Helminthiasis is an infection from soil transmitted nematode parasitic worms (helminthes), which affects the skin, and ultimately the intestines. Soil-transmitted helminths (STH's) are commonly known as intestinal worms and are most prevalent in 32 of 36 countries in the Western Pacific Region, such as

• Cambodia,

• Fiji,

• Kiribati,

• Tonga,

• Tuvalu, and

• Vanuatu.

However, any region in the world that is impoverished and lacking education and proper sanitation facilities is susceptible to parasitic soil contamination. This infectious disease predominantly affects school-aged children two to fourteen years old.

Helminthiasis is caused by one of three types of species of parasitic worms found in soil:

• hookworms,

• roundworms, and

• whipworms.

Soil contamination results when feces, containing parasite eggs from an infected person are deposited in the soil, usually in regions lacking sanitation (toilet) facilities. In addition to the soil, water in communities or villages also becomes contaminated with worm eggs, which mature and become infectious to humans. Roundworm and hookworm eggs mature in about 2 weeks, and in 3 weeks for whipworms. These parasites can be infectious to humans at various stages (egg, four larvae, and adult) of its lifecycle, but is usually infective during the third larva stage.

Transmission from parasite-contaminated soil occurs through either direct ingestion of mature eggs or through larvae penetrating the skin. There is no direct person-to-person transmission due to the period required for egg maturity.

Human infection by ingestion results when eggs that attach to foods grown in soil-infected areas are improperly washed, peeled, or cooked. Ingestion of water contaminated with eggs, or hand to mouth contact after handling soil infected with eggs, and improper hand washing are other means of transmission and infection by ingestion. Once the eggs reach the small intestine, the larvae develop into half-inch-long worms, attach themselves to the intestinal wall and suck blood, leading to the possibility of various symptoms and health implications.

Infection through skin penetration occurs when soil-transmitted helminth (STH) larvae penetrate the skin, often through bare feet when a person walks on infected soil. The larvae travel to the lungs, through the respiratory tract to the mouth and are swallowed, eventually reaching the small intestine. This process occurs over the course of about one week. In the small intestine, the larvae develop into half-inch-long worms, attach themselves to the intestinal wall, and suck blood.

STH's do not multiply in human hosts. Thus, reinfection results from repetition of the cycle of soil contamination by humans, to ingestion or skin penetration of helminths, and new contact with an infected environment.

The first signs of infection from cutaneous transmission are usually itching and a rash at the site where skin touched contaminated soil or sand. Once the infection becomes intestinal, signs and symptoms may be non-specific with mild diarrhea and cramps. Symptoms become evident with severe infection and may include anemia and protein deficiency caused by:

• blood loss,

• nausea,

• abdominal pain and enlargement,

• tiredness,

• loss of appetite,

• impaired digestion,

• nutritional deficiency from malabsorption,

• difficulty breathing,

• enlargement of the heart, and

• arrhythmias.

The condition may be diagnosed and the particular helminth confirmed through microscopic examination of fecal specimens.

Treatment may be administered relative to the particular parasitological, environmental, and socioeconomic variables found endemic to vulnerable regions.

Five antihelminthic drugs identified by the World Health Organization (WHO) (2003) may be considered for single-dose treatment of soil-transmitted helminths and of filariae. These include Albendazole, Mebendazole, Pyrantel, Levamisole, and Ivermectin.

Treatment generally follows one of three regimens:

• Universal mass treatment which involves administering medications to communities irrespective of age, sex, infection status, or other social characteristics

• Targeted mass treatment provides medications to a specific group in a community defined by age, sex, or other social characteristics irrespective of infection status, such as children aged 2-14 years

• Individual treatment which is based on diagnosis of a current infection.

Hookworms and roundworms infections generally are treated for 1-3 days with follow-up microscopic stool examination. Positive re-examination requires repeated treatment.

Severe whipworm infections are treated for 3 days. Asymptomatic or light infections do not require treatment.

There is the possibility of the emergence of drug resistance in human populations or drug resistant helminthes. Infections may recur.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% and/or other requirements/qualifications under 38 CFR 3.350 [Special monthly compensation ratings]. Also reference 38 CFR 3.155(d)(2).   

•  Consider service connection on a presumptive basis as a former prisoner of war (FPOW) (38 CFR §3.309 (c)).

• After active disease has resolved, rate at 0 percent for infection. Rate any residual disability of infection within the appropriate body system