Common Intestinal Parasitic Disease

Common Intestinal Parasitic Disease

The high prevalence of intestinal infestation in the pediatric population in developing countries poses a serious challenge to health workers. Multiple infestation so-called poly parasitisms are often encountered. Varying degrees of protein energy malnutrition is an important component of the clinical picture.


Ascaris lumbricoides (Round worm) accounts for the highest proportion of intestinal parasitosis. The worm is 20-40 cm in length. Its appearance is so characteristic that the diagnosis is practically beyond doubt when there is a good history of expulsion of the worm in the stools or in the vomitus.

Clinical features

The clinical picture depends upon the worm-load, the child's nutritional status and worm location in or outside the gastrointestinal tract, and upon the stage of worm development from larva to adult worm.
Ascariasis is a great mimicker. The most important symptoms are: abdominal pain and distension, vomiting, growth failure, excessive appetite or geography. In some cases it may he asymptomatic.

Occasionally it presents as acute intestinal obstruction, small intestinal function and structure, however, remain normal Pica, sleeplessness,irritability, urticaria, anemia and evidence of vitamin deficiencies and diarrhea are present in some cases.

Migration of larvae may cause Ascaris pneumonia (Loet'ller's syndrome), asthma-like manifestations, hepatomegaly, splenomegaly or encephalopathy. Gross eosinophilia and Ieukocytosis are generally present.

Prevention :

Prevention of ascariasis will not he achieved in some tropical areas for many years and will be related both to improvement of socio-economic conditions and better health education of the community. The corner-stone in the prevention of ascariasis is the provision of adequate disposal of faeces.


Hookworm infestation is particularly common within rural populations and amongst slum dwellers in towns. Each adult worm depletes the host of a little over 0.1 to 0.5 ml of blood. Two main types of hookworm-Ancylostoma duodenal and Necator americanus produce a similar picture.

Adult worms are found in the duodenum and small intestine. Eggs are passed in the stools, develop into free living larvae on reaching the soil and after four days or more these become mature and are capable of penetrating unbroken skin. They are carried to the lungs and migrate via the bronchi and trachea lo the esophagus and eventually in the small intestine.

Clinical feature:

It includes progressive anemia, anorexia, and abdominal pain. Malnutrition is often present .Advanced cases may have a gross iron deficiency anemia with hypo protein anemia leading to edema and even anasarca. Diarrhea alternating with constipation and even malabsorption occurs in some cases.

The so-called ground itch, as a result of larval skin invasion over feet is often unnoticed.


Infestation with Enterobius vermicularis. popularly known as thread worm or pin worm is very common, particularly in infants and young children. Often there is 'a hislory of passage of a worm which is invariably reliable. Routine stool examination will usually miss the ova. The cellophane -tape technique should he employed in doubtful cases.

Clinical features

Clinical features consist of pruritus arm with or without superadded infection due to intense itching and scratching. In some girls there is associated vulvo-vaginitis. As a result of nocturnal pruritus, restlessness and insomnia may occur resulting in poor appetite. Behavioral problems like grinding of teeth, masturbation and enuresis may occur. In rare invasions appendicitis and salpingitis may be caused by Enterobiasis .


Infeclion with Trichuris trichura, the so-called whip worm is not common. It causes prolonged diarrhea with anemia, rectal prolapsed and allergic manifestations like eosinophilia and Charcot-Leyden crystals in the stool. It especially affects children of preschool age.


This infestation is not common, although higher incidences are reported from many countries. There are three kinds of tape worm. Hymenolepis nana (Dwarf tape worm), Tenia saginata (Beef tape worm) and Tenia solium (Pork tape worm).


The prevalence of this infestation in children is far less than the 15% prevalence in adult populations.

Clinical features

E. histolitica presents as diarrhea with or without blood. There is no typical picture and stool inspection may show it to be formed, with flakes of blood and mucous, or resembling red currant jelly. Varying degrees of fever, flatulence, large bowel colic and tenesmes may he associated with acute diarrhea.

It also may be associated with amoebic liver abscess. hepatitis, partial or complete intestinal obstruction, intussusceptions, perforation of the colon, peritonitis. rectal ulcers and fistulae. A group of patients may remain symptom-free while passing cysts in their stools; this is rarely encountered in pediatric practice.


This infection causes considerable morbidity and mortality in infancy and childhood. Giardia lamblia was, interestingly, regarded for many years as a normal part of the gut flora. Considerable evidence of its pathogenicity having accumulated, this is a fascinating example of how medical concepts can undergo radical change.

Clinical Features

Symptomatic patients have vague upper abdominal pain, recurrent diarrhea with a history of constipation, poor appetite, failure to thrive and nutritional deficiencies. In some of the cases it may present as a malabsorption syndrome. Occasionally, there may be an acute dysenteric presentation. It may actually lead to subtotal villous atrophy of the small intestine.


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