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Ayu. 2011 Apr-Jun; 32(2): 165–170.
PMCID: PMC3296334
A survey on etiopathological correlation of Krimi (intestinal helminths) and Pandu (anemia)
V. G. Tengse,1 M. S. Baghel,2 S. N. Vyas,3 and J. R. Joshi4
1Lecturer, Department of Roga Nidan, Gomantak Ayurveda College, Goa, India
2Director, Institute for Post Graduate Teaching and Research in Ayurveda,Gujarat Ayurved University, Jamnagar, India
3Ex.Head, Department of Kaya Chikitsa, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, India
4Consultant Pathologist, Jamnagar, Gujarat, India
Address for correspondence: Dr. Vaishnavi Tengse, B 4, “Samadhan”, Vishwambhar Nagar, Ponda Margao Rd, Dhavali Ponda Goa, 403 - 401, India. E-mail: vgtengse/at/rediffmail.com
A survey study was aimed to find etiopathological status of intestinal helminths and also to accomplish its association with clinical condition Pandu. The survey samples included population of five schools and two localities in and around Jamnagar. The study was conducted on 337 subjects, of whom 36.20% cooperated to give stool samples to pathology laboratory; more than half of the samples surveyed were suffering with various parasitic infestations and one-third of the total subjects were found at risk to develop Pandu. Ascariasis patients were found in 71.14%, a potent cause of Pandu. Enterobius vermicularis was found in 19.05%, while Hymenolepis nana in 6.35%. 77.77% were in the age group of 10 to 20 years, 58.73% were male, 93.65% patients were Hindu, 80.95% of the patients had secondary level of education, dominancy of rural habitat was in 77.77%, and 39.68% each were from lower and lower middle class.
Keywords: Intestinal helminths, Pandu, Ascariasis, Udara Krimi
Health education and awareness is a boon to the society. But still, there is a class of population who are victims of parasitic infestations which is ruining their health. The actual prevalence rate cannot be figured out as some either remain undiagnosed or many do not even bother to report. With the advancement of healthcare and awareness about health issues, it was mandatory to know the present etiopathological status of intestinal Helminths. There are always two sides of a coin; though advances follow, there is still ignorance and poverty causing parasites to damage our lives.
The branch microbiology in Ayurveda is not well established in comparison with the modern science. Kaviraj Gananath Sen in the preface of his book “Siddhanta Nidana” has mentioned the necessity of knowledge of microorganisms to Vaidyas to fulfill objects like: Satya Anaveshanartha (to know the truth), Sankraman Avaarnartha (to check the spread of the diseases), Chikitsa Vishesh Abhyupgamanartha (to plan and find out special and new treatments), and lastly but most important Pradurbhoota Kechan Navin Rogah (to study certain newly occurring diseases).[1] It is the need of the hour to add up in the areas of lacunae mandatory for the propagation of science.
Aims and objectives
Survey aimed at achieving the following two goals:
  • To study the incidence of intestinal helminths in the population.
  • To establish etiopathological correlation between Udara Krimi and Pandu.
The study includes surveyed samples from five schools and two localities in and around Jamnagar. Routine investigations of hematology, macroscopic and microscopic examination of stool were done in Pathology laboratory of I.P.G.T. and R.A. Stool examination for detection of intestinal helminthes or their ova, cystic forms was done by zinc sulfate concentration method[2] [Tables [Tables11 and and22].
Table 1
Table 1
Details of survey study
Table 2
Table 2
Details of intestinal helminths diagnosed in the survey study
Observations: Areas of survey study
The area of the study has been depicted at Figure 1.
Figure 1
Figure 1
Area of survey study
General observations
The general observations have been depicted at [Figure 2].
Figure 2
Figure 2
General observations
The results and observations have been depicted at Tables Tables113.
Table 3
Table 3
Symptoms of Ascaris lumbricoides in percentage (n = 45)
Table 4
Table 4
Symptoms of Enterobius vermicularis in percentage (n = 12)
Table 5
Table 5
Symptoms of Hymenolepis nana in percentage (n = 5)
Table 6
Table 6
Classical Nidana sevan reported by patients of Udara Krimi (n = 63)
Table 7
Table 7
Causative factors reported by 63 patients of Krimi Roga
Table 8
Table 8
Etiological factors found specific to causative organism
Ascaris lumbricoides
  • (a) 
    Macroscopic findings of stool samples show 66.66% had Sama mala Pravrutti, 82.22% had not well-formed stools, 48.88% had frequency of defecation immediately after meals, and in 64.44% visible food particles were seen.
  • (b) 
    Status of hemoglobin - Maximum patients, i.e., 30.23% had Hb between 11.4 and 12.4 gms%, 20.93% having between 10.5 and 11.4 gms%, and 25.58% were having between 9.5 and 10.4 gms%.
