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Three common presentations of ascariasis infection in an urban Emergency Department
C C Valentine1, R J Hoffner, S O Henderson
1Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Insights
Ascariasis, a common infection in the US, can present with severe complications in the Emergency Department (ED). Prompt diagnosis and single-dose mebendazole treatment in the ED can effectively manage Ascariasis and prevent hospitalization.
Area of Science:
- Medical Parasitology
- Infectious Diseases
- Emergency Medicine
Background:
- Ascariasis, caused by Ascaris lumbricoides, affects millions annually in the United States.
- Complicated Ascariasis presentations in the Emergency Department (ED) require prompt recognition and management.
- This study reviews ED presentations, diagnostics, and treatments for Ascariasis complications.
Observation:
- A retrospective case review identified three distinct Ascariasis complications: periappendiceal abscess, Loeffler's syndrome, and biliary colic/choledocholithiasis.
- Diagnostic tools utilized included computed tomography, chest X-ray, KUB X-ray, and ultrasonography.
- All identified cases confirmed Ascaris lumbricoides infection via stool ova and parasites testing.
Findings:
- Effective management strategies varied per complication, including abscess drainage, supportive care for pneumonia, and endoscopic retrograde cholangiopancreatography.
- All patients received a 3-day course of mebendazole for Ascaris lumbricoides eradication.
- Symptomatic Ascariasis cases can be successfully treated in the ED, averting hospital admission.
Implications:
- Emergency Departments in the US should be prepared to diagnose and manage Ascariasis complications.
- Utilizing available diagnostic tools aids in identifying the parasitic infection and its sequelae.
- Early, single-dose anthelmintic therapy in the ED is crucial for favorable patient outcomes and resource optimization.
Abstract:
In the United States, approximately 4 million people per year are infected with Ascaris lumbricoides. We reviewed the common presentations of complications of Ascariasis infection in the Emergency Department (ED) and the diagnostic tools and treatment available. This was a retrospective case review conducted on all patients diagnosed with Ascariasis (using ICD-9 codes) over a 6-year period at Los Angeles County and University of Southern California Medical Center. Three patients with distinct complications secondary to Ascariasis were chosen, and all ED and inpatient records were reviewed. The patient's age, sex, race, presenting symptoms, data, outcome, and ED course and diagnosis were recorded. The three cases included a periappendiceal abscess, Loeffler's syndrome, and biliary colic/choledocholithiasis. The first patient underwent a computed tomography-guided drainage of the abscess. The second patient received supportive care and antibiotic therapy secondary to a superimposed bacterial pneumonia. The third patient underwent endoscopic retrograde cholangiopancreatography with sphincterotomy. All three patients had a stool ova and parasites positive for A. lumbricoides, and all received a 3-day course of mebendazole. Symptomatic cases of Ascariasis may present to EDs in the United States. Important diagnostic tools for the ED include chest X-ray, X-ray of the kidney-ureter-bladder and ultrasonography. Single-dose medications given in the ED are very effective in eradicating A. lumbricoides infection, thus avoiding hospitalization.