Unwanted Hitchhikers – Worms

One of the most dreaded scenarios many travelers face is infestation by worms.

Worldwide parasites are common and expected. In one of the remote villages I visited in Nepal – Tipling people there actually thought it was normal to have worms in their stool!

Besides being aesthetically unpleasing, several types of worms lead to chronic health care problems, such as anaemia, vitamin deficiency and even bowel obstruction.

Eating food that is well cooked and prepared and handled carefully is the best guarantee of being worm-free.

Usually if someone gets sick on a short vacation (1-2 weeks) it is unlikely they would have worms since they usually require some time to grow before causing significant symptoms. Bacteria reproduce by binary fission and can multiply very quickly whereas multicellular parasites do not thrive so quickly.

Sudden diarrhoea and cramps is most suggestive of traveler's diarrhoea caused by bacteria or viruses. Usually it should end promptly but if symptoms continue worms could be a possibility.

After, people with parasites will start to notice indigestions and irregularity with bowel movements several weeks after their trip. At this point their family physician may review their health and request a stool analysis for parasites and eggs.

This may easily show the parasite or not. Unfortunately worms and parasites do not always show up early on a single analysis and repeat testing sometimes confirms the diagnosis.

Treatment for parasites is usually uncomplicated with a series of anti-parasitic medication. Also, sometimes less common parasites like giardia or cyclospora may be suspected when people fail to improve with regular treatments.

Most people recover uneventfully and there is also the possibility that the body also eliminates parasites from time to time by itself.

Places of poor hygiene where the person is exposed to a higher “wormload” present a different scenario in that, there, people are constantly exposed to risky food. People living with constant exposure to parasites may from time to time take antiparasitic medication effectively “deworming” themselves.

Ocassionally travelers may experience problems with digestion long after their trip. For reasons not entirely known some individuals are prone to “tropical sprue? ” – a malabsorption problem that follows some form of bowel infection.

There, people are best referenced to gastrologists who can accurately determine the cause and prescribe proper treatment.

It is important to remember that diarrhea in its self is not a single disease but a symptom and through careful examination a cause and treatment may be found.

Sometimes irregularities in bowel movements may be only coincidental with travel and be from some other disease.

I have heard of one traveler who dismissed persistent diarrhea as only to find out much later it was bowel cancer. That is why Cancer Care Manitoba urges everyone whether a traveler or not to be examined if they are having persistent problems (www.cancercare.mb.ca)