87 Romanian JouRnal of medical PRactice – Vol. 16, SuPPlement 4 (79), 2021 Ref: Ro J Med Pract. 2021;16(Suppl4) DOI: 10.37897/RJMP.2021.S4.19 Corresponding author: Roxana Smădeanu E-mail: rsmadeanu@yahoo.com Article History: Received: 21 July 2021 Accepted: 15 August 2021 Ascaris “Download” as a cause of acute recurrent pancreatitis in a child Roxana SMĂDEANU 1,2 , Gabriela LEȘANU 1 , Radu NICOLAESCU 3 , Cristian GEORGESCU 3 , Vlad DIMA 4 , Anca A. SIMIONESCU 2,5 , Cristina BECHEANU 1,2 1 Department of Pediatrics, “Grigore Alexandrescu” Emergency Hospital for Children, Bucharest, Romania 2 “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania 3 Department of Radiology, “Grigore Alexandrescu” Emergency Hospital for Children, Bucharest, Romania 4 Department of Neonatology, Filantropia Clinical Hospital, Bucharest, Romania 5 Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania Abstract Introduction. Infestation with the roundworm Ascaris lumbricoides is one of the most prevalent helminthic diseases belonging to the soil-transmitted helminths class. Infections are especially affecting children in tropical countries and low and middle-income countries but also may occur in developing countries where sanitation and hygiene are poor. We aim to present a case report to sound the alarm on this widespread pathology. Case presentation. We report the case of a 9-year-old boy with Down syndrome and duodenal stenosis admitted to our hospital with recurrent bouts of pancreatitis secondary to ascariasis. Child is living in poor sanitation conditions. The first episode of pancreatitis was at the age of seven. The abdominal ultrasound shows enlargement and heterogeneity of the head and body of the pancreas, and multiple images of "the strip sign" in the duodenum, suggesting the presence of Ascaris lumbricoides. Live worms were expelled several times. During the next two years, this child was admitted for similar episodes suggesting re-infection with the soil-transmitted helminths, repeated courses of albendazole were administered to the patient and to his close relatives contact. Conclusions. Ascaris lumbricoides infection is rarely a direct cause of mortality, but it contributes to overwhelming morbidity. Periodically repeated de-worming treatment and additional preventive measures such as improvements to water, sanitation and hygiene (WASH) could ensure high rates of eradication. Keywords: pancreatitis, ascariasis, water, sanitation and hygiene INTRODUCTION The roundworm Ascaris lumbricoides is one of the most prevalent parasites belonging to the class of the soil-transmitted helminths (STH) [1]. Ascariasis remains the leading helminthic infection worldwide, affecting around 738 million to 872 million people worldwide [2], disproportionally affecting children in tropical countries and low-income and middle-income coun- tries [3]. Other factors closely associated with this STH are immunodeficiency, malnutrition, overcrowding and poverty, using stools to make fertilizer, poor health ed- ucation, especially of mothers, not washing hands be- fore eating, pig ownership or livestock breeding and open defecation [4].