The medical profession uses the term Strongyloides stercoralis to refer to so-called dwarf threadworms. Dwarf threadworms are parasites about 3 mm long that reside in the small intestine. Among other things, they are responsible for strongyloidiasis. As a rule, this disease occurs in tropical regions; in Europe, on the other hand, this disease only occurs in warm environments. Especially employees of mines or tunnel construction are affected. Likewise, immunocompromised persons who have HIV, for example, are among the risk groups.
What is a dwarf threadworm infection?
Dwarf threadworms make their way into the body through the skin. This is known as skin penetration. Above all, walking barefoot increases the risk of getting a so-called dwarf threadworm parasite. The parasite enters the lungs via the bloodstream. It migrates into the cavity, passes through the respiratory tract directly into the throat and is swallowed from there. Through this swallowing, the parasite ultimately reaches where it wants to go – the small intestine. In the small intestine, the dwarf nematode develops into a larva and mutates into a sexually mature female. Of course, the females lay their eggs in the small intestine, and it is here that the larvae hatch and are excreted through the intestine – in the stool. Infestation of dwarf threadworms brings infection, as the larvae cause inflammation in the affected section of the intestine.
Causes
There are usually two reasons why a dwarf threadworm infection occurs. Primarily, it is when there is an endoautoinfection. The larvae become infectious while still in the intestine and inflame the intestinal tract. Then the larvae pass from the intestinal wall directly into the bloodstream. The larvae often make their way through the scrotum, the colon as well as the appendix. Exautoinfection, on the other hand, involves infectious larvae that are already present in the stool. The larvae re-enter the human body through the skin in the anal region. Thus, it is possible that these again find their way into the bloodstream.
Symptoms, complaints and signs
Infestation with dwarf threadworms (Strongyloides stercoralis) is particularly dangerous for people with weakened immune systems. Otherwise, the infection may be asymptomatic. Often, however, the disease becomes chronic because the newly hatched larvae can constantly re-enter the body from the inside via the intestinal mucosa or from the outside via the skin. In the case of a chronic infection, severe skin itching very often occurs because the worms move in the skin and produce persistent skin inflammations due to bacteria carried along. In some cases, the lungs may also be affected. In some cases, pneumonia and asthmatic complaints are observed. Digestive complaints with nausea, vomiting, bloody diarrhea and a constant feeling of fullness can also occur as early as three to four weeks after the initial infection. However, in some affected individuals, these symptoms do not become apparent for years. There are also infected persons without any symptoms. Then the multiplication of eosinophils, a special form of white blood cells, is the only indication of an infestation with dwarf threadworms. When the worms multiply greatly, the level of infestation can become so severe that the larvae introduce a large number of bacteria into the bloodstream. This results in life-threatening sepsis. Fatal superinfections with bacteria are particularly common in immunocompromised individuals. Without intensive treatment, death then occurs due to multiple organ failure.
Diagnosis and course
The physician establishes the diagnosis with the aid of a microscope. It is not possible to determine whether the worms are actually dwarf threadworms until three weeks after infection. The treating physician likes to speak of prepatency during this time. Thus, he refers to the period between the onset of infection and the multiplication products, which take place in the form of eggs and larvae. The two possible types of autoinfection are sometimes a reason why the patient can suffer from a very strong contamination. As a rule, this infection is a relatively persistent and unpleasant disease. In the end, the main danger lies in the fact that the larvae and dwarf threadworms introduce bacteria into the bloodstream. Therefore, sepsis – general infection – is possible.As early as one week after the onset of the infection, the patient complains of respiratory symptoms. The patient may even report asthma-like conditions if the infestation is very severe. Even pneumonia – inflammation of the lungs – can be caused by the parasites. However, eosinophilia is often the only symptom and sign that the patient may be suffering from such an infestation. Here, an imbalance of granulocytes in the blood occurs in particular. Here the physician speaks of the eosinophils. These are, in effect, defense cells that belong to the group of leukocytes, the white blood cells. The leukocytes occur more frequently when infections are present in the body. Thus, they declare war on the dwarf threadworms. After about one month, it is possible that further complaints occur in the digestive tract. Many patients complain of a feeling of fullness. Often, nausea as well as vomiting, also bloody stools and severe diarrhea are further signs of infection by dwarf threadworms. However, the complaints and symptoms do not have to appear after three or four weeks. It is possible for patients to have no symptoms for months or years, even though they are infested with dwarf threadworms.
