|It's a wormy world||Aug. 23, 2008|
|Provided by: Sun Media|
|Written by: DOCTOR GIFFORD-JONES|
Suppose you passed a worm one foot long!
In medicine, it might be said trivial decisions can cause needless deaths.
The Canadian Medical Association Journal reports that a 22-year-old woman, who had been in good health, was examined due to a four-day history of hemorrhagic lesions on both legs. During that time the lesions had been increasing in number.
She stated that neither she nor her family had experienced previous bleeding problems. Nor was she taking medication that could have triggered the bleeding.
Examination showed her temperature was normal. Cardiovascular, respiratory and abdominal exams were normal. And there was no evidence of physical trauma.
Doctors in Canada were not sure of the diagnosis. But initially they believed that blood within the patient's vessels was clotting for unknown reasons. They decided, in view of her trip to Peru, that they would use Medline and Google Scholar to find a diagnosis. They discovered that two species of caterpillar could cause symptoms of this kind.
Unfortunately, when they contacted the local poison control centre, it had no knowledge of such a reaction. But they did contact doctors in Brazil who recommended a locally produced antivenin. This, however, did not arrive in Canada for 48 hours.
FATAL ORGAN FAILURE
During the first two days in hospital the patient's condition remained satisfactory. But 12 hours later she developed acute kidney failure and went into shock. In spite of the antivenin from Brazil, the support of renal dialysis, mechanical ventilation of the lungs and several drugs, she died on the third day due to failure of multiple organs. All for the want of a shoe this young women was lost.
But, regardless of whether you wear shoes, it's always prudent to be a cautious traveller. For instance, don't go for a dip in the lakes and rivers of Caribbean islands. They often harbour schistosomiasis which infects the bladder, and causes bloody urine. Take your swim in the ocean. You've got a better chance with sharks!
Experts in tropical disease have known for years that we live in a wormy world. The U.S Centre for Disease Control reports that in rural areas of the world, nearly everyone has worms. They add that in North America, 25% of people are infected with Ascaris lumbricoides, which looks like an earthworm and can be a foot long.
I normally do not treat patients infected with worms. But, several years ago, a terrified patient arrived at my office having noticed one of these creatures in the toilet following a bowel movement.
Ascaris lumbricoides normally lives out its lifetime in the bowel, but on rare occasions it can migrate to the stomach or lungs, and provide another frightening experience when people cough up one of these worms. Fortunately, they do not multiply in the body and can be eradicated by drugs.
The best way to prevent this infection is to wash your hands as it is spread by fecal contamination.
And, if you're planning a trip to South America, be sure to pack shoes and wear them.
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