• Home

Home > Medical Reference > Complementary Medicine

•    Related Program - Center for Integrative Medicine

Roundworms

Also listed as: Ascariasis; Guinea worm disease; Hookworm; Loiasis; Lymphatic filariasis; Parasitic infection - roundworms; Pinworm; River blindness; Threadworm; Trichinosis; Visceral larva migrans; Whipworm

• Signs and Symptoms
• Causes
• Risk Factors
• Diagnosis
• Preventive Care
• Treatment
• Other Considerations
• Supporting Research

Roundworms, or nematodes, are parasites that can infect humans, usually by residing in the intestines. Several different species of worm can cause infection, and worms can range in length from 1 millimeter to 1 meter. As with other parasitic diseases, roundworm infections are more common in warm, tropical climates than in cooler, temperate areas of the world. Ascariasis (caused by the worm Ascaris lumbricoides ) is the most common roundworm infection, and affects as many as 1 billion people worldwide.

Signs and Symptoms

The signs and symptoms of roundworm infection include:

• Passage of worm by mouth, rectum, or, with certain species (particularly dracunculosis), through skin ulcers. Worm eggs may also be passed in feces.
• Abdominal cramps
• Loss of appetite
• Diarrhea or constipation
• Flatulence
• Weight loss
• Anemia
• Cough, chest pain, or difficultly breathing
• Nausea and vomiting
• Fever
• Skin lesions, rashes, hives, itching
• Muscle aches
• Swelling of lymph nodes
• Visual impairment with certain species (particularly onchocerciasis)

Causes

According to the National Institute of Allergy and Infectious Diseases, many roundworm parasitic diseases result from a lack of appropriate personal hygiene and sanitation measures. Most roundworms or their eggs are found in the soil and can be picked up on the hands and transferred to the mouth or can enter through the skin. Different species of roundworms cause different infections.

The various roundworm infections include:

• Ascariasis : Ascariasis is an infection caused by the roundworm Ascaris lumbricoides . Infection occurs when an individual consumes food or drink contaminated with fecal matter that contains mature worm eggs. Adult worms can reside in the small intestine and produce eggs for a year or more.
• Whipworm (trichuriasis) : A whipworm infection occurs when an individual consumes food or drink contaminated with fecal matter containing the roundworm Trichuris trichiura . After eggs are ingested, larvae hatch in the small intestine and mature in the large intestine.
• Hookworm (ancylostomiasis) : A hookworm infection occurs when larvae of the roundworms Ancylostoma duodenale or Necator americanus penetrate human skin, making their way through the lungs to the small intestine, where they attach and mature into adults, laying more eggs. Children are particularly susceptible to this kind of infection. Once infected, children become weak and experience stunted growth patterns. These roundworms infect about 25 % of the world's population.
• Threadworm (strongyloidiasis) : Threadworm is an infection caused by the roundworm Strongyloides stercorali . This type of roundworm infects humans in the same way as Ancylostoma duodenale . About half of the population of some African countries has been infected with Strongyloides stercorali .
• Pinworm (enterobiasis) : A pinworm infection occurs when an individual consumes food or drink contaminated with fecal matter containing the roundworm Enterobius vermicularis . After being ingested, eggs hatch in the small intestine, and adult worms ultimately inhabit the large intestine. The pregnant female worms migrate to the anus and deposit large numbers of eggs in the skin around that area. Pinworm, which is commonly spread in day care centers, schools, and camps, affects as many as 1/3 of all American children.
• Visceral larva migrans, or VLM (toxocariasis) : VLM is an infection caused by the roundworms Toxocara canis , Toxocara cati , or Baylisascaris procyonis . These parasites ordinarily infect dogs, cats, and raccoons, respectively, but a human can become infected by consuming soil contaminated by infected animal feces. While the larvae do not mature to adults in humans, they penetrate the intestinal wall and migrate to various parts of the body, particularly the lungs and liver.
• Trichinosis (trichiniasis) : Trichinosis is an infection caused by the roundworm Trichinella spiralis . These larvae live in pigs and other wild carnivores, such as bears, but humans can become infected with Trichinella spiralis when they eat such meat (particularly pork) that is undercooked. The larvae mature in small intestines and migrate to muscle cells where they can live for months or years.
• Guinea worm disease (dracunculosis) : Humans can become infected with Guinea worm disease when they consume drinking water contaminated with the roundworm Dracunculus medinensis . Larvae penetrate the intestinal wall, where they mature and migrate to connective tissues. This type of roundworm infects 10 - 40 million people annually worldwide, primarily in the Indian subcontinent, West and Central Africa, and some Middle Eastern countries.
• Lymphatic filariasis : A lymphatic filariasis infection occurs when an individual is bitten by a mosquito containing the roundworms Wucheria bancrofti , Brugia malayi , or Brugia timori . Over a period of 6 - 12 months, adult worms mature and live in human lymph vessels and nodes and can eventually circulate through the blood. About 90 million people worldwide have been infected with these roundworms.
• River blindness (onchocerciasis) : River blindness is an infection caused by the roundworm Onchocerca volvulus . Onchocerciasis, which is spread by day-biting flies, is the leading cause of blindness worldwide, affecting about 20 million people, mostly in Africa.
• Loiasis : Loiasis is an infection caused by the roundworm Loa loa . Like river blindness, loiasis is spread by day-biting flies. An estimated 3 - 13 million people in equatorial Africa have been infected with Loa loa .

