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Child healthcare: a learning programme for professionals
unusual parasites not normally seen in healthy children (e.g. Toxoplasmosis).
When you have completed this unit you should be able to:
11-2 Which are the common intestinal
In Southern Africa the common intestinal
• Diagnose and treat amoebiasis.
• Diagnose and treat bilharzia.
11-1 What are parasites?
These are small creatures (animals) which invade and infect (infest) the body. They may be either:
11-3 What is a roundworm?
External parasites which live on or in the
Roundworms are the most common parasites
found in the gut of children. The worms are
Internal parasites which live in the body.
Many internal parasites live in the bowel
long. They look like pale garden earth worms.
(i.e. intestinal parasites such as worms). Other parasites live in the blood (e.g.
Roundworms produce thousands of eggs a day
which are passed in the child’s stool (faeces).
The eggs have a very characteristic shape and can be easily recognised if a sample of stool is examined under a microscope.
A large bunch (bolus) of worms can cause colic (cramping abdominal pain) and even
Roundworms are the most common bowel
parasite in many poor countries.
of worms may be palpable on abdominal examination.
The roundworm is Ascaris lumbricoides
Migrating worms can get stuck in the bile
Infection with roundworms is called ascariasis.
duct, resulting in acute, severe pain over the liver (biliary colic).
11-4 How do children get roundworms?
Roundworms can also cause bowel
If human faeces are not disposed of in a
perforation, volvulus, intussusception, colangitis
hygienic way, or if sewerage sludge is used as
and pancreatic duct obstruction. With heavy
a garden fertiliser, children can swallow and
infections, bunches of roundworms can be
get infected by roundworm eggs. Roundworm
seen in a plain abdominal X-ray. Do not give mebendazole or albendazole if acute abdominal
eggs can survive in soil for years. Playing or
pain is present as treatment increases the worms’
crawling in contaminated soil or eating raw
tendency to migrate and may precipitate bowel
vegetables that have not been washed may
obstruction. Surgery must be considered if there
result in infection. High prevalence rates are
common in communities with poor sanitation. This is a major public health problem in many
11-6 How can roundworms cause chest
Roundworm eggs hatch in the child’s small
The larvae (which hatch out of the eggs in the
bowel, and the newly hatched larvae then pass
gut) can causes respiratory symptoms and signs
through the bowel wall into the bloodstream
during the time that they are migrating through
and are carried to the alveoli of the lungs.
the lungs. Children with roundworm larvae in
From here they make their way up the bronchi
the lungs present with a dry cough or wheeze.
and trachea then get swallowed. In the small bowel the roundworm larvae mature into adult
A high eosinophil count in the peripheral
worms where they can live for 2 years.
blood (10% or more) is typical. Chest X-ray may show a pneumonitis.
11-5 Do roundworms in the gut cause
11-7 How are roundworms treated?
healthy and have no symptoms. Often the only way the parents know that their children
Mebendazole orally 100 mg (i.e. 1 tablet)
have roundworms, is when worms are seen in
twice a day for 3 days if below 5 years and
the stool. Sometimes worms can be vomited.
500 mg as a single dose if 5 years or older.
When the child is ill with a fever, roundworms
may make their way up the child’s oesophagus
tablets) for children below 2 years and 400
Large numbers of worms in the bowel can cause problems:
11-8 How can infection with roundworms
(adequate sanitation), e.g. water borne sewerage or correctly built pit latrines
By washing raw vegetables before they are
11-11 What are the clinical features of
Whipworms usually infect children over 5
years of age. If the infection is light there are
usually no symptoms or signs. Heavy infection
11-9 When is deworming recommended?
Rectal prolapse may occur with very heavy
for children between the ages of 2 and 5
infections. With prolapse, the worms may
years in communities with poor hygiene and
be seen attached to the rectal mucosa.
inadequate sanitation (poor toilet facilities).
This should be done even if there is no history
blood loss in the stool. This may be severe.
of roundworms in the stool. Medication is
usually given at the local primary care clinic or in schools. Deworming has been found to
Whipworm infection can cause iron deficiency
improve the learning capacity and growth of
11-12 What is the treatment of whipworm
for deworming is the same as for treating roundworms. Both these drugs are highly
1. Prevention through good hand hygiene,
washing raw vegetables and the correct disposal of human faeces (as with prevention of roundworms)
Regular deworming of young children is
2. Mebendazole or albendazole, as given for
recommended in communities where roundworms
3. Treat iron deficiency anaemia with oral iron.
11-13 What are pinworms?
