Helminthic Infections

Helminths are pathogenic or parasitic worms. They include roundworms (nematodes), flukes (trematodes), or
tapeworms (cestodes). Most helminths begin life when the eggs or larvae are eliminated in the feces or urine of humans.
They are then transmitted to the oral cavity by contaminated foods or hands. Because children tend to be careless
about washing their hands before eating or tend to suck their thumbs, it makes them prone to this infections.

Types of Helminths:

Roundworms (ASCARIASIS)

 Ascaris Lumbricoides are generally asymptomatic infections but when there is an extensive parasite load,
malnutrition and gastrointestinal symptoms result (AAP, 2015).
 With an incubation period of 8 weeks, the nurse must obtain a history of travel to underdeveloped countries.
 The roundworm parasite lives in the intestinal tract. Larvae, which hatch from the ingested eggs, penetrate the
intestinal wall and enter the circulation. From there, they may migrate to any body tissue.
 Children develop a loss of appetite and nausea and vomiting. Intestinal obstruction may occur from a mass of
roundworms in the intestine.
 The roundworms are transmitted through the consumption of contaminated food or water, especially in areas
where sanitation is poor. Once inside the body, the worms can grow up to 35 centimeters in length and lay eggs
that are then passed out in the feces.
 Ascariasis can be prevented by the sanitary disposal of feces to prevent contamination of the soil.
 There are several treatment options
a. a single dose of albendazole with food
b. Nitazoxanide twice a day for 3 days
c. A single dose of ivermectin (off-label use and not to be used in children less than 15kg.) (AAP, 2015)

Hookworms

 Hookworm infections tend to be asymptomatic and are more common in children living in tropical climates with
poor sanitation. Hookworm eggs, like roundworm eggs, are found in human feces. They enter children's bodies
through the skin and then migrate to the intestinal tract, where they attach themselves onto the intestinal villi
and suck blood from the intestinal wall to sustain themselves.
 They are named for their hook-like mouthparts, which they use to attach themselves to the intestinal wall and
feed on blood.
 Abdominal pain which is colicky in nature, nausea, and diarrhea with marked eosinophilia can be presenting sign
4 to 6 weeks after exposure.
 If a great number of hookworms are present, severe anemia may result.
 Treatment is with Albendazole (albenza), Mebendazole (Vermox), and pyrantel pamoate (Pin X) are effective
(AAP, 2015). Children may also need therapy for the anemia.
 hookworms can also cause intestinal obstruction in severe cases. In addition, hookworms can also cause skin
irritation and a rash known as "ground itch" when they penetrate the skin during their life cycle.

Enterobiasis (Pinworms)

 Pinworms are small, white, threadlike worms that live in the cecum (A pouch that forms the first part of the
large intestine. It connects the small intestine to the colon, which is part of the large intestine.). After ingestion
of the egg either by ingestion or breathing, the mature worms develop over a period of 2 months in the cecum.
The mature female pinworm then migrates out of the anus to deposit eggs on the skin in the anal and perianal
region.
  The movement of the worms causes the anal area to itch, and the child will awaken at night crying and
scratching. Some of the eggs are then carried from the child's fingernails to the mouth. After being ingested,
they hatch in the child's intestinal tract, and the cycle is repeated (CDC, 2016f).
 The worms are large enough that they can be seen if the child's buttocks are separated. Pressing a piece of
cellophane tape against the anus and then inspecting it under a microscope will generally reveal pinworm eggs.
 Treatment is with a single dose of Mebendazole (Vermox) or pyrantel pamoate (Anthihelminthic) (CDC, 2016f).
Underclothing, bedding, towels, and nightclothes should be washed before reuse. In addition, all family
members need to be treated for pinworm infestation. Because the worms are easily transmitted from person to
person. Teach children to avoid nail biting and to wash their hands before food preparation or eating to avoid
transfer of pinworm eggs and to prevent this type of infection.

