WORM INFESTATION medicine POWER POINT.pptx

WORM INFESTATION
Medicine and medical Nursing
Presenter :George masiye
5th
year students
Unza
Supervisor Mr P. Mwanza

GENERAL OBJECTIVE
• At the end of this lecture / discussion students
should be able demonstrate an understanding
of pin worms infestation

SPECIFIC OBJECTIVES:
• At the end of the lecture, student nurses
should be able to;
• Define pin worm infestation
• Describe the life cycle of the pin worms.
• Outline how pin worms are diagnosed
• Describe the treatment of pin worms.
• Outline the preventive measure of pin worms

INTRODUCTION
• Pin worm infestation occur world wide and is
most common among children 5 – 10 years old .
• In the USA it is estimated that there are more
than 40 million cases each year.
• Pinworm infections occur in all socioeconomic
groups; however, human-to-human spread is
favored by close, crowded living conditions

PINWORM INFESTATION
• Pinworm infestation is a type of human
intestinal infection by the pinworm.
• Pinworms are tiny, narrow worms that are
white about one cm long.
• Pinworms are also known as Enterobius
Vermiacularis Schull (2005)

LIFE CYCLE
• The cycle of infection begins with the ingestion
of the eggs.
• The eggs enter the small intestine until they
hatch into larvae and mature.
• The adult female pinworms moves into the
colon where they live.
• At night the female adult exit the body through
the anus and lay eggs in the folds of skin around
the anus.

• The presence of these eggs often causes
itching and irritation.
• When a person scratches the affected area,
the pinworm eggs are transferred to the
fingers.
• The eggs can survive for several hours on the
hands

• . If the infected person touches bedding,
clothing, toilet seats, toys, or other household
objects, the eggs are transferred to these
surfaces.
• Pinworm eggs can survive on these
contaminated surfaces for up to three weeks.

• The transfer of pinworm eggs is easier among
children, who may put infected toys or other
objects into their mouths.
• The eggs can also be transferred from
contaminated fingers to food or liquids.
• it’s also possible for adults to inhale eggs that
become airborne when bedding or clothing is
shaken.

Signs and symptoms
• frequent and strong itching of the anal area
• restless sleep due to the itching and
discomfort
• pain, rash, or other skin irritation around the
anus
• the presence of pinworms in the area of the
child’s anus
• the presence of pinworms in stools

diagnosis
• Finding eggs on the cellophane tape or scotch tape
placed on the skin around the anus.
• The laid eggs will stick to the tape.
• The tape is placed over night and check the
following morning.
• The tape is placed on the slide and examined
under the microscope.
• The pin worm eggs are seen.

DRUGS
• Mebendazole 100mg BD for 3 days.
• Aldendazole 400 mg single dose.
• Piperazine citrate 50 to 75mg per kg bwt OD
for 2 days.
• Lavemisole 150mg for adult and 5mg per kg
bwt for children
• Nitazoxanide 200 mg BD x 3 days
• Tribendimine 400 mg single dose

prevention
• Ensure infected person and family members
practice hand washing with warm water and
soap before eating.
• .
• Clean everyone’s fingernails and cut them
short.
• infected person and others to stop biting their
nails.

• Avoid shaking clothing and bedding to prevent
pinworm eggs from spreading into the air.
• Do not allow children to bathe together to
prevent spreading pinworm eggs in the bath
water.
• Encourage everyone to shower and change their
underwear every morning

• infected person to refrain from scratching the
anal area.
• Use hot water to launder all bedding, towels,
washcloths, and clothes in the affected house.
• Thoroughly clean any surfaces that may be
infected, including toys, floors, countertops,
and toilet seats.

SPECIFIC OBJECTIVES
• At the end of the lecture/discussion, the
students should be able to
• Define hookworm infestation
• Describe the life cycle of hookworms.
• Explain the signs and symptoms of hookworms
• Describe how hookworms are diagnosed.
• Mention the treatment of hookworms.
• Outline the prevention of hook worms

DEFINITION
• Hookworm infestation is the infection of the
small intestine with hook worms.(Scull 2005)
• There are two types of hookworms namely:
1. Necator Americanus
2. Ancylostoma Dueodenale

LIFE CYCLE OF HOOKWORMS
• The infective larvae penetrate the intact skin
especially the feet that are in contact with the
ground.
• The infective larvae are carried through the
bloodstream to the heart then to the lungs..
• The infective larvae penetrate the pulmonary
alveoli.

