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- Duration, description of stools (frequency, amount, presence of

blood or mucus)
INFECTIOUS:
• Cramping abdominal pain
FOOD POISONING & WORMS/PARASITES
• Fever-duration, magnitude, pattern
Dr. Mylene Letigio-Casil, MD, DPPS
• Body malaise
TOPIC OUTLINE: • Amount and type of solid and liquid oral intake
I. Food poisoning
II. Worms
III. Ascariasis
IV. Trichuriasis
V. Enterobiasis
VI. Hookworm Infection

Food Poisoning

- Intake of contaminated food

- Most common causes:
● Infectious
- S. aureus, B. cereus, Campylobacter, Salmonella, E. coli
spp
● Non-Infectious
- Direct toxic effect of the food (mushrooms), contamination
(heavy metals), or fish or shellfish toxins (such as in
scombroid poisoning)

- Symptoms can appear within a few hours but usually 12 to 48 hours

after the consumption of contaminated food

Based on history:
• Persons who ate the same food are also affected
• Nausea
• Vomiting - onset, amount, and frequency
• Diarrhea (usually watery diarrhea)

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Food Poisoning
• Treatment
• Usually self-limited to 1-3 days
• Rehydration and maintenance ORS plus replacement of continued losses in diarrheal
stools and vomitus after rehydration
Continued breastfeeding and refeeding with an age-appropriate, unrestricted diet as
soon as dehydration is corrected
• Zinc supplementation is recommended

Counseling
• Do not give anti-diarrheal medications
• Remind the family about the importance of food storage, hand hygiene and adequate
cooking

Chart 1A. Diarrhea treatment plan A

Treat diarrhea at home
►Give as much extra fluid as the child will take to prevent dehydration.
- Breastfeed frequently and for longer at each feed.
- If the child is exclusively breastfed, give ORS or clean water in addition
to breast milk.
- If the child is not exclusively breastfed, give one or more of the following:
ORS solution, food-based fluids (e.g. soup, rice water and yogurt -
drinks) or clean water.
- Do not give drinks with a high sugar content.
- In addition to the usual fluid intake, give ORS after each loose stool
- 50-100 mL if the child is < 2 years 100-200 mL if the child is 2 years or
older.
How to prepare and give ORS
- Wash your hands with soap and water.
- Mix 1 package of ORS with 1 liter of clean water. Do not keep the mixed
ORS solution for more than 24 h.
- Give frequent small sips from a cup or spoon.
- If the child vomits, wait 10 min. Then continue, but more slowly.
- Continue giving extra fluid until the diarrhea stops.

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Oral Rehydration Salts

Contents of 5 sachets dissolved in 1 liter water will provide: Worms
Sodium 75 mmol
Potassium 20 mmol Intestinal parasitic worms include roundworms, whipworms and hookworms, pinworms
Chloride 65 mmol ● Pinworms-most common in children and adolescents and do not cause
Citrate 10 mmol serious disease
Glucose 75 mmol Can compromise nutritional status, affect cognitive processes and lead to intestinal
Total Osmolarity 245 mmol obstruction and rectal prolapse
● Cause:
►Continue feeding and providing a normal healthy diet to the child. - Eating food contaminated with eggs or larvae, or Penetration of
►Give paracetamol if the child has high fever (239°C) that causes distress. the skin by infective larvae in the soil
►Diarrhea usually lasts for 5-7 days and up to 2 weeks. - Infected people excrete helminth eggs in their feces
►Return immediately if your child: ASCARIASIS
- becomes sicker (deep unresponsiveness, inactivity) - Most prevalent human helminthiasis in the world
- drinks poorly - Etiologic agent: Ascaris lumbricoides (roundworm)
- is unable to drink or breastfeed - Adult worms inhabit the lumen of the small intestine
- presents fever that persists after 2-3 days - Infective stage: embryonated egg
- has blood in the stool. - Principal host: Humans
►Return after 5-7 days if your child shows none of these signs but is still not - Most common in tropical areas (South America, Africa, Asia)
improving. - Occur at any age, the highest rate is in preschool or early school-age
children
- ↑ incidence: poor socioeconomic conditions, use of human feces as
fertilizer, and geophagia
MOT: primarily hand to mouth but may also involve ingestion of contaminated raw fruits
and vegetables
Clinical Manifestation
Most common clinical problems:
- Pulmonary disease
- Loeffler syndrome: transient respiratory symptoms such as cough and
dyspnea, pulmonary infiltrates, and blood eosinophilia
Obstruction of the intestinal or biliary tract
- Vague abdominal complaints: vomiting, abdominal distention, and
cramps

