Pancreatitis aguda por áscaris en un adulto del área urbana de Bogotá, a propósito de una presentación inusual. Reporte de caso / Acute pancreatitis due to ascaris in an adult from the urban area of Bogotá, regarding an unusual manifestation. Case report

Resumen Introducción: la pancreatitis aguda es una de las entidades que afectan más normalmente el tracto gastrointestinal. Sus causas más frecuentes son la biliar y la alcohólica; sin embargo, no se deben descartar las causas infecciosas, entre ellas las parasitarias. Caso: se presenta un caso de un hombre de 35 años de edad procedente del área urbana de Bogotá que ingresó por un dolor torácico al servicio de urgencias del Hospital San Ignacio, posteriormente con migración hacia el abdomen y síntomas gastrointestinales asociados. Se diagnosticó pancreatitis aguda, se descartaron las causas biliar y alcohólica, y se evidenció en la escanografía un cuerpo extraño endoluminal gástrico hacia las asas intestinales, cuyo diagnóstico se confirmó de manera endoscópica (áscaris lumbricoides). Se extrajo el helminto en su totalidad y se continuó el manejo intrahospitalario. Como complicación presentó un compromiso necrotizante con colecciones asociadas en imágenes de control, sin compromiso multiorgánico. Finalmente, se dio egreso por una adecuada evolución clínica. Conclusión: la ascariasis es una causa infrecuente de pancreatitis aguda en adultos de zonas urbanas, incluso en países en vías de desarrollo como Colombia. Su diagnóstico y manejo terapéutico se realizan vía endoscópica con la extracción del helminto. Como en todos los casos de pancreatitis, debe realizarse un seguimiento clínico en busca de complicaciones asociadas y compromiso multiorgánico.

Abstract Introduction: Acute pancreatitis is one of the most common entities affecting the gastrointestinal tract. Its most frequent causes are biliary and alcoholic; however, infectious causes, including parasitic ones, should not be ruled out. Case: We present the case of a 35-year-old man from the urban area of Bogotá who was admitted to the emergency department of the San Ignacio Hospital due to chest pain, with subsequent migration to the abdomen and associated gastrointestinal symptoms. Acute pancreatitis was diagnosed, biliary and alcoholic causes were ruled out, and the scan revealed a gastric endoluminal foreign body towards the intestinal loops; the diagnosis was confirmed endoscopically (Ascaris lumbricoides). The helminth was entirely extracted, and the intrahospital management was continued. As a complication, he had necrosis with associated collections in control images without multi-organ involvement. Finally, he was discharged due to adequate clinical evolution. Conclusion: Ascariasis is a rare cause of acute pancreatitis in adults in urban areas, even in developing countries such as Colombia. Its diagnosis and therapeutic management are carried out endoscopically with the extraction of the helminth. As in all cases of pancreatitis, a clinical follow-up should be conducted in search of associated complications and multi-organ involvement.

Ascariasis errática biliar como causa exótica de ictericia obstructiva / Erratic Biliary Ascariasis as an Exotic Cause of Obstructive Jaundice

Introducción: Áscaris lumbricoides es el helminto más frecuente en el tracto gastrointestinal humano; la mayor prevalencia se registra en países en desarrollo, tropicales y subtropicales. En Cuba constituye una causa exótica de ictericia obstructiva con pocos casos reportados. Objetivo: Describir el manejo terapéutico exitoso de un caso de un hombre con ictericia obstructiva secundaria a ascariasis coledociana. Caso clínico: Paciente de 74 años operado en el Hospital Clínico Quirúrgico "Lucía Íñiguez Landín" de la provincia Holguín por ictericia obstructiva por ascariasis coledociana, con evolución clínico-quirúrgica satisfactoria. Conclusiones: En países en desarrollo debe tomarse en cuenta la ascariasis como causa de enfermedad obstructiva biliar o pancreática. El conocimiento del cuadro clínico y sus complicaciones, además, de las diferentes opciones en el tratamiento, debe ser del dominio de todo médico. La ictericia obstructiva por áscaris lumbricoides constituye en Cuba una causa exótica de esta infestación por parásitos(AU)

Introduction: Ascaris lumbricoides is the most frequent helminthiasis in the human gastrointestinal tract; the highest prevalence is recorded in developing, tropical and subtropical countries. In Cuba, it constitutes an exotic cause of obstructive jaundice with few reported cases. Objective: To describe the successful therapeutic management of a case of a man with obstructive jaundice secondary to choledochal ascariasis. Clinical case report: We report the case of a 74-year-old patient operated on at Lucía Íñiguez Landín Surgical Clinical Hospital, in Holguín province, for obstructive jaundice due to choledochal ascariasis, with satisfactory clinical-surgical evolution. Conclusions: In developing countries, ascariasis should be taken into account as a cause of biliary or pancreatic obstructive disease. Knowledge of the clinical condition and its complications, in addition to the different treatment options, should be the domain of every physician. Obstructive jaundice due to ascaris lumbricoides constitutes an exotic cause of this parasite infestation in Cuba(AU)

Spatial-temporal clustering analysis of soil-transmitted helminth transmission risk in Jiangxi, 2016-2019 / 中国热带医学

