Intestinal Parasites and Other Pesky Parasites? Let's find out exactly what they are!

Do you sometimes experience stomach discomfort, bloating, or a feeling of fullness? Perhaps you don't even realize that the cause of this could be small, annoying parasites living in your intestines. Although this name may sound a little scary when you hear it, if you are properly informed about it, it is not a big problem for us. Today, let's talk about these intestinal parasites (`Intestinal Parasites`).

What are these intestinal parasites?

Simply put, intestinal parasites are tiny, single-celled organisms that live in your intestines. A parasite is an organism that lives in the body of another organism (the host) and gets its nourishment and shelter from that host. Think of it like a group of parasites that just show up uninvited, sit on our bodies, and live off of our food and drink.

These parasites use the host's body to reproduce and try to find the next host. However, these parasites do us no good . Instead, they cause us various uncomfortable symptoms, sometimes even serious health problems.

What types of parasites are these?

There are two main types of intestinal parasites: worms called `Helminths` and single-celled organisms called `Protozoa`.

Helminths (intestinal parasitic worms)

Helminths are a group of parasitic worms that include various roundworms (round-bodied) and flatworms (flat-bodied). Although they thrive inside our bodies, they often cannot reproduce inside us. Instead, they lay eggs, which are passed out of our bodies in our feces. Then, when other people unknowingly come into contact with these eggs (for example, by eating with dirty hands), they become new hosts, and the worm species persists.

Here are some of the most common types of intestinal worms:

• Pinworms (or enterobiasis): These are thread-like worms. They are spread by touching a spot where pinworm eggs are found and then putting them in your mouth. The eggs hatch in your small intestine. Females lay eggs around the anus at night. This can cause itching around the anus . So, if you scratch that area and touch another area without washing your hands, the eggs will get on there too, which is how it spreads. This is very common among young children.

• Roundworms (`Ascaris` or `ascariasis`): When viewed under a microscope, these worms look like small worms. They are transmitted when the eggs in the soil come into contact with dirty soil and are ingested. "Dirty soil" means that feces containing worm eggs have been mixed with the soil. This condition can be seen in areas where there are few toilet facilities and people defecate in the open. Also, `Ascaris` worms can be transmitted from vegetables and fruits grown using human feces as fertilizer.

• Whipworms (or trichuriasis): These worms get their name from their whip-like shape. Like Ascaris, whipworms are transmitted by ingesting eggs found in contaminated soil.

• Hookworms (Ancylostomiasis): Hookworms have a hook-like head. This is how they attach to the walls of our intestines and suck blood. Like Ascaris and whipworms, hookworms are spread through contaminated soil. The difference here is that the eggs in the soil develop into larvae. If you walk barefoot in the soil , these hookworm larvae can enter your body through your skin.

• Strongyloides (or strongyloidiasis): These worms are transmitted through contact with contaminated soil. They can be ingested orally, or they can enter through the skin when walking barefoot. Unlike other helminths, Strongyloides can also reproduce within a host.

• Tapeworms (or taeniasis): These worms have a body like a tape, divided into segments. They live in the digestive tracts of humans and animals (pigs, cattle, fish). If you eat undercooked pork, beef, or fish, you can ingest the eggs or larvae. Or, you can get tapeworms by touching an area with eggs and putting them in your mouth.

• Trichinella (or trichinosis): Trichinella is transmitted in a similar way to tapeworms. This roundworm is transmitted by eating raw or undercooked meat from an infected animal (usually pigs).

• Flukes: These flatworm infections can be contracted by drinking dirty water or eating infected aquatic plants or fish. Types that live in our intestines include Fasciolopsis buski (which causes fasciolopsiasis) and Heterophyes (which causes heterophysisis).

Single-celled organisms (`Protozoa`)

Like helminths, these single-celled organisms called protozoa are transmitted when even a small amount of their eggs are ingested. They are most often transmitted through contaminated water or contaminated fruits and vegetables. However, protozoa can also reproduce within a human host.

Here are some of the most commonly seen types of protozoa:

• Giardia (`Giardia` - this causes the disease `giardiasis`)
• Entamoeba histolytica (which causes amebiasis)
• Cyclospora (`Cyclospora` - this causes `cyclosporiasis`)
• Cryptosporidium (`Cryptosporidium` - this causes `cryptosporidiosis`)
• Blastocystis species (`Blastocystis species` - this causes `Blastocystosis`)
• Cystoisospora belli (causes cystoisosporiasis)

What is the most common parasite?

