The controversy of parasitic infection in pediatric appendicitis: a retrospective analysis

Abstract

Background Controversy still exists regarding the relationship between parasitic infections and acute appendicitis.
Aim To investigate the role of parasitic infections in the etiology of acute pediatric appendicitis.
Patients and methods A two-center retrospective study included 1500 pediatric and adolescent patients who had undergone surgical therapy for a diagnosis of acute appendicitis over a period of 8 years from January 2001 to December 2008 in the Suez Canal University hospitals and Alexandria Health Insurance Sporting Hospital for School Students and children. The patients’ records were reviewed thoroughly to gather the demographic data on age, sex, and residence. Clinical data including the chief complaints on admission, duration of symptoms, history of similar attacks, previous hospitalization, and history of any chronic inflammatory diseases and drug history, if any, were analyzed. Laboratory and imaging studies were also reviewed. A thorough study of operative data was conducted, including a descriptive review of the operative findings during surgery. Postoperative complications, if any, and the histopathology reports of the removed appendices were also studied. Patients were divided into two groups according to the presence or the absence of parasites in the appendix lumen. In group I (n= 98), parasitic infection was observed, whereas in group II (n= 1402), no parasitic infection was present.
Results Parasites were reported in 98 patients out of the 1500 patients included in the study (6.5%). Of those 98 parasitic infestations, 40 (40.8%) were Enterobaisis, 23 (23.5%) were Schistosomiasis, 15 (15.3%) were Ascaris lumbricoides, 12 (12.2%) were Trichuris trichiura, and eight (8.2%) were Taenea saginata. All patients showed a single parasitic infection. The percent of patients with suppurative, gangrenous, or perforated appendicitis was similar in both groups, with no statistical significance irrespective of the presence or the absence of parasitic infection.
Conclusion Intestinal parasitic infection may not be considered as a risk factor for the development of acute appendicitis among the studied patients, and the low prevalence of parasites among the appendectomy specimens does not support the notion that parasites are a major cause of appendicitis in pediatric patients. However, parasitic infections could mimic the clinical picture of acute appendicitis, which need verification before the diagnosis of acute appendicitis.

Keywords: appendicitis, Enterobius vermicularis, parasitic infection