@#Abstract: Objective　To analyze the epidemic characteristics of soil-transmitted helminth (STH) by the spatial epidemiological method in Jiangxi Province. Methods　Surveillance data of STH in Jiangxi Province from 2016 to 2019 were collected for descriptive epidemiological analysis. The space-time permutation distribution of STH infection areas was analyzed with spatial autocorrelation, hotspot analysis methods and retrospective space-time permutation scan statistics. Results　The infection rates of STH were 1.32% (947/71 766), 1.14% (803/70 547), 0.87% (604/69 507) and 0.90% (628/69 620), respectively, and the differences were statistically significant in different years (P<0.01). The rates of hookworm infection were 0.65% (466/71 766), 0.64% (450/70 547), 0.48% (336/69 507) and 0.52% (362/69 620), respectively, and the differences were statistically significant (P<0.01). The infection rates of Ascaris lumbricoides were 0.55% (393/71 766), 0.41% (287/70 547), 0.32% (221/69 507) and 0.32% (225/69 620), respectively, and the differences were statistically significant in different years (P<0.01). The infection rates of Trichuris trichiura were 0.17% (125/71 766), 0.10% (74/70 547), 0.08% (57/69 507) and 0.07% (49/69 620), respectively, and the differences were statistically significant among different years (P<0.01). The results of global spatial autocorrelation analysis showed that there was a spatial autocorrelation index Moran's I value of hookworm infection rate in 2016, Trichuris trichiura infection rate in 2016, 2018 and 2019, with statistical significance (P<0.05). The results of hotspot analysis, SaTScan and FleXScan spatial and temporal scanning analysis showed that there were high-value aggregation regions for each species in each year. Conclusion　The infection rates of STH, hookworm, Ascaris lumbricoides and Trichuris trichiura showed a decreasing trend and space-time clustering from 2016 to 2019. It should be taken into account in the formulation of control strategies.

Pancreatitis necrotizante por áscaris lumbricoides: causas, diagnóstico y tratamiento actual / Necrotizing pancreatitis due to Ascaris lumbricoides: Causes, diagnosis, and current treatment

Resumen La necrosis en la pancreatitis aguda muestra una mortalidad muy alta a pesar de los avances en cuidados críticos. Después de la etiología biliar y alcohólica, la tercera causa más común de pancreatitis es la idiopática, con un 10 % de los casos secundarios a parásitos, y el áscaris es el parásito más común implicado en la necrosis e inflamación del páncreas. Teniendo en cuenta la alta mortalidad que representa la pancreatitis necrotizante, se describe un reporte de caso por ascariasis, destacando su creciente epidemiología, sus causas, su diagnóstico clínico e imagenológico, y su tratamiento antiparasitario según la evidencia actual.

Abstract Necrosis in acute pancreatitis presents a high mortality rate despite advances in critical care. After biliary and alcoholic etiology, the third most common cause of pancreatitis is idiopathic etiology, with 10% of cases related to parasites, being Ascaris the most common parasite involved in pancreas necrosis and inflammation. Considering the high rates of mortality related to necrotizing pancreatitis, a case of ascariasis is analyzed, including its growing epidemiology, its causes, its clinical and imaging diagnosis, and its antiparasitic treatment based on current evidence.

Ascaridiasis hepatobiliar en una adulta joven / Hepatobiliary ascaridiasis in a young adult woman

Se presenta el caso clínico de una paciente de 27 años de edad, con antecedentes de colecistectomía convencional desde hacía 10 meses por aparente colecistitis, quien acudió al Hospital Luis Vernaza de Guayaquil, Ecuador, por presentar ictericia y dolor abdominal. Teniendo en cuenta los hallazgos clínicos, de laboratorio e imagenológicos se le diagnosticó sepsis de foco abdominal, colangitis y coledocolitiasis. Durante la intervención quirúrgica se observó la presencia de 2 Ascaris lumbricoides y cálculo de colesterol en la vía biliar, por lo que se le realizó una derivación bilioentérica. Después de algunas complicaciones como insuficiencia respiratoria y descompensación hemodinámica, la paciente egresó de la institución a los 25 días de operada, con seguimiento por consulta externa durante 2 meses.

The case report of a 27 years patient is presented, with history of conventional cholecystectomy for 10 months due to apparent cholecystitis who went to Luis Vernaza Hospital in Guayaquil, Ecuador, presenting jaundice and abdominal pain. Taking into account the clinical, laboratory and imaging findings a sepsis of abdominal focus, cholangitis and choledocolithiasis was diagnosed. During the surgical intervention the presence of 2 Ascaris lumbricoides and cholesterol calculi in the bile duct was observed, reason why a bilioenteric bypass was carried out. After some complications such as breathing failure and hemodynamic upset, the patient was discharged from the institution 25 days after the surgery, with follow up in outpatient clinics during 2 months.

Ascaris lumbricoides, causa de la colecistitis aguda en el servicio de emergencia del Hospital "Alfredo Noboa Montenegro", 2018 / Ascaris lumbricoides, cause of acute cholecystitis in the emergency service of the "Alfredo Noboa Montenegro" Hospital, 2018

Ascaris lumbricoides provoca una de las helmintiasis más frecuentes en los países tropicales, pudiendo producir efectos patológicos en cualquier parte del organismo, siendo los conductos biliales uno de los sitios recurrentes provocando una colecistitis aguda. La CA es una de las principales causas de ingreso al servicio de Emergencia, es una inflamación de la vesícula cuyo diagnóstico oportuno es de vital importancia para la prevención de complicaciones. Por tal razón, determinar la frecuencia de las variables clínicas, de laboratorio y ecográficas, su relación con las comorbilidades asociadas a las características demográficas de los pacientes y el nivel de severidad de la colecistitis aguda causada por la A. lumbricoides de las Guías de Tokio 2018 del Servicio de Emergencia del Hospital Alfredo Noboa Montenegro durante el periodo junio - diciembre 2018, para la elaboración de un esquema diagnóstico. La metodología de investigación fue cuantitativa descriptiva de corte transversal. Dentro de los principales hallazgos, el CA aparece con prevalencia en el género femenino en un 69,41%, promedio de edad de 32 a 45 años, el 10% de 170 pacientes presentaron en su ecografía una forma parasitaria compatible con A. Lumbricoides, los resultados clínicos arrojaron presencia de dolor (67,34%), fiebre (68,65%), náuseas (45,93%); en los laboratorio la Proteína C Reactiva estuvo aumenta en el 94,18% de los casos, en imagenología se refleja presencia de líquido pericolecistico en un 78,82% y un engrosamiento de pared vesicular en un 34,12%. El nivel de severidad registrado según los criterios de las guías de Tokio 2018 fue grado I 35,3%, grado II 47,1% y grado III 17,6%. Se recomienda la estructuración de un esquema diagnóstico oportuno de colecistitis aguda causada por A. Lumbricoides(AU)

