A Neonate with Worms

Extract

An 11-week-old infant was referred to our clinic for evaluation of worms moving toward the child's urethra. The otherwise healthy infant was the product of a term pregnancy. He was formula-fed, had good weight gain, and was experiencing normal neurodevelopment. He lived with his parents and 2-year-old brother in West Virginia; all members of the family were healthy. The infant had no history of travel outside of the regional area. The family owned no indoor pets, although they had owned 2 outdoor dogs since the infant was 4 weeks of age. There was no report of fleas in the house. A review of the patient's systems revealed gastroesophageal reflux with occasional episodes of projectile vomiting; 2 ultrasound examinations of the gastric outlet had normal findings. Stools were infrequent and firm. At 2 weeks of age, the parents reported small, rice grain—sized worms in the child's stool. At a local emergency department, the parents were told that the infant likely had a worm infection but was too young for treatment. The father collected a stool sample containing a worm segment from the diaper when the child was 5 weeks of age and a single worm segment in a specimen cup when the child was 7 weeks of age. The samples were interpreted as “no ova or parasites seen on concentrate or trichrome stain” and “no ova or parasites seen,” respectively, by the local hospital laboratory.