Worm infestation: Adults not immune

It is a common thought that only children are affected by worms, but that is a misconception. Adults, too, are vulnerable to worm infestation, especially where exposure to contaminated food, water, or soil is common. 

Consuming undercooked or improperly handled food can introduce worms into the body, leading to health complications. 

Symptoms may go unnoticed at first, but over time, infestation can cause fatigue, abdominal pain, digestive issues and even nutrient deficiencies.

Who is at risk?  

Children under the age of five are highly vulnerable to worm infestation, according to Dr Aisha Namirimu, a paediatrician in Wakiso district.

Playing in dirt, putting unclean objects in their mouths and crawling or sitting on contaminated surfaces expose them to worm eggs, which can easily enter their bodies. 

These eggs develop into parasites that feed on nutrients meant for the child’s growth. Adults are not immune to worm infestation. Namirimu warns that in some cases, the effects can be even more severe than in children. 

Statistics 

In 2021, the World Health Organisation (WHO) reported that 29.9% of people needing treatment for parasitic worms were reached globally. Among those requiring treatment, 43.3% were school-aged children. 

The WHO also highlights that over 260 million preschool-age children and 654 million school-age children are at risk. 

A study showed an overall intestinal worm infection prevalence of 49.38%, with Ascaris being the most common parasite at 46.88%.

Worms typically live in the intestines.

Common causes 

Worm infections are often linked to poor sanitation and the consumption of contaminated food and water, according to Sharon Naluwende, a nutritionist at Mulago Hospital. 

Other common causes include eating unwashed fruits and vegetables, using dirty hands or unclean surfaces when preparing food and consuming raw or undercooked meat or vegetables. 

Handling pets and not washing hands afterwards can also expose people to parasite eggs found in animal faeces. 

These can enter the body when one touches the mouth or food. Walking barefoot improves circulation, but can also increase the risk of acquiring hookworms in contaminated areas. 

Larvae in soil can penetrate the skin, especially through bare feet, leading to infection.

Symptoms 

Worm infestation occurs when parasitic worms, such as hookworms, roundworms or tapeworms, enter the body, often through contaminated food, water or soil, according to Dr Hassan Mayanja of Mercy Hospital. 

Once inside the body, these worms travel through the bloodstream to organs such as the lungs and intestines. 

This can trigger a chronic cough and fever as the immune system responds to the foreign invaders. Severe infestation, Mayanja says, can cause significant blood and nutrient loss, leading to anaemia, fatigue and malnutrition. 

Skin rashes and eye pain may occur if larvae migrate to those tissues. Among children, if untreated, worm infestation can lead to malnutrition, weakened immunity, stunted growth and poor school performance. 

Mayanja explains that worms typically live quietly in the intestines, but once they multiply, they can cause intestinal obstruction, leading to severe abdominal pain, vomiting and constipation. 

In advanced cases, worm-related infections, such as amoebiasis, may enter the lymphatic system or bloodstream, affecting the lungs (causing coughing), liver (causing swelling or abscesses or life-threatening inflammation), or even the brain (causing seizures or confusion). 

Worms can weaken the immune system by stealing nutrients and causing chronic inflammation, making the body more vulnerable to other diseases and reducing its ability to fight infections. 

Other symptoms of a worm infestation include bloating, diarrhoea and night-time anal itching, especially from pinworms, explains Haspha Nassolo, a nurse at Joint Clinical Research Centre. 

These effects impact both children and adults, though children are more vulnerable to long-term consequences such as stunted growth and poor cognitive development.

Deworming should be done at least twice a year for individuals at a high risk of worm infestation.

Treatment and prevention 

In both children and adults, deworming is one of the often recommended treatments, which plays a crucial role in maintaining overall health and preventing severe complications. 

Namirimu recommends that children under five years be dewormed every three months. Since entire households often share meals and environments, experts recommend that deworming should be done as a family exercise. 

Treating just the children while ignoring the adults can lead to re-infestation and ongoing health problems. Worm infestation depletes essential nutrients, making it harder for children to develop properly. 