11-10 What are whipworms?
Pinworm infection is very common. They are
small, thin worms (about 4 cm long). Pinworms
of children in Southern Africa. They are
are especially common where children sleep
short, thin worms (about 4 cm) that attach
or play together in crowded conditions. Adult
themselves to the mucosa of the large bowel
female worms pass out the anus at night to lay
where they cause bleeding. It is rare to see the
eggs on the perineum. Eggs are swallowed from
contaminated fingers, clothing or bed linen.
(swallowed) with soil. The eggs hatch in the
and sanitation are of a high standard. They are
child’s gut and the larvae attach to the bowel
wall. Unlike roundworms, the larvae do not
The pinworm is Enterobius vermicularis
The whipworm is Trichuris trichura
. The eggs
in the stool have a typical ‘tea tray’ appearance.
11-14 What are the clinical features of
11-18 What are the clinical features of
Perianal itching and scratching at night. This
Usually, there are no symptoms unless there
may cause loss of sleep. Secondary infection
is heavy infection. The child may have an
of the scratched skin is common. In girls the
unusually large appetite and want to eat sand.
worms may enter the vulva causing irritation
In severe cases there may be signs of iron
Pinworm infection presents with perianal itching
11-19 How is hookworm infection
and scratching, especially at night.
Worms and their eggs may be found in the stools.
11-15 How is pinworm infection
11-20 What is the treatment of hookworm
The clinical diagnosis can be confirmed by the
parent finding the small worms on the skin around the anus at night. A piece of sticky tape
(Sellotape) should be placed against the anus
and surrounding skin during the night and then
Pyrantel (Combantrin) orally 10 mg/kg as a
immediately removed. In this way eggs can be
collected and identified under a microscope.
11-16 What is the treatment of pinworms?
Mebendazole or albendazole, as used for roundworms
11-21 What are tapeworms?
human gut are the pork and, to a lesser degree, the beef tapeworm. They are very long (up to 5 metres) segmented worms that grow
11-17 What are hookworms?
in the small bowel of humans after eating uncooked or partially cooked meat, which is
contaminated with tapeworm cysts. Tapeworm
segments filled with eggs are excreted in
poor sanitation, hookworm eggs in the stool
by animals (pigs or cows). The eggs hatch
contaminate the soil and hatch rapidly. They
in the animal’s gut and are carried in the
then infect the feet of barefoot children. Once
bloodstream to the muscles of the animals
the skin is penetrated, hookworms behave like
where they become tapeworm cysts. Eating
roundworms as they enter the bloodstream
infected, uncooked meat of these animals
and travel via the lungs to get into the small
completes the life cycle of the tapeworm when
bowel. The worms attach to the bowel mucosa
the eggs hatch, resulting in adult worms living
There are two types of hookworm, Ancylostoma duodenale
and Necator americanus
Most tapeworms result from eating poorly cooked
pork which is infected with tapeworm cysts.
The pork tapeworm is Taenia solium
are a common cause of fits in children that live
beef tapeworm is Taenia saginata
in rural areas where toilets are not available. Good sanitation, safe water, hand-washing
11-22 How is tapeworm infection
and washed vegetables will reduce the risk of
Small segments of the worm are seen in the stool or may be found in the bed. Often there
Swallowed pork tapeworm eggs from human
are no other symptoms. However, tapeworms
faeces result in tapeworm cysts in the brain.
can cause abdominal discomfort, failure to thrive and loss of appetite.
The tapeworm cysts (cysticerci) are best
identified in the brain by MRI or CT scanning.
11-23 What is the treatment of tapeworm
With time they become calcified and can be
seen on X-ray. Cysts may also occur in muscles. Antibody tests are of little help. Treatment of
Mebendazole orally 100 mg twice daily for 7
neurocysticercosis in hospital is with steroids and
11-24 How can tapeworm infection be
If possible, animals should be slaughtered in a registered abattoir where all meat is inspected
11-26 What is hydatid disease?
to ensure that it is not infected by tapeworm cysts. Cooking meat well kills the cysts.
