CASE 9

HELMINTHIASIS

PARACYTIC INFECTION:
HELMINTHIASIS
(ASCARIASIS & ENTEROBIASIS)

TIM AKADEMIK
DIVISI SOOCA
NOSTRA
 CASE REVIEW

5 y.o., male

CC : vomiting of a rounded smooth, cream-colored worm, 15-20 cm

History taking Physical Examination Lab Examination

• had history of anal itch • appearance: pale, dirty finger- • Hb ↓
• had history of weight nails • complete blood count
loss • weight: 15 kg, height: 100 cm shows eosinophilia
• loss of appetite was • chest xray: eosinophilic lung • stool examination find-
noticed for last 4 weeks ings: Ascaris lumbricoides,
allo-anamnesis Enterobius vermicularis
• lived in rural area in eggs
kecamatan Jatinangor
• had poor socio-econom-
ic status
• parents had poor level
of education
• did not have proper
defecation facility
• boy barefooted most of
the time
• boy rarely had his
fingernails cut & hands
washed before taking food

Diagnosis : Ascaris lumbricoides & Enterobius vermicularis infection

Treatment:
non-pharmacology: health education, discriminate defecation,
hand-washing before meals, thorough washing of vegetables &
fruit eaten raw, wear sandal or shoe to avoid contact with con-
taminated soil
pharmacology: antihelminthic drug, regular fecal examination
(twice yearly) followed by deworming if possible
 FBS
Sign & symptoms
CONCEPT MAPPING
RF: poor hygiene, 5 y.o. boy
rural area, habits
eat with dirty hands
worm eggs enter body infectious stage, parasit, morphology
helminthiasis prevention & control
STH swallowed infective A. lumbricoides eggs treatment, BHP, PHOP
diagnostic procedure
egg hatch in gaster
NSTH swallowed infective E. vermicularis eggs
transform into larvae in small intestine
dyspnea gaster, larvae
penetrate intestinal walls
eosinophilia caecum
carried to right heart
cough
maturation
carried to lungs break capillary blood
& move around adult in intestine
inflammation fever copulation
penetrate trachea male worms die female migrate to perianal area
swallowed back into small intestine insert tail pin into perianal mucosa
adult worms in small intestine ovideposition
lay eggs interfere food intake migrate to gastric irritate intestine pruritus (irritation around anal region)
eggs carried by faeces malnutrition abdominal tension blood eosinoplihilia
weight loss anemia womit adult worm
pale Hb ↓
 1. Host, parasites, and parasitism
2. Human nematodes (soil-transmitted & non-soil
transmitted helminths)
3. General morphology of worm eggs, larvae, adult
worms
4. Identification of infective stages
5. Lifecycle of STH and NSTH (Ascaris & Enterobius)
6. Pathogenenesis and pathophysiology of ascariasis &
enterobiasis related to sign & symptoms
7. Diagnostic procedure of helminthiasis
8. Non-pharmacologic management
9. Prevention & control, risk factor
10. PHOP: deworming strategy, personal hygiene,
sanitation; BHP: mass deworming treatment → dis-
cuss ethic of blanket (whole community) treatment
vs individual treatment

BASIC SCIENCE
HOST, PARASITES, & PARASITISM
PARASITES
Organism living temporarily or permanently in or on the surface of other organisms in order to ac-
quire their nutritional needs as well as protection from the organisms
Parasitic terms
• Obligate parasites (permanent): parasites unable to live without host
• Facultative parasites (opportunist): free-living organism that can be parasite if the condi-
tion permits, e.g. amoeba (Neglasia & Acanthamoeba), Microsena
• Temporary/intermittent parasites: parasites living part of their life cycle freely, and the
rest being parasitic, e.g. Strongloides stercoralis
• Coprozoic/spurious parasites (false): foreign parasites that passes the host intestinum &
found in stool dead or alive, but do not infect host at all
• Pseudoparasit: parasite-like artifacts
• Incidental parasites: parasites that lodge on host not usually infested
Based on parasites' living space on host
• Ectoparasites: lives on the body surface (skin) of host, most are arthropods. The attach-
ment of ectoparasites on the host's body is called infestasion
• Endoparasites: lives inside the host's cody. The entry of endoparasites into the host's body
is called infection
Based on amount of definitive host
• Homoksenosa: only need one definitive host, e.g. Enterobius vermicularis
• Stenoksenosa: need a small amount of definitive host
• Heteroksenosa: need a large amount of definitive host, e.g. Clonorchis sinenses
Based on inflicted damage
• Pathogenic parasites: inflict local/systemic damage
• Apathogenic parasites: do not inflict any damage
Parasitic entrance
Mouth, skin penetration, arthropod bites, inhalation, transplacental/congenital, transmammary,
sexual acts, hypodermic needle, blood transfusion, organ transplantation
Sources of infection
• Contaminated soil or water. E.g.: stool (Ascaris lumbricoides, Trichiuris trichiura, Strongy-
loides stercoralis, and hookworm). Contaminated water may contain amoeba cysts, intestinal
flagellas, Taenia solium eggs, and the cercaria stage of blood trematodes
• Food containing parasitic infective stages
• Blood-sucking arthropods, e.g.: Leshmania, Trypanosoma, Filaria
• Both wild and domesticated animals, e.g.: pork may contain Trichinalla spiralis and Tania
solium larves; dogs are source of Echinococcus granulosus larves and hydatid cysts
• Hydrophytes, e.g. Trapa spp. contain Fasciolopsis buski and watercress contain Fasciola
hepatica
• Other humans, e.g. Entamoeba histolytica, Enterobius vermicularis, Hymenolepsis nana
• Autoinfection (from one-self), e.g. Strongyloides stercoralis

