Worm Infestation (Intestinal)

Infestation with worms is very common. Poor hygiene or contact of bare skin with soil in which the worm or its eggs live predisposes individuals to infestation.

Cause

Hookworm
Ascaris
Strongyloides
Tape worm
Thread worm
Whip worm

Symptoms

Generalised Itching
Perianal itching (threadworm)
Dry cough (when the larvae pass through the lungs)
Wheeze (when the larvae pass through the lungs)
Abdominal discomfort and or pain
Easy fatiguability
Passage of worm(s) in the stool
Altered bowel habit
Vomiting of worms

Signs

Pallor
Features of malnutrition
Poor physical growth in children
Large distended abdomen in children
Wheezing

Investigations

Stool for routine examination
FBC

TreatmentTreatment Objectives

To eliminate the worms
To treat the complications of infestation e.g. anaemia, malnutrition
To ensure proper sanitation

Non-pharmacological treatment

Ensure proper nutrition
Proper hand washing with soap and running water

Pharmacological treatment

Pharmacological treatment of Worm Infestations
Worm	Treatment	Note	Evidence Rating
Hookworm	Mebendazole, oral Adults 500 mg as single dose Or 100 mg 12 hourly for 3 days Children > 12 months 100 mg 12 hourly for 3 days Or	Not recommended for children below 12 months and in pregnant women	B
Hookworm	Albendazole, oral Adults and children > 12 months 400 mg as a single dose Children below 12 months 200mg as a single dose	Not recommended during pregnancy	B
Ascaris	Mebendazole, oral Adults and children above 12 months; 100 mg 12 hourly for 3 days Or 500 mg as single dose Or	Not recommended for children below 12 months and in pregnant women	A
Ascaris	Albendazole, oral Adults and children above 12 months 400 mg as a single dose Children below 12 months 200 mg as a single dose	Not recommended during pregnancy
Whipworm	Mebendazole, oral Adults and children above 12 months 100 mg 12 hourly for 3 days Or 500 mg as single dose Or	Not recommended for children below 12 months and in pregnant women	B
Whipworm	Albendazole, oral Adults and Children above 12 months 400 mg as a single dose Children below 12 months 200 mg as a single dose	Not recommended during pregnancy
Threadworm	Mebendazole, oral Adults and children above 12 months 100 mg 12 hourly for 3 days Or 500 mg as single dose Or	Not recommended for children below 12 months and in pregnant women. Repeat treatment after 3 weeks	C
Threadworm	Albendazole, oral Adults and Children above 12 months 400 mg as a single dose Children below 12 months 200 mg as a single dose	Not recommended during pregnancy. Repeat treatment after 3 weeks
Strongyloides	Albendazole, oral Adults and Children above 12 months 400 mg 12 hourly for 3 days Children below 12 months 200 mg 12 hourly for 3 days Or Tiabendazole (Thiabendazole), oral Adults 1.5 g 12 hourly for 3 days Children 25 mg/kg 12 hourly for 3 days	Not recommended during pregnancy Repeat treatment after three weeks. Alternatively, a 7-days treatment without repeat is acceptable. Ivermectin is the drug of choice but has the danger of precipitating life-threatening encephalopathy in microfilaria endemic areas.	B
Tapeworm	Praziquantel, oral, Adults and children 5-10 mg/kg as a single dose. (25 mg/kg as a single dose for Hymenolepis nana; repeated in 10 days) Or	Taken after a light breakfast	C
Tapeworm	Niclosamide, oral, Adults and children above 6 years 2g as a single dose Children < 2 years 500 mg as a single dose 2-6 years 1 g as a single dose Chew tablets 2 hours before a meal		C

Referral Criteria

Refer patients with intestinal obstruction from a heavy load of suspected worm infestation to a surgical specialist.