming less severe, often persisting of residual swellings under the skin. Fluid may collect in the abdomen. Large lower limbs like elephant legs are now rarely seen.

Tropical Eosinophilia Syndrome

In some patients, an abnormal response to Wuchereria Bancrofti infections results with a clinical picture reflecting a spesific allergic sensitization to filarial worms. These patients present symptoms of a cough, asthma like symptoms, respiratory distress and eosinphil count 3000/ cu.mm or greater with X-ray changes in the lung.

Melioidosis

It is an infection by a bacteria now been recognised in our country which can have serious consequences. This is an organism found in the soil and surface water, is widely distributed. Infection follows inhalation or direct inoculation. Most of the patients have predisposing disease like diabetes. It may be sudden or a long drawn out illness. The most serious form is a generalized disease with multiple abscesses that is frequently fatal.

Amoebiasis

This is caused by a ptotozoan. It is transmitted by contaminated food or water. Or spread directly by person to person contact. Many carry it without symptoms. The usual course is a long drawn out illness with mild intermittent diarrhea and abdominal discomfort. It may progress to bloody diarrhoea and accompanied with headache, nausea. The liver can get affected with tender swollen liver with high fever and toxicity.