Helminths are multicellular parasitic organisms that can cause a range of infections [1]. They are encountered in the areas of the developed world with poor sanitation and socioeconomic conditions, and where various vectors that facilitate their transmission are present [1] [2] [3]. More than 2 billion people are affected worldwide. Helminthiasis, is an infection caused by several parasites which are classified as [1] [2] [3] [4] [5] [6] [7]:

• Intestinal roundworms - Ascaris lumbricoides (large intestinal roundworm), Ancylostoma duodenale and Necator americanus (hookworms), Strongyloides stercoralis (threadworm), Enterobius vermicularis (pinworm) and Trichuris trichura (whipworm) are perhaps the most prevalent helminthic organisms in the world, affecting almost 1 billion people in poorly developed parts of Latin America, Africa, and Asia (China and India) [1] [3] [4] [6]. Intestinal roundworms are all introduced into the human body after ingesting food or other products from soil contaminated with parasitic eggs, thus the term "soil-transmitted helminths" is frequently used [5] [6]. Some intestinal roundworms, however, can cause an infection by invading the human host through breaks in the skin when being in contact with contaminated soil, such as Necator americanus and Strongyloides stercoralis [1] [8]. The majority of patients are asymptomatic, but a range of clinical manifestations may be seen in severe infestation, particularly in immunocompromised children and adults [4] [6] [7]. Gastrointestinal complaints (nausea, vomiting, chronic abdominal pain, diarrhea, malnutrition, reduced appetite), pulmonary symptoms (cough, dyspnea), skin rashes and perianal pruritus are some of the most common symptoms, whereas dissemination of the parasite from the intestines into other organs might occur as well [1] [2] [3].
• Tissue roundworms - Filarial parasites (Loa loa, Wucheria bancrofti, Onchocerca volvulus, Brugia malayi), Trichinella spiralis (the causative agent of trichinellosis), Dracunculus medinensis (Guinea worm), Toxocara canis and T. cati (the causative agent of visceral larva migrans), and Ancylostoma braziliense (responsible for cutaneous larva migrans) are classified into this group of nematodes as they cause infections related to other tissues in the body [2] [3] [4]. Except for trichinellosis, widely known for its acquisition through contaminated meat products, and Dracunculiasis (ingestion of water contaminated with copepods that harbor parasitic eggs) various vectors are integral parts of tissue roundworm life cycle (Anopheles, Aedes, and Culex mosquitoes, as well as black flies) [1] [2] [3]. The sub-Saharan Africa is the principal area where tissue roundworm infections are diagnosed, while Latin America and Asia are also important sites [4]. When the infection is symptomatic, clinical features include lymphedema and elephantiasis (W. bancrofti and B. malayi), conjunctivitis, chorioretinitis and visual deficits (Loa loa and O. volvulus), whereas watery diarrhea, vomiting, abdominal pain, myalgia and weakness appearing peaking in intensity approx. 2-4 weeks after ingestion of contaminated meat are the hallmarks of T. spirallis, which may be life-threatening if complications (myocarditis, encephalitis) develop [6] [7] [8].
• Flukes - The most important helminth belonging in this group are Schistosoma spp. that cause human infection after their acquisition from water sources (through swimming, fishing or drinking) being contaminated by their eggs from snails, pivotal hosts for their life cycle [3]. The clinical course involves three distinct syndromes - the swimmer's itch (manifesting as a maculopapular rash 2-3 days after infection), acute schistosomiasis (also known as Katayama fever, distinguished by fever, hepatosplenomegaly and generalized lymphadenopathy), and chronic infection, in which gastrointestinal (diarrhea, vomiting, abdominal pain, nausea) and urinary (hematuria, obstruction, dysuria, etc.) symptoms are seen, depending on the species responsible for the infection [1] [2] [3]. Other notable flukes are those infecting the intestines (Fasciola hepatica, Fasciolopsis buski) and the liver (Clonorchis sinensis and Opisthorchis viverinni).

• Generalized Lymphadenopathy

  lymphadenopathy), and chronic infection, in which gastrointestinal (diarrhea, vomiting, abdominal pain, nausea) and urinary (hematuria, obstruction, dysuria, etc.) symptoms are seen, depending on the species responsible for the infection. [symptoma.com]

• Fatigue

  Recently, Aluna started to feel quite ill and began suffering from nausea, vomiting, and extreme fatigue. She has also become very confused. [study.com]

  Said parasites resides & stay in the gastrointestinal tracts, the liver & other organs Symptoms & Signs Symptoms includes abdominal pain, diarrhea, fever, fatigue, enlarged liver & spleen, cough, malabsorption, anemia bowel obstruction,dehydration, itchy [signssymptoms.org]