Ascaris lumbricoides causes one of the most frequent helminthiases in tropical countries, being able to produce pathological effects in any part of the body, being the bile ducts one of the recurrent sites causing acute cholecystitis. AC is one of the main causes of admission to the Emergency service, it is an inflammation of the gallbladder whose timely diagnosis is of vital importance for the prevention of complications. signs and symptoms, the timely diagnosis is of vital importance for the prevention of complications. For this reason, determine the frequency of clinical, laboratory and ultrasound variables, their relationship with the comorbidities associated with the demographic characteristics of the patients and the level of severity of acute cholecystitis cause of A. lumbricoides of the Tokyo Guidelines 2018 of the Hospital Emergency Service Alfredo Noboa Montenegro during the period June - December 2018, for the elaboration of a diagnostic scheme. The research methodology was quantitative cross-sectional descriptive. Among the main findings that were prevailed in the female gender in 69,41%, average age from 32 to 45 years, 10% of 170 patients presented in their ultrasound a parasitic form compatible with A. lumbricoides, clinical results that prevailed was presence of pain (67.34%), fever (68.65%), nausea (45.93%); in the laboratory findings the C Reactive Protein was increased in 94,18% of cases, in imaging the presence of pericolecist fluid is reflected in 78,82% and a thickening of the vesicular wall in 34,12%. The severity level recorded according to the criteria of the Tokyo 2018 guidelines was grade I 43,53%, grade II 48,24% and grade III 8,24%. The structuring of a timely diagnostic scheme for acute cholecystitis cause of A. lumbricoides is recommended(AU)

Ascariasis hepatobiliar en una lactante con desnutrición severa: reporte de caso / Hepatobiliary ascariasis in severely malnourished infant: case report

Resumen La Ascariasis es la geohelminitiasis más común del mundo, catalogándose como una enfermedad tropical desatendida, que puede causar compromiso pulmonar, gastrointestinal, hepatobiliar y nutricional. Se presenta el caso inusual de una lactante procedente de una zona de extrema pobreza quien consultó por fiebre, vómito, ausencia de deposiciones, distensión y dolor abdominal. Fue diagnosticada con pseudoobstrucción intestinal, desnutrición severa, choque séptico de origen intraabdominal, retraso del neurodesarrollo y deprivación psicoafectiva, cuyas imágenes reportaron ascariasis hepatobiliar y granulomas hepáticos calcificados y abscedados, con infestación severa por Ascaris lumbricoides. Recibió manejo antibiótico y antiparasitario con recuperación exitosa. En nuestro medio, las infecciones por helmintos son causa frecuente de anemia, retraso cognitivo y del crecimiento en niños en edad escolar. Sin embargo, la infestación y complicaciones hepatobiliares como colangitis, colecistitis, pancreatitis, litiasis biliar y hepatitis abscedada son inusuales en menores de dos años. A través de este caso se pretende resaltar la presentación atípica de la enfermedad en lactantes e incitar al fortalecimiento de las intervenciones en salud pública. MÉD.UIS.2020;33(1):67-72.

Abstract Ascariasis is the most common geohelminitiasis in the world. It is categorized as an unattended tropical disease, which can cause pulmonary, gastrointestinal, hepatobiliary and nutritional compromise. We present the unusual case of an infant from an extreme poverty area presenting fever, vomiting, absence of bowel movements, bloating and abdominal pain. She was diagnosed with intestinal pseudoobstruction, severe malnutrition, abdominal septic shock, neurodevelopmental delay and emotional deprivation. The images reported hepatobiliary ascariasis and calcified and abscessed hepatic granulomas, with severe infestation by Ascaris lumbricoides and Trichuris trichiura. She was treated with antibiotics and antiparasitic agents with successful recovery. In our environment, helminth infections are a frequent cause of anemia, stunting and neurodevelopmental delay in school-age children. However, infestation and hepatobiliary complications such as cholangitis, cholecystitis, pancreatitis, biliary lithiasis and hepatic abscess are unusual in children under two years old. Through this case, it is intended to highlight the atypical presentation of this disease at the age of this patient and encourage the strengthening of public health interventions. MÉD.UIS.2020;33(1):67-72.

Effect of Socio-economic Status, Quality of Hygiene, Nutritional Status on Helminthic Infection Among School Going Children