Risk Factors

The risk factors for roundworm infection include:

• Living in or visiting a warm, tropical climate
• Poor sanitation
• Poor personal hygiene
• Crowded conditions, such as day care or institutional settings
• Frequent practice of anal intercourse
• Compromised immune system
• Malnutrition
• Eating undercooked meat from carnivorous animals
• Eating dirt or clay (children and especially boys tend to become infected this way)
• Contact with animal feces
• Multiple insect bites

Diagnosis

Diagnosing roundworm infection involves identifying the species of worm causing the infection. If a worm passes through the mouth or rectum, it should be brought to the physician for analysis and identification. Other steps in diagnosis may include:

• Physical exam
• Stool and urine samples -- identify microorganisms in the stool and urine
• Blood tests -- detect infection in the blood
• Muscle or skin biopsy -- reveals infections that affect the muscle or skin
• Ultrasound -- reveals worms in lymph nodes
• X-ray -- reveals large worms in abdominal region
• Sampling of contents of small intestine may reveal the presence of roundworms.
• Tape test -- used particularly for pinworm infections. A doctor applies cellulose acetate tape to the skin around the anal region, removes the tape, and then examines it for pinworm under a microscope.

Preventive Care

Probably the best solution to the problem of roundworms rests in preventing these infections rather than in curing them. The steps to preventing roundworm infection include:

• Practice good personal hygiene (such as washing hands and avoiding contact with fecal matter).
• Avoid uncooked or unwashed fruits and vegetables in areas where sanitation is poor.
• Avoid mosquito or fly-infested areas, unfiltered water, and direct skin contact with soil in areas where roundworm infections are prevalent.
• Wear protective clothing, and use insect repellant.
• Cook or freeze meat thoroughly.
• Keep children away from pet feces.
• Consult a veterinarian about deworming pets.
• Public health measures in areas where roundworm infections are prevalent include improving general sanitation, especially sewage disposal, and reducing mosquito and fly populations.

Treatment

The use of antiparasitic medications is the primary therapy for roundworm infections, and the medication a health care provider prescribes depends on which specific roundworm infects the individual. Surgical procedures may be necessary under certain circumstances, but such procedures are not always readily available in areas where roundworm infections are prevalent. Roundworm infections can inflame the lining of the gut and limit the absorption of and compete with many essential nutrients, including vitamins A and B6. Vitamin A deficiencies are believed to increase the risk of parasitic infections, so some researchers speculate that vitamin A supplementation may help prevent or reduce symptoms associated with roundworm infections.

Medications

Antiparasitic drugs and other medications used to treat roundworm infections and certain complications include:

• Mebendazole -- for ascariasis, whipworm, hookworm, and pinworm
• Albendazole -- for ascariasis, whipworm, and hookworm
• Thiabendazole -- for threadworm
• Pyrantel pamoate -- for ascariasis, hookworm, and pinworm
• Prednisone -- for severe VLM and at certain times in cases of trichinosis
• Diethylcarbamazine (DEC) -- for lymphatic filariasis
• Ivermectin -- for river blindness, and may also be effective for threadworm
• Oral iron -- if anemia is present
• Analgesics, anti-inflammatories, antihistamines, and antibiotics -- for relief of symptoms or to treat bacterial infection

See "Warnings and Precautions" for certain medications that an individual with roundworm infection should avoid.

