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Worms again?
- David E Bratt (28 June 2007)
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Study of Prevalence of hookworm infection in districts of west Bengal, India and its linkage with Anemia
- Professor Pranab Kumar Bhattacharya, Bhattacharya Rupak Bsc(cal) Msc(JU),Bhattacharya Ritwik 7/51purbapalli, Sodepur, 24PGS(N)Kol-110Gayen Biplab MBBS Demonstrator, Pathology, IPGMER Kolkata-20, Bhattacharya Upasana Delhi Public School, Rubi Park, Kolkata, , Bhattacharya Palash MD(PGT) Patho (8 July 2007)
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David E Bratt, Paediatrician in solo private practice 36 Ranjit Kumar St. St. James, Port of Spain, Trinidad & Tobago, West Indies
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Worms used to be a big thing in Trinidad and Tobago. Of late, they are trying desperately to make a come-back, pushed by blatantly false advertising from some of the drug companies. They used to form part of the deadly West Indian triad of children’s ailments: teething, maljo and worms! Like the three W’s in cricket, they are gone now, leaving lazy, indisciplined batsman and viruses to stand the bounce. When I returned home in 1977 and began to work as a paediatric consultant at the Port of Spain General Hospital, I was informed by all and sundry, from the other consultants to the ward nurses and nursing aides, oh yes, especially the aides, that worms, or “Wums” was a huge problem in TT. It seemed that everybody had “worms”, not only the children. It was reliably rumored that even the father of the nation (the real one), had “worms” and used to take his medicine regularly. All sorts of things were attributed to worms. Grinding teeth was a certainty. Woe to the child who was heard to be grinding his teeth during sleep. Worms was the certain diagnosis and a dose of castor oil, followed by worming medicine was immediately instilled into the offending child followed by a nice rectal enema or laxative and then everyone could breathe a sigh of relief that another child had been spared the inevitable ravages of the deadly worm by a good “worming-out”. From one end to the other it went. If it wasn’t grinding teeth, it was itchy bottoms. Or irritable sleep. Or not sleeping. Lack of appetite was a sure tip-off. But too much appetite also. Then for sure you had a tape worm. No mind nobody had ever seen one in a West Indian child. There were plenty of pictures in the books of children in Africa with tape worms. Remember how your mother used to try to get you to eat the last spoon of spinach by saying, “Take one for the poor starving children in Africa.” Or India? Or China? Yeah! Forget the starving children in Central or up the hill or out near Sangre Chiquito. It’s more romantic to save the children far, far away. To this day, Trinidadians believe, in their heart, that real doctors go away to Africa or somewhere to save starving children. Yeah. “That is doctor, father!” You could have too much energy. Worms did it. Too little energy. That was worms for sure. There was even a worm look. “That child looking wormy!” A sort of “quiety, miserable, skinny, sallow skinned, chupidee” looking child. Worm medicine STAT! In addition there these strange looking little ads on TV showing funny looking little black children vaguely resembling gollywogs who just loved worm medicine and immediately started doing cartwheels and rushing around the place the second after taking down a teaspoon of worm medicine, as someone with a strong English accent pronounced them healthy and wealthy, rather like the ad for a sugar drink we now have on TV. So when I returned home and was given a consultancy post, not knowing much about worms and under severe pressure from the workplace, I started to worm the children who fit these sophisticated criteria. In fact, sometime I had no recourse. The good nurses would often take one look at a child, declare, “he wormy” (for some reason little boys were supposed to have worms more frequently than little girls, perhaps because of the nursery rhyme about little girl being made of “sugar and spice and everything nice” whilst little boys were made of “snips and snails, and puppy dogs' tails” and before I could say “Oh father!”, the poor struggling boychild had had worm medicine poured down his throat and a general feeling of satisfaction was to be felt throughout the ward. “Footie” the child! The problem was that none of the children passed worms and none of the children looked any different days later on discharge. So I decided to look into the matter for myself and began ordering stool examinations on all the children who fit the worm criteria as defined by the worm specialists in the country: the paediatric consultants and their advisors the nursing aides and respective aunties and old maids. After just over one hundred samples returned negative, I triumphantly announced the results one morning on the ward and was met with ironic smiles. “So what? The lab wrong. Lab technicians know anything about worms?”. It took another passing of the generations before I was able to stop routine worming on my patients. Competing interests: None declared |