Background: Helminthic infections have been major publichealth burdens. Some isolated helminths include Ascarislumbricoides, the whipworm Trichuris trichuira, the hookwormAncylostoma duodenale, Necator americanus andStrongyloides stercoralis. The present study was conducted tostudy the effect of socio-economic status, quality of hygiene,nutritional status on helminthic infection among school goingchildren aged between 5 to 13 years.Materials and Methods: A cross-sectional study on 352children at Govt. Primary school, Rajapur was conducted fromJanuary 2007 to June 2008. Children were interviewed usingpre-tested proformas to identify the risk factors and prevalenceof Helminthic infestation. Stool examination was done by usingthe formal ether concentration technique in microbiologylaboratory at M. R. Medical college. Statistical analysis wasdone by using the percentage, chi-square, SPSS statisticalsoftware.Results: Out of 352 children 162 tested positive for variousintestinal helminth’s in the age group 5 to 13 years. The overallprevalence of Helminthic infestation was 46.02% thepredominant parasites were Ascaris Lumbricoides 48.77%followed by Hymenolepsis Nana 27.16% Ancylostomaduodenale 11.73%, Trichuris Trichiura 9.88% & Enterobiusvermicularis 2.46%. 4.94% cases were of mixed infection. Thepresent study found that Socio-economic class, nutritionalstatus and pallor was significantly associated with prevalenceof Helminthic infestation. Habit of digit sucking or nail bitting,Storage of food and water were not significantly associatedwith Helminthic infestation (p>0.05). The association betweenHand wash before eating food, Status of Nails, practice of openair defecation and hand wash with soap after defecation,footwear use, eating mud or pica, drawing water for drinking,source of water, eating of raw vegetables or fruits, eating offood sold by vendor and prevalence of Helminthic infestationwere found to be significant (P<0.05). The association betweenprevalence of Helminthic Infestation and KAP of children wasalso found to be Significant.Conclusions: In the present study the prevalence ofhelminthic infestation in school children are on the higher sidewhich requires due attention and consideration despitehelminthic control programme in school for all children.

Prevalence of soil - borne nematode infections among residents living in urban/town areas of China in 2015 / 中国血吸虫病防治杂志

Objective To understand the prevalence of soil-borne nematode infections among residents living in urban/town areas of China, so as to provide insights into the control and elimination of soil-borne nematodiasis. Methods A total of 5 epidemic areas were classified in China according to the prevalence of human Clonorchis sinensis infections captured from the 2014–2015 national survey on major human parasitic diseases in China, and the total sample size was estimated according to the binomial distribution and Poisson’s distribution. Then, the total sample size was allocated proportionally to each province (autonomous region, municipality) of China based on the percentage of residents living in urban and town areas, and the number of survey sites in each province (autonomous region, municipality) was proportionally assigned according to the percentages of residents living in urban and town areas. Then, stratified sampling was performed at county, township and community levels according to the number of sampling sites in each province (autonomous region, municipality), and the survey site (community) was defined as the smallest sampling unit. All permanent residents in the survey sites were selected as the study subjects, and their stool samples were collected for identification and counting of parasite egg using a Kato-Katz technique. The prevalence and intensity of each parasite species were calculated. Results From 2014 to 2015, among the 133 231 residents detected in 31 provinces (autonomous regions, municipalities) of China, the overall prevalence of soil-borne nematode infections was 1.23% (1 636/133 231), and the prevalence rates of hookworm, Ascaris lumbricoides and Trichuris trichiura infections were 0.77% (1 032/133 231), 0.32% (426/133 231) and 0.17% (224/133 231), respectively. The highest prevalence of soil-borne nematode infections was seen in Jiangxi (4.03%, 82/2 034) and Chongqing (4.03%, 524/13 012), followed by in Hainan (3.47%, 72/2 075). The prevalence of soilborne nematode infections was 1.07% (662/62 139) in men and 1.37% (974/71 092) in women, and the greatest prevalence was found in residents at ages of 65 to 70 years (2.56%, 219/8 569). With regard to occupations and education levels, herdsmen (2.47%, 2/81) and illiterate residents (3.33%, 226/6 795) were found to have the highest prevalence of soil-borne nematode infections, respectively. In addition, mild infections were predominantly identified in hookworm-, A. lumbricoides- and T. trichiura-infected individuals (all > 90%). Conclusions The overall prevalence of soil-borne nematodiasis remains low in urban and town areas of China; however, human infections are widespread. According to the epidemiological features, health education combined with deworming are recommended to reduce the prevalence of soil-borne nematode infections among residents living in urban and town areas of China.

Ascariasis intestinal. Tres casos pediátricos con complicaciones severas en Cauca, Colombia / Intestinal ascariasis. Three pediatric cases with severe complications in Cauca, Colombia

Se presentan tres casos clínicos de niños atendidos en el Hospital Universitario San José de Popayán en Cauca, Colombia, quienes consultaron por una infección severa causada por Ascaris lumbricoides. La severidad de la infección tuvo como consecuencia en el primer caso una colangitis aguda, en el segundo caso una obstrucción intestinal con peritonitis generalizada, y en el tercer caso una perforación intestinal y choque séptico. El objetivo de mostrar estos casos es dar a conocer estas presentaciones clínicas poco frecuentes en el entorno médico. Además, se resalta la importancia del conocimiento sobre esta especie de parásito, que termina siendo un problema más de salud pública, no solo en nuestro país, sino en gran parte del mundo

We report three clinical cases of children treated at the San José University Hospital in Cauca, Colombia, who consulted with a severe infection caused by Ascaris lumbricoides. The severity of the infection resulted in acute cholangitis in the first case, in intestinal obstruction with generalized peritonitis in the second case, and in intestinal perforation and septic shock in the third case. The objective of this report is to inform the medical community about these unusual clinical presentations. In addition, the importance of this parasite is highlighted as a public health concern, not only in our country but also globally

Association Between Age, Sex, Religion and Helminthic Infection Among Children Aged Between 5 to 13 Years: An Institutional Based Study

