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Helminthiasis

Helminthiasis is a term describing a parasitic infection by helminths, a wide group of roundworms, flukes, and tapeworms. They infect a substantial proportion of the world's population, particularly in poorly developed areas, such as South East Asia and certain parts of Africa and Latin America. The diagnosis rests on clinical criteria, a properly obtained patient history with an emphasis on demographics, travel, and microbiological studies.


Presentation

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]
  • Anemia has also been associated with reduced stamina for physical labor, a decline in the ability to learn new information, and apathy, irritability, and fatigue.[en.wikipedia.org]
  • Although global funding for these programmes has increased markedly in recent years, “donor fatigue” may set in as a major obstacle to sustained funding if initial successes (which are invariably largest at the beginning), are not maintained.[doi.org]
Italian
  • […] these practises from ancestral heritage in an advanced country like Italy, is only relevant if the aim is to recoup a cultural identity which is already in decline.It is significant to report a piece: on 14 October 2007 the news on a well-known national Italian[ncbi.nlm.nih.gov]
  • Marco Bertoni, Giorgio Brunello and Lorenzo Rocco, When the cat is near, the mice won't play: The effect of external examiners in Italian schools, Journal of Public Economics, 104, (65), (2013).[doi.org]
Camping
  • Using an immunoassay for Δ9-tetrahydrocannabinol-11-oic acid (THCA), a urinary biomarker of recent cannabis consumption, we validated cannabis use in men currently residing in camps near a logging road (n 62).[ncbi.nlm.nih.gov]
Fever of Unknown Origin
  • […] of unknown origin [FUO] Fever with chills Fever with rigors Hyperpyrexia NOS Persistent fever Pyrexia NOS worm B83.9 Granuloma L92.9 ICD-10-CM Diagnosis Code L92.9 Granulomatous disorder of the skin and subcutaneous tissue, unspecified 2016 2017 2018[icd10data.com]
Intravenous Drugs
  • Cryptosporidiosis among HIV positive intravenous drug users in Malaysia. Southeast Asian J Trop Med Public Health. 1995;25(4):650–3. Norhayati M, Zainudin B, Mohammod CG, Oothuman P, Azizi O, Fatmah MS.[spaj.ukm.my]
Abdominal Pain
  • FINDINGS: Less than half of the 65 care providers mentioned one or more major symptoms of intestinal schistosomiasis (abdominal pain 43.1%, bloody diarrhoea 13.9% and bloody stool 7.7%).[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • 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]
  • Dependent on parasite burden, symptoms range from none in a light infection to diarrhea, malnutrition, weight loss, abdominal pain, malaise, impaired cognitive and physical development, and anaemia in a heavier infection.[infontd.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]
Lactose Intolerance
  • In pigs and humans, Ascaris has been linked to lactose intolerance and vitamin A, amino acid, and fat malabsorption.[en.wikipedia.org]
Maculopapular Rash
  • 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[symptoma.com]
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]
  • Only a few participants reported mild abdominal pain, headache, dizznes or slight fever, as other previous reviews mentioned [14], [52].[doi.org]
  • Mostly due to a lack of available data on a global scale, the current estimate for cysticercosis is limited to its role in epilepsy in endemic countries and does not yet include the role of this infection in causing severe chronic headaches and hydrocephalus[doi.org]

Workup

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].

Toxocara Canis
  • 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[symptoma.com]
  • canis Toxocara catiHelminthiases are classified as follows (the disease names end with "-sis" and the causative worms are in brackets): Filariasis (Wuchereria bancrofti, Brugia malayi infection) Onchocerciasis (Onchocerca volvulus infection) Soil-transmitted[en.wikipedia.org]
Chlamydia
  • […] peritoneum in infectious diseases classified elsewhere 2016 2017 2018 2019 Billable/Specific Code Manifestation Code Code First underlying disease, such as: congenital syphilis ( A50.0 ) helminthiasis ( B65.0 - B83.9 ) Type 1 Excludes peritonitis in chlamydia[icd10data.com]
  • Burton MJ, Holland MJ, Makalo P, Aryee EA, Sillah A, et al. (2010) Profound and sustained reduction in Chlamydia trachomatis in The Gambia: a five-year longitudinal study of trachoma endemic communities. PLoS Negl Trop Dis 4: e835.[doi.org]
Tissue Nematode
  • 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]

Treatment

  • 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]
  • ; and (iii) bi-annual treatment coupled with latrine construction at family level and regular health education.[ncbi.nlm.nih.gov]
  • Seven, 74 and 79 participants belonged to three different treatment groups.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The simultaneous diagnosis of filariasis and intestinal parasites as well as the high frequency of geohelminths justify the need to reevaluate the treatment strategy used in the Brazilian filariasis large-scale treatment program.[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]

Prognosis

  • Prognosis - Helminthiasis Not supplied. Treatment - Helminthiasis Not supplied. Resources - Helminthiasis Not supplied.[checkorphan.org]

Etiology

  • 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]

Epidemiology

  • The present review attempts to compile the available data on schistosomiasis and STHs, from 1940 to 2014, to provide an insight on the epidemiological profile of these infections.[ncbi.nlm.nih.gov]
  • To collect contemporary epidemiological information, a cross-sectional survey was undertaken inclusive of: signs and symptoms of disease, individual treatment histories, local water, sanitation and hygiene (WASH)-related factors and malacological surveillance[ncbi.nlm.nih.gov]
  • 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]
  • We performed a meta-analysis of six drug efficacy trials and one epidemiological survey.[ncbi.nlm.nih.gov]
  • However, epidemiological data available are often limited to prevalence estimates.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Prevention

  • 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]
  • 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]
  • 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]
  • Findings indicate that years of disease prevention and control efforts in these areas have been unable to bring down prevalence in children and their parents.[ncbi.nlm.nih.gov]
  • Preventive chemotherapy (PC), the large-scale distribution of anthelminthic drugs to population groups at risk, is the core intervention recommended by the WHO for reducing morbidity and transmission of the four main helminth infections, namely lymphatic[ncbi.nlm.nih.gov]

References

Article

  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.

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Last updated: 2019-07-11 22:10