Ascariasis, trichuriasis and fatal non-transfusion

Blood transfusion for chronic anemia can lead to acute or decompensated heart failure in patients who have fluid overload as part of their compensatory response and/or have intrinsic heart disease, and then it could be fatal in such clinical scenarios. This is the report of a case of profound chronic anemia in a young male patient, who was not transfused and then developed confusion followed by terminal cardiopulmonary arrest. Autopsy revealed severe trichuriasis to be the cause of the anemia, along with severe ascariasis, but minimal intrinsic brain disease. This supports the conclusion that anemia was the cause of the confusion, and the lesson that confusion may be a sign that the benefit of blood transfusion outweighs the risk in a patient with severe chronic anemia.

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)

Ascaris lumbricoides coinfection reduces tissue damage by decreasing IL-6 levels without altering clinical evolution of pulmonary tuberculosis or Th1/Th2/Th17 cytokine profile

Abstract INTRODUCTION: Immunological control of Mycobacterium tuberculosis infection is dependent on the cellular immune response, mediated predominantly by Th1 type CD4+ T cells. Polarization of the immune response to Th2 can inhibit the host immune protection against pathogens. Patients with tuberculosis coinfected with helminths demonstrate more severe pulmonary symptoms, a deficiency in the immune response against tuberculosis, and an impaired response to anti-tuberculosis therapy. METHODS: We evaluated the cellular immune response and the impact of the presence of Ascaris lumbricoides on the immune and clinical response in pulmonary tuberculosis patients. Ninety-one individuals were included in the study: 38 tuberculosis patients, 11 tuberculosis patients coinfected with Ascaris lumbricoides and other helminths, 10 Ascaris lumbricoides patients, and 34 non-infected control individuals. Clinical evolution of pulmonary tuberculosis was studied on 0, 30, 60, and 90 days post-diagnosis of Mycobacterium tuberculosis and Ascaris lumbricoides. Furthermore, immune cells and plasma cytokine profiles were examined in mono/coinfection by Mycobacterium tuberculosis and Ascaris lumbricoides using flow cytometry. RESULTS: There were no statistical differences in any of the evaluated parameters and the results indicated that Ascaris lumbricoides infection does not lead to significant clinical repercussions in the presentation and evolution of pulmonary tuberculosis. CONCLUSIONS: The association with Ascaris lumbricoides did not influence the Th1, Th2, and Th17 type responses, or the proportions of T lymphocyte subpopulations. However, higher serum levels of IL-6 in tuberculosis patients may explain the pulmonary parenchymal damage.

Eritema nudoso asociado a parasitismo por Ascaris lumbricoides. Presentación de caso / Nudose erythema associated to Ascaris lumbricoides parasitism: Cases presentation

Introducción: El Eritema nudoso es una paniculitis, de relativa frecuencia, que se expresa como manifestación de trastornos internos de gran envergadura, como las enfermedades del tejido conectivo, las enfermedades infecciosas y el cáncer. Es por ello, que los pacientes que lo presenten, deben ser estudiados cuidadosamente en busca de la causa. Objetivo: Presentar un caso clínico de Eritema nudoso resaltando el diagnóstico de la causa parasitaria y su tratamiento. Presentación de Caso: Se muestra el caso de una paciente femenina de 29 años, de raza blanca, residente en un municipio rural (Jatibonico), profesora de escuela primaria, sin antecedentes patológicos, quien acude a consulta por eritema elevado muy doloroso en la superficie anterior de ambos miembros inferiores, malestar general y artralgias. Se le diagnosticó clínicamente un eritema nudoso, y durante varios meses se realizaron complementarios para establecer la posible causa; se encontró solo un parasitismo intestinal por Ascaris lumbricoides. Recibió tratamiento médico con antiparasitarios, y desapareció el eritema. Conclusiones: El diagnóstico clínico certero, más la búsqueda constante de la causa del eritema nudoso y el tratamiento del parasitismo encontrado, llevaron a la solución del problema de la paciente. El eritema nudoso siempre debe ser estudiado por la posibilidad de ser un síndrome reactivo a procesos grave(AU)