Complications
Dwarf threadworm infection leads to very unpleasant symptoms and, without treatment, can also lead to various complications. The affected person usually suffers from a very strong itching that occurs at the anus. This significantly reduces the quality of life of the affected person and makes everyday life more difficult. Irritability of the affected person can also occur. Furthermore, the patients suffer from a strong feeling of fullness and likewise from frequent vomiting or bloody bowel movements. Likewise, the dwarf threadworm infection leads to severe diarrhea, so that the affected person suffers from dehydration and various deficiency symptoms if the diarrhea persists for a long period of time and the dwarf threadworm infection is not treated. Furthermore, respiratory problems or even asthma occur. If treatment is still not initiated, it can also lead to blood poisoning, which can be fatal for the affected person. The treatment of the dwarf threadworm infection is carried out without complications with the help of medication. This usually leads to a positive course of the disease in a short time. Also, the life expectancy of the affected person is not reduced if the disease is treated early.
When should one go to the doctor?
A physician should be consulted if there is a decrease in physical performance or faintness. A general feeling of illness or malaise indicates the presence of a health disorder. If complaints persist or increase in intensity, a check-up visit to a doctor is recommended. Abnormalities of the gastrointestinal tract, digestive problems or disorders such as nausea, vomiting and dizziness should be examined and treated. If respiratory impairments are evident, there is cause for concern. Shortness of breath, anxiety, sleep disturbances and rapid fatigability are signs of a present illness. If there is an increase in body temperature, blood in the stool, a feeling of fullness or itching, clarification of the cause is advisable. To avoid complications or secondary diseases, a visit to the doctor is already necessary at the first health irregularities. In the case of a severe course of the disease, pus may form. If this gets into the bloodstream, it represents a life-threatening situation. If left untreated, organ failure may result in premature death. In some patients, the health impairments develop over a period of several years. As soon as the affected person becomes aware of the changes in his or her health condition, a physician should be consulted.
Treatment and therapy
The medical professional treats the infection with mebendazole. This preparation is an active substance that, in effect, helps against all types of worms. For this reason, the active ingredient also bears the name “broad-spectrum anthelmintic.” The active ingredient primarily kills the worms. Treatment with mebendazole lasts three days. After the treatment, the body is free from parasites or inflammation and infection. Further treatment is not necessary in the case of an infestation of dwarf threadworms. The rest of the therapy depends on the control of symptoms (nausea, vomiting, diarrhea).
Prevention
There is no prevention against dwarf threadworms. In the end, it helps to strengthen the immune system and to visit the doctor at the first symptoms.
Aftercare
Even though patients should have noticed virtually nothing of this infection, it has weakened the entire body and thus its immune system. The worms have triggered an infection that causes stress to the entire organism. Therefore, after a dwarf threadworm infection, the first thing to do is to treat the residual symptoms, such as nausea, vomiting or the remaining foci of infection, and thus to strengthen the immune system again. With a well-functioning immune system, a new infection can also be prevented. Above all, a healthy diet is important for a good immune system. Patients should attach importance to fresh food, if possible from organic cultivation, and prepare it in a way that preserves nutrients. One to two liters of water or herbal tea daily with and between meals is a must. Everything that could burden the body should be avoided. This includes stimulants such as nicotine and alcohol, as well as too fatty and too heavy food or an irregular sleep/wake rhythm. Naturopathic physicians can test possible deficiencies in the patient and balance them with appropriate orthomolecular substances. The daily intake of small amounts of healing clay or even turmeric can simultaneously detoxify the body. Very important in the post-treatment of a worm infection is intestinal care. The intake of probiotics, i.e. living microorganisms, is therefore recommended. Here, too, there are dietary supplements or even medications that are freely available in pharmacies and provide a healthy intestinal environment.
What you can do yourself
To support the treatment of a dwarf nematode infection, the patient can do a few things himself. Consistent hygiene is particularly important. It serves to prevent a new infection. It also prevents other people from becoming infected. One of the most important hygiene measures is regular hand washing with soap. This applies especially after visiting the toilet. The anus should also be thoroughly cleaned with clean water after each bowel movement. The appropriate washcloths should only be used once. Likewise, the fingernails should not be disregarded. It is recommended to cut them short and clean them with a brush at regular intervals. Another important self-help measure is the cleaning of night and bed linen as well as washcloths and towels. They should be changed daily and washed in a washing machine at temperatures of at least 60 degrees. Washing clothes must not be used by relatives because of the risk of infection. To prevent the eggs of the dwarf threadworms from getting into the bed, it is recommended to wear well-fitting underwear also at night. In addition, the individual living spaces should be subjected to thorough cleaning, which applies primarily to the bedroom. To prevent recurrence of dwarf nematode infection, it is important to treat all members of the family at the same time.
