1- Serviço de Pediatria Médica 5.1, Área de Pediatria Médica, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa
2- Unidade de Infecciologia, Área de Pediatria Médica, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa
3- Serviço de Imagiologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa
- The 32nd Annual Meeting of the European Society for Paediatric Infectious Diseases. Dublin, Ireland. 6-10 May, 2014.
- Poster Viewing
Introduction: Ascaris infection is a worldwide helminthic infection, though rare in developed countries. It is usually paucisymptomatic, but extra-intestinal complications may occur. We describe a case of a complicated Ascaris infection in a child from an endemic area.
Case report: An eight-year old healthy female child complained of diffuse abdominal pain for six months. One week before admission, referred progressive right abdominal pain, constipation and vomiting, with no fever or jaundice. She was living in São Tomé e Princípe until four months before. On physical examination an upper right abdominal tenderness was noted. Blood tests showed normocytic normocromic anemia, leucocytes 5.7x10^9/L, eosinophils 15%, C-reactive protein 18,2 mg/L , AST 159 U/L, ALT 154 U/L, gamma-GT 96 U/L, normal levels of bilirubins, serum alkalyne phosphatase and amilase. Abdominal ultrasound observed common bile duct (CBD) wall thickening suggesting cholangitis, biliary sludge and linear hypoechoic tubular structures within the CBD and in the intestinal lumen.
Ascaris lumbricoides ova were observed on stool and for the first five days in the ward, worms were expelled through anus and mouth.
She was treated with albendazole (three days) and, subsequently, with piperazine (two days) with progressive improvement. Household contacts were treated with albendazole.
Conclusion: We intend to illustrate that ascariasis should be suspected in an immigrant child from an endemic area. The migration of larva through the intestinal lumen to the bile ducts, called biliary ascariasis, is rare. Early diagnosis and treatment is important to prevent surgical complications.
Key words: biliary ascariasis; developed countries
Key words: biliary ascariasis; developed countries