|
Chronic Worm Infestation
Antihelminthic treatment have always been the part and parcel of any pediatric prescription, but not so lately, due to a false notion that, with the improved socio-economic status, worm infestation may not be so prevalent. Approach To The Patient With Chronic Helminthiasis Take the history of
Management Of Worm Infestations Whip Worms It is prevalent in rural community and in areas where sanitation facilities are lacking. Children in the age group 5-15 years have highest prevalence and have heavier worm loads than adults. Symptoms: Mild infestation is asymptomatic. Highly infected children may lose blood and may have bloody diarrhoea, sometimes with rectal prolapse, growth retardation and associated malnutrition. Therapeutic Management: Drug of choice is Mebendazole-100 mg twice a day for 3 days regardless of body weight (for children more than 2 years of age). Albendazole-400 mg (single dose). For children less than 10 kg, 200 mg as a single dose. For heavy infestations the albendazole treatment may be needed for 3 days. If the problem persists, Mebendazole retention enema will be necessary. Round Worm It has world wide prevalence, most common in pre-school and young school age children and equally seen in both sexes. Clinical Features: Often asymptomatic. Vague abdominal pain is the next common presentation. The common problems due to round worm infestations are pulmonary (eosinophila + Blood stained sputum) and nutritional disorders. Intestinal and biliary obstruction may also occur. Therapeutic Management: Piperazine citrate elixir - 75 mg/kg orally for 2 days. This is the treatment of choice in heavy infestations and in cases with worm mass. It produces neuromuscular parlysis so that the risk of worm migration is minimal. Mebendazole - 100 mg twice daily for 3 days for children more than 2 years of age. Pyrantel pamoate - 11mg/kg as a single dose. Albendazole - A single dose of 400mg. Children less than 10kg may be given 200mg as a single dose. Worm Mass Worm mass causes intestinal obstruction and hence the child presents with abdominal pain and vomiting. The worm mass will feel like irregular mobile mass in the abdomen. Never deworm during the stage of acute abdominal pain with mass - it will precipitate acute intestinal obstruction! The basic principle of treatment is to hydrate the child but dehydrate the worms! (IV fluids & nil orally). The worm mass will disperse in 24-48 hours and the mass will disappear. Then give deworming; preferably Piperazine citrate. It will paralyze the worms and hence there is minimal danger of worm migration. Slow acting cidal drugs like mebendazole will cause extensive worm migration and worm vomiting and hence is contraindicated. Hook Worm It affects about 1/3 of the world's population. Morbidity and mortality from hook worm infestation depends on the worm load. Clinical Features: Early manifestations are ground itch, intense pruritis, erythema and vesicular rash at the site of penetration. Major manifestations are iron deficiency anemia and chronic protein energy malnutrition.
Therapeutic Management: Mebendazole - 100mg twice daily for 3 days regardless of body weight results 95% cure (use above 2 years of age).
Anaemia should be corrected with iron therapy. Ferrous sulphate 6mg/kg/day (of elemental iron) orally afterfood and continued for 3 months after the Hb level has risen to 12g/100ml. Patient with severe hypoprotienemia should be adequately and quickly treated.
Pin Worm Infestation of pin worm is most common in children in the age group of 5-14 years. Because the life span of the worm is relatively brief, long standing infestation may be due to continuous reinfection. Clinical Features: Perianal and perineal pruritis is the common feature. Majority of the cases may be asymptomatic. Therapeutic Management: Pyrantel pamoate - 11mg/kg orally for the first dose and second dose after 2 weeks. Mebendazole - 100mg single dose for children more than 2 years of age. It is better to give a 3 day course to cover other helminthes. Retreatment after 2 weeks with a single dose of 100mg. Under-garments should be dried in sun for extended periods. Treat all family members simultaneously. Nails should be cut short. Albendazole 400mg OD single dose, followed by repeat dose after 2 weeks. Better to treat family members and close group contacts simultaneously. Thorough cleaning of toilet seats, floor or rooms, bedding and clothing must be continued for several days to avoid re-infection. Discourage scratching the bare anal area (let them scratch over the clothes) their clothes must be sun dried for extended period of time to destroy ova. Tape Worm The intestinal tape worm infestation occurs due to the consumption of beef and pork infected with larvae. Unwashed raw vegetables contaminated with eggs of tape worm will produce cysticercosis rather than intestinal infestation (Taenia solium).
Therapeutic Management: Niclosamide - 40mg/kg/dose. (T.Niclosan 500mg) Tabs are to be crushed or chewed (drug of choice for tapeworms). Saline purge after 1 hour. Examine if scolex is passed out, failing which treatment may have to be repeated. Usual rule of thumb is 1 gram for 2-6 years & 1.5 gm for over 6 years followed by purging.
Contraindications/ Side Effects
Mebendazole
Piperazine Pyrantel pamoate Management Of Worm Infestation At The Community Level The epidemic or worm infestation is common in coastal areas and in areas where sanitation facilities are poor. The recurrence of the infestation is higher in these areas due to poor physical hygiene, improper treatment and poor sanitation. Hence its management need high priority. The infestation of round worm and hook worm is common and is relevant in the prevention of malnutrition. In areas where worm infestation is suspected, we have to find out the reason. Chronic worm infestation exists because of improper treatment, poor physical hygeine, and poor sanitation. Prevention And Control
Methods based on primary prevention are the most effective in the interruption of transmission cycle of the worm infestation.
For children, deworming at every 6 months is a must after 1 year of age. If there is infestation before 1 year, it would be treated immediately. Drugs which are administered acts only on the adult worms and have no action on ova. So periodic deworming at the intervals of 2-3 months should be undertaken. This may be needed where protein-energy malnutrition is highly prevalent. Mass treatment will not interrupt transmission of disease, but will substantially reduce the worm load. By and large the infestation with worms are disappearing spontaneously in certain areas as a result of improved sanitation.
Copyright © 2002 Indian Academy of Pediatrics. All rights reserved. Unauthorized duplication and distribution strictly prohibited. Developed by : webcottage.com |
| Home About Office Bearers Awards Events Publications Recommendations Academy Today |
| Affiliations Education Members Forums/Bulletin Board Contact Us Links |
|
|