Worms In Children

Worm Infestation & Worm Disease in Children

It is certainly not a pretty sight to see worms in your child's chair. Although we live in Austria, a country with a high standard of hygiene, worms and worm diseases are not that rare. Worms (helminths) are parasites of humans. If they get into the human body, they can trigger different symptoms and diseases.

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• Worm infestation or worm disease?
• Common worms in children
• Pinworm
• Dog roundworm and cat roundworm
• Whom can I ask?
• How are the costs going to be covered?

Worm infestation or worm disease?

Today more than 340 species of worms are known worldwide, which essentially belong to the following three large groups:

• Flukes or leeches,
• Tapeworms,
• Roundworms.

Among the different types of worms, there are some that cause little or no symptoms of the disease. In this case one speaks of a worm infestation (e.g. beef tapeworm infestation). On the other hand, there are also worm species that induce diseases with severe courses - some of them can even be fatal. If a worm infestation has a clinical effect through the appearance of symptoms, one speaks of worm disease or helminthosis (e.g. alveolar echinococcosis or fox tapeworm disease).

In principle, humans can be the ultimate or intermediate host for worms. If it is the final host, it will hardly suffer from the infection or infestation (the parasites will not multiply). If, on the other hand, humans take on the role of an intermediate host, this can endanger health. After all, humans can also be a false host, namely when the worm happens to get into humans in which it cannot develop further. In this case too, human health is usually severely impaired.

Common worms in children

The spectrum of worms (helminths) in Central Europe only includes about two dozen types of worms, but only a few of them are of greater medical importance, either because they are common and / or dangerous. Three types of worms are important to children. This includes the

• Pinworm (Enterobius vermicularis),
• Dog roundworm (Toxocara canis),
• Cat roundworm (Toxocara cati).

In addition, children can of course also acquire other helminth infections, either domestically, e.g. great liver fluke (Fasciola hepatica), beef tapeworm (Taenia saginata), dwarf tapeworm (Hymenolepis nana) or fox tapeworm (Echinococcus multilocularis) as well as abroad, e.g. paired leech (Schistosoma haematobium), pork tapeworm (Taenia solium) or whipworm (Trichuris trichiura). However, the pathogens mentioned are not typical parasites that occur in Central Europe, especially in children.

Pinworm

The pinworm (Enterobius vermicularis, also known under the plural term "Oxyuren") is an exclusive parasite of humans, it lives in the large intestine of humans. The female worms reach a body length of a maximum of twelve millimeters, the males are maximally five millimeters long, they are colored white. The fertilized female leaves the intestine to lay eggs and sticks 5,000 to 10,000 eggs to the skin around the anus (anus). The female worm moves when laying eggs. This causes anal itching. The result is that the person affected by oxyurs tries to stop the itching by scratching. This in turn means that the fingers become contaminated with worm eggs, which become infectious within a few hours. If the contaminated fingers get into the face orthe eggs in the mouth and via the digestive tract into the large intestine, the life cycle of the parasite is closed. Overall, the development from egg to adult worm takes five to ten weeks. The lifespan of adult worms is three to four months.

Transmission & Symptoms

The eggs are usually transmitted through dirt and smear infection through contact with contaminated toilet seats or door handles in kindergartens, after-school care centers and schools. Airborne transmission (via the airway) by swallowing whirled pinworm eggs is also possible. The main symptom of pinworm infestation is anal itching, which occurs mainly at night. This not infrequently leads to sleep problems in children. Occasionally, patients also complain of abdominal pain and diarrhea. Pinworms can accidentally enter the vagina, which can lead to insomnia and severe vaginal itching and ultimately to vaginal discharge (fluorine vaginalis).

Diagnosis & Therapy

Diagnosis & Therapy

The incubation period is between one and four weeks. The adult, often highly mobile female worms very often lie on the stool and can be recognized macroscopically. The detection of the worm eggs is problematic and can best be done with a transparent adhesive strip, with which one dabs the anal rim and the anal region before the morning shower. The tape can then be glued to a glass slide and examined under the microscope. A stool examination for pinworm eggs is not effective as the eggs are not deposited inside the intestine but outside the body in the anal fold. Nevertheless, Enterobius eggs can occasionally (accidentally) be found in the stool.

