Pediatric emergency medicine trisk 2330 2330
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Asia, and Africa, the infection is also seen in the southeastern United States.
Patients present with itchy papules at the entry site with a migratory, raised,
erythematous, serpiginous pattern as the larvae migrate. The feet and buttocks
most commonly are affected. The parasites enter the bloodstream and have a
maturation phase in the lungs. With a large inoculation, eosinophilic pneumonitis
(Löeffler syndrome) can be seen. Eosinophilia can also be seen with invasive
enteritis, but is not a feature of isolated CLM. The diagnosis is clinical; biopsy is
not recommended, but pathology may demonstrate an eosinophilic infiltrate.
Serologies and EIAs are not commercially available. While usually a self-limited
disease, albendazole or ivermectin can be used for treatment. Patients with
substantial eosinophilia should be monitored for manifestations of mast cell
degranulation after treatment, and some may require corticosteroids along with
antiparasitic therapy. Contact precautions are recommended for the incontinent
child.
Filariasis
Filariases are mosquito-borne infections caused by the nematodes (roundworms)
Wuchereria bancrofti, Brugia malayi, or Brugia timori ( e-Table 94.25 ). The
incubation period ranges from 3 to 12 months depending on the species. W.
bancrofti ’s clinical manifestations include acute adenolymphangitis (ADL),
hydrocele, lymphedema, elephantiasis, chyluria, and tropical pulmonary
eosinophilia (TPE). ADL is characterized by malaise, fever, chills, and enlarged
painful lymph nodes, usually in the lower limb. Hydrocele (unilaterally or
bilateral) is the most common chronic manifestation of W. bancrofti. Chronic
lymphedema may progress to elephantiasis and typically involves the lower
extremities. Edema usually becomes nonpitting with skin thickening and loss of
skin elasticity. Secondary bacterial and fungal infections are common. Chyluria
is seen when dilated lymphatics rupture and drain into the urinary excretory
system. It is typically recurrent and lasts for days to weeks. TPE is the result of
immune hyperresponsiveness to microfilaria in the lung. Patients with TPE
typically present with nocturnal coughing and wheezing and extreme peripheral
eosinophilia (counts >3,000 cells/mm3). If left untreated, TPE may progress to
chronic interstitial fibrosis and permanent lung damage. Brugian filariasis
(caused by both B. malayi and B. timori ) is very similar to Bancroftian filariasis,
except that hydroceles, genital manifestations, and chyluria are less common,
and that the elephantiasis is usually limited to the lower legs in Brugian
filariasis.
