Question

Can you answer the following:

CASE STUDY South East Asia You are working with a medical group that has donated time and effort to an international health organization. Your group is spending two weeks at a remote part of the Philippine Islands. A child has been admitted to the unit. You were not present upon the admission, nor were you present when report was given concerning the child. The child is in diapers and must be almost 18 months old. The child looks malnourished. The child is not assigned to you, but is in your unit. At 2 AM, a couple of your co-workers go on break and you are alone in the unit. Screams emanate from the child's room. When you walk into the room, you are met with a scene not soon forgotten. On the bed next to the child is a pile of at least 10-15 worms which are about 6-10 inches long, about half the diameter of a pencil, tapered on either end, and light colored. It appears as if these worms were the result of emesis. One worm is exiting a nostril. One worm is curled on top of the head. Worms are crawling out of the diaper. 1. What organism is this? 2. What should you immediately do? 3. What medication had been given? What medication, if any, should be given? 4. How is this disease spread? Give the complete life cycle. 5. What do these worms do to the child? (Explain the disease and the disease process.) 6. What is the prognosis?

Answer 1

Observations & Child is 18 months old. Child looks mal no weished Worms are 6-10 inches long, half the diameter of pencil, tapered on either end, light coloured They have emanated due to emesis Cact of vomiting). 1 One worm exits through nostrils. Worms on the head or crawling out of diaper Diagnosis says - Ascaris lumbricoides are largest and to most common of intestinal helminths and measure 1.5 - 3cm in length. Female worms can be upto 15 inches long. They have pink/white body with tapered ends. They come out in the act of vomiting, They can also migrate to lungs and come out in a cough or nasal cavity Worms being thick as pencil in children with weight loss /mal nutrition. . The child should be taken for body et scan and MRI Cif required after the emesis episode is over. The Child examined for any blockage in ne the body that would be met by surgery.

6 5 ③ then medication should be given for recovery Massaging the bowel to eliminate obstruction of intestine is preferred over incision. o Piperazine citrate solution (75 mg/kg perday) may be given by gastrointestinal tube! Piperazine was administered, which paralyses worms, allowing them to be excreted with intestinal paralysis Later, Meben dazole can be given for 3 days for treatment of asymptomatic and symptomatic infections. 4 How does the disease spread? - Round worms tend to be more common in warm, wet tropical countries. They are common People living in poverty o there is in adequate disposal of human Crops are fertilized with human feces. Children are more likely to be infected after playing in contaminated soil and putting their contaminated hands into their mouth Eating unwashed fruits and vegetables that were grown in contami- -nated soil.

Unfertilized eggs are larger and more clougated in shape, have a thinner shell and are poorly organized internally, being a mass of variably siaed granules. Life-cycle - • Adult stage is reached 8-12 weeks after being ingested by a human host and adults live for approximately a year. ① Adult Ascaris worms live in the lumen of the small bowel. ☺ A female may produce about 200,000 eggs/ daye the eggs are excreted with faces. Unfertilized eggs may be ingested are not in fective. ③. Ihr the environment, fertile eges, depending on the conditions, embryonate and become infective after 18 days to several weeks, optimal conditions are moist , warm shaded soil. Infective eggs are swallowed. 6 In the romall bowel, eggs hatch into larvae. Larwae penetrate the wall of the small bowel and migrate via portal circulation through the liver, then wie the vaystemic circulation to the lungs, where they mature further I (10-14 days) I The larvae penetrate the alveolar walls, ascend the bronchial free to the throat and are -

swallowed. They then retwin to the womall bowel, where they develop into adult worms. Popeatation where is it found - Ascaris lumbricoides is the most common intestinal parasite of humans. It has no known predators or other hosts, A suum is a parasite of pigs. Pathogenesis / How it affects humans - • They migrate through intestinal mucosa, liver and lungs provoke hypersensitivity wreaction in the human host. • Some larwae may be immobilised and covered with eosino- -phils, resulting in the formation of granulomas. • In the linge, movement of the larval from blood Nessels to air space causes haemorrhage • There is oedema of the alveoli. Alveolar sacs are filled with a serous exudate, the peribronchial tissues become infiltrated with eosinophils and neutrophils, mucus production in the bronchi is increa- -sed. known as Loeffler's syndrome. - • Adult Ascaris in intestine induces dis ordered changes in the jejunal mucosa and intestinal mucosal layers / muscle layers on They cause protein energy malnutrition, reducod food intale, intestinal, biliary obstruction and allergic reactions.

Clinical manifestation in Children A younger child may be more likely to have symptoms. this is because there intestines are narrower and the worms have less room symptoms include: - and o Worms in a bowel movement that look like earthworms o Worms coming out of nose and mouth o Stomach pain, coaughing, loss of appetite, fever, wheezing, • Weight loss or failure to grow. If worms block intestines teads to vomiting, Belly (abdomen) that is painful , bloated and hard. the adult worms can be stimulated to migrate under stressful conditions and by anti-helminthic drugs... a Peritonitis ocaurs - secondary to intestinal wall penetration I Common bile duct obstruction resulting in acute obstructive jaundice. I I Heavy worm loade in children leads to acute intestinal obstruction. E

Prognosis - very good prevented once the parasite is eliminated is as long as reinfection can be and transmission avoided Undiagnosed or untreated infections can result in multiple complications. - Complications such as intestinal blockage. - severe infection of lungs may result respiratory failure. - Mild infection of lungs may result in chronic cough - Chronic infections in growing children may lead to growth retardation and malnutrition.