Case Report
A Rare Case of Convulsions and Loss of Consciousness Due to Ascariasis in a Young Adult Male at Tanga Regional Hospital, In Tanga Region, Tanzania, East Africa
- Shabbir Moizali Walijee *
Tanga Regional Referral Hospital, Tanga, Tanzania.
*Corresponding Author: Shabbir Moizali Walijee, Tanga Regional Referral Hospital, Tanga, Tanzania.
Citation: Shabbir M. Walijee. (2025). A Rare Case of Convulsions and Loss of Consciousness Due to Ascariasis in a Young Adult Male at Tanga Regional Hospital, In Tanga Region, Tanzania, East Africa. Clinical Case Reports and Studies, BioRes Scientia Publishers. 9(5):1-3. DOI: 10.59657/2837-2565.brs.25.233
Copyright: © 2025 Shabbir Moizali Walijee, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: February 01, 2025 | Accepted: February 16, 2025 | Published: February 23, 2025
Abstract
A 25-year-old male presented with convulsions and loss of consciousness without any accompanying fever or abdominal pain. Initial investigations, including imaging and blood tests, were normal. The patient was empirically treated with antihelminthic therapy, which resulted in the expulsion of multiple Ascaris lumbricoides. This case highlights the importance of considering parasitic infections in the differential diagnosis of neurological symptoms, even in the absence of typical gastrointestinal manifestations.
Keywords: ascariasis, convulsions; neurological symptoms; anthelminthic therapy; case report; young adult male; parasitic infections
Introduction
Ascariasis is a common helminthic infection caused by Ascaris lumbricoides, primarily affecting children in tropical and subtropical regions. While gastrointestinal symptoms are typical, neurological manifestations are rare and often overlooked [1]. This case report describes a young adult male who presented with convulsions and loss of consciousness, later diagnosed with ascariasis.
Case Presentation
A 25-year-old male, muslim in religion, farmer with standard seven primary education living in village with poor socioeconomic status with positive travel history to endemic area but has no history of pork consumption and doing labour work with no significant past medical history presented to the emergency department with sudden onset convulsions and loss of consciousness. The patient had no fever, abdominal pain, or other systemic symptoms. Physical examination was unremarkable, and vital signs were stable.
After the initial presentation and treatment, the patient took one week to recover fully and excreted the worms after one week of staying in the male ward after the initial treatment with anti helmintichs the follow-up period was six months, with monthly visits to monitor his condition.
Investigations
• Complete blood count (CBC): Normal
• Electrolytes: Normal
• Liver function tests (LFTs): Normal
• Renal function tests (RFTs): Normal
• Brain imaging (CT/MRI): Normal
• Electroencephalogram (EEG): Normal
Given the absence of an obvious cause, a broad differential diagnosis was considered, including infections, metabolic disorders, and central nervous system pathologies. Despite normal initial investigations, empirical antihelminthic treatment was initiated due to the patient's history of travel to an endemic area.
Treatment
The patient was treated with albendazole, 400 mg orally once, followed by a second dose after 14 days. Albendazole is a broad-spectrum anthelmintic that is effective against a variety of helminths, including Ascaris lumbricoides [2].
Outcome
Following the treatment, the patient reported the expulsion of multiple adult worms identified as Ascaris lumbricoides. There were no further episodes of convulsions or loss of consciousness, and the patient recovered fully.
Patient’s Perspective: The patient was informed about his illness and the presence of Ascaris lumbricoides. He was initially shocked but relieved after understanding that the condition was treatable with medication. The patient followed the treatment regimen as prescribed and reported a complete recovery without further episodes of convulsions or loss of consciousness. The patient expressed gratitude for the thorough care and follow-up provided by the medical team.
Figure: The image below shows the expelled Ascaris lumbricoides from the patient described in the case report.
Discussion
Ascariasis is typically associated with gastrointestinal symptoms such as abdominal pain, nausea, and intestinal obstruction. However, ectopic migration of larvae can lead to unusual presentations, including neurological symptoms [1]. Neurological manifestations of ascariasis are rare but can occur due to several mechanisms. One potential mechanism is the aberrant migration of larvae through the bloodstream, leading to direct central nervous system involvement (3). Another possibility is an immune-mediated response triggered by the presence of the parasite, causing inflammation and neurological symptoms [2]. The pathophysiology of neurological manifestations in ascariasis is not well understood but may involve aberrant migration of larvae or immune-mediated responses. This case underscores the importance of considering parasitic infections in patients with unexplained neurological symptoms, particularly in endemic areas.
Clinical Significance
This case emphasizes the need for a high index of suspicion for parasitic infections in patients presenting with unexplained neurological symptoms, especially in regions where such infections are endemic. Early diagnosis and treatment with appropriate anthelmintic therapy can prevent complications and lead to a complete recovery.
Review of Literature
- Steinmann et al. (2010) highlighted the global epidemiology of ascariasis, noting that it predominantly affects children in tropical and subtropical regions. The study emphasized the public health impact of soil-transmitted helminths and the need for effective control measures.
- De Silva et al. (2003) updated the global picture of soil-transmitted helminth infections, discussing the burden of disease and the challenges in control and prevention. The authors noted that neurological manifestations, while rare, should be considered in endemic areas.
- Bethony et al. (2006) reviewed soil-transmitted helminth infections, including ascariasis, trichuriasis, and hookworm, discussing their pathophysiology, clinical manifestations, and treatment options. The review highlighted the importance of recognizing atypical presentations of these infections.
Conclusion
This case report highlights a rare presentation of ascariasis with convulsions and loss of consciousness in a young adult male. Prompt recognition and treatment with antihelminthic therapy led to the resolution of symptoms, emphasizing the need for a high index of suspicion for parasitic infections in similar clinical scenarios.
Declarations
Informed Consent
Informed consent was obtained from the patient for the publication of this case report and any accompanying images. Consent was also obtained from the hospital medical officer in charge.
Funding
No funding was sought for this case report
Disclosure of interest
The author has no conflict of interest to disclose
References
- Steinmann, P., et al. (2010). Epidemiology of Ascariasis. Infectious Disease Clinics of North America.
Publisher | Google Scholor - De Silva, N. R., et al. (2003). Soil-transmitted helminth infections: updating the global picture. Trends in Parasitology.
Publisher | Google Scholor - Bethony, J., et al. (2006). Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. The Lancet.
Publisher | Google Scholor
