A Good Ol' Fashioned Worming

Published by the Children's Clinic of Ocean Springs

Pediatrician Dr. George D. Fain, M.D.

Office Telephone (228) 875-1184 or 1185 -- 24 hours

South Mississippi is a semitropical area that is home to a host of remarkable wild life. Along with the red fish, however, there are several other critters that are not so popular. As a pediatrician, I have at least one parent a day asking for "worm pills". There are several different types of "worms" and other parasites. Every parent has to deal with intestinal parasites sooner or later on the Gulf Coast. I'd like to take a minute to talk about three of the most common of them. It took the title of this piece from a grandmother who was with her grand baby in my clinic. She proudly told me that all he needed was, "just a good old fashioned worming". I have never forgotten this good lady.

Without a doubt, the scourge of parents of small children is the PINWORM (Enterobius vermicularis). This terror of the daycare has resulted in more calls to the doctor and emergency room visits than any other parasite. The first thing a parent should know is to relax. You are not a bad parent and you didn't keep a dirty house. The fact that your little one has pinworms is not a reflection on you. You are, however, the possessor of a child.

Listen, don't look for pinworms on image searches.

The male pinworm is 2 to 5 millimeters (MM) long. That is about 1/20th of an inch. The female can be up to 13 MM or about 1/5th of an inch. The female is the one you see in the diaper. The worm is yellow white in color and has a long thin pointed tail. The female migrates down the intestinal tract, passing through the anus, and deposits eggs on the skin. The eggs hatch and are ready to infect within hours of being hatched. Typically it causes a condition called Pruritis Ani. Pruritis means "itchy" and Ani is why your child is scratching his behind. As your child scratches, the eggs attach to his fingers. When the child touches another person's face or a toy due to enter the mouth, the eggs are passed on to another child. With the typical hygiene of children in school, it is no wonder the animal spreads so quickly through the community. The multiplicity of symptoms attributed to this animal are legion. It is possible for the eggs to migrate into the vaginal tract causing local irritation. There are a few persons who are actually allergic to the secretions and their intestinal reaction is more profound.. There have been no documented cases of appendicitis, peritonitis, or pneumonia although stories abound. They have been recovered from all three areas, but are unlikely to cause any significant problems.

Treatment is simple, and can be obtained over the counter from your pharmacist. Pin - X is one local brand here in Mississippi. In a family situation, with small children, it is a good idea to treat the entire family. The majority of infestations are asymptomatic. Washing of the bed clothes the night after treatment is necessary to prevent recontamination. The most important aspect of pinworms is that it NOT an emergency and can be treated on a routine basis. Itching can be soothed by a sitz bath at night to ease the symptoms. If there is any doubt as to the diagnosis, a simple piece of cellophane tape applied to the anus before the baby wakes up will capture the eggs for identification by the hospital lab.

The second most common parasite in South Mississippi is not a worm at all and cannot be seen without a microscope. His name is Giardia lamblia. This aggravating little character is naturally found in the ground water in the South. This makes life difficult for people who have well water. It can also contaminate home grown vegetables.
Giarida is also excreted in the stool of the person carrying it. Fecal oral communication is common in our school system. They attach by sucking disks on the animal to the upper part of the small intestine and can reproduce and attach by the thousands. Some persons carry Giardia and remain asymptomatic, but the majority of its victims do no fare so well. Children can manifest any part of a complex of symptoms consisting of: mild diarrhea, flatulence (gas), anorexia (loss of appetite), cramping abdominal pain, stomach aches, fatty malabsorption stools, to a full blown malabsorption syndrome and failure to thrive. In it's worst manifestations, they can cause imbalances in the blood salts (the electrolytes), weight loss, and a deficiency of IgA which is the immune factor that helps defend against viral illnesses. As can be seen, this is not a benign organism living in peaceful coexistence with mankind. As a pediatrician, I have found that stool samples do not always reveal the presence of Giardia. The best detection is a war, wet stool on a microscope slide to actually see the Giardia swim by. Five negative stools will give you a 95% chance that you do not have Giardia. The organism quickly dies in refrigerated stool. In rare cases it has been necessary to treat preemptively when all the diagnostic tests are negative and the parasite is still suspect. Treatment, under the careful eyes of the physician, is simple and effective. However, the entire family is not treated until they too are symptomatic. The best way to prevent spread in a family or day care is religious hand washing between children. People with their own water supply should have their water tested periodically and consider installing a filtration system.

The parasite that causes the most EMOTIONAL trauma in parents and children is without a doubt Ascaris lumbracoides. This is a nematode, a round worm that actually looks like a worm. These range from 3 to 12 inches long. They are about as round as a pencil and are a pinkish white in color.
Their transmission is again fecal to oral in nature. As a child with this parasite passes the eggs in his stool, he carries them on his hands to another person. The eggs hatch while in the intestine of the host and migrate through the body. They migrate through the lymphatic system to the liver, up to the heart, and finally to the lungs. After about ten days they migrate from the lungs up the trachea and are swallowed back into the intestines where they reproduce. Three months after ingestion, a single female worm can produce up to 200,000 eggs daily. This can lead to intestinal blockage, stomach pain, gallbladder symptoms, and liver abscess. A lesser known problem is a condition known as Loeffler's pneumonia caused by the migration of the organism through the lungs. Ascaris worms have been known to crawl up the esophagus and migrate out the nose of the victim. (Pinworms don't sound so bad now do they?) They have even been found in Barium studies in the hospital where their gut is outlined by the Barium they swallow. Ironically, while all this is going on, the child is often symptom free. The first clue of infection is often when your toddler runs from the bathroom crying that there is a snake in the toilet. Soap and water will prevent the spread through the family, but by the time the animal is seen, others will be infected. Stool samples are very reliable diagnostic tools in detecting Ascaris infestation. Treatment is again fairly easy, but side effects are common. Some of them are: nausea, vertigo, and diarrhea. Since the cure is so harsh, it should be used only under the care of a doctor and only those affected should be treated. It remains a good idea to have the stools of the whole family checked.

There are literally hundreds of other parasites in this area. There is simply not enough space to discuss them all. The main message is that there are so many types of parasites, that a simple unified treatment is impossible. Your doctor can decide which treatment is right for you. Remember that it is not necessary to go the Emergency Room and there is no need to panic when you find out that your child is not alone inside his own body. Rational treatment and therapy are the best course.

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