Basically, the active ingredients mebendazole, albendazole, pyrvinium or pyrantel are effective against worms. However, only mebendazole and albendazole are ovicidal (negative effect on the worm eggs present in the females). In addition, group therapy is useful, even if only one group or family member is obviously affected.

prevention

prevention

An effective prophylaxis requires a lege artis treatment of the affected patient and the group with a suitable anthelmintic. In addition, children in particular should be convinced to wash their hands regularly after using the toilet. Recurring (recurrent) pinworm infestation requires an extended treatment strategy (over six months).

Dog roundworm and cat roundworm

Both the dog roundworm (Toxocara canis) and the cat roundworm (Toxocara cati) live as adult worms (body length: eight to 18 cm) in the small intestine of dogs and foxes or cats. The female roundworms produce up to around 200,000 eggs a day, which are released into the open with their faeces. Within three to five weeks, an infectious larva develops in the egg, which - if the worm egg is swallowed by a natural host (dog, fox, cat) - hatches in the small intestine. It pierces the lining of the small intestine and reaches the lungs by blood via the liver and heart, where it leaves the blood vessel system. Then it travels up the windpipe and is swallowed in the throat into the esophagus. Once in the small intestine, the larva develops into an adult male or female roundworm. This completes the life cycle.

transmission

Humans acquire a roundworm infection by swallowing infected eggs from dog, fox or cat faeces through contaminated food, contaminated water or contaminated hands (e.g. after contact with the ground or direct contact with infected dogs, foxes or cats). Airborne transmission (via the air) is also possible in principle. As in natural hosts, a larva hatches from the roundworm egg in the human small intestine, which reaches the lungs via the bloodstream in the liver and the heart. However, the larva does not leave the blood vessel system in the lungs, but is transported back to the heart, from there via the large bloodstream to the whole body. Since humans represent a false host for the roundworm species, the larvae can never develop into adult worms,they always remain a larva (about 250-350 µm in length), which, however, can stay alive for many years.

Symptoms

Symptoms

Many roundworm infections have no apparent symptoms (asymptomatic). A small proportion of infected people (in Austria that is several hundred patients per year) develop clinical symptoms that can be assigned to very different clinical pictures. Today we know the so-called "Larva migrans visceralis syndrome", which can be observed especially in children and which is mainly due to recurring coughs (bronchitis), liver enlargement, increase in the number of white blood cells (including eosinophilic granulocytes) and / or also increase in IgE levels).

If the larvae get into the eye or the central nervous system, one speaks of an "ocular larva migrans syndrome" or neurotoxocarosis. In addition, there are other clinical pictures ("common toxocarosis", "hidden toxocarosis") that can often limit the health of those affected for months or even years.

The fact is that knowledge of the canine and cat roundworm and the diseases they cause is very limited in Austria (as in other Central European countries) and toxocarosis (as a collective term for all the syndromes mentioned) is rarely considered by the medical profession is pulled. A recurring increased number of eosinophilic granulocytes in the blood count should therefore always be the reason to include toxocarosis in the differential diagnosis.

Diagnosis & Therapy

The diagnosis of a roundworm infection is nowadays very easily possible through the detection of specific antibodies in human serum, but the laboratory carrying out this test should have the appropriate expertise. However, the detection of specific antibodies only means that the affected person had contact with the pathogen, and this in turn means that the worm larvae are still present in the body.

A causal relationship between the antibody level and the symptoms of the disease cannot be proven using laboratory diagnostic methods. However, it is obvious if clear and high antibody levels are measured and the roundworm-infected person shows symptoms as described above.

Asymptomatic roundworm infections (Toxocara infections) are consistently not treated. People with symptoms of the disease, possibly in combination with an existing eosinophilia and / or an increase in IgE, can be treated with the active ingredient albendazole (Eskazole®). The corresponding dosage regimen provides a daily dose of 10 to 15 mg / kg body weight for (at least) 18 days. In the presence of neurotoxocarosis or ocular larva migrans syndrome, the antihelminthic treatment should be carried out under cortisone protection.

prevention

Due to the fact that children in particular can easily acquire a roundworm infection when playing outdoors, through contact with the ground, but also through geophagia (eating earth), it should be ensured that the children's hands after "handling" the Can be washed outdoors with soap, which significantly reduces the risk of infection. In addition, dogs and cats must be dewormed regularly.

Whom can I ask?

If you suspect a worm infestation or worm disease, you can contact a doctor specializing in general medicine or a doctor specializing in paediatrics. In addition, the Department of Medical Parasitology of the Institute for Specific Prophylaxis and Tropical Medicine at the Medical University is available for further questions.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB).

However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.