Roundworms
Introduction:
Roundworms,
or nematodes, are parasites that can infect people. They usually live
in the intestines. There are different species of worms that can cause
infection, and worms can range in length from 1 millimeter to 1 meter.
Most often, eggs or larvae live in the soil and get into the body when a
person gets them on his or her hands and then transfers them to the
mouth. Some can also get into the body through the skin.
Like
other parasitic diseases, roundworm infections are more common in warm,
tropical climates. Ascariasis is the most common roundworm infection,
and affects as many as 1 billion people worldwide.
Signs and Symptoms:
The signs and symptoms of roundworm infection include:
Ascariasis
- Cough
- Shortness of breath
- Abdominal pain
- Nausea and diarrhea
- Blood in the stool
- Weight loss
- Fatigue
- Presence of worm in vomit or stool
Guinea worm disease
Symptoms
start about one year after infection. When the adult worm is ready to
lay eggs, it comes out through the skin. A blister develops, usually on
the legs of feet, and becomes an open wound. When the wound is submerged
in water, the tip of the worm emerges to lay its eggs. Symptoms include
pain and swelling at the site of the wound.
Hookworm
Often no symptoms are present. Or they may include:
- Itchy rash
- Cough
- Wheezing
- Difficulty breathing
- Abdominal pain
- Weight loss
- Diarrhea
- Loss of appetite
Loiasis
- Watery or itchy eyes
- Blurred vision
- Some people may see the worm move across the eyes
Lymphatic filariasis
- Swelling and scarring, especially of the legs and groin
- Infections
River blindness
- Itchy rash
- Sores on the skin
- Swollen lymph nodes
- Skin turns white (loss of pigmentation)
- Loss of vision
Threadworm
- Itch where the worm enters the skin (similar to a bug bite)
- Nausea and diarrhea
- Fever
- Blood in the stool
- Dry cough or coughing up blood
- Difficulty breathing
Trichinosis
- Diarrhea
- Abdominal pain
- High fever
- Muscle pain
- Sensitivity to light (photosensitivity)
- Headache
- Pink eye (conjunctivitis)
Whipworm
- Abdominal pain
- Diarrhea (sometimes bloody)
- Anemia
Causes:
According
to the National Institute of Allergy and Infectious Diseases, many
roundworm parasitic diseases are caused by poor sanitation and hygiene.
Most roundworms or their eggs are found in the dirt and can be picked up
on the hands and transferred to the mouth. Or they can get into the
body through the skin. Different species of roundworms cause different
infections.
The various roundworm infections include:
- Ascariasis: People become infected when they eat food or drink that contains the eggs of the roundworm Ascaris lumbricoides. That can happen when people eat food grown in soil that has been mixed with human feces. Once in the body, the larvae enter the lungs and then the throat, where they are coughed up and swallowed. Once they swallowed, larvae enter the intestines and become adults. They can produce eggs for a year or more.
- Guinea worm disease (dracunculosis): People can become infected with Guinea worm disease when they drink contaminated water. Larvae grow into adults in the intestines, where they can grow to be 3 feet long. Then the adult moves to another area of the body (usually the legs) and emerges through a painful blister. The tip of the worm comes out through the skin to lay its eggs whenever the skin is immersed in water. This type of roundworm infects 10 - 40 million people annually worldwide, mostly in the Indian subcontinent, West and Central Africa, and some Middle Eastern countries.
- Hookworm (ancylostomiasis): A hookworm infection occurs when larvae come into contact with human skin, through contaminated soil or feces. They penetrate the skin, making their way through the lungs to the small intestine, where they latch on and grow into adults, laying more eggs. They feed off the blood of the infected person, which can lead to anemia. Children are especially vulnerable to this kind of infection. These roundworms infect about 25% of the world's population.
- Loiasis: Loiasis is an infection caused by the roundworm Loa loa. Like river blindness, loiasis is spread by day-biting flies. An estimated 3 - 13 million people in equatorial Africa have been infected with Loa loa.
- Lymphatic filariasis: A lymphatic filariasis infection occurs when a person is bitten by a mosquito containing the roundworms Wucheria bancrofti, Brugia malayi, or Brugia timori. Over 6 - 12 months, adult worms mature and live in human lymph vessels and nodes. Eggs are released and circulate through the blood. About 90 million people worldwide have been infected with these roundworms.
- Pinworm (enterobiasis): A pinworm infection occurs when a person consumes food or drink contaminated with feces containing the worm. The eggs hatch in the small intestine, and adult worms ultimately live in the large intestine. The pregnant female worms move to the anus and deposit large numbers of eggs in the skin around that area. Pinworm, which is commonly spread in day care centers, schools, and camps, affects as many as 1/3 of all American children.
- River blindness (onchocerciasis): River blindness is an infection of the eyes caused by the roundworm Onchocerca volvulus. River blindness is spread by day-biting flies, and is the leading cause of blindness worldwide. It affects about 20 million people, mostly in Africa.
