Abdominal complications of ascariasis in childhood.

OBJECTIVE: Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients. DATA SOURCES: A PubMed search was conducted using the key terms "ascariasis complications" and "hepatobiliary ascariasis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023. SUMMARY OF FINDINGS: Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed. CONCLUSION: The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides.

An Outbreak of Intestinal Obstruction by Ascaridia Galli in Broilers in Minas Gerais

Industrial broilers raised on helminthic medication-free feed were diagnosed with a severe disease caused by Ascaridia galli, characterized by intestinal hemorrhage and obstruction. A. galli was identified based on the morphological features of the nematode. Broilers were raised for a longer period (63 days) for weight recovery, grouped as stunted (n=500), had low body score and had fetid diarrhea. The duodenum-jejunum segment was the most severely affected with obstruction and had localized accumulation of gas. The intestinal mucosa was severely congested with petechial and suffusive hemorrhages. The outbreak resulted in morbidity of about 10% and mortality of up to 4% and was associated to the absence of preventive medication on feed and slack biosecurity. The reemergence of A. galli is discussed in view of the alternative poultry management and raising conditions for drug free and welfare.

An Outbreak of Intestinal Obstruction by Ascaridia Galli in Broilers in Minas Gerais

Industrial broilers raised on helminthic medication-free feed were diagnosed with a severe disease caused by Ascaridia galli, characterized by intestinal hemorrhage and obstruction. A. galli was identified based on the morphological features of the nematode. Broilers were raised for a longer period (63 days) for weight recovery, grouped as stunted (n=500), had low body score and had fetid diarrhea. The duodenum-jejunum segment was the most severely affected with obstruction and had localized accumulation of gas. The intestinal mucosa was severely congested with petechial and suffusive hemorrhages. The outbreak resulted in morbidity of about 10% and mortality of up to 4% and was associated to the absence of preventive medication on feed and slack biosecurity. The reemergence of A. galli is discussed in view of the alternative poultry management and raising conditions for drug free and welfare.(AU)

Obstrucción intestinal por Ascaris lumbricoides en un adulto mayor / Intestinal obstruction due to Ascaris lumbricoides infection in a geriatric patient

Ascaris lumbricoides is considered the largest intestinal nematode with a higher incidence in the childhood, representing a truly medical and public health problem, principally in undeveloped countries. We present the case of an 83 year old man, born and coming from the amazon region, without any relevant previous history of disease, admitted in the emergency department of our hospital for presenting intestinal obstruction and also presumptive biliary obstruction due to multiple balls of parasites, requiring immediate surgical intervention. We emphasize the need of consider this etiologic possibility in the differential diagnosis, that in this particular case, wasn't suspected in the first place.

Ascaris lumbricoides es considerado el nemátodo intestinal de mayor tamaño. Se presenta con mayor frecuencia en la infancia, representando un verdadero problema médico y de salud pública, especialmente en países en vías de desarrollo. Presentamos el caso de un varón de 83 años, natural y procedente de la región amazónica del Perú, sin antecedentes médicos de relevancia, que ingresa a Servicio de urgencias de nuestro hospital por un cuadro de obstrucción intestinal y presunta obstrucción biliar, requiriendo una intervención quirúrgica inmediata. El diagnóstico final de obstrucción intestinal por la presencia de múltiples ovillos de Ascaris lumbricoides, no fue considerado dentro de los diagnósticos diferenciales previo al acto quirúrgico.

[Intestinal obstruction due to Ascaris lumbricoides infection in a geriatric patient]. / Obstrucción intestinal por Ascaris lumbricoides en un adulto mayor.

Ascaris lumbricoides is considered the largest intestinal nematode with a higher incidence in the childhood, representing a truly medical and public health problem, principally in undeveloped countries. We present the case of an 83 year old man, born and coming from the amazon region, without any relevant previous history of disease, admitted in the emergency department of our hospital for presenting intestinal obstruction and also presumptive biliary obstruction due to multiple balls of parasites, requiring immediate surgical intervention. We emphasize the need of consider this etiologic possibility in the differential diagnosis, that in this particular case, wasn't suspected in the first place.