host
Organism harboring parasites; place of parasitic living and breeding
• Definitive host (terminal): human, plants, or animals hosting mature parasites and/or
sexually reproducing parasites
• Intermediate host: human, plants, or animals hosting immature parasites/larva (ergo a
place to spend part of their life cycle)/asexual reproduction
• Paratenic host: potential host that can house parasites, although young parasitic develop-
ment does not occur; neither supporting nor hindering parasites in completing their life cycle
• Vectors: host that tranfers parasites to human.
ƒƒ Biologic vectors: essential in parasitic life cycle
ƒƒ Mechanic vectors: non-essential in life cycle

parasitism
Relationship between host and parasites and is one type of symbiosis (permanent, mutual relation-
ship between two different species). In this type of interaction, only one species benefits while the
other suffers.

GROUPS IN PARASITOLOGY
Sarcomastigophora

Apicomplexa

Cillophora

Zooparasite Protozoa Microspora

(Parasitology) Metazoa Arthropods

Helminths
PARASITES Phytoparasite Fungus (mycology)

Bacteria (bacteriology)

Spyrochaeta and viruses (virology)

Protozoa
• Unicellular with eukaryotic cellular structure
• Divided into intestinal parasites and blood & tissue parasites
• Small and microscopic
• Part of life cycle is spent outside human host, can multiply inside human
• Infection by ingestion, inhalation, or insect bite
• No eosinophilia found in protozoa infection
• Has fragile trophozoitic stage and resistant cyst

Metazoa
• Multicellular with eukaryotic cellular structure
• Divided into helminthes and arthropods
• Large and visible to the eye
• Part of life cycle is spent outside human host, but cannot multiply in human
• Infection by ingestion, skin penetration, or insect bite
• Eosinophilia found in almost all helminthic infection

Parasitic life cycle

• Sexual: hermaphrodite and sexually separate
• Assexual
Characteristic of diseases by parasite: no tissue damage and no clinical symptoms

HUMAN NEMATODES (STH AND NON-STH)

soil transmitted helminths
Soil-transmitted helminths are nematodes which undergoes embryonal development in the earth;
also requires period of development and maturation during its life cycle in soil.
Habitat: in the lumen of small intestine: jejunum and ileum.
Soil-transmitted helminths that inhabits the human intestines are:
• Ascaris lumbricoides
• Trichiuris trichiura
• Hookworm (Necator americanus and Ancylostoma duodenale)
• Strongyloides stercoralis
In Indonesia, soil-transmitted helminthes remain a public health problem with a high prevalence.
Factors encouraging the development and infection of these helminths in Indonesia are:
• The wet and humid tropical climate
• Poor hygiene and sanitation
• Low level of education and socio-economic status
• High population density and poor lifestyle
General characteristics of soil-transmitted helminthic infection:
• Non-acute and non-fatal
• Occurs primarily in slum areas
• Children are commonly infected with Ascaris lumbricoides and Trichiuris trichiura
• Young adults are commonly infected with hookworms (in the plantation and mining area):
Necator Americanus and Ancylostoma duodenale

nonsoil-transmitted helminths
Nonsoil-transmitted helminths are nematodes which infection of humans and life cycle are inde-
pendent of soil. Nonsoil-transmitted helminths that infect humans are:
 • Enterobius vermicularis
• Trichinella spiralis
• Capillaria philippinensis
• Angiostrongylus cantonensis
• Gnathostoma spinigerum
What's important about STH & NSTH is that we can diffirentiate between the both of them. For
example, if a patient has a single infection of Ascaris lumbricoides, man-to-man infection cannot
occur because A. lumbricoides is essentially soil-transmitted and it has to mature in the soil first to
become infective.
In this case, infection of A. lumbricoides does not occur because the boy is barefooted most
of the time. Infection by skin penetration normally occurs on hookworm infection; A. lumbricoides
infection mostly occur by ingestion.

