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Of the total 480 patients studied, 420 (87.5%) had round worm infestation. 300 patients had moderate to severe round worm infestation and were studied to see the severity of infestation and the results ofantihelminthic drugs. 120 patients hadpresented with varied surgical complication due to ascariasis. Pain abdomen, vomiting and constipation were common modes of presentation. 100 patients had palpable worm masses. Eiosinophilia of more then 6 percent and haemoglobin of less then 10 gm/dl was observed in 15 and 32 patients respectively. Worm masses in plain radiographs were detected in 40 patients ultrasonography findings included worms in gut in 20 patients, signs of obstruction in 16 patients and hepatbbiliary ascariasis in 10 patients. History, clinical examination, laboratory investigation and radio-imaging helped in making the diagnosis. 100 patients were managed conservatively and 20 patients underwent surgery. Bolus obstruction near ileocaecal region was the commonest surgical finding and milking of worms from ileum to caecum was the common surgical procedure adopted. Average duration of hospital stay among surgical group was highly significant statistically (p<.001).
Sonographic examination of the abdomen was performed in 100 patients admitted with features of acute intestinal obstruction caused by ascariasis. In 72 patients sonography of the abdomen was of no help. In 28 patients ascaris lumbricoides were seen in the gut. The sonographic appearance of worms was noted as coiled up masses of worms which were hyperechoic and with out acoustic shadowing and linear hyperechoic shadows of worms in fluid filled bowel. 92 patients were managed conservatively and 8 patients underwent surgery.
A review of forty-five cases of intestinal obstruction caused by round worms is presented.
A Vietnamese refugee was admitted to the hospital with signs and symptoms of an acute condition within the abdomen. Examination ultimately led to the roentgenographic diagnosis of an Ascaris lumbricoides infestation. The patient recovered after medical treatment with intravenous fluids and nasogastric suction, followed by piperazine citrate administration. This ubiquitous parasite has the potential for causing many serious abdominal complications. An awareness of this disease is particularly timely, in view of the recent influx of nearly 150,000 Indo-Chinese into North America.
(Arch Intern Med 136:1044-1045, 1976)
Parasitic pulmonary diseases are mainly present in developing countries. However, their importance is growing worldwide because of their association with AIDS and other states of immunosuppression, human migration, and worldwide travel. This review discusses the parasites that most commonly appear in clinical practice in both normal and immunosuppressed hosts. Toxoplasmosis and strongyloidiasis can induce respiratory failure especially in immunosuppressed patients. Lung involvement because of Plasmodium falciparum develops in 3% to 18% of infected patients and can lead to death if untreated. The presence of severe pulmonary hypertension in patients of endemic regions indicates the possibility of the diagnosis of pulmonary schistosomiasis. Patients with pulmonary amebiasis should undergo further investigation to exclude the presence of amebic pericarditis, which is associated with a 30% mortality rate. The differential diagnosis of pulmonary nodules must include dirofilariasis. Small and lobulated cysts seen on a chest roentgenogram may suggest the diagnosis of pulmonary echinococcosis. The pulmonary cycle of helminthic infestation can induce patchy migratory infiltrates and eosinophilia, defined as Loffler's syndrome. Basic hygiene procedures, the avoidance of undercooked food in endemic regions of paragonimiasis, and specific antimalarial prophylaxis must always be encouraged. In conclusion, a high level of clinical suspicion leading to an early treatment of the parasitic pulmonary diseases can be associated with successful treatment and good prognosis.
The radiographic findings and complications ofAscaris lumbricoides infection of the gastrointestinal tract are presented. Since the clinical symptoms of ascariasis are usually vague or nonspecific, the radiologist may be in a position to play a major role in the proper diagnosis of this disease.
Eosinophilia in travelers may be caused by infections acquired during travels. Infections with helminthic, but not protozoan, parasites are the most likely causes of eosinophilia, although other etiologies may warrant consideration. This article reviews the parasitic and other causes of eosinophilia. Helminthic infections early in their development may elicit the most pronounced eosinophilia yet be difficult to diagnose. Chronic helminthic infections may yield eosinophilia that persists for prolonged periods of time after initial infection.
Since the dawn of recorded time man has had to adapt to an ever-changing and often hostile environment. Not the least of these adaptations has been his struggle through the ages with the innumerable parasites handed down by his animal ancestors. That he has survived and even prospered in the face of such adversities is a tribute to his tenacity and adaptability. Even so, after six thousand years of recorded history and considering the immense strides of mankind in the past century, particularly in the areas of medicine and public health, one's complacency is staggered by the immense toll of human life and suffering still inflicted today by these same ageless parasitic diseases, especially in the tropics.
1.A review of forty-five cases of intestinal obstruction caused by round worms is presented.2.Eosinophilia was present in only one case.3.Initial treatment should be conservative, consisting of nasogastric suction and piperazine given via nasogastric tube, as well as intravenous fluids.4.Surgery should not be delayed if signs and symptoms warrant laparotomy. In this series seven patients underwent surgery, and volvulus of the terminal ileum was the most common finding.5.One death occurred in this series and was attributable to extensive peritonitis secondary to gangrenous ileum twisted about a bolus of ascaris.6.At surgery, if involved bowel is viable, the worms should be milked into the colon. If this cannot be done, enterotomy should be performed and the worms removed.7.Piperazine in recommended dosages should be given early in the postoperative period.
The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Published with practicing clinicians in mind, the journal aims to be easily accessible, organizing its content by topic, both online and in print. www.amjgastro.com, *2007 Journal Citation Report (Thomson Reuters, 2008)
TO THE EDITOR: Adult form nematodes are mainly asymptomatic, and there is very little agreement that they can cause chronic diarrhea. Here we present a case with weight loss and chronic diarrhea for which no reason other than intestinal nematode (ascaris) has been found within a 6-yr period, despite intermittent routine parasitological examinations and our extensive investigations.
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