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.

Short Term Outcome of Therapeutic ERCP in the Management of Biliary Ascariasis in a Tertiary Care Hospital of Bangladesh.

The history of ascariasis is very old. It is endemic in various parts of Bangladesh. Hepatobiliary ascariasis is a well-known complication of the intestinal ascariasis. Although cosmopolitan, it predominantly affects people in Asia, Africa, and South America. This was a prospective observational study conducted from July to December 2014 to explore the short term outcome of therapeutic ERCP in the treatment of biliary ascariasis in a tertiary care hospital of Bangladesh. A total of 60 cases of biliary ascariasis were selected conveniently in this study. Data were collected by face-to-face interviews and observation with the help of data sheet. Data were checked for quality control and analyzed by computer using SPSS software. The mean±SD age of the patients was 30.96±7.66 years. All the patients were aged between 17 and 55 years and predominantly affect women in the 3rd and 4th decades. The most common presentation was upper abdominal pain in 47(83.32%) of the patients. Ultrasound was the diagnostic tool of choice, where biliary ascariasis was found in 40(66.7%) of patients. ERCP is reserved mainly for therapeutic purposes and found successful in 57(95%) of the patients.

Prevalence of Ascaris lumbricoides in contaminated faecal samples of children residing in urban areas of Lahore, Pakistan.

Ascariasis is a common public health problem of preschool and primary school children in developing countries like Pakistan. The aim of the present study was to determine the prevalence and pattern of Ascaris lumbericoides (A. lumbricoides) infection among children residing in urban areas of Lahore, to provide information on ascariasis to promote awareness and prevention programs between the participants specially on the months or season of higher prevalence. To investigate the prevalence of Ascaris Lumbricoides in the contaminated faecal samples of children residing in urban areas of Lahore, a study was conducted from November 2010 to October 2012 and we collected 3600 stratified faecal samples from six urban study areas. Overall 32/3600 (0.88%) prevalence of fecal samples was found positive for eggs of Ascaris lumbricoides. Area wise highest presence positivity 1.67% was observed in Allama Iqbal Town followed by 1.17% in Samanabad, 1.00% in Wapda Town, 1.00% in Gulberg, 0.50% in Cantt, and the lowest 0.00% in Valencia Town respectively (p < 0.001) The highest month wise positivity prevalence 3/300 (3.33%) (p < 0.001) was observed in the month of September that gradually declined up to 0/300 (0.00%) in the month of March. The results reveal that urban areas of Lahore are susceptible to Ascaris Lubricoides infection and the highest prevalence were observed autumn on the month of September.

Ascaridiosis en la vía biliar intrahepática: a propósito de un caso pediátrico / Ascariasis in the intrahepatic biliary duct: about a case in pediatrics

El 25 % de la población mundial se encuentra infectada por Ascaris lumbricoides. La ascaridiosis hepatobiliar ocurre en zonas con alta endemicidad y gran carga parasitaria, y genera desde intensa inflamación hasta fibrosis. Se presenta a un paciente de 2 años, que consultó por distensión abdominal y tos de 1 mes de evolución asociada a fiebre en las últimas 72 h. Se realizó una ecografía abdominal que evidenció áscaris en la vía biliar, en el estómago y en el intestino delgado, y una radiografía de tórax con infiltrado inflamatorio intersticial, asociado a hiperleucocitosis con hipereosinofilia y gamma-glutamiltranspeptidasa elevada. Se administró un tratamiento antibiótico, antihelmíntico, sin lograr la eliminación de los parásitos de la vía biliar, por lo que se requirió su extracción mediante colangiografía percutánea

Twenty five percent of the world population is affected by Ascaris lumbricoides. Hepatobiliary ascariasis occurs in areas with high endemicity and great amount of parasitic load, generating intense inflammation to fibrosis. We report a two-year-old patient that consults about abdominal distension and cough of one month of evolution associated with 72 hours of fever. Abdominal ultrasound is performed, which shows bile duct, stomach, small intestine with ascaris and chest x-ray with interstitial inflammatory infiltrate, associated with hyperleukocytosis with hypereosinophilia and elevated gamma-glutamyl transpeptidase. Antibiotic, anthelminthic treatment is administered, without achieving the elimination of the bile duct parasites, requiring their removal by percutaneous cholangiography.

[Ascariasis in the intrahepatic biliary duct: about a case in pediatrics]. / Ascaridiosis en la vía biliar intrahepática: a propósito de un caso pediátrico.

Twenty five percent of the world population is affected by Ascaris lumbricoides. Hepatobiliary ascariasis occurs in areas with high endemicity and great amount of parasitic load, generating intense inflammation to fibrosis. We report a twoyear- old patient that consults about abdominal distension and cough of one month of evolution associated with 72 hours of fever. Abdominal ultrasound is performed, which shows bile duct, stomach, small intestine with ascaris and chest x-ray with interstitial inflammatory infiltrate, associated with hyperleukocytosis with hypereosinophilia and elevated gamma-glutamyl transpeptidase. Antibiotic, anthelminthic treatment is administered, without achieving the elimination of the bile duct parasites, requiring their removal by percutaneous cholangiography.

El 25 % de la población mundial se encuentra infectada por Ascaris lumbricoides. La ascaridiosis hepatobiliar ocurre en zonas con alta endemicidad y gran carga parasitaria, y genera desde intensa inflamación hasta fibrosis. Se presenta a un paciente de 2 años, que consultó por distensión abdominal y tos de 1 mes de evolución asociada a fiebre en las últimas 72 h. Se realizó una ecografía abdominal que evidenció áscaris en la vía biliar, en el estómago y en el intestino delgado, y una radiografía de tórax con infiltrado inflamatorio intersticial, asociado a hiperleucocitosis con hipereosinofilia y gammaglutamiltranspeptidasa elevada. Se administró un tratamiento antibiótico, antihelmíntico, sin lograr la eliminación de los parásitos de la vía biliar, por lo que se requirió su extracción mediante colangiografía percutánea.