GENERAL MORPHOLOGY OF EGGS,

LARVAE, AND ADULT WORMS
Eggs
• Immature aggs are passed in the stool, found in three forms (diagnostic stage): fertilized,
decortocated, and unfertilized eggs
• Maturation of eggs occur in the soil (20-24 days) → mature eggs (infective stage
• Fertilized eggs
ƒƒ Broadly ovoidal, thick, transparent shell, brown/yellow
ƒƒ Measure 60x45 µm
ƒƒ Floats in satiation salt
ƒƒ Resistant shell wall composed of 3 layers:
ŠŠ Outer layer: albuminoid, coarse
ŠŠ Middle layer: chitine (polysaccaride-derived from glycogen
ŠŠ Inner layer: vitelline membrane (sterole), highly impermeable
• Decorticated eggs
ƒƒ Fertilized eggs that's undergone disappearance of the albuminoid
layer
ƒƒ Floats in the satiation salt
• Unfertilized eggs
ƒƒ Measure 90x40 µm with thin wall
ƒƒ May be passed by unfertilized females of during the early period of
oviposition of fertilized females
ƒƒ Sink down in satiation salt
• Infective eggs are embryonated eggs, which is fertilized and decorti-
cated eggs that has matured in the soil into infective eggs
• The eggs are very resistant to chemicals, extreme temperatures and
other rough conditions and can survive for months
Larvae
Smaller than adult worms
Adult worms
• Largest intestinal nematodes, yellowish white or pink
• Elongated round body with both ends pointed, anterior part blunter
than posterior
• Anterior: 3 folds of the lip (1 dorsal lip and 2 ventral lips)
• Male worms
ƒƒ Measure 15-30 cm x 3-5 mm
ƒƒ Posterior arched forward
ƒƒ Cloaca with 2 retractable spicules
 • Female worms
ƒƒ Vulva opening to the front, on the 2/3 part of the posterior there is a narrowing of
the vulvar opening (ring copulation)
ƒƒ Measure 22-35 cmx 3-6 mm
ƒƒ Generate 200k eggs/day during its life, aged 6-12 months

enterobius vermicularis
Eggs
• Oval-shaped (asymmetric), flat on one side with the other
side convex
• Translucent eggs and thick walls
• Contains a folded embryo, larvae can be seen in embryo-
nated eggs
• Measure 50-60 µm x 20-30 µm and have a thin semi-trans-
parent shell consisting of:
ƒƒ Outer albuminoid layer
ƒƒ Two chitinous layer
ƒƒ Inner lipoidal membrane
• The albuminoid layer is very sticky and can cause intense
itching in infected individuals, especially women
• Eggs are usually laid partially embrionated, contain infective rhabiditiform larvae at 35 C
(require oxygen for complete development, do not develop below 22 C)
Adult worm
• Called pinworms (pinworm) because of its long, sharp, and needle-like tail, whitish color
• Mouth surrounded by 3 buccal lips, 1 dorsal lip, 2 lateroventral lips
• Has no buccal capsule
• On anterior end of the section there is a widening shaped like wings → alea cephalic lat-
eral
• Female worms
ƒƒ At 1/5 of the posterior looks like a pointy spine composed of hyaline tissue
ƒƒ Duplex vulve, located at 1/3 anterior part of the body
ƒƒ Anus is located at 1/3 posterior part of the body
• Male worms
ƒƒ Blunt, curved tail, spicule rarely seen
ƒƒ Dies after copulation

