What is ascariasis. How do people get infected with roundworms. What are the symptoms of ascariasis. How is ascariasis diagnosed and treated.

Understanding Ascariasis: A Common Parasitic Infection

Ascariasis is an infection caused by the parasitic roundworm Ascaris lumbricoides. This intestinal parasite affects millions of people worldwide, making it the most common intestinal worm infection globally. Despite its prevalence, many individuals remain unaware of its causes, symptoms, and potential health risks.

Approximately 1 billion people are infected with ascariasis worldwide, with an estimated 4 million cases in the United States at any given time. The infection is more common in warm climates and areas with poor sanitation practices.

The Life Cycle of Ascaris Lumbricoides: From Egg to Adult Worm

The life cycle of Ascaris lumbricoides is complex and involves several stages:

1. Eggs are passed in the stool of infected individuals and contaminate soil.
2. People ingest contaminated food or drink containing roundworm eggs.
3. Eggs hatch in the small intestine, releasing larvae.
4. Larvae migrate through the bloodstream to the lungs.
5. Larvae move up through the airways and are swallowed back into the stomach.
6. In the small intestine, larvae mature into adult roundworms.
7. Adult worms lay eggs, which are then passed in feces, continuing the cycle.

Adult roundworms can live in the small intestine for 10 to 24 months, continuously producing eggs and perpetuating the infection cycle.

Risk Factors and Transmission of Ascariasis

Several factors contribute to the spread of ascariasis:

• Poor sanitation practices
• Use of human feces as fertilizer
• Inadequate handwashing
• Consumption of contaminated water or food
• Living in warm, tropical climates

Children are particularly susceptible to ascariasis and often experience more severe symptoms than adults. This increased vulnerability is due to their frequent contact with contaminated soil and less developed hygiene habits.

Can ascariasis be transmitted from person to person?

Ascariasis is not directly transmitted from person to person. The infection requires a period where eggs are released into the environment and embryonate in soil before becoming infectious. This process typically takes several weeks, highlighting the importance of proper sanitation and hygiene practices in preventing transmission.

Recognizing the Symptoms of Ascariasis

Ascariasis can manifest in various ways, ranging from asymptomatic cases to severe complications. Common symptoms include:

• Abdominal pain and discomfort
• Nausea and vomiting
• Diarrhea or constipation
• Bloody sputum
• Cough and wheezing
• Low-grade fever
• Shortness of breath
• Skin rash
• Visible worms in stool

In severe cases, worms may be expelled through the nose or mouth, which can be a distressing experience for the infected individual.

Is eosinophilic pneumonia a common complication of ascariasis?

Eosinophilic pneumonia is an uncommon but potential complication of ascariasis. It occurs when larvae migrate through the lungs, causing inflammation and an increase in eosinophils, a type of white blood cell. This condition can lead to respiratory symptoms such as cough, wheezing, and shortness of breath.

Diagnosing Ascariasis: From Symptoms to Laboratory Tests

Diagnosing ascariasis involves a combination of clinical evaluation and laboratory tests. Healthcare providers may consider the following diagnostic approaches:

1. Physical examination: Checking for signs of malnutrition and abdominal tenderness.
2. Stool examination: Microscopic analysis to detect worm eggs or adult worms.
3. Blood tests: Complete blood count (CBC) to check for elevated eosinophil levels.
4. Imaging studies: Abdominal X-rays or other imaging techniques to visualize worms or complications.

In some cases, worms may be visible in the stool or vomit, providing a clear indication of infection.

How accurate are stool examinations in diagnosing ascariasis?

Stool examinations are highly effective in diagnosing ascariasis, especially when multiple samples are analyzed. The sensitivity of this method increases with the number of samples examined, as egg production can be inconsistent. However, it’s important to note that early infections may not be detected if the worms have not yet reached egg-laying maturity.

Treatment Options for Ascariasis: Medications and Procedures

Effective treatment of ascariasis typically involves antiparasitic medications and, in severe cases, medical procedures. The primary treatment options include:

• Antiparasitic medications: Albendazole, mebendazole, or ivermectin to paralyze or kill the worms.
• Endoscopy: Used to remove worms in cases of intestinal blockage.
• Surgery: Rarely needed for severe complications or blockages.

After treatment, patients should be re-examined after three months to ensure complete eradication of the infection. If eggs are still present in the stool, a second round of treatment may be necessary.

Are there any natural remedies effective against ascariasis?