Enterobius vermicularis
  • (a) 
    Macroscopic findings of stool - In 83.33%, semi liquid consistency was found, 58.33% had passage of worms.
  • (b) 
    Status of hemoglobin - 36.36% patients had 10.5 to 11.4 gms% of hemoglobin, while 27.27% had between 11.5-12.4 and 12.5-13.4 gms% each.
Hymenolepis nana
  • (a) 
    Macroscopic findings - Drava in consistency and frequency immediately after meals was observed in 100%, 75% had Sama Mala Pravrutti.
  • (b) 
    Status of hemoglobin - 50% of patients had hemoglobin concentration between 12.5 and 13.4 gms%, while in 25%, it was noted between 9.5-10.4 gms% and 11.5-12.4 gms% each.
On survey methodology
Random sampling method was adopted for the present survey wherein five schools and two localities were selected to find the incidence of intestinal helminths in the population of Jamnagar.
On significant observation
  • The age group found maximum in 10 to 20 years: The reason obviously is that the majority portion of survey sample was belonging to high school going age group. A published data also favors above findings that rate of incidence is high in age groups 10 to 20 years, 20 to 30 years and decreases from 31 to 50 years and 51 to 65 years. Also, a study conducted to find incidence of anemia concludes that severe to moderate type of anemia is predominant in adolescent age group, i.e., 10 years and 19 years, wherein the stated cause found was worm infestation.[3]
  • Maximum were male in gender and Hindu in religion. The study does not bear relevancy with gender and religion. It denotes the dominancy of population in the area of survey.
  • Education in maximum was up to secondary level as the majority of sample was from schools hence the findings. With the secondary level education, subjects at least were aware of measures of personal hygiene but still were not practicing.
  • The dominancy of rural habitat with 77.77% reflects improper sanitation, drainage facilities, poor hygiene maintenance, etc., as reasons for infestations.
  • Occupation showed majority as students followed by one-third of sample as laborer. The sample size was largely from schools hence the findings. Contact with contaminated soil, waste, etc., is also a major source of infection, hence data in this category was felt necessary to note.
  • Socioeconomic status was lower and lower middle in the study. Socioeconomic status mainly determines quality of food and living standards. The data made to arrive on the reason as may be the deficient nutrients in the diet lowered the immune system making the patients susceptible to many infections.
Causative organism in the study found in maximum patients were Ascaris lumbricoides with 71.43%, especially fertilized ova found in 71.11%; followed by infestation of Enterobius vermicularis in 19.05%, while Hymenolepis nana in 6.35%. Patients of Ancylostoma duodenale and Trichuris trichiura were each in 1.59%. This shows the endemic status of A. lumbricoides in the area of survey.
A. lumbricoides is commonest intestinal nematode of human beings and affects more than one billion people worldwide.[4] The feces with fertilized ova is the carrier of infection, whereas feces of unfertilized ova is not infectious.[5]
Utpadaka Nidana is mainly that which imply the probable source of contamination and suggests maintenance of poor personal hygiene which helps parasites to thrive on host.
Maximum reported feco-oral contamination and nail biting habit was found in 95.24%, followed by irregular bathing habits in 90.45%, no regular brushing habits in 82.54%, habit of consumption of low branded ice candies in 74.60% with maintenance of poor personal hygiene, and in 57.14%, there was history of use of public toilet facilities.
Vyanjaka Nidana here in the context means those which create a favorable environment for parasites to grow.
Data obtained from the study illustrate Pishtanna sevan in 82.54%, habit of eating stale food in 80.95%, liking toward Madhura and Amla Rasa in 79.34%, Guda sevan in excess quantities in 76.19%, not properly cleaned Parnashaka eating habit in 77.77%, habit of eating uncooked or raw grains while cleaning in 69.84%, habit of eating without proper digestion of previously taken meal Adhyashana in 68.25%, habit of eating mud particularly from the banks of lakes and of the roots of lotus plants in 66.66%, and habit of Diwaswaapa in 58.73%.
The potentiating etiological factors are suggestive of the following:
Agni Dushti - Habit of eating stale food in 80.95%, habit of eating uncooked or raw grains while cleaning in 69.84%, habit of eating without proper digestion of previous meal Adhyashana in 68.25%, and habit of eating clay particularly from the banks of lakes and of the roots of lotus plants in 66.66%.
Kapha Prakopa - Pishtanna sevan in 82.54%, Madhura and Amla Rasa in 79.34%, use of Guda in excess quantities was reported in 76.19%, and habit of Diwaswaapa in 58.73%.
