Enteric Parasites

Fuentebella, Judy; Fridge, Jacqueline; Bass, Dorsey M.

doi:10.1016/b978-1-4377-0774-8.10040-5

Cited by 2 publications

(2 citation statements)

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“…7 Whipworm is roughly 4 cm in length, pinkish-gray, and is named for its thin anterior part, which is shaped like a whip and used to attach to the bowel. 7,8 None of these descriptions match the dark substances found in this patient's stool. Ascaris lumbricoides worms are quite large (15-40 cm), white or pinkish in color, and resemble earthworms.…”

Section: Discussionmentioning

confidence: 85%

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Banana Fibers Masquerading as Worms in the Stool of a 14-Month-Old Girl

Young

2014

Clin Pediatr (Phila)

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A 14-month-old girl with no past medical history presented to the pediatric emergency department with diarrhea for the previous 9 days. On the first day of illness, she had vomiting that resolved on that day. On the second day of illness, she had a fever of 101.9°F but had been afebrile since. Her mother noticed small streaks of blood in the diarrhea on the fifth day of illness that resolved by the following day. She was brought to the emergency department because the patient's mother noted dark brown and black thread-like substances in the stool starting 2 days prior. Mother was concerned that these were worms and reported that she saw them moving in the stool. She presented a dirty diaper ( Figure 1). The substances noted in the stool were still. Mother denied any recent changes in the patient's diet. When asked if anyone else cared for her, mother stated that the patient's grandfather watched her in the mornings. Mother was asked to call grandfather to inquire about any changes in the patient's diet while she was under his care. Over the phone, grandfather stated that he had been feeding her several slices of banana each morning during the illness.In the emergency department, the patient was afebrile with a temperature of 98.5°F, and the remainder of her vital signs were normal. On examination, the child was playful and interactive. Her abdomen was nontender and not distended. There were no anal fissures visible and no rash in the diaper area.Stool was sent to the lab for ova and parasite and culture. Examination for ova and parasite was negative. The thread-like substances in the child's stool were taken to the clinical lab, examined under a microscope and compared with a sample taken from a banana from the hospital's cafeteria. The two samples showed an identical structure except for color (Figure 2). Stool culture was positive for Campylobacter jejuni, and the child's mother was contacted to bring her back to the emergency department 2 days after the initial visit. At that time, she was well appearing, but had continued diarrhea, so she was treated as an outpatient with a 3-day course of azithromycin. DiscussionDescriptions of banana fibers in the stool mimicking worms appear surprisingly early in the medical literature. Walter Bierring described the identification of banana fibers in the stool of a 5-year-old child suspected of having tapeworm 111 years ago by preparing a sample of the child's stool and a separate sample of a banana with potassium hydroxide and examining both under a microscope. 1 This was the method used in the case presented above. More modern descriptions are infrequent. One report described the identification of banana fibers in the setting of a parent concerned for black worms in a child's stool in a pediatric clinic. 2 Banana fibers have been recovered at endoscopy by a gastroenterologist who initially mistook them for worms. 3 This information is not available in medical textbooks. A computer-driven search Figure 1. The child's diaper.

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Section: Discussionmentioning

confidence: 85%

“…Ascaris lumbricoides worms are quite large (15-40 cm), white or pinkish in color, and resemble earthworms. 7,8 None of these descriptions match the dark substances found in this patient's stool.…”

Section: Discussionmentioning

confidence: 85%