Q: Good day. I bought a 400MG DE-WORM DRUG. How do I take it? Is it before eating in the morning or I can take it this evening before eating or after eating?

A: Hey! Thanks for writing in.

How do you know your symptoms are due to worms? Was your stool (faeces) examined? It’s important that you visit the health facility to get a proper diagnosis so that appropriate treatment can be started and/or so you don’t take medicines you don’t need.

Having said that, worms oftentimes do not present with any symptoms but sometimes people with this infestation complain of non-specific symptoms of the digestive system.

So, what is a worm (helminth) infection? There are different types. I will explain a couple.

A) Ascariasis – This is a type of roundworm infection and is one of the most common types of worm infections. This infection is spread when a person comes in contact with ascaris eggs in soil mixed with human feces or infected water. This is common in many developing countries, with poor sanitary conditions leading to people defaecating in fields and ditches and sometimes, human feces is used as fertilizer. When children play in this sort of environment and inevitably put dirty fingers in mouths or when unwashed fruits and veggies grown in the contaimnated soil, infection occurs

Most people will show no symptoms but a heavy infestation will cause problems depending on the area of the body affected.

In the intestines, the severity of symptoms depend on the number of worms

• Abdominal pain, which could be vague or severe
• Nausea and vomiting
• fatigue
• Diarrhea or bloody stool
• Weight loss
• Presence of worm in stool or vomit

In the lungs, they cause symptoms that resemble those of asthma

• Wheezing
• Persistent cough
• Shortness of breath

Prevention is really through good personal hygiene. Wash your hands before meals, before food prep, after using the bathroom, after gardening or coming in from outside. Just make it a habit to wash your hands, consistently.

Then practice good food hygiene too. Wash your fruits and veggies thoroughly before use, especially those that will be eaten raw. Drink only potable water – use bottled water (especially when you travel) or boil and filter your own water at home.

Other soil transmitted helminths are hookworm (usually causes iron-deficiency anaemia) and trichuris trichuria aka whipworm.

Diagnosis is by stool microscopy and treatment with anti-helminthics, mebendazole, ivermectin or albendazole is usually effective.

Surgery may be necessary in cases of heavy infestation to remove worms and repair damage or obstruction of the intestines, remove inflamed appendix or remove bile duct obstruction

B) Another example of infection caused by worms is elephantiasis. Elephantiasis is a disease condition in which there is swelling of the limbs, genitals or other body parts making them appear swollen and puffed-up, resembling an elephant. How does this happen? It actually starts with the bite of an infected mosquito (Aedes, Culex, Mansonia or Anopheles mosquito) which transmits filarial worms that block the lymphatic system. I see the look of confusion already on your faces! J What’s the lymphatic system, you say “)

Well, the lymphatic system is a network of vessels and glands distributed all over the body. They help to fight infections and drain excess fluids from tissues in the body. When this system is blocked, fluid no longer drains freely from the tissues leading to collection of fluids in the tissues, resultant body swelling and fever when this fluid collection gets infected. Chronic (longstanding) infection with these worms leads to elephantiasis with swelling (lymphedema) and hardening of the limbs. It really does require years of exposure to these infected mosquitoes for elephantiasis to occur. It is important to handle the infection before it gets to this stage.

Most people, however, will not have symptoms until years after being exposed when they develop these swellings.

There is no medication that is really active against adult worms. Focus is on management of symptoms. Exercise encourages lymphatic drainage, healthy diet, good skin care to prevent infection can help. Wearing special compression stockings/garment or having a special massage by a specialist to help lymph fluid drainage are also helpful aids.

Prevention of elephantiasis is key.

• Use of mosquito nets
• Use of medications to kill microfilariae in the blood
• Antibiotics for infections
• Surgical prevention of infected tissue

C) Schistosomiasis, another worm infection, is acquired by exposure to fresh water contaminated by snails especially in sub-Saharan Africa. Infection can persist for many years after exposure and symptoms include those of:

• Chronic renal failure
• Bladder cancer
• Portal hypertension

Diagnosis is made by:

• Stool microscopy
• Urine microscopy
• Schistosoma serology

Treatmentis usually with a medicine called Praziquantel.

So, as first steps, I suggest you go visit your doctor and get a proper diagnosis. After that, the right treatment option for you, including best way to take it  (eg with fatty foods, during or after meals etc) will be decided.

All the best!