|Year : 2014 | Volume
| Issue : 6 | Page : 787-789
A case of coinfection of Ascaris lumbricoides and Vibrio cholerae in a 3-year old child
Trupti Bajpai1, Ganesh S Bhatambare1, Neelesh Gagrani2, Vikrant Chitnis1
1 Department of Microbiology, Sri Aurobindo Institute of Medical Sciences Medical College and PG Institute, Indore, India
2 Pediatric Consultant, Gagrani Hospital, Dewas, Madhya Pradesh, India
|Date of Web Publication||18-Nov-2014|
Department of Microbiology, Sri Aurobindo Institute of Medical Sciences Medical College and PG Institute, MR-10 Crossing, Indore-Ujjain Road, Indore, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
A 3-year-old male child presented with multiple episodes of diarrhea and vomiting. Several adult worms of Ascaris lumbricoides were passed in the stool and vomit. Stool was examined and the coexistence of Vibrio cholerae bacteria and Ascaris lumbricoides parasite was confirmed.
Keywords: Ascaris lumbricoides, diarrhea, Vibrio cholerae
|How to cite this article:|
Bajpai T, Bhatambare GS, Gagrani N, Chitnis V. A case of coinfection of Ascaris lumbricoides and Vibrio cholerae in a 3-year old child. Med J DY Patil Univ 2014;7:787-9
|How to cite this URL:|
Bajpai T, Bhatambare GS, Gagrani N, Chitnis V. A case of coinfection of Ascaris lumbricoides and Vibrio cholerae in a 3-year old child. Med J DY Patil Univ [serial online] 2014 [cited 2021 Jan 16];7:787-9. Available from: https://www.mjdrdypu.org/text.asp?2014/7/6/787/144884
| Introduction|| |
Diarrheal diseases are one of the most common categories of life-threatening diseases for children in developing countries. These can be caused by several different pathogenic organisms. Despite the high prevalence of Ascaris infection in areas where diarrhea is common, there are surprisingly few reports on the effects of coinfection with Ascaris on diarrheal diseases. 
Helminthic infections, even when asymptomatic, contribute to malnutrition, anemia and decreased immunity to other infections. Diagnosis and treatment of intestinal helminthiasis is therefore essential from a public health standpoint. However, diagnosis is usually missed due to infrequent coprological surveys and use of insensitive methods of diagnosis. Subsequently, helminthiasis may manifest itself when complicated by a second process, resulting in diarrhea. This may confuse clinicians who may falsely attribute acute infectious diarrhea to these helminths.
We present a case of helminth infection that became amenable to diagnosis after a second process producing greater intestinal motility intervened. It was successfully managed within a reasonable period of time.
| Case Report|| |
A 3-year-old male child presented with a 1-day history of loose motions (6-7 times/h, greenish yellow, watery, foul-smelling, no blood, no pus and no worm) and vomiting (5-6 episodes, non-bloody, non-bilious and non-projectile containing two worms of 10 cm each, which his attendants brought with them as a sample). On admission, the child was dull, lethargic, severely dehydrated and had sunken eyes. No history of fever, burning micturition, abdominal pain and passage of worm or worm segment in stool was reported. However, in the next few hours of admission, there were 15-20 episodes/h of rice watery, non-foul smelling stool. Three worms were also passed in the stool. On examination, the child was emaciated, weighing 9.5 kg, dehydrated and had no cyanosis or icterus. He had a pulse of 104 beats/min, blood pressure of 94/68 mmHg, respiratory rate of 32 breaths/min and temperature of 98.4 o F. His vitals were normal. Systemic examination, ultrasonography of the abdomen and chest X-rays were also normal.
According to the patient's clinical condition and severity of diarrhea and dehydration, the cause of gastroenteritis was suspected to be cholera. The patient was kept on intravenous fluid. Blood, stool sample and the worms were sent for laboratory examination.
