Intestinal Parasites in the orphan child
Are Intestinal parasites common in orphan children? What do I as an adoptive parent need to know?
Unfortunately, intestinal parasites, particularly parasitic infection is the most common medical condition that I diagnose in many of the Internationally Adopted children that I examine shortly after they arrive to the United States. The principal reason why these children are so prone to this condition is because of crowded living conditions of the orphanage, and because of the poor hygiene by both the children and the staff that cares for them. Intestinal parasites are widespread in orphanages across the world. Clinical finding encountered in infested child can range from anemia, chronic diarrhea, and failure to gain weight. In Eastern European orphanages, Giardia Lamblia infestation is the most common organism, but in other parts of the developing world, multiple infestations can coexist. Reinfection rate in developing countries can be so great that medical professionals do not even bother to treat them.
In order to determine which child is infected with parasites, universal screening should be performed at the post-arrival visit regardless if there are signs or symptoms. It is imperative to diagnose and threat the infected child before it becomes a public health hazard for the home and school system.
Clinical signs that should suggest a parasitic infection in an Internationally adopted child:
4) Trouble digesting foods
5) Rectal itching
6) Recurrent abdominal pain
7) Large volume in stools
8) Blood or mucous in stool
9) Abdominal distention
Unfortunately, these vague abdominal signs and symptoms can also be associated with many other problems encountered in adopted children, such as, introduction in new foods to the diet, food allergies, and lactose intolerance.
In order to determine which child is infected with parasites, universal screening should be performed at the post-arrival visit regardless if there are signs or symptoms. It is imperative to diagnose and threat the infected child before it becomes a public health hazard for the home and school system. Three screening stool samples for intestinal parasites need to be carefully investigated 2-3 days apart. Multiple specimens are required to increase the detection rate. A special collection kit that will be supplied by the reference lab needs to be used in order to collect the stool specimen. Stools that have been collected in the early morning left to sit for a couple hours are not adequate for evaluation. My personal approach to the collection of stools is as follows. At the post-adoption examination, I provide the collection medium to the parents and multiple tongue depressor sticks. They can catch to stool in the diaper and immediately transfer the specimen to the appropriate collection medium. In the toilet trained child, I suggest that they apply saran wrap around the toilet bowel and allow the child to stool right into the wrap. The parent can the use the tongue depressor sticks and transfer the specimen into the transport medium. In both cases, the parents are instructed to immediately deliver the specimen to the laboratory for processing. Along with the routine screening for Ova and Parasites, I concomitantly check for Giardia Antigen, and Cryptosporidium antigen.
Just because the initial evaluation of the stool testing was determined to be negative, sometimes a late onset presentation of intestinal parasite can occur moths later. Children that have persistent signs or symptoms of intestinal pathology should be retested, regardless of prior studies. Therapy may need to be implemented if stool evaluations are determined to be positive.
Written By George Rogu M.D. Medical Director and Founder of Adoptiondoctors.com and Adoptioneducationclasses.com
Additional information and references:
1) Miller, L. (2004). The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers. Oxford University Press, Cary, NC
2)William W. Hay M.D. Current Pediatric Diagnosis and Treatment. McGraw-Hill Medical Publishing.