Surgery and Other Procedures

Surgical removal of worms from Guinea worm disease and river blindness are possible but are usually not available in many areas where roundworm infection is prevalent. Surgery may be necessary in some cases when the infection causes obstructions in the intestines or other organs. Measures to alleviate soft tissue swelling from lymphatic filariasis may include bandaging, physical therapy, careful skin care, as well as drainage of excess fluids.

Nutrition and Dietary Supplements

Malnutrition may be associated with roundworm infection, so maintaining optimal nutritional status may be helpful in preventing and treating roundworm infection. A comprehensive treatment plan for roundworm infections may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce the chances of becoming infected with roundworms or support a healthy body if infected:

• Eat bitter and spicy foods, such as those containing turmeric (curries), cayenne peppers, green chillies, olives, figs, garlic, and ginger.
• Drink warm teas that contain spices such as cardamon, clove and cinnamon.
• Eat more dark leafy greens (such as spinach and kale) and sea vegetables.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein. Stay away from pork and other meats from carnivorous animals.
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, five days a week.

Nutritional deficiencies may be addressed with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 3 tablespoonfuls oil, one to three times daily, to help with immunity.
• Probiotic supplement (containing Lactobacillus acidophilus and other species), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• Grapefruit seed extract ( Citrus paradisi ), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily when needed, for antiparasitic activity.
• Whey protein, 10 - 20 grams daily mixed in favorite beverage, for support of immunity and weight gain when needed.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea ( Camellia sinensis ) for antioxidant, anticancer, and immune effects. Prepare a tea from the leaf of this herb and drink 1 - 2 cups, one to three times daily.
• Olive leaf ( Olea europaea ) standardized extract, 250 - 500 mg one to three times daily, for antiparasitic and immune effects.
• Turmeric ( Curcuma longa ) standardized extract, 300 mg three times a day, for antiparasitic properties.
• Garlic (Allium sativum) , standardized extract, 400 mg two to three times daily, for antiparasitic and immune activity.
• Wormwood ( Artemisia absinthium ), black walnut ( Juglans nigra ), and clove ( Syzygium aromaticum) are commonly used in combination herbal formulas for parasitic infections. Many products on the market combine these herbs, so take as directed by your health care provider.

Other Considerations

Pregnancy

Most antiparasitic drugs used to treat roundworm infection should not be used during pregnancy.

Warnings and Precautions

• Ivermectin -- this medication, sometimes used to treat roundworm infections, should not be given to nursing mothers, the severely ill, children under 5 years old, or those weighing less than 15 kg (6.8 lb).

Prognosis and Complications

There are several possible complications associated with roundworm infections. They include:

• Intestinal obstruction (caused by the roundworm itself)
• Inflammation of the intestines or gall bladder
• Kidney disease
• Pus accumulation in the liver
• Inflammation of the pancreas
• Appendicitis
• Peritonitis (inflammation of the sac surrounding the abdomen, generally with fluid accumulation)
• Encephalopathy (disorder of the brain)
• Cardiomyopathy (disease of the cardiac muscle of the heart)
• Malnutrition
• Distorted, abnormal growth of the skin and surrounding soft tissue
• Blindness (from onchocerciasis)

The course of some roundworm infections can be long and unpleasant, and there are many possible complications. Individuals living in areas where roundworm infections are prevalent may become infected more than once. Fortunately, most roundworm infections can be successfully treated with antiparasitic medications and dietary supplementation. For example, the prognosis in cases of ascariasis and pinworm is generally excellent.

Supporting Research

Beers MH, Berkow R, eds. The Merck Manual of Diagnosis and Therapy . Whitehouse Station, NJ: Merck Research Laboratories; 1999. Section 13, Chapter 161.

Bennett A, Guyatt H. Reducing intestinal nematode infection: efficacy of albendazole and mebendazole. Parasitol Today . 2000;16(2):71-74.

Brabin L. Sex differentials in susceptibility to lymphatic filariasis and implications for maternal-child immunity. Epidemiol Infect . 1990;105(2):335-353.

Bundy DA, Grenfell BT, Rajagopalan PK. Immunoepidemiology of lymphatic filariasis: the relationship between infection and disease. Immunol Today . 1991;12(3):A71-A75.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr . 2006;25(2):79-99.

Carman JA, Pond L, Nashold F, Wassom DL, Hayes CE. Immunity to Trichinella spiralis infection in vitamin A-deficient mice. J Exp Med . 1992;175(1):111-120.