While some natural remedies are touted as effective against parasitic infections, there is limited scientific evidence supporting their use for ascariasis. Prescribed antiparasitic medications remain the most reliable and effective treatment. Patients should always consult with a healthcare provider before attempting any alternative treatments.

Preventing Ascariasis: Hygiene and Sanitation Practices

Preventing ascariasis relies heavily on improving sanitation and hygiene practices. Key preventive measures include:

• Proper handwashing with soap and water, especially before handling food
• Safe disposal of human waste
• Avoiding the use of human feces as fertilizer
• Thoroughly washing fruits and vegetables before consumption
• Drinking clean, filtered water
• Regular deworming in endemic areas

Community-wide efforts to improve sanitation infrastructure and educate populations about hygiene practices are crucial in reducing the prevalence of ascariasis.

How effective are mass deworming programs in controlling ascariasis?

Mass deworming programs have shown significant success in reducing the prevalence and intensity of ascariasis infections, especially in school-aged children. These programs, often implemented in endemic areas, involve the periodic administration of antiparasitic drugs to entire populations. While effective in the short term, sustainable control of ascariasis requires combining deworming with improvements in water, sanitation, and hygiene practices.

The Global Impact of Ascariasis: Public Health Perspectives

Ascariasis remains a significant public health challenge, particularly in developing countries. The infection can lead to:

• Malnutrition and impaired growth in children
• Reduced cognitive development and school performance
• Economic burden due to healthcare costs and lost productivity
• Complications such as intestinal obstruction in severe cases

Addressing ascariasis requires a multifaceted approach, including improved sanitation, regular deworming programs, and public health education initiatives.

How does ascariasis contribute to the cycle of poverty in affected communities?

Ascariasis can perpetuate the cycle of poverty by impacting individual health, educational attainment, and economic productivity. Children with chronic infections may experience stunted growth and cognitive impairment, leading to reduced educational outcomes. Adults may suffer from decreased work capacity and increased healthcare expenses. These factors collectively contribute to economic challenges at both individual and community levels, making it harder for affected populations to break free from poverty.

Ascariasis Information | Mount Sinai

Intestinal parasite – ascariasis; Roundworm – ascariasis

Ascariasis is an infection with the parasitic roundworm Ascaris lumbricoides.

Roundworms are the most common type of worm infection. It is estimated that there are 4,000,000 cases in the United States at any time. Infection is more common in warm climates. Eggs are passed in the stool of infected animals and contaminate the soil. Ingestion of contaminated soil then leads to roundworm infection. (Image courtesy of the Centers for Disease Control and Prevention.)

The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

Causes

People get ascariasis by consuming food or drink that is contaminated with roundworm eggs. Ascariasis is the most common intestinal worm infection. It is related to poor sanitation. People who live in places where human feces (stool) are used as fertilizer are also at risk for this disease.

Once consumed, the eggs hatch and release immature roundworms called larvae inside the small intestine. Within a few days, the larvae move through the bloodstream to the lungs. They travel up through the large airways of the lungs and are swallowed back into the stomach and small intestine.

As the larvae move through the lungs they may cause an uncommon form of pneumonia called eosinophilic pneumonia. Eosinophils are a type of white blood cell. Once the larvae are back in the small intestine, they mature into adult roundworms. Adult worms live in the small intestine, where they lay eggs that are present in feces. They can live 10 to 24 months.

An estimated 1 billion people are infected worldwide. Ascariasis occurs in people of all ages, though children are affected more severely than adults.

Symptoms

Most of the time, there are no symptoms. If there are symptoms, they may include:

• Bloody sputum (mucus coughed up by the lower airways)
• Cough, wheezing
• Low-grade fever
• Passing worms in stool
• Shortness of breath
• Skin rash
• Stomach pain
• Vomiting or coughing up worms
• Worms leaving the body through the nose or mouth

Exams and Tests

The infected person may show signs of malnutrition. Tests to diagnose this condition include:

• Abdominal x-ray or other imaging tests
• Blood tests, including complete blood count and eosinophil count
• Stool exam to look for worms and worm eggs

Treatment

Treatment includes medicines such as albendazole that paralyze or kill intestinal parasitic worms.

If there is a blockage of the intestine caused by a large number of worms, a procedure called endoscopy may be used to remove the worms. In rare cases, surgery is needed.

People who are treated for roundworms should be checked again in 3 months. This involves examining the stools to check for eggs of the worm. If eggs are present, treatment should be given again.

