MEDICAL EMERGENCIES IN PARASITIC DISEASES Prof.Dr. Manar M.S. El-Tonsy By Prof.Dr. Manar M.S. El-Tonsy Parasitology Department, Faculty of Medicine Ain shams University

Although parasitic diseases usually present with chronic manifestations, yet sometimes an emergency may set in and necessitates immediate intervention without procrastination. All systems are liable to be involved; 1- Gastrointestinal system 2- Nervous system 3- Cardiovascular,……. etc

GASTROINTESTINAL EMERGENCIES Variceal haemorrhage in schistosomiasis can be serious and even fatal. (video- oesophageal varices)

Intestinal obstruction may occur in cases with heavy ascariasis. Strongyloidiasis may cause intestinal obstruction in hyperinfection syndrome. (video on operation of removing Ascaris worms from intestines)

Rupture of hydatid cyst Hydatid cysts of the liver exert pressure on the surrounding parenchyma, and in approximately one-fourth of the cases, due to higher pressure in the cyst, the cysts eventually leak or rupture leading to anaphylactic shock.

Acute appendicitis can be caused by: 1- Enterobius vermicularis. 2- Trichocephalus trichiurus 3- Migrating Ascaris worms 4- Entamoeba histolytica

Acute cholangitis Fasciola worms, Clonorchis and Opthorchis may cause cholangitis and cholangiectatic abscess. Intrabiliary rupture of hydatid cyst. It occurs into the right duct in 55–60% of cases, into the left duct in 25–30% and rarely into the gall bladder. Obstructive jaundice: Fasciola worms may cause biliary obstruction leading to obstructive jaundice. Migrating Ascaris worms may obstruct the bile duct. Pancreatitis may be caused by the obstruction of ampulla of Vater by an adult Ascaris worm.

DEHYDRATION A dual infection with Cryptosporidium parvum and microsporidia in an AIDS patient is common. In a compromised patient, the diarrhea can be quite severe and prolonged, with tremendous fluid loss and eventual death. In patients with AIDS, isosporiasis can vary from a chronic and intermittent illness to a severe and life-threatening diarrheal illness.

Acute peritonitis 1- Intraperitoneal rupture of amoebic liver abscess. 2- In schistosomal hepatospleneomegaly, ascites may be superimposed by bacterial peritonitis 3- Ascaris worms may cause intestinal perforation leading to peritonitis. Also, in Strongyloides hyperinfection in immuno-compromised patients, intestinal perforation and peritonitis may occur. 4- Rupture hydatid cyst into the peritoneal cavity. (video-Endoscopy of the intestine - moving Ascaris worm)

Patient with amoebic liver abscess, with perforation of abscess through abdominal skin

CARDIOVASCULAR EMERGENCIES: Chagas' disease may cause arrhythmia in the form of ventricular fibrillation , congestive heart failure, or even embolic phenomena (cerebral, pulmonary, mesenteric, etc). The most serious results of hookworm infection are the development of anemia and protein deficiency caused by blood loss. Severe hookworm disease can cause congestive heart failure.

In heavy Trichinella infections, the inflammation may cause cardiac (myocarditis, heart failure & arrhythmia). Death may result from myocarditis or encephalitis. Capillaria philippinensis infection may be associated with protein and electrolyte loss especially potassium leading to arrhythmia. Death may occur as a result of heart failure, low electrolytes, or secondary bacterial infections.

Neurological emergencies Cerebral malaria (video-cerebral malaria) Toxoplasma encephalitis, especially in HIV patients Neurocysticercosis (video) Amoebic brain abscess Tick paralysis ( 2 videos: tick paralysis & How to remove ticks) Hydatid cyst in the brain (video-operation to remove hydatid cyst from the brain)