Background: Worm infestation is a major Health problem inchildren of developing countries, its effective prevention andcontrol requires identification of local risk factors particularlyamong high risk groups. The present study was conducted tostudy t various factors like age, sex, religion and helminthicinfection among children aged between 5 to 13 years.Material and Methods: A cross-sectional study on 352children at Govt. Primary school, Rajapur was conducted fromJanuary 2007 to June 2008. Children were interviewed usingpre-tested proformas to identify the risk factors and prevalenceof Helminthic infestation. Stool examination was done by usingthe formal ether concentration technique in microbiologylaboratory at M. R. Medical College. Statistical analysis wasdone by using the percentage, chi-square, SPSS statisticalsoftware.Results: Out of 352 children 162 tested positive for variousintestinal helminth’s in the age group 5 to 13 years. The overallprevalence of Helminthic infestation was 46.02% thepredominant parasites were Ascaris Lumbricoides 48.77%followed by Hymenolepsis Nana 27.16% Ancylostomaduodenale 11.73%, Trichuris Trichiura 9.88% & Enterobiusvermicularis 2.46%. 4.94% cases were of mixed infection.Helminthic infestation among males was 48.33% and females43.60%. Religion, Sex, Type of family were not significantlyassociated with Helminthic infestation (p>0.05). Theassociation between prevalence of Helminthic Infestation andKAP of children was also found to be Significant.Conclusion: This study concluded that the prevalence ofHelminthic infestation among primary school children were highand need to be addressed.

Intestinal parasitic infections and prevalence of anaemia among tribal school going children: a one year study

Background: Intestinal parasitic infections are one of the neglected tropical diseases listed by world health organization. Parasitic infections among school going tribal children cause significant anaemia and malnutrition. Our study mainly focused on estimating the prevalence of intestinal parasitic infections and focused on iron deficiency anaemia among the tribal school going children.Methods: A prospective study for one year was conducted at a tertiary care hospital and study group was tribal children from hostels and schools. Ethical committee approval was obtained and study included collection of socio demographic data, anthropometric data, stool examination for intestinal parasitic infections, Hb% estimation by 'Hemocue globinometer Hb 301 System' a portable hemometer for Hb estimation. S. iron, S. transferrin and Total iron binding capacity were also estimated. Statistical analysis was performed by using SPSS version 20 and analyzed. P value <0.05 was considered significant.Results: This 428 study participants with 66.36% boys and 33.64% girls were enrolled. The prevalence of parasitic infections was 42.06%. Protozoal infections were 41.11% when compared to helminthic infections (26.67%) and mixed infections in 32.22%.' Entamoeba histolytica was the predominant protozoal parasite identified (30%) and Ascaris lumbricoides among the helminthic infection (13.3%). Presence of anaemia in the present study population was 11.21% and among the study group with parasitic infections it was 66.67%.Conclusion: To conclude, regular deworming practices, awareness regarding hand washing practices, iron and folic acid supplementation irrespective of nutritional status and health education could significantly reduce the incidence of anaemia associated with intestinal parasitic infections.

Obstrucción intestinal por Áscaris lumbricoides / Intestinal obstruction due to Ascaris lumbricoides infection

RESUMEN Fundamento: la parasitosis más frecuente y cosmopolita de todas las helmintiasis humanas es la ocasionada por Áscaris lumbricoides. Se estima que, alrededor de un cuarto de la población mundial está infectada y cerca de 60 000 personas fallecen anualmente a consecuencia de ello. El ser humano se infecta al ingerir los huevos larvados del parásito. Objetivo: presentar un caso con el diagnóstico de obstrucción intestinal por Áscaris lumbricoides. Presentación del caso: paciente femenina de 19 años de edad, con antecedentes de salud, sin antecedentes quirúrgicos. Acudió al servicio de urgencias por presentar desde hace dos días vómitos, en número de entre cinco y seis diarios, al examen físico se constataron síntomas y signos de deshidratación, con cuadro de abdomen agudo oclusivo. Conclusiones: la oclusión intestinal por Áscaris lumbricoides es una enfermedad poco frecuente en adultos y muy rara en Cuba en la actualidad.

ABSTRACT Background: the most frequent and cosmopolitan parasitosis of all human helminthiasis is that caused by Ascaris lumbricoides. It is estimated that around a quarter of the world's population is infected and about 60,000 people die annually as a result. The human being becomes infected by ingesting the larvae eggs of the parasite. Objective: to present a case with the diagnosis of intestinal obstruction by Ascaris lumbricoides. Case report: a 19-years-old female patient with a health history, with no surgical history. He went to the emergency department for presenting two days vomiting, in number between five and six daily, physical examination was confirmed symptoms and signs of dehydration, with acute abdominal occlusive symptoms. Conclusions: intestinal occlusion by Ascaris lumbricoides is a rare disease in adults and very rare in Cuba at present.

Children from a rural region in The Chiapas Highlands, Mexico, show an increased risk of stunting and intestinal parasitoses when compared with urban children / Alto riesgo de desmedro y parasitosis intestinal en niños de una región rural de los Altos de Chiapas, México, en comparación con niños de una región urbana

Abstract Background: The state of Chiapas has held the first place of extreme poverty in Mexico. The majority of Chiapas' municipalities are inhabited by marginalized, indigenous populations, who usually present diarrhea of unknown etiology. We evaluated the nutritional status, intestinal parasites, and common bacterial pathogens, including DEC (diarrheagenic Escherichia coli) strains, in 178 children under five years of age with a high (rural) and a moderate (urban) degree of marginalization. Methods: Z-scores for anthropometric indexes from the children were obtained, whereas intestinal parasites were investigated by using a direct coproparasitoscopic analysis and a concentration method. DEC strains were detected by polymerase chain reaction (PCR). Results: The stunting prevalence in children from the rural and urban regions was 79.8 and 7.5%, respectively. Only children from rural municipalities were parasitized (72.6%), being Ascaris lumbricoides and Entamoeba histolytica/Entamoeba dispar the most prevalent parasites (57.1 and 38.1%, respectively). More than half of the children presented moderated ascariasis. Besides Giardia intestinalis, these parasites were associated with stunting. The prevalence of DEC strains was similar in both regions. Conclusions: Only children from the Chiapas Highlands (rural zone) exhibited high prevalences of stunting and intestinal parasites. A reevaluation of social development programs should be in place to address stunting and intestinal parasitoses, mainly in rural regions of Chiapas, to avoid adverse functional consequences on these children.

