Worms - A deeper look into pinworms (threadworm)

Ever experience itchy bum during your childhood and your mum said that you must have worms in your tummy? And then you cry so hard because you just can't imagine there are worms living in your tummy?

Worms

There are some worms are parasitic who live in our guts such as tapeworm (usually found in uncooked meats), roundworm, hookworm, whipworm, pinworm etc. Usually all these worms feed on food (nutrients) we ingest and reproduce in our GI system. Our guts are lovely home for some worms especially for pinworms. However, there are some worms who live in other parts of our bodies such as blood, brain, eyes, liver etc.

Some worms can be transmitted from animals to human while the others (pinworms) can't.

Today, we are going to look into pinworms, that could be usually treated by OTC (over-the-counter) medicines.

What are pinworms? 

Image of pinworm/threadworm

Pinworm is very common in New Zealand. Pinworm is also commonly known as threadworm.  To date, it is believed that human is the only host that threadworm prefer (lucky us. lol). Almost everyone has the chance to be infected by threadworms.

Threadworms, as what its name tell us - is a cotton-like threads that is about 5-10 mm long.

Threadworms can be easily spread around. If you inhale the dust containing threadworm's eggs, they can then grow in your lower GI tract. It can be also spread by contact - saliva from others, personal things sharing , and infected surface (eggs can survive few days to weeks even they are outside the human body).

When threadworms or eggs are being swallowed, they will hatch in your gut and stay around your over gut, At nighttime, the female adult threadworms will travel to your bottom and lay thousands of eggs (sounds scary), which stick to your bottom with "glues". Those "glue" may cause allergy reactions and result in itchiness.

If you scratch your bottom and do not wash your hand properly, you may ingest the eggs and re-infect yourself [feacal-oral route transmission]. So, personal hygiene is crucial. Your mum is right ! Wash your hands before you eat.

What makes you think you or your kids have worms? 

Usually, we notice our kids have worms when they keep scratching their bottoms or complain about itchiness around their bottoms especially at night time.

There are other signs that you or your kids may have worms

- bedwetting or teeth grinding ( which they normally do not have)
-restlessness at night
- become irritable or tired during day time because of lacking sleep

Sometimes, the intense scratching can damage the skin around the bottom and cause secondary infection. If there is oozing , weepy or crusty


Rarely, they will complain about stomach discomfort or abdominal pain.

Usually, we do not have to diagnose worms by physically spotted worms around the bottom. The worms and their eggs are tiny that hardly spotted with bare eyes.

However, if you are concerned and want to see if they have worms, you can do this at night after your child sleeps. Use a torchlight to help you observe if there is presence of white thread-like moving creatures (threadworms). Or you can simply look at your child stools to see if there is presence of white threads.

Treatment options 

Anthelmintic (anti-worm) medicines can be used to get rid of the worms. 

For pinworms, the common two medicines used on the market is either mebendazole or pyrantel. 

(a) Mebendazole 

eg Combatrin-1

-mebendazole works by reduce the absorption of glucose by worms and eventually starve the worms to death. 

- can use to treat every single member from family ( unless pregnant or aged < 2 years) as single dose. 

- may repeat treatment after 2-weeks if required. 

Talk to a pharmacist if the child is under 2-years. Under certain conditions, pharmacist may recommend the use of this medicine for those who are > 6 months. 

The formulations available on the market is either chewable tablet or liquid form. If the kids still cannot swallow well, can crush the chewable tablet and mix them in food

Combatrin-1 - single dose treatment of threadworms

Single  dose treatment - mebendazole 100 mg 

Vermin containing mebendazole 

(b) Pyrantel 

- pyrantel works by paralyses ("stunt") the worms and thereby losing their ability to cling on to the bowel wall go our gut. As a result, the worms are flushed out from our body together with stool whilst we pass our motion.

-it is believe that pyrantel could be more effective than mebendazole, but you need to calculate the dosing or you can get help form pharmacy staff (believe me, it's easy calculation)

- For pyrantel, we need to calculate the dosing for each family member  (child aged > 2 years and adult) based on weight - 10mg/kg.

- (pyrantel is safe for those aged more than 12-months and onwards)

 e.g. If your kid is 20 kg, then give 2 squares (200mg) to him/her

Calculation: 20 kg x 10 mg/kg = 200 mg
           
1 square contain 100 mg , therefore 2 squares (200 mg) are needed

may repeat 2-4 weeks after treatment

Combatrin - contain pyrantel 

Combatrin contain pyrantel 

Advice 

Personal hygiene is imperative in preventing the spread or re-infection of threadworms.

Wash your hands frequently (especially before eating, after going to toilets)  [as we knows the worms could be transmitted via fecal-oral route]. 

Therefore, train your kids to have a good practice of cleanliness 

(i) use washing gel or sanitiser in school often. 

(ii) Keep fingernails short and clean 

(ii) Abstain from nail biting or finger sucking 

Wash bed linen (to get rid of threadworms and their eggs) using hot water 

Referral point 

 - If scratching caused oozing pus, crusty or angry read skin , refer to a pharmacist or doctor
- if customers have been to overseas ( especially developing countries or remote area) within past 24 months (some worms grow very slowly)
- unexplained decrease in weight
- pregnant ladies
-allergy to OTC medicines (mebendazole or pyrantel)
-have tried anti-worms medicine but do not seem to work

References 

1. https://medlineplus.gov/druginfo/meds/a608048.html

2. https://medlineplus.gov/druginfo/meds/a610019.html

3. https://medlineplus.gov/druginfo/meds/a682315.html

4. http://www.combantrin.co.nz/treatment.html

5. https://medlineplus.gov/druginfo/meds/a682820.html



NB: the pictures displayed were obtained form Google search images.