Understanding Heterogeneity in the Impact of National Neglected Tropical Disease Control Programmes: Evidence from School-Based Deworming in Kenya.

BACKGROUND: The implementation of soil-transmitted helminth (STH) treatment programmes occurs in varied environmental, social and economic contexts. Programme impact will be influenced by factors that affect the reduction in the prevalence and intensity of infections following treatment, as well as the subsequent rate of reinfection. To better understand the heterogeneity of programme impact and its underlying reasons, we investigated the influence of contextual factors on reduction in STH infection as part of the national school based deworming (SBD) programme in Kenya. MATERIALS AND METHODS: Data on the prevalence and intensity of infection were collected within the monitoring and evaluation component of the SBD programme at baseline and after delivery of two annual treatment rounds in 153 schools in western Kenya. Using a framework that considers STH epidemiology and transmission dynamics, capacity to deliver treatment, operational feasibility and financial capacity, data were assembled at both school and district (county) levels. Geographic heterogeneity of programme impact was assessed by descriptive and spatial analyses. Factors associated with absolute reductions of Ascaris lumbricoides and hookworm infection prevalence and intensity were identified using mixed effects linear regression modelling adjusting for baseline infection levels. PRINCIPAL FINDINGS: The reduction in prevalence and intensity of A. lumbricoides and hookworms varied significantly by county and within counties by school. Multivariable analysis of factors associated with programme impact showed that absolute A. lumbricoides reductions varied by environmental conditions and access to improved sanitation at schools or within the community. Larger reduction in prevalence and intensity of hookworms were found in schools located within areas with higher community level access to improved sanitation and within counties with higher economic and health service delivery indicator scores. CONCLUSIONS: The study identifies factors associated with the impact of school-based deworming and in particular highlights how access to water, sanitation and hygiene and environmental conditions influence the impact of deworming programmes.

Wandering biliary ascariasis with hepatic abscess in a postmenopausal woman.

Hepatobiliary ascariasis is common in developing countries where there is a low standard of public health and hygiene. We are reporting a rare case of ascariasis which induced multiple liver abscesses in a post menopausal woman who presented with fever, anorexia, nausea, vomiting and mild hepatomegaly. Ultrasonography revealed biliary ascariasis with multiple hepatic abscesses. Laparoscopic drainage of hepatic abscesses was done and microscopic examination of drainage materials showed decorticated eggs of Ascaris Lumbricoides. The post operative recovery of the patient was uneventful. Ultrasonography is a reliable modality to diagnose and follow up of such cases.

Ascaris lumbricoides: complicaciones graves en niños hospitalizados en el Centro Hospitalario Pereira Rossell / Ascaris lumbricoides: serious complications in children hospitalized in the Centro Hospitalario Pereira Rossell

La infección por Ascaris lumbricoides (AL) es una geohelmintiasis que constituye un problema de salud pública, especialmente en niños con vulnerabilidad socio económica y ambiental. La carencia de saneamiento y agua potable, el hacinamiento, la precariedad de la vivienda y las malas condiciones de higiene constituyen los principales factores de riesgo. El impacto de esta enfermedad en Uruguay no está claramente definido. La existencia de casos graves de infección por AL sugiere la presencia de zonas de alta prevalencia. El objetivo de esta comunicación es alertar sobre la presencia de complicaciones y formas graves de esta enteroparasitosis. Se revisaron los aspectos patogénicos y modalidades de evaluación y tratamiento. Se incluyeron siete niños hospitalizados entre el 1 de enero de 2007 y el 31 de mayo de 2012, edad mínima 18 meses y máxima 59 meses. Todos habitaban viviendas precarias, de las cuales cinco carecían de saneamiento y cuatro de baño interno. Las complicaciones asociadas fueron: abscesos múltiples pulmonares y hepáticos, síndrome suboclusivo, oclusión intestinal, síndrome de Loffler, peritonitis biliar por perforación del conducto hepático común y colangitis. Los síntomas abdominales fueron los más frecuentes. La media de la estadía hospitalaria fue 11 días. Ingresaron a Unidad de cuidado intensivo cuatro niños, dos requirieron alimentación parenteral y dos apoyo ventilatorio. En todos los casos se realizaron estudios imagenológicos. Requirieron tratamiento quirúrgico tres niños. Todos sobrevivieron. Esta enfermedad es un “marcador de pobreza” y se relaciona directamente con las condiciones de vida de la población. Fortalecer las medidas de promoción y prevención contribuye al control de esta enfermedad. Erradicar el problema exige políticas dirigidas a superar las condiciones de exclusión social, identificando zonas de riesgo con intervenciones intersectoriales.

Parasitic infestations requiring surgical interventions.

Parasitic infestation is common in developing countries especially in Africa. Children are often more vulnerable to these infections. Many health problems result from these infestations, including malnutrition, iron-deficiency anemia, surgical morbidities, and even impaired cognitive function and educational achievement. Surgical intervention may be needed to treat serious complications caused by some of these parasites. Amoebic colitis and liver abscess caused by protozoan infections; intestinal obstruction, biliary infestation with cholangitis and liver abscess, and pancreatitis caused by Ascaris lumbricoides; biliary obstruction caused by Faschiola; hepatic and pulmonary hydatid cysts caused by Echinococcus granulosus and multilocularis are examples. Expenditure of medical care of affected children may cause a great burden on many African governments, which are already suffering from economic instability. The clinical presentation, investigation, and management of some parasitic infestations of surgical relevance in African children are discussed in this article.