Journal of Pediatrics and Neonatal Care

Neonatal : A Rare Entity

Abstract Case Report

Worm infestation is very common in school going children especially in developing Volume 6 Issue 3 - 2017 country but it is rarely seen in infancy or neonates. We present a case of Neonatal Enterobius vermicularis infestation manifesting as anemia and poor weight gain. Keywords: Neonate; Worm infestation; Anaemia; assessment 1Department of Paediatrics, GMC Jammu, India 2Department of Microbiology, Jammu University, India

Introduction *Corresponding author: Aakash Pandita, Department of Neonatology, Fernandez Hospital, Hyderabad, India. Email: Worm infestation is a common health problem seen both in tropical and subtropical countries. Nearly 7% of Indian population is known to be infested with . The incidence is much Received: October 03, 2016 | Published: February 13, 2017 higher in children with around 2 million children under the age of 4 years having [1]. It may be explained Diagnosis [13-15] by their frequent contact with the soil that is contaminated with the eggs. However Neonates are mostly indoors and hardly have Eggs are invisible to the naked eye, but they can be seen using any such contact.There are very few case reports reporting worm a low-power . Adult pinworms are clearly visually infestation in infants or neonates [2-7]. Enterobius vermicularis (E detectable, usually during the night when they move near the V) is a white slender with a pointed tail. In humans, anus. Transparent adhesive tape applied on the anal area will pick they reside in the , , and [8]. The up deposited eggs, and diagnosis can be made by examining the life cycle takes place within the lumen of the gastrointestinal tape with a microscope. This test is most successful if done every tract [9]. Ingested eggs hatch in the stomach and upper small morning for several days, because the females do not lay eggs intestine leading to larval forms which migrate to the , every day, and the number of eggs vary. caecum, and appendix. After moulting twice they become adults. Pinworms do not lay eggs in the faces. As such, routine Adult females settle in the lower ileum, caecum, appendix or examination of faecal material gives a positive diagnosis in only ascending colon leading to ulcerations at the site of attachment 5 to 15% of infected subjects, and is therefore of little practical causing haemorrhage and secondary infection .Four methods of diagnostic use. In a heavy infection, female pinworms may exist: adhere to stools that pass out through the anus, and they may thus be detected on the surface on the stool. Adult pinworms are occasionally seen during . On a microscopic level, (a)(b) directExposure infection to viable by fingernail eggs on contamination soiled bed linenor autoinfection and other pinworms have an identifying protruding ridges running the contaminated environmental objects length of the worm. (c) By contaminated dust containing embryonated eggs Treatment [16] (d) Retrograde infection; after hatching on the anal mucosa, The treatment of E. vermicular is one dose of pamoate

larvae migrate into the sigmoid colon, and caecum [4-8]. We 11 mg/kg, or 100 mg, or 400 mg orally present a Neonate with Enterobius vermicularis infestation with a second dose in 2 weeks to treat possible reinfection. It is causing poor weight gain and blood in stools. also recommended that family members be treated to eliminate asymptomatic reservoirs. [10-12] The most common symptoms are itching mostly at night, in Case Report and around the anus and around the perineum and is caused Case: A preterm male neonate weighing 1.2 kg was admitted in by the female pinworms migrating to lay eggs around the anus. NICU for respiratory distress and was started on oxygen therapy The mechanisms causing this intense pruritus have not been explained. The itching leads to continuously scratching the area around the anus, which can further result in tearing of the skin historyand intra suggestive venous fluids. of chorioamnionitis. His APGARS were Chest 7/7/8. X rayThere done was was no and complications such as secondary bacterial . Other normal.history ofBaby any began significant to improve illness with in oxygen mother and and tube there feeds was were no symptoms include, and restlessness. A considerable started at 12 hours of life. Oxygen was stopped by 24 hours. On proportion of children suffer from loss of appetite, , day 2 baby was on full feeds. Baby was shifted to mother side for , emotional instability, and . KMC on day 3. Baby was accepting feeds well and had no other complains. Baby was kept under observation and subsequently

