The clinical significance of gastrointestinal helminths--a review

Gastrointestinal helminths (nematodes, trematodes and cestodes) constitute some of the most common and important infective agents of mankind and are responsible for much morbidity and some mortality. Whereas many symptoms and signs are confined to the intestine and less often the associated digestive organs, systemic manifestations are also numerous; this applies especially to indigenous populations of developing 'Third World' countries. Using a clinical classification these organisms can be broadly separated into those involving the small-intestine and those which have a colo-rectal distribution; of the former, a minority has been causally related to intestinal malabsorption. Clearly, however, not all gastrointestinal helminths are associated with disease and it is important to be able to separate these two groups; when present at high concentration and especially in infants and children some of the least pathogenic are not, however, entirely asymptomatic. Maintenance of a high 'index of suspicion' is necessary and this applied especially to 'western' populations in whom rapid and extensive travel to areas of the world with substandard sanitation and contaminated food and water supplies is now common; first evidence of infection in them may result from serious clinical complications. Recent advances have focussed on treatment, and especially the introduction of the benzimidazole compounds (especially albendazole) for nematode, and praziquantel for cestode, infections. Treatment of strongyloidiasis remains, however, unsatisfactory. Mass elimination of gastrointestinal helminths in developing 'Third World' countries remains a major challenge.