A Parasitic Journey

Le résumé fourni par la source

Introduction: A 42-year-old male presented with a 4-week history epigastric abdominal pain and intermittent non-bloody, non-bilious vomiting. History was notable for travel to Peru 2 months prior. Physical exam was remarkable for midepigastric tenderness. Laboratory results revealed a mild leukocytosis (12.82 K/uL ) with an eosinophil count of 1.02 K/uL. Computed tomography (CT) of the abdomen without contrast was suspicious for obstruction at the proximal to mid-jejunum, thought to be secondary to post-operative adhesions or an inflammatory process. At endoscopy, within the second portion of the duodenum, a long, white, actively moving parasite was seen and retrieved with a Roth net. Capsule endoscopy was performed the next day, and did not reveal any additional parasites. Pathology confirmed the diagnosis of Ascaris lumbricoides. The patient was treated with 400 mg of albendazole, and it was suggested that his family also undergo treatment. More than 1 billion people are infected with Ascaris lumbricoides, and tropical countries have the highest prevalence. The ability to recognize the symptoms associated with parasitic infection is crucial, and timely diagnosis may prevent further complications. In general, the burden of worms correlates with the progression of symptoms. Children tend to develop worm clusters, and their status can shift rapidly towards complications such as sepsis. Adults may present with acute non-specific symptoms that progress to more complicated sequelae, even with only a single adult worm. Suspicion of parasitic enteritis warrants immediate CT of the abdomen with and without contrast to assess for obstruction or hepato-pancreato biliary involvement. Depending on the degree of obstruction or worm burden, endoscopy and laparascopy may be warranted. A thorough history of a patient’s travels and water or food handling can be a tremendous aide in the diagnosis of this type of infection. This case underscores the importance of obtaining a travel history in the setting of nonspecific gastrointestinal symptoms.

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