Sunday, May 16, 2010

Minor ailment: Deworming - what, when, how

Given the cleanliness and hygiene in Singapore, there are still many parents who are concerned about their children having "worms". Some of the common question asked would be 'how often to deworm?', 'what are the signs of worm infection?' and 'how to prevent worm infection?'.

Worm infections can be broadly classfied into roundworm, whipworm, hookworm, tapeworm, fluke or pinworm infections. Most common one that usually presents with not much symptoms or minor signs is pinworm infection which I would briefly describe here. The age group most at risk is young children as most of them are in playschool, infection could be spread while playing or eating if one of them has got it because the eggs could be picked up on their fingers. So educating children on the habit of hand-washing before eating and avoid putting their fingers or nails to their mouth is important, on top of basic personal hygiene. Other sources of worm infection could be from ingestion of contaminated food/water, raw food, soil, faeces or infected animals.

The most frequent symptom would be perianal itching esp at night (when the female worm lays its eggs), other possible symptoms include abdominal discomfort, insomnia, nervousness, loss of appetite, nausea and diarrhea. Signs would include finding small white worms near the anus or in stools. 'Tape test' can also be used to check for pinworm infection.
If child presents with any of such more severe symptoms like abdominal pain, persistent diarrhea, headache, fever or weightloss, parents should bring them to a doctor for further assessment to ascertain whether there are other underlying causes or infections. Note that not all children with poor appetite or abdominal relates to pinworm infection.

Despite adminstering self-treatment if symptoms are minor and signs point to pinworm infection, personal hygiene cannot be further emphasized. Hygiene at home and in school is very important to prevent a re-infection.

Some tips to get rid of pinworm eggs:
  • Wash all the sheets, blankets, towels and clothing in hot water
  • Cut fingernails short
  • Scrub toys, countertops, floors and other surfaces the infected child has touched
  • Vacuum carpets
Read here for more details and about prevention.

So how often to deworm?

In the developing countries where children are more prone to worm infection, deworming is recommended to be administered routinely in schools instead of 'only when confirmed' according to WHO guide. It would be carried out once, twice or thrice yearly depending on the prevalence of the condition in the area.

In Singapore I have not come across any guidelines on routine deworming, correct me if I am wrong. Thus, I would recommend deworming only on an as-needed basis.

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Albendazole dosing for pinworm treatment:

1-2 years old 200mg as a single dose, adult and children>2 years old 400mg taken as a single dose. Can be repeated in 2-3 weeks if symptoms recur.

Note that family members in the house should also be treated concurrrently if a child is infected. If symptoms persist after 2 weeks or worsen to include symptoms like abdominal discomfort, insomnia, nervousness, fever etc. patient should see a doctor.

Tablets may be chewed or taken with water after food in healthy individuals with no known allergy to this medication. Young children should take the liquid formulation.

**Consult your doctor before self-medicating if pregnant.
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Interesting encounter - a patient came to ask for albendazole for treating worms in the leg and if I recalled correctly, it was for a 2 weeks duration. For cases like whipworm, threadworm... there are information on albendazole dosing for 3 days but for 2 weeks it is really rare. The only case that I saw in a book for 2-week treatment period is for Hydatid cyst. I had to refer the patient back to his doctor because it is really not a normal 'pinworm' case, there is no notes or script from the doctor and 'worm in the leg' is unheard of.

For unusual signs of suspected worm infection, it is advisable to see a doctor and request for a prescription before purchasing albendazole. This is so that we can ascertain a proper diagnosis has been made and the appropriate dosing is being prescribed. =)
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Tapeworm infection usually come about from the ingestion of contaminated water or raw / partially cooked meat. Different types of tapeworms come from different animals. There are myths about using tapeworm to lose weights, but as myths are myths, this is a dangerous and unfounded method which could lead to serious complications. To read more, check out WebMD here http://www.webmd.com/digestive-disorders/tapeworms-in-humans

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