Common Worm Infestations in Children Dr Nishant Verma

Common Worm Infestations in Children Dr Nishant Verma Department of Pediatrics

Burden of disease The 7 Most Common NTDs 1. Ascariasis 2. Hookworm 3. Lymphatic Filariasis Neglected Tropical Diseases (NTDs) are the most common diseases of the world’s poor. These diseases disable and debilitate one in six people worldwide, including half a billion children. 4. Onchocerciasis 5. Schistosomiasis 6. Trichuriasis 7. Trachoma

For just 50 cents, treatment can be provided to a person against seven NTDs for an entire year The 7 Most Common NTDs 1. Ascariasis 2. Hookworm 3. Lymphatic Filariasis 4. Onchocerciasis 5. Schistosomiasis 6. Trichuriasis 7. Trachoma

Helminthiasis Nematodes (Round Worms) Ascaris lumbricoides Enterobius vermicularis Hook worm Trichuris trichiura Brugia malayi Wuchereria bancrofti Trematodes (Flukes) Schistosoma Clonorchis Fasciola hepatica Cestodes (Tape worms) Taenia solium Taenia saginata Echinococcus Diphyllobothrium latum

Ascaris lumbricoides – Life cycle

Ascaris lumbricoides • C/F – Abdominal • Pain, distension, vomiting • Passage of worms in stool/vomitus • Obstruction – Pulmonary: Loeffler syndrome – Growth failure

Ascaris lumbricoides • Diagnosis – Eggs in stool sample – Worms in stool / vomitus – Imaging • Treatment • Albendazole 400 mg Once (Taken with food) • Other options • Mebendazole • Ivermectin • Nitazoxanide

Enterobius vermicularis (Pin Worm) • Peri-anal itching • More at night

Enterobius vermicularis (Pin Worm) • Diagnosis – Stool microsopy: not useful – Eggs can be demonstrated in peri anal swabs collected early morning – Sticky tape on a tongue depressor • Treatment • Albendazole 400 mg Once, repeat in 2 wk • Other options • Mebendazole • Pyrantel • Treat entire family

Hook worm Ancylostoma duodenale / Necator americanus

Hook worm • C/F – – Ground itch Abdominal pain, anorexia Iron deficiency anemia Hypoproteinemia • Dx – Stool microscopy – Peripheral smear • Treatment • Albendazole 400 mg Once • Other options • Mebendazole • Pyrantel • Oral Iron therapy

Filariasis Wuchereria bancrofti, Brugia malayi, B. timori

Filariasis • C/F – Most remain asymptomatic – IP: 8 -16 months – Episodes of Fever, lymphangitis, lymphadenitis – Last for 7 -10 d – 8 -10 episodes/yr – Tropical Pulmonary Eosinophilia – Chronic stage: Lymphatic obstruction • > 25 yr age • Lymphedema / Elephantiasis

Filariasis • Dx – Mf identified in thick blood film – Nocturnal periodicity – Adult worm in LN biopsy • Treatment • Di –Ethyl-Carbamazine (DEC) 6 mg/kg /day q 8 hr for 12 days • Other options • Single dose Ivermectin • Ivermectin + Albendazole • Prevention

Echinococcosis Alveolar Echinococcosis Cystic Echinococcosis Echinococcus granulosus, E. multilocularis

Echinococcosis • C/F – Site and mass effect of the cyst – Rupture: fever, anaphylaxis

Echinococcosis • Diagnosis – Imaging – Serology: Sensitive, not specific • Treatment • Surgical • Complete removal • USG/CT guided Percutaneous Aspiration, Instillation of hypertonic saline, Reaspiration (PAIR) • Medical • Albendazole 15 mg/kg/day for 2 wk • May require repeated courses • Monitor by serial USG

Taeniasis Taenia saginata Beef Tapeworm Pork Tapeworm Taenia solium

Taeniasis

Taeniasis • C/F – Mild epigastric discomfort, nausea, flatulence, diarrhea • Dx – Microscopic identification of eggs and proglottids in feces • Treatment • Praziquantel 5 -10 mg/kg single dose • Alternative option • Niclosamide 50 mg/kg single dose

Cysticercosis

Cysticercosis

Cysticercosis

Neurocysticercosis • C/F – Depends on site and number of cysts – Seizures, headache – Cysticercal encephalitis • Dx – Neuroimaging – Diff from tuberculoma

Neurocysticercosis • Treatment – Anticonvulsants – Albendazole • If active lesions on imaging • 15 mg/kg/day for 7 -28 days • Adjunctive steroids – Relative C/I for albendazole • Intraocular cysts • Intraventricular cysts • Spinal cysts • Prevention