• The larvae enter the bronchial tree into the
trachea, the pharynx and are swallowed.
• The larvae go into the small intestine where
they mature and become adult worms.
• The adult hookworms attach to the wall of the
intestine with buccal capsure
–

• The adult male and female met and the female
lay eggs that come out in the faces.
• The eggs are passed into the soil and under
favourable condition hatch into infective larvae.
• The favourable condition includes moisture,
warm and shady environment.

SIGNS AND SYMPTOMS
• Ground itch itchiness and small rash caused
by an allergic reaction as the larvae enter the
skin.
• Diarrhoea
• Abdominal pain or colic
• Intestinal cramps
• Nausea
• Fever

• Blood in stool
• Loss of appetite
• Other signs are
• Anemia due to the worms feeding on blood
• Malnutrition due to the worms feed feeding
on the food that the person eats.
• Ascites due to protein deficiency.

diagnosis
• Stool examination
• Eggs in fresh stool less than 24hrs
• Larvae in old stool more than 24hrs
• Blood test
• Eosinophilia raised eosinophils level

Prevention of hookworms
• Using protective clothes like gumboots for the
farmers and fishermen
• Dress the children in shoes.
• Mass treatment of all the under 5 children
• Mass treatment of the people in the location
where many people are diagnosed with hook
worms

• Use of toilets for defecation to prevent soil
contamination
• Good hand hygiene after toilet and before
eating.
• Food hygiene that is washing all the fruits and
other raw foods before eating.
• Information education communication to the
community on sanitation

DEFINITION
• Round worm infestation is the infection of the
intestine by round worms.
• Round worm also called Ascaris Lumbricoides.
are the largest nematode parasitizing the
human intestine.
• Adult females: 20 to 35 cm; adult male: 15 to
30 cm.

Life cycle
• The infective eggs are swallowed goes into
the small intestine
• In the small intestine the eggs hatch into
larvae.
• The larvae penetrates the intestinal wall into
the portal vein and go to the liver.
• The larvae then goes to the lungs passing
through the heart.

• In the lungs the larvae mature after 10 to 14
days.
• The larvae penetrates the alveolar wall,
ascend the bronchial tree to the throat and
are swallowed.
• Upon reaching the small intestine, they
develop into adult worms.

• Between 2 and 3 months are required from
ingestion of the infective eggs to when the
adult female lay eges.
• Adult worms can live 1 to 2 years in the
lumen of the small intestine

• A female may produce approximately 200,000
eggs per day.
• Eggs are passed in the feces.
• Unfertilized eggs are not infective.
• Fertile embryonate eggs become infective
after 18 days to several weeks, depending on
the environmental conditions

Signs and stmptoms
• Pulmonary manifestation called Loeffler,s
syndrome includes:
• . mild to severe cough
• . dyspnoe
• .thoracic pain
• . fever

• Abdominal signs and symptoms.
• .Abdominal pain
• .Anorexia
• . Nausea
• .Diarrhoea
• .Heavy infestation leads to impaired food
nutrients absorption

diagnosis
• Stool examination
• Detection of eggs in faces-no concentration
technique is needed worm lay 200,000 eggs
per day.
• Full blood count
• There is significant eosinophilia during lung
passage

• x-ray of the intestine
• Show one or more worms .worms form a long
thin dark area if using barium contrast.
• Ultra sound of the pancreas biliary tract and
gall bladder show ectopic migration

COMPLICATION OF ROUND WORMS
• Intestinal obstruction
• numerous adult worms may form a ball and cause mechanical
intestinal obstruction.
•
• Biliary obstruction
• Migration into the biliary tract may lead to biliary obstruction
(cholestasis) with possibly infection (cholangitis, liver abscess).
•
• Pancreatic duct obstruction
• Migration into the pancreatic duct can cause
obstruction( pancreatitis)

• Appendicitis
• Sometimes there is migration to the appendix
with inflammation.
• Sometimes an adult Ascaris is present in vomitus.
• Occasionally, an adult can penetrate the lacrimal
duct.

Prevention of round worms
• Mass treatment of the under 5 children
• Mass treatment of the people in the location
where there man people are being diagnosed
with worm infestation
• Use of toilets for defecation to prevent soil
contamination

• Good hand hygiene after toilet and before
eating.
• Food hygiene that is washing all the fruits and
other raw foods before eating.
• Information education communication to the
community on sanitation

• Tape worms are flat segmented worms that
live in the intestine of animals including man.
• The most common tape worms to man are
beef tape worms called taenia saginata and
pork tape worm called taenia solium.

• Man gets infected with tape worms by eating
raw or under cooked beef or pork from
infected animals.

BEEF TAPE WORMS(Taenia saginata)
• Cause taeniasis.
• The head ( scolex) has 4 hemispherical suckers.
The scolex imbeds in the mucosa of the intestine.
• The neck is the budding zone from which
segments are formed.
• The strobilus consists of immature, mature and
pregnant proglottides. Proglottides are segments

• There are hermaphroditic (there contain both
male and female reproductive organs in every
mature proglottid).
• Digestive tract is absent. Nutrition is absorbed
by the villi of the body surface.
• All adult worms infest the digestive tract of
mammals.

PORK TAPE WORM(taenia solium)
• The scolex(head) is global with 4 suckers and 1
rostellum
• The rostellum is for attaching to the mucosa
and the suckers are for sucking blood.
• The rostellum has 25 -50 hooklets for
attaching to the mucosa

LIFE CYCLE
• IN MAN
• infection is by ingesting of raw or under
cooked containing cystececus (pork and beef).
• In the intestine the cystececus develop into
adult tape worms after two months which can
survive for years.
• The adult worm attaches to the mucosa by the
scolex and reside in the small intestine

• The adult tape worm produce proglottids
which mature, become gravid and are passed
into stool.
• The eggs are released after the proglottids are
passed in stool.
• The taenia solium cystececus invades the
intestinal mucosa enter the bloodstream and
lodge in the brain, skin, tongue or eyes.

IN ANIMALS
• Cattle or pig get infected by ingesting eggs or
gravid proglottids during grazing.
• In the animal intestine the eggs hatch into
larvae (oncospheres).
• The oncospheres invades the intestinal wall,
migrate through blood stream to the muscles
where it encysts, forming cysticerci

Signs and symptoms
• Taeniasis
• Taeniasis is caused by the adult tape worm
residing in the small intestine.
• The adult worm irritates the small intestine
causing:
• Abdominal pain

• Anorexia
• Chronic indigestion
• Diarrhea
• Weight loss.

CYSTICERCOSIS
• Caused by cysticerci living in human tissue.
Cysticercosis is divided into three types
•
• Subcutaneous type:
• The subcutaneous nodules usually found on
the head, limbs, abdomen and back.
• Are movable and painless

• Ocular type
• The Cysticercus is usually found in the vitreous
body or subretina.
• Visual disturbance often occurs.
• The dead worms may provoke local
inflammation causing blindness.

• Brain type:
• The patients may manifest with headache, nausea,
vomiting, and epilepsy, and paralysis, weakness in
limbs, dizziness, and mental disorder.
• Epilepsy is the most frequent symptom of brain
cysticercosis.

Diagnosis
• 1.Taeniasis:
•
• Finding gravid proglottides or eggs in stool.
• 2. Cysticercosis:
• Biopsy of subcutaneous nodules,
• X-ray, CT or MR for brain type
• Ophthalmoscope examination:
• for ocular type.

TREATMENT
Taeniasis
• Praziquantel 5 -10 mg per kg body weight
single dose
• Niclosamide adults and children above 6
years give 2g single dose after light breakfast
followed after 2 hours by a laxative

Cysticercus
Excision - removal of cyst.
• Praziquantel - destroys Cysticercus in brain
• Metrifonate- for cutaneous type
• Corticosteroid reduce the inflammatory
process

PREVENTION
• Health education on how to cook meat
• Avoid eating raw pork.
• Avoid pigs eating human stool.
• Inspection of slaughter houses.
• Sanitary disposal of night soil.
• Improved meat inspection
• Improved meat processing
• Deworming all the pigs

SUMMARY
• Tape worms are contracted by ingestion of
cysticerci in the raw or under cooked meat .
Man pass proglottids which contain eggs in
stool.
• Pigs or cattle get infected by ingesting the
eggs, the larvae form cysticerci the muscle.
Tape worms are prevented by eating well
cooked meat

• REFERENCES
• Cook.G.C and Zumla (2003), Manson’s Tropical
Disease, 21st
Edition, Saunders, Elsevier
Sciences Division, 32 Jamestown Road London.
• Schull C.R (2005), Common Medical Problems in
the Tropics, 2nd
Edition macmillan Education
Between
•

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