Introduction: Nudose erythema is a panniculitis, of relative frequency, that it is expressed like a manifestation of internal disorders of great significance, like the illnesses of the connective tissue, the infectious diseases and the cancer. So the patients that show it, must be studied carefully in search of the cause. Objective: To Present a nudose erythema clinic case highlighting the diagnose of parasitical cause. Cases presentation: Is show the case of a white female patient, 29 years old, resident at rural municipality (Jatibonico), elementary school teacher, without pathological past health history, that assist at the consult for nodular due to a high very painful erythema on the anticus surface of both inferior members, general discomfort and arthralgia. Was clinically diagnosed a nudose erythema, and during several months were performed complementary to establish the possible cause, finding only an intestinal parasitism for Ascaris lumbricoides. He received medical treatment with antiparasitcs, disappearing the erythema. Conclusions: The accurate diagnostic, furthermore, a constantly cause searching of the cause of the nudose erythema plus the treatment of parasitism found, solve the patients problem. Nudose erythema always must be studied due to the possibility to be a reactive syndrome of seriously ill process(AU)

Obstrucción intestinal por Ascaris lumbricoides en un adulto mayor / Intestinal obstruction due to Ascaris lumbricoides infection in a geriatric patient

Ascaris lumbricoides is considered the largest intestinal nematode with a higher incidence in the childhood, representing a truly medical and public health problem, principally in undeveloped countries. We present the case of an 83 year old man, born and coming from the amazon region, without any relevant previous history of disease, admitted in the emergency department of our hospital for presenting intestinal obstruction and also presumptive biliary obstruction due to multiple balls of parasites, requiring immediate surgical intervention. We emphasize the need of consider this etiologic possibility in the differential diagnosis, that in this particular case, wasn't suspected in the first place.

Ascaris lumbricoides es considerado el nemátodo intestinal de mayor tamaño. Se presenta con mayor frecuencia en la infancia, representando un verdadero problema médico y de salud pública, especialmente en países en vías de desarrollo. Presentamos el caso de un varón de 83 años, natural y procedente de la región amazónica del Perú, sin antecedentes médicos de relevancia, que ingresa a Servicio de urgencias de nuestro hospital por un cuadro de obstrucción intestinal y presunta obstrucción biliar, requiriendo una intervención quirúrgica inmediata. El diagnóstico final de obstrucción intestinal por la presencia de múltiples ovillos de Ascaris lumbricoides, no fue considerado dentro de los diagnósticos diferenciales previo al acto quirúrgico.

Ascaris lumbricoides: una causa de pancreatitis aguda / Acute pancreatitis due to Ascaris lumbricoides

La ascariasis es una infección parasitaria causada por un helminto de distribución global, con más de 1.4 billones de personas infectadas en el mundo. La mayoría de estas infecciones ocurren en países en vías de desarrollo de América latina y Asia. El helminto usualmente se aloja en el intestino delgado en forma silente pero puede causar obstrucción intestinal o peritonitis perforativa, siendo más común en la niñez. A su vez, puede migrar a través de la ampolla de Vater y producir pancreatitis, colecistitis, colangitis y, en forma menos frecuente, absceso hepático. El objetivo de nuestra comunicación es notificar un caso de pancreatitis aguda secundaria a Ascaris lumbricoides, siendo ésta una complicación infrecuente pero grave de una enfermedad endémica como la ascariasis.

Ascariasis is a helminthic infection of global distribution with more than 1.4 billion persons infected throughout the world. The majority of infections occur in the developing countries of Latin America and Asia. This helminth usually lives harmlessly in small intestine but can also cause intestinal obstruction or perforation peritonitis that is common in childhood. Ascaris can also migrate through ampulla of Vater to produce pancreatitis, cholecystitis, cholangitis and, rarely, hepatic abscess. The main goal of this article is to present a case of an acute pancreatitis due to Ascaris lumbricoides, an uncommon but severe complication of an endemic disease such as ascariasis.