This is caused by the dog tapeworm which
Therefore, avoid eating raw or partially cooked
can occur in the gut of dogs. Eggs, which are
meat. Meat lightly cooked on an open fire may
passed in the dog’s stool, may be swallowed
by sheep and goats, resulting in tapeworm cysts in their muscles. Other dogs can then
be infected with tapeworms by eating the raw
so that it cannot be eaten by pigs. This will
prevent the pigs from becoming infected with tapeworm cysts. Parts of the Eastern
If eggs of the dog tapeworm are swallowed by
Cape of South Africa are particularly heavily
humans instead, the eggs hatch in the human
gut and are carried by the bloodstream to the liver or lung where they form large cysts (hydatid cysts). These large cysts may cause
In villages, pigs must be prevented from eating
clinical problems (hydatid disease) and will
11-25 Can tapeworm cysts enter the brain?
they should not be allowed to eat raw meat,
Yes. Sometimes the eggs of the pork tapeworm,
which have been passed in human faeces, are
infected with the cysts of the dog tapeworm.
swallowed by other humans (instead of by pigs)
Prevent children eating soil as it may be
in food or water contaminated by infected
human faeces. The eggs hatch in the child’s
Always wash hands before eating. Also wash
gut and are then carried by the bloodstream
into all parts of the body including the brain. In the brain they form many small tape worm
Hydatid disease results when children swallow
cysts (neurocysticercosis) which cause fits
the eggs of the dog tapeworm.
(convulsions). Tapeworm cysts in the brain
Treatment is with mebendazole or albendazole
11-29 What is the treatment of giardia
The dog tapeworm is Echinococcus
Metronidazole (Flagyl) 500 mg (under 4 years)
or 800 mg (4 years or older) daily for 3 days.
The prevention, diagnosis and treatment of
It is best to avoid infection with giardia by sandworm infection is discussed in Unit 12.
not drinking contaminated water or eating unwashed vegetables or salad.
11-27 What is giardiasis?
11-30 What is amoebiasis?
Giardiasis is an infection with a single-celled
Amoebiasis is an infection caused by a single-
organism (protozoa) called giardia. The cysts
celled organism (protozoa) called an amoeba
of giardia are swallowed in contaminated food
or water. Giardia lives in the small bowel and
are passed in the stool from where they can
cysts are passed in the stool. The cysts in human
contaminate food or water causing infection in
stools contaminate the soil and nearby water.
others. Therefore, the provision of toilets and
NOTE Giardia lamblia
is the cause of giardiasis.
a safe water supply are important to prevent amoebiasis.
11-28 What are the clinical features of
NOTE Entamoeba histolytica
is the amoeba which
Giardiasis is usually asymptomatic. However, with heavy infection the child develops loose,
11-31 What are the clinical features of
Mild infection is asymptomatic. However,
the infection resolves in a few days but it may
heavy infection causes abdominal discomfort
become chronic. Chronic giardiasis may cause
and dysentery with blood and mucus in the
chronic diarrhoea with malabsorption leading
stools. Amoebae can also cause abscesses in
to failure to thrive and malnutrition.
the liver. This presents with an enlarged tender
It is difficult to confirm the diagnosis by
liver. Severe bowel infection can result in
finding cysts in the stool. Therefore, diagnosis
is usually suspected from the clinical history
and confirmed when the symptoms and signs
warm stool. A blood test for antibodies against
amoebae is useful in identifying patients with amoebiasis.
Giardiasis can cause chronic diarrhoea and failure
11-32 What is the treatment of amoebiasis?
Metronidazole (Flagyl) 200 mg 3 times daily
Giardia is a common cause of ‘travellers’
for 5 days. All children with severe dysentery
or suspected liver abscess must be referred urgently. A large liver abscess may need to be aspirated.
Clean water, washing hands before eating,
avoiding unwashed vegetables and salads, and
the safe disposal of human faeces prevents
It is important that parents are aware of the
clinical features of infection with intestinal parasites and can recognise the worms if they
11-33 How can infection with many types
of intestinal parasite be prevented?
The same basic steps are needed to prevent most intestinal parasites:
11-35 What is bilharzia?
correctly-made pit toilets (VIP toilets). Never pass urine or stool near a stream or
Bilharzia (schistosomiasis) is a disease caused
by the bilharzia parasite. About 2 million people
are infected with bilharzia in South Africa.
There are 2 forms of bilharzia. One affects
the bowel while the other affects the bladder.
3. Always use a clean, safe source of water for
Bilharzia of the bladder is the most common
form of bilharzia in children in South Africa.
