8 year old male who recently immigrated from Thailand presents to the emergency department with bowel distension, constipation, and non-bloody vomiting. His mother notes that one week prior the patient had non-bloody diarrhea associated with diffuse abdominal pain. The patient has had recurrent diarrhea for several months associated with a mild cough. The mother states the patient has not had any recent fever. On physical exam, the patient is afebrile, uncomfortable with a distended abdomen with no focal abdominal tenderness.
What infection does this child have? Hint, it is the most common helminth in the world.
Answer: Giant roundworm, Ascaris lumbricoides
1/4 to 1/3 of the world’s population is infected by nematodes, and Ascaris lumbricoides is the most common.
Immigrants and travelers from Latin America and Asia are at higher risk as are children.
The life cycle consists of ingestion of eggs, followed by migration of worms to the lungs, then to the GI tract.
While the presentation of Ascaris lumbricoides can vary from asymptomatic, to fever with cough (4 – 16 days after egg ingestion), to diarrhea with abdominal pain (6 – 8 weeks after ingestion), the most concerning presentations are bowel obstruction and biliary obstruction.
Diagnoses: CBC showing eosinophilia, feces showing eggs
Treatment: Benzimidazoles (most commonly Albendazole and Mebendazole)
Our patient underwent a colonoscopy with successful relief of the obstruction followed by 3 days of Mebendazole and was discharged home safely.
eMedicine – Ascaris Lumbricoides : Article by Aaron Laskey”. Archived from the original on 27 January 2008. Retrieved 2008-02-03.