- Threadworm (strongyloidiasis): Threadworm usually occurs when someone walks barefoot on contaminated soil, and larvae get into the skin. Inside the body, they move to the lymph nodes and then to the lungs and throat. When the person coughs, the larvae are swallowed and move to the intestines. There they grow into adults and produce eggs. About half of the population of some African countries has been infected with threadworm.
- Trichinosis (trichiniasis): Trichinosis is an infection caused by the roundworm Trichinella spiralis. These larvae live in pigs and other wild carnivores, such as bears. People can get infected when they eat meat (particularly pork) that is undercooked. The larvae mature in the small intestine and move to muscle cells where they can live for months or years.
- Visceral larva migrans, or VLM (toxocariasis): VLM is an infection caused by the roundworms Toxocara canis, Toxocara cati, or Baylisascaris procyonis. These parasites usually infect dogs, cats, and raccoons, respectively. People can get infected by ingesting soil contaminated by animal feces. While the larvae do not grow to be adults in people, they penetrate the intestinal wall and move to various parts of the body, particularly the lungs and liver.
- Whipworm (trichuriasis): A whipworm infection occurs when a person eats food contaminated with soil containing eggs of the worm. After eggs are eaten, larvae hatch and attach themselves to the large intestine.
Risk Factors:
The risk factors for roundworm infection include:
- Living in or visiting a warm, tropical climate
- Poor sanitation
- Poor personal hygiene
- Crowded conditions, such as day care or institutional settings
- Weakened immune system
- Malnutrition
- Eating undercooked meat
- Eating dirt or clay -- children tend to become infected this way
- Contact with animal feces
- Multiple insect bites
Diagnosis:
Diagnosing
roundworm infection involves finding out which worm is causing the
infection. If you have lived in or visited an area known to have these
parasites, your doctor may suspect an infection. If a worm passes
through the mouth or rectum, take it to your doctor so it can be
identified. Other steps in diagnosis may include:
- Physical exam
- Stool and urine samples -- identify microorganisms in the stool and urine
- Blood tests -- find infection in the blood
- Muscle or skin biopsy -- find infections that affect the muscle or skin
- Ultrasound -- reveals worms in lymph nodes
- X-ray -- show large worms in abdominal region
- Tape test -- used particularly for pinworm infections. A doctor applies sticky tape to the skin around the anal region, removes the tape, and then examines it under a microscope for pinworm.
Preventive Care:
It is easier to prevent roundworms than to cure them. The steps to preventing roundworm infection include:
- Practice good personal hygiene -- wash hands and avoid contact with fecal matter.
- Don' t eat uncooked or unwashed fruits and vegetables.
- Stay away from mosquito or fly-infested areas; don' t drink unfiltered water; and don' t touch the soil in areas where roundworm infections are common.
- Wear protective clothing, and use insect repellant.
- Cook or freeze meat thoroughly.
- Keep children away from pet feces.
- Ask a veterinarian about deworming pets.
- Public health measures include improving general sanitation, especially sewage disposal, and reducing mosquito and fly populations.
Treatment:
Medications
that kill parasites are the primary treatment for roundworm infections.
The medication prescribed depends on which roundworm infects the
person. Surgery may sometimes be needed, but is not always readily
available in areas where roundworm infections are common. Roundworm
infections can cause inflammation in the intestines and make it hard for
your body to absorb essential nutrients, including vitamins A and B6.
Some scientists think that vitamin A deficiencies increase the risk of
parasitic infections. So some researchers believe that vitamin A
supplements may help prevent or reduce symptoms of roundworm infections.
Medications
Antiparasitic drugs and other medications used to treat roundworm infections and certain complications include:
- Ascariasis -- Medendazole (Vermox), pyrantel (Pin-Rid or Antiminth), albdendazole (Albenza)
- Hookworm -- Medendazole (Vermox), albdendazole (Albenza)
- Loiasis -- Dieythelcarbamazine (Hetrazan), ivermectin (Stromectol)
- Lymphatic filiariasis -- Albdendazole (Albenza), dieythelcarbamazine (Hetrazan)
- River blindness -- Ivermectin (Stromectol)
- Threadworm -- Ivermectin (Stromectol), thiabendazole (Mintezol), albdendazole (Albenza)
- Trichinosis -- Albdendazole (Albenza), medendazole (Vermox)
- Whipworm -- Medendazole (Vermox), albdendazole (Albenza)
Other medications:
- Prednisone -- for severe VLM and at certain times in cases of trichinosis
- Oral iron -- if anemia is present
- Analgesics, anti-inflammatories, antihistamines, and antibiotics -- for relief of symptoms or to treat bacterial infection
See "Warnings and Precautions" for certain medications that someone with roundworm infection should avoid.
