Helminthiasis

Introduction:

Helminthiasis is infestation with one or more intestinal parasitic worms (nematodes and cestodes), which   are commonly associated with poor personal and environmental hygiene and transmitted through contaminated soil.  Infection contributes to anemia, vitamin A deficiency, malnutrition and impaired growth, delayed development, and intestinal blockages.

Clinical features  :

·         Asymptomatic

·          Abdominal pain 

·          Diarrhoea

·         Vomiting 

·         Itchy anus

·         Fatigue  

·         Fever  

·         Cough 

·         Malabsorption 

·         Anaemia

·         Weight loss

Warning sign: Severe anaemia, Generalized oedema, Malabsorption

Complication:

·         Small-bowel obstruction, sometimes complicated by perforation, intussusception, or volvulus. 

·         Biliary colic, cholecystitis, cholangitis,  pancreatitis when large worm can occlude the biliarry tract

Diagnosis:

·         Microscopic examination of feces for eggs or ova of  helminths

·         CBC with PBF—Microcytic  hypochromic  anaemia with eosinophilia

·         In case of complication:  Plain X-ray abdomen , USG of  whole abdomen and   CXR                                                                                                                                               

Treatment:    Drug of choice: ( Any one can be used)

Levamisole, 120 – 150 mg (3 – 4 tablets) P.O. to be taken as a single dose

OR

Albendazole, 400 mg P.O. as a single dose, for children:1 – 2 years, 200 mg as a single dose.

OR

Mebendazole, 100 mg P.O.BID for 3 days

·         Mild iron-deficiency anemia -oral iron .

·          Hypoproteinaemia - nutritional support and oral iron replacement .

·         In case of  acute abdomen   --NPO

                                             --Nasogastric suction,

                                             -- IV antibiotics  ( Ciprofloxacin 200 mg BD)

                                             -- IV Nutrition.

                                             -- If no improvement / deterioration of  condition - Referral

N.B: In pregnancy- Drug of choice- Pyrantel pamoate (11 mg/kg once; maximum, 1 g) . Other drug is contraindicated.

Acute Bloody Dysentery

Introduction

This is a clinical diagnosis based on frequent near-liquid diarrhea flecked with blood, mucus or pus.

Causes

• ·         Shigella
• ·         Campylobacter  jejuni
• ·         Escherichia coli
• ·          Non-typhoid Salmonella
• ·         Entamoeba histolytica
• ·         Non-infectious causes- Ulcerative colitis, clostridium deficile associated diarrhoea (CDAD)

Clinical feature

·         Fever, chill

·         Nausea

·         Body aches, fatigue

·         Abdominal pain or cramping, bloating

·         Fecal incontinence

·         Feeling of incomplete emptying

·         Urgent need to pass stool

·         Vomiting

o    Life threatening feature

·         Confusion and disorientation

·         Difficulty breathing

·         High fever (higher than 101° F)

·         Rapid pulse /  Hypotension

·         Rigid, board-like abdomen

·         Severe abdominal pain

Complication

             Anemia
Dehydration
Hemolytic uremic syndrome or other type of kidney failure
Severe blood loss
Shock

Investigations

·         Stool R/M/E

o    Polymorphoneuclear leucocytosis

o    Trophozoites or cysts of E. histolytica

·         Stool C/S

·         CBC

o    Neutrophilic leucocytosis

·         Blood urea

·         Serum electrolytes

Management

·         General management

o    Rehydration- ORS, if severely dehydrated or vomiting- IV fluid

o    Anti pyretic if required

o    Anti spasmodic if required

o    Don’t use loperamide as this may develop toxic mega colon

·         Specific management

o    Ciprofloxacin 500 mg bid for 3-5 days

o    Metronidazol 400 mg tds for 5 days in case of amoebic dysentery

·         Re-evaluate after 48 hours, if following features appear then refer the patient

o    No improvement

o    Deterioration of patient

Development of complication