IDENTIFICATION OF INFECTIVE STAGE

The infective stage of worms based on medium of transmission can be divided into 5 groups (WHO,
1964):
• Through the stool (faeces): eggs or larvae become infective if they are in the anus, there-
fore infection occurs from person to person; e.g. Enterobius vermicularis
• Through the soil (soil transmitted/geohelminths): eggs or larvae become infective after
undergoing maturation processes in the soil; e.g. Ascaris Lumbricoides
• Arthropods: eggs or larvae develops into the infective stage within arthropods, transmis-
sion occurs when arthropod bites/is swallowed by a human; e.g. Filaria
• Snails: the infective stage develops in the snail's body-as an intermediate host-or after
partial development occurs in the snail; e.g. Schistosoma
• Meat: the infective stage develops in animals whose meat is a main food source of hu-
mans; e.g. Gnatostoma
ASCARIS LUMBRICOIDES
Infective stage
Infective phase occurs after the maturation of immature eggs in moist and shaded soil for 20-24
days with an optimum temperature of 30 C. Then the infective embryonated eggs will be swallowed
together with soil-contaminated food. Infective eggs, measuring 60x45 µm are round or oval with a
strong shell wall consisting of 3 layers: albuminoid, chitin, and vitellin.
Noninfective/diagnostic stage
The noninfective stage is immature eggs that are passed with the stool.

enterobius vermicularis
The presence of infective phase (Enterobius eggs) is due to rupture of pregnant female worms. The
eggs that are passed with feces are asymmetric, ovoidal, colorless, transparent and contains larvae.
How Enterobius infection occurs:
• Autoinfection: the perianal area itches so when the fingers touch it, the eggs stick under
the fingernails and are then swallowed with food
• Aerogen: eggs are scattered on the bed/bedspread or in the dust that can infect through
inhalation
• Retrograde infection: eggs hatch in perinanal, larvae enter again into the colon via the
anus and cause new infections

LIFE CYCLE OF STH & NSTH

(ASCARIS & ENTEROBIUS)

ASCARIS LUMBRICOIDES
Giant roundworms that are the most common parasitic worm in humans, occurs worldwide but
mostly in tropical and subtropical countries, has high prevalence in areas of poor sanitation and
where human feces are used as fertilizer.
Habitat is in the small intestine of humans.
Life cycle:
• Eggs carried out in the state of not yet proliferating (diagnostic stage)
• To be infective, they need ripening in moist soil for 20-24 days with an optimum tempera-
ture of 30 C
• Infective embryonated eggs are swallowed with food into the stomach; they can be ac-
quired from dirty fingers, water or food that has been contaminated with feces of an infected
human
• The eggs hatch and produce larvae
• Larvae are activate by the gastric fluid and migrates into the small intestine
• In the small intestine, the larvae penetrate the intestinal wall to enter the blood capillar-
ies (bloodstream)
• The larvae are carried by the bloodstream to the liver, right heart and then into the lungs
• The larvae go out of the capillaries and into the alveoli and the bronchioles, bronchus,
trachea, then to the larynx
• From the larynx, the larvae will be ingested back into the esophagus and into the stomach
• Then into the small intestine for the second time to become adult worms
• Adult worms attach themselves to the intestinal walls ready to mate
• The time required for the larvae to migrate from the intestinal mucosa, lung, and to the
lumen of the intestine is 10-15 days
• Adult female worms produce eggs (for 6-10 weeks); adult worms can live for 1-2 years in
the intestinal lumen
• Eggs produced by female adult worms will be passed with feces
enterobias vermicularis
• The pinworms mate in the last part of the small intestine, ileum-after copulation, the male
worms die
• The gravid (pregnant) female worms reside at the beginning of the large intestine,
colon,eating whatever food passes through the intestinal tract
• Female pinworms reach fertility within four week. They migrate toward the anus at night
at the rate of 12 cm/hour
• During sleep when body temperature is low and there is less movement the female pushes
out from the anus and lays eggs on the outside skin; female worms die after laying eggs
• The eggs found in the folds of perianal region are not passed with feces
• Within a few hours, the eggs mature and become infective
• Infection occur by autoinfection, inhalation, or retrograde infection
• The eggs hatch in the duodenum, the first part of the intestine, into larvae which will
develop into adults in the caecum and the surrounding area
• The time required from ingesting infective eggs to female worms producing eggs is ap-
proximately 2-4 weeks
• The worms are relatively short-lived (2-5 months)
 Pathogenenesis and pathophysiology of ascariasis
& enterobiasis related to sign & symptoms
ascaris lumbricoides
swallowed infective A. lumbricoides eggs

egg hatch in gaster

transform into larvae in small intestine

dyspnea
penetrate intestinal walls
eosinophilia
carried to right heart
cough
carried to lungs break capillary blood
& move around

inflammation fever

penetrate trachea

swallowed back into small intestine

adult worms in small intestine

lay eggs interfere food intake migrate to gastric irritate intestine

eggs carried by faeces malnutrition abdominal tension blood eosinoplihilia

weight loss anemia womit adult worm

pale Hb ↓

enterobius vermicularis
swallowed infective E. vermicularis eggs

gaster, larvae

caecum

maturation

adult in intestine

copulation

male worms die female migrate to perianal area

insert tail pin into perianal mucosa

ovideposition

pruritus (irritation around anal region)

