Cleanliness is of great importance in the prevention of many kinds of infections—infections of the gut, the skin, the eyes, the lungs, and the whole body. Personal cleanliness (or hygiene) and public cleanliness (or sanitation) are both important.

Many common infections of the gut are spread from one person to another because of poor hygiene and poor sanitation. Germs and worms (or their eggs) are passed by the thousands in the stools or feces (shit) of infected persons. These are carried from the feces of one person to the mouth of another by dirty fingers or contaminated food or water.

There are many types of worms and other tiny animals (parasites) that live in people’s intestines and cause diseases. Those which are larger are sometimes seen in the stools (feces, shit). The only worms commonly seen in the stools are roundworms, pinworms, and tapeworms. Hookworms and whipworms may be present in the gut in large numbers without ever being seen in the stools.

1. Roundworm (Ascaris)

20 to 30 cm. long. Color: pink or white

How they are spread:
Feces-to-mouth. Through lack of cleanliness, the roundworm eggs pass from one person’s stools to another person’s mouth.

Effect on health:
Once the eggs are swallowed, young worms hatch and enter the bloodstream; this may cause general itching. The young worms then travel to the lungs, sometimes causing a dry cough or at worst, pneumonia with coughing of blood. The young worms are coughed up, swallowed, and reach the intestines, where they grow to full size.
Many roundworms in the intestines may cause discomfort, indigestion, and weakness. Children with many roundworms often have very large, swollen bellies.
Rarely, roundworms may cause asthma, or a dangerous obstruction or blockage in the gut. Especially when the child has a fever, the worms sometimes come out in the stools or crawl out through the mouth or nose. Occasionally they crawl into the airway and cause gagging.

Prevention:
Use latrines, wash hands before eating or handling food, protect food from flies.

Treatment:
Mebendazole will usually get rid of roundworms. Piperazine also works. Some home remedies work fairly well, eg. using papaya.
Warning: Do not use thiabendazole for roundworms. It often makes the worms move up to the nose or mouth and can cause gagging.

2. Pinworm, Threadworm, Seatworm (Enterobious)

1 cm. long. Color: white. Very thin and threadlike.

How they are transmitted:
These worms lay thousands of eggs just outside the anus (ass hole). This causes itching, especially at night. When a child scratches, the eggs stick under his nails, and are carried to food and other objects. In this way they reach his own mouth or the mouths of others, causing new infections of pinworms.

Effect on health:
These worms are not dangerous. Itching may disturb the child’s sleep.

Treatment and Prevention:

  • A child who has pinworms should wear tight diapers or pants while sleeping to keep him from scratching his anus.
  • Wash the child’s hands and buttocks (anal area) when he wakes up and after he has a bowel movement. Always wash his hands before he eats.
  • Cut his fingernails very short.
  • Change his clothes and bathe him often—wash the buttocks and nails especially well.
  • Put Vaseline in and around his anus at bedtime to help stop itching.
  • Give mebendazole worm medicine. Piperazine also works, but should not be used for babies. When one child is treated for these worms, it is wise to treat the whole family at the same time. For a home remedy using garlic.
  • Cleanliness is the best prevention for threadworms. Even if medicine gets rid of the worms, they will be picked up again if care is not taken with personal hygiene. Pinworms only live for about 6 weeks. By carefully following the guidelines of cleanliness, most of the worms will be gone within a few weeks, even without medicine.

3. Whipworm (Trichuris, Trichocephalus)

3 to 5 cm. long. Color: pink or gray.
This worm, like the roundworm, is passed from the feces of one person to the mouth of another person. Usually this worm does little harm, but it may cause diarrhea. In children it occasionally causes part of the intestines to come out of the anus (prolapse of the rectum).

Prevention: The same as for roundworm.

Treatment: If the worms cause a problem, give mebendazole. For prolapse of the rectum, turn the child upside down and pour cool water on the intestine. This should make it pull back in.

4. Hookworm

1 cm. long. Color: red.

Hookworms cannot usually be seen in the feces. A stool analysis is needed to prove that they are there.

How hookworms are spread:

  • The baby hookworms enter a person’s bare feet. This can cause red marks on the feet and itching.
  • In a few days they reach the lungs through the blood stream. They may cause a dry cough (rarely with blood).
  • The person coughs up the young worms and swallows them.
  • A few days later the person may have diarrhea or a stomach-ache.
  • The hookworms attach themselves to the walls of the gut. Many worms can cause weakness and severe anemia.
  • The hookworm eggs leave the body in the person’s stools. The eggs hatch on moist soil.

Hookworm infection can be one of the most damaging diseases of childhood. Any child who is anemic, very pale, or eats dirt may have hookworms. If possible, his stools should be analyzed.

Treatment: Use mebendazole, albendazole, or pyrantel. Treat anemia by eating foods rich in iron and if necessary by taking iron pills.

