HELMINTHIC INFESTATION CHALLENGES IN

DIAGNOSIS AND MANAGEMENT

Submitted to
Biju Patnaik University of Technology, Rourkela
For
Partial fulfilment of the requirement of
B.Pharm Submitted by

Mr. SAMARJIT PATRA

B.Pharm, 7th sem
(Regd.No. 2003267073)

Under the guidance of

Dr. Jyoti Prasad Pattnaik
MBBS, PGDMCH, PGDHM
Assistant Professor

ROLAND INSTITUTE OF
PHARMACEUTICAL SCIENCES,
BERHAMPUR ODISHA 2023-2024

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 ROLAND INSTITUTE OF
PHARMACEUTICAL SCIENCES,
BERHAMPUR,GANJAM,760010

VISION
To emerge as ‘Centre for Excellence’ in Pharmacy Education and Research.

MISSION
 To maintain high education standards and uphold ethics in pharmacy
profession.

 To appoint qualified and experienced teachers who can inspire the

students.

 To create state of art infrastructure and facilities.

 To provide well-fortified library and additional sophisticated equipment’s for

promoting good research.

 To prepare legally qualified and technically competent pharmacists to cater to

the needs of industry, hospitals, and the profession in the changing scenario.

 To promote closer ties with industry for internship, placement,

and collaborative research.

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 ROLAND INSTITUTE OF PHARMACEUTICAL SCIENCES,
BERHAMPUR, GANJAM, 760010

CERTIFICATE

This is to certify that the work reported in this project thesis entitled
“HELMINTHIC INFESTATION CHALLENGES IN DIAGNOSIS AND MANAGEMENT” is
a record of independent and unique project work carried out by Mr. SAMARJIT PATRA
for the partial fulfilment of the requirement of 7th semester of B.Pharm, under the guidance
and supervision of Dr. Jyoti Prasad Pattnaik, Assistant Professor, Roland Institute
Of Pharmaceutical Sciences, during 2023-24. The above work is original and has not
been submitted to any other university for the award of any degree or diploma.

Place: PRINCIPAL
Date: Prof. (Dr.) B.V.V.Ravi Kumar
M. Pharm , Ph.D , RIPS
Berhampur
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 ROLAND INSTITUTE OF PHARMACEUTICAL SCIENCES,
BERHAMPUR, GANJAM, 760010

CERTIFICATE

This is to certify that the work reported in this project thesis entitled “HELMINTHIC
INFESTATION CHALLENGES IN DIAGNOSIS AND MANAGEMENT” is a record of
independent and unique project work carried out by Mr. SAMARJIT PATRA for the
partial

fulfilment of the requirement of 7th semester of B.Pharm under the guidance and supervision
of Dr. Jyoti Prasad Pattnaik, Assistant Professor, Roland Institute Of Pharmaceutical
Sciences, during 2023-24. The above work is original and has not been submitted to any other
university for the awardof any degree or diploma.

Place: Signature of the Guide

Date: Dr. Jyoti Prasad Pattnaik
M.Pharm (Asst. Professor)
RIPS, Berhampur

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 ROLAND INSTITUTE OF PHARMACEUTICAL SCIENCES,
BERHAMPUR, GANJAM, 760010

DECLARATION

The project thesis entitled “HELMINTHIC INFESTATION CHALLENGES IN DIAGNOSIS

AND MANAGEMENT” submitted to Biju Patnaik University of Technology, Rourkela, Odisha
for partial fulfilment of award of degree of Bachelor of Pharmacy, is a bonafide work, carried
out by me, under the guidance of Assistant Professor, Dr. Jyoti Prasad Pattnaik in the
laboratories of Roland Institute of Pharmaceutical Sciences, Berhampur & has not been
submitted to any other university for the award of any degree or diploma.

Place: Berhampur Signature of Student

Regd. No: 2003267073 Mr. SAMARJIT PATRA
Date: RIPS, Berhampur

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 ACKNOWLEDGEMENT

I take this opportunity to express my deep sense of gratitude to our

beloved Principal Prof. (Dr.) B.V.V. Ravi Kumar, Roland
Institute of Pharmaceutical Sciences, Berhampur for this valuable
suggestion, moral support and guidance and allow me to use college
resources during my assignment.

I owe my profound gratitude to our project guide, Dr. Jyoti Prasad

Pattnaik,
M. Pharm. (Assistant Professor), Roland Institute of Pharmaceutical
Sciences, Berhampur, who took keen interest on my project work and
guided
me all along, till the completion of my project workby providing all
necessary information, precious advice, moral support, direct supervision
to complete my assignment.

I am grateful to my teachers for their guidance advice and constant

encouragement for carrying out this work successful. I also acknowledge
all of my friends for their help, support and encouragement during the
course work.

