1083
Views & Citations83
Likes & Shares
Ascaris
lumbricoides infestation is the most prevalent parasitic
infection among the children in tropical and developing country but incidence
of sudden blindness on passing the worm per oral is undocumented, the lag
period depend on the prodromes and varies from 5 days, investigation reveal
mere raised eosinophilic count and decreased hemoglobin with normal CT scan and
CSF examination.
Materials: 10
cases of sudden blindness investigated and treated at various centre without
any positive response attended our centre after 30-45 days of incidence, during
January 2018 to March 2019 were selected.
Methods: Selected
patient’s parent were interrogated for the course of disease, treatment taken
and their response, patients were clinically examined, investigated for basic
bio parameters, vision and were treated with the prescribed regime containing
pyridoxin, methyl cobalamin, nicotinamide, pantothenic acid and herbal
neurovitalizer composite NEUROVIT.
Results: All
patients had progressive vision gain and attended complete vision on 6 months
therapy without any adversity and residual effect or any alteration in hepato-renal
profile.
Conclusion: Sudden
blindness in children after passing round worm or with history of round worm
must be suspected for photoreceptor blockade by roundworm toxin and be treated
with pyridoxin and herbal neurovitaliser to assure complete recovery.
Keywords: Ascaris
lumbricoides, CT scan, CSF, Photo receptor, Neurovitaliser,
Recovery
INTRODUCTION
Prevalence of
intestinal worm infection is 49.35% and Ascaris
lumbricoides is most common parasitic infection 46.85% soil transmitted
Helminth infection form the most important group of intestinal worm affecting 2
billion people world-wide causing considerable morbidity. Ascaris lumbricoides remain the most prevalent parasitic infection,
i.e., 75% despite of therapeutic response of Albendazole and Mebendazole, but
eradication is difficult due to recurrent infection. Considering the changing
effect of worm infestation GOI has launched a program to combat the worm infestation,
i.e., National deworming day for children of age group 1-19 years biannually.
As per WHO >836 million children are at risk of parasitic manifestation
worldwide and 214 million children are of age group 1-14 years [1-14]. In
addition evidence of disproportionate worm infestation [15] and self-drug use
resulting resistance to available deworming agent and presently a combination
of parasitocide, i.e., Albendazole and Ivermectine [16] is in quite
consideration. As these agents only act on adult worm not on cyst or ova its
recurrent dose must be prescribed as on 45th day every ova is
developed to active adult round worm.
MATERIALS AND
METHODS
Materials
10 children
attending the centre for critical care with complaints of sudden blindness
after passing round worm per oral having treated at various hospitals without
any positive response and were
suggested brain surgery,
Method
All the patients
presenting with sudden blindness and associated history of passing round worm
per oral and treated at various hospitals without any vision improvement in
spite of medication and no pathology were detected on various investigation
like CT brain, retinal examination and various hematological examination, were
interrogated examined thoroughly, investigated for basic hematological, hepatic
and renal profile.
All the selected
patients were administered the following irrespective of age and presentation:
Herbal
neurovitaliser NEUROVIT constitutes:
Patients parent were instructed to practice
daily to ascertain visual response by finger counting or light reflex, in
addition also suggested to mark any adversity or new emerging manifestation if
any and report immediately.
Patients were routinely examined on every
week to ascertain response of the therapy and safety profile. At the end of
therapy when patient ensured their complete vision patients were examined by
ophthalmologist for vision and visual acuity.
OBSERVATIONS
Selected patients
were of age group 6-14 years (Table 1)
and among them 04 was male and 06 female (Figure
1), though they approached for Medicare within the lag period of 3-5 days
at appropriate centre, investigated for CT scan, ophthalmological examination
to asses vision and retina status which remain within normal limit in all
cases, except raised eosinophilic count (Table
2). Patients were treated with many neurotropics and topical eye drops
without any positive response. Majority patients attended our centre after
30-45 days of the onset of blindness and lag period of onset of blindness and
passing the round worm per oral was 1-5 days while patients presenting with
associated CNS manifestation like involuntary movement and headache has very
short lag period, i.e., 1 or 2 days. At our centre hematological examination
show raised eosinophil count with other normal other parameters, i.e., hepatic
and renal.
