You know I’m not one to raise my voice and make scene.

Ok, I always raise my voice and make a scene, but only when I think something really warrants our attention and the issue of under-recognised, under-estimated and mismanaged chronic worms, demands our attention.  I’ve been talking about this ever since the first patient stepped into my clinic, a young girl with severe mood issues who just happened to also have treatment-resistant chronic threadworm, and since then, as the volume of patients I see affected by this has grown, so too has the volume of my message. And there’s actually so much to say.

Chronic worm problems don’t always come with an itchy bottom calling card. In fact, many individuals don’t have any of the telltale signs you might be used to screening for.  Recent research suggests adult men, in particular, are commonly asymptomatic when infected with them (Boga et al 2016)

So what alerts us as practitioners to the possibility of chronic worms – so many things…but here’s just some thought bubbles to get you started.

Are you treating patients with recurrent or treatment-resistant Dientamoeba fragilis?

Are you seeing women who have thrush-like symptoms, in spite of negative swabs and no benefit from antifungals?

Are you faced with families coming undone because of one child’s behaviour whether that’s aggression, defiance, emotional lability or just serious sleep problems?

I could go on.  And I will 😉 I had a return appointment recently with another family, who have 5 young kids but just one with terrible behavioural issues. I got to not only hear about this from the parents but see it firsthand in my much so I thought, don’t bring them in again, seriously.  Our recent follow-up after finally breaking the cycle of threadworm for this child,  I wanted to hug that same little one that I had previously recoiled from.  I wanted to shed a tear and say… even I misjudged the degree to which those cunning critters had contributed to their outbursts.  I’ve seen this so many times now, you would think the surprise element would have diminished..but it gets me every time.  This family tell me, like so many others, this is a different child to the one they originally brought to my clinic.

So what about the adults too…the ones I spoke of above, the 30% of women who present at gynaecological appointments (Skylarova et al 2014) that are found to be affected, the men who can’t get rid of D.frag.  Are we onto this?  Or have we been shooting the messenger? Access more detailed information, references and patient resources here.

In response to the perceived need for better education and resources on understanding worms – the good (yes there is some good that can come from some, it is true), the bad and the seriously ugly, Rachel has created an online resource centre for the public and practitioners alike: The Worm Whisperer.  With a free eBook, several recordings that go deeper into the science of all things worm (!) and finally some products truly effective at breaking the cycle.