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Larvae migrating through these tissues

- Allergic symptoms: fever, urticaria, and granulomatous disease ASCARIASIS
- Chronic: impaired growth, physical fitness, and cognitive development Lab work-up:
- Microscopic examination of fecal smears
- High number of eggs excreted by adult female worms
- Ultrasound examination of the abdomen: Capable of visualizing
intraluminal adult worms

Treatment:
• Albendazole 400 mg orally once, for all ages
• Mebendazole
- 100 mg orally twice daily for 3 days or
- 500 mg once, for all ages
• Pyrantel pamoate 11 mg/kg orally once; maximum dose: 1g)
• Ivermectin 200 µg/kg orally once

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ASCARIASIS
Prevention
• Offering universal treatment to all individuals in an area of high endemicity
• Offering treatment targeted to groups with high frequency of infection, such as
children attending primary school
• Offering individual treatment based on intensity of current or past infection
• Improving education about and practices of sanitary conditions and sewage
facilities, discontinuing the practice of using human feces as fertilizer, and
education are the most effective long-term preventive measures

TRICHURIASIS
Etiology: Trichuris trichiura (whipworm)
● Inhabits the cecum and ascending colon
● Infective stage: embryonated, barrel-shaped eggs
Principal host: humans
MOT: ingesting embryonated, barrel-shaped eggs by direct contamination of
hands, food (raw fruits and vegetables fertilized with human feces), or drink
Highest rate of infection: 5-15 years old
↑ incidence: poor rural communities with inadequate sanitary facilities and soil
contaminated with human or animal feces

Clinical Manifestation
• History of right lower quadrant or vague periumbilical pain
• Anemia
• Poor growth
• Developmental and cognitive deficits
• Chronic dysentery
• Rectal prolapse

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TRICHURIASIS ENTEROBIASIS
Lab work-up:
● Fecal smear - barrel-shaped ova of T. trichiura Etiologic Agent: Enterobius vermicularis (pinworm infection)
Treatment ● Small (1 cm in length), white, threadlike nematode, or roundworm
● DOC: Albendazole 400 mg PO x 3 days, for all ages ● Inhabits the cecum, appendix, and adjacent areas of the ileum and
● Alternatives: ascending colon
- Mebendazole 100 mg PO twice daily x 3 days ● Infective stage: embryonated egg
- Ivermectin 600 µg/kg orally x 3 days -Humans are the only known host
Highest cure rate: Albendazole 400 mg + oxantel pamoate (20 mg/kg) on 3 MOT:
consecutive days ● Fecal-oral route typically by ingestion of embryonated eggs that are
carried on fingernails, clothing, bedding, or house dust
● Autoinoculation
Highest in children 5-14 years of age
↑ incidence: children live, play, and sleep close together

Clinical Manifestation
● Itching and restless sleep secondary to nocturnal perianal or perineal
pruritus
- Intensity of infection
- Psychologic profile of the infected individual and the family
- Allergic reactions to the parasite

Prevention
• Personal hygiene
• Improved sanitary conditions
• Eliminating the use of human feces as fertilizer

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Lab work-up
● History of nocturnal perianal pruritus - strongly suggestive
● Definitive diagnosis - identification of parasite eggs or worms
- Microscopic examination of adhesive cellophane tape/scotch
tape pressed against the perianal region early in the morning
frequently demonstrates eggs
- Repeated examinations increase the chance of detecting ova;
one examination detects 50% of infections, three examinations
90%, and five examinations 99%.

