The Unexpected Diaper Discovery

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Presentation

A 23-month-old boy from Central America (emigrated with mother three months prior) was airlifted to the Pediatric Emergency Department from an outside hospital due to acute respiratory failure. Patient had a prior history of fever, vomiting and diarrhea. Infectious Disease was consulted for pulmonary infiltrates and prolonged coughing. Due to the patients’ presentation physicians were suspicious of community acquired pneumonia (CAP).

Lab Testing

A number of bacteriology and virology related lab tests were conducted to rule out all possible causes of infection. However, all tests that were ordered were negative. During a routine diaper change in morning rounds a resident noticed a 10-inch-long roundworm in patient’s diaper. Macroscopic examination revealed the roundworm to be Ascaris lumbricoides

Cause of Symptoms

Ascaris lumbricoides can cause a variety of symptoms in the human host such as cough, difficulty breathing, chest pain, abdominal pain, nausea, vomiting, diarrhea, intestinal perforation, intestinal blockage, weight loss and malnutrition.  In many cases, pulmonary ascariasis shows fleeting infiltrates. The respiratory distress experienced during pulmonary ascariasis is referred to as Löffler's Syndrome and occurs 4 to 16 days after ingesting embryonated roundworm eggs.

Humans and swine are the major hosts of Ascaris lumbricoides. Ascaris is a Genus of parasitic nematodes known small intestinal roundworms. Humans who place their contaminated hands into their mouths are at the highest risk. Ascaris is one of the most common helminthic parasitic infections worldwide. Highest prevalence is in tropical and sub-tropical regions especially where there is poor sanitation. Infections also occur in rural areas in the southeastern United States.

Treatment

Patient received antiparasitic treatment with Albendazole (400mg x1).
 

Contact Information

Nicole Jackson, njackson@asmusa.org