Outlook (Prognosis)

Most people recover from symptoms of the infection, even without treatment. But they may continue to carry the worms in their body.

Complications can be caused by adult worms that move to certain organs, such as the:

• Appendix
• Bile duct
• Pancreas

If the worms multiply, they can block the intestine.

Possible Complications

These complications may occur:

• Appendicitis
• Blockage in the bile ducts of the liver
• Blockage in the intestine
• Hole in the gut

When to Contact a Medical Professional

Contact your health care provider if you have symptoms of ascariasis, particularly if you have traveled to an area where the disease is common. Also call if you have any of the following:

• Symptoms get worse
• Symptoms do not improve with treatment
• New symptoms occur

Prevention

Improved sanitation and hygiene in developing countries will reduce the risk in those areas. In places where ascariasis is common, people may be given deworming medicines as a preventive measure.

Centers for Disease Control and Prevention website. Parasites-ascariasis. www.cdc.gov/parasites/ascariasis/index.html. Updated November 23, 2020. Accessed December 29, 2022.

Mejia R, Weatherhead J, Hotez PJ. Intestinal nematodes (roundworms). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 286.

Last reviewed on: 12/4/2022

Reviewed by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Ascariasis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Ascaris lumbricoides, the causative agent of ascariasis, is the most common parasitic worm in humans. Ascariasis can be asymptomatic, causing only malnutrition and growth retardation, or it may present with abdominal pain, nausea, vomiting, bloating, and diarrhea. This activity outlines the evaluation and treatment of ascariasis and explains the role of the interprofessional team in managing patients with this condition.

Objectives:

• Identify the nematode Ascaris lumbricoides in the etiology of ascariasis.

• Describe the pathophysiology of ascariasis.

• Summarize the use of a stool exam to detect ova and parasites in the evaluation of ascariasis.

• Outline the importance of improving care coordination among the interprofessional team members to enhance the delivery of care for patients affected with ascariasis.

Access free multiple choice questions on this topic.

Introduction

Approximately one billion people worldwide are infected with Ascaris lumbricoides, and more than 60,000 people die from the disease annually. It affects mostly tropical and subtropical countries around the world, and it is frequently documented in Sub-Saharan Africa, Latin America, China, and East Asia. Unfortunately, it is a neglected tropical disease that causes an estimated loss of 1.2 to 1.5 disability-adjusted years.[1][2][3]

Etiology

Ascaris lumbricoides, a soil-transmitted large nematode, causes Ascariasis. The female adult can reach up to 20 cm to 30 cm in length, and adult males up to 15 cm to 20 cm. The nematodes are pink/yellow/white roundworms. The female worms are thicker and have a straight rear end. The male worm is more slender with a ventrally incurvated rear end with two retractile copulating spicules. The average life of the adult parasite is one year, after which it dies, and it is spontaneously eliminated as it evacuates through the digestive tract. This is the reason why a spontaneous cure of disease can happen if there is no reinfection. Adult worms do not multiply in the human host.[4][5]

Epidemiology

Ascariasis is one of the most common human parasitic infections. It is found worldwide. Ascariasis has been a disease that has affected the world population for centuries. It was described in ancient Egyptian papyruses and has been identified in Egyptian mummies from around 800 B.C. Even Hippocrates and Aristotle described the helminth. This disease has been described in children and adults in tropical and subtropical areas with poor sanitation and poor personal hygiene and in places where human feces are used as fertilizer. There is a higher risk of infection in nonendemic areas due to the increased rate of migration and travel.[6][7]

Pathophysiology

Infection occurs when the host ingests eggs found in stool-contaminated soil. Once in the duodenum, larvae are released and enter the circulation via the enteric mucosa. Once in the capillaries (venous, arterial or lymphatic), it reaches the liver via the portal vein and then the lungs within the first week. In the lung, they damage the alveolar membrane and mature in the alveolus. Eventually, the larvae are expectorated and swallowed, reentering the gastrointestinal tract. Once in the small intestine lumen, the larvae mature into adult worms in about 20 days. When the adult female and male worms are present, they copulate, and the female can produce approximately 200,000 eggs per day. They are later eliminated in the feces of the soil. In the appropriate conditions of a moist, shady, and warm environment, the eggs mature to infective form in two to eight weeks and remain viable for up to 17 months. They can be ingested and restart the infective cycle.[5][8][9]

