Worm infestation also known as helminthiasis is a macro parasitic disease infected by parasitic worms, known as helminths. Patients often present with variety of symptoms such as abdominal pain, loss of appetite, weight loss, fatigue, nausea and vomiting.
Medications (based on type of worm infestation):
- Ascariasis, pinworm and hookworm – Tab. Milibend (Albendazole 400 mg) 1 tablet as a single dose. Then repeat dose after 2 weeks.
- Whipworm – Tab. Milibend (Albendazole 400 mg) 1 tablet a day for 3 days. Then repeat dose after 2 weeks.
- Strongyloidiasis, trichinosis and toxicariasis – Tab. Milibend (Albendazole 400 mg) 1 tablet twice a day for 7 days.
- Cysticercosis – Tab. Milibend (Albendazole 400 mg) 1 tablet twice a day for 8 to 30 days.
- Echinococcal – Tab. Milibend (Albendazole 400 mg) 1 tablet twice a day for 1 – 6 months.
- Tapeworm – Tab. Helminthex 50 (Praziquantel 50 mg) 5 – 10 mg/kg as a single dose.
- Filariasis without cysticercosis – Tab. Hetrazan (Diethylcarbamazine 100 mg) 6 mg/kg/day or 1 tablet thrice a day for 12 days.
- Filariasis with cysticercosis – Tab. Milibend (Albendazole 400 mg) 1 tablet twice a day for 10 days AND tab. Ivermectol (Ivermectin 12 mg) 1 tablet only once. For children adjust the dose of Ivermectin to 0.2 mg/kg only once.
- Heavily infected patients should be given corticosteroids 2 days before starting antiparastitic treatment.
Supportive treatments:
For iron deficiency anaemia-
- Cap. R B Tone (Elemental iron 30 mg, Folic acid, Vit B12, Zinc) 1 capsule a day, two hours after meal AND
- Tab. Limcee (Vitamin C 500 mg) 1 tablet once a day two hours post meal for 3 months.
For vitamin B 12 deficiency-
- Cap. Meganeuron OD Plus (Methylcobalamin 1500 mcg, Pyridoxine 5 mg; Folic acid 5 mg) – one capsule once a day for 3 months.
General advice:
- Ensure adequate sanitation systems.
- Educate patients about safe hand washing and general cleanliness.
- Advice patients to drink clean and filtered water.
- Deworm any pets if needed.
Investigations:
- Stool microscopy (samples over 3 consecutive days) – For parasite identification and it’s ova.
- Stool occult blood – Occult blood is positive in parasitic infestation but can also be positive in a wide variety of gastrointestinal conditions.
- Complete blood count – to rule out anaemia.
- Abdominal ultrasound scan and X ray – to rule out evidence of obstruction or any other pathology.
Referral:
Consider referral to gastroenterologist in cases of severe worm infestations or if patient fails to respond. Consider referral to general surgeon if there is clinical evidence of intestinal obstruction.