An Unusual Sneeze

 


 

Many years ago I, in conjunction with my family, started to grade sneezes on a scale of one to ten according to the noise generated. This quickly developed into a competition to see who could sneeze the loudest. A rating of five or six would be what most people would consider normal with lower numbers reserved for the more discreet. On the other hand, between eight and ten would be considered sufficiently loud to make other people’s ears bleed or to knock over small children.

 The sneeze in this story, however, was unusual not because of its volume, but because of the product - I am not talking about snot or blood here, or even a bead previously inserted into a nostril by a small child and subsequently sneezed out. A lady came to one of our rural clinics asking for some worm medicine – we routinely prescribed this to young children as hookworm infestation is common in Cambodia as a result of them walking barefoot on contaminated soil. The larvae penetrate the skin of the foot and then enter the lungs via the bloodstream. From here they are coughed up into the throat, swallowed, and  enter the intestine. It is not uncommon for affected people to see the worms in their stools, but in many cases there are no specific symptoms. Nevertheless, anaemia is a common result because the worms in the intestine feed on blood. However, when we asked this patient how she knew she was infected, she explained that she had recently sneezed a worm out of her nose! On another occasion I saw a patient who woke up one morning to see a worm lying on the pillow next to her head which had, presumably, been coughed up while she was asleep.

Fortunately, the infestation is simply treated with an antihelminthic such as albendazole which can be swallowed or chewed. Health education to help break the lifecycle of the parasite is also important, especially the wearing of footwear outdoors particularly when there are a large number of dogs and cats around as these are the definitive hosts.

For more information the Center for Disease Control in the USA has a useful site:  https://www.cdc.gov/dpdx/hookworm/index.html

Comments

Post a Comment

Popular posts from this blog

Unorthodox Use of Chopsticks

Image
 I don't know whether you have watched Jackie Chan in the film "The Legend of Drunken Master"  but there is an entertaining scene involving a fight over food using chopsticks.  I worked until recently as a surgeon in a small hospital in Northwestern Cambodia. A number of years ago I dealt with a case in which a chopstick had been used as a weapon during a family dispute resulting in the patient being stabbed in the back with a metal one. The initial story given was that he had fallen over and landed on the chopstick, but as is so often the case, this did not hold up under closer scrutiny as a chopstick does not normally balance on it's end! The family initially wanted to fly back home to South Korea for treatment, but this was not an option and eventually they agreed to him staying at our hospital. The patient himself had a punctured lung and, ironically, needed a larger metal object to be inserted into his chest (trocar for a chest drainage tube) in order to treat th...
Read more

A Cambodian Splinter

Image
    I have just moved from Battambang to Phnom Penh – hence the late arrival of this episode of my blog, but it has reminded me of an extraordinary sight I witnessed a number of years ago. Many houses in Cambodia are built of wood and rest on stilts to prevent them from flooding during the rainy season. Imagine my surprise, therefore, when I looked out of my window one day to see a large group of men lifting our neighbour’s house from the ground by the stilts and carrying it down the street to be relocated some distance away. It transpired that the owners had purchased a new piece of land but didn’t want to build a new property. It certainly brings a whole new meaning to the expression “moving house”.   I do not know whether splinters were a problem for those carrying the house, but a splinter certainly caused a major problem for an elderly gentleman I saw with a nasty infected wound on his scrotum. It had been discharging pus on and off for several months by the ti...
Read more

A Shot in the Dark

Image
      The purpose of this blog is to provide some intriguing and, at times, amusing medical cases that I have encountered over many years of clinical practice in Cambodia, the UK and on the Isle of Man. I hope that they will be of interest to both medical and non-medical readers and I have pitched them primarily at a non-medical audience. Please feel free to leave comments and suggestions as I am new to the blogging community! Just to reassure you that any photographs I use have been taken with the consent of the persons depicted and do not allow their identification. Continuing from last week’s theme of weapons, my story this week concerns a slightly more conventional one, albeit rather more old-fashioned, in the form of an arrow. As before, the circumstances surrounding the injury were unusual and took the form of an accident rather than a deliberate attack. In Cambodia it is not uncommon to find home-made arrows being used for hunting rats, frequently fired from some s...
Read more