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  1. Thessicar E. Antoine-Reid, Ph.D. Vanderbilt University Medical Center THE UNEXPECTED DIAPER DISCOVERY
  2. Patient History • A previously healthy 2 year old boy from Central America presents to the Emergency Department with abdominal pain, diarrhea, non-bloody emesis (vomiting), fever, and seizure. • Prior to admission the toddler was noted to have a 3-month history of fatigue and chronic cough. Infectious Disease was consulted within 24 hours of admission.
  3. Differential Diagnosis Pediatric Infectious Disease team at VUMC suspected community acquired pneumonia was the primary cause of infiltrates due to the chronic cough the toddler was experiencing.
  4. Laboratory Results • Blood cultures: Negative • Respiratory Pathogen Panel: Negative • Hepatitis B surface Ag & Ab: Negative • Hepatitis B core Ab: Negative • Hepatitis C : Negative • HIV Ag/Ab : Negative • Trypanosoma cruzi IgG and IgM: Negative • Rocky Mountain Spotted Fever IgG and IgM: Negative • Ehrlichia PCR CSF & Serum: Negative • Quantiferon: Negative • Histoplasma Ag & Ab: Negative • Meningitis panel: Negative
  5. During a routine diaper inspection at afternoon rounds, a resident came across an interesting finding that was immediately sent over to the VUMC laboratory. “How to Know if Your Baby Is Developing Normally” by wikiHow is licensed under CC BY-ND 3.0, Desaturated from original.
  6. An ova and parasite was ordered on the stool specimen and a macroscopic identification was performed on the submitted roundworm. Photo Credit: Thessicar E. Antoine-Reid, Ph.D.
  7. Stool Examination • Ova and Parasites (O&P) are the most common procedure performed in the Parasitology Laboratory. • During this procedure stool is examined for the egg stages and other morphologic forms of parasites. • Macroscopic and microscopic examination are the two general components associated with an O&P. • As in all laboratory testing, the quality of the result is dependent on the collection of the specimen. • The general turn-around-time is 24hr.
  8. Macroscopic Stool Examination Consistency Hard, soft, mushy, loose, watery, formed and semiformed Color Dark brown, black, pale brown, clay, yellow, red-brown, green Gross Abnormalities Adult worms, proglottids, pus, and mucus Photo Credit:
  9. Common Nematodes Found in the Intestines Intestinal Species Enterobius vermicularis Trichuris trichiura Ascaris lumbricoides Necator americanus Ancylostoma duodenale Strongyloides stercoralis Intestinal-Tissue Species Trichinella spiralis Dracunculus medinensis
  10. Egg Stages of Common Nematodes Intestines Photo Credit: Centers for Disease Control and Prevention
  11. Macroscopic Examination Summary Specimen Stool Consistency Non-formed Identification Ascaris lumbricoides Common Name Roundworm of Man Measurement 10 inches Patient Travel History Recent relocation to TN from Honduras Photo Credit: Thessicar E. Antoine-Reid, Ph.D.
  12. Photo Credit: Centers for Disease Control and Prevention
  13. Additional Information on Ascaris lumbricoides
  14. Ascariasis is the most common human helminthic infection globally. The burden is highest in tropical and subtropical regions in climates are moist and warm, and in areas with inadequate sanitation. Geographic Distribution Approximately 1 billion people are affected worldwide. It ranks second in frequency in the United States, with the highest incidences in the Appalachian Mountains. Humans and swine are the major host of Ascaris. Children who place their contaminated hands into their mouths are at the highest risk. Ingestion of vegetables from infected soil can place individuals at risk. Epidemiology Risk Factors
  15. Albendazole and mebendazole are the drugs of choice. Ascaris is generally, treated for 1-3 days and has very few side effects. Poor personal hygiene, poor sanitation, the usage of human feces as fertilizer, Transmission can be prevented by the implementation of effective sewage disposal systems. Additionally, the prevention of defecating outdoors is very effective in preventing transmission. Clinical Symptoms Transmission Treatment Symptom's include abdominal pain, vomiting, fever distention, cough, intestinal blockage intestinal perforation and growth impairment in children.
  16. Transmission Prevention The best way to prevent the contraction of Ascaris from humans or pigs is to: • Avoid the ingestion of soil that is contaminated with human or pig feces. • Practice proper hand hygiene by washing hands with soap and water before handling food. • Wash your hands with soap and water after handling pigs, cleaning pig pens, or handling pig manure. • Teach children the importance of hand hygiene to prevent infection. • Supervise children around pigs, ensuring that they do not place their unwashed hands in their mouths. • Wash peel and cook all raw vegetable and fruits before eating, particularly those that have been grown in soil that has been fertilized by manure.
  17. Patient Outcome • After Ascaris lumbricoides was found in stool patient was given Albendazole (400mg x1). • The patient was suspected to have contracted the parasite before moving to Tennessee.
  18. References 1. Jourdan PM, Lamberton PH, Fenwick A, Addiss D. Soil- transmitted Helminth Infections. Lancet 2018;391 (10117):252- 265. 2. Massara CL, Enk MJ. Treatment Options in the Management of Ascaris lumbricoides. Expert Opinion Pharmacother. 2004 5(3):529-539.
  19. Thessicar E. Antoine-Reid, Ph.D. Dr. Antoine-Reid is a second year CPEP fellow at the Vanderbilt University Medical Center. She completed her Ph.D training at the University of Illinois at Chicago where she studied the usage of nanoparticles to inhibit the entry, replication, and spread of Herpes simplex viruses. Dr. Reid’s research interest include the tracking of multi-resistance organism in hospital acquired infections.