Fever Without An Obvious Source

Intestinal helminth infections include ascariasis, hookworm, Trichuris infection, Enterobius infection and other nematodes. Transmission is favoured by inadequate sanitation, contaminated soil, poor hand hygiene and, for some species, ingestion of contaminated food.

Disease burden ranges from asymptomatic carriage to anaemia, malnutrition, intestinal obstruction and impaired growth.

• Abdominal discomfort
• Reduced appetite
• Diarrhoea or altered stool pattern
• Poor growth
• Iron deficiency anaemia, particularly with hookworm
• Perianal nocturnal itching with Enterobius
• Passage of worms in stool

Heavy Ascaris infection can cause intestinal obstruction, biliary migration or pancreatitis.

• Stool microscopy for ova and parasites is useful when species identification is necessary.

• Enterobius is better detected using an early morning perianal adhesive tape test.

• FBC may show eosinophilia or iron deficiency anaemia.

• Imaging is required when obstruction or hepatobiliary migration is suspected.

For common soil transmitted helminths:

• Albendazole 400 mg PO as a single dose in children aged 2 years or older.

• Albendazole 200 mg PO as a single dose in children younger than 2 years where treatment is indicated.

Alternative:

Mebendazole 100 mg PO twice daily for 3 days or 500 mg once according to age and formulation.

Treat associated iron deficiency and nutritional deficits.

Intestinal obstruction from a heavy worm burden requires bowel rest, fluid correction, surgical assessment and careful timing of antihelminthic treatment rather than simply administering medication immediately.