Helminthiasis: what tests are needed and why it is not necessary to “poison worms” once a year - in Tashkent

What helminthiases are most common?

The most common are intestinal forms. Understanding who exactly caused the disease determines both treatment and preventive measures for other family members.

• Enterobiasis (pinworms) is the undisputed leader in children; transmitted directly from person to person through hands, bed, toys, therefore easily spreads in the family and in kindergarten
• Ascariasis - infection through unwashed vegetables, herbs, soil; The larvae pass through the lungs, causing coughing and wheezing in the early stages
• Toxocariasis is a parasite of dogs and cats; in humans, larvae migrate throughout the organs, characterized by high eosinophilia
• Taeniarinhoz and taeniasis - through insufficiently heat-treated beef and pork
• Diphyllobothriasis - through raw and lightly salted fish, can lead to vitamin B12 deficiency
• Opisthorchiasis - through river fish of carp breeds
• Echinococcosis - through contact with dogs and contaminated products; affects the liver and lungs and is treated surgically

The routes of infection differ fundamentally, and this is useful to know in practice. Pinworms are transmitted directly from person to person, so washing vegetables does not protect against them - hand hygiene, short nails, and daily change of linen work. Roundworms enter the body through soil, sand and poorly washed greens, and this is where thorough washing of food makes the difference. Tapeworms and opisthorchids come with insufficiently processed meat and river fish, and no amount of hand hygiene affects them. The same set of measures does not cover all options at once - prevention must correspond to the real risk.

Why annual “preventive courses” are a bad idea

The practice of deworming once a year with the whole family, including small children, is widespread and is passed down through families. Let's look at why this doesn't work.

• The drug does not create protection for the future: it kills parasites that exist now, and a week after the course you can become infected again
• Anthelmintic drugs have side effects - from the liver, blood, nervous system; taking them without indication means taking a risk without benefit
• Different drugs work on different parasites; chosen at random may not have any effect on the one who really is
• A “blind” course erases the picture: if the symptoms persist, the examination after taking the drugs will become less informative
• False peace: having written off complaints as “treated worms,” the family postpones searching for the real cause

There is a separate case of enterobiasis: when pinworms are confirmed in one family member, treatment is indeed prescribed to everyone living together - but this is not prevention, but treatment for epidemiological reasons, prescribed by a doctor after confirmation of the diagnosis.

It is worth distinguishing between the situation with pets. Regular deworming of dogs and cats at the veterinarian is indeed carried out on schedule and is completely justified: it protects both the animal itself and the people around it - primarily from toxocariasis and echinococcosis. Transferring this logic to people is erroneous: humans and animals have different risks of infection, different frequency of contact with the source and different medications. It is from veterinary practice that the habit of “worming according to the calendar” most often migrates into the family.

When is it really necessary to get tested?

The signs that warrant a search for helminths are quite specific. Fatigue, “bruises under the eyes,” grinding teeth in sleep and moodiness are not included in this list: the connection between bruxism and helminths has not been confirmed, and weakness has dozens of causes.

• Itching in the anus, worse at night, is a classic sign of pinworms
• Detection of the worms themselves or their fragments in the feces
• Persistent increase in eosinophils in the general blood test
• Prolonged diarrhea, abdominal pain, nausea without other explanation
• Unexplained anemia or vitamin B12 deficiency
• Pruritus, urticaria and rashes resistant to conventional treatment in combination with eosinophilia
• Losing weight with normal or increased appetite
• Episode of consumption of raw meat, fish, water from an open source with subsequent complaints
• Returning from a trip to a region with a high prevalence of parasitosis

It is also useful to remember the opposite: the absence of all the listed signs is also information. If the child is growing well, eating normally, bowel movements are regular, eosinophils in the general blood test are normal and there is no nighttime itching, the likelihood of significant helminthic infestation is low, and a preventive course of medications will not add anything to this picture. Parents’ anxiety is understandable, but it makes more sense to relieve it with an analysis rather than a pill: one scraping and one stool test are cheaper and safer than a blind course of the drug.