Eggs of the bladder parasite are passed in the
urine. If the urine reaches a source of water,
the parasite can infect and multiply in a special
snail often found in pools, dams, reservoirs,
6. Prevent pigs from eating human faeces.
canals or slow flowing streams. Parasites
7. Do not leave dog faeces lying around.
released from the snail can penetrate the skin
Public awareness campaigns are an important
of humans. From here the parasites enter the
method of reducing the number of infected
bloodstream and are carried to the bladder.
children. Methods of preventing infection
Sometimes they may also reach other organs.
with intestinal parasites should be taught and
inflammation, bleeding and eventually scarring. Damage can extend to the rest of the
Safe toilets and clean water will prevent infection
urinary tract, resulting in urinary obstruction
with most intestinal parasites.
Bilharzia (schistosomiasis) is caused by either Schistosoma haemotobium
(bladder parasite) or
11-34 What is the treatment of intestinal
Most intestinal parasites can be effectively
Bilharzia of the bladder is common in South
treated with oral mebendazole or albendazole.
Some require a single dose (roundworms, whipworms and pinworms) but others need a daily dose for a number of days (tapeworms).
11-36 What are the clinical features of
bilharzia of the bladder?
treated with metronidazole (Flagyl).
At the time of infection an itchy, papular rash
Regular treatment of children (e.g. deworming
may occur at the site where the parasites enter
for roundworms) is advised for some intestinal
the skin (called ‘swimmers’ itch’). This may be followed a few weeks later by a flu-like illness.
parasites is often asymptomatic. With more severe infection, the classical sign is terminal haematuria (blood seen in the urine towards
11-40 What is malaria?
Malaria is a serious illness caused by a malaria parasite which is transmitted to humans by a
Bilharzia of the bladder usually presents with
special type of mosquito. When a mosquito
bites an infected person, human blood containing malaria parasites is taken in by the
Bilharzia of the bowel may cause dysentery.
mosquito. The mosquito becomes infected (but not ill) and can then bite and infect other
11-37 How is the diagnosis of bilharzia of
humans. In the human, the malaria parasite
the bladder confirmed?
infects both red cells and the liver. Infection of the red cells causes haemolysis, resulting
By finding the typical bilharzia eggs in the
in anaemia. It also causes the red cells to stick
urine under a microscope. It is best to collect
together which obstructs small blood vessels.
Malaria is a common cause of chronic illness
released. A blood test for antibodies to the
and death in many low lying regions where
Eosiniphilia in the blood is usually present
Malaria is an important cause of death in many
parts of southern Africa.
11-38 What is the treatment of bilharzia?
Praziquantel 40 mg/kg orally as a single
As falciparum malaria is by far the most
dose. This treatment can be given at a clinic.
common form of malaria in South Africa, other
Unfortunately, children who live in a bilharzia
rarer forms of malaria will not be considered.
region may have to be treated repeatedly for
Almost all malaria in Southern Africa is
caused by Plasmodium falciparum
which is transmitted by female Anopheles mosquitoes
11-39 How can bilharzia be prevented?
Every effort must be made to prevent bilharzia infection. Never pass urine into a stream or
11-41 What are the clinical signs of
pool of water. Standing or slow-moving water
such as farm dams and irrigation furrows are
The patient develops an acute illness with
the home of the bilharzias snail, especially
fever, shivering rigors and flu-like symptoms
in the eastern areas of South Africa and in
1 to 2 weeks after being bitten by an infected
Zimbabwe. Fast-moving streams are usually
mosquito. Headache, nausea and body pains
safe. Swimming or bathing in infected water
are common in uncomplicated (mild) malaria.
must be avoided as this is the common way of
The symptoms and signs of malaria are very
getting bilharzias. Efforts are being made to
non-specific, making the clinical diagnosis
Do not swim in standing water where there are
drowsiness suggest the development of severe
malaria. Mild malaria may become severe and even fatal within hours.