5. Tapeworm

In the intestines tapeworms grow several meters long. But the small, flat, white pieces (segments) found in the feces are usually about 1 cm. long.
Occasionally a segment may crawl out by itself and be found in the underclothing. People get tapeworms from eating pork (pig meat), beef (cow meat) or other meat or fish that is not well cooked.

Prevention: Be careful that all meat is well cooked, especially pork. Make sure no parts in the center of roasted meat or cooked fish are still raw.

Effect on health: Tapeworms in the intestines sometimes cause mild stomach aches, but few other problems.

The greatest danger exists when the cysts (small sacs containing baby worms) get into a person’s brain. This happens when the eggs pass from his stools to his mouth. For this reason, anyone with tapeworms must follow the guidelines of cleanliness carefully—and get treatment as soon as possible.

Treatment: Take niclosamide, or praziquantel.

6. Trichinosis

These worms are never seen in the stools. They burrow through the person’s intestines and get into her muscles. People get these worms, like tapeworms, from eating infected pork or other meat that is not well cooked.

Effect on health: Depending on the amount of infected meat eaten, the person may feel no effects, or she may become very sick or die. From a few hours to 5 days after eating the infected pork, the person may develop diarrhea and feel sick to her stomach.

In serious cases the person may have:

  • fever with chills.
  • muscle pain.
  • swelling around the eyes and sometimes swelling of the feet.
  • small bruises (black or blue spots) on the skin.
  • bleeding in the whites of the eyes.

Severe cases may last 3 or 4 weeks.

Treatment: Seek medical help at once. Albendazole or mebendazole may help. Cortico-steroids may help, but should be given by a health worker or doctor.
Important: If several people who ate meat from the same pig get sick afterward, suspect trichinosis. This can be dangerous; seek medical attention.

Prevention of trichinosis:

  • Only eat pork and other meat that has been well cooked.
  • Do not feed scraps of meat or leftovers from butchering to pigs unless the meat has first been cooked.

7. Amebas

These are not worms, but tiny animals—or parasites—that can be seen only with a microscope (an instrument that makes things look much bigger).

How they are transmitted:
The stools of infected people contain millions of these tiny parasites. Because of poor sanitation, they get into the source of  drinking water or into food, and other people become infected.

Signs of infection with amebas:
Many healthy people have amebas without becoming sick. However, amebas are a common cause of severe diarrhea or dysentery (diarrhea with blood)—especially in persons already weakened by other sickness or poor nutrition. Less commonly, amebas cause painful, dangerous abscesses in the liver.

Typical amebic dysentery consists of:

  • diarrhea that comes and goes—sometimes alternating with constipation.
  • cramps in the belly and a need to have frequent bowel movements, even when little or nothing—or just mucus—comes out.
  • many loose (but usually not watery) stools with lots of mucus, sometimes stained with blood.
  • in severe cases, much blood; the person may be very weak and ill.
  • if there is fever, it means there may also be a bacterial infection.

Diarrhea with blood may be caused by either amebas or bacteria. However, bacterial dysentery (Shigella) begins more suddenly, the stools are more watery, and there is almost always fever. As a general rule:

Diarrhea + blood + fever = bacterial infection (Shigella)
Diarrhea + blood + no fever = amebas

Occasionally bloody diarrhea has other causes. To be sure of the cause, a stool analysis may be necessary. Sometimes amebas get into the liver and form an abscess or pocket of pus. This causes tenderness or pain in the right upper belly. Pain may extend into the right chest and is worse when the person walks. If the person with these signs begins to cough up a brown liquid, an amebic abscess is draining into his lung.

Treatment:

  • If possible get medical help and a stool analysis.
  • Amebic dysentery can be treated with metronidazole, if possible together with diloxanide furoate. For dosage, length of treatment, and precautions.
  • For amebic abscess, treat as for amebic dysentery, and then take chloroquine for 10 days.

Prevention: Make and use latrines, protect the source of drinking water, and follow the guidelines of cleanliness. Eating well and avoiding fatigue and drunkenness are also important in preventing amebic dysentery.

8. Giardia

The giardia, like the ameba, is a microscopic parasite that lives in the gut and is a common cause of diarrhea, especially in children. The diarrhea may be chronic or intermittent (may come and go). A person who has yellow, bad-smelling diarrhea that is frothy (full of bubbles) but without blood or mucus, probably has giardia.

The belly is swollen with gas and uncomfortable, there are mild intestinal cramps, and the person farts and burps a lot. The burps have a bad taste, like sulfur. There is usually no fever.

Giardia infections sometimes clear up by themselves. Good nutrition helps. Severe cases are best treated with metronidazole. Quinacrine (Atabrine) is cheaper and often works well, but causes worse side effects.