PREDISPOSING FACTORS:
(also known as parasitic worm infections, are a common health problem among children, particularly in low-income
countries. The risk factors for helminthic infections in children include:)

 Poor sanitation - lack of access to clean water, proper disposal of human waste and hygienic living conditions
increases the risk of helminthic infections.
 Poverty - children from low income households are at higher risk of helminthic infections due to inadequate
housing, poor nutrition, and limited access to health care
 Living in rural areas - children living in rural areas where there is a high prevalence of helminth infections among
humans and animals are at increased risk of infection
 Lack of education - lack of awareness and knowledge about the risks of helminthic infections, and the
importance of hygiene and sanitation practices can increase the risk of infection.
 Poor nutrition - malnutrition and inadequate intake of essential nutrients can weak a child's immune system,
making them susceptible to infections.
 Contact with contaminated soil - children who play in contaminated soil or are involved in agriculture, such as
farming, fishing, or animal husbandry, are at increased risk of infection
 Lack of access to deworming treatment - children who do not receive regular deworming treatment are at
higher risk of infection and re-infection.

(it is important to address these risk factors to prevent and control helminthic infections in children. This can be achieve
through improved sanitation, health education, access to clean water and regular deworming treatment.

CAUSES
(Helminthic infections in children are caused by different types of parasitic worms that live in the human body. The
transmission of these infections can occur in various ways, including)

 Contaminated soil - The eggs or larvae of some helminths can be present in soil contaminated with human or
animal feces. Children who play in soil or live in areas with poor sanitation may come into contact with these
parasites.
 Contaminated food and water - Helminth eggs or larvae can contaminate food and water supplies, especially in
areas with poor hygiene and sanitation.
 Poor hygiene - Poor personal hygiene practices such as not washing hands after using the toilet or before eating
can lead to the transmission of helminthic infections.
 Contact with infected individuals - Some helminths can be transmitted through direct contact with infected
individuals or their bodily fluids.
 Vector-borne transmission - Certain helminths are transmitted by insect vectors, such as mosquitoes or flies,
that feed on human blood.
 Animal-to-human transmission - Some helminths can be transmitted to humans through contact with infected
animals or consumption of undercooked or raw meat.
 Mother-to-child transmission - In some cases, a pregnant woman with a helminthic infection can transmit the
parasite to her unborn child.
PATHOPHYSIOLOGY
(The pathophysiology of helminthic infections depends on the type of worm that has infected the host, but in general,
the worms cause damage to the body by)

1. Feeding on the host's tissues: Parasitic worms feed on the host's blood or tissues, which can lead to anemia,
malnutrition, and tissue damage.
2. Blockage of vital organs: Large numbers of parasitic worms can block vital organs such as the intestines, lungs,
or bile ducts, leading to organ dysfunction or failure.
3. Inducing an immune response: The immune response to parasitic worms can cause inflammation, tissue
damage, and hypersensitivity reactions.
4. Altering host physiology: Some parasitic worms release substances that alter the host's physiology, such as
increasing the permeability of the intestines or altering the host's immune response.
5. Contributing to co-infections: Helminthic infections can also increase the risk of co-infections with other
pathogens, such as bacteria and viruses.

CLINICAL MANIFESTATIONS:
(The clinical manifestations of helminthic infections in children can vary depending on the type of worm and the
severity of the infection. Some of the common clinical manifestations of helminthic infections in children are:)

 Abdominal pain - parasitic worms in the intestines can cause abdominal pain, bloating, cramps
 Diarrhea - helminthic infections can cause diarrhea which can be chronic or acute
 Malnutrition - due to the parasites feeding on the host's nutrients
 Anemia - parasitic worms that feed on blood can cause anemia, which can lead to fatigue, weakness and pale
skin
 Skin rash - some helminthic infections can cause a skin rash or itching
 Coughing and wheezing - helminthic infections in the lungs can cause coughing, wheezing and DOB
 Allergic reactions - some children may develop allergic reactions to helminthic infections, which can cause hives,
itching and swelling
 Fever - can cause a low-grade fever, which can be persistent in some cases
 Anal itching - some helminths, such as pinworms, can cause anal itching and discomfort.

( It is important to note that some children with helminthic infections may not show any symptoms, and the severity of
symptoms can vary depending on the child's immune system and overall health status.)