Infection of other organs such as the liver
(jaundice), gut (diarrhoea), lungs (respiratory
distress) and kidneys (oliguria with renal failure)
may occur. Massive haemolysis (blackwater fever)
Is not vomiting repeatedly, and is able to
area, or within 2 weeks of leaving a malaria
In uncomplicated malaria the parasite count
area, must be suspected of having malaria.
on a thin blood smear is less than 5%, i.e. less
Thinking of malaria is the most important
than 5% of red cells containing malaria parasites.
step in the clinical diagnosis. As the clinical
In severe malaria the patient may have any of
symptoms and signs of malaria are very varied,
it is always important to confirm the clinical suspicion. There are often no clinical signs at
Hypoglycaemia, jaundice or severe anaemia (Hb less than 5 g/dl)
Suspect malaria in anyone with a flu-like illness
who lives in or has recently visited a malaria
In severe malaria the parasite count is well
11-42 How is the diagnosis of malaria
over 5% (hyperparasitaemia). The higher the
count, the more severe the malaria. Metabolic acidosis may occur.
1. Seeing the malaria parasites within red
11-44 What is cerebral malaria?
the traditional ways of confirming the diagnosis. Repeated smears may be needed
This is the most dangerous complication of
severe malaria as the brain is affected and can
may be negative early in the infection.
lead to rapid death. Young children, pregnant
2. A blood test to detect malaria proteins
women and people who are HIV infected are
(rapid antigen test) is also useful in making
particularly susceptible to cerebral malaria.
a rapid diagnosis. It is very reliable and
Signs of cerebral malaria must always be
diagnosis of malaria as soon as possible.
Depressed level of consciousness, i.e. drowsy, unable to stand, confused or
Most deaths due to malaria are caused by delayed
diagnosis or late treatment.
Remember that many other serious conditions
Confusion is an important sign of potentially fatal
may present with the same symptoms and signs as malaria, e.g. bacterial meningitis. Children
may also have malaria plus another infection.
In cerebral malaria the large numbers of
parasites obstruct the normal blood flow to the
11-43 How can you tell whether malaria is
uncomplicated or severe?
Is fully alert and able to stand and walk
11-45 How is uncomplicated malaria
In future intravenous artesunate will probably
replace quinine as it is safer. Rectal artesunate is also an effective emergency treatment.
Early and accurate diagnosis with urgent treatment using the correct drugs is the key
A loading dose of quinine 20 mg/kg diluted
to successful management. It is important
in 5% dextrose water (10 ml/kg) must always be
to differentiate uncomplicated from severe
given as a slow infusion over 4 hours and never as a bolus. This is followed by 10 mg/kg 8 hourly
malaria. If possible all patients with malaria are
intravenously. Change to oral quinine as soon as
referred to a hospital or clinic where the staff
are experience in treating malaria. They must be closely followed up for the first few days.
Patients with confirmed malaria are usually
uncomplicated and severe malaria is more
treated with coartemether (Coartem). Coartem
effective and less likely to result in resistance in
is a combination of two potent, rapidly acting
the community than monotherapy (one drug
anti-malarial drugs which are well tolerated.
only). The patient should improve clinically within 48 hours and the fever should settle
Coartem should be taken immediately, then again after 8 hours, followed by a twice daily
11-47 How is malaria prevented?
dose for the next 2 days. Each dose is 1 tablet if 10–14 kg, 2 tablets if 15–24 kg, 3 tablets if
1. Pregnant women and young children should
25–34 kg and 4 tablets if 35 kg or more. Best
not enter a malaria areas if at all possible.
evening and early morning. Therefore, stay
malarial treatment. Most strains of malaria
doors or wear light coloured clothes, long
are now resistant to chloroquine alone or in
sleeves and trousers with shoes and socks
combination with other drugs. Paracetamol
is best for reducing the fever. Make sure the
3. Use a bed net impregnated with insecticide
Uncomplicated malaria can also be treated with
4. Use insect repellent on the skin and clothes
oral quinine. However, there are some serious
or burn repellent coils or pads or sprays at
side effects of quinine, e.g. myocardial toxicity.
The dose of oral quinine is 10 mg/kg 8 hourly
for 7 days PLUS clindamycin 5 mg/kg 8 hourly for 7
recommended for short visits to a malaria
days or doxycycline (if over 8 years of age) 4 mg/kg
immediately then 2 mg/kg daily for 7 days.
6. By reducing the number of mosquitoes.
The quinine tablets are very bitter but can be
Preventing mosquito bites is more effective
crushed and taken with jam, or mashed banana.
than prophylaxis. Usually both are needed.
11-46 How is severe malaria treated?