Mr. SAMARJIT PATRA

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 Table of Contents
ACKNOWLEDGEMENT ...................................................................................................................... 6
INTRODUCTION .................................................................................................................................. 8
LITERATURE REVIEW........................................................................................................................ 9
LIFE CYCLE OF HELMINTHIC .......................................................................................................... 11
RISK FACTOR FOR HELMINTHIC INFESTATION ......................................................................... 12
DIAGNOSIS ........................................................................................................................................... 13
MANAGEMENT OF HELMINTHIC INFESTATION......................................................................... 13
AIM AND OBJECTIVES................................................................................................................... 14
PLAN OF WORK ................................................................................................................................ 15
Collection of Data from literature ......................................................................................................... 15
Helminthic infestation challenges in diagnosis and management......................................................... 15
Compilation of the Data........................................................................................................................ 15
Evaluation of Data ................................................................................................................................ 15
REFERENCES ..................................................................................................................................... 16

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 INTRODUCTION

Helminthic infestation describes the condition of acquisition of parasitic infection as a consequence of being a
primary or intermediate host in the life cycle of a helminthic. Pediatricians, general practitioners, community
health specialists and primary health care workers need to understand helminthic infestations considering the
preventable childhood morbidity and mortality inflicted by them. By definition, helminths are multi-cellular
eukaryotic invertebrates of the phyla Nemathelminthes (roundworms) or Platyhelminthes (flat worms). The
present review intends to cover only commonly prevalent intestinal nematodes of public health importance
roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura), two species of hookworm (Ancylostoma
duodenale and Necator americanus) and pinworm (Enterobius vermicularis)[1].

First three of them are spread by contaminated soil, hence also named as Soil Transmitted Helminths (STH) or
geo-helminths. Nearly one fourth of the world’s population is known to be affected by one or more worms
particularly affecting the children from the low and middle income countries in India[2].

The burden of disease due to worm infestation using a metric of disability-adjusted life years dalys i.e., the
number of life years lost either from premature death or disability), is estimated 22.1 million dalys lost for
hookworm,
10.5 million for ascariasis; and 6.4 million for Trichuris. Given their public health importance, there is imperative
need for all stakeholders to optimize understanding of worm infestations as well as diagnosis and management
both at individual as well as community level[3-5].

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 LITERATURE REVIEW

A STUDY OF PREVALENCE OF INTESTINAL WORM INFESTATION AND EFFICACY OF

ANTHELMINTHIC DRUGS [6]

Intestinal worm infestation is a global health problem. Soil-transmitted helminth (STH) infections form the most
important group of intestinal worms affecting two billion people worldwide, causing considerable morbidity and
suffering, though entirely preventable. The present study was undertaken to measure the parasite load in the target
population and evaluate the efficacy of anthelminthic drugs.

Current study was undertaken from 01 July 2012 to 30 June 2013. All outdoor as well as indoor patients
advised stool examination formed the study population and it included 2656 males and 76 females (including 6
children). Investigations included stool examination and blood counts. A single-oral dose of anthelminthic drug
was given to all positive cases. Stool tests were repeated after 14–21 days to evaluate cure rate.

Overall prevalence of intestinal worm infection was found to be 49.38%. Ascaris was the most
common parasite (46.88%), followed by Taenia (2.1%) and Hymenolepis nana (0.21%). Cure rate was found to
be 66% for Ascaris and 100% in other cases.

The study reveals high prevalence of intestinal helminths in our subject population and calls for immediate
control measures, including preventive chemotherapy and treatment of entire ‘at risk’ population and
improvement of their living conditions including provision of potable water.

SOIL TRANSMITTED HELMINTH INFECTIONS IN GHANA: A TEN YEAR REVIEW[7]

For more than a decade, intervention programs have been instituted in Ghana to combat soil transmitted helminth
(STHs) infections. Knowledge of the trend of the infection in the country is needed for evaluation and
modification of existing control programs to achieve national targets. The objective of this review is to examine
the pattern of soil transmitted infections in Ghana between 2009-2018. farmers, food vendors, children in
orphanage home and psychiatric institution. Although there is some downward trend over the period, soil
transmitted helminths are still prevalent in Ghana.

We performed a review of research based published literature on STHs in Ghana in peer-reviewed journals and
theses in institutional repositories of universities in the country over a ten year period of January 1st, 2009 to
December 31st, 2018. We employed PRISMA guidelines in the conduct of the study to ensure the review was
well carried out . zones. The country is geographically divided into six major ecological zones: Sudan Savanna
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Zone, Wet and Moist Evergreen Forest Zone, Deciduous Forest Zone, Coastal Savanna Zone, Transitional Zone
and Guinea Savanna Zone .

