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.

A Case of Gastroenteritis Associated with Gastric Trichuriasis

A rare human case of gastroenteritis and eosinophilic ascites associated with gastric trichuriasis is described. The patient was a 32-yr-old woman who was working in a farm near Pohang, Korea. She complained of abdominal pain, diarrhea, and vomiting. Endoscopic examination found focal linear hyperemia on the mucosa of the stomach antrum, and endoscopic biopsy confirmed eosinophilic inflammation of the mucosa and submucosa of the stomach, terminal ileum, and cecum. The biopsy specimen of the stomach included a female Trichuris trichiura which was covered by many inflammatory cells on its surface. Ascites and intestinal wall thickening was found by CT scan, and Douglas pouch centesis aspirated bloody ascites which included many eosinophils. She was medicated with prednisolone and albendazole and cured. She is the first case of eosinophilic inflammation of the gastrointestinal tract and ascites associated with trichuriasis in the stomach.

Tricocefalosis masiva en un adulto diagnosticada por colonoscopía / Massive trichuriasis in an adult diagnosed by colonoscopy

A case of massive trichuriasis in a 37 year old female from a rural locality of the Metropolitan Region of Chile, with antecedentes of alcoholism, chronic hepatic damage and portal cavernomatosis, is presented. Since 12 year ago she has had geophagia. In the las six months she has frequently presented liquid diarrhea, colic abdominal pains, tenesmus and sensation of abdminal distention. Clinical and laboratory test confirmed her hepatic affection associated with a celiac disease with anemia and hypereosinophilia. Within a week diarrhea became worse and dysentery appeared. A colonoscopy revealed and impressive and massive trichuriasis. The patient was succesfully treated with two cures of 200 mg tablets of mebendazole twice daily for three days with a week interval. After the first cure she evacuated a big amount of tricuris trichiura, fecal evacuations became normal, geophagia disappeared and recovered 4 kg of body weight

Intestinal geohelminthiasis and growth in pre-adolescent primary school children in Northeastern Peninsular Malaysia.

A cohort of one hundred 8-9 year old school children in Northeastern Peninsular Malaysia underwent stool examination, weight and height measurements. Seventy-three children were infected with Ascaris lumbricoides and/or Trichuris trichiura. All infected children were treated with albendazole at baseline, 6 months and 9 months. Measurements were repeated on all but 2 children at 1 year. Repeat stool examination (n = 94) at 1 year revealed a marked reduction in the level of Ascaris infection and a modest reduction in Trichuris infection. There was no difference in net growth between treated children and uninfected controls. Post-hoc analysis by gender however revealed that infected girls (n = 33) experienced significantly higher increments in weight, height and weight for age. Furthermore, children found to be infected at baseline level but worm free at follow-up, were observed to have experienced greater increments in height and height for age. The evidence suggests that periodic antihelminthic treatment may have a positive effect on the growth of subsets of pre-adolescent children but it is emphasised that further work is required to validate these findings.

Ascaris and Trichuris do not contribute to growth retardation in primary school children.

To access the effectiveness of the treatment of soil-transmitted helminthiasis (STH) on the growth of primary school children, 353 children were block stratified to receive either mebendazole plus pyrantel oxantel pamoate every three months or a placebo. The children were followed for two years with 89% completing the trial. Follow-up stools indicated that the treatment was efficacious for ascariasis and trichuriasis. There was virtually no hookworm infection. The children were malnourished as measured by the number below -2 SD of height and weight standards. There was no difference in height or weight between the treatment and control groups by sex initially or at the end of two years of follow-up. The treatment of Ascaris and Trichuris had no effect on growth parameters. The effect of STH on growth may be mediated through hookworm infections.

Retroalimentacion biologica y cirugia en el tratamiento de la incontinencia fecal con lesion del esfinter anal externo: seguimento a largo plazo / Biofeedback and surgery in the treatment of fecal incontinence and lesion of the external anal sphincter: long-term follow-up

INTRODUCCION: En niños, el traumatismo de la región anal que afecta tanto al esfínter anal externo como al esfínter anal interno es un grave problema. La retroalimentación biológica no es efectiva si hay destrucción del esfínter anal externo, y la restitución de la morfologia con cirugía tampoco cura la incontinencia. CASO CLINICO: Niña de 6 años 8 meses de edad, que desde los 2 años sufrió tricocefalosis masiva recurrente; condicionándole prolapso rectal, abscesos y fístulas perianales, fistulectomías, y finalmente destrucción de la región perianal, con incontinencia total. Previa manometría rectoanal, y determinación de receptores rectales, se efectuó retroalimentación biológica antes y después de la transposición del músculo gracilis y colostomía. a los 12 meses se obtuvo continencia total, que aún persiste a 7 años de seguimiento. CONCLUSIONES: En la incontinencia fecal con destrucción del esfínter anal externo, y alteración fisiológica del esfínter anal interno, se debe efectuar: manometria y determinación de receptores rectales, reconstrucción del esfínter anal externo con transposición del músculo gracilis, y retroalimentación biológica

Manifestaciones clínicas en niños con asociación exclusiva de geohelmintos: Ascaris lumbricoides y Trichuris trichiura / Clinical manifestations in children with exclusive association of geohelminths: Ascaris lumbricoides and Trichuris trichiura

Se estudiaron 75 pacientes en forma retrospectiva con ascariasis, tricocefalosís y con asociación de ambos helmintos, en forma pura. Hubo 25 pacientes para cada parasitosis, demostrada con exámenes CPS (Faust), y cuantificados con CPS por el método de Stoll. Se realizó biometría hemática para investigar la presencia o ausencia de anemia y/o eosinofilia. Los grupos de edad más afectados fueron los preescolares con el 57% y los escolares con el 30.6%. No hubo diferencia con respecto al sexo. Los casos masivos se asociaron más al sexo masculino. La ascariasis fue la que presentó mayor frecuencia de estos mismos con un 29.3%. La anemia predominó en los casos con tricocefalosis (24%) y la asociación de ambos parásitos, 32%. La eosinofilia se presentó con igual frecuencia en la ascariasis (32%) y en la tricocefalosis (36%) pero fue mayor en los casos con asociación de ambos parásitos: 60%. Los síntomas más frecuentes en la asociación de ambos helmintos fueron dolor abdominal 52%; hiporexia, geofagia y palidez 32%; flatulencia y expulsión de helmintos 24%. Desde el punto de vista clínico no es posible hacer el diagnóstico de asociación de A. lumbricoides y T. trichiura, debido a que la sintomatología no es característica, ya que ésta se puede encontrar en otros padecimientos. Por lo tanto, es necesario realizar exámenes CPS para hacer el diagnóstico certero de dicha asociación