Multiple Soil-Transmitted Helminths Infection in 5-Year-Old Girl Presenting As Severe Anemia, Rectal Prolapse, and Stunting: Complicated Neglected Tropical Disease in Ende, East Nusa Tenggara, Indonesia

Abstract

BACKGROUND: Soil-transmitted helminth (STH) infections in the pediatric population are still prevalent and spread in various regions in Indonesia. It is associated with a disease burden of over 3.3 million disability-adjusted life years and a global prevalence of 1.7 billion cases. East Nusa Tenggara is one of the provinces that have severe endemicity of STH infection.  STH infections frequently coexist with anemia and malnutrition brings negative impacts on child growth and development. Here we present the case of multiple STH infections with its consequences in a 5-year-old girl in Ende, East Nusa Tenggara.

CASE: A 5-year-old girl suffering from pale and fatigue. Her physical examination showed pale conjunctiva, tachycardia, rectal prolapse and anthropometrics status concluded as stunting. Laboratory examination showed severe anemia (Hemoglobin 1.5 gr/dl) with eosinophilia, the fecal smear showed egg form of Ascaris lumbricoides, Ancylostoma duodenale, and Trichuris trichiura. The screening for parasite research on her parent’s stool was negative, the patient never wears footwear in daily activity. The patient was treated successfully with triple dose Albendazole, packed red cell (PRC) transfusion, heart failure management, nutritional intervention, and discharged from the hospital in stable condition.

CONCLUSION: STH infection still being the burden of disease in endemic area like Indonesia. Increased awareness of STH in daily practice can reduce the serious complication like severe anemia, and stunting. Environmental health should be identified to asses the risk factor of STH infection.