Chandrashekar R. Recent advances in diagnosis of filarial infections. Indian J Exp Biol . 1997;35(1):18-26.

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm . 2004;54(3):243-50.

Daoud AA, Abdel-Ghaffar AE, Deyab FA, Essa TM. The effect of antioxidant preparation (antox) on the course and efficacy of treatment of trichinosis . J Egypt Soc Parasitol . 2000;30(1):305-314.

Fenwick PK, Aggett PJ, Macdonald D, Huber C, Wakelin Dl. Zinc deficiency and zinc repletion: effect on the response of rats to infection with Trichinella spiralis . Am J Clin Nutr . 1990;52(1):166-172.

Frydas S, Papaioanou N, Vlemmas I, et al. Vitamin B ₆ -deficient diet plus 4-deoxypyridoxine (4-DPD) reduces the inflammatory response induced by T. spiralis in diaphragm, masseter and heart muscle tissue of mice. Mol Cell Biochem. 1999;197(1-2):79-85.

Harnett W, Bradley JE, Garate T. Molecular and immunodiagnosis of human filarial nematode infections. Parasitol . 1998;117(suppl):S59-S71.

Heron S, Yarnell E. Treating parasitic infections with botanical medicines. Altern Complement Ther . 1999;8:214-224.

Jalal F, Nesheim MC, Agus Z, Sanjur D, Habicht JP. Serum retinol concentrations in children are affected by food sources of beta-carotene, fat intake, and anthelmintic drug treatment. Am J Clin Nutr . 1998;68(3):623-629.

Kightlinger LK, Seed JR, Kightlinger MB. Ascaris lumbricoides aggregation in relation to child growth status, delayed cutaneous hypersensitivity, and plant anthelmintic use in Madagascar. J Parasitol . 1996;82(1):25-33.

Kiuchi F, Goto Y, Sugimoto N, Akao N, Kondo K, Tsuda Y. Nematocidal activity of turmeric: synergistic action of curcuminoids. Chem Pharm Bull . 1993;41(9):1640-1643.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide . Hudson, OH:LexiComp; 2000: 452-454.

Liangmin L. Clinical observation on combined use of herbal medicine and acupuncture for treatment of 50 cases of biliary ascariasis complicated by infection. J Tradit Chin Med . 1996;16(3):194-197.

Mishra V, Khan NU, Singhal KC. Potential antifilarial activity of fruit extracts of Ficus racemosa Linn. against Setaria cervi in vitro. Indian J Exp Biol . 2005 Apr; 43(4):346-50.

Persson V, Ahmed F, Gebre-Medhin M, Greiner T. Increase in serum beta-carotene following dark green leafy vegetable supplementation in Mebendazole-treated school children in Bangladesh. Eur J Clin Nutr . 2001 Jan; 55(1):1-9.

Persson V, Ahmed F, Gebre-Medhin M, Greiner T. Relationships between vitamin A, iron status and helminthiasis in Bangladeshi school children. Public Health Nutr. 2000;3(1):83-89.

Public Health Service. Parasitic Roundworm Diseases. NIAID Fact Sheet . October, 1998.

Rajan TV, Gundlapalli AV. Lymphatic filariasis. Chem Immunol . 1997;66:125-158.

Rajan TV. Molecular biology of human lymphatic filariasis. Exp Parasitol . 1990;70(4):500-503.

Shcherbakov AM, Lur'e AA. [The enhanced bioavailability of mebendazole in echinococcosis patients when used with Essentiale]. Med Parazitol (Mosk). 1993 Jan-Feb; (1):43-5.

Sherif A, Hall RG, El-Amamy M. Drugs, insecticides and other agents from Artemisia . Med Hypotheses . 1987;23:187-193.

Storey DM. Filariasis: nutritional interactions in human and animal hosts. Parasitology . 1993;107(suppl):S147-S158.

Tietze PE, Tietze PH. The roundworm, Ascaris lumbricoides . Prim Care . 1991;18(1):25-41.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs . 2000;9(9):2103-19.

Wenk P. The vector-host link in filariasis. Ann Trop Med Parasitol . 1991;85(1):139-147.

Zambou NF, Mbiapo TF, Lando G, Tchana KA, Gouado I. Effect of Onchocerca volvulus infestation on plasma vitamin A concentration in school children in a rural region of Cameroon [in French]. Cahiers Santé . 1999;9:151-155.

• Review Date: 10/20/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process . A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2007 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.