Laboratory results revealed: Hemoglobin:10.7 gm%, total leukocyte count: 11,000/cu mm and differential leukocyte count: Polymorphs −63%, lymphocytes −33%, monocytes −3%, eosinophils −01% and basophils −0%. The liver and renal function tests were within normal limits. The worm was identified in the laboratory as Ascaris lumbricoides [Figure 1]. On gross examination, the stool was whitish in color and watery in consistency. The stool was processed for hanging drop preparation and a darting motility of a Vibrio cholera-like organism was seen after enrichment in alkaline peptone water. An aerobic stool culture revealed the growth of Vibrio cholera. A large number of fertilized and few unfertilized eggs of Ascaris lumbricoides were seen in routine microscopy [Figure 2].
|Figure 1: Ascaris lumbricoides worms passed by the patient in vomit and stool (one female and four male worms)|
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|Figure 2: Fertilized egg of Ascaris lumbricoides passed in the stool of the patient|
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The patient was started on doxycycline and mebendazole.  The condition was under control in 72 h and the patient was discharged home within the next 48 h after giving advice for personal and food hygiene.
| Discussion|| |
Parasites travel together, but parasites and bacteria may coexist as well. Cholera is caused by a gram negative bacterium, Vibrio cholera, which causes five million cases of cholera annually.  Transmission occurs through contaminated water. Diagnosis is made by identification of dartingly motile bacteria in the rice watery stool followed by stool culture.
Ascariasis is caused by an intestinal roundworm, a geohelminth, Ascaris lumbricoides. It affects greater than 1.5 billion worldwide. The Ascaris are soil-transmitted nematodes with a life cycle that involves no intermediate host or vectors. Infection occurs through fecal contamination of soil, food and water. Ascaris Lumbricoides, although harmful to the gastrointestinal mucosa, has migratory behavior and can cause obstruction in the gastrointestinal lumen. , Diagnosis is made by identifying the worms or eggs in the stool. Both Vibrio cholerae and Ascaris lumbricoides can coexist in children, and have been reported in South Asia.  Our case was also of a 3-year-old (pre-school) child.  The wide and unrestricted spread of infection is attributed to poor socioeconomic class, poor personal and environmental sanitation, overcrowding, limited access to clean water, tropical climates, low altitude, geophagia, presence of pools or water and sewage around houses and forced or unforced habit of kids to defecate in the bushes.  Our case report strongly correlates with the socioeconomic status and habitat of the infected child. The source of infection could be contaminated food and water.
Diarrheal pathogens potentially alter the impact of Ascaris infection through the modification of the luminal environment of the host gastrointestinal tract and through the generation of strong pro-inflammatory immune responses.  Alterations in mucus production, peristalsis and nutritional availability may affect adult longevity in the gut. As a consequence of the mechanisms activated to flush out the diarrheal pathogen, Ascaris cannot maintain its position in the gut and gets flushed away. 
In our case also, a patient hailed from a developing country and had harbored helminth infections before presentation. This is obvious when the malnutrition condition in the child is considered.  Although Vibrio cholerae was responsible for the acute gastrointestinal infection, helminth was the first pathogen to be diagnosed on a routine basis. It should be emphasized that the case could have been falsely attributed to a helminth infection if the laboratory tests were not pursued further. It follows that for acute gastroenteritis, when helminths are recovered, coinfecting pathogens should be actively looked for. The above case also highlights the need for diagnosis and treatment of asymptomatic helminth infection in a developing country like India. 
Proper education on hygienic habits and sanitation should be provided and regular deworming exercises, especially at pre-school and primary school levels, coupled with legislation against indiscriminate disposal of feces and its endorsement, should be carried out. 
| Acknowledgement|| |
The authors wish to thank the Chairperson and Dean of the institute for providing laboratory facilities and a healthy working atmosphere during the study period. The authors are also thankful to the technical staff of the institute for providing the necessary helping hand during the endeavor.
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[Figure 1], [Figure 2]