Preventing mosquito bites is the most effective
way of avoiding malaria.
intravenous quinine PLUS oral doxycycline (if over 8 years) or clindamycin (oral,
11-48 What malaria prophylaxis is
children). Intravenous drugs must be started immediately and the patient urgently
Malaria prophylaxis is needed by all who enter
referred to hospital. Look for and manage
a malaria area (a region where malaria occurs),
hypoglycaemia, shock or convulsions.
even if it is only a one day visit. The risk of
becoming infected by malaria is particularly
CASE STUDY 1
high in the rainy season when mosquitoes are common. Full compliance is very important.
A mother brings her 5-year-old son to the
However, prophylaxis is never 100% effective.
clinic because he has passed 2 roundworms
with his stool. He is generally well but the
proguanil) for children of 10 kg or more. It
mother complains that he scratches his anus at
2. Mefloquine (Larium) for children of 5 kg
1. How do children get roundworms?
3. Doxycycline for older children (over 8
They ingest the roundworm eggs after playing in sand or soil. If human faeces are not
It is best for all children under 5 years,
disposed of correctly they can contaminate
especially children under 5 kg, not to enter a
soil in the village, garden or playground. Eggs
malaria area as they are at high risk for severe
can survive for years in soil and may also
infection. Chloroquine alone, chloroquine
contaminate pools of water or raw vegetables.
with proguanil, and Coartem should not be
This is a common public health problem.
Malanil daily ¼ tablet if 5–20 kg, ½ tablet
2. Can roundworms cause clinical
if 21–30 kg, ¾ tablet if 31–45 kg and 1 tablet if
over 45 kg starting one day before entering and stopping one week after leaving a malaria area.
Usually not. However, with heavy infections
Mefloquine weekly ¼ tablet if 5–20 kg, ½ tablet
if 21–30 kg, ¾ tablet if 31–45 kg and 1 tablet if
pain or discomfort and lose their appetite.
over 45 kg starting one week before entering and
Roundworms can cause bowel obstruction or
stopping 4 weeks after leaving a malaria area.
block a bile duct. The larvae of roundworms
Doxycycline 100 mg daily starting 1 day before
entering and stopping 4 weeks after leaving a
Seasonal Intermittent Treatment of children
3. How should this child be treated?
in malaria regions decreases the incidence of clinical malaria.
With a single oral dose of mebendazole or albendazole. The mother should be told how to avoid reinfection.
11-49 How can the number of mosquitoes
4. Is routine deworming recommended for
with the use of controlled spraying around homes with insecticides. This is done by
regions where roundworms are common.
5. What is a common cause of perianal itch
at night in children?
Malarial mosquitoes have become resistant
to many insecticides. The controlled use of DDT
Pinworms. These are short worms that infect
is very effective but remains controversial due to
the gut and leave the anus at night, causing
the risk of environmental pollution and dangers
irritation to the skin around the anus. They
to other animals and possibly the newborn infant.
can also cause a vaginal discharge in girls.
6. How can the diagnosis be confirmed?
5. Can tapeworms affect the brain?
A strip of Sellotape should be stuck onto the
Yes. If eggs of the pork tapeworm are passed
child’s skin over and next to the anus and then
in human faeces and then later get swallowed
immediately removed. Pinworm eggs will stick
by another human rather than a pig, they
to the Sellotape. These can then be seen under
can hatch in the gut of that person and then
a microscope. The treatment is the same as for
travel in the bloodstream to the brain where
they form many small cysts. This is called neurocysticercosis and usually presents with convulsions. Neurocysticercosis is common in
CASE STUDY 2
communities where there are pigs and human faeces are not disposed of safely.
A malnourished child from a rural village presents at the local clinic after passing a piece
6. What problems can be caused by the dog
of tapeworm in her stool. Pigs run free and eat
human faeces. There are also a number of dogs
If eggs of the dog tapeworm are ingested
by humans they hatch in the gut, enter the bloodstream and are carried to organs such as
1. What are the common types of
the liver and lungs where they grow into large
tapeworms in children?
(hydatid) cysts. Therefore it is important that
The pork or beef tapeworms. Pig tapeworms
children do not play in areas where dog faeces
are left to mix with the soil or pools of water.
Hydatid disease can be treated with oral daily
2. What is the clinical presentation of
Large cysts may have to be removed surgically.
Infected children are often asymptomatic. However, tapeworms can cause poor appetite,
CASE STUDY 3
abdominal discomfort and weight loss. This child’s malnutrition may be partly explained by the tapeworm.
