Helminth Infections in Neonates and Young Children

Andrea J. Lack, MD; Jill E. Weatherhead, MD; Laila Woc-Colburn, MD, DTM&H

Disclosures

June 25, 2014

Helminth Infections in Young Children

Of the preceding answer choices, only ascariasis typically presents with intestinal obstruction. The roundworm A lumbricoides and the whipworm T trichiura are both soil-transmitted helminthes with a peak incidence in young children.[25] Infection is acquired from ingesting soil contaminated with eggs. Young children, who frequently exhibit geophagia (ingestion of soil) and who explore their environment orally, are naturally predisposed to soil-transmitted helminthes infections. Furthermore, an underdeveloped immune system -- often exacerbated by malnutrition -- increases the risk for infection.

Roundworm

A lumbricoides is the most prevalent helminth worldwide, with an estimated 1221-1472 million people affected.[2] Eggs are ingested and hatch in the small intestine. Like hookworms, the larvae enter the bloodstream and travel to the lungs, where they erupt and are reingested. The pulmonary phase may cause a pneumonitis termed "Loeffler syndrome." As with other intestinal helminthes, chronic infection is associated with malnutrition, poor growth, and impaired cognition.[26]

Furthermore, the large worm burden common in ascariasis, combined with the relatively long length of the worms, can lead to obstructive phenomena. At a tertiary care center in Kashmir, ascariasis was reported as the single most common cause of bowel obstruction in children.[27] Another study showed that ascariasis-induced bowel obstruction is most prevalent among young children younger than 5 years.[28] Ascaris can also migrate up the biliary tract to cause cholangitis, pancreatitis, or hepatitis.

Whipworm

T trichiura is another geohelminth infection that is important in children. After ingestion of eggs, larvae hatch in the small intestine and migrate to the large intestine. Unlike Ascaris, Trichuris has no pulmonary phase. Trichuriasis can cause severe colitis, leading to dysentery and even rectal prolapse in young children.

Together, Ascaris, hookworm, and Trichuris are the top 3 most common helminth infections and account for the loss of an estimated range of 2.9-39 million disability-adjusted life-years (DALYs).[2] Albendazole or mebendazole can effectively treat all 3 infections.

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