History and Physical

Patients infected with ascariasis can be asymptomatic, only showing long-term manifestations of growth retardation and malnutrition. If symptoms are present, abdominal pain, bloating, nausea, vomiting, anorexia, intermittent diarrhea are the most common manifestations. If the number of larvae passing through the lung is significant, pneumonitis and eosinophilia can be seen (also known as Loeffler syndrome). Symptoms include wheezing, dyspnea, cough, hemoptysis, and fever. In superinfection, adult worms can migrate to tubular structures like the biliary and pancreatic system causing cholecystitis, cholangitis, pancreatitis, small bowel obstruction, volvulus, appendicitis, and intussusception. Children are more susceptible to complications than adults.

Evaluation

A female worm can produce up to 200,000 eggs a day. This makes retrieval from a stool exam easier. The best diagnostic test is still the stool exam for ova and parasites, searching for large oval brown trilayered eggs with a mamillated coat. It is important to note that stool can be negative while the worm migrates and matures (approximately one month). Only when worms are mature do they start secreting eggs. Sometimes an adult worm can be seen in the stool or coming out of the rectum but can also be coughed up or passed in the urine. A complete blood count can show eosinophilia during the active migration phase from the intestine to the lungs, and larvae can be found in the sputum. Abdominal x-rays can be sensitive but not specific when a whirlpool sign is present. Ultrasound and CT scans can be used to identify worms in the biliary duct and gallbladder. Endoscopic retrograde cholangiopancreatography (ERCP) can be used for diagnosis and treatment. [10]

Treatment / Management

Even mild cases of Ascaris infection should be treated to prevent complications from parasite migration, and however, during active migration through the lungs, medical therapy is not indicated, secondary to the increased risk of pneumonitis. Medical therapy with albendazole 400 mg as a single dose is the drug of choice. The second choice of treatment is mebendazole 100 mg twice a day for three days or 500 mg as a single dose or ivermectin 100 microgram/kg to 200 microgram/kg once. In pregnancy, piperazine 50 mg/kg/day for five days or 75 mg/kg one dose or pyrantel pamoate (11 mg/kg up to a maximum of 1 g) is administered as a single dose; the latter is the drug of choice. Medical therapy will target adult worms, which is the reason why treatment should be repeated after one to three months, to give time to larvae that can be present to mature to adulthood and be susceptible to therapy. Alternative agents include nitazoxanide and levamisole.[11][12][13]

If partial bowel obstruction is present, a nasogastric tube should be placed, give nothing per mouth, give intravenous fluids and piperazine. If total bowel obstruction is present, the patient may need laparotomy for enterotomy for the extraction of worms, but if necrosis is found, they may need resection and reanastomosis. Once the surgery is performed and intestinal transit is restored, medical anti-parasitic treatment should be given to kill any residual eggs.

Differential Diagnosis

• Acute cholangitis

• Acute pancreatitis

• Appendicitis

• Ascending cholangitis

• Asthma

• Cholecystitis and biliary colic

• Hookworm

• Intussusception

• Large bowel obstruction

• Small bowel obstruction

Prognosis

Studies from Asia and Africa reveal that single-dose treatment with albendazole results in cure rates of over 95% with a gradual reduction in eggs over the next few weeks in 995 of cases.

However, patient relocation is vital to prevent a recurrence. There is also a great need to improve basic sanitation and provide clean drinking water in these areas.

Many communities are now being targeted for improvement in socioeconomics to help reduce the burden of ascariasis.

Avoiding contact with manure, wearing proper shoes, and education are vital in preventing ascariasis.

Complications

• Bleeding per rectum

• Bowel obstruction

• Appendicitis

• Hepatobiliary disease

• Pancreatic pseudocyst

Postoperative and Rehabilitation Care

• To ensure that children do not have a failure to thrive, they should have vitamin A supplementation.

• Retreatment in 3-6 months is recommended in endemic areas if the stool ova still persist.

• Compliance with drug therapy is necessary to eradicate the disease.

Deterrence and Patient Education

Education, providing fresh water, and improving sanitation are necessary.

Pearls and Other Issues

The life span of an adult worm is two years. They do not multiply in the host. If there is no reinfection by the ingestion of fecal-contaminated food, the patient can clear the infection without treatment. This is why the first line of management should be an education in good hygiene and public health. Hand hygiene is of unmeasurable importance to prevent infection with Ascaris lumbricoides. In areas of high endemicity, early diagnosis and treatment are important to prevent acute complications, and in the long term, prevent malnutrition, cognitive disabilities, and loss of productive years.