Resumen Introducción: El estado de Chiapas ha ostentado el primer lugar de pobreza extrema en México. La mayor parte de la población de los municipios de Chiapas es indígena, vive en condiciones de marginación y padece de diarrea de etiología desconocida. Este trabajo evaluó el estado nutricional, la presencia de parásitos intestinales y patógenos bacterianos comunes, además de cepas DEC (Escherichia coli diarreogénica) en 178 niños menores de cinco años, provenientes de una localidad con alto grado de marginación (rural) y de una con moderada marginación (urbana). Métodos: Se obtuvieron los puntajes Z de los índices antropométricos de los niños. Los parásitos intestinales se investigaron con el método coproparasitoscópico directo y un método de concentración. Las cepas DEC se detectaron mediante reacción en cadena de la polimerasa. Resultados: La prevalencia de desmedro en niños de la zona rural y urbana fue de 79.8 y 7.5%, respectivamente. Únicamente los niños de la zona rural estuvieron parasitados (72.6%), y los más prevalentes fueron Ascaris lumbricoides y Entamoeba histolytica/Entamoeba dispar (57.1 y 38.1%, respectivamente). Más de la mitad de los infantes exhibieron ascariasis moderada. Estos parásitos, además de Giardia intestinalis, se asociaron con el desmedro. En ambas regiones, la prevalencia de DEC fue similar. Conclusiones: Solo los niños de los Altos de Chiapas (zona rural) exhibieron alta prevalencia de desmedro y parásitos intestinales. Para evitar las consecuencias adversas entre los infantes, es necesario reevaluar los programas de desarrollo social para combatir el desmedro y la parasitosis intestinal, principalmente en las regiones rurales de Chiapas.

Surveillance of soil-borne nematodiasis in Danyang City from 2012 to 2018 / 中国血吸虫病防治杂志

Objective To monitor the epidemic status of human soil-borne nematodiasis in Danyang City, so as to provide scientific evidence for formulating control measures. Methods The soil-borne nematode infections were tested using a modified Kato-Katz technique among residents aged more than 3 years living in Danyang City from 2012 to 2018, and the Enterobius vermicularis eggs were detected using the transparent adhesive tape anal swab method among children at ages of 3 to 12 years. Results A total of 13 540 residents were monitored for soil-borne nematode infections from 2012 to 2018, and the prevalence of human soil-borne nematode infections was 0.45%. The prevalence of Ascaris lumbricoides, Trichuris trichura and Enterobius vermicularis infections was 0.32%, 0.12% and 0.01%, respectively, and a single parasite infection was predominant. There were significant differences in the prevalence of soil-borne nematode (χ2 = 42.610, P < 0.05), A. lumbricoides (χ2 = 26.276, P < 0.05) and T. trichura (χ2 = 20.692, P < 0.05). The prevalence of human soil-borne nematode infections was 0.45% in males and 0.47% in females, and lower prevalence was found in local residents than in floating population (0.28% vs. 0.66%; χ2 = 10.561, P < 0.05). The highest infection was found in subjects at ages of 31 to 40 years (0.59%), followed by in subjects at ages of 41 to 50 years (0.56%), and the lowest infection was seen in children at ages of 3 to 5 years (0.27%). In addition, the prevalence of human soilborne nematode infections varied significantly in occupation (χ2 = 75.692, P < 0.05), with the highest infection seen in boatmen. Among the 5 078 children monitored, the prevalence of E. vermicularis infection was 0.37%, and the prevalence of E. vermicularis infection varied significantly in year (χ2= 15.466, P < 0.05). Conclusion The human soil-borne nematode infection is at a low level in Danyang City; however, the surveillance of soil-borne nematodiasis remains to be intensified in children living in rural areas and immigrant populations.

Surveillance of soil-borne nematodiasis in Danyang City from 2012 to 2018 / 中国血吸虫病防治杂志

Objective To monitor the epidemic status of human soil-borne nematodiasis in Danyang City, so as to provide scientific evidence for formulating control measures. Methods The soil-borne nematode infections were tested using a modified Kato-Katz technique among residents aged more than 3 years living in Danyang City from 2012 to 2018, and the Enterobius vermicularis eggs were detected using the transparent adhesive tape anal swab method among children at ages of 3 to 12 years. Results A total of 13 540 residents were monitored for soil-borne nematode infections from 2012 to 2018, and the prevalence of human soil-borne nematode infections was 0.45%. The prevalence of Ascaris lumbricoides, Trichuris trichura and Enterobius vermicularis infections was 0.32%, 0.12% and 0.01%, respectively, and a single parasite infection was predominant. There were significant differences in the prevalence of soil-borne nematode (χ2 = 42.610, P < 0.05), A. lumbricoides (χ2 = 26.276, P < 0.05) and T. trichura (χ2 = 20.692, P < 0.05). The prevalence of human soil-borne nematode infections was 0.45% in males and 0.47% in females, and lower prevalence was found in local residents than in floating population (0.28% vs. 0.66%; χ2 = 10.561, P < 0.05). The highest infection was found in subjects at ages of 31 to 40 years (0.59%), followed by in subjects at ages of 41 to 50 years (0.56%), and the lowest infection was seen in children at ages of 3 to 5 years (0.27%). In addition, the prevalence of human soilborne nematode infections varied significantly in occupation (χ2 = 75.692, P < 0.05), with the highest infection seen in boatmen. Among the 5 078 children monitored, the prevalence of E. vermicularis infection was 0.37%, and the prevalence of E. vermicularis infection varied significantly in year (χ2= 15.466, P < 0.05). Conclusion The human soil-borne nematode infection is at a low level in Danyang City; however, the surveillance of soil-borne nematodiasis remains to be intensified in children living in rural areas and immigrant populations.

