Worm infestations constitute an important health problem, especially in the children. Worm infestations are generally not noticed but can sometimes lead to significant problems, which affect many organ systems. Most of these are a result of unsanitary living conditions and poor food preparation. In countries like India, these constitute an important public health problem because infestation by hookworms is the cause of anemia in a significant number of children

A wide variety of worms infest humans, these range from half-inch pinworms to tape worms as long as 30 feet. The more important among them are the pinworms, the roundworms, and the hookworms.

Most (not all) of the worms live in the intestines and generally don't cause prominent symptoms unless they penetrate the intestinal wall and move to another part of the body. Any worm infestation can lead to respiratory or cardiovascular complications.

Pinworms:
These are very small worms, the size of about 2-4 mm, white in color and generally seen in clumps. It is characterized by the intense itching it produces in the anal area. Pinworms live in people's lower intestinal tracts. The female worm leaves the anus to deposit eggs in the anal area at night and induces severe itching. The consequent scratching transfers the eggs to the host's fingers. If inadvertently eaten, the eggs reach the intestines - hatch in the intestines and thus the cycle continues.

Roundworms causing Ascariasis:
Roundworms constitute a major public health problem. It is estimated that upto 1/4th of the world's population is infected with roundworms. It lives in the small intestine, lays enormous quantities of eggs that are excreted in the feces. The eggs remain viable for a long time in the soil and can enter the body in unwashed or raw food. Foods that are eaten raw like salads and vegetables readily transmit the infection. Children playing in soil can also pick up infection.

Hookworms:
It has been estimated that more than 200 million people are infected in India alone. Hookworms enter the body through skin, commonly through bare feet. It may also be acquired by food also.

The larvae migrate to the small intestine, where they may live for several years taking nutrients from the intestinal walls. Hookworm infection causes chronic blood loss and depletion of body's Iron stores leading to Iron deficiency anemia. This can lead to retarded growth; Low Birth Weight babies (if the mother is infected). Their eggs are excreted in feces; if the infested feces contaminate soil, the cycle is repeated.

Symptoms
Apart from the characteristic itching in the anal area produced by pinworm infection most of the symptoms of worm infection are non characteristic. These include:

• Anemia
• Diarrhea
• Nausea, vomiting
• Changes in appetite and fatigue
• Wheezing, coughing or other breathing difficulties.

Diagnosis
Most of the worms can be diagnosed from stool samples, which demonstrate their eggs/cysts. Pinworms can be diagnosed by using a piece of sticky tape to pick up any eggs that may be around the anal area; the tape is then checked under a microscope. The worm itself is sometimes visible in stool samples or around the anus.

Treatment
Most worms, thankfully, can be treated with a wide variety of available medicines effectively. Medicines commonly used include Mebendazole, Albendazole, Piperazine and Pyrantel.

The treatment is usually repeated after two weeks to ensure removal of the worms and their eggs.

Prevention

• Make sure children always wash their hands after going to the bathroom and before eating.
• Keep fingernails short to reduce the chances of picking up worm eggs underneath them.
• Wash all the vegetables, fruits thoroughly before eating raw.
• Meat, especially pork should be thoroughly cooked before eating.
• Ensure that children don't play barefoot in soil.

Suggested Reading -
Childhood infections - pneumonia to pink eye - Childhood brings with it many common infections and illnesses. Get practical tips on how to recognize and handle there.

Pinworms - Pinworms are a common problem, which can be very distressing to the affected child. A little hygiene will go a long way in preventing it.

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