 Diagnostic procedure of helminthiasis
Lab technique for examination of intestinalhelminths

macroscopic microscopic

macroscopic
• Check for:
ƒƒ Color
ƒƒ Consistency
ƒƒ Presence of blood & mucous
ƒƒ Visible parasite, foreign bodies
• Normal stool: black to clay colored
• Ascaris and pinworm eggs → present on surface of frech specimen
• Blood is an abnormal finding
ƒƒ On surface: sigh of bleeding haemorrhoids
ƒƒ Bloody mucous on liquid specimens: amebic ulceration, inflammatory of bowel
ƒƒ Occult blood on dark-colored stool: intestinal bleeding due to parasitic infection

microscopic examination
• Quantitative examination is to determine the amount of eggs: Stoll dilution method, Kato-
Katz cellophane thick smear method
• Qualitative examination is to determine the presence of infection: Direct wet mount,
Concentration, Permanent stained smear, Floatation method, Formaldehyde ether sedimentation
(Ritchie's method)

Ascaris lumbricoides
• Based on finding eggs on feces, larvae in sputum, adult worm from anus, mouth, nose
• Define infection level by checking the number of eggs/gram feces, number of female worm
(1 worm can lay 2000-3000 eggs/gram feces)
• Infection by male worm → photo of thorax
No. Level of Ascariasis Eggs/gr feces Amount of female worm
1 Light Less than 7000 5 or less
2 Medium 7000-35000 6-25
3 Heavy More than 35000 More than 25
• Finding eggs on feces: direct wet mount
• Finding larvae: sputum
ƒƒ Sputum is a thick fluid produced in the lungs and in the adjacent airways
ƒƒ Specimen can be collected by coughing, induced by saline, and should be collected in
the morning
ƒƒ Specimen must be from lower respiratory passages, not saliva
ƒƒ Material can be examined in direct wet mount (saline/iodine), concentrated (N-acetyl-
L-cysteine
• Identification of Ascaris can also be made from
ƒƒ Full blood count revealing eosinophilia >20% → suspected ascariasis
ƒƒ Abdominal x-ray → intestinal obstruction
Enterobius vermicularis
• Examination of feces → less effective, 5% positive result from expected
• Using cellophane tape prep (scotch tape test)
• Commonly used procedure for recovery of Enterobius vermicularis egg:
 ƒƒ During night, adult female worm migrates to anus and deposit her eggs around peri-
anal region
ƒƒ Specimen should be collected in the morning before bathing/defecating
• Method:
ƒƒ Cut a piece of clear cellophane tape
ƒƒ Apply to anal region
ƒƒ Remove tape and apply to microscope slide (have been added with iodine in xylol),
sticky side down
ƒƒ Examine for eggs
• Expected result (+): recovery of typical oval-shaped, thick walled eggs of Enterobius ver-
micularis
• Diagnosis: negative result in 7 days

NONPHARMACOLOGIC MANAGEMENT

Common intervention
Improved sanitation
Improved sanitation is aimed at controlling transmission by reducing soil and water contamina-
tion. Sanitation is the only definitive intervention to eliminate STH infections, but to be effective
it should cover a high percentage of the population. Therefore, because of the high costs involved,
implementing this strategy is difficult where resources are limited (Asaolu and Ofoezie 2003).
Moreover, when used as the primary means of control, it can take years or even decades for sanita-
tion to be effective (Brooker, Bethony, and Hotez 2004).
Health Education
Health education is aimed at reducing transmission and reinfection by encouraging healthy behav-
iors. For STH infections and schistosomiasis, the aim is to reduce contamination of soil and water
by promoting the use of latrines and hygienic behavior. Without a change in defecation habits,
periodic deworming cannot attain a stable reduction in transmission. Health education can be pro-
vided simply and economically and presents no contraindications or risks. Furthermore, its benefits
go beyond the control of helminth infections. In this perspective, it is reasonable to include this
component in all helminth control programs.
Other control measures

nonpharmacologic management
• Herbs: garlic, goldenseal, black walnut, wormwood, wormseed, pumpkin seed
• Diet: no coffee, sugar and alcohol, anti-parasitic food
• Intestinal cleansing: high fiber food for detix and cleansing
• Health education
• Handwashing before eating
• Wash fruits and vegetables before cooking
• Wear sandals/shoes to minimize direct contact to contaminated soil
• Defecate properly

