Helminths are parasitic worms such as roundworm, hookworm, whipworm, pinworm, Strongyloides and tapeworms, spread through soil, food, water or close contact. Most infections are mild, but heavy loads cause anemia, malnutrition and poor growth in children.
Key symptoms
- Often no symptoms
- Abdominal pain, nausea and diarrhea
- Itching around the anus at night
- Tiredness and pallor from anemia
- Passing a worm, or poor weight gain in a child
What you find on exam
- Pallor and signs of malnutrition
- Abdominal distension or tenderness
- Scratch marks around the anus
- Itchy creeping rash or hives
- Ask about travel, bare feet on soil, undercooked meat and household contacts
Tests
- Stool ova and parasites on 3 separate samples
- Tape test on the anal skin in the morning for pinworm
- Blood count for eosinophilia and anemia; iron studies
- Strongyloides serology before steroids in people from endemic areas
Treatment basics
- Albendazole or mebendazole for most roundworms and pinworm
- Pinworm: repeat dose in 2 weeks and treat the household
- Ivermectin for Strongyloides; praziquantel for tapeworms
- Iron and nutrition support for anemia
- Handwashing, shoes, safe water and well-cooked meat
Red flags
- Severe abdominal pain, vomiting and distension
- Fever, rash and sepsis in a patient on steroids
- Severe anemia or failure to grow
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.