Gastro Intestinal Parasites
Gastro Intestinal Parasites
Gastro Intestinal Parasites
Also known as: intestinal parasites including tapeworms, roundworms and protozoa.
2013
study in Dadeldhura
•
31% of school children with GI parasites
•
Tapeworm (most common)
•
Hookworm
•
Roundworm (Ascaris)
•
Giardia
•
GI symptoms: 49% with parasites
•
No GI symptoms: 14% with parasites
Tapeworm (Hymenolepis nana)
•
Most common human tapeworm infection worldwide.
•
Most common in children.
•
Most asymptomatic, but symptoms become more common as the
parasite burden increases.
• Diagnosis should prompt family screening or empiric treatment, given the potential for person-to-person spread.
Hookworm
• Two major species of hookworm that
cause human infection: Ancylostoma duodenale and Necator americanus
• Acute gastrointestinal symptoms
• Chronic nutritional impairment- common
cause of chronic blood loss/ iron deficiency
•
The
major impact of hookworm infection is on nutritional status. This is
particularly important in endemic areas where children and pregnant women may
have limited access to adequate nourishment. In addition, maternal hookworm
infection is associated with low birthweight.
•
Hookworms
cause blood loss during attachment to the intestinal mucosa by lacerating
capillaries and ingesting extravasated blood. Each N. americanus and A.
duodenale worm consumes about 0.3 mL and 0.5 mL of blood per day,
respectively. The daily losses of blood, iron, and albumin can lead to anemia
and contribute to impaired nutrition, especially in patients with heavy
infection.
The eggs of N. americanus and A. duodenale are morphologically
indistinguishable.
Roundworm
(Ascaris)
- Largest intestinal nematode parasite
- Most common among children 2 to 10 years of age
- Decreases after >15 years
- Tends to cluster in families.
- Most patients asymptomatic.
- All patients warrant treatment, even if asymptomatic
Antenatal
anthelminthic treatment, birthweight, and infant survival in rural Nepal
- Prospective study in The Lancet 2004
- Women treated with albendazole twice during pregnancy
- Lower rate of severe anemia in 3rd
trimester
- Higher birthweight infants
- Lower infant mortality at 6 month
Giardia
•
Giardia can even survive exposure to
bacteria-killing chemicals such as chlorine.
•
Only takes 10 cysts for a person to develop
giardiasis.
Acute Giardiasis: Presentation
•
Acute watery diarrhea
•
Loss of appetite
•
Abdominal distension with increased gas
•
Abdominal cramps and bloating (foul smell;
rotten eggs smell)
•
Fatty stools (steatorrhea)
• Nausea, Vomiting, Constipation, Urticaria
Chronic Giardiasis: Presentation
•
Loose stools but usually not diarrhea•
Steatorrhea•
Profound weight loss•
Malabsorption•
Malaise•
Abdominal cramping•
Flatulence•
Burping
Entamoeba:
•
Majority of infections are asymptomatic
•
Clinical manifestations include amebic dysentery
and extra-intestinal disease.
•
Cysts can remain viable in the environment for
weeks to months, and ingestion of a single cyst is sufficient to cause disease.
Entamoeba: Presentation
- Symptoms range from mild diarrhea to severe dysentery
- Abdominal pain (12 -80%)
- diarrhea (94-100%)
- bloody stools (94-100%)
- fulminant amebic colitis
- Weight loss (50%)
- Fever in up to 38%.
Amebic liver abscess
•
Amebic liver abscess Amebic liver abscess is the most common
extraintestinal manifestation of amebiasis.
Amebic liver abscess: Presentation
•
Symptom: RUQ
pain: may be referred to the epigastrium, the
right chest, or the right shoulder.
Fever , Cough,
sweating, malaise, weight loss,
anorexia, hiccough
•
Physical exam: Tender hepatomegaly
•
Labs: leukocytosis
Elevated
ALP
AST, ALT may also be elevated
referances:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17023-2/fulltext
•
Symptom: RUQ
pain: may be referred to the epigastrium, the
right chest, or the right shoulder.
Fever , Cough,
sweating, malaise, weight loss,
anorexia, hiccough
•
Physical exam: Tender hepatomegaly
•
Labs: leukocytosis
Elevated
ALP
AST, ALT may also be elevated
Very good information
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