According to the World Health Organization (WHO), about 25% of the world's population has an intestinal parasitic infection. This figure is as high as 50% in tropical and subtropical regions, where access to clean water and sanitation is poor. The most common intestinal parasitic infection worldwide is roundworm infection (ascariasis). It affects about one billion people worldwide.

In the United States, the most common protozoan infections are those caused by the parasite Giardia. Pinworms are the most common intestinal worms there. These conditions can also be seen in our country to a lesser extent, especially in areas where hygiene is less important.

What are the symptoms of these parasitic infections?

Some infections don't show any symptoms, so you may not even know you have a parasite. If symptoms do appear, what they are will depend on the type of parasite you are infected with.

Common symptoms of intestinal parasites are:

• Diarrhea - loose stools
• Abdominal pain
• Gas and gas pain
• Bloating - stomach bloating
• Nausea and vomiting
• Anal itching ( especially due to pinworms)

Are these parasites passed out with the stool? Can they be seen in the toilet?

Usually, the eggs of parasitic worms are passed out with the stool, but the worms themselves are rarely passed out. The eggs are so small that they need to be seen with a microscope.

However, tapeworms are a little different. Sometimes the tapeworm's body parts, along with the eggs, can be passed out in the stool. Then you'll see small pieces in the toilet that look like white grains of rice stuck to the stool.

How do these parasitic infections occur?

The way parasites are transmitted can vary from parasite to parasite. However, most people get intestinal parasites by ingesting parasite eggs that are passed through feces. These eggs are so small that you may not even realize you are swallowing them.

Here are some ways you can get intestinal parasitic infections:

• Drinking contaminated water: From public and private drinking water sources, swimming pools, rivers, lakes, etc.
• Eating contaminated food: Eating vegetables and fruits that have been washed in dirty water, or eating things grown in dirty soil. It can also be contracted by eating raw or undercooked meat and fish that contain the parasite.
• Putting your fingers in your mouth: Some parasite eggs can survive on various surfaces for a while. You can become infected if you touch such a surface and then put your hand in your mouth. Depending on the parasite, these surfaces can include bedding, pet fur, and even human skin.
• Walking barefoot in dirty soil: The larvae of some intestinal worms can enter your body through your skin if you walk barefoot in the soil where they live.

Who is at higher risk of developing these?

Your risk of becoming infected with a parasite (and spreading it to someone else) depends on where you live and your daily habits.

Infections are more likely to occur in places like these:

• Areas with warm and humid climates: especially tropical and subtropical regions, such as sub-Saharan Africa, Asia, Latin America, and the Caribbean. (The `Strongyloides` worm is most common in the southeastern United States and rural Appalachian regions.)
• Places with limited clean water facilities.
• Places where there are insufficient public sanitation facilities.
• Places where many people live huddled together.
• Places where people live in close proximity to farm animals.

These habits can also increase your risk:

• Open defecation (due to lack of adequate public sanitation facilities).
• Using human feces as fertilizer.
• Walking outside without sandals in a high-risk area.
• Engaging in unprotected oral-anal or penile-anal sex in a high-risk area.

What are the possible complications of parasitic infections?

If you have a heavy parasitic load, you may develop severe symptoms. If you have a weakened immune system or are pregnant , you are at higher risk. Depending on the parasite, if left untreated, complications such as:

• Dehydration ( due to severe diarrhea)
• Malnutrition
• Iron-deficiency anemia
• Bowel obstruction
• Appendicitis
• Intussusception (intestinal intussusception)
• Cholangitis
• Cholecystitis
• Pancreatitis
• Peritonitis (infection of the abdominal cavity)
• Dysentery
• Rectal prolapse
• Internal organ damage (if a tapeworm travels to the brain, eyes, heart, lungs, or liver)

How do you identify these exactly?

Your doctor will ask you about your symptoms and do a physical exam. Then, they will do some stool tests to check for parasite eggs in your stool. In most cases, that is all that is needed.

Other diagnostic tests are:

• Scotch™ tape test: This test can help you see if you or your child has pinworms. A piece of sticky tape is placed around your anus and any eggs that may be there are collected. The doctor then looks at the tape under a microscope to see if there are any eggs.
• Blood tests: Blood tests can show if you have a low number of red blood cells (anemia) or an increased number of eosinophils, a type of white blood cell. This can be a sign of some parasitic infections. Some tests detect things called antigens or antibodies. These small proteins can indicate the presence of a parasite.
• Imaging tests: Your doctor may order an X-ray, ultrasound, MRI (magnetic resonance imaging), or CT scan (computed tomography scan) to see if there are adult worms in your intestines.
• Colonoscopy: This test can show damage inside your intestines caused by an intestinal infection.

