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Cases
Worm Found in a Diaper
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Background
An anxious father reports that he found a worm in the diaper of his 2-year-old son, who has had diarrhea for 2 days. The boy has no history of fever, irritability, loss of appetite, or blood in the stool. The father states that the family has not traveled recently, but that his sister and her family, including their 3-year-old child, have been visiting from Costa Rica for the past 6 weeks.
The child's vital signs are normal, with no abnormality on lung examination. The abdomen is soft, with no tenderness to palpation. The child generally appears well and has no history of weight loss.
The worm was sent to pathology for identification. What is the diagnosis?
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Scroll
down for Hint and Answer
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***** HINT *****
This nematode is the most common helminth.
***** ANSWER *****
Ascariasis: Ascaris lumbricoides is the cause of the most common helminthic infection worldwide. The infection is transmitted in a fecal-oral manner, primarily from the ingestion of food contaminated with parasite eggs. Ascaris larvae hatch after ingestion and are released into the intestine, from where they migrate to the lungs. After 1-2 weeks, the partially developed larvae ascend the trachea and are reswallowed. They then develop into mature worms and produce eggs that are excreted in the stool. The worms can reach up to 30 cm in length.
This worm is thought to infect approximately 4 million Americans and an estimated 1.4 billion individuals worldwide. As in this case, the most common presentation is the passage of a worm in the stool. Although most infected individuals are asymptomatic, some present with coughing, wheezing, hemoptysis, colicky abdominal pain, or bilious emesis. Life-threatening complications may occur as a result of biliary or complete intestinal obstruction due to a heavy worm burden. Ova and parasites may be found in the stool.
The drugs of choice are oral mebendazole 100 mg administered twice a day for 2 days or oral albendazole 400 mg given once, with another dose given at 3 weeks. Flaccid paralyzing agents, such as piperazine citrate, are preferred when intestinal obstruction is suspected. Pyrantel pamoate, a spastic paralyzing agent, is easier to administer as a single dose, but it increases the risk of intestinal obstruction.
For more information about ascariasis, see the eMedicine articles Ascariasis (within the Pediatrics specialty) and Ascariasis and Nematode Infections (within the Internal Medicine specialty).
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Author:
Peggy Wu, MD
Associate Editor:
John Leung, MD, Northwestern University, Northwestern Memorial Hospital
eMedicine Editor:
Rick Kulkarni, MD, Attending Physician, Department of Emergency Medicine, Olive View - UCLA Medical Center, Assistant Professor of Medicine, David Geffen School of Medicine at UCLA
Source
http://emedicine.com
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