Niger J Paed 2016; 43 (1):51 - 53
CASE REPORT
Akintan PE
Recurrent severe anaemia caused by
Emokpae A
Mabogunje CA
multiple infestation with ankly-
Osofisan J
lostoma duodenale and entamoeba
histolytica in a 5 months old female
Nigerian infant
DOI:http://dx.doi.org/10.4314/njp.v43i1.10
Accepted: 3rd August 2015
Abstract : Worm and parasitic
case of multiple infestation
in
infestation is a common problem
infancy. We hereby report an in-
Akintan PE
(
)
in children with most occurring in
fant with recurrent anemia and
Osofisan J
school age . Low socio-economic
melena and bloody stools caused
Lagos University Teaching Hospital
Idiaraba formerly Massey Street
status and poor sanitary hygiene
by anklylostomaduodenale and
Children Hospital
has been associated with worm
entamoebahistolytica
infesetation. Though it is rare in
Emokpae A
infancy, there had been reports in
Key words: Infant Anaemia ,
Mabogunje CA
these group of children. However
Worm Infestation, Ankylostoma
Massey Street Children Hospital Lagos
there has been no documented
Duodenale, Entamoeba Histolytica
Introduction
transfused with packed cell and given antibiotics based
on initial suspicion of sepsis. Her blood count showed
The World Health Organization (WHO) recognizes that
a packed cell volume: 20.4%; total white blood count:
worm infestation is a public heath burden with a preva-
22,500/L, neutrophils: 28%, lymphocytes: 53%, mono-
lence of between 13 – 86 % .Intestinal worm infesta-
1,
cytes: 4%, eosinophils 10%, basophils 4%, malaria para-
tions is common in children who suffer higher infesta-
site was negative with rapid diagnostic test, blood film
tion rates and heavy worm burden . Studies in Africa
2
was normal and post tranfussion packed cell volume
have shown that there is a high prevalence of worm in-
was 36%. She improved and
was discharged. Eight
festation among children especially in rural and low
weeks later, she represented with history of palor, fast
income communities. The commonest
worms impli-
breathing, cough and seizures. Her packed cell volume
cated are ascaris and hook worm. The effects of worm
3
had droped to 11% the admitting diagnosis was severe
infestation include aneamia
,4,5,6
, malnutrition and poor
anaemia with anemaic heart failure secondary to severe
cognitive functions especailly ascaris and anklylostoma.
7
malaria, keeping in view sepsis . Her total white cell
Most studies were done in school age and a few in under
count was within normal limits. There were no malaria
-fives.
parasites seen on thick film. The aneamia was corrected
with packed cell transfusion, and post transfusion
A Nigerian study had showed that worm infection with
packed cell volume was 43%. While on admission she
aneamia is prevalent in preschool children and incidence
started passing very dark stools initially followed by
increased with age .Factors associated with worm infes-
6
episode of bloody stools with a drop in her packed cell
tation in children include poor sanitary conditions, low
volume to 24% necessitating a second transfusion. She
socioeconomic status and low litracy level especially in
was not on any iron supliments before or during admis-
mothers.
,8 ,9.
Various reports have shown that worm
sion. The diagnosis was changed to recurrent anaemia
infestation occur in infants but no documented case on
secondary to gastrointestinal bleeding of undetermined
multiple infestations in the same infant ,hence we de-
cause. However on further probing, there was a history
cided to publish this case report
of passage of dark coloured stools in the past before her
last admission which resolved before presentation, and
Case report
occurred shortly before this second admission.
A 5 month old female infant first seen at age of two and
Stool microscopy showed heavy anklyostoma doudenale
half months at Massey Street Children Hospital Lagos
ova, as well and cyst and trophoziotes of entamoeba
with complaints of palor, cough and fast breathing. She
hystolytica. She resides in a coastal area of Lagos along
was found to be severely pale, acyanotic, anicteric not
the beach. She had been bathing and drinking water ob-
dehydrated. She had tachycardia and dyspnea with a
tained from the river close to her residence since birth.
tender hepatomegaly of 3 cm, then a diagnosis of anae-
Her parents were fishermen who lived on wooden plank
mic heart failure of unknown origin was made she was
built on the coastline . She was transfused to correct the
52
15
anemia, and treated with metronidazole and albendazole.
East who presented with refusal of feeds, hyperactive
Her packed cell volume before discharge was 39 %.
bowel sound, vomiting, and diarrhea. Studies have
Bloody stool stopped 5 days after she was commenced
shown a high prevalence of ameabiasis in infants in tur-
key and Saudi Arabia with
16
17
on the medication. There were no facilities for endocopy
prevalence reaching as
in the centre and she responded well .She was later dis-
high as of 50% . Ogunlesi et al in cross sectional study
charge and has remained well and followed up for two
on diarrhoea in under five children recorded two in-
month post discharge.
fants aged two and four month old respectively with
amoebic dysentery in Ilesa Nigeria. There were case
reports in neonates in india . All the cases were suc-
19
cessfully treated with parenteral or oral metronidazole
Discussion
similar to our patient who responded well to oral met-
ronidazole.
Parasitic infestation is more prevalent in children espe-
cially under- fives’., however there are case reports and
Risk factors for amoebasis include poor hygiene, eating
studies showing that worm infestation occur in infancy.
or drinking food contaminated with cyst. Socio-
There had been reports of infestation in infants in
economic risk factors have been implicated in aiding the
Asia
2,10
with prevalence increasing with age. In India,
transmission which include, poor sanitary conditions
there were case reports of a 12 week and 8month infants
and poor socio economic status. There is need to control
who had melana stools with upper GI endoscopy show-
the spread of these infestations and there has been calls
ing worms attached to the intestine. A twelve day old
11
for policy to be put in place in control of these infesta-
Nepalese infant developed severe anaemia owing to
tion. To our knowledge there has been no case report of
hook worm infestation and responded well to mebenda-
a concomitant anklyostoma and ameobic infection in a
zole . In Africa there has been reports of hookworm
12
infant which makes this case perculiar.
infestation in a 3 and 4 month old in Nigeria and
Uganda respectively, presenting with melena and severe
anemia with fever
13,14
. Both infants were treated with
albendazole dosages approparate for their ages and re-
Conclusion
sponded well. It was suggested that worm infestation
should be suspected in children with severe anemia liv-
Parasitic
infestation should be suspected in children
ing in communities with high risk of infestation, pre-
especially infant who present with aneamia, stooling
senting with diarrhoe and or melena stools. These were
with or without melenaand bloody living in areas prone
similar to our case both in presentations and treatment.
to worm infestation. Investigations should include stool
Ameobiasis continue to cause morbidity and mortality in
microscopy and endoscopy where facilities exist.
children in developing countries epespecaily in
extreems of life. Timimg between infectivity and symp-
Conflict of interest: None
toms ranges between 2 to 4 weeks. There has been re-
Funding: None
port of a 4 month old with ameobiasis in the Middle
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