Enhancing Healthcare Team Outcomes

Many programs have been started by the WHO to help diagnose and manage ascariasis. However, this parasite affects close to 1.2 billion people, and an interprofessional approach is the only way to fight the infection. Besides infectious diseases, the primary care provider, including nurses and pharmacists, play a vital role in the education of the patient and their families on sanitation, washing food, and the importance of clean water. [11][14] [Level II]

Outcomes

Ascariasis needs to be tackled on a broader spectrum rather than just healthcare. There is a need for improved farming practices, food and personal hygiene, and the availability of clean drinking water. Also of importance is to remove cultural perceptions and improve compliance with medications. Ascariasis has enormous morbidity and affects many organs in the body. While the mortality rates are unknown, the numbers are not minuscule. The WHO has stepped in and is working with an interprofessional group of healthcare workers to lower the burden of this parasite.[15][16] [Level III]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Fahim SM, Das S, Gazi MA, Mahfuz M, Ahmed T. Association of intestinal pathogens with faecal markers of environmental enteric dysfunction among slum-dwelling children in the first 2 years of life in Bangladesh. Trop Med Int Health. 2018 Nov;23(11):1242-1250. [PMC free article: PMC6282798] [PubMed: 30133067]

2.

Darlington CD, Anitha GFS. Ascaridial Volvulus: An Uncommon Cause of Ileal Perforation. Iran J Med Sci. 2018 Jul;43(4):432-435. [PMC free article: PMC6055212] [PubMed: 30046214]

3.

Zakzuk J, Casadiego S, Mercado A, Alvis-Guzman N, Caraballo L. Ascaris lumbricoides infection induces both, reduction and increase of asthma symptoms in a rural community. Acta Trop. 2018 Nov;187:1-4. [PubMed: 30040946]

4.

Adu-Gyasi D, Asante KP, Frempong MT, Gyasi DK, Iddrisu LF, Ankrah L, Dosoo D, Adeniji E, Agyei O, Gyaase S, Amenga-Etego S, Gyan B, Owusu-Agyei S. Epidemiology of soil transmitted Helminth infections in the middle-belt of Ghana, Africa. Parasite Epidemiol Control. 2018 Aug;3(3):e00071. [PMC free article: PMC6020085] [PubMed: 29988303]

5.

Sharma M, Somani P, Prasad R, Jindal S, Pathak A. Biliary ascariasis: mimicker of biliary stent. VideoGIE. 2017 Jul;2(7):179-181. [PMC free article: PMC5991772] [PubMed: 29905283]

6.

Sklyarova VО. [Epidemiological features of parasitary invasis in women of reproductive age with disorders of reproductive health]. Wiad Lek. 2018;71(3 pt 2):674-677. [PubMed: 29783245]

7.

Claus PE, Ceuppens AS, Cool M, Alliet G. Ascaris lumbricoides: challenges in diagnosis, treatment and prevention strategies in a European refugee camp. Acta Clin Belg. 2018 Dec;73(6):431-434. [PubMed: 29458300]

8.

Sharma A, Jariwala P, Kaur N. Biliary ascariasis presenting with gangrenous perforation of the gall bladder: report of a case and brief review of literature. Trop Doct. 2018 Jul;48(3):242-245. [PubMed: 29649951]

9.

Bradbury RS, Harrington H, Kekeubata E, Esau D, Esau T, Kilivisi F, Harrington N, Gwala J, Speare R, MacLaren D. High prevalence of ascariasis on two coral atolls in the Solomon Islands. Trans R Soc Trop Med Hyg. 2018 Apr 01;112(4):193-199. [PubMed: 29800343]

10.

Ghosh G, Shah S, Maltz C. Ascariasis Diagnosed by Wireless Capsule Endoscopy. Clin Gastroenterol Hepatol. 2018 Jun;16(6):A23. [PubMed: 28865763]

11.

Wright JE, Werkman M, Dunn JC, Anderson RM. Current epidemiological evidence for predisposition to high or low intensity human helminth infection: a systematic review. Parasit Vectors. 2018 Jan 31;11(1):65. [PMC free article: PMC5791198] [PubMed: 29382360]

12.

Bharti B, Bharti S, Khurana S. Worm Infestation: Diagnosis, Treatