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Worm infestation as a cause of severe anemia in a frail older adult: a case report

INTRODUCTION: Worm infestations are a common occurrence in low-income countries. Anemia due to iron deficiency can be brought on by human intestinal worms. The authors report a case of an 86-year-old frail older adult with upper gastrointestinal (GI) bleeding caused by a worm infestation most likely...

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Autores principales: Shah, Suveksha S., Shah, Raju, Basnet, Rohan, Patel, Dhruvit, Bhattarai, Urza, Shah, Bhupendra, Sharma, Sanjib K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10553005/
https://www.ncbi.nlm.nih.gov/pubmed/37811116
http://dx.doi.org/10.1097/MS9.0000000000001171
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author Shah, Suveksha S.
Shah, Raju
Basnet, Rohan
Patel, Dhruvit
Bhattarai, Urza
Shah, Bhupendra
Sharma, Sanjib K.
author_facet Shah, Suveksha S.
Shah, Raju
Basnet, Rohan
Patel, Dhruvit
Bhattarai, Urza
Shah, Bhupendra
Sharma, Sanjib K.
author_sort Shah, Suveksha S.
collection PubMed
description INTRODUCTION: Worm infestations are a common occurrence in low-income countries. Anemia due to iron deficiency can be brought on by human intestinal worms. The authors report a case of an 86-year-old frail older adult with upper gastrointestinal (GI) bleeding caused by a worm infestation most likely to be hookworm. CASE PRESENTATION: An 86-year-old male, presented to the Emergency Department with complaints of bilateral lower limb swelling and shortness of breath for 4 days associated with melena for 2 months. The authors made a provisional diagnosis of heart failure precipitated by anemia. Upper GI endoscopy revealed multiple whitish exudates, which are resistant to water jets. Multiple worms were noted in the second part of the duodenum. Based on clinical evaluation and endoscopy, the diagnosis of oesophagial candidiasis and iron deficiency anemia secondary to upper GI bleeding due to Hookworm infestation was made. CLINICAL DISCUSSION: In low-income countries, especially those involving the tropical area, worm infestation should be considered as an important cause of obscure acute GI bleeding and severe anemia. Usually, malignancy is suspected in an older adult with severe anemia but hookworm infestation is a treatable disease with a good prognosis and complete recovery. The most commonly used drugs for treatment are mebendazole and albendazole. In a low-income country with a high burden of worm infestations, empirical treatment of iron deficiency anemia with single dose albendazole has been recommended. CONCLUSION: Usually, severe anemia in an older adult is mostly attributed to an underlying malignancy. Our case serves as a good example of how a treatable condition can improve the quality of life in a frail older adult. Normally, there is a tendency to defer UGI endoscopy in frail elderly due to ageism. However, the diagnosis of a treatable cause of upper GI bleeding can be made by a simple upper GI endoscopy. Severe anemia due to hookworm infestation is treated effectively and quickly with albendazole and iron therapy.
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spelling pubmed-105530052023-10-06 Worm infestation as a cause of severe anemia in a frail older adult: a case report Shah, Suveksha S. Shah, Raju Basnet, Rohan Patel, Dhruvit Bhattarai, Urza Shah, Bhupendra Sharma, Sanjib K. Ann Med Surg (Lond) Case Reports INTRODUCTION: Worm infestations are a common occurrence in low-income countries. Anemia due to iron deficiency can be brought on by human intestinal worms. The authors report a case of an 86-year-old frail older adult with upper gastrointestinal (GI) bleeding caused by a worm infestation most likely to be hookworm. CASE PRESENTATION: An 86-year-old male, presented to the Emergency Department with complaints of bilateral lower limb swelling and shortness of breath for 4 days associated with melena for 2 months. The authors made a provisional diagnosis of heart failure precipitated by anemia. Upper GI endoscopy revealed multiple whitish exudates, which are resistant to water jets. Multiple worms were noted in the second part of the duodenum. Based on clinical evaluation and endoscopy, the diagnosis of oesophagial candidiasis and iron deficiency anemia secondary to upper GI bleeding due to Hookworm infestation was made. CLINICAL DISCUSSION: In low-income countries, especially those involving the tropical area, worm infestation should be considered as an important cause of obscure acute GI bleeding and severe anemia. Usually, malignancy is suspected in an older adult with severe anemia but hookworm infestation is a treatable disease with a good prognosis and complete recovery. The most commonly used drugs for treatment are mebendazole and albendazole. In a low-income country with a high burden of worm infestations, empirical treatment of iron deficiency anemia with single dose albendazole has been recommended. CONCLUSION: Usually, severe anemia in an older adult is mostly attributed to an underlying malignancy. Our case serves as a good example of how a treatable condition can improve the quality of life in a frail older adult. Normally, there is a tendency to defer UGI endoscopy in frail elderly due to ageism. However, the diagnosis of a treatable cause of upper GI bleeding can be made by a simple upper GI endoscopy. Severe anemia due to hookworm infestation is treated effectively and quickly with albendazole and iron therapy. Lippincott Williams & Wilkins 2023-08-10 /pmc/articles/PMC10553005/ /pubmed/37811116 http://dx.doi.org/10.1097/MS9.0000000000001171 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Case Reports
Shah, Suveksha S.
Shah, Raju
Basnet, Rohan
Patel, Dhruvit
Bhattarai, Urza
Shah, Bhupendra
Sharma, Sanjib K.
Worm infestation as a cause of severe anemia in a frail older adult: a case report
title Worm infestation as a cause of severe anemia in a frail older adult: a case report
title_full Worm infestation as a cause of severe anemia in a frail older adult: a case report
title_fullStr Worm infestation as a cause of severe anemia in a frail older adult: a case report
title_full_unstemmed Worm infestation as a cause of severe anemia in a frail older adult: a case report
title_short Worm infestation as a cause of severe anemia in a frail older adult: a case report
title_sort worm infestation as a cause of severe anemia in a frail older adult: a case report
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10553005/
https://www.ncbi.nlm.nih.gov/pubmed/37811116
http://dx.doi.org/10.1097/MS9.0000000000001171
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