ABSTRACT
En climas templados, yungas (zona intermedia entre valle y trópico) y trópico, prevalecen dos parásitos hematófagos: Necator americanusy Ancylostoma duodenale, responsable de una anemia crónica, que lleva a los niños a tener niveles tan bajos de Hb, que a veces sonconsiderados incompatibles con la vida; rara vez originan sangrado agudo severo.Describimos el caso de un niño, de seis meses de edad, procedente de Coroico (Nor Yungas) con disentería inicial, misma que luego secomplica con melenas y rectorragia de sangre rutilante que origina una hipovolemia severa, rayana en el choque. Sometido a exploraciónquirúrgica por persistencia del sangrado, previo gammagrafía para descartar un divertículo de Meckel, no se halla el sitio de sangradopor lo que se realiza laparotomía exploratoria y posteriormente una endoscopía, identifi cándose en duodeno foco de sangrado originadopor parásitos, que por su morfología se asume que se trate de Necator americanus. Con este diagnóstico, recibe transfusiones para suestabilizar su hipovolemia y Mebendazol, con buena evolución, remisión del sangrado de tubo digestivo, y buena tolerancia a la alimentación.El sangrado agudo por uncinarias, es excepcional, hecho que justifi ca la presentación del caso y permite realizar un recordatorio breve delos mecanismos responsables de ello...
In temperate climate, yungas (intermediate zone between valley and tropical lowland), two blood sucking parasites are prevalent: Necator americanus and Ancylostoma duodenale, responsible for chronic anaemia in children that causes extremely low Hb levels sometimesconsidered as incompatible with life; only in rare cases acute bleeding occurs.We describe the case of a six months old child stemming from Coroico (Nor Yungas) initially with dysentery that becomes complicated by melaena and rectal bleeding originating severe hypovolaemia bordering on shock. After gammagraphy in order to exclude Meckels diverticle, the child was submitted to surgical exploration, where no source of bleeding could be found, therefore an explorative laparotomy was performed and later on an endoscopy, where the source of bleeding was identifi ed in the duodenum as caused by the parasite Necator Americanus. With this diagnose, blood transfusions were administered to the child in order to stabilize the hypovolaemia and Mebendazol was given. The evolution was good, the bleeding stopped and feeding was well tolerated.Acute bleeding caused by hook worms is exceptional; therefore we present this case as a short reminder of the responsible mechanisms.
Subject(s)
Humans , Male , Infant , Hypovolemia/surgery , Hypovolemia/etiology , Hypovolemia/physiopathology , Necator/classification , Necator/growth & development , Necator/parasitologyABSTRACT
Stool surveys in Soong Nern district, Korat Province, were done by the MF concentration technique. The intensity of hookworm infection, egg counts, results of treatment by anthelminthic drugs, observations on new infections and reinfections following treatment throughout the year and the density of nematode larvae in soil in the study area were investigated. Hookworm infection rates were high in Na-Glang village, both in adult villagers and school-aged children. The intensity of hookworm infections was considered mild and after treatment the numbers of eggs in the stools diminished or disappeared. New cases and reinfection increased during the rainy month, due to socio-environmental factors in the village that favoured the development of hookworm larvai in the soil. Although in this study it was impossible to distinguish hookworm larvae among the nematode larvae collected form soil it was highly probable that hookworm larvae were present. Control of hookworm infection in the study area was proposed by improvement of environmental sanitation and health education.