Thus, according to UNICEF, children who are regularly dewormed have better learning abilities, growth rates and weight gain compared to those who are not. 

Mayanja advises that deworming should be done at least twice a year for individuals at a high risk of worm infestation. However, if someone exhibits symptoms or notices worms in their stool, they should deworm more frequently. 

In severe cases, one may need more than dewormers, including treatments such as antibiotics, herbal remedies, and colon cleansers. Mayanja advises against self-prescription, advising that one seek medical personnel’s advice on the treatment for worms. 

Parasitic worms follow a lifecycle that includes eggs, larvae and adult stages. To eliminate an infestation completely, Namirimu advises that this entire cycle must be broken. 

Deworming medications are effective at killing adult worms, but if eggs are left behind, often in the intestines or on contaminated surfaces, they can hatch and restart the cycle. 
Similarly, treating eggs without killing the adults leads to continued egg-laying. 

Deworm as a family 

Proper management 

Proper management includes taking follow-up doses of medication and maintaining strict hygiene. 

Good sanitation involves using clean toilets, washing hands after using the toilet and before eating, cutting fingernails short, washing beddings regularly and ensuring clean food and water. 

It is also important to safely dispose of stool because when human waste contaminates soil or water, it spreads parasite eggs. These practices help prevent reinfection and protect others. 

Although walking barefoot is said to improve blood circulation, Mayanja recommends that the practice should be done in clean environments to avoid infections. 

Walking barefoot in dirty and contaminated areas or where animal or human waste may be present exposes you to worm infestation. 

Staying well-hydrated is crucial during a worm infestation, especially when symptoms include diarrhoea and vomiting, which can cause fluid loss, Naluwende explains. 

Drinking plenty of clean water helps flush out toxins, supports digestion and aids recovery. Proper hydration also prevents complications such as dehydration, which can worsen weakness and fatigue during treatment and healing. 

While self-prescribed deworming may be safe for mild cases, routine cases, especially in children, require seeking medical advice if symptoms persist, worsen or interfere with daily activities, to rule out serious complications.

Worm infestation can cause intestinal obstruction, leading to severe abdominal pain.

Caution 

Mayanja explains that while some home remedies, such as papaya seeds, garlic and pumpkin seeds, are believed to expel worms, they are not a substitute for medically approved deworming treatment.

Diagnosis 

According to Haspha Nassolo, a nurse at Joint Clinical Research Centre, signs that require seeing a doctor include persistent stomach pain, blood in the stool, chronic fatigue, weight loss or visible worms. 

One examination to determine an infestation of intestinal worms, such as roundworms, hookworms, tapeworms and whipworms, is a stool test. For threadworms, a tape test is commonly used. 

Blood tests can detect parasites such as filarial worms or signs of anaemia, explains Dr Hassan Mayanja of Mercy Hospital. 

Imaging tests such as X-rays, ultrasounds, MRIs or colonoscopy may be used in severe cases to detect worm-related complications or when worms invade organs outside the intestines.

Types of intestinal worms 

Intestinal worms come in different types, some microscopic and others visible to the naked eye. According to Dr Aisha Namirimu, a paediatrician in Wakiso district, the common types of worms include: 

Tapeworms: These are flat, ribbon-like and are usually contracted from eating undercooked pork, beef or fish. Symptoms include tiredness, weight loss, diarrhoea and abdominal pain. 

Hookworms: These enter the body through the skin, especially when walking barefoot on contaminated soil. They feed on blood in the intestines and can cause severe anaemia and diarrhoea.

Roundworms: They are often contracted through contaminated soil, food or stool. Children are more vulnerable due to hand-to-mouth behaviour. If untreated, roundworms can migrate to the lungs, liver or eyes, causing cough, breathing issues, liver damage or vision problems. Severe cases may lead to malnutrition and intestinal blockage. 

Liver flukes: These attack the liver, creating holes in it. They are transmitted through consuming contaminated food. 

Pinworms/threadworms: They are commonly found in children as they spread through poor hygiene, which includes contaminated hands, surfaces or bedding. They lay eggs around the anal opening, causing intense itching especially at night, irritability, loss of appetite and abdominal pain.