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Ask the doctor: pets, worms and the dengue fever you don’t feel

The Phnom Penh Post has partnered with licensed doctors from the International SOS Clinic to answer readers’ medical questions every first Wednesday of the month. Send your medical questions to

I heard from a friend that it’s almost a certainty that everyone who stays in Cambodia for at least six months will get worms and should get it checked out. Is that true? What are the symptoms?

Worms are quite common wherever sanitation and hygiene are not up to the best standards and Cambodia is no exception. All that it takes is improper waste disposal, dirty unfiltered water or someone not washing after using the loo to allow worms to spread. Worms come in many different varieties, but the 2 largest groups are hookworms and tapeworms.  Hookworms live in feces-contaminated soil. 

When a person steps barefoot in the soil, they hook into the skin of the foot and enter the body.  In a few weeks, they have migrated to the gut where they attach and feed off blood and the nutrients that you eat. They mature, find a mate and then start producing eggs, which then pass into the stools.  Tapeworms are a bit different.  You become infected by eating the eggs hidden in infected improperly cooked meat. Beef, pork, and fish can all harbor tapeworms.

Most of the time, worm infections cause very few symptoms, if any. Occasionally you can suffer from loose stools, but mostly they just cause gradual weight loss and anemia. Every once in a while, a migrating worm can get “lost” on its way to the gut and can become lodged in the liver, or make its way to the lungs or brain.  In these cases, they can cause worse symptoms such as abdominal pain, vomiting, pneumonia, and even seizures.

It is possible to avoid getting worms by taking a few simple precautions. Don’t walk around barefoot outside.  Properly clean fruits and vegetables you prepare at home and eat only well-cooked meats.  If you do go out to eat, choose wisely.  Check out the bathroom in the restaurant or observe the kitchen staff a little bit.  Chances are if their bathroom is dirty or the staff don’t bother to wash tables or counters, then they likely haven’t washed their hands either.

Above all, just use common sense. (The guy on the side of the road selling those tasty meats on a stick doesn’t have a sink or a bathroom. Do you think he is washing his hands?)

If you are worried about having worms, you can always come in to the clinic to get your stool sample checked. We don’t recommend periodic deworming without knowing what you are treating, since most empiric regimens (antibiotics) will not completely kill the worms and get rid of the eggs. Just like with other infections, the worms can develop resistance to the medications if not dosed accurately.

Can you get a really mild version of Dengue fever that you don’t even know if you have it? I recently went to a doctor who said I might have a low platelet count, which could indicate dengue, but I haven’t felt unwell lately.

Yes, most dengue infections are actually mild and have few symptoms. 

In a survey conducted during a dengue outbreak in Cuba, 76 per cent of the infections were classified as mild, as opposed to only 22 per cent classified as dengue fever and dengue hemorrhagic fever, requiring a hospital/clinic visit. It is also more common for young children to have mild disease (fever or fever with rash) than adults. 

There are many reasons to have a low platelet count (thrombocytopenia) and dengue infection is just one of them. 

If you did have dengue though, the low count is not permanent and will resolve in a couple of weeks. 

While your platelet count is low (especially if less than 100, 000), you should avoid aspirin and other medicines that can thin the blood like ibuprofen and naproxen.

So many people have pets here. Lots of them let cats and dogs sleep in their beds.  Is it a health risk?

Having a pet sleep in your bed is not usually a health hazard unless you are allergic to their fur or if they are infected with fleas. 

Allergy symptoms are pretty obvious: congested or runny nose, teary, itchy eyes, dry cough, or trouble breathing. If your child or you have asthma, allergies to pet hair can definitely make it worse.  

You’ll also know pretty quickly if you have fleas.  They jump from your dog or cat onto your skin and then bite, causing itchy bumps all over.  

There are other risks to pets but mostly if they spend time outdoors or are not properly vaccinated. Dogs and cats may have contact with wild animals and can be vectors for rabies. They also have very dirty teeth and claws and if they bite or scratch deeply, almost certainly the wound will become infected, requiring medical treatment.

This week’s guest columnist is Dr Claire Uebbing, the new full-time American General Practitioner at International SOS.
This article contains general information about medical conditions and treatments. The information is not advice, and should not be treated as such. You must not rely on the information as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider.



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