Surgery and Other Procedures
Guinea
worms should be removed surgically, but surgery not be available in
many areas where infection is common. Surgery may be needed in other
cases when the roundworm infection causes obstructions in the intestines
or other organs. Treatment to reduce soft tissue swelling from
lymphatic filariasis may include bandaging, physical therapy, careful
skin care, as well as draining fluids.
Nutrition and Dietary Supplements
Many
people who are infected with roundworms are malnourished, so getting
enough nutrients for overall health may help in preventing and treating
roundworm infection. A comprehensive treatment plan for roundworm
infections may include a range of complementary and alternative
therapies. Ask your doctor about the best ways to incorporate these
therapies into your overall treatment plan. Always tell your health care
provider about the herbs and supplements you are using or considering
using.
Following these
nutritional tips for general health may lower the chances of becoming
infected with roundworms or support a healthy body if infected:
- Eat bitter and spicy foods, such as those containing turmeric (curries), cayenne peppers, green chilies, olives, figs, garlic, and ginger.
- Drink warm teas that contain spices such as cardamom, clove and cinnamon.
- Eat more dark leafy greens (such as spinach and kale) and sea vegetables.
- Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
- Avoid refined foods, such as white breads, pastas, and especially sugar.
- Eat fewer meats, and more cold-water fish, tofu (soy, if no allergy) or beans for protein. Stay away from pork and other meats from carnivorous animals.
- Use healthy oils in foods, such as olive oil or vegetable oil.
- Avoid caffeine, alcohol, and tobacco.
- Drink 6 - 8 glasses of filtered water daily.
- Exercise at least 30 minutes daily, five days a week.
- Take a multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
Herbs
Herbs
are generally a safe way to strengthen and tone the body's systems. As
with any therapy, you should work with your health care provider to get
your problem diagnosed before starting any treatment. You may use herbs
as dried extracts (capsules, powders, teas), glycerites (glycerine
extracts), or tinctures (alcohol extracts). Unless otherwise indicated,
you should make teas with 1 tsp. herb per cup of hot water. Steep
covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for
roots. Drink 2 - 4 cups per day. You may use tinctures alone or in
combination as noted.
Although
there are no scientific studies that show any herbs help treat
roundworm infections, the following herbs may help overall health:
- Green tea (Camellia sinensis) may help boost the immune system. Prepare a tea from the leaf of this herb and drink 1 - 2 cups, one to three times daily. Caffeine-free products are available.
- Olive leaf (Olea europaea) standardized extract, 250 - 500 mg one to three times daily, may help boost the immune system. Olive leaf may lower blood pressure and blood sugar. Ask your doctor before taking it if you take medications for high blood pressure or diabetes.
- Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, appears to kill parasites in test tube and animal studies, although there is no evidence of that yet in human studies. Turmeric may increase the risk of bleeding. Ask your doctor before taking turmeric if you also take blood thinners such as aspirin or warfarin (Coumadin).
- Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, has been shown to kill parasites in test tubes and animals, but there is no evidence yet whether it works in humans. Garlic may increase the risk of bleeding. Ask your doctor before taking garlic if you also take blood thinners such as aspirin or warfarin (Coumadin).
- Wormwood (Artemisia absinthium), black walnut (Juglans nigra), and clove (Syzygium aromaticum) are often used in combination herbal formulas for parasitic infections. Many products on the market combine these herbs, so take as directed by your health care provider. Be sure to ask your doctor before taking wormwood if you have stomach ulcers. Pregnant women should not take wormwood. Wormwood may interact with some anti-seizure medications.
Other Considerations:
Pregnancy
Most antiparasitic drugs used to treat roundworm infection should not be used during pregnancy.
Warnings and Precautions
Ivermectin,
a medication sometimes used to treat roundworm infections, should not
be given to nursing mothers, the severely ill, children under 5 years
old, or those weighing less than 15 kg (6.8 lb).
Prognosis and Complications
There are several possible complications associated with roundworm infections. They include:
- Intestinal obstruction, caused by the roundworm itself
- Inflammation of the intestines or gall bladder
- Kidney disease
- Pus accumulation in the liver
- Inflammation of the pancreas
- Appendicitis
- Peritonitis, inflammation of the sac surrounding the abdomen
- Encephalopathy, a brain disorder
- Cardiomyopathy, a disease of the heart muscle
- Malnutrition
- Abnormal growth of the skin and surrounding soft tissue
- Blindness (from onchocerciasis)
Some
roundworm infections can last a long time, and there are many possible
complications. People living in areas where roundworm infections are
common may become infected more than once. Fortunately, most roundworm
infections can be treated with antiparasitic medications. For example,
the prognosis in cases of ascariasis and pinworm is generally excellent.
Alternative Names:
Ascariasis;
Guinea worm disease; Hookworm; Loiasis; Lymphatic filariasis; Parasitic
infection - roundworms; Pinworm; River blindness; Threadworm;
Trichinosis; Visceral larva migrans; Whipworm
- Reviewed last on: 9/12/2010
- Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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