We observed low rate of published research work on STHs infections in Ghana. The four most common STHs
known in Ghana are still prevalent among all the high-risk populations of children, pregnant women and
farmers. Hookworm and roundworm remain the most prevalent of infection recorded in the studies. The highest
hookworm infections recorded were from studies done in the forest savanna ecological zone of Brong
Ahafo Region. However further research is required in the various regions of the country to support effective
development of control programs in the country.

SIGNIFICANCE OF DIAGNOSING PARASITIC INFESTATION IN EVALUATION OF UNEXPLAINED

EOSINOPHILIA [8]

The evaluation of unexplained eosinophilia in an asymptomatic individual has always been a diagnostic challenge
and requires understanding about a wide range of probable causative agents. Helminthic infestation and
schistosomiasis are the main parasitic causes of eosinophilia. Therefore, the availability of simple and accurate
diagnostic tests for detection of parasitic infections can prove to be valuable in early diagnosis and solving the
mystery of unexplained eosinophilia.

In the present study we attempt to find an association between relative eosinophilia and parasitic infections and
also to find the parasites responsible for eosinophilia in a substantial number of cases. A retrospective study for
the presence of eosinophilia was done on 621 cases positive for parasitic infestation.

From the study it is concluded that eosinophilia is not a universal finding in cases with parasitic infestation.
Although presence of eosinophilia can serve as one of the many diagnostic clues to look for the presence of
helminthic infestation if other non-infectious causes of eosinophilia are ruled out.

PARASITIC INFESTATION IN APPENDICITIS. A RETROSPECTIVE ANALYSIS OF 660 PATIENTS AND

BRIEF LITERATURE REVIEW [9]

To investigate the incidence of parasitic infestations and inflammation accompanying parasitosis in a series of
appendectomy cases.

Six-hundred-sixty patients who had undergone appendectomy in Bingöl State Hospital, Bingol, Turkey with the
preliminary diagnosis of appendicitis between January 2012 and February 2015 were included in this
retrospective study. They were retrospectively evaluated in terms of age, gender and pathological findings. Cases
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diagnosed with parasitic infestations were re-evaluated histopathologically for inflammatory response.

Parasitic infestations are among the probable causes in appendicitis etiology and should be kept in mind during
differential diagnosis. However, whether every parasitic infestation leads to appendiceal inflammatory response
is controversial.

EVALUATING EFFECT OF ALBENDAZOLE ON TRICHURIS TRICHIURA INFECTION: A

SYSTEMATIC REVIEW ARTICLE[10]

The aim of the study was assessment of defaults and conducted meta-analysis of the efficacy of single-dose oral
albendazole against T. trichiura infection. We searched PubMed, ISI Web of Science, Science Direct, the
Cochrane Central Register of Controlled Trials, and WHO library databases between 1983 and 2014. Data from
13 clinical trial articles were used. Each article was included the effect of single oral dose (400 mg) albendazole
and placebo in treating two groups of patients with T. trichiura infection. For both groups in each article, sample
size, the number of those with T. trichiura infection, and the number of those recovered following the intake of
albendazole were identified and recorded. The relative risk and variance were computed. Funnel plot, Beggs and
Eggers tests were used for assessment of publication bias. The random effect variance shift outlier model and
likelihood ratio test were applied for detecting outliers. In order to detect influence, DFFITS values, Cook’s
distances and COVRATIO were used. Data were analyzed using STATA and R software. The estimated RR and
our meta-analyses show that treatment of T. trichiura with single oral doses of albendazole is unsatisfactory. New
anthelminthic are urgently needed.

LIFE CYCLE OF HELMINTHIC

Understanding life cycle patterns of worms are important to decode the morbidity caused by the worms and
further
customize preventive and treatment strategies for their control. There are three main life cycle stages in these
parasitic worms– eggs, larvae and adults. Adult worms usually infect definitive host defined as the host where
sexual maturation and subsequent egg production take place whereas larval stages may be free living or have
intermediate hosts.

There are predominantly two modes for transmission feco-oral and transdermal. Life cycle of the whipworm
(Trichuris) and pinworm are simple with feco-oral transmission of eggs passed in the feces of one of the host and
ingested by another or same host through contaminated food or water, infected soil as well as fomites. Ascaris
lumbricoides also has feco-oral transmission in a single host with an obligatory period of development in soil and
a distinct phase of pulmonary migration of ingested eggs before they finally mature in the gut. Hookworm eggs
also undergo compulsory moulting in soil twice and then third stage larvae infect human host by the dermal
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penetration which further undergo pulmonary migration and ultimately infect the intestines. Most human worm
infestations necessitate outside exposure of eggs to undergo moulting before re-entering human host.

