Hello Dr,sy Dr ***** Mo dari Hosp G***** sy nk refer satu kes ke ED YZ. Case referred to Peadiatric Dept already.
4 y old boy,presented to casualty with cough of worms...
“He was brought by mother to casualty after being couging up 3-4 “pieces” of worm at home this morning”
Also had been feverish since 3 days ago. No episodes of loose stool but got difficulties in pass motion.
Clinically he looks lethargy,tachypnic,tachycrdic and look cachexic
Futher assestment was done to him
BP 110/65 HR 120 Temp 38.2 RR 30
Chest Xray : Pneumonic patches at right lower zone Abdomen : Distended,no guarding No murmur,heart sound S1S2 Throat not injected,Tonsil grade I
Pt in respiratory distress,So we put him on FM5L.Spo2 at 97%
“mother ade bawak x sample worm yg di kluar masa batuk tu?”
“Xbawak”kata mo ditalian,
“Tapi ni katanya dah hmpir 3 kali dh batuk dan each time batuk kluar at least 4-5ekor”
Takpe,just send him over here ASAP.
..................45 minutes later ..................
Ambulance heard from maingates approaching YZ door.
Stretcher was pushed inside YZ with one MO, one nurse accompanied.
“How pt’s vital in ambulance? Any desaturation during transfer?
“Pt sustaining with FM throghout journey but he coughing one times in ambulance”
O2 97% FM5L
Ok transfer him to bed now! Nurse connect those FM to our wallplug oxygen.Get vital and get me those xray!
“Itu ke yg u maksudkan worm tdi tu?”
- Something moving inside facemask length about 5-6cm size about 1/2cm-
literally crawled out from mouth and nose.
“Nurse,can get me forceps satu x?”
Pulling out those worms from frothy saliva inside facemask and one from below tongue.
“Prep it inside biohazard bag”
Hello Dr ******,Dr Faruq dri ED,sy nk update i pt,i just got referral from Hosp G******
Patient was stable under FM but
But he just literally coughing up worms .
i thinks its “Severe ascaris lumbricoides infestation with suspected pulmonary migration”
Read : Ascariasis
“ok i come down to ED now”, said paediatrician on the phone.
Actual size and length of the “worm”
This sample was plucked from mouth of the patient himself
“Googled image of ascaris lumbricoides”
This story end up with that boy actually an orang asli boy,4years old really have poor hygiene and never been deworminization.
Been in environment forest,lack of food hygiene,not wearing shoes/slippers around turn out to be infestation of ascariasis inside his belly.
lack of bowel motion might suspected heavily infestation of worm inside his belly causing food unable to be pass out. Cachexic looking because of lack nutritional intake.Absorbed by worm instead of body.
In this case we treat him with high dose albendazole and IV Cefotaxime for pneumonia part- based on paediatrician.
Moral of story :children above 1 years old and below 5 should be given syrup albendazole at least once in their life.Our Klinik Kesihatan procide this medication.
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