Ascaris lumbricoides: complicaciones graves en niños hospitalizados en el Centro Hospitalario Pereira Rossell / Ascaris lumbricoides: serious complications in children hospitalized in the Centro Hospitalario Pereira Rossell

La infección por Ascaris lumbricoides (AL) es una geohelmintiasis que constituye un problema de salud pública, especialmente en niños con vulnerabilidad socio económica y ambiental. La carencia de saneamiento y agua potable, el hacinamiento, la precariedad de la vivienda y las malas condiciones de higiene constituyen los principales factores de riesgo. El impacto de esta enfermedad en Uruguay no está claramente definido. La existencia de casos graves de infección por AL sugiere la presencia de zonas de alta prevalencia. El objetivo de esta comunicación es alertar sobre la presencia de complicaciones y formas graves de esta enteroparasitosis. Se revisaron los aspectos patogénicos y modalidades de evaluación y tratamiento. Se incluyeron siete niños hospitalizados entre el 1 de enero de 2007 y el 31 de mayo de 2012, edad mínima 18 meses y máxima 59 meses. Todos habitaban viviendas precarias, de las cuales cinco carecían de saneamiento y cuatro de baño interno. Las complicaciones asociadas fueron: abscesos múltiples pulmonares y hepáticos, síndrome suboclusivo, oclusión intestinal, síndrome de Loffler, peritonitis biliar por perforación del conducto hepático común y colangitis. Los síntomas abdominales fueron los más frecuentes. La media de la estadía hospitalaria fue 11 días. Ingresaron a Unidad de cuidado intensivo cuatro niños, dos requirieron alimentación parenteral y dos apoyo ventilatorio. En todos los casos se realizaron estudios imagenológicos. Requirieron tratamiento quirúrgico tres niños. Todos sobrevivieron. Esta enfermedad es un “marcador de pobreza” y se relaciona directamente con las condiciones de vida de la población. Fortalecer las medidas de promoción y prevención contribuye al control de esta enfermedad. Erradicar el problema exige políticas dirigidas a superar las condiciones de exclusión social, identificando zonas de riesgo con intervenciones intersectoriales.

Ascariasis vesicular: reporte de un caso / Gallbladder ascariasis: case report

We report a case of a young patient who was admitted for study and management of severe hypocalcemia. During evolution of the condition the patient presents abdominal pain (biliary colic) related to the presence of Ascaris lumbricoides in the gallbladder, responding to conservative medical therapy.

Reportamos un caso de un paciente joven que ingresó para estudio y manejo de una hipocalcemia grave. Durante su evolución el paciente presentó dolor abdominal (cólico vesicular) relacionado con la presencia de un ejemplar de Ascaris lumbricoides en la vesícula biliar, que respondió a terapia médica conservadora.

Severity of atopic dermatitis and Ascaris lumbricoides infection: an evaluation of CCR4+ and CXCR3+ helper T cell frequency / Gravidade da dermatite atópica e infecção por Ascaris lumbricoides: uma avaliação da frequência de células T auxiliares CCR4+ e CXCR3+

INTRODUCTION: Ascaris lumbricoides-infected patients present lower prevalence of severe atopic dermatitis. METHODS: Peripheral blood of infected children with atopic dermatitis was assessed by flow cytometry of the frequency of Th1 and Th2 cells through the expression of CXCR3 and CCR4 chemokine receptors, respectively. RESULTS: Helminth-free patients with atopic dermatitis presented a high frequency of CCR4+Th2 cells. Parasitized patients with atopic dermatitis showed a lower frequency of CXCR3+Th1 cells compared to infected individuals only. CONCLUSIONS: Ascariasis modifies the blood traffic of Th2 cells in atopic dermatitis patients, while the allergic disease down-regulates the traffic of Th1 cells in parasitized patients.

