Thanks to Dr. Bradby for today’s Morning Report!
Parasitic Worms
Ascariasis – large intestinal roundworm
– 807- 1,221 million people in the world are infected with Ascaris lumbricoides
– live in the intestines, eggs passed in the feces of infected persons
– eggs get ingested into GI tract, larvae hatch in the intestine, burrow through the gut wall into the blood system, break into alveoli, then get coughed up and swallowed again, where then they live in the intestine and mature into adult worms.
– transmitted via fecal-oral route (think: feces used as fertilizer)
Signs and Symptoms
– Often asymptomatic
– When symptomatic it is usually one of the following things:
– heavy infections causing intestinal blockage & growth impairment
– cough due to migration of worm through the body
– pneumonitis, enlargement of liver or spleen, peritonitis, inflammation
Treatment
– Albendazole 400mg PO x 1 dose (contraindicated in pregnancy and age <2y)
– Mebendazole 100mg PO q12h x 3 days
– Pyrantel pamoate 11mg/kg (up to max of 1g) PO daily x 3 days
Hookworm
Hookworm
– 576-740 million people worldwide infected
– Once very prevalent in the SE region of the US, but decreased now with improvement in living conditions
– 2 species infect humans: Ancylostoma duodenale and Necator americanus
Transmission: through the skin (walking barefoot in soil contaminated with fecal matter) -> migrate through vascular system to the lungs -> coughed up and swallowed -> live in the intestines
Signs and Symptoms
– Usually patients are symptomatic
– Cutaneous larvae migrans: creeping skin eruption – serpiginous vesicles
– Severe or prolonged cases may cause:
– GI symptoms: N/V/D, epigastric pain, indigestion, constipation
– Coughing, Chest Pain, Wheezing, Fever – large numbers of larvae
– Advanced symptoms: anemia, cardiac failure, abdominal distension with ascites, emaciation
– Morbidity caused by: intestinal blood loss, iron def anemia, and malnutrition
Treatment – same as for ascariasis
Jay Khadpe MD
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