Successful treatment of lipoid pneumonia associated with bowel obstruction by Ascaris lumbricoides.

Partial bowel obstruction is a serious complication of ascariasis infestation generally treated with mineral oil. This prospective study aimed to evaluate the efficacy of multiple bronchoalveolar lavages (BAL) as a therapeutic strategy for reducing lung inflammation of lipoid pneumonia associated with ascariasis. The study included five children (mean age 25 months) with partial small-bowel obstruction by Ascaris lumbricoides, who underwent diagnostic bronchoalveolar lavage for assessment of refractory pneumonia. Routine biochemical, microbiological and cytological analysis were carried out in the BAL. Protein, lactate dehydrogenase and tumor necrosis factor-alpha (TNF-α) cytokine levels were determined in the serum before and after treatment. At admission, children consistently had respiratory symptoms, altered hematological function, increased immunoglobulin E serum level and peripheral blood eosinophilia. Chest tomography showed consolidation with air bronchogram (4/4), ground-glass infiltration (3/4) and decreased attenuation in the consolidation areas (2/4). Presence of marked pleocytosis with Sudan positive foamy alveolar macrophages, high protein and lactate dehydrogenase levels in the BAL indicated presence of mixed alveolitis. One child with extensive consolidation and air bronchogram in both lungs died before treatment. Multiple bronchoalveolar lavages efficiently removed alveolar oil deposits, restored BAL cellularity, improved clinical symptoms, radiological parameters and further reduced inflammatory reaction evidenced by marked decrease of the inflammatory cytokine, TNF-α. This study presents a therapeutic strategy for management of lung complications caused by mineral oil administration to treat intestinal bowel obstruction associated with ascariasis.

Surgical diagnosis and management of intestinal obstruction due to Ascaris lumbricoides.

BACKGROUND: Ascariasis continues to be one of the most important parasitic diseases in terms of its burden and complications in children in the developing world. METHODS: Case report and literature review (Medline, SCI, and LILACS). RESULTS: We report herein a case in which a Paraguayan infant presented with one of these complications: An intestinal obstruction due to Ascaris lumbricoides being diagnosed during surgery. The patient was managed with a conservative protocol for the extraction of the parasites using liquid petrolatum administered through a nasogastric tube followed with extensive water irrigation through the tube, in conjunction with the administration of piperazine as antiparasitic treatment. CONCLUSIONS: This case, as with others reported previously, shows that this complication can be managed successfully without major intestinal surgery. Early recognition of this condition, based on local prevalence, can prevent serious surgical complications, morbidity, and mortality associated with intestinal obstruction due to A. lumbricoides.

[Ascaris lumbricoides-caused risk factors for intestinal occlusion and subocclusion]. / Factores de riesgo para oclusión y suboclusión intestinal por Ascaris lumbricoides.

OBJECTIVES: Our objective was to determine risk factors and mortality for partial and complete bowel obstruction caused by Ascaris lumbricoides as well as diagnostic validity of eosinophilia in peripheral blood. MATERIAL AND METHODS: We studied 50 patients with partial or complete bowel obstruction and expulsion of Ascaris lumbricoides by mouth or anus, as well as 50 patients as controls; no patient had a negative coproparasitoscopic study. The period of study was from January 1995-December 2001 at the General Hospital of Ciudad Valles, San Luis Potosí State, Mexico. RESULTS: Cases with partial bowel obstruction had average age of 3.1 years against 10.13 years for those with complete obstruction (p = 0.029). Females accounted for 55% and males 43%, respectively. We do not find a relationship among nutritional status, gestational order in the family, and place of excreta deposition in this study group. In the case of eosinophilia, best point of section found was three or more eosinophils with sensitivity of 34% but specificity of 100%; mortality was 2%. CONCLUSIONS: We do not find a statistical difference between partial and complete bowel obstruction for different variables studied with the exception of age. To find 3% or more of eosinophils in peripheral blood strongly suggests the etiology of the obstruction as Ascaris lumbricoides at prevalence sites of this parasite.