Separately about eosinophils. Their increase in the general blood test is not proof of helminthiasis, but a signal that it is worth taking a closer look: it happens with allergies, and when taking medications, and with a number of other conditions. But the combination of high eosinophilia with skin or pulmonary complaints and a risk episode in history is exactly the case when a targeted search for parasites is justified and informative.

Which tests are informative and which are not?

Here it is important to divide studies into those that confirm the diagnosis, those that suggest the direction of the search, and those that do not provide anything other than an estimate. The difference between them is not in price or in the modernity of the method, but in what question it can answer.

1. Соскоб (отпечаток) с перианальных складок на энтеробиоз — main метод выявления остриц. Берётся утром, до подмывания и до дефекации.
2. Соскоб повторяют трёхкратно с интервалом в несколько дней: самки выходят откладывать яйца не каждую ночь, и однократный отрицательный результат остриц не исключает.
3. Исследование кала на яйца гельминтов — базовый метод для кишечных форм; его также имеет смысл повторять, а качество зависит от методики обогащения в лаборатории.
4. Общий анализ крови с лейкоцитарной формулой — эозинофилия служит поводом для целенаправленного поиска, особенно при тканевых гельминтозах.
5. Серологические исследования крови — обоснованы при токсокарозе, эхинококкозе, описторхозе и других тканевых формах, когда паразита нельзя найти в кале.
6. УЗИ органов брюшной полости, при необходимости КТ или МРТ — при подозрении на эхинококковые кисты и поражение органов.
7. Не имеют самостоятельной ценности: «панели антител ко всем паразитам сразу» без клинических показаний, диагностика по волосам, ногтям и приборам биорезонанса.

Treatment and what to do for the family

• The drug, dose and duration are selected by the doctor for the specific parasite and the patient’s age
• With enterobiasis, repeated doses are often required at intervals prescribed by the doctor in order to act on the parasites that have matured during this time.
• If pinworms are confirmed, treatment is prescribed for everyone living together - otherwise the infection continues in a circle
• At the same time as taking the medications, sanitary measures are carried out: changing and ironing linen, daily change of underwear, short nail cutting, wet cleaning
• For tissue helminthiasis, treatment is long-term and carried out under supervision, sometimes in a hospital
• Echinococcosis is treated mainly surgically - tablets have no independent meaning here
• Control tests after the course are prescribed by the doctor depending on the type of parasite

Intestinal obstruction and the creep of roundworms into the biliary tract are rare but real complications of massive invasion that require urgent surgical care. This is another argument in favor of being treated according to diagnosis and supervision, and not according to advice from the Internet.

Sanitary measures for enterobiasis are no less important than the drugs themselves. Pinworm eggs persist on bed linen, towels, door handles, toys and under nails, so if you limit yourself to one tablet, re-infection occurs literally within the same days, and the treatment appears to have “not worked.” The correct order is treatment and cleaning at the same time: daily change of underwear, washing at high temperatures and ironing, wet cleaning, short nail cutting, a separate towel for each family member.

Prevention without pills

1. Мытьё рук с мылом после туалета, улицы, песочницы, контакта с животными и перед едой.
2. Короткие ногти у детей и отучение от привычки грызть их — прямая профилактика энтеробиоза.
3. Тщательное мытьё овощей, фруктов и особенно зелени; при необходимости — ошпаривание.
4. Достаточная термическая обработка мяса и рыбы; отказ от сырого фарша и слабосолёной речной рыбы.
5. Кипячение воды of непроверенных источников.
6. Регулярная дегельминтизация домашних животных у ветеринара и уборка за ними.
7. Ежедневная смена нижнего белья и проглаживание постельного при выявленном энтеробиозе в семье.

None of these points look impressive, and this is the main difficulty: the prevention of helminthiasis consists of everyday habits, and not of one-time measures. But it works continuously, unlike a course of drugs, the effect of which ends with the last tablet. If we evaluate honestly, the contribution of hand washing and proper cooking to protecting the family is many times higher than the contribution of any preventive medications.