AlcantaraCanalijaMendoza

PangcatanPantinople

OBJECTIVES At the end of the exercise, the student be able toapply the knowledge learned in the diagnosis and management of Ascariasis;explain the transmission of Ascariasis; and list down some measures to prevent the disease.

CASE

HISTORY OF PRESENT ILLNESSThis is a case of a 5-year-old male, child, residing in Brgy. Santiago, Iligan City, complaining of colicky abdominal pain for 2 days.The pt. was in in his usual state of health until 2 days ago, when malaise, anorexia, and mild, colicky, RLQ pain began. The symptom intensified during the last 24 hrs. He now feels feverish and vomited 2x with a large worm, and his pain in moderately severe. No shaking chill, no diarrhea, dysuria, or hematuria has occurred. Persistence of the pain prompted the pt. to consult he doctor.

PERSONAL AND SOCIAL HISTORYThe patient is the 6th among 8 siblings. He lives with his family in a small house with only one room near the dumping site of garbage materials.

Water source is from deep well within the area. He is fond of playing with his brothers in the nearby mountain of soil and garbage

LEGEND:♂♀

Patient

PHYSICAL EXAMINATIONWt: 10kgs T= 38 ?C PR= 80bpm RR= 24cpmPertinent findings include:HEENT: Pale conjuctivaeLungs: Minimal wheezes in right lower lung fieldAbdomen: Abdomen is slightly distended, normal bowel sounds, with direct tenderness on both right and lower quadrant. No palpable mass, liver and spleen are not palpable.Rectal: Stool light yellow and soft, no blood.

LABORATORY EXAMINATIONBLOOD:• Hct-35%• Hgb-90mg/dL• WBC-10,000• Neutophils-65%• Lymphocytes-22%• Monocytes-3%• Eusinophils-10%

URINALYSIS (normal)

FECALYSIS (positive for ascaris ova)

MEDICAL DIAGNOSIS

Intestinal Ascariasis

ETIOLOGY & EPIDEMIOLOGYAscaris lumbricoidesEtiology of the dse.Romans referred it as Lumbricus teres - common earthwormmost common of among helminthsFlourishes in warm, moist climates or in moist, temperate regions

EMBRYONATED

EGGS

DISEASE

INFECTI

ON

ETIOLOGIC AGENTAscaris lumbricoides

Ingestion of embryonated egg through contaminated food or waterMigration of larvae: Little damage is caused by the penetration Some larvae migrate to ectopic sites and dependent upon number and location, cause various inflammatory responses, leading to very severe allergic reactions Spleen, liver, lymph nodes and brain Transplacental migration can also occur

TRANSMISSION & PATHOLOGY

TRANSMISSION & PATHOLOGYIn the lungs:Worms destroy capillaries in the lungs, causing hemorrhage Heavy infections can lead to pools of blood which block air sacs Migration of white blood cells lead to more congestion; a condition known as Ascaris pneumonitis Loeffler's pneumonia Lung tissue destroyed and bacterial infections occur, may be fatal

How the worms cause Pathology ? Normal worm activities - Rob the host ofnutrients Overcrowding leads to wandering Females wander in search of males If worms migrate to stomach, acid irritates

them leading to nausea, abdominal pain,restlessness and allergic reactions Penetration of the intestine or appendix can lead to peritonitis w/c is often fatal Aspiration of a vomited worm can result

in death If worms migrate to lungs, they can cause extensive damage and possible death

DIAGNOSTIC TESTConcentration method

and Direct Fecal Smear:

Kato-katz

TREATMENT & PROGNOSISAlbendazole

A single oral dose of 400 mg Mebenazole 100 mg orally twice daily for 3 days Piperazine Pyrantel pamoate Ivermectin Levamisole

NURSING CAREChildren and adults must be provided with clean, comfortable toilets. Children must be taught to use them for each defecation.Wash hands after defecation and before feeding.Careful washing of toy, raw vegetables.All infected persons must receive treatment.In hospital, teach mother about:• Careful disposal of stools.• Hygienic care and preventive measurs.• Avoid overdosage of Piperazine citrate may cause irritation to intestinal mucosa).• Provide with calm environment and adequate diet.

PREVENTIONGood hygiene is the best preventive measure Avoid contacting soil that may be contaminated with human feces Wash hands w/ soap & water before handling food When traveling to areas where sanitation & hygiene are poor, avoid water/food that may be contaminated Wash, peel or cook all raw vegetables and fruits before eating

Dispose of diapers properly Prevention of reinfection poses a substantial problem since this parasite is abundant in soil Good sanitation is needed to prevent fecal contamination of soil

THANK YOU!!!