  Symptoms Symptoms of Helminthiasis are as follows: 1) Abdominal pain 2) Diarrhea 3) Fever 4) Fatigue 5) Pruritis ani 6) Gastrointestinal inflammation 7) Weight Loss 8) Eosinophilia 9) Dehydration 10) Anorexia 2. [slideshare.net]

  Other effects of hookworm infection include itchy rash, cough, fever, bloody sputum, and loss of appetite, nausea, vomiting, diarrhea, abdominal discomfort, paleness, fatigue and blood in the stool [21]. Figure 4. [intechopen.com]

• Problems at School

  Abstract Even with a national control programme in place, intestinal schistosomiasis continues to be a major public health problem in school-aged children and other community members in Uganda. [ncbi.nlm.nih.gov]

  Wisniewski, Child Nutrition, Health Problems, and School Achievement in Sri Lanka, World Development, 38, 3, (315), (2010). Scott Barrett, Stop! [doi.org]

• Nightmare

  Sound like a nightmare? It is indeed, a real nightmare! And here it is: Soil-transmitted Helminthiasis (STHs). Imagine one day, you wake up in the middle of the night, you ran to your mum. [neglecteddiseasesissue.wordpress.com]

  Hicks, "Computer Viruses: Controller's Nightmare", Management Accounting, Vol. 71, No. 4, Pg. 44, 1 October 1989. Markoff, J., "Author of Computer 'Virus' is Son of U.S. Electronic Security Expert", Pgs. A1, A7, The New York Times, 5 November 1988. [tools.ietf.org]

• Developmental Disorder

  Morbidity associated with STH infection includes iron deficiency anemia, malnutrition, growth and developmental disorders including short stature, and cognitive developmental disorders. [hindawi.com]

• Fever of Unknown Origin

  (inanition) (of unknown origin) (persistent) (with chills) (with rigor) R50.9 ICD-10-CM Diagnosis Code R50.9 Fever, unspecified 2016 2017 2018 2019 Billable/Specific Code Applicable To Fever NOS Fever of unknown origin [FUO] Fever with chills Fever with [icd10data.com]

• Abdominal Pain

  Gastrointestinal complaints (nausea, vomiting, chronic abdominal pain, diarrhea, malnutrition, reduced appetite), pulmonary symptoms (cough, dyspnea), skin rashes and perianal pruritus are some of the most common symptoms, whereas dissemination of the [symptoma.com]

  Recurrent urticaria, abdominal pain, peripheral eosinophilia, hyperimmunoglobulin E and small bowel abnormalities on roentgenograms prompted evaluation of a 36 year old man for intestinal parasitism. [ncbi.nlm.nih.gov]

  Common gastrointestinal complaints associated with helminth infection include abdominal pain, nausea, and diarrhea. [amboss.com]

  Disease Symptoms and Treatments: People with light soil-transmitted helminth infections usually have heavy infections can cause a range of health problems, including abdominal pain, diarrhoea, blood and protein loss, rectal prolapse, and physical and [omicsonline.org]

• Abdominal Distension

  The commonest presenting features were abdominal distension (44 patients) and abdominal pain (38 patients). Thirty-three patients presented with vomiting, of whom 8 vomited worms. Twenty-five patients presented with peritonitis. [ncbi.nlm.nih.gov]

• Epigastric Pain

  Examples include migration of A. lumbricoides through the mouth, occasional gastrointestinal symptoms (epigastric pain 0.3%, diarrhoea 0.3%, nausea 0.2%, vomiting 0.1%), central nervous system symptoms (headache 0.2%, dizziness 0.1%), and rare allergic [doi.org]

• Headache

  Reported adverse reactions include occasional vomiting (5%), dizziness (3%), headache (3%), and weakness (2%); all such reactions were mild and transient [37] – [39]. [doi.org]

  The usual mild side effects of praziquantel which generally do not require treatment are malaise, headache, dizziness, abdominal discomfort with or without nausea and/or vomiting, fever and urticarial. [intechopen.com]

• Behavior Problem

  McDermott S, Coker AL, Mani S, Krishnaswami S, Nagle RJ, et al. (1996) A population-based analysis of behavior problems in children with cerebral palsy. J Pediatr Psychol 21: 447-63. [omicsonline.org]