What is the treatment for this?

Some infections go away on their own, but many people need to take antiparasitic drugs prescribed by a doctor to get rid of intestinal parasites. These drugs work by weakening the parasites, stopping their growth, or killing the parasite or its eggs. The specific medication you need will depend on which parasite you have and how severe your symptoms are.

Some commonly used antiparasitic drugs:

• For pinworms: `Pyrantel pamoate`
• For soil-borne intestinal worms: `Mebendazole` or `albendazole`
• For protozoal infections: `Metronidazole`, `tinidazole` or `trimethoprim/sulfamethoxazole (TMP-SMX)`

Depending on the medication, you may only need to take one dose to clear the infection. Other medications may need to be taken once or several times a day, for anywhere from three days to three weeks. Some, like deworming medications, require a short break before you can take them again. It is very important to take your medication exactly as your doctor tells you.

You will notice that your symptoms will subside after the medication eliminates the parasite and its eggs.

What happens after treatment?

Most intestinal parasites die quickly with medication. Once the parasites are gone, the symptoms usually go away.

Infections can be more difficult to cure if you have a weak immune system or if you are pregnant. In such cases, your doctor will carefully monitor whether the treatment is working and whether the parasite is going away.

How can you protect yourself from these infections?

Clean water and sanitation facilities are the best solution to prevent most intestinal parasite infections.

However, you can also protect yourself from intestinal parasites by doing these things:

• Drink clean water. Avoid drinking water from lakes, rivers, and ponds. If you are in doubt about the purity of the water, use bottled water.
• Wash your hands often. Use clean water and antibacterial soap to keep your hands free of parasite eggs. Always wash your hands after using the toilet, before preparing food, before eating, and after cleaning up after small children (dirty nappies) or pets.
• In high-risk areas, eat only well-prepared vegetables and fruits. Avoid eating raw vegetables and fruits if you are in an area where intestinal parasites are common. Eat only vegetables and fruits that have been washed with clean water, peeled, and cooked.
• Wear shoes and gloves. Wearing shoes that don't expose your feet can help prevent whipworm infections. Wear gloves if you're working with soil.
• Cook meat and fish thoroughly until they reach a safe temperature. Cook whole cuts of meat to 145 degrees Fahrenheit (62.8 degrees Celsius) and ground meat to 160 degrees Fahrenheit (about 71 degrees Celsius).
• Practice safe sex. Use a condom or dental dam during sex to reduce the risk of infection.

What should we do when there is an infection?

While the infection is healing, do the following:

• Stay hydrated: Drink plenty of water, sports drinks, or broth to prevent dehydration.
• Get adequate nutrition: Eat clean, nutritious food and get the nutrition you need for the day. If you have stomach problems, try eating smaller meals instead of larger meals.
• Prevent reinfection if possible: Medication can treat current infections, but it cannot prevent future infestations. Sometimes, bathing and washing bedding daily while you are being treated (for pinworms) can help prevent reinfection. Other times, you can do this by always wearing shoes and gloves when working outdoors. Take steps to avoid getting infected with a parasite again.

What are the best times to see a doctor?

If you have symptoms of an intestinal parasite, especially if you live in a high-risk area, have recently traveled to one, or suspect you may have eaten undercooked food , be sure to see your doctor.

When do you need to go to an emergency room (ER)?

If you have symptoms of dehydration, go to an emergency room immediately:

• Severe, watery diarrhea that occurs repeatedly.
• Dizziness.
• Sudden confusion.
• Headache .
• Decreased production of urine or dark urine.
• Fatigue.

Most people get intestinal parasites by ingesting parasite eggs (often found in feces). This may come as a surprise to you. We all think we have complete control over what we put in our mouths. However, this is not the case with parasite eggs. They are too small to be seen with the naked eye. If you rub the eggs on your fingertips, you could unknowingly spread them all over your body, onto food, and eventually into your mouth.

But, awareness is key . When you understand how intestinal parasites are spread, you'll think twice about skipping hand washing and eating undercooked food. If you develop an infection, don't delay seeing a doctor. Antiparasitic medications can help get rid of these uninvited guests in your body before they cause you any health problems.

Finally, what to remember

Intestinal parasites are something we shouldn't ignore, but we don't need to be afraid either.

• Cleanliness is key. Simple things like washing your hands thoroughly, drinking clean water, and cooking food properly can make a big difference.
• If you have symptoms , don't ignore them. Seek medical advice immediately.
• Follow the treatment given by the doctor exactly .
• Share this information with your family and friends . Awareness is the best defense.

So, let's all try to stay healthy, keeping these things in mind!

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