THE TREATMENT OF THREADWORM INFECTION
stuck under the nails or on the fingers are transferred between children
in schools and nurseries or to the family at home.
They easily get transferred to the mouth and some will be
swallowed. The sharing of bath towels is another way in which they can
be spread. They survive for up to a couple of weeks on clothing,
bedding, in carpets and within household dust. The habit of thumb
sucking and sucking other fingers is strongly associated with the
prevalence of threadworms (Herrström et al 1997).
ingested, the eggs hatch out as threadworm larvae in the small
intestine. The adult worms live in the colon. Adult worms live for about
6 weeks. A female threadworm can lay up to 16,000 eggs before dying.
The female adult worms, while the sufferer is inactive in sleep,
move to the mouth of the anus and deposit eggs just outside it. This
causes irritation around the anus and the sufferer will scratch the
itching area, collect eggs on the fingers and under the nails, and this
way the infection can spread to clothes and other members of the
A common infection
decade ago in a general practice of 10,000 patients, there would be
roughly 40 consultations a year for threadworm (McCormick et al, 1995),
but a vast number of people will tend to treat themselves and their
families by over-the-counter medications and never report the infection
to their GP or practice nurse. With annual education campaigns aimed at
parents and children (e.g. the Fredworm campaign
during Threadworm Action Month in September 2005), awareness of
threadworm infection is increasing
and parents are less embarrassed at approaching their pharmacist, GP or
practice nurse to discuss ‘Fredworm’.
is most common among school children aged 5-10 years old. Recent and
referenced published figures in the
to the Health Protection Agency’s advice to Prodigy, it is not
necessary to exclude children with threadworm infection from school.
Symptoms of infection
tickling or itching sensation around the anal area at night is the most
common symptom, but 9 out of ten sufferers will not feel this symptom
(Ibarra, 1989b). Sleep may be disturbed and some children develop
sore bottoms. Usually worms are only seen in the toilet, if at all. Many
people will show no symptoms. In the Swedish study, 21% of children
studied were symptom-free carriers of the worm
(Herrström et al, 1997).
nurse or GP may occasionally be able to make the diagnosis by seeing the
worms in the area around the anus. Rarely, perhaps in only 5-15% of
cases, worms might be detected in stools (Cook, 1994).
testing which involves applying hypoallergenic tape around the anus to
collect eggs/worms is no longer used as a diagnostic tool in general
there are no complications, but it is worth the nurse being alert to the
possibilities. The most common complication is a sore bottom, as the
skin around the anus becomes broken, and secondary infection occurs
Also if the infection is heavy or goes on for a long time it can cause loss of appetite, weight loss, insomnia and irritability (Prodigy, 2004). Enuresis may be another possible complication of threadworm infection (Cook, 1994)
girls and women, the worms may migrate from the skin around the anus
over the perineum to enter the vagina and cause vulvovaginitis (Joishy
et al, 2005). Threadworms or eggs have been found in vaginal and
cervical smears (Chung, Kong et al, 1997), and in peritoneal granulomas
(Brooks et al 1962; Khan et al 1981; Saffos and Ratigan, 1977; Sun et al
1991). There have been very rarely granulomas of the liver, ovary,
kidney, spleen and lung when the worms have got into the abdominal
cavity (Cook and Zumla, 2002).There have been at least 11 cases of
threadworm related granulomas of the perianal tissues that required
surgery (Mattia, 1992); Simon and Walla, 1974; Kropp et al, 1978).
Treatment of the infection
Treatment without drugs
without drugs is possible through hygiene controls for 6 weeks, breaking
the cycle of infection by removing all eggs and allowing the adult worms
to die. It is important that the whole family take these hygienic
measures. For some people this may be the preferred option if they do
not want to take medication or if it is not recommended. For example, it
is usually inadvisable to give drug treatment during pregnancy.
to remove eggs include: the use of tape or jelly at night around the
anus, followed by washing or wet-wiping the perianal area after rising
from bed and at 3-hourly intervals during the day; changing the nappies
of babies and cleaning the bottom every 3 hours (eggs can hatch in 4-6
hours and some larvae could migrate back into the rectum).
guidance, designed for nurses, nurse prescribers, GPs and other health
professionals, advises that every person in the house:
can be removed by daily damp dusting of surfaces and washing the cloth
frequently in hot water or using disposable clothes. Good ventilation
and reduced humidity both help to kill off the eggs. Daily vacuuming of
carpets is another piece of advice that is commonly given. The eggs can
survive for 2 weeks on clothing, bedding, or other objects.
is always stressed that the above hygienic measures to prevent
re-infection are an important part of treatment, even if drug treatment
is to be given.
drug treatment, it is best to treat the entire family at the same time.
The most commonly used drug treatments for threadworm include piperazine
only Piperazine treatment available is Pripsen Powder Sachets which is
Piperazine combined with a mild laxative (senna).
Piperazine works by paralysing the worms which are then evacuated
by the laxative action of the senna. A second dose of piperazine is
given after 14 days to ensure that any worms that were unhatched at the
time of the first dose will be cleared from the system. Pripsen Powders
are the only drug treatment for threadworms which can be given to
children under the age of two years old (from 3 months of age).
(Pripsen tablets) is given as a single dose, but if reinfection occurs a
second dose is given after two weeks. Mebendazole prevents sugar
absorption by the worms and they die a few days later.
Efficacy studies are rare and old (and mostly against old
products not used in the
who must see a doctor
the parent or adult being treated may be treating the rest of the
family, it is important to check that no one they are treating needs to
see the GP first.
who is pregnant or planning a pregnancy or who is breast feeding a child
should see a doctor. Similarly, children under 2 years of age will need
to be seen by a doctor before they are treated with drugs. Mebendazole
is not to be used in children under 2 years of age. People should not be
treated with piperazine if they have epilepsy, a gut blockage, liver
disease or severely decreased kidney function. People with a
neurological disease should be seen by their GP first. Check also that
no one is allergic to any of the components of the treatment.
potential complications of the infection have been mentioned and are
rare. Patients with such complications should be seen by a doctor, as
should a patient who you suspect of roundworm infection or other
secondary infestations. Also
patients who persistently relapse should be seen by the GP and possibly
referred to a parasitologist.
infection is very common in school children and even when treated,
reinfection is frequent. Strict hygiene controls for the whole family
for six weeks is one way of treating the disease, especially for people
who cannot or are willing to take medication. This should break the
cycle of infection by removing all eggs and letting the adult worms die
naturally without being replaced by young worms. Drug treatment should
be combined with hygiene measures. Drug treatment includes piperazine
and/or mebendazole. Generally, threadworm is a harmless infection.
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