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Professor Pranab Kumar Bhattacharya, Professor of Pathology, Incharge Unit, Blood Bank& VCTC, Cytogenetics,Ronald Ross Malaria Clinic Institute of Post Graduate Medical Education & Research, 244A AJC Bose Road, Kolkata-700020, W.B,, Bhattacharya Rupak Bsc(cal) Msc(JU),Bhattacharya Ritwik 7/51purbapalli, Sodepur, 24PGS(N)Kol-110Gayen Biplab MBBS Demonstrator, Pathology, IPGMER Kolkata-20, Bhattacharya Upasana Delhi Public School, Rubi Park, Kolkata, , Bhattacharya Palash MD(PGT) Patho
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In a very recent study(unpublished work) by Bhattacharya .P.K etal, from four districts of West Bengal state, India, North24 Parganas, South 24 Parganas, Hooghly and Kolkata, when stool collection were done from both sexes from households collections in pre-coded plastic containers (2per person- one container was provided with 10% normal saline for its use in concentration technique) and all stool samples was examined with normal saline as well as with lugol’s iodine for detecting cysts, helminth’s egg and larvae by sedimentation technique of concentration method, Stoll’s Method for Worm Burden(4) and copro-culture using Harda Moris technique(5) for identifying species of hookworm and hemoglobin were estimated of the persons suffering from hookworm infestation by standard Cyneameth hemoglobin method showed that of total collected 2420 stool samples examined Hooghly districts(680 samples) has highest 25%, followed by in North-24 parganas(736 samples) 20% , South 24 parganas(401samples) 8% and in Kolkata(603 samples) 0.15% were positive for hookworm. Of both types of hookworm were prevalent with Necetor americanus being the predominant species varying from 98%-76% in all districts. The load of egg count/gram stool was mostly mild(>1000- 3000) in 3 districts, when in South 24 parganas moderate(>3000- 10,000). Amongst the accompanying infestation Ascaris Lumbericoidis was most prevalent from 12.9%-35% and Trichuris infestation in South 24 parganas(25%). About half of the population with hookworm infestation studied had normal hemoglobin and in those who did suffer from anemia was mild to moderate Our study actually showed that hookworm is highly prevalent infestation in West Bengal state of India. This is because the state of West Bengal is land of high inequity in regard to economy and health services, lack of hygiene, open air defecation(due to lack of sanitary latrine in most houses) in the rural and suburban population, work and walking with bare foot(lack of capability to purchase shoe for every person in the family) leading to increased transmission of disease Chatterjee KD in 1976 also concluded that N. Americanus was the most prevalent worm infestation in India(1). In Kolkata district, the prevalence of hookworm is low as people uses sanitary toilet in the metropolis except in slums areas. The degree of anemia is mild to moderate because of the fact that infection is caused by N. Americans which sucks blood per 24 hours less than A. deodenalo which is more pathogenic. Chakma(2) in 2000 conducted a study among school going children in the tribal areas of Madhyapradesh and he showed 16% hookworm and A. Lumbercoidis(19%) were the common parasites and 30% of children in his study had anemia. Mahajan(3) also reported in 1993 that 30% of people had prevalence of intestinal parasite infestation amongst general population of East Delhi .The high prevalence of Parasitic infestation in West Bengal is related to extreme poverty, unhygienic living conditions of poor household and lack of knowledge about the disease particularly mode of transmission of hook worm infestation amongst the common people References 1)Chatterjee.K.D. “Parasitology” 12th Edition 1980. P177 2)Chakma.T, Rao.PV, Tewary RS “ Prevalance of anemia and worm infestation in tyribal areas of Madhyapradesh” JIMA 2000.98(9);567-571 3)Mahajan.M, Mathur .M, Talwar.V, Revathi.G’ Prevalance of Intestinal Parasitic infestation in East Delhi” Indian. J. Commun.Med.1993;18;177-180 4)Stoll NR andHansher W.C “ Concerning two options in dilution egg counting: small drop and displacement” Am. J. Hyg 1926;6;134-145 5)Harda Y & Mori.R “A new method for cultering Hookworm” Yonago Aeta Med 1955;1;177-79 . Authors_: Professor Pranab Kumar Bhattacharya MD(cal), FIC path(Ind) Professor of Pathology, In-charge of Cytogenetics ,Blood Bank,&VCTCEx- incharge of Ronald Ross Malaria clinic, Institute of Post Graduate Medical Education & Research 244A aJC Bose Road, Kolkata-20, West Bengal, India E.mail – profpkb@yahoo.co.in pranab@unipathos.com 2)Mr. Rupak Bhattacharya , Bsc(cal), Msc(JU) 7/51 Purbapalli, Po=Sodepur, 24 Parganas(north)-Kolkata-110, West Bengal, India E.mail- pranab@unipathos.com 3) Mr. Ritwik Bhattacharya B.Com(cal) 7/51 Purbapalli, Po=Sodepur, 24 Parganas(north)-Kolkata-110, West Bengal, India E.mail- profpkb@yahoo.co.in 4)Dr. Biplab Gyen MBBS(cal) Demonstrator, Dept. of Pathology Institute of Post Graduate Medical Education & Research 244A aJC Bose Road, Kolkata-20, West Bengal, India E.Mail-dr_biplab@rediffmail.com 5) Bhattacharya Upasana Delhi Public school, Rubipark, Kolkata 6) Bhattacharya Palash MBBS(cal) MD(PGT) Dept of Pathology Institute of Post Graduate Medical Education & Research 244A aJC Bose Road, Kolkata-20, West Bengal, India Competing interests: None declared |
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