RESULTS
All patients
started visual improvement by 8th day of therapy and complete visual
recovery by 6th month of therapy without any visual debility;
optometry confirmed the vision in all patients as 6/6 in both eyes (Tables 3 and 4 and Figure 2). No
adversity or sequel is noted in any case or any evident of post therapy
withdrawal affect, i.e., decline in vision or visual acuity or any CNS
manifestation.
DISCUSSION
Round worm
infestation is very common but manifestation like blindness after passing the
worm per oral is very uncommon or remain unmarked, in addition variable lag
period of onset of blindness and worm passage, i.e., 1-5 days suggest its
dependence on prodromes, those who had CNS prodromes like headache and
involuntary movement had earlier onset [17-22]. Patients presentation on
passing worm per oral suggest worm irritation leading to release of a
polypeptide ASCARON which stimulate the intestinal mucosal nerve endings
resulting in nausea, vomiting and lose motion, absorption of toxin in blood
causes anaphylactic reaction resulting in fever and urticarial rash while
access to CSF results in neurosuppression due to inhibition of neurotransmitter
GABA as a result of inhibition of coenzyme pyridoxal phosphatase enzyme by the
toxin [23,24]. Sudden blindness is due to effect of neuroconduction suppression
results in blockade of neurotransmission from photo receptor of retinal fovea (Figures 3 and 4) [25,26]. No change in
bio parameters are observed in any case and eosinophil count came to normal.
All patients
recovered of blindness having progressive vision gain from perception of light
to normal vision in 6 months duration with the treatment is attributed to:
·
Intravenous mannitol 10% with glycerine
10% relieved neural edema.
·
Supplementation of pyridoxin as
injection of methyl cobalamin, pyridoxin, nicotinamide and pantothenic acid
competitively inhibit polypeptide and activate pyridoxal phosphatase and ensure
increased neurotransmitter GABA, methyl cobalamin and pantothenic acid promote
neuro conduction.
·
Herbal composite NEUROVIT constituents
ensure neurovitalization and photoreceptor activation [27].
·
Administration of albendazole plus
ivermectin ensures worm eradication.
·
Nutritious diet support recovery.
CONCLUSION
Sudden blindness after passing round worm or
without patient must be duly taken care suspecting Ascaris toxin as a factor
and duly treatment will ensure cure and safety from undue expenses especially
in tropical countries where round worm infestation is very common. Herbal
composite and pyridoxine supplementation proves boon for cure.
1. Seltzer
E (1999) Ascariasis: Tropical infectious disease - Principles, Pathogen and
Practice. 1st Edn. Guerrant RL, Weller PF (Eds), Philadelphia: Churchill
Livingstone, p: 553.
2. Salam
N, Azam S (2017) Prevalence and distribution of soil-transmitted helminth
infections in India. BMC Public Health 17: 201.
3. WHO
(2019) Prevalence of soil transmitted helminths.
4. Lobo
DA, Velayudhan R, Chatterjee P, Kohli H, Hotez PJ (2011) The neglected tropical
diseases of India and South Asia: Review of their prevalence, distribution and
control or elimination. PLoS Negl Trop Dis 5: e1222.
5. Padmaja
N, Swaroop PS, Nageswararao P (2014) Prevalence of intestinal parasitic infections
among school children in and around Amalapuram. J Public Health Med Res 2:
36-38.
6. Panda
S, Rao UD, Sankaram KR (2012) Prevalence of intestinal parasitic infections
among school children in rural area of Vizianagaram. IOSR J Pharm Biol Sci 3:
42-45.
7. Ragunathan
L, Kalivaradhan SK, Ramadass S, Nagaraj M, Ramesh K (2010) Helminthic
infections in school children in Puducherry, South India. J Microbiol Immunol
Infect 43: 228-232.
8. Golia
S, Sangeetha K, Vasudha C (2012) Prevalence of parasitic infections among
primary school children in Bangalore. Int J Basic Appl Med Sci 4: 12-18.