Krimi and its signs and symptoms
Ascaris lumbricoides
  • Data clearly illustrate that four each symptoms of Shleshmaja and Purishaja were found in percentages above 50%. But the percentages are higher in Purishaja Krimi lakshanas. Thus, A. lumbricoides produces symptoms of both the Krimis, i.e., Shleshmaja and Purishaja. This confirms the hypothesis that the Krimis should be graded as Udara Krimi. Above data are suggestive of Agni Dushti and Aam formation hampering digestion.[6]
  • Data also support that A. lumbricoides interferes with proper digestion and absorption of food.[7] This can be said on the basis of visible food particles in stool in maximum patients.
  • The data are also suggestive that maximum numbers of patients, i.e., 76.74% are in mild or “grade 1” anemia, while 2.33% signify severe grade of anemia. This implies Ascaris as a potent cause of anemia. The symptoms of Pandu were found clinically in 91.11%, which suggest that these patients are at risk to alter the objective parameter if left untreated and if Nidana Parivarjan is not practiced.
Enterobius vermicularis
  • Data reveal five lakshana of Purishaja variety above 50% and two of Shleshmaja variety thus may be considered as of Purishaja variety.
  • Improper consistency of stool is suggestive of hampered digestion and passage of specific worms is the specific diagnostic feature of a particular helminth which is also mentioned in Purishaja Krimi lakshana as Gudat Nishkraman. Sushruta[8] has mentioned a characteristic feature of Purishaja Krimi as those which travel down toward the anus.
  • The data suggest values of hemoglobin percentage within normal range and is not suggestive of anemia, which specifies clearly that the patients of E. vermicularis are least causative for the anemia.
Hymenolepis nana
  • Purishaja Krimi lakshana are found maximum, so may be considered as a variety of Purishaja Krimi.
  • Clinical features according to modern parasitology include diarrhea;[9] the study also supports the above as in maximum patients, consistency of stool was drava with increased frequency.
  • Normal values of hemoglobin concentration were noted.
Probable Samprapti (pathogenesis)
Fills the channels by material which tissue cannot assimilate causing Bala, Varna, Agni Nasha; hampering nutrition of the host leading to Udara Krimi as etiopathological cause of Pandu [Figure 3].
Figure 3
Figure 3
Probable Samprapti (Pathogenesis)
  • Study implies that more than half of the surveyed sample is invaded by infestation of intestinal helminths and one-third of the total is at risk to develop Pandu. Infection of A. lumbricoides is dominant in the sample and it is a potent cause of Pandu.
  • The Shleshmaja Krimi description is of migrating larvae of A. lumbricoides; E. vermicularis and H. nana can be categorized as Purishaja Krimi. The classical description of Shleshmaja Krimi is of parasites in upper gastrointestinal tract, while Purishaja Krimi are intestinal parasites in general.
  • The symptoms produced due to infestation of A. lumbricoides, E. Vermicularis, and H. nana are more toward Purishaja Krimi; however, symptoms of Shleshmik Krimi are already available, which support the interpretation that the Krimis should be diagnosed as Udara Krimi in general and accordingly should be treated.
  • Etiological factors of Pandu potentiated by Utpadak Nidana of Krimi follows an intermediate Avipaktva state giving rise to clinical condition Pandu due to Udara Krimi.
1. Baghel MS. Monograph article on Micro organisms and Ayurveda. Jamnagar: Gujarat Ayurved University press; 1989. p. 85.
2. Karyakarte Rajesh, Damale Ajit. Medical Parasitology, Arunaben Sen Books and Allied (P) ltd. Kolkata: Chintamoni Das lane; 2003. Jan, p. 215.
3. Oluwafemi O. Oguntibeju: Parasitic infestation and Anemia : The prevalence in a rural Hospital Setting. [accessed on 25/1/08];Journal of Indian Academy of clinical medicine. 2003 Jul-Sep;4(3) Available from: www. hindu.com/2007 -Nov14th .
4. Chakraborty P. Textbook of Medical Parasitology. 2nd edition. Kolkata: New central book agency (P) Ltd; 2005. Jan, p. 146.
5. Joshi J.R. Personal conversation, on 09/09/09 at 10:45am.
6. Acharya Jadavji Trikamji., Vd, editor. Charak Chikistasthana. 52. Vol. 15. Varanasi: Chaukhamba Surabharti Prakashan; 2005. Agnivesh's Charak Samhita; p. 57.
7. Rajesh K, Ajit D. Kolkata: Arunaben Sen Books and Allied (P) ltd; 2003. Jan, Medical Parasitology; p. 148.
8. Acharya Jadavji Trikamji., Vd, editor. 7th edition. 9. Vol. 54. Varanasi: Chaukhamba Orientalia; 2002. Sushruta, Sushruta Samhita, Uttara tantra, krimi pratishedha adhyaya; p. 773.
9. Rajesh K, Ajit D. Medical Parasitology. Kolkata: Arunaben Sen Books and Allied (P) ltd; 2003. Jan, p. 122.
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