DIAGNOSTICS
(The diagnosis of helminthic infections in children involves a combination of clinical evaluation, laboratory tests, and
imaging studies. Some of the common diagnostic methods for helminthic infections in children include)

 Stool examination - examination of stool samples for the presence of parasite eggs, larvae, or worms is a
common diagnostic method for H.I. different techniques such as direct wet mount, concentration methods like
formalin-ether sedimentation, or antigen detection by ELISA can be used.
 blood tests - can detect the presence of specific antibodies to helminths, which can help diagnose the infection
 Imagine studies - such as ultrasound, x-ray, or CT scans can be used to detect the presence of helminthic
infections in various organs, such as the liver or lungs.
 Serological tests - are blood tests that can detect specific antibodies to helminths, and can be used to confirm
the diagnosis of some type of helminthic infections
 Biopsy - in some cases, a tissue biopsy may be performed to confirm the diagnosis of helminthic infections
(The choice of diagnostic method depends on the type of helminth and the location of infection. In some cases, a
combination of diagnostic methods may be required to make an accurate diagnosis. Early diagnosis and treatment of
helminthic infections in children is crucial to prevent complications and improve outcomes.)

MEDICAL MANAGEMENT

(there are several non-pharmacologic measures that can be used to manage helminthic infections in children, both in
the hospital and community settings. Here are some examples)

 Nutritional support - helminthic infections can cause malabsorption of nutrients, leading to malnutrition.
Nutritional support, including the provision of high-energy, protein-rich foods, vitamin and mineral supplements,
and hydration therapy, can help manage malnutrition and improve the immune response to infection
 Blood transfusion - in severe cases of anemia caused by helminthic infections, blood transfusions may be
necessary to restore the child's red blood cell count.
 Surgery - in rare cases of severe infection, surgical intervention may be necessary to remove worms or treat
complications such as bowel obstruction.
 Education and hygiene promotion - education about good hygiene practices, such as regular hand washing,
proper disposal of human waste and avoidance of contaminated soil, can help prevent the spread of helminthic
infections in the community.
 Environmental sanitation - Improving sanitation infrastructure, such as providing access to clean water and
proper waste disposal systems, can reduce the risk of exposure to helminth infections.
 Social support - The emotional and psychological impact of chronic helminthic infections can be significant,
particularly in children. Social support, including counseling and community support groups, can help children
and their families cope with the challenges of living with these infections

PHARMACOLOGIC MANAGEMENT:
(The pharmacologic management of helminthic infections in children involves the use of anthelmintic drugs that are
effective against specific types of helminths. The choice of drug depends on the type of helminth and the severity of the
infection. Here are some commonly used anthelmintic drugs for the treatment of helminthic infections in children)

 Albendazole - is effective against a wide range of helminths, including roundworms, hookworms, whipworms,
and tapeworms. It is usually given as a single dose or for a few days. (to treat infections caused by worms. It
works by keeping the worm from absorbing sugar (glucose), so that the worm loses energy and dies)
(Albendazole is usually not recommended in infants (less than 1 year) because we don't have enough safety data
in this age group. According to WHO, the albendazole 200 mg dose is recommended for children in age group 1-
2 years. A single dose is sufficient to treat worm infestations.)
 Mebendazole - is used to treat infections with roundworms, hookworms, and whipworms. It is given for a few
days. (Mebendazole is a type of medicine for treating worms. It's used mainly for infections of the gut such as
threadworms (sometimes known as pinworms) and other less common worm infections (whipworm,
roundworm and hookworm). It works by stopping worms from using sugar (glucose) to live.)
 Praziquantel - is used to treat infections with tapeworms and flukes. It is given as a single dose. (Praziquantel is
used to treat schistosoma (infection with a type of worm that lives in the bloodstream) and liver fluke (infection
with a type of worm that lives in or near the liver). Praziquantel is in a class of medications called anthelmintics.
It works by killing the worms).
 Ivermectin - Take tablets on an empty stomach. Tablets may be crushed for administration to small children.
Ivermectin is also used for the treatment of strongyloidiasis (200 micrograms/kg single dose) and cutaneous
larva migrans (200 micrograms/kg daily for 1 to 2 days).
 Pyrantel pamoate - children 12 years of age and over, and children 2 years to under 12 years of age - oral
dosage is a single dose of 5 milligrams of Pyrantel Base per pound (or 11 milligrams per kilogram) of body
weight, not to exceed 1 gram (4 teaspoonfuls).
( the dosage and duration of treatment depend on the type of helminth and the severity of the infection. In some cases,
repeat treatment may be required to ensure complete eradication of the worms. These drugs may cause side effects
such as nausea, abdominal pain, and diarrhea. Serious side effects are rare.

It is important to note that pharmacologic management alone is not enough to control helminthic infections in children.
Preventive measures such as good hygiene practices, access to clean water and sanitation facilities, and regular
deworming treatment are also important. Children in endemic areas should receive regular deworming treatment every
6 to 12 months, regardless of symptoms or infection status.)

