In many places in Cambodia, there could be hundreds of creepy-crawlies crawling actively on the spot where we stepped on. The commonest creepy-crawlies in the warm tropical soil of Cambodia nowadays are the larvae of hookworms.
That’s what we would probably see under the microscope in some places especially in the provinces of Cambodia. These larvae crawl around actively hoping for their host to pass by. To them, the human intestine is their ultimate home and the human bare foot their welcoming red carpet. The bare foot that happened to land on them, is like a fortune fallen on them from heaven.
From the foot, they get into the bloodstream that flows to the heart and lungs. In the lungs they crawl up the airways to the throat and triggers a cough that expel them into the gut. They are then swallowed into the stomach before they finally end up in their ultimate home – the human intestine, where they mature into adult hookworms.
Behaving like little vampires within the human body, they force their mini sharp ‘fangs’ into the lining of the intestine causing it to bleed so that they can feed on the blood for their continuous sustenance. Soon, they lay many more eggs that we pass out onto the warm tropical soil to hatch. The eggs hatch into tiny little larvae that roam around in the soil until they too find their favourite barefoot. Indeed, whosoever walks barefooted on Cambodian soil are literally inviting these hungry baby vampire worms to invade them.
That is the life cycle of hookworms. Hookworm infection is the most common worm infection among children in Cambodia. It is also not surprising to see adults being infected by hookworms here. In the more developed countries, hookworm infection in adults would hardly ever cross the doctors’ mind. Nevertheless, in this ‘Land of Wonders’, hookworm infection in adults is not infrequent. It is a likely possibility especially in pale-looking children or adults who presented with abdominal symptoms such as pain or discomfort.
Hundreds of these little vampire worms could be sucking blood from their intestine every day. If left untreated, the infected person may become anaemic or in layman’s term – suffering from depleted number of red blood cells. These red blood cells carry oxygen and glucose to our muscles and brain. Thus, the lack of it can cause the victims to feel lethargic and weak.
Neglected cases may progress to develop severe anaemia that could result in debilitating heart failure. Thus, we should think twice, if we are tempted to walk barefooted on the warm Cambodian soil. Nowadays, you may not step on a bobby trap as they are largely cleared by the diligent and experienced demining team. However, you are likely to be warmly greeted by many larvae or baby ‘vampire worms’ roaming in the soil, waiting desperately for your warm bare feet to step on them.
That’s not all. There are canine and feline baby hookworms too, eagerly looking out for the paws of dogs and cats. Two common species of such worms named Ancylostoma braziliense and Toxocara canis often burrow into the human skin by mistake. Upon entering they suddenly realise, “Oh my gosh, this is not my house.” From then on, they would struggle to get out but somehow they couldn’t find their way out. So, they would continue to burrow around under the human skin for weeks or months until they eventually die. While doing so, they create a small haphazard ‘tramline’ on the skin that is extremely itchy, especially at night.
In my practice, I have seen such lesions on the hand, back, buttocks, and feet. If you ever experienced this after sunbathing on the warm tropical beach-sand where you could see dogs and cats roaming freely around, you should quickly consult your doctor.
Worms may cause “itchy backside”, too. Children and sometimes adults may present with severe itch in and around their anus. There may be many causes of such itch. Nonetheless, it is wise to consider worm infection as a likely possibility if someone who have been staying in Cambodia complains of an “itchy backside”. The two species of threadworms known as Strongyloides stercoralis and Enterobius vermicularis often cause such itch when the larvae or the adult worms crawl in and around the anus. Recent studies have shown that Strongyloides stercoralis are commonly found in Cambodia especially in the outskirts of provinces.
Prof. Peter Odermatt of Basel University in Switzerland who headed a team to study on this threadworm since 2008 found that infection with such worm is still highly prevalent in Cambodia. The team found that about 25 to 50 percent of the rural Cambodian population were infected with this worm. Prolonged infection can cause abdominal symptoms such as pain and discomfort or skin problems that manifest as hives or urticaria.
The largest worm of all, known as Ascaris lumbricoides or roundworm in layman’s term, can grow up to a length of 14 inches. According to a survey published in the Korean Journal of Parasitology in 2014, this worm is still the commonest worm infection in the southwestern areas of Cambodia, including Koh Kong and Preah Sihanouk provinces. In these areas, about one out of four in the population are infected with this worm. In most other areas, the rate of roundworm infection has fallen following the national deworming programme in schools. In such areas, hookworm has replaced roundworm to become the most common worm infection.
Lastly, let us be reminded that in Cambodia, we are living with assortment of worms namely hookworms, roundworms, threadworms, whipworms, tapeworms and animal worms. Some of these worms are roaming actively in the soil as little larvae and others may be contaminating our vegetables, water or hands in the form of eggs that are passed out in human or animal feces. Thus, we should practise hand-washing before taking food and avoid walking barefooted, sunbathing on uncovered sandy beaches or eating raw vegetables. It is also advisable to deworm children periodically (at least once a year). Adults with frequent abdominal pain or those noticing worms in their stool should seek treatment from their family physician.
My next column will be on ‘The men’s menopause’.
Dr. Victor Ti, MD, MFAM (Malaysia), FRACGP (Australia), Dip P Dermatology (UK), Dip STDs/AIDS (Thailand), Dip. AARAM (USA), LCP of Aesthetic Med.(Malaysia) is an experienced expat specialist generalist (Family Physician) of BH Clinic, Phnom Penh. As a specialist generalist, he is skillful at diagnosing all general diseases and excluding the sinister ones. Apart from the general diseases, Dr. Victor is also known for his skill in skin diseases, sexually transmitted diseases, minor surgery and aesthetic medicine. He can be contacted via email [email protected]
Tel: 023900446 or Whatsapp: +60164122977