Here's an overview of the 3 common worms children catch on holiday, how to very easily avoid them and what to do about them if caught.
Soil transmitted worms (soil transmitted helminths), are the most common infections worldwide. Worms in pregnancy and childhood can have serious consequences, and they are present all over the tropics.
Soil transmitted worms are so called because they enter your body from soil. Patients become infected by either swallowing the worm eggs or by worms penetrating the skin (hookworms). As such, infection is more common in people who dont wear shoes and in children (small children are grubby and they put hands into their mouths a lot!), and in places where hygiene is poor (lack of latrines/ use of ‘night-soil’/ lack of clean water).
The 2 that you swallow:
Whip worm (Trichuris trichiura)
Whipworm eggs in poo contaminate soil, and therefore vegetables, in many Low-resource settings. When swallowed on unwashed veg, the eggs travel to the next persons intestine where the worms can grow (adults are whip-shaped) and feed on tissue juices. That can cause vague tummy discomfort but most people don’t know they have them unless they have a lot of them-
with heavy infestations the worms need more space so they move lower down to the rectum, where they are less welcome. Here infestation can cause bloody diarrhoea and subsequent anaemia and tiredness. Whipworm is also capable of direct infection from anus to mouth if hands arent washed.
Is whipworm dangerous?
Heavy infestation often leads to rectal prolapse but this is treatable.
Roundworm (Ascaris Lumbricoides)
Roundworm eggs live in soil and so again they get onto chicken eggs, or veggies. If swallowed their larvae go to your intestine and enter blood and lymph vessels.
Within a fortnight they reach the lung (where they often cause wheezing and an asthma like picture), climb up the throat and get swallowed down to the stomach where they will start to develop into adults. Adults (upto 40cm long) live in the intestine and enjoy the food that is eaten, causing nutritient deficiencies, anaemia and fatigue.
Roundworm rarely cause symptoms except for the fright when seen in poo. Though they don’t cause pain they do cause nutrient deficiency in children and are important to avoid.
Is Roundworm dangerous?
Occasionally worms wander to cause pancreatitis or liver abscess, or appendicitis. Rarely, ascaris worms may tangle cause dangerous intestinal obstruction. They are infamous for poking out of noses to have a look around!
I changed my mind about showing that photo. A worm crawling out of a childs nose.
Help your child avoid these worms in travel:
Wash food in clean water, practice regular hand washing!
You can watch a hand-washing video for children from the CHC here: https://youtu.be/x3QUtQQp8W4?si=KcuiTLBzk9_HHsEG
Diagnosis and treatment
Diagnosis overseas is easy by looking at poo samples in level 2/3 hospital facilities (or by Ultrasound in level 4 facility), or indeed when you return to the UK.
They are easily treated with medicines like mebendazole but you must see a doctor to check the medication is suitable for you and also that you dont have other worms first. Do not deworm children under 2 years old with over the counter medicines without specialist advice.
The 1 that enters through our skin:
Human Hookworm (Ancylostoma duodenale or Necator americanus)
Hookworm living in the soil enter skin via hair follicles or old cuts. That's usually when walking without shoes or if kids have been sitting on the sand with their bare bottoms. From the skin they travel to the lung. The tiny adults (only about 1cm long) migrate and enter the intestine. They bite and suction onto bowel lining. These worms do actually feed on blood.
The most common symptom is ‘ground itch’ at the site where larvae have entered the skin. You can see the larvae moving under the skin in what we call "Larva migrans".
Its extremely relentlessly itchy such that I've seen it make grown men cry.
It can be treated at this point with cream or oral medicine depending on the childs age.
With a load of worms in their tummy patients may have a distended uncomfortable tummy, flatulence, nausea, vomiting and (sometimes bloody) diarrhoea. These symptoms, along with the tiredness from loosing blood very much affect learning capacity in school children.
Is Hookworm dangerous?
Hookworm adults consume very little blood; (only about 1 ml per day, with a little extra lost from the site of attachment) but when dietary intake is also poor then hookworm infestation gradually contributes to iron deficiency anaemia. It is then associated with cognitive impairment over time.
Help your child avoid these worms in travel:
Wear flip flops or other shoes on beach and grass, put a picnic blanket on the sand where your child is sitting.
Diagnosis and treatment
Hookworm eggs, with their characteristic shape can be seen in poo under a microscope at most medical centers, whether overseas or back home. Blood tests may show anaemia. Over the counter Medicine is currently effective- see a doctor to check its suitable, as depending on where you have travelled and for how long you may have other parasites that this medicine could cause to abruptly move as they try to flee from it.
Summary
Soil transmitted worms are rather disgusting and they cause chronic health problems to millions of children in the tropics. In travellers they can be easily avoided and treated.
So if you have been living in a country where local children have worms or working closely with children overseas you should plan to be dewormed on your return home.
If you think you may have worms because you have some symptoms see a doctor for testing. This is especially important for small children and in pregnancy.
Never de-worm a child somewhere remote with no access to healthcare because of the rare but potential side effects.
Do you have questions about worms pre or post travel?
Feel free to contact me here: https://www.childrenstraveldoc.com/ask-a-query
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