INTESTINAL POLYPARASITISM 



Besides these, however, there were a number of undetermined 

 forms. The infection with Trichuris is variously given in different 

 countries — e.g., Porto Rico (Commission), 7-27 per cent.; India 

 (Fearnside), 6-95 per cent.; India (Dobson), 4-4 per cent.; Central 

 Africa (Daniels), 279 per cent. The infection with Ancylostoma 

 and Necator is given in India (Calvert), 83 per cent.; (Dobson), 

 57-58 per cent.; (Fearnside), 65-83 per cent. Ascaris infection in 

 West Africa (Wellman) is 50*97 per cent. Garrison considers his 

 figure of 26 per cent., which is based upon adults only, as much too 

 low. Strongyloides is placed in Central Africa at (Daniels) i'5 per 

 cent.; West Africa (Wellman), 0-65 per cent.; Porto Rico (Com- 

 mission), 0*8 per cent. Oxyuris is given in India (Dobson) at 

 15-37 per cent. 



etiology. — Ascaris lumbricoides is, in our experience, by far the 

 most common parasite, and it is often associated with either Trichuris 

 trichiura or Necator americanus (or Ancylostoma duodenale) in 

 double infections, but triple infections with these three parasites are 

 not uncommon, and quadruple infections of the three associated 

 with Strongyloides intestinalis are also common. 



Associated with one or more of these worms it is by no means 

 unusual to find LoeschicB and flagellates, especially Trichomonas 

 hominis, and more rarely ciliates — e.g., Balantidium coli. Oxyuris 

 vermicularis is fairly common in children, but tapeworms are not 

 so frequently met with in Ceylon, India, and Equatorial Africa, 

 while they are extremely common in Abyssinia. 



In China and other countries Trematode infections must also be 

 considered, and in the West Indies and Africa infection with 

 Schistosoma mansoni. 



Symptomatology. — The symptoms presented by the patients may 

 be nil if the parasites are few in number, and will in any case depend 

 mostly upon the action of that species which is known to be the more 

 pathogenic or which is most abundant, but it may be very difficult 

 or impossible to separate the symptoms caused by one parasite from 

 those due to another. Cases may show signs of fever, anaemia, 

 diarrhoea, and even dysenteric symptoms may appear if the infection 

 is heavy. 



Treatment. — The treatment must commence with that laid down 

 for the parasite which is the more important from a pathogenic point 

 of view — e.g., in the case of a double infection with Ancylostoma 

 and Ascaris, the ankylostomiasis must be treated first and then 

 the ascariasis. 



Rare Infections. 

 Gordiaceiasis and Acanthocephaliasis (see pp. 678 and 679) . 



Infections with species of the Gordiacea and Acanthocephala are rare. 

 Treatment would be on the same Unes as for 'ascariasis.' 



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