Ascariasis case studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Imtiaz Ahmed Wani, M.B.B.S

Case #1

Clinical Summary

Shortly after arriving home after two years in Peru with the Peace Corps this 27-year-old female presented to the emergency room with a fever of 103.5°, anterior cervical lymphadenopathy, and pharyngitis. A rapid Strep test was positive and she was treated with penicillin.

Two days later she returned to the emergency room with abdominal distension, paroxysmal periumbilical pain, and repeated emesis. On examination, there was diffuse abdominal tenderness and bowel sounds were hyperactive and high-pitched. The WBC count was unremarkable except for a 12% eosinophilia. An upright film of the abdomen revealed dilated loops of small bowel with air fluid levels and the absence of colonic gas. Surgical exploration confirmed the presumptive diagnosis of small bowel obstruction and identified a tangled mass of approximately 50 adult Ascaris lumbricoides worms as the cause.

One-week post surgery, stool examination revealed the continued presence of Ascaris ova, as well as cysts of Entamoeba histolytica and Giardia lamblia. The patient was treated with appropriate anthelmintics and made a complete recovery.

Histopathological Findings

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

This is a photograph of an adult ascarid like the ones removed from the small bowel of this patient.

This is a photograph of an autopsy specimen from another case of ascariasis. The adult ascarid (arrow) can be seen in the section of small bowel from this patient.

This is a high-power photomicrograph of a fecal specimen from this patient showing an ascarid egg (arrow).

This is a higher-power photomicrograph of another ascarid egg.

This high-power photomicrograph of the fecal specimen from this same patient shows an Entamoeba histolytica cyst (arrow).

This high-power photomicrograph of the fecal specimen from this patient shows a Giardia lamblia trophozoite. Note the two nuclei and the tapered end (that goes out of the plane of focus) containing flagella (arrow).

This high-power photomicrograph of the fecal specimen from this patient shows a Giardia lamblia cyst (arrow).

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