WHY IS MY DAUGHTER THROWING UP WORMS

Abstract

Introduction

Soil-transmitted helminths afflict humans through ingestion of infective eggs or contact with larvae, infected up to 1.5 billion individuals in tropical/subtropical areas. Symptoms may be subtle or dramatic. 

Case report

A 3 year old girl presented in an urban emergency department with complaint of acute onset of persistent vomiting associated with fever and poor oral intake. Her mother showed photo of a worm in her vomitus. Further history revealed recent travel to Cameron Highland prior to onset of symptoms. She also has habit of playing outside her home barefoot. On arrival, her vital signs were within normal range. She was mildly dehydrated but her perfusion was good. Her abdomen was soft, non-distended with non-palpable liver and spleen. Other examinations were unremarkable. She was started on oral Albendazole and admitted to ward for hydration.

Discussion and conclusion

A quarter of world’s population are infected with soil-transmitted helminths (STH), mainly affecting developing countries. No preventive chemotherapy required in Malaysia since 2009 possibly due to low prevalence of STH in Malaysia in past decade. Three main STH are hookworm, Ascaris lumbricoides and most prevalent in Malaysia, Trichuris trichiura. Majority of infected population are those in school-going age (3 – 14 years) owing to the fact that children are least careful with maintaining good hygiene making them high risk for exposure. Initial symptoms include fever, cough and dyspnea as larvae migrate through the lungs in the first few weeks of infection. Incessant infection may cause blockage of the gastrointestinal tract by bolus of worms. Worm infestation is treated with anti-helminthic. Repeated chemotherapy may be needed since re-infection can occur as early as two month after first treatment. STH is still prevalent even in urban population and should not be underestimated as treatment is easily accessible.