Intestinal worms are one of the most common complaints that we see in the general community. Along with the all other things conjured up in the vision of the tropical lifestyle, intestinal worms are one of the less glamorous aspects to consider. Some intestinal invaders (or “nematodes”), have little or no effect on their host. Basically they are just there for the free ride. Others, however, have the ability to damage the intestinal wall causing a myriad of unpleasant symptoms such as :
-Diarrhea or constipation.
-Flatulence (or gas).
-Abdominal pain.
-Poor appetite or excessive appetite.
-Nausea.
-Anemia.
-Lethargy (tired all the time).
-Anal pruritis (itching).
-Cough.
What are intestinal worms?
Intestinal worms come in a large variety, the most common of which we will deal with in this brief article.
Pinworm (Oxyuriasis)
This is most common worm affecting children. On average 20% of children are affected, some populations exhibit up to 90% infestation. Cross infection usually results from finger transfer of eggs from the anal area to clothing, bedding or toys, from which the eggs are picked up by the next person, transmitted to the mouth and swallowed. Apart from troublesome anal itching, pinworm infestation is usually asymptomatic. Diagnosis can be made by examining the anal region of a child 1 – 2 hours after the child has been put to bed. The female pinworm, which is about 5-10 mm in length, can be clearly seen at the anal orifice. Failing this, sticky taping the anal area first thing in the morning will collect the pinworm ova. This tape should then be taken to your local laboratory for examination.
Whipworm (Trichuriasis)
Very common in the tropics as a warm moist climate is necessary for incubation of these worms’ eggs in the soil. Infestation occurs after ingestion of eggs from contaminated soil, by either human or animal excreta. Once ingested the eggs hatch and the larvae embeds its head into the lining of the bowel, where it grows and thrives. The mature female whipworm produces about 5,000 eggs a day. Once again this worm may produce no symptoms at all unless there is heavy infestation. When this occurs there may be abdominal pain, diarrhea, blood loss (anemia), and even appendicitis or bowel obstruction. Diagnosis is by microscopic stool examination for Trichuriasis eggs.
Roundworm (Ascariasis)
This is also a tropical worm, requiring the damp warm soil to complete its life cycle. Once ingested the eggs of this worm hatch in the small intestine, it migrates through the intestinal wall, and via the lymphatic system reaches the lungs. After ascending through the breathing passages, the larvae are re-swallowed and grows to full adult maturity in the small intestine. This is one of the larger intestinal parasites, growing 20 – 50 cm in length, and 2 – 6 mm in diameter. Apart from the gastrointestinal symptoms such as abdominal pain and cramps, this worm may also cause respiratory symptoms such as cough, wheeze as well as fever. Once again microscopic stool examination will demonstrate the presence of eggs, however the adult worm may also be passed in the stool or vomited.
Hookworm (Ancylistoma)
An average of 25% of the world’s population is infected with the Hookworm. When eggs are passed onto the soil, they hatch into larvae, and may penetrate the skin of humans. After they have penetrated the skin they migrate via the blood and lymphatics to the lungs and are swallowed. Once in the intestine they attach to the lining of the mucosa and suck the blood of their host. A skin rash may develop at the entry site of the larva; abdominal pain and respiratory symptoms may be present, and for obvious reasons, anemia (low blood count) can be a problem. Eggs will be seen easily on the microscopic stool examination.
Threadworm (Strongiloidiasis)
Endemic to the tropics, the Threadworm has a very similar life cycle to the Hookworm, except the eggs hatch in the intestine, so larva rather than eggs are passed into the stool.
The symptoms are also as for the Hookworm. Detecting the larvae may take several specimens, as few larvae may be present in each stool.
Treatment
It’s easy to see where Stephen Spielberg and his fellow creators of the unthinkable got their ideas from. Fortunately, these horrors of the gut are not difficult to remedy, and the treatments are readily available “over the counter” at most pharmacies and supermarkets. Wherever worm infestation is suspected in a family member (or pet), it is wise to treat all other household members. As infestation is so often asymptomatic I usually recommend that worming treatments are used routinely at 3 - 6 monthly intervals for all family members, including house staff.
Combantrin (Pyrentil) is sold as a single catch cover tablet or flavoured syrup. The dose is based on 10 mg/kg as a single dose for the treatment of the threadworm, roundworm, pinworm and hookworm. This may need to be repeated in 2-3 weeks for heavy infestations. Combantrin is well tolerated, however is contraindicated in pregnancy and in children under 2 years of age. It should be used with caution in those with active liver disease. Combantrin is not active against the whipworm.
Vermox (Mebendazole) is also sold here as a single catch cover dose (500mg) or flavoured syrup. Vermox is effective as a single dose against the pinworm, however if the threadworm, whipworm, roundworm, hookworm or mixed infestation are suspected I recommend that Vermox 100mg should be taken morning and evening for 3 days. The dose for adults and children is the same. In cases of heavy infestation this may be repeated in another 2-3 weeks. As “Vermox” is only available as a 500mg tablet in Bali, you may have to cut the tablet into four pieces (this will give you 125mg/dose), or ask for the generic Mebendazole 100mg tablet at the pharmacy. Vermox (or mebendazole) is well tolerated, however is contraindicated in pregnant woman and children less than 2 years of age.
Other Treatments
Mothers to be, and young children always pose a problem when treating worms, as of course the standard treatments are both contraindicated. The following “Kitchen remedies” are proven to be affective against most intestinal invaders.
Garlic – Most effective if eaten raw (1 clove swallowed 3 times daily for 5 days), however commercially available garlic extracts or tablets may also help. This is safe for pregnancy and children.
Lemon (or Grapefruit) & Honey – Grind 5 lemon (or grapefruit) pips and mix with a little honey. To be taken daily for 5 days. Safe for pregnancy and children.
Cayenne & Senna – Mix ground cayenne pepper with a little yoghurt, and follow with senna tablets. Cayenne will stun the worm, and senna will help to expel them. To be taken daily for 3 days. Safe for pregnancy but not for young children. Not to be used by persons suffering from gastric ulcers / gastric irritation.
Also, the Holistic Healing Center at Kuta Poleng (Dijon complex) has a natural anti parasite package of cloves, worm wood and black walnut oil. Call 766 259.
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Kim Patra is a qualified Registered Nurse and Midwife that has been living and working in Bali for almost twenty years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com”.