9. Krishnan
A, Sekar U, Sathanantham DK (2013) Prevalence and pattern of helminthic
infection among children in a primary school of rural Tamil Nadu. Acad Med J
India 1: 40-42.
10. Fernandez
MC, Verghese S, Bhuvaneswari R, Elizabeth SJ, Mathew T, et al. (2002) A
comparative study of the intestinal parasites prevalent among children living
in rural and urban settings in and around Chennai. J Commun Dis 34: 35-39.
11. Dhanabal
J, Selvadoss PP, Muthuswamy K (2014) Comparative study of the prevalence of
intestinal parasites in low socio-economic areas from south Chennai, India. J
Parasitol Res 630968.
12. Sunish
I, Rajendran R, Munirathinam A, Kalimuthu M, Kumar VA, et al. (2015) Impact on
prevalence of intestinal helminth infection in school children administered
with seven annual rounds of diethyl carbamazine (DEC) with albendazole. Indian
J Med Res 141: 330-339.
13. Clark
A, Turner T, Dorothy KP, Goutham J, Kalavati C, et al. (2003) Health hazards due
to pollution of waters along the coast of Visakhapatnam, east coast of India.
Ecotoxicol Environ Saf 56: 390-397.
14. Nikolay
B, Brooker SJ, Pullan RL (2014) Sensitivity of diagnostic tests for human
soil-transmitted helminth infections: A meta-analysis in the absence of a true
gold standard. Int J Parasitol 44: 765-774.
15. Shankar
A (2008) Disproportionate worm infestation, a cause of anthelmintic default.
IJM Today 03: 31-32.
16. Shankar
A (2009) Albendazole and ivermectin in management of helminthiasis. IJM Today
04: 50-52.
17. Wani
ML, Ashraf HZ, Ahangar AG, Wani SN, Nayeem UH, et al. (2012) Unusual
presentation of Ascaris lumbricoides. J Clin Case Rep 2: 174.
18. Coursin
DB (1969) Vitamin B6 and brain function in animals and man. Ann N Y Acad Sci
166: 7-15.
19. Gale
K (1985) Mechanisms of seizure control mediated by y-aminobutyric acid: Role of
the substantia nigra. Fed Proc 44: 2414-2424.
20. Kaufman DL, Houser CR, Tobin AJ (1991) Two
forms of the gamma-aminobutyric acid synthetic enzyme glutamate decarboxylase
have distinct intraneuronal distributions and cofactor interactions. J
Neurochem 56: 720-723.
21. Martin
DL, Martin SB, Wu SJ, Espina N (1991) Cofactor interactions and the regulation
of glutamate decarboxylase activity. Neurochem Res 16: 243-249.
22. Martin
DL, Rimvall K (1993) Regulation of y-aminobutyric acid synthesis in the brain.
J Neurochem 60: 395-407.
23. Miller LP, Walters JR, Martin DL (1977)
Post-mortem changes implicate adenine nucleotides and pyridoxal-5’-phosphate in
regulation of brain glutamate decarboxylase. Nature 266: 847-848.
24. Tews
JK (1969) Pyridoxine deficiency and brain amino acids. Ann N Y Acad Sci 166:
74-82.
25. (2016)
How the human eye sees? WebMD. Ed. Alan Kozarsky. WebMD.
26. Than
K (2016) How the human eye works? LiveScience. TechMedia Network.
27. Shankar
A (2019) Herbal composite constituents. Pharmacological Basis of Indigenous
Therapeutics, Bhalani Publication: Mumbai.
QUICK LINKS
- SUBMIT MANUSCRIPT
- RECOMMEND THE JOURNAL
-
SUBSCRIBE FOR ALERTS
RELATED JOURNALS
- Journal of Allergy Research (ISSN:2642-326X)
- Advance Research on Alzheimers and Parkinsons Disease
- Journal of Psychiatry and Psychology Research (ISSN:2640-6136)
- Journal of Oral Health and Dentistry (ISSN: 2638-499X)
- Journal of Ageing and Restorative Medicine (ISSN:2637-7403)
- Journal of Carcinogenesis and Mutagenesis Research (ISSN: 2643-0541)
- Advance Research on Endocrinology and Metabolism (ISSN: 2689-8209)