Oluwole G. Ajao

Enterobius vermicularis (pin worm) causing symptoms of appendicitis

Continued from p 177 Malaria Retinal findingspredictiveof outcome in cerebral malaria Research in Malawi concentrated on the direct and indirect ophthalmoscope examinations of 141 Malawian children with strictly defined cerebral malaria. Two distinct and prognostically significant findings were identified, papilloedema and extramacular retinal oedema. The relative risk of death in patients with papilloedema was nearly seven times greater than those without papilloedema and extramacular retinal oedema was associated with a nearly threefold increase in the relative risk of dying. The mortality rate in patients with none of these signs was only 1.3% compared to an overall mortality rate of 9.2%. Extramacular retinal oedema was identified by finding discrete areas of intra-retinal opacification sometimes occurring within the macular area or outside it. Whilst this generally occurred in discrete spots they sometimes coalesced to give large areas of retinal whitening deep to the retinal vessels. The authors believe that this sign is unique to cerebral malaria, not having observed it over a period of 4 years examining Malawian children with other conditions. Based on these findings the authors suggest that two pathways to poor outcome may exist in children, one with increased intracranial pressure manifesting as papilloedema and the other 183 symptoms of appendicitis making even the most experienced surgeon operate in such cases. These clinical features are independent of any histopathological changes of the wall of the appendix, but are dependent on the presence of a foreign body in the lumen of the appendix. In this case the most significant findings histopathologically were the presence of the worm, and haemorrhage within the lumen of the appendix. Surgical intervention was necessary to make the diagnosis.