Intestinal Ascariasis Presenting as Profuse Vomiting of Adult Worm of Ascaris lumbricoides in Two-Year-Old Girl in Ende-East Nusa Tenggara: A Neglected Tropical Disease in Rural Area

Abstract

BACKGROUND: Ascariasis is a soil-transmitted helminth (STH) disease and is included in 20 neglected tropical diseases that caused by Ascaris lumbricoides. Indonesia is one of the countries with the highest prevalence of Ascariasis in the world, reaching 32%. Clinical symptoms of Ascariasis in children are initially asymptomatic. Patients begin to complain when worms increase in the digestive tract. In this article, we report about Intestinal Ascariasis Presenting Profuse Vomit Containing Adult Worms of Ascaris lumbricoides in a Two-Year-Old Girl in Ende, East Nusa Tenggara.

CASE: A 2-year-old child came with complaints of worm-contained vomiting since approximately three days ago. The patient vomited five times per day, containing more than 10 worms measuring 12 cm in each episode of vomiting, mixed with fluid and food. Vomiting is accompanied by abdominal pain in the umbilical area. On physical examination, the stomach appears slightly distended, tenderness in periumbilical area, and increased bowel sounds. The fecal smear examination revealed Ascaris lumbricoides eggs were found. Abdominal x-rays showed multiple worm-shaped structures in the cecum. The patient got albendazole 400 mg/day for 3 consecutive days. After treatment, she gained clinical improvement with no more worms contained vomiting.

CONCLUSION: As health workers, we need to increase our awareness of worm infections, especially in endemic areas. Although supporting examinations to confirm the diagnosis are still very limited in this area, early detection with clinical assessment and complete stool examination is very useful for preventing further complications. Giving albendazole 400 mg/day for 3 days gives good results in patients affected by ascariasis.