COMPLICATIONS
(Helminthic infections in children can lead to several complications, particularly if the infection is chronic or severe.
Some of the complications that can occur include:

 Malnutrition - helminthic infections can cause malabsorption of nutrients from food, leading to malnutrition and
stunting in children.
 Anemia - chronic blood loss due to intestinal worm infestation can lead to iron deficiency anemia.
 intestinal obstruction - in rare cases, a large number of worms can cause obstruction of the intestines, leading
to abdominal pain, vomiting and constipation
 Growth and development delays - helminthic infections can interfere with normal growth and development in
children, leading to delays in physical and cognitive development.
 Cognitive impairment - chronic helminthic infections have been associated with cognitive impairment and poor
school performance in children
 Immunological impairment - helminths can suppress the immune system, making children more susceptible to
other infections
 Liver and lung damage - some helminths can migrate to the liver or lungs, causing inflammation and damage to
these organs
 Chronic diarrhea - helminthic infections can cause chronic
diarrhea, leading to dehydration and electrolyte imbalances

(The severity of complications depends on the type and duration of the infection, as well as the child's age and overall
health. Prompt diagnosis and treatment of helminthic infections, along with preventive measures such as good hygiene
practices and regular deworming treatment, can help reduce the risk of complications in children.)

NURSING DIAGNOSIS
(Nursing diagnosis for helminthic infections in children may vary depending on the type and severity of the infection.
However, here are some potential nursing diagnoses that may apply)

 Imbalanced Nutrition: Less than Body Requirements related to malabsorption of nutrients caused by helminthic
infection.
 Risk for Deficient Fluid Volume related to chronic diarrhea caused by helminthic infection.
 Risk for Infection related to the presence of helminths and the potential for secondary infections due to
weakened immune system.
 Anxiety related to the diagnosis and treatment of helminthic infection, fear of complications, and the potential
impact on daily life.
 Knowledge Deficit related to lack of understanding about the cause, transmission, prevention, and treatment of
helminthic infections
 Pain related to abdominal cramps caused by the presence of worms.
 Altered Growth and Development related to chronic malnutrition caused by helminthic infection.
 Altered Self-Concept related to the physical appearance caused by chronic malnutrition, such as stunted growth
and wasting.
 Risk for Impaired Skin Integrity related to scratching and itching of the perianal area caused by the presence of
worms.
(These nursing diagnoses can guide the nursing interventions and the development of the care plan for children with
helminthic infections. The nursing interventions should focus on promoting good nutrition, maintaining fluid balance,
preventing infections, providing education, and managing symptoms such as pain and anxiety.)

NURSING INTERVENTIONS
(The nursing interventions for helminthic infections in children will depend on the specific needs of the child, the type
and severity of the infection, and the care setting. Here are some general nursing interventions that may apply)

 Administer prescribed medications - anthelmintic drugs are the primary treatment for helminthic infections.
The nurse should ensure that the child receives the correct medication and dose as prescribed by the physician.
 Provide nutritional support - Malnutrition is a common complication of helminthic infections. The nurse should
encourage the child to eat a balanced diet and provide nutrient-rich foods such as fruits, vegetables, and protein
sources.
 Monitory fluid balance - Chronic diarrhea caused by helminthic infections can lead to dehydration and
electrolyte imbalances. The nurse should monitor the child's fluid intake and output and administer oral or
intravenous fluids as needed.
 Promote good hygiene - Helminthic infections are often transmitted through contact with contaminated soil or
feces. The nurse should educate the child and family about the importance of hand washing, proper disposal of
human waste, and avoidance of contaminated soil.
 Manage symptoms - Abdominal cramps and itching in the perianal area are common symptoms of helminthic
infections. The nurse should provide comfort measures such as warm compresses and administer analgesics or
antipruritics as prescribed by the physician.
 Provide education - The nurse should provide age-appropriate education about the cause, transmission,
prevention, and treatment of helminthic infections. The child and family should also be educated about the
importance of regular deworming and follow-up care.
 Monitor for complications - Helminthic infections can lead to complications such as anemia, malnutrition, and
cognitive impairment. The nurse should monitor the child for signs of these complications and intervene as
appropriate.

(These nursing interventions can help manage the symptoms, prevent complications, and promote the child's recovery
from helminthic infections.)