INTRODUÇÃO: Pacientes infectados com Ascaris lumbricoides apresentam menor prevalência de dermatite atópica grave. MÉTODOS: Sangue periférico de crianças infectadas com dermatite atópica foi analisado por citometria de fluxo quanto à frequência de células Th1 e Th2 pela expressão de receptores de quimiocina CXCR3 e CCR4, respectivamente. RESULTADOS: Pacientes sem helmintos com dermatite atópica apresentaram alta frequência de células Th2CCR4+. Pacientes parasitados com dermatite atópica apresentaram menor frequência de células Th1CXCR3+ comparados aos indivíduos apenas infectados. CONCLUSÕES: Ascaridiases altera o tráfego sanguíneo de células Th2 em pacientes com dermatite atópica, enquanto a doença alérgica diminui o tráfego de células Th1 em pacientes parasitados.

Áscaris lumbricoides en el corazón de una gestante / Presence of Ascaris lumbricoides in the heart of a pregnant woman

El áscaris es el nematodo de mayor tamaño que parasita al hombre; es un helminto dioico (sexos separados). Su prevalencia se debe fundamentalmente a la contaminación fecal del suelo y a la capacidad de supervivencia de los huevos. Los adultos de áscaris lumbricoides se localizan en el intestino delgado, aunque algunas veces puede haber migraciones erráticas de parásitos adultos a lugares como el hígado, peritoneo, riñones, etc. Describir la forma de presentación del parasitismo intestinal por áscaris lumbricoides en una embarazada, actualizar e informar sobre el parasitismo intestinal, mostrar la experiencia en el manejo de un caso de difícil diagnóstico y transmitir conocimientos, contribuir a la docencia médica, son los objetivos de esta presentación. Se realizó una revisión bibliográfica sobre el parasitismo intestinal, específicamente del áscaris lumbricoides partiendo de la existencia de un caso obstétrico portadora de manifestaciones cardiovasculares importantes y de difícil manejo, por lo que se revisó exhaustivamente la historia clínica de dicha paciente en los 2 hospitales en los cuales estuvo ingresada. Paciente portadora de una gestación de 12 sem que acude con manifestaciones respiratorias y cardiovasculares, la primera impresión diagnóstica fue de una miocarditis o miocardiopatías, después de concluir estudios pertinentes se concluye como portadora de áscaris lumbricoides en corazón derecho y además se complica con un tromboembolismo pulmonar. A pesar de ser infrecuente en nuestros días, debemos pensar en el parasitismo como una explicación a ciertas sintomatologías de extraña presentación clínica

The ascaris is the higher nematode to parasitizes the man; it is dioecious helminths (having separate sexes). Its prevalence is due mainly to soil fecal contamination and to survival ability of eggs. The adult Ascaris lumbricoides are located in the small bowel, although some times may be erratic migrations of adult parasites to places like the liver, peritoneum, kidneys, etc. The aim of present paper is to describe the presentation way of intestinal parasitism by Ascaris lumbricoides in a pregnant woman, to update and to inform on the intestinal parasitism, to show the experience in the management of a case of difficult diagnosis and to transmit the knowledges, and to contribute to medical teaching. A bibliographic review on the intestinal parasitism was made, specifically of Ascaris lumbricoides from the existence of a obstetric case carrier of significant cardiovascular manifestations and of a difficult management, thus we made an exhaustive review of medical record of this patient in the two hospitals where she was admitted. A patient with 12 weeks pregnancy to come to consultation due to respiratory and cardiovascular manifestations, the first diagnostic impression was a myocarditis or myocardiopathies. After conclude the pertinent studies she is classified as a Ascaris lumbricoides carrier in right heart and that also it is complicated with a pulmonary thromboembolism. Despite this condition is infrequent nowadays, we must to think about the parasitism like an explanation for some symptomatology of a rare clinical presentation

Utilização da jejunostomia para extração endoscópica de Ascaris lumbricoides da via biliar principal em paciente com doença de Caroli / Use of visiting jejunostomy loopfor extracting Ascaris lumbricoides in the common bile ducts in patients with Caroli diseases

Grumbach-Auvert disease represents a type of Obstructive Disease of the Intrahepatic Biliary Tree. We presents a case report of a patient with hepatic abscess caused by Ascaris which ascended into hepatic parenquima through hepaticojejunostomy, resolved by endoscopic extraction of it after the jejunostomy of permanent access was opened.

