Page 174 - Medical Parasitology_ A Textbook ( PDFDrive )

14 Case Reports 167

Microscopic examination of the mouthpart was not clear and detailed enough to
allow specific species identification. For specific species characterization, the worm
was therefore, subjected to PCR which confirmed the hookworm species as
Ancylostoma ceylanicum.

Source: Ngui, Romano, Yvonne AL Lim, Wan Hafiz Wan Ismail, Kie Nyok Lim,
and Rohela Mahmud. “Zoonotic Ancylostoma ceylanicum infection detected by
endoscopy.” The American Journal of Tropical Medicine and Hygiene 91, no. 1
(2014): 86–8.

Learning Points
1. This report calls attention to the fact that, in areas where A. ceylanicum (cat and
dog hookworm) occurs, this worm can infect and reach maturity in human and in
heavy infections, may produce hookworm disease (in this case, the bleeding is
unlikely due to A. ceylanicum since only 1 worm was found on OGDS). Often,
this information is forgotten by practitioners who assume that all adult hook-
worms reported from humans are either Necator americanus or Ancylostoma
duodenale.
2. PCR aids in confirmation of the hookworm species.

Case 11: Enterobius vermicularis Salpingitis Seen in the Setting of Ectopic
Pregnancy
Case report: A 23-year-old woman in her second pregnancy at 8 weeks gestation,
presented to the Emergency Department, complaining of vaginal bleeding for 3 days
associated with pricking, nonradiating and progressively increasing suprapubic pain.
She did not have any vaginal discharge or fever. The urine pregnancy test was posi-
tive. On physical examination, she was pale, tachycardic, and hypotensive. Her abdo-
men was mildly distended with tenderness at the lower abdomen and guarding.
Vaginal examination revealed a positive cervical excitation test with fullness in the
Pouch of Douglas. Adnexal tenderness was elicited bilaterally. Transabdominal pel-
vic sonography revealed an empty uterus with a right irregular adnexal mass measur-
ing 9 mm and a free fluid. She had a haemoglobin of 6.7 g/dL and a normal white
blood cell count and platelet level. Preoperative diagnosis of a ruptured right ectopic
pregnancy with hypovolemia was made. She underwent laparotomy and a ruptured
right ovarian ectopic pregnancy was discovered and removed. She was transfused
with 4U of packed cells and had an uneventful postoperative recovery. The histo-
pathological examination of the ectopic pregnancy revealed a fibrotic nodule attached
to the wall of the right fallopian which contained rounded structures reminiscent of
eggs and adult remnants of pinworms (Enterobius vermicularis). Clinicopathological
and molecular findings confirmed the final diagnosis of E. vermicularis salpingitis
complicated with intra-abdominal bleeding secondary to perforation of vessels of
mesosalpinx and complete miscarriage. Upon review later, she was pain free and
ambulating well. She was started on albendazole for a week.