Ascariasis pneumonitis: a potentially fatal complication in smoke inhalation injury

Ascaris pneumonitis in areas of endemic infestation is considered a benign condition. Smoke inhalation with any burn injury can be potentially fatal. A heavy infestation of Ascaris could further exacerbate the smoke-induced lung injury. After ingested eggs hatch in the small intestine, the larvae penetrate the mucosa and invade the blood stream and are then carried to the lungs. The larvae break out into the aveolar spaces as they are too large to cross the capillary bed and are carried up the bronchial tree and eventually swallowed. This study describes three cases of Ascaris infection in thermally injured children. While the burns were < 30 per cent total body surface area, two patients who were injured in the same fire had a further complication of smoke inhalation which necessitated sophisticated therapy in order to promote survival. All patients were treated initially with Vermox. The one patient without smoke inhalation did not develop ascariasis pneumonitis even with positive stool samples and was discharged with no complications, whereas the two with smoke inhalation developed severe pneumonitis. One patient was placed on ECMO and did not receive a full course of the Vermox treatment. This patient died after several weeks of ECMO treatment. The third patient received a full course of Vermox, slowly recovered, and went home. Supportive therapy only is recommended during the lung migration phase of the Ascaris lifecycle. We feel that continuation of chemotherapy (Vermox) would have been beneficial in the fatal case based on the survival of the second patient.(ABSTRACT TRUNCATED AT 250 WORDS)