Notable feature in the life cycle of helminths is lack of capacity to reproduce and multiply within their hosts.
Indeed, their eggs are voided to infect new hosts and their burden of adult worms, therefore, is directly related to
number of infective stages ingested.

RISK FACTOR FOR HELMINTHIC INFESTATION

Personal and environmental hygiene are the key drivers of parasitosis in humans. Poverty, overcrowding, warm
cli mate, open defecation, vulnerable water supply and poor food hygiene are main factors underpinning parasitic
bur den in children. Most of the worms are geographically distributed in the warm and moist climates of tropics
and subtropics.

However, Enterobius vermicularis (Pinworm) infection is the only exception which has ubiquitous pres ence
worldwide independent of socioeconomic status of population and is not included under the classification of
Neglected tropical diseases.

Increasing age was independently associated with hookworm infection. It may be noted that ascariasis, trichuriasis
and enterobiasis reach maxi mum age intensities among preschool- and school-age children whereas maximum
hookworm intensity is typical ly seen in adolescence or early adulthood.

Fig 1: Helminth infestation and its management

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DIAGNOSIS
Stool microscopy is a diagnostic tool for identification of par asitic organisms including protozoa and helminths.
However, other samples like duodenal aspirate or perianal swabs may sometimes be used to detect the parasites.
Stages of helminths found in stool are egg and larva, though whole adult worm or segments of worm may also be
seen. Diagnosing worm infestation by microscopic detection of eggs in feces does not necessarily reflect the
clinical morbidity as latter is driven by the actual number of adult worms inhabiting the intestines. Various
diagnostic investigations for worm infestation are enumerated below.

MANAGEMENT OF HELMINTHIC INFESTATION

The drug armamentarium against worm infestation has evolved tremendously in last three to four decades with
the availability of more efficacious and broad spectrum anthelminthics, yet children from marginalized society
continue to suffer disproportionately higher morbidity and even mortality due to worm infestations. To fill this
wide quality chasm, a system of coordinated preventive measures, individualized therapy and community
treatment is highly warranted. To be effective, it requires whole system implementation with active community
support and continued involvement of clinicians and health workers as partners.

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 AIM AND OBJECTIVES

Aim
Evaluation of helminthic infestation challenges in diagnosis and management.

Objectives
 Literature searches on helminthic infestation challenges in diagnosis and management.
 Evaluation of helminthic infestation challenges in diagnosis and management.

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 PLAN OF WORK

 Literature Search
 Report compilation
 Statistical analysis, if required
 Interpretation of results

Collection of Data from literature

Helminthic infestation challenges in diagnosis and management

Compilation of the Data

Data from PUBMED, Google, Science Direct will be evaluated and analyzed.

Evaluation of Data

Data from PUBMED, Google, Science Direct will be evaluated for Helminthic infestation challenges
in diagnosis and management and will be reported.

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REFERENCES

1. Lucy, H., L. Robert, and S. Wani, Diagnosis and selection of appropriate drug
treatments for common Helminths infections. The Pharmaceutical Journal, 2015.
295: p. 7882.
2. Wakelin, D., Helminths: Pathogenesis and defenses. 2011.
3. Maizels, R.M., et al., Helminth parasites–masters of regulation. Immunological
reviews, 2004. 201(1): p. 89-116.
4. Elliott, D.E. and J.V. Weinstock, Helminth–host immunological interactions:
prevention and control of immune‐mediated diseases. Annals of the New York
Academy of Sciences, 2012. 1247(1): p. 83-96.
5. Pullan, R.L., et al., Global numbers of infection and disease burden of soil
transmitted helminth infections in 2010. Parasites & vectors, 2014. 7: p. 1-19.
6. Kumar, H., K. Jain, and R. Jain, A study of prevalence of intestinal worm
infestation and efficacy of anthelminthic drugs. Medical Journal Armed
Forces India, 2014. 70(2): p. 144-148.
7. Ahiadorme, M. and E. Morhe, Soil transmitted helminth infections in Ghana: a
ten year review. The Pan African Medical Journal, 2020. 35.
8. Khanna, V., et al., Significance of diagnosing parasitic infestation in evaluation
of unexplained eosinophilia. Journal of Clinical and Diagnostic Research: JCDR,
2015. 9(7): p. DC22.
9. Altun, E., V. Avci, and M. Azatçam, Parasitic infestation in appendicitis. A
retrospective analysis of 660 patients and brief literature review. Saudi medical
journal, 2017. 38(3): p. 314.
10. Jouybari, T.A., et al., Evaluating effect of albendazole on Trichuris trichiura
infection: A systematic review article. Iranian Journal of Parasitology, 2016.
11(4):
p. 441.

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