Arciaga, Frances Geline R.

May 19, 2021

2MD Parasitology

SGD Case for Parasitology:

Case:
Ryan, 9 year old, son of a farmer in Pangasinan was complaining of on and off epigastric pain for the past
few months. What he could remember was there was program by the NGO called “Oplan Tsinelas”,
however he missed. He was disappointed that he went home barefooted in the rice field where human
feces were used as fertilizer. He experienced itchiness and redness on both feet. His mother noted his
son was slowly using weight.
On Physical Examination, he was pale, ill-looking, and slightly underweight, but his vital signs were
stable. Laboratory results revealed overt anemia: RBC 1.66 x 10 6/uL; WBC3.8 x 103/uL, Hgb 7.4 g/dL, Hct
22.4%, neutrophils 56%, lymphocytes 25%, monocytes 11% and eosinophils 8%, Mcv 74.7 fL, MCH 20.5,
MCHC 27.4 g/dL, platelet count 162 x 10 3/uL. Total iron binding capacity 318 mg/dL ferritin 10ng/ml
RBCs were microcytic and hypochromic. Stool examination was negative for occult blood but showed
the presence of thinned shelled ova in its 2-8 cell stage division, ovoidal and colorless >20/hpf.
Other biochemistry examination, including electrolytes, liver and renal functions were within normal
limits.

Guide questions:

A. What is your impression? What is your basis for the diagnosis?

Based on the patient’s case, he may have a hookworm infection.

Hookworm Infection
 Basis for Diagnosis
 Chief Complaint: On and off epigastric pain
 S/S: Redness and Itchiness on both feet
 PE
 Pale
 ill-looking
 Slightly underweight
 Vital signs: Stable
 Laboratory results
 CBC: Reveals overt anemia

Complete Blood Count Results Normal Value

RBC (Red Blood Cell) 1.66 x 106/uL Male: 4.35-5.65
Female: 3.92-5.13
Hemoglobin 7.4 g/dL Male: 13.2-16.6
Female: 11.6-14
Hematocrit 22.4% Male:38.3-48.6
 Female: 35.5-44
3
WBC (White Blood Cell) 3.8 x 10 /uL 5-10

Differential Count
Neutrophil 56% 40-60
Lymphocyte 25% 20-40
Monocyte 11% 2-8
Eosinophil 8% 1-4
Basophil 0-1
RBC Indices 74.7 fL
MCV (Mean Corpuscular 20.5 pg 81-100
Volume) 27.4 g/dL
MCH (Mean Corpuscular 26-34
Hemoglobin)
MCHC (Mean Corpuscular 31-36
Hemoglobin Concentration)
Platelet Count 162 x 103/uL 150-400
TIBC (Total Iron Binding 318 mg/dL 250-450
Capacity)
Serum Ferritin 10 ng/mL 50.160

 Peripheral Blood Smear: microcytic hypochromic RBC

 Fecalysis: Positive: Thin shelled ova (2-8 cell stage),ovoidal and colorless; >20 ova/HPF
 Biochemistry
 Electrolytes: Normal
 Liver Function test: Normal
 Renal Function test: Normal

B. Using a concept map, how will you correlate the signs and symptoms of Ryan with the
pathogenesis of the infection?
 Hookworm infection stimulates the activation of CD4+ T cells, induces downregulation and
upregulation of the Th1 and Th2 responses respectively, and upregulates the suppressive activity of the
regulatory T cells that reduce IFN-γ expression. Progressive retardation in IFN-γ levels with increasing
worm burden and the induced increase in regulatory CD206+ and/or IL-10+ monocytes/macrophages
may ameliorate inflammation but the upregulated Th2 response promotes fibrosis.
Iron deficiency anemia caused by heavy hookworm burden may result in reduced IL-2 secretion,
reduced number of macrophages and reduced CD4+ T-cell count or activity, but the impact of these
outcomes in the pathology of podoconiosis appears elusive.

C. What will be your plan of management pharmacologically and non-pharmacologically?

Pharmacologic Management

Drug Dosage
Albendazole 400 mg orally once
Mebendazole 100 mg orally twice a day for 3 days or
500 mg orally once
Pyrantel pamoate 11 mg/kg (up to a maximum of 1 g) orally
daily for 3 days

Non - Pharmacologic Management

 Adequate Hydration & Nutrition

- Patients w/ parasitic infections frequently suffer from malabsorption, vomiting &
diarrhea, resulting in malnutrition
- Ensure that patient’s nutritional & hydration status are maintained at acceptable
levels
 Replacement of Fluid & Electrolyte Losses
- Vomiting & diarrhea result in fluid & electrolyte losses, mainly Na & K
 Blood Transfusion & Treatment w/ FeSO4
- These measures may be necessary in hookworm infections which may cause severe
anemia

D. What are the preventive measures you are to give to Ryan?   

Prevention
1. Personal Care:
 Improved personal hygiene
- Wearing shoes, especially in soiled areas with a high risk of contamination
- Taking safety precautions, such as wearing gloves and shoes when gardening
- Avoid passing stool in the soil or outdoors or Proper disposal of feces
- Improved nutrition with dietary iron
2. Avoiding consuming soil or unwashed foods that may be contaminated with hookworm
3. Avoid using fertilizer made from human feces
4. Covering children’s sandboxes
5. Using a barrier to prevent the skin from touching the soil when sitting on the ground
6. Treating pet dogs and cats for hookworm
Reference/s:

Hookworm (slideshare.net)
https://www.medicalnewstoday.com/articles/313077#prevention
Parasitic Infections Treatment | MIMS Philippines
TropicalMed | Free Full-Text | Involvement of Hookworm Co-Infection in the Pathogenesis and
Progression of Podoconiosis: Possible Immunological Mechanism | HTML (mdpi.com)