● DRE may also be used to obtain samples for a wet mount

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ENTEROBIASIS MOT:
Treatment: Penetrating through the skin
● DOC: Albendazole 400 mg PO with a repeat dose 2 week later All ● N. americanus
age-groups; cure rates exceed 90% ● A. duodenale,
● Alternatives: ● A. braziliense
- Mebendazole 100 mg PO with a repeat dose 2 weeks later and Ingestion
- Pyrantel pamoate 11 mg/kg base PO 3 times a day up to a ● A. duodenale
maximum of 1 g, repeat at 2 weeks

● Supportive
- Morning bathing
- Frequent changing of underclothes, bedclothes, and bedsheets

Complications:
● Appendicitis, chronic salpingitis, pelvic inflammatory disease, peritonitis,
hepatitis, and ulcerative lesions in the large or small bowel
Prevention
● Household contacts can be treated at the same time as the infected
individual
● Repeated treatments every 3-4 months if with repeated exposure
● Good hand hygiene - most effective method of prevention

Hookworm Infection
Causes:
● Necator americanus - most common cause of human hookworm infection
● Ancylostoma duodenale - classic hookworm infection
● Ancylostoma braziliense - principal cause of cutaneous larva migrans

Rural areas - human feces used for fertilizer or sanitation is inadequate

● Highest prevalence: Sub-Saharan Africa, East Asia, and tropical regions
of the Americans

Hookworm Infection
● Infective stage: filariform larvae

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HOOKWORM INFECTION Lab work-up

● Direct fecal examination - eggs
Clinical Manifestation ● Quantitative method - determine heavy worm burden
● Intestinal blood loss → Iron deficiency anemia
● Pallor
● Protein malnutrition
● Physical growth retardation and cognitive and intellectual deficits

Dermatitis → Ground itch

● As it penetrate human skin
● Vesiculation and edema

Cutaneous tracts of cutaneous larva migrans

● A. braziliense - lateral migration of the larvae

Cough, Pharyngitis
● A. duodenale and N. americanus
● Larvae migrate through the lungs

Upper Abdominal pain, anorexia, and diarrhea

● Entry of larvae in the Gl tract

Ancylostomiasis - infantile form for hookworm infection

● Heavy A. duodenale infection
● Diarrhea, melena, failure to thrive, and profound anemia

Cutaneous Larva Migrans (Creeping Eruption)

● A. braziliense
● Localize at the epidermal-dermal junction and migrate in this plane,
moving at a rate of 1-2 cm/day
● Raised, erythematous, serpiginous tracks, which occasionally form bullae
● Single or numerous
● Localized to an extremity, but may affect any part of the body
● Intense localized pruritus without any systemic symptoms

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HOOKWORM INFECTION Complications:

- Appendicitis, chronic salpingitis, pelvic inflammatory disease, peritonitis,
Lab work-up hepatitis, and ulcerative lesions in the large or small bowel
● Cutaneous Larva Migrans - none
- Clinical examination of the skin Prevention
- History: recall the exact time and location of exposure since ● Implement programs of periodic deworming
there is intense itching at the site of penetration ● Improvements in sanitation
● Health education
● Avoidance of human feces as fertilizer

G. Deworming
The Department of Health Administrative order 2015-0054: Revised Guidelines
on Mass Drug Administration and the Management of Adverse Events Following
Deworming (AEFD) and Serious Adverse events (SAE) recommends deworming
for all children aged 1 to 12 years.

The WHO and the DOH both recommend the use of either albendazole or
mebendazole in the following doses and schedule:

● Albendazole
- 12 months to 23 months: 200 mg, single dose every 6 months
- 24 months and above: 400 mg, single dose every 6 months

● Mebendazole
- 12 months and above: 500 mg. single dose every 6 months

Either drug shall be taken ON FULL STOMACH.

Treatment
● Albendazole 400 mg PO one dose, for all ages Deworming must not be done in children with:
- May required additional doses in refractory cases of N. - Severe malnutrition
americanus - High-grade fever
● Mebendazole 100 mg PO twice daily for 3 days, for all ages - Profuse diarrhea
- Abdominal pain
Alternative: - Serious illness
● Pyrantel pamoate 11 mg/kg (max 1g) PO once daily for 3 days - Previous hypersensitivity to antihelminthic drug

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