Host immune response to Toxoplasma gondii and Ascaris lumbricoides in a highly endemic area: evidence of parasite co-immunomodulation properties influencing the outcome of both infections

Toxoplasmosis and ascaridiasis evoke polar Th-1 and Th-2 host immune responses, respectively. A study to investigate the specific cytokine profile production by in vitro cultures of peripheral blood mononuclear cells from individuals living under precarious sanitary conditions in a highly endemic area for the parasites Toxoplasma gondii and Ascaris lumbricoides was conducted. High levels of both IFN-³ (Th-1) and IL-13 (Th-2) were observed in groups of co-infected individuals presenting toxoplasmic ocular lesions. Significantly lower IL-10 and TGF-² levels were produced by co-infected individuals in comparison with groups of individuals not infected with A. lumbricoides and either positive or negative for T. gondii living under good sanitary conditions (control groups). The possible influence of co-parasitism on the clinical presentation of ocular toxoplasmosis is discussed.

Biliary ascariasis in the indian subcontinent: a study of 42 cases

History of ascariasis is known to stretch back many centuries. One quarter of the world's population is known to be infected by ascariasis. It is endemic in various parts of the Indian subcontinent and the gangetic plain of West Bengal is one of them. We aimed to study the various types of clinical presentations, complications and different diagnostic tools and to assess various options for the management of biliary ascariasis. Forty-two cases of hepatobiliary ascariasis were studied over a period of 3 years. All the patients were adults aged between 20 and 50 years and all but two were admitted with acute upper abdominal pain. In this study, biliary ascariasis was found to be more common in females, 73.8% [31 patients]. The most common presentation was upper abdominal pain in 95.2% of the patients [40 patients]. Complications observed were obstructive jaundice in 28.56% [12 patients], cholangitis in 16.7% [seven patients], acute pancreatitis in 2.4% [one patient] and hepatic abscess in 2.4% [one patient]. History of worm emesis was present in 38.1% [16 patients]. History of previous cholecystectomy was present in 16.7% [seven patients] and endoscopic sphincterotomy in 4.8% [two patients]. Ultrasound was the diagnostic tool of choice with 100% results. Conservative management was successful in 83.3% [35 patients]. During follow-up, worm reinvasion of the biliary system occurred in 7.1% [three patients]. In endemic countries, ascariasis should be suspected in patients with biliary disease, especially if a cholecystectomy or sphincterotomy has been performed in the past. Most of the patients respond to conservative management

Acute eosinophilic pneumonia due to round worm infestation.

We report a case of an 18 month old child who presented with sever eosinophilic pneumonia requiring ventilation as a result of round worm infestation. This child presented with symptoms alike acute severe asthma and had high absolute eosinophil count of 9,234/cmm.A course of steroids, albendazole and diethylcarbazine were followed by rapid recovery and a decrease in eosinophil counts to 616/cmm within one month of treatment. This is the first reported case of a child with severe eosinophilic pneumonia requiring ventilation as a result of roundworm infection.

Demographic and biochemical features associated to children infected with intestinal helminths

The objective of the study was to characterize demographic and clinical presentations of children with intestinal helminthiasis and also assess the effects of ascariasis on some plasma biochemical parameters. It was a cross-sectional community-based study carried out amongst rural children aged between 0-16 years. One stool sample per child was collected and examined microscopically for parasites. Stool smear positive children were studied and evaluated for clinical signs and symptoms. Blood was obtained from them and total protein, serum albumin, packed cell volume, vitamin C and E were determined in them as well as among children with stool parasite negative which served as controls. A total of 239 children were enrolled and had their stool samples collected, 147[61.5%] of the stool were infected. The most prevalent intestinal helminth was Ascaris lumbricoides 105[43.9%], Trichuris trichuria 28[11.7%] and Hookworm 14[5.9%]. The commonest complain among the children was diarrhea 40[27.2%] and the least vomiting 4[2.7%]. The commonest clinical finding was pallor 15[10.2%] and the least wheezing 3[2.0%]. Biochemically, the plasma total protein, albumin, Vitamin C and E as well as the PCV were significantly reduced in children with moderate and heavy Ascaris infection than controls. Heavy and moderate ascariasis are associated with various morbidities evident by both clinical and biochemical findings. Our findings should re-emphasize the need for all stakeholders to support and implement community-based control programmes of intestinal helminthiasis in Nigeria and other tropical countries

Conservative treatment for round worm intestinal obstruction.