Prevention & control, risk factor

risk factors
• Age: it is a common infection in children under 10 years old
• Humid weather: Ascaris live in humid areas, such as in developing countries
• Poor sanitation facilities: inadequate sanitary and defecation facilities causes human feces
to mix with soil
 • Poor personal hygiene: not washing hands, indiscriminate defecation, not wearing sandals,
not cutting the nails, etc.
• Environmental hygiene greatly affect worm infections
• Economic & social status and low education levels: infections are commonly found in poor
communities that are not informed about helminthiasis prevention

prevention
Through critical stage in parasitic life cycle
• Decrease the infection source (soil, water, food)
• Health education to precent spreading of infectious diseases
• Hygiene and sanitation control in water, food, and environment
Ascaris lumbricoides
• Tp break the worm's life cycle
• Treatment of patients with ascariasis
• Health education, especially regarding food hygiene and the disposal of human excretion
• Discriminate defecation
• Wash hands before eating, cooking food, vegetables and water well, although water is
rarely a source of infection ascariasis
Enterobius vermicularis
• Keeping personal hygiene
• Cutting nail short
• Wash hands after defecating and before eating
• Wash the anal region after waking up
• Avoid getting dirt on food or eating with dirty hands
• After bathing/showering, swap underwear with clean ones

strategy control
• Ensuring wide availability of antihelminthics in health services in endemic areas
• Ensuring good care management of symptomatic cases, e.g.: IMCI (Integrated Management
of Childhood Illness)
• Regular treatment of all children at risk, including adolescent girls
• Treating pregnant women at risk, through antenatal care and other health programmes
• Ensuring safe water supply and adequate sanitation practice among school children and
caregivers (handwashing, latrine, footwear) through community capacity development and
school curricula

bhp
mass treatment
The mass deworming program is commonly done to all students in a school by giving antihelminthic
medication without first doing stool examination.
If the prevalence is:
• > 30 %, mass treatment should be done 3x/year
• 20-30 %, mass treatment should be done 3x/year
• 10-20 %, mass treatment should be done 3x/year
• <10 %, mass treatment should be done 3x/year
The mass treatment should pay attention to the following:
• Drugs should be accepted by society
• Easy drug administration
• Minimum side effects
 • Polyvalent, means effective treatment of several types of worms
• Cheap and affordable

individual treatment
Individual treatment should be preceded by stool examinationbefore diagnosis and drug delivery.
Medication for individuals:
• One piperazine dose of 3-4 gram for adults, for children 25 mg/kgBB
• One pirantelpamoat dose of 10mg/kgBB
• One mebendazole dose of 2x100mg/hour for 3 hours or 500mg
• One albendazole dose of 400mg

PHOP
deworming strategy
Deworming is an attempt to eliminate the worms in the human body, and can be done in children
or adults. The strategy is to inform the public that:
• Children can be effectively treated with a dose of 2 pills, one pill for all the common types
of intestinal worms and the other for Schistosomiasis (bilharzia)
• The treatment is safe, even if given to a healthy person
• The drugs used are albendazole or mebendazole for intestinal worms, and praziquantel for
schistomiasis
• Deworming every 6 months
• Consultation with your doctor to determine the prevalence of parasites in a particular area,
internal deworming, as well as the treatment and dose that should be used
• Regular deworming of pets and livestock to prevent worm spreading to the community

personal hygiene
To protect the body from and prevent infection of worms, we must maintain the personal hygiene
of our body. Personal hygiene is the first step to good health. Basic hygiene is common knowledge
and easy to maintain: each part of the body needs sufficient attention and needs to be cleaned
regularly. E.g.: hair, hands, skin, nails, teeth, feet, and genital hygiene.

sanitation
The main purpose of good sanitation is to protect and promote public health by providing a clean
environment and breaking the life cycle of the disease. So by keeping the sanitation, the environ-
ment will not encourage the development of the worm's life cycle. People should defecate and
urinate discriminately. To ensure the continuation of the programme, sanitation systems must be
economically viable, socially acceptable, technically precise and institutions and also to protect the
environment and natural resources.