As the majority of helminths can be diagnosed through appropriate microbiological methods, it is the physician's clinical suspicion during the assessment of the patient which plays an important role in the workup. Because helminthiasis encompasses a large number of parasitic organisms, however, a comprehensive clinical and laboratory workup is vital in narrowing the list of potential pathogens responsible for the infection. As most helminths are endemic for tropical parts of the world, a detailed patient history of recent travel to these areas, or if they resided in these parts of the world for a prolonged period of time [1] [3] [5] should be obtained. If patients did visit endemic regions, the physician should further assess if they consumed local products or were exposed to water sources that may have been contaminated [1] [3]. After performing a meticulous physical examination, laboratory workup should start with a complete blood count (CBC), which will reveal eosinophilia, one of the most important findings that point toward helminthiasis as the underlying cause of symptoms [7]. Current diagnostic strategies advise testing of feces, sputum, blood, urine, skin, and biopsies of the liver or muscle in rare cases, but the examination of feces is perhaps the main diagnostic method in the field of parasitology [1] [2] [3] [7] [8]. The majority of parasites are excreted in stool in their egg form, including all intestinal roundworms, the majority of flukes, and tapeworms as well (Taenia saginata, T. solium, Diphyllobothrium latum and Hymenolepsis nana) [1] [2] [3] [7]. On the other hand, detection of specific antibodies is available for several helminths, such as Strongyloides stercoralis, T. spiralis, lymphatic filariae (W. bancrofti and b. malayi), virtually all flukes, and T. canis and T. cati [1] [3].

• Tissue Nematode

  […] and Larval Tissue Nematodes. ii) Tapeworms: They are found in the intestine or larvae in the tissues. iii) Flukes: These are hermaphrodites with an exception of blood flukes. [slideshare.net]

FINDINGS: Expanded community-wide treatment was highly cost effective compared with treatment of only school-aged children (ICER $167 per DALY averted) and WHO guidelines (ICER $127 per DALY averted), and remained highly cost effective even if treatment [ncbi.nlm.nih.gov]

At the dosage recommended for STH treatment, the incidence of side effects following treatment reported in the literature is very low. [doi.org]

Moreover, quantitation of worm burden is also important to assess the intensity of infection and prognosis. [ncbi.nlm.nih.gov]

The treatment of drug-resistant TB is much more complicated requiring much longer treatment regimens of up to 2 years, an even so, with very poor prognosis and suboptimum treatment outcomes. [intechopen.com]

We also conducted etiological survey of parasitic diseases in Japan. 1) Treatment with Nationally Unlicensed Medicines (Sub-projects: ‘Importation, management and distribution of unlicensed drugs for parasitic diseases’, ‘Efficacy and safety of nationally [nettai.org]

METHODOLOGY: Adults were administered an anamnestic questionnaire in mid-2010 during a cross-sectional epidemiological survey in the Taabo health demographic surveillance system in south-central Côte d'Ivoire. [ncbi.nlm.nih.gov]

Latinne D, Fiasse R (2006) New insights into the cellular immunology of the intestine in relation to the pathophysiology of inflammatory bowel diseases. Acta Gastroenterol Belg 69:393–405 PubMed Google Scholar 28. [link.springer.com]

Clinical Guidelines NTDs & Others Helminthiasis Subcategories: Sort by: select Language: Recommendations Preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups Preventive chemotherapy to control soil-transmitted [medbox.org]

OBJECTIVE: To determine the STH infections among the schoolchildren in the Mekong River basin near rural Ubon Ratchathani, Thailand and Champassak, Laos PDR, including their caregiver knowledge and attitude concerning prevention of STH infections. [ncbi.nlm.nih.gov]

Prevention and Control Following measures can be taken for prevention and control of the disease: 1. Sanitary measures a. Sanitary disposal of human excreta to prevent or reduce faecal contamination of the soil. b. [slideshare.net]

Treatment/Prevention Strategy: Multiple drugs can be used to treat the infections or for preventative chemotherapy. Albendazole (donated by GlaxoSmithKline), which is also used for LF, and mebendazole (donated by Johnson & Johnson) are most common. [ntdenvision.org]

1. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2016.
2. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
3. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Seventh edition. Philadelphia: Elsevier/Saunders; 2013
4. Hotez PJ, Brindley PJ, Bethony JM, King CH, Pearce EJ, Jacobson J. Helminth infections: the great neglected tropical diseases. J Clin Invest. 2008;118(4):1311-1321.
5. Croker C, Reporter R, Redelings M, Mascola L. Strongyloidiasis-Related Deaths in the United States, 1991–2006. Am J Trop Med Hyg. 2010;83(2):422-426.
6. Brooker S, Clements AC, Bundy DA. Global epidemiology, ecology and control of soil-transmitted helminth infections. Advances in parasitology. 2006;62:221-261.
7. Nutman TB. Evaluation and differential diagnosis of marked, persistent eosinophilia. Immunol Allergy Clin North Am. 2007;27(3):529-549.
8. Nikolay B, Brooker SJ, Pullan RL. Sensitivity of diagnostic tests for human soil-transmitted helminth infections: a meta-analysis in the absence of a true gold standard. Int J Parasitol. 2014;44(11):765-774.