OBJECTIVE: The ascariasis is one of the most cosmopolitan intestinal parasite infections and it can be in inhospitable regions inhabited by human being, but its biggest prevalence is observed in the tropical and subtropical areas. Intestinal obstruction has been estimated to occur in 2 per 1000 ascaris-infected children per year. We are presenting a study emphasizing the conservative treatment for complete intestinal obstruction due to roundworms without sign and symptom of peritonitis and perforation. METHODS: A total of 22 patients of roundworm obstruction partial or complete without signs of and symptoms of peritonitis were admitted in the Department of Pediatric Surgery IMS, BHU Varanasi India in the period form 2003-2005. Patients were put nil by mouth, intravenous fluid, antibiotics, piperazine salt through nasogastric tube and glycerine + liquid paraffin emulsion enemas and were evaluated for duration of hospital stay, rate of conversion to surgical treatment and complications. RESULTS: 19 (86%) patients were treated successfully with conservative line of management. Only 3 patients required surgical intervention. No mortality, complication and mean hospital stay was 4.1 days (range 4-5 days). CONCLUSION: Round worm intestinal obstruction can be effectively treated by conservative line of management.

Enclavamiento de Ascaris lumbricoides en vía biliar: presentación de un caso / Bolts of ascaris lumbricoides in via biliary: presentation of a case

La ascariasis es una parasitosis cosmopolita, frecuente en la población infantil a nivel mundial, dado que no requiere factores climáticos o ambientales especiales. Ingresa al organismo por ingesta de huevos, cumpliendo un ciclo hístico-tisular trans-alveolocapilar en su desarrollo para retomar al yeyuno como parásito adulto, etapa en la cual tiene una movilidad exagerada cuando se altera la homeostasis (sobre todo fiebre en los niños), pudiendo migrar a diferentes sitios originando diversas complicaciones entre las que destaca la migración a vía biliar y su enclavamiento. Presentamos el caso de una escolar de 8 años de edad, procedente de Beni, que consulta por dolor abdominal severisimo en flanco derecho de diez días de evolución, irradiado a epigastrio. Se interna en el Hospital de San Borja y al no ser controlado el cuadro, es remitido al Hospital del Niño de la ciudad de La Paz , donde se encuentran dos Ascaris móviles en interior de vesícula y colédoco en la ecografía. Se administra pamoato de pirantel, sin disminución inicial del dolor, mismo que por su intensidad, tiempo de evolución, se decide programarla para cirugía; ante ls atenuación del dolor se solicita control ecográfico en el que se evidencia la salida espontánea de los parásitos, por lo que se continua con una conducta conservadora, con buena evaluación.

The Ascaris is a cosmopolitan parasite, frequent in children inthe whole world, since it does not need any special climatic orenvironmental factors for its growth and development.It enters the organism by intake of eggs, completing a histicaltissuetransalveolar capillary cycle in its development returning tothe jejunum as adult parasite. In this stage it has an exaggeratedmobility when the homoeostasis is altered (principally fever inchildren), being able to migrate to different locations causing diversecomplications, among which the migration to bilious conducts standsout with the ascaris´ enclosure.We present the case of an 8 year-old school boy, who came from theBeni with extremely severe abdominal pain on the right side with anevolution of 10 days and irradiation to the epigastrium. The boy hadbeen admitted to the hospital of San Borja, and since his problemwas not solved, he was transferred to the Hospital del Niño in la Paz,where two mobile ascaris were found inside the gall bladder and thecholedoco in the echography. Pamoato of pirantel was administered,without initial decrease of the pain. Due to the intensity, and the timeof evolution of the pain, surgery was considered. When the pain wasattenuated an echographic control was made that showed thespontaneous exit of the parasites. For this reason, the conservativetreatment was continued with a positive evolution.