A month after returning from holiday on a farm in the Eastern Cape, a 14-year-old child
3. How did this child get infected with a
presents with a 3-week story of loose stools,
and terminal haematuria for 2 days. While on holiday he swam in a farm dam.
Probably by eating uncooked or partially cooked pork. Tapeworm eggs get passed in the
1. What is the common cause of terminal
stool and then may be eaten by pigs if toilets
are not available. The eggs hatch in the pig’s gut and then travel in the bloodstream to the
muscles where they form cysts. If these cysts in
micturition is typical of bilharzia. The bilharzia
the meat are eaten by humans, they hatch out
parasite settles in the wall of the bladder where
it causes inflammation and bleeding.
4. What is used to treat intestinal
2. When did the infection probably occur?
When he swam in the farm dam. The special
Oral mebendazole twice daily for 7 days.
bilharzia snail is common in the eastern parts of South Africa where it lives in standing or slow-moving water such as farm dams or
irrigation furrows. If someone with bilharzia
indicates severe, probably cerebral malaria.
passes urine into the water the snails can
Malaria can progress from uncomplicated to
become infected. The parasites released from
the snails can then penetrate the skin of anyone walking or playing in the water.
3. How can the diagnosis be confirmed?
By examining a blood smear or performing a
3. Can bilharzia be treated?
Yes. It can be treated very effectively with praziquantel. It is best to first confirm the
4. What is the correct treatment?
diagnosis by seeing bilharzia parasites in a urine sample collected around midday.
She must be admitted to hospital urgently as
Chronic bilharzia infection can lead to damage
cerebral malaria can be fatal. She needs to be
of the urinary system causing renal failure.
treated with intravenous quinine plus either doxycycline or clindamycin. Uncomplicated malaria can be adequately treated with oral
4. What is the probable cause of the
Coartem provided the clinical diagnosis has
diarrhoea for the past 3 weeks?
The child may have a bowel infection with giardia, which causes diarrhoea. Although it
5. How can malaria be prevented while on
is often acute it may last for weeks or months.
Giardia is common where a safe water supply and adequate toilets are not present.
The only way to confidently avoid malaria is not to enter a malaria area. However, malaria can usually be avoided by making efforts not
5. Which drug is used to treat giardiasis?
to be bitten by mosquitoes and by taking
malaria prophylaxis. Insecticide impregnated bed nets are very effective. Also keeping indoors after sunset with mosquito screens on
CASE STUDY 4
the door and windows. Wear long trousers and sleeves, and shoes and socks if going out in the
Two weeks after returning from a malaria area,
evening or early morning, when mosquitoes
a 10-year-old child presents with headache,
shivering and vomiting. The mother gave her some paracetamol for the fever. A few hours
6. What malaria prophylaxis should be
later the child becomes confused and cannot
stand up. The family did not take malarial
prophylaxis because they planned to be in the
(Malanil) for children of 10kg or more, or
mefloquine (Larium) for children of 5 kg or more. Children over 8 years can also use
1. Do you think this child has malaria?
doxycycline. The medication must be taken
Yes. Malaria has an incubation period of 1 to
correctly, including for the correct period after
2 weeks and presents with fever and a flu-like
leaving the malaria area. Prophylaxis must be
2. How severe is the infection?
At presentation it was uncomplicated, with fever and vomiting. However, within hours she was confused and could not stand. This
Newsletter – Edizione del 15 marzo 2013 Redazione: Donatella Bucca; Francesco D'Aiuto; Luigi D'Amelia; Enrico V. Maltese Indirizzo: firstname.lastname@example.org SOMMARIO: A. EVENTI 1. "AFRICA-IFRIQIYA. CULTURES OF TRANSITION IN NORTH AFRICA BETWEEN LATE ANTIQUITY AND EARLY MIDDLE AGES" (ROMA, 28.02.-02.03.2013) 2. "LE STORIE DELL'ARTE. CONVERSAZIONI AL MUSEO DIOCESANO DI TERNI" (TERNI,
La noción del valor en la filosofía de Meinong1 Abstract: Aunque Meinong es conocido por defender una posición realista acerca de los valores, se hallan en su obra por lo menos tres concepciones diferentes de esta noción. El objetivo de este artículo consiste en analizar estas tres tesis diferentes acerca de los valores defendidas por Meinong a lo largo de su vida. Con este fin, ex