2017 HCHB_digital

Worms
Pinworms (Enterobius vermicularis) are small worms that live in the lower
digestive tract. Pinworms may also be called threadworms, enterobiasis or
oxyuriasis. They are white and thin and look like a small piece of white cotton
about the size of a staple (5–10mm). Occasionally they can be spotted in the
stool (poo) or around the anus, but are usually difficult to see. A "sticky tape"
test involves sticking and then quickly removing a piece of sticky tape to the
anus in an attempt to catch any pinworm eggs. This is best done late at night or
early morning as the female pinworm deposits her eggs outside the anus during
the night. The tape is then viewed under a microscope for the presence of eggs.
Generally, it is not considered necessary to confirm the diagnosis by actually
observing either pinworms or their eggs; the suspicion of an infection is usually
enough for treatment.
Humans are considered the only hosts of pinworms, so this type of worm
cannot be caught from pets. Pets carry other sorts of worms, such as roundworm,
tapeworm and hookworm which can be transmitted very occasionally to people.
Children and individuals who are immunocompromised are more vulnerable to
infection with animal worms than adults.
Pinworm is the most common worm infection occurring in New Zealand and
it is estimated that every child is infected with this parasite at least once before
reaching secondary school.
Symptoms of worms
Many people infested with worms have no symptoms at all. Some people,
particularly children, are more likely to complain of:
• itching around the bottom, typically at night – this is caused by a reaction to
the glue used by the pinworm to attach its eggs to the skin
• sleep disturbance from scratching, which may result in daytime tiredness or
irritability
• teeth grinding or bed-wetting
• broken, infected skin around the bottom from persistent scratching (refer to
pharmacist)
• abdominal pain, nausea or vomiting with severe infestations.
Sometimes in females, the adult worms migrate to the vagina instead of
returning to the bowel. Itchiness in the vaginal region along with a mucous or
blood-stained discharge may be reported.
Symptoms of either hookworm or tapeworm infections are usually nonspecific.
Infection may cause inflammation in the intestines which may then
cause abdominal discomfort and loss of appetite leading to weight loss and
malnutrition. Roundworms tend to migrate around the body to the lungs, liver
and eyes and, while most mild infections are asymptomatic, some people may
have a swollen liver, rash, or complain of lung or eye problems.
Transmission of worms
Pinworm eggs are able to survive outside of their human host for up to two
weeks and the eggs are easily picked up through contact with infected surfaces
(such as bed sheets, toys, taps) and then swallowed if hands are not washed
properly before eating. Airborne eggs carried in dust or released into the air after
making the bed may also be inhaled.
Larvae hatch out of the pinworm eggs and live in the lower bowel, migrating
out of the infected person’s bottom (usually at night) to lay their eggs. If children
scratch their bottom, the eggs can get under their fingernails. The eggs can then
be transferred to objects or other people and be swallowed, starting the cycle
again. Children are more likely to become infected because they sometimes
forget to wash their hands after playing, going to the toilet, or before eating
food and are often putting their hands in their mouth.
People get roundworm and hookworm infections through direct contact
with infected pet faeces. Tapeworms are transmitted by fleas and also through
undercooked meat from infected animals. Pets should be wormed and deflead
monthly, and dog faeces should be bagged and disposed off promptly.
Eggs and larvae of roundworm and hookworm are very resilient and can
survive for a long time in areas such as parks, playgrounds, backyards, and
even inside homes.
Initial assessment
In a quiet area of the pharmacy, talk with the caregiver or person with suspected
worms about their symptoms (it is not necessary to actually visualise a worm).
TREATMENT OPTIONS
Category Examples Comments
Mebendazole
Pyrantel
Sanitising products
[PHARMACY ONLY MEDICINE]
eg, Combantrin-1, de-Worm, Vermox
[PHARMACY ONLY MEDICINE]
eg, Combantrin
[GENERAL SALE]
eg, Dermasoft Alcohol Free Foaming Hand
Sanitiser, Germ-X range
The dose is the same for everybody aged over two years. Repeat dose in two to four weeks.
Chewable tablets, squares or suspension are available. The tablet can also be crushed and
given to children mixed with honey, food or fruit juice.
The dose is 10mg/kg (consult guide on back of packet). Recommended for children aged
one year or older. Treatment of children aged less than one year should be under medical
advice. Repeat the dose in two to four weeks. Chewable squares, suspension and tablets are
available. Take as a single dose, after food.
Encourage children and adults to wash their hands or use sanitising gels or wipes before
eating and after going to the toilet. This can help stop the spread of worms.
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Page 170 HEALTHCARE HANDBOOK 2017-2018 Common Disorders