IntroductionIntestinal parasites cause substantial morbidity and mortality, particularly in children in whom they have detrimental effects on growth and cognitive performance (1-4).Parasitic infestation leads to deformities, longterm disabilities, and often stigmatizes the child. Parasitized pregnant women are anemic, have increased fetal wastage, and have low birth weight newborns (4).Though tropical diseases affect a large portion of the world's population, less than one percent of new drug development over the past 30 years has been aimed at tropical disease (4). In recent years, philanthropic interest has resulted in research, long tardy, for this group of children.EpidemiologyThe three soil-transmitted helminth infections: Ascaris, hookworm and Trichuris are often called the "Unholy Trinity" by WHO. They are ubiquitous to tropical climates and even temperate rural areas in poverty that are stricken communities with poor sanitation (5,6) (see Table 1). Ascaris and Trichuris increase in prevalence from infancy to puberty, and then decreases in adulthood. In contrast hookworm, the leading cause of anemia throughout the world, increases throughout life, not reaching a plateau until age forty (7). Significantly, this affects women of childbearing age and is associated with small-forgestation newborns as well as increasing fetal loss.SymptomatologyWHO has classified parasitic infestation by egg intensity to clarify symptomatic and asymptomatic infestations (see table 2). Children with light worm loads are often asymptomatic, but children form the greatest proportion of the heavy intensity group. Even children who are clinically asymptomatic may have subtle differences in learning and intellectual achievement.Clinical presentation is often related to parasite migration in the skin, viscera, and gastrointestinal tract. Trichuris and Ascaris are a result of fecal-oral ingestion. Features such as wheezing, dyspnea, nonproductive cough, fever, bloody sputum, chest x-ray infiltrates, and systemic eosinophilia are associated with pulmonary vascular migration. Once swallowed, the larvae mature and their migration in the gastrointestinal tract causes abdominal pain, distention, and malabsorption.If adult Ascaris worms migrate into the biliary tree, then pancreatitis, cholangitis or cholecystitis can result. Even hepatic abscesses and appendicitis have been attributed to Ascaris worm migration. In younger children, heavy loads of worms can cause partial or complete bowel obstruction in the ileum. Swelling of Peyer's patches can lead to intussusception or cause volvulus. On occasion, unrecognized obstruction leads to bowel infarction and perforation with peritonitis.Trichuris infects the colon, preferring the cecum. Eggs release the larvae in the small intestine and the worms mature in the colon where they tunnel into the mucosa causing inflammation. Heavy infestation causes a dysentery syndrome severe enough to cause rectal prolapse. Impaired growth and anemia are the result of the chronic disease state.Hookworm infects through skin penetration. An itching, erythematous rash from multiple skin penetrations causes severe pruritus of the feet or hands. The larvae use the pulmonary vasculature to access the bronchial secretions and then when swallowed, mature in to adults in the gastrointestinal tract. The bronchial migration can present as a clinical pneumonitis, or can be mistaken for asthma, but seldom are the pulmonary symptoms or clinical response as serious as Ascaris worm migration. The significant sequelae of infection are related to intestinal blood loss. An infestation of as few as 40 worms can reduce hemoglobin to below 11g/dl. Heavy infestations can lead to hypoproteinemia and even anasarca.Helminths cause anemia and malnutrition, growth stunting and cognitive deficits associated with poor school attendance and performance (8). Since helminth infestation occurs in impoverished areas of poor nutrition, intestinal worms cause even more severe malnutrition to the children's limited diet. …