HOOKWORM, ROUNDWORM, THREADWORM AND PINWORM - CLINICAL PRESENTATION, EXAMINATION AND INVESTIGATION

HOOKWORM, ROUNDWORM, THREADWORM AND PINWORM - CLINICAL PRESENTATION, EXAMINATION AND INVESTIGATION

• Intestinal helminthic infections are commonly caused by Nematodes (roundworms).

• The most prevalent types include:

  • Hookworm – Ancylostoma duodenale, Necator americanus

  • Roundworm – Ascaris lumbricoides

  • Threadworm – Strongyloides stercoralis

  • Pinworm – Enterobius vermicularis

• These infections are common in children and populations with poor hygiene.

• In Ayurveda, they are referred to as Krimi Roga, specifically Antraja Krimi (intestinal worms).

📜 Charaka Samhita Viman Sthana 7/6:
"अन्नपानविधानेन कृमयः सम्प्रजायते।"
(Improper food and hygiene are causative for Krimi Roga)

ETIOLOGY (NIDANA)

• Poor hygiene and sanitation

• Walking barefoot (Hookworm)

• Consumption of contaminated food/water (Roundworm, Threadworm)

• Improper handwashing (Pinworm)

• Weak immunity and malnutrition

📜 Ashtanga Hridaya Uttara Tantra 4/2:
"सङ्ग्रहस्तम्भनक्षुत्तृष्णारुचिपाण्डुतालुकण्ठकण्ठशूलकासकृच्छ्रकृमिवृद्धयः।"
(Multiple symptoms arise due to Krimi affecting various systems)

CLINICAL PRESENTATION

HOOKWORM (Ancylostoma duodenale / Necator americanus)

• Skin phase: Ground itch at site of entry (feet)

• Lung phase: Cough, wheezing (Löffler’s syndrome)

• Intestinal phase:

  • Iron deficiency anemia

  • Pallor

  • Fatigue and weakness

  • Epigastric discomfort

  • Pica

  • Edema (in chronic blood loss)

ROUNDWORM (Ascaris lumbricoides)

• Often asymptomatic in mild cases

• Lung phase:

  • Cough, wheezing

  • Hemoptysis

  • Fever (Löffler’s syndrome)

• Intestinal phase:

  • Abdominal pain

  • Vomiting of worms

  • Malnutrition and stunted growth in children

  • Intestinal obstruction in heavy infestations

  • Biliary or pancreatic duct obstruction

THREADWORM (Strongyloides stercoralis)

• Dermatological: Itchy rash (larva currens)

• Pulmonary: Dry cough, wheezing

• Intestinal:

  • Diarrhea or constipation

  • Abdominal cramps

  • Nausea

• Hyperinfection syndrome in immunocompromised

PINWORM (Enterobius vermicularis)

• Perianal itching, especially at night

• Restlessness and disturbed sleep

• Irritability and loss of concentration

• Vulvovaginitis in female children

• Occasional secondary bacterial infections

📜 Kashyapa Samhita Krimi Nidanam:
"कृमयो बहवः सन्ति जन्तवो मांसशोणिताशिनः।"
(The parasites dwell on bodily tissues and blood causing disorders)

RELEVANT EXAMINATION

• General physical examination:

  • Pallor (Hookworm, Roundworm)

  • Nutritional status (weight, growth monitoring)

  • Skin rash or lesions (Threadworm)

  • Perianal region examination (Pinworm)

• Systemic examination:

  • Abdominal tenderness or distension

  • Lung auscultation for crepitations (in pulmonary migration)

  • Neurological examination in suspected CNS involvement (rare)

• Ayurvedic assessment:

  • Darshana, Sparshana, Prashna pareeksha

  • Vikruti Jnana: Dushti of Rakta, Pitta, Purisha

  • Krimi Lakshanas: Kandu, Aruchi, Shula, Pandu, etc.

📜 Charaka Samhita Chikitsa Sthana 7/17:
"अतिसारारुचिपाण्डुहृद्रोगकृच्छ्रभ्रमप्रलापिनः।"
(Symptoms like diarrhea, loss of taste, pallor, heart disease, etc., can indicate Krimi)

RELEVANT INVESTIGATIONS

BLOOD INVESTIGATIONS

• Complete Blood Count (CBC):

  • Eosinophilia (especially in Roundworm, Hookworm, Threadworm)

  • Microcytic hypochromic anemia (Hookworm)

• Serum iron and ferritin levels – Low in hookworm infestation

STOOL EXAMINATION

• Direct smear microscopy:

  • Hookworm: Oval, thin-shelled eggs

  • Roundworm: Fertilized/unfertilized oval eggs

  • Threadworm: Larvae (rarely eggs)

  • Pinworm: Not easily found in routine stool

• Concentration techniques (salt flotation, formalin-ether) improve detection

• Ova, cyst, parasite detection – Vital in diagnosis

SPECIAL TESTS

• NIH Swab Test / Scotch Tape Test:

  • Used for Pinworm (done early morning before bathing)

• Stool culture – For Strongyloides

• Duodenal aspiration – Rare, for strongyloidiasis

• Chest X-ray – For Löffler’s syndrome in Ascaris/Hookworm/Strongyloides

• Serology – ELISA for Strongyloides

📜 Sushruta Samhita Uttara Tantra 54/21:
"कृमीनां लक्षणं तेषां यथावत् परिचक्षते।"
(Symptoms and identification of Krimi must be understood thoroughly)

MODERN CORRELATION

AYURVEDIC PERSPECTIVE

• Antraja Krimi Lakshanas:

  • Shula (pain), Aruchi (anorexia), Pandu (pallor), Atisara (diarrhea)

• Dushyas involved: Rakta, Rasa, Purisha, Pitta

• Srotas affected: Annavaha srotas, Purishavaha srotas

• Rogamarga: Abhyantara

📜 Ashtanga Hridaya Uttara Tantra 4/9:
"शूलारुचिकफार्तानां कृमिभिर्भवति क्षयः।"
(Abdominal pain, loss of appetite and kapha vitiation are signs of Krimi)