Farm to Harm: Parasite Infection in an Elderly Farmer on Long-term Steroids

  1. Shikhir Malhotra
  2. Twishi Shrimali
  3. Vibhor Tak
  4. Mahendra Lodha

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Abstract

We present a rare case of Enterobius vermicularis and Helicobacter pylori coinfection in an 82-year-old male from a rural area of Jodhpur, India. The patient had a long history of rheumatoid arthritis and chronic corticosteroid use, resulting in immunosuppression. He presented with non-specific gastrointestinal symptoms such as abdominal pain, weight loss, malaise, and heartburn. Laboratory and stool analyses revealed the presence of a small worm, which was later identified as Enterobius vermicularis. Additionally, the patient tested positive for H. pylori infection through various diagnostic modalities. The patient responded well to a combination of Albendazole and an H. pylori eradication kit. This case highlights the unusual presentation of E. vermicularis in an elderly patient and its coinfection with H. pylori, typically not associated with this demographic.

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  2. Version published to 10.1099/acmi.0.000937.v2 on Access Microbiology
  4. Access Microbiology

    Comments to Author

    Abstract: "rendering him immunosuppressed" should be altered. Render is inappropriate scientific language, suggest "resulting in immunosuppression'. Introduction: "usually affects the paediatric and young adult populations". Remove "the" Overall well written

    Please rate the quality of the presentation and structure of the manuscript

    Very good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  5. Access Microbiology

    Comments to Author

    1. Description of the case(s) Interesting and unique case worthy of publication 2. Presentation of results 59) Moderate anaemia 80) two doses two weeks apart is standard treatment, did the patient receive a second dose? 3. How the style and organization of the paper communicates and represents key findings Well laid out and clearly presented. 4. Literature analysis or discussion 102-108) assumption is made that patient's presenting symptoms were due to Enterobius infection. Important to consider symptoms may have been due to either infection, which adds to the complexity of this case. Patients are often asymptomatic with Enterobius infection. 128-133) does not add value, consider omitting. 5. Any other relevant comments This patient had risk factors that predisposed him to both infections, suggest mention the pertinent common risk factors. Suggest discussing previous research studies which have investigated coinfection with Helicobacter pylori and various intestinal parasites, including the alteration of immunological response which may have been of particular importance in this immunosuppressed patient.

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  6. Access Microbiology

    Comments to Author

    More details and explanation is required for the clinical statement on 106 and 107. Kindly review the statement about Enterobious vermicularis being responsible for the vague and non-specific gastrointestinal symptoms because the could as well be caused by H. pylori. Secondly, could you characterize the abdominal pain, was it generalized, epigastric (suggestive of gastritis likely due to H. pylori) or umbilical.

    Please rate the quality of the presentation and structure of the manuscript

    Very good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  7. Access Microbiology

    Comments to Author

    Assessment: This is a well-written and well-presented case report. Concerns: While the authors are correct that adult enterobiasis is rarely reported, it is not a novel finding and it is estimated that over one billion people are infected globally (e.g., Wendt et al., 2019). Considering the symptomatology, demographics, and immunocompromised status of the patient, testing for a range of pathogens was warranted.

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  8. Version published to 10.1099/acmi.0.000937.v1 on Access Microbiology