Case

A 2-year-old male child presented with high

grade fever, abdominal distention, pedal
edema.
He was pale, had pitting edema in both lower
limbs and showed features of chronic growth
retardation.
He belonged to low socio-economic status, both
mother and father were uneducated and had
poor personal hygiene.
But he was active and playful and had no
features of sepsis

Investigations
Blood investigations revealed anaemia,
hypoproteinemia, normal liver and renal function
tests.
Ultrasonography showed common bile duct (CBD)
which was dilated (10mm) and in intra-hepatic
biliary radicals with abscesses.
Computed Tomography of the abdomen revealed
multiple small liver abscesses (maximum diameter
2cm) with dilated intrahepatic biliary radicals and
dilated common bile duct (10mm) with opacities
within the abscesses, intrahepatic biliary radicals
and common bile duct.

Management
He was kept nil by mouth, daily saline enemas
were given.
Intravenous antibiotics- ceftriaxone
(100mg/kg/day), metronidazole (2ml/kg/day),
amikacin (15mg/kg/day) were given for 7 days.
The patient, along with his family members
treated for seven days with albendazole.
Orals were started later.
Patient recovered well without any sequalae
and is doing well on follow-up.

Common Worm
Infestations
in Children

Dr Anand V
Department of
Pediatrics

Burden of disease
Neglected Tropical Diseases (NTDs) are the
most common diseases of the worlds poor.
These diseases disable and debilitate one in
six people worldwide, including half a
billion children.

The 7 Most Common

NTDs
1. Ascariasis
2. Hookworm
3. Lymphatic Filariasis
4. Onchocerciasis
5. Schistosomiasis
6. Trichuriasis
7. Trachoma

Disease picture
Number of worms living in a child is called as worm load.
A heavy worm load usually causes symptoms. A light worm
load may be asymptomatic.
Parasitic infection differs form viral or bacterial infection. One
virus or bacterium can develop into millions after entering the
body. On the other hand on parasitic larva grow into only one
adult worm. So the size of a childs worms load depends on
how many larvae get into him.
Intestinal parasites complete for food, damage the intestine
and decrease food absorption.
Light round worm infection can lead to 3 % calorie
wastage. Heavy infection can lead to caloric loss of 5% of
daily consumption
Lffler's syndrome or Loeffler's syndrome is a disease in
which eosinophils accumulate in the lung in response to a
parasitic infection.

CHILDHOOD SUSCEPTIBILITY TO
WORMS

For just 50 cents, treatment can be

provided to a person against seven
NTDs for an entire year
The 7 Most Common
NTDs
1. Ascariasis
2. Hookworm
3. Lymphatic Filariasis
4. Onchocerciasis
5. Schistosomiasis
6. Trichuriasis
7. Trachoma

Helminthiasis

Nematodes
(Round Worms)
Ascaris lumbricoides
Enterobius vermicularis
Hook worm
Trichuris trichiura
Brugia malayi
Wuchereria bancrofti

Trematodes
(Flukes)
Schistosoma
Clonorchis
Fasciola hepatica

Cestodes
(Tape worms)

Taenia solium
Taenia saginata
Echinococcus
Diphyllobothrium latum

Ascaris lumbricoides Life cycle

Ascaris lumbricoides
C/F
Abdominal
Pain, distension, vomiting
Passage of worms in stool/vomitus
Obstruction

Pulmonary: Loeffler syndrome

Growth failure

Ascaris lumbricoides
Diagnosis
Eggs in stool sample
Worms in stool / vomitus
Imaging

Treatment
Albendazole 400 mg Once
(Taken with food)
Other options
Mebendazole
Ivermectin
Nitazoxanide

Enterobius
vermicularis (Pin
Worm)

Peri-anal
itching
More at night

Enterobius vermicularis (Pin

Worm)
Diagnosis
Stool microsopy: not
useful
Eggs can be
demonstrated in peri
anal swabs collected
early morning
Sticky tape on a tongue
depressor
Albendazole
400 mg Once,

in 2wk
repeat
Treatment
Other options

Mebendazole
Pyrantel
Treat entire family

Hook worm
Ancylostoma
duodenale /
Necator
americanus

Hook worm
C/F

Ground itch
Abdominal pain, anorexia
Iron deficiency anemia
Hypoproteinemia

Dx
Stool microscopy
Peripheral smear

Treatment
Albendazole 400 mg Once
Other options
Mebendazole
Pyrantel
Oral Iron therapy

Filariasis
Wuchereria bancrofti, Brugia malayi, B. timori

Filariasis
C/F
Most remain asymptomatic
IP: 8-16months
Episodes of Fever, lymphangitis,
lymphadenitis
Last for 7-10d
8-10 episodes/yr
Tropical Pulmonary Eosinophilia
Chronic stage: Lymphatic
obstruction
> 25yr age
Lymphedema / Elephantiasis

Filariasis
Dx
Mf identified in thick blood
film
Nocturnal periodicity
Adult worm in LN biopsy
Di Ethyl-Carbamazine (DEC) 6mg/kg /day q8hr
Treatment
for 12 days
Other options
Single dose Ivermectin
Ivermectin + Albendazole

Prevention

Echinococcosis

Alveolar
Echinococcosis

Cystic
Echinococcosis

Echinococcus granulosus, E. multiloculari

Echinococcosis lifecycle

Echinococco
sis

C/F
Site and mass
effect of the cyst
Rupture: fever,
anaphylaxis

Echinococcosis
Diagnosis
Imaging
Serology: Sensitive, not specific

Treatment

Surgical
Complete removal
USG/CT guided Percutaneous
Aspiration, Instillation of
hypertonic saline, Reaspiration
(PAIR)
Medical
Albendazole 15mg/kg/day for
2wk
May require repeated courses

Taeniasis

Taenia saginata
Beef
Tapeworm

Pork
Tapeworm

Taenia solium

Taeniasis

Taeniasis
C/F
Mild epigastric discomfort,
nausea, flatulence,
diarrhea

Dx
Microscopic identification
of eggs and proglottids in
feces
Praziquantel 5-10mg/kg
single dose
Alternative option
Niclosamide 50mg/kg single
dose

Treatment

Neurocysticercosis
C/F
Depends on site and number
of cysts
Seizures, headache
Cysticercal encephalitis inc.
ICT

Dx
Neuroimaging
Diff from tuberculoma

Neurocysticercosis
Treatment
Anticonvulsants
Albendazole
If active lesions on imaging
15mg/kg/day for 7-28 days
Adjunctive steroids

Relative C/I for albendazole

Intraocular cysts
Intraventricular cysts
Spinal cysts

Prevention

Cysticercosis

Cysticercosis

 THE NATIONAL DEWORMING DAY is observed on February

10 2015 by the Ministry of Health and Family Welfare and its
main objective is to deworm children between the ages of (119) at schools and anganwadi centres.
Necessity of deworming children:
Worm infections can cause anemia, malnourishment, impaired
mental and physical development; and may cause a serious
threat to children's health, education, and productivity
Necessity of deworming program in India:
According to WHO, India has the highest burden of SoilTransmitted Helminths (STH) in the world, with 220 million
children aged 1-14 estimated to be at risk of worm infections.
Deworming Tablet:
Children at the age of (1-2) are given half a tablet of
albendazole (400mg), and above the age of 2 are given 1 full
tablet of albendazole (400mg) to chew.