Ascaris Lumbricoides: complicaciones cardíacas y resolución quirúrgica de urgencia

Introducción: La parasitosis intestinal por Geohelmintiasis es una de las Enfermedades Infecciosas Desatendidas (OMS), que afecta a poblaciones vulnerables. Existen factores predisponentes como: condiciones precarias de vivienda, bajos ingresos económicos y nivel educativo deficiente. De los helmintos, el Ascaris lumbricoides es el más grande nematodo intestinal en humanos -alcanza hasta 40 centímetros-. La presentación clínica depende del grado de infestación variando desde anemia, astenia, pérdida de peso, hasta invasión interna de órganos blancos como hígado, pulmones, cerebro y corazón en casos extremos. Caso Clínico: Niña de 16 meses de edad, con historia de fiebre prolongada y expulsión espontánea de parásitos por orificio naturales, que llega al servicio de urgencias con síntomas de shock cardiorrespiratorio. Se realiza Ecocardiográfía visualizándose imágenes de cuerpos extraños en forma de cintas y con movimientos espontáneos, compatibles con parásitos de localización cardíaca (2 en aurícula y ventrículo derecho y 1 cabalgando las arterias pulmonares); en el seguimiento ecocardiográfico se constatan múltiples trombos a lo largo del parásito localizado en aurícula derecha y, que dada la gravedad del cuadro se determinó su extracción quirúrgica de urgencia. Se extrajeron 4 parásitos adultos,y, coágulos adherido a uno de ellos. Discusión: El estudio parasitológico y anatomopatológico concluyó que correspondían a hembras adultas de Ascaris lumbricoides. Alta al 8° día post-operatorio en buenas condiciones. Aunque este caso fue exitoso, las complicaciones cardiacas e infecciones sistémicas graves, son de alta morbi-mortalidad, que pueden evitarse con programas de desparasitación y reducción de carga parasitaria mediante mejoras en el saneamiento ambiental y educación sanitaria. A nuestro conocimiento este es el primer caso reportado en el mundo, de extracción de Ascaris Lumbricoides formas adultas del Corazón humano.

Introduction: Geohelminthiasis intestinal parasitosis is one of the neglected Infectious Diseases (WHO) that affects vulnerable populations. Predisposing factors are: poor housing conditions, low economic income and poor educational level. Of the helminths, Ascaris lumbricoides is the largest intestinal nematode in humans - it reaches up to 40 centimeters. The clinical presentation depends on the degree of infestation, which varies from anemia, asthenia, weight loss to internal invasion of organs such as liver, lungs, brain and the heart in severe cases. Case Report: A 16-month-old girl with a history of prolonged fever and spontaneous expulsion of parasites through a natural orifice, arrived at the emergency department with symptoms of cardiorespiratory shock. Echocardiography showed foreign bodies in the form of tapes and with spontaneous movements, compatible with cardiac parasites (2 in the atrium and right ventricle and 1 riding the pulmonary arteries); at echocardiographic follow-up, multiple thrombi were found along the parasite located in the right atrium and, given the severity of the condition, emergency surgical removal was performed 4 adult parasites were removed, with clots adhered to one of them. Discussion: The parasitological and pathological study concluded that the parasites were adult Ascaris lumbricoides females. The patient was discharged on the 8th post-operative day in good condition. Although this case was successful, the cardiac complications and serious systemic infections have a high morbidity and mortality, which can be avoided with deworming programs and reduction of parasite load through improvements in environmental sanitation and health education. To our knowledge, this is the first reported case of Ascaris Lumbricoides adult form extraction from the human heart in the world.

Obstrucción intestinal por ascaris lumbricoides en un niño de 6 años. Reporte de un caso / Intestinal obstruction by ascaris lumbricoides in a 6-years-old child. A case report

Resumen Las sintomatologías de la infección por ascaris lumbricoides es generalmente gastrointestinal y su tratamiento es clínico, sin embargo, la obstrucción intestinal es la forma de presentación más rara y requiere de tratamiento quirúrgico. Se presenta el caso de un paciente de 6 años, con vómito, dolor y distensión abdominal de 48 horas de evolución. La radiografía abdominal mostró niveles hidroaéreos. Se realizó una exploración quirúrgica que encontró un apelotonamiento de parásitos a nivel del íleon. Se describe el manejo terapéutico.

Abstract The symptomatology of Ascaris lumbricoides infection is generally gastrointestinal and the treatment is clinical, however intestinal obstruction is the most rare form of presentation and requires surgical treatment. The case of a 6-year-old patient with vomiting, pain and abdominal distension over 48 hours of evolution is presented. Abdominal radiography showed fluid levels. A surgical exploration was performed which found a package of parasites at the ileum. Therapeutic management is described.

Ascariasis biliar: caso clínico pediátrico reportado en Hospital General Enrique Garcés / Biliary ascariasis: pediatric clinical case reported in Hospital General Enrique Garcés

Áscaris lumbricoides, nemátodo frecuente en la población infantil, relacionado con situaciones socioeconómicas bajas y condiciones higiénicas desfavorables. El ciclo de vida del parasito inicia con la ingesta de huevos embrionados, tras esto desempeña un período hístico-tisular y transalveolocapilar, posteriormente alcanza el intestino delgado como parásito adulto. En ocasiones migra a diferentes sitios causando complicaciones, destacando la migración a vía biliar provocando colecistitis parasitaria. El siguiente caso trata de un adolescente de 12 años 9 meses que consulta por dolor abdominal localizado en epigastrio y cuadrante superior derecho. Es ingresada en el Hospital General Enrique Garcés de la ciudad de Quito, Ecuador donde se evidencia en ecografía la presencia de Áscaris lumbricoides en el interior de la vesícula biliar. Se realiza manejo clínico administrando antihelmíntico. Dos días posterior a su ingreso y culminado el tratamiento se solicita control ecográfico sin evidenciar la presencia del parásito

Ascaris lumbricoides is a frequently nematode in children associated with low socio-economic situations and unfavorable hygienic conditions. The life cycle of the parasite starts with the intake of embryonic eggs, then it plays an hyshc-hssue period and trans-capillary period. Subsequently reaches the bowel intestine as anadult parasite. Sometimes they migrate to different places causing complications, including migration to bile duct causing parasitic cholecystitis. The following case is a boy of 12 years 9 months old consulting for abdominal pain located in epigastrium and right upper quadrant. He was hospitalized in the General Hospital Enrique Garces in the city of Quito ­ Ecuador evidenciating the presence of on Ascaris lumbricoides in the interior of the gallbladder in the ultrasound. Antiprotoozarios were given. Two days after finishing the treatment, we requested a control ultrasound without observing the parasite

Intervenção educacional sobre enteroparasitoses: um estudo quase experimental / Educational intervention on enteroparasitosis: a quasi-experimental study / Intervención educativa sobre enteroparasitosis: un estudio cuasi-experimental

Resumo Introdução As enteroparasitoses vêm ocasionando sérios problemas de saúde pública no mundo, sobretudo nos países em desenvolvimento. Mesmo com a população em geral relatando que tem conhecimento sobre as parasitoses intestinais, estudos apontam que não sabem identificar as verminoses. Objetivo Elaborar, implementar e avaliar um programa educativo sobre parasitoses intestinais em uma escola pública de Ribeirão Preto - SP. Materiais e Métodos Estudo quase experimental, não randomizado realizado com 56 alunos do 1º a 4º ano do ensino fundamental. Para avaliar o conhecimento dos alunos antes e após intervenção educativa, foi aplicado um questionário semiestruturado (Pré e Pós - teste). Resultados Houve mudanças nas respostas dos alunos em relação hábitos de higiene, especialmente nas questões sobre como os vermes se alimentam (p=0,008); o que não fazer para não se contaminar com vermes (p=0,05); qual o formato dos vermes quando é ingerido (p=0,001); quais órgãos os vermes atravessam (p=0,001). Assim, ficou evidente que este tipo de atividade educativa foi eficiente para auxiliar na aprendizagem de alunos do ensino fundamental. Discussão Após a atividade educativa sem notou um crescimento nos acertos para a maioria das questões, contudo ainda houve dificuldades de compreensão sobre os sintomas, o ciclo e quais organismos são vermes. Conclusões Espera-se que este trabalho incentive profissionais da saúde e da educação a incluir práticas educativas sobre saúde no contexto escolar.

Abstract Introduction Enteroparasitosis has been causing serious problems of public health globally, especially in developing countries. Even with the general population reportedly having knowledge about intestinal parasites, studies indicate that they do not know how to identify the verminoses. Objective To elaborate, implement, and evaluate an educational program on intestinal parasites in a public school in Ribeirão Preto - SP. Materials and Methods Quase-experimental, non-randomized study conducted with 56 students from the first to the fourth grades of elementary education. In order to evaluate the students' knowledge before and after the educational intervention, a semi-structured questionnaire was applied (pre- and post-test). Results Changes were evidenced in the students' responses to hygiene habits, especially in questions about how worms feed (p = 0.008); or what not to do to avoid contamination with worms (p = 0.05); what is the form of the worms when ingested (p = 0.001); which organs the worms enter (p = 0.001). Thus, it was evident that this type of educational activity was efficient to help in the learning by elementary school students. Discussion After the educational activity, growth was noted in the correct answers for most of the questions, however, difficulties persisted in understanding about the symptoms, the cycle, and which organisms are worms. Conclusions It is hoped that this work will encourage health and education professionals to include health educational practices in the school context.

Resumen Introducción Las enteroparasitosis ocasionan serios problemas de salud pública en el mundo, sobre todo en los países en desarrollo. Incluso con la población en general relatando que tienen conocimiento sobre las parasitosis intestinales, estudios apuntan que no saben identificar las helmintiasis. Objetivo Elaborar, implementar y evaluar un programa educativo sobre parasitosis intestinales en una escuela pública de Ribeirão Preto - SP. Materiales y Métodos Estudio cuasi-experimental, no aleatorizado realizado con 56 alumnos de 1º al 4º año de enseñanza primaria. Para evaluar el conocimiento de los alumnos antes y después de la intervención educativa, se aplicó un cuestionario semiestructurado (Pre y Post - prueba). Resultados Hubo cambios en las respuestas de los alumnos en relación a hábitos de higiene, especialmente en las preguntas sobre cómo los helmintos se alimentan (p = 0,008); que no hacer para no contaminarse con helmintos (p = 0.05); cual es la forma de los helmintos cuando son ingeridos (p = 0.001); cuales órganos los helmintos atraviesan (p = 0.001). Así, quedó evidente que este tipo de actividad educativa fue eficiente para auxiliar en el aprendizaje de alumnos de la enseñanza primaria. Discusión Después de la actividad educativa se notó un crecimiento en los aciertos para la mayoría de las preguntas, sin embargo todavía hubo dificultades de comprensión sobre los síntomas, el ciclo y cuáles organismos son helmintos. Conclusiones Se espera que este trabajo incentive a profesionales de la salud y la educación a incluir prácticas educativas sobre salud en el contexto escolar.