[Anthelmintics as a risk factor in intestinal obstruction by Ascaris lumbricoides in children]. / Antihelmínticos como factor de riesgo en la obstrucción intestinal por Ascaris lumbricoides en niños.

In a retrospective study the authors analyzed the clinical records of 199 children ages one month to 16 years hospitalized, with the diagnosis of intestinal ascariasis, in the Instituto Nacional de Pediatria of Mexico from 1984 to 1999. The purpose of the study was to evaluate the use of anthelmintics drugs as a risk factor of intestinal obstruction by A. lumbricoides. Two groups were made for the study: Group A (n = 66) of children who presented intestinal obstruction, Group B (n = 133) children with no complications. A comparative analysis of clinical data of both groups was made by means of chi square with Yates correction and a stratified analysis by means of chi square. Possible confusing elements were overcrowding, age and the use of antiparasitic drugs. The calculus of risk factors for intestinal obstruction by A. lumbricoides was done by means of contingency tables of 2 x 2 and odds ratio with an IC of 95%. The significant risk factors were included in a model of logistics regression with an impact variable consting in the presence or absence of intestinal obstruction in order to establish a multivariate model of predictive risk at level of significance of p < 0.05. Twenty-seven patients (40.90%) in group A (n = 66) were given anthelmintics medications prior to the intestinal obstruction: mebendazol, 14 (51-85%); two, albedazol (7.4%); eight, a non-specified anthelmintic (29.6%). In addition, an anthelmintic medication without a specified time of ingestion: two with mebendazol and one with piperazine (11.3%). In the case of mebendazol, the drug most frequently associated with intestinal obstruction, seven patients received it on the same day of the obstruction; five patients received it between one and seven days prior to the obstruction; two received it seven days prior to the complication. In the control group, only 7% had taken the anthelmintic one to seven days before the diagnosis of uncomplicated intestinal ascariasis diagnosis was made. With the step by step (Backward) logistic regression conditioned by the treatment variable with an anthelmintic, an X2 = 38.15 gl, p < 0.000 was obtained for which reason it was considered by A. lumbricoides. Of the probable risk factors analyzed in this study, the only one capable of influencing and predicting the presentation of intestinal obstruction by A. lumbricoides in children, was the prior anthelmintic treatment particularly with mebendazol.

[Intestinal obstruction caused by ascaris in pregnancy. Report of a case]. / Obstrucción intestinal por áscaris y embarazo. Presentación de un caso.

A pregnant woman may be infected up to a 90% by intestine parasites, and it all depends on the geographical area associated to the environmental factors allowing this to be spread. The abdominal obstruction related to the pregnancy is rare due to the fact that it only happens in one out of 2,500-6,000 pregnancies. This occlusion, when given by Ascaris lumbricoides, is even more complicated due to the lack of medical literature reference, and thus being unable to make any comparisons. A 45-year old pregnant woman, with several births and multi-pregnancies presenting an acute abdomen by intestinal obstruction through out this helmint. She was pacticed an exploratory laparotomy with the evacuation of several ascaris throughout and enterostomy, and then during the 37th week, she gave birth by means of an eutocic labor work to a healthy female product weighting 2.825 kgs. The anatomopathology study of the placenta shows no alterations. The nosology of the intestinal obstruction by ascariasis during the pregnancy, and out of it, are very similar and could only be affected by late diagnosis of the pregnant woman due to anatomical and physiological changes, increasing the mother's and the fetus morbi-mortality. In Mexico, there are endemic areas where it would be convenient to identify the characteristical eggs in the mother's stool due to the fact that if an advanced pathology is not put in place, it does produce states of maternal malnutrition, anaemia, abdominal pain and low weigh product at the moments of its birth.