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on examination there was only 40 grams weight gain over next 3 Dr. Kishour reviewed and revised the manuscript. weeks. Baby was evaluated with septic screen which was negative Dr. Dharti critically reviewed the manuscript. (CRP- 0.8mg/dl, leucocyte count 8,600/mm3) Electrolytes (Na 138, K 4.2meq/l), Urine examination, Renal Function Test (Urea agree to be accountable for all aspects of the work. examination was normal. Feeding was checked for quantity and All authors approved the final manuscript as submitted and technique.28mg/dl, creatinine Baby was 0.6mg/dl), getting exclusive 2D Echo breastall were feeds normal. with Systemic human References 1. both were normal. Ph was 7.36 and urine output was 2.5ml/ milk fortifier. ABG was also done and urine output was monitored, TrendsDe Silva Parasitol NR, Brooker 19(12): S, Hotez 547-551. PJ, Montresor A, Engels D, et al. (2003) low with a haematocrit of 25% at 21 days of life. There was no Soil-transmitted helminth infections: updating the global picture. Otaigbe BE, Eneh AU, Oruamabo B (2005) Hookworm infestation in a jaundicekg/hour. andStool no output evidence was of also haemolysis. normal. Platelet Haemoglobin count done was 2. 3-month old female. Niger J Med 14(2): 227-230. also normal with a value of 2.6 lac/mm3. Malaria was also ruled out in view of anemia. Careful history was sought from parents 3. and mother gave history of passing some in stools by the Hookworm causing melaena and severe anemia in early infancy. Ann Budhathoki S, Shah D, Bhurtyal KK, Amatya R, Dutta AK (2008) neonate (Figure 1). A clinical diagnosis of Enterobias vermicularis Trop Paediatr 28(4): 293-296. 4. Bhatia V, Das MK, Kumar P, Arora NK (2010) Infantile hookworm of Enterobius vermicularis and for occult blood. A single dose disease. Indian Pediatr 47(2): 190-192. infestation was made. Stool sample sent was positive for eggs 5. next 10 days baby had weight gain of around 100 grams and was anemia owing to hookworm in a 12-day-old Nepalese infant. Ann discharged.of Albendazone On follow 200 mg up wasbaby given had weightto the gainbaby of .Subsequently 110 grams in in a TropTiwari Paediatr L, James 24(4): J, Chowdhary 361-363. S, Sharma A, Puliyel JM (2004) Severe week. 6. review. Acta Trop 59(4): 265-270. Yu SH, Jiang ZX, Xu LQ (1995) Infantile hookworm disease in China. A 7.

MedKang Int G, HealthMathew 3(1): MS, 70-75.Rajan DP, Daniel JD, Mathan MM, et al. (1998) of intestinal parasites in rural Southern Indians. Trop 8. Centers for Disease Control and Prevention. Parasites - Enterobiasis (also known as Infection). Parasitic Diseases Information.

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10. first report in the UK. Ann Trop Med Parasitol 81(2): 195-8. transmission, and genitourinary complications of enterobiasis (pinworms).Burkhart CN, Int BurkhartJ Dermatol CG44 (10): (2005) 837-840. Assessment of frequency,

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366.Gutiérrez, Yezid (2000) Diagnostic pathology of parasitic infections Figure 1: Enterobius vermicularis in a Neonate. with clinical correlations (Second edn). United Kingdom, pp. 354- 13.

Garcia, Lynne Shore (2009) Practical guide to diagnostic parasitology. 14. AmericanCaldwell JP Society (1982) for Pinworms Microbiology. (Enterobius pp. 246-247. Vermicularis). Can Fam Conclusion Physician 28: 306-309.

Young infants coming from low socioeconomic families, having 15. Enterobiasis. DPDx. Division of Parasitic Diseases, Centers for poor environmental and sanitation and presenting with Disease Control and Prevention. Retrieved 2009-04-08. poor weight gain and severe anaemia, should be suspected of 16. can be managed effectively through simple and well known Van Riper G (1993) Pyrantel pamoate for pinworm infestation. Am interventionhaving worm strategies. infestation if there is no other findings. The disease Pharm NS 33(2): 43-45. Contributors’ Statement Page Dr. Pandita conceptualized and designed the study, and drafted the initial manuscript.

Citation: Digra KK, Pandita D, Pandita A (2017) Neonatal Worm Infestation: A Rare Entity. J Pediatr Neonatal Care 6(3): 00242. DOI: 10.15406/jpnc.2017.06.00242