INTESTINAL WORMS INFECTONS

Intestinal worm infection is a tropical and sub tropical disease caused by a lack of hygiene and healthy behavior, most of the time transmitted by touching contaminated or eating uncooked food grown in contaminated soil or irragated with inadequately trated wastewater.

Definition
The WHO defines the Ascarisasis, the most common human parasitic infections, as "an infection of the small intestine caused by Ascaris lumbricoides, a large roundworm. The eggs of the worm are found in soil contaminated by human feaces or in uncooked food contaminated by soil containing eggs of the worm. A person (and especially a child) becames in fected after accindentally swallowing the eggs. The eggs hatch into larvae within the person's intestine. The larvae pentrate the intestine wall and reach the lungs through the blood stream. in the intestines, the larvae develop into adult worms. the female adult worm which can grow to over 30 cm in length, lays eggs that are then passed into the feaces. if soil is polluted with human or animal feaces containing eggs the cycle begins again. eggs develop in the soil and become infective after 2-3 weeks, but can remain infective for several months or years.

Kind Of Disease :

1. Ascaris lumbricoides (roundworm), high prevalence, especially among children, frequency 60 - 70%, worm size 10 - 35 cm, the worm can produce roe around 100000 - 200000/day, a big worm in the kidney sucks 0.14 g carbohydrate/day and disturb absorption of vitamin A.
2. Necator Americanus and Ancylostoma deudenale (hookworm), high prevalence especially in planantation area, land loose. Relate to the using of the faeces as fertilizer and the habit of not using slipper/shoes, size around 1 cm, giving roe 10.000 granules/day. A big worm sucks 0,1-0,2 mL blood/day.
3. Trichuris trichiura(whipworm), frequency around 30-90%, the spreading is related to contamination between the soil and faeces, size 4 - 5 cm, a worm can produce 3000-10000 roes/day. do not pass lung cycle, big worm live especially in the ascending colon, sucking food subsance and 0.005 mL blood/day
4. Enterobius Vermicularis (pincourm), Transmission can occur in a family or a group staying in the same environment (dormitory house), size 2 - 13 mm. worm produce 11.000-15.000 roes/day in perianal area.

Symptoms
Several symptoms can be noticed :

• Degestive symptoms ; stomach ache, nausea, vomit, low weight, fever, darrrhea, or constipation. Diarrhea can sometimes be combined with dysentery syndrome and ractum polactus. The pinworm can give pruritus ani especially at night, enuresis, and irritability. A chronic infection can also contrubute to food allergy. a worum living in the kidney can also cause a reduction of nutritive substances (macronutrient and micronutrient) leading to malnutrition problems, less appetite, absropstion difficulties.
• Respiratory symptoms; cough, wheezing and difficulty in breathing, or fever.
• Urinary tract symptoms: kidney obstruction (roundworm)
• Metabolic symptoms: blood artery wall iritation (whipworm). iron deficiency (leading to anaemia)
• Immunological suppression
• Genarally lagging development (but mostly physical)

Interventions
Health education providing the following massages reduces the number of infected people :

• Avoid contact with soil that may be contaminated with human faeces;
• Wash hands with soap and water before handling food;
• Wash, peel or cook all raw vegetables and fruits;
• Protect food from soil and wash or reheat any food that falls on the floor.

Treatment
The tratment can be conducted publicly or personally, with pyrantel pamoat, membendazol, or albendazole. Infected individuals should be treated to reduce total of 1,913 (93%) of children aged 2 - 5 years in two districts of Aceh were given OPV + albendazole (400mg)

Sources : WHO, Medical Editor,