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Chemotherapeutic agents
take care to avoid forming preconceptions or judge-
ments. It is very important for the nurse or midwife to
understand the disease process and to explain the disease
and treatment carefully to help the person to cope with
both the diagnosis and the treatment.
INTESTINE-INVADING WORM INFECTIONS
Many of the worms that infect humans live only in the
intestinal tract. Proper diagnosis of a helminthic infec-
tion requires a stool examination for ova (eggs) and
parasites. Treatment of a helminthic infection entails
the use of an anthelmintic drug. Another important
part of therapy for helminthic infections involves the
prevention of re-infection or spread of an existing
infection. Measures such as thorough hand washing
after use of the toilet; frequent laundering of bed linens
and underwear in very hot, chlorine-treated water;
disinfection of toilets and bathroom areas after each
use; and good personal hygiene to wash away ova are
important to prevent the spread of the disease. See
Table 13.1 for a summary of worms that cause intesti-
nal infections.
Infections by nematodes
Nematodes
, or roundworms, include the commonly
encountered pinworms, whipworms, threadworms,
Ascaris
and hookworms. These worms cause diseases
that range from mild to potentially fatal.
Pinworm infections
Pinworms
are usually transmitted when the worm
eggs are ingested, either by transfer by touching the eggs
when they are shed to clothing, toys or bedding; or by
the inhalation of eggs that become airborne and are then
swallowed. Pinworms, which remain in the intestine,
cause little discomfort except for perianal itching or
occasionally vaginal itching. Infection with pinworms is
the most common helminthic infection among school-
aged children.
H
elminthic infections, or infections in the gastrointesti-
nal tract or other tissues due to worm infestation, affect
about one billion people, making these types of infec-
tions among the most common of all diseases. These
infestations are very common in tropical areas, but they
are also often found in other regions, including coun-
tries such as Australia and New Zealand. With so many
people travelling to many parts of the world, it is not
uncommon for a traveller to contract a helminthic infec-
tion in one country and inadvertently bring it home,
where the worms can then infect other individuals (see
Box 13.1). The
helminths
that most commonly infect
humans are of two types: the nematodes (or round-
worms) and the platyhelminths (or flatworms) that cause
intestine-invading worm infections; and tissue-invading
worms.
Being diagnosed with a worm infestation may be
personally confronting. Nurses and midwives need to
Travellers and helminths
People who come from or travel to areas of the world
where schistosomiasis is endemic should always be
assessed for the possibility of infection with such a
disease when seen for healthcare. Areas of the world
in which this disease is endemic are mainly tropical
settings, such as Puerto Rico, islands of theWest Indies,
Africa, parts of South America, the Philippines, China,
Japan and Southeast Asia. People travelling to these
areas should be warned about wading, swimming or
bathing in freshwater streams, ponds or lakes. For
example, swimming in the Nile River is a popular
attraction on Egyptian vacation tours; however, this
activity may result in a lasting (unhappy) memory
when the traveller returns home and is diagnosed with
schistosomiasis.The nurse or midwife can suggest
to people who are planning a visit to one of these
areas that they contact the SmartTraveller website for
health and safety guidelines, as well as what signs and
symptoms to watch for after returning home. Smart
Traveller information can be reached on the Internet at
.
Cultural considerations
BOX 13.1
■■
TABLE 13.1 Helminthic infections
Intestine-invading worm Mechanism of disease
Manifestations
Pinworms
Remain in intestine
Perianal itching
Occasionally, vaginal itching
Whipworms
Attach to wall of colon
Colic
Bloody diarrhoea (with large numbers of worms)
Threadworms
Burrow into intestine; can enter lungs, liver
and other tissue
Pneumonia, liver abscess
Ascaris
Burrow into intestine; enter the blood and
infect lungs
Cough, fever, pulmonary infiltrates; abdominal
distension and pain
Hookworms
Attach to the wall of the intestine
Anaemia, fatigue, malabsorption
Cestodes
Live in the intestine, ingesting nutrients
from the host
Weight loss, abdominal distension
