7/1/2019
I Got Worms… ADAM C. HUNT, DO, MHS COVENANT EMERGENCY CARE CENTER, SAGINAW, MI
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Disclosures
This is gonna make you cringe…
No financial disclosures
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Tapeworm (Cestoda)
Taenia sp (Saginata, Solium) https://www.cdc.gov/parasites/taeniasis/biology.html
Beef and Pork
Diphyllobothrium latum
Bear/Fish Tapeworm
Cysticercosis v. Adult Tapeworm
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Tapeworm
Presentation: Dizziness, Abd Pain, diarrhea, headache, localized pain Treatment Praziquantel & albendazole
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Sushi worm
Anisakis simplex (Anisakiasis)
Preparation/Cooking/Freezing
Japan (2K-3K), ↑ in US
Treatment
EGD & Albendazole
https://www.cdc.gov/parasites/anisakiasis/biology.html
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Hookwork
Ancylostoma duodenale & Necator americanus
Barefoot (skin) contact with larvae hatched from human feces
Anemia from blood loss in GI tract
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Hookworm
Life Cycle
Phases
Cutaneous, Pulmonary, Intestinal
Symptoms
Cutaneous Larval Migrans
Cough, hemoptysis
Abd Pain, Diarrhea, Anemia
Treatment
Albendazole, Mebendazole
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Schistosomiasis
Schistosoma mansoni, haematobium, japonicum
CDC: “In terms of impact this disease is second only to malaria as the most devastating parasitic disease. Schistosomiasis is considered one of the neglected tropical diseases (NTDs).”
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Schistosomiasis
Life Cycle Migratory, Acute and Chronic Phases Treatment Praziquantel Long term effects Bladder CA Ascites Adults live in vascular system and soft tissue Prevention
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Roundworm
Ascaris lumbricoides (Human Roundworm)
Soil transmitted helminths (STH) along with hookworm and whipworm
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Roundworm
Fecal-Oral
Ingest eggs from contaminated soil or vegetables
Symptoms
Very mild, abdominal discomfort, cough, progresses to bowel obstruction
Treatment
Albendazole and Mebendazole
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Filarial Worm
Wuchereria bancrofti, Brugia malayi and Brugia timori
Lymphatic filiariasis, Lymphedema, Elephantiasis
Arthropod Born Disease (Anopheles, Aedes, Culex quinquefasciatus, Mansoni)
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Filarial Worm
No animal intermediate host
Adult worms live in lymphatic vessels
Treatment
Diethylcarbamazine (DEC)… funny story
Ivermectin, if co-infected with Onchocerciasis or Loa Loa
Doxycycline???
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Whipworm
Trichuriasis (Trichuris trichiura)
Fecal-Oral (Contaminated soil or veggies)
Symptoms
Depends on worm burden, can be painful stools with mucus, water and blood
Children can have anemia, growth retardation, impaired cognitive development
Rectal Prolapse
Treatment
Albendazole or Mebendazole
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Pinworm
Enterobiasis (Enterobius vermicularis)
Most common worm infection in the US
Mostly affects children, people who are institutionalized and those who care for these populations
Gravid females migrate to perianal region and lay eggs at night
Scotch tape test
Treatment
Mebendazole, pyrantel pamoate, or albendazole
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Fun Book
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Resources
Atlas of Tropical Medicine. 6th Ed. Wallace Peters & Geoffrey Pasvol. 2008.
Foundations of Parasitology. 6th Ed. Gerald Schmidt, Larry Roberts & John Janovy. McGraw-Hill. 2000.
CDC website
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