Infestation with parasitic worms is a common occurrence worldwide, but climate and other factors determine which are the most prevalent in any region. Most worms that infect humans reside in the intestinal tract, spreading through poor sanitation or food or water contaminated with worm eggs. In the United States, pinworms are the most common, afflicting an estimated 5 to 15 percent of the population at any given time. These parasites, which look like tiny straight pins, mature in the human intestinal tract. While the host sleeps, the female worm emerges from the anus to lay thousands of eggs, causing skin irritation and severe anal itching. Scratching transfers some of the eggs to the hands and fingernails; if they are carried to the mouth and swallowed, the cycle of infestation begins again.

The eggs can also be picked up from toilet seats, bedding, clothing, and other objects; some become airborne and can be inhaled and swallowed. Hookworms infect about 25 percent of the world's population, but they are relatively uncommon in the United States, occurring mostly in the rural South. The eggs are discharged in the stool and hatch a day or two later in the soil. The larvae then enter the human body through the skin, usually on the soles of children or others who go barefoot. They migrate to the lungs, are coughed up, and swallowed. They then take up residence in the small intestine, where they attach themselves to its wall and feed on the person's blood. Left untreated, a large infestation of hookworms can cause iron deficiency anemia and abdominal pain.

Threadworms, which have a life cycle similar to that of hookworms, can cause coughing, shortness of breath, and even pneumonia when lodged in the lungs. In the small intestine, they can produce abdominal pain, severe diarrhea, and other GI symptoms. Roundworms enter the body as eggs carried in contaminated water, food, or soil contaminated hands. The adults resemble earthworms, and are some times found in the stool or vomit. Thpeworms are rare in the United States but common in the developing countries of Africa, the Middle East, Asia, and Eastern Europe. Humans become infected by eating undercooked pork, beef, or fish that contain cysts of larvae. When these cysts reach the intestinal tract, the worms develop into their adult stage and may grow up to 30 feet in length. The body is made up of hundreds of segments called proglottids, which contain eggs. These break off and are passed in the stool, beginning a new life cycle. Many tapeworm infections are asymptomatic; others may cause anemia, diarrhea, and pain.

Diagnostic Studies And Procedures

The diagnostic procedure varies according to the type of worm. Pinworms can sometimes be seen by in specting the anal area a few hours after a child has gone to bed. Otherwise, the eggs can be detected by patting the anal skin with a piece of transparent tape, sticky side down, and then exam ­ ining the tape under a microscope. This should be done when the child first awakens in the morning. In other infes tations, a doctor may order a stool analysis to look for eggs or worm parts. Repeated tests may be needed, as eggs may be discharged only sporadically. Blood tests may be ordered to check for possible iron-deficiency anemia, especially if hookworms are found.

Medical Treatments

Worms are treated primarily with medications called antihelminthics, with specific drugs used depending on the type of worm. Pinworms, hookworms, and roundworms are usually eradicated with pyrantel pamoate or mebendazole . A single dose is usually effective, but a follow-up dose may be needed to eliminate all eggs and larvae. If one child in a family has pinworms, any siblings between ages 2 and 10 should also be treated. In some instances, adult family members may also be advised to take the medication. Japeworms are generally eliminated with niclosamide or praziquantel .

Alternative Therapies

A number of folk remedies are said to eliminate worms, and some may actually work. However, antihelmin ­ thic drugs are the fastest and surest treatment; any alternative approaches should be considered adjuncts to a doctor's prescribed treatment. Herbal Medicine. Garlic, taken fresh or in capsule form, is believed to help eliminate worms.

Nutrition Therapy

Worms can cause anemia and other nutritional deficiencies; maintaining a well balanced diet is important. If you are anemic, iron supplements may be recommended, but you should consult a doctor before taking iron pills.

Self Treatment

Self care is focused on preventing reinfestation. To avoid resurgence of pinworms, clean the entire house on the same day that medication is taken. Wash towels, bed linens, pajamas, and underclothes in hot water, using a strong detergent and bleach. Clean the bathroom with a disinfectant and sterilize objects that might go into a child's mouth by washing them also with disinfectant, then rinsing thoroughly. Trim children's fingernails and make sure that they wash their hands after going to the toilet and before eating. To avoid hookworms or thread worms , do not go barefoot outdoors and use proper sanitary measures. To prevent tapeworm infestations, cook beef, pork, and fish until they are well done.

Other Causes of Worm Symptoms

Hemorrhoids or an anal fissure can cause anal itching. Intestinal disorders, such as appendicitis, colitis, and irritable bowel syndrome can produce abdominal discomfort, and diarrhea.

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