BABY AND CHILDHOOD DIGESTIVE SYSTEM DISORDERS: WORMS
There are all kinds of worms. Some you find when digging in the garden. They’re usually long, juicy-looking, slimey things but they are useful (so my gardening friends remind me) for aerating the ground and helping plants grow. Then there are cut-worms which always seemed to chop off my new seedlings at ground level (that’s why I gave up gardening). My older brother, an inveterate and fanatical fisherman in his spare time, often searches the beach for worms when holidaying. He says they make good bait.
But I’m getting carried away… I wish to talk about human worms, or rather worms that inhabit the human system. They are commonly called threadworms, or Enterobius vermicularis if you like scientific names you can hardly get your tongue around. They are called threadworms because they look just like that. A bit of white cotton cut up into little lengths. Only they are very active and can turn and twist and crawl around in a most active way.
Worm infestations are common in children. Often the worms, in large numbers, come from the anal canal and crawl around the external part of the back passage. In fact, if examined at night with a torch, many of these creepy crawling things may be seen in a child with a heavy infestation. Personally, they give me the creeps.
In turn, this produces irritation and itching of the back passage. Often the child scratches, and the area may become sore or even infected if the skin is broken and germs start multiplying. Worms are commonly blamed for irritation, nail biting, nervousness and restlessness, especially during the night. Often vague gastric and nerve symptoms are related to infestations, rightfully or wrongfully. And the worms in their merry-making may become lost; cases have been reported in girls where the worms have reached the vagina and set up irritations there. They are also blamed for some cases of ongoing bed-wetting in children. But often there are few or no symptoms.
Commonly all of the children in a family may be infected. The eggs are highly infectious, and transmitted by scratching fingers from the anal region, they may reach toys, school books, writing implements and other objects that are of common interest. Once the eggs have reached the fingers, it is only a matter of time before they reach the mouth, then the bowel. Here they readily and rapidly hatch out, to set up further infestation. Inattention to adequate hygiene is a major factor in their spread. Inadequate hand washing after handling another person’s property, or before handling food or putting the hands to the mouth, is an important factor.
Treatment
Often it is simple to make the diagnosis, and often parents themselves will see the worms in their children. A simple examination of the stools will often reveal their presence; sometimes the doctor will have an examination carried out to discover either the worms or their eggs. These may be collected from fresh stools, or from around the anal margin. A simple test to detect their presence is done by sticking a piece of cellophane adhesive against the patient’s skin, removing it and replacing it on a glass slide which is then examined under the microscope. The doctor or pathologist may do this.
General hygiene is important. All members of the household should be treated at the same time—or the whole class if the disorder is widespread and has come to the general attention of the teachers.
The hand-washing routine after attending the toilet every time, and before handling or eating food, is essential. Soap and hot water should be used. The fingernails should be scrubbed often with a nail brush and soap. Nails should be kept short at all times, and regularly retrimmed. Regular washing of underclothing and bedclothes is important in getting rid of eggs.
Medication is usually very effective. However, although a single dose is often adequate to kill the organism in the bowel, reinfection is common. Ideally, the whole family is treated at the same time, and proper medical supervision is suggested. Pyrantel embonate (commercially known as Combantrin) and viprynium embonate (Vanquin) have been widely and successfully used for several years. Mebendazole (Vermox) in one single dose is also extremely effective.
Roundworms
Infestation by roundworms (Ascaris lumbricordes) is rare in this country. It is common in tropical countries, and may cause abdominal distention, colic, diarrhoea and emaciation. It is diagnosed when the worm or its eggs are located in stools. The egg may be passed in the faeces into the soil, where larvae develop, and are retransmitted to humans via soil-contaminated fingers or feet. Medical treatment is satisfactory.
Tapeworms
Tapeworms (caused by Taenia saginata from beef or Taenia solium from pork) come through eating inadequately cooked infected meat. General abdominal symptoms, diarrhoea and fever may occur. The parasite sucks blood from the bowel lining. Diagnosis is made when parts of the body are detected in faeces. Medical treatment effects a cure.
Giardiasis
A parasitic bowel infestation, giardiasis has been around for many years, but only for a short time, to any appreciable extent, in Australia. It produces loose bowel actions that do not stop within a few days, as do most bowel upsets. Motions are loose, watery, frothy, offensive. Most doctors consider a diarrhoea that has been persisting for a week or more to be most likely caused by this parasite. It is treated with metronidazole, and proper medical supervision is advisable. Treatment is invariably effective, but recurrences may occur. Most cases have been imported into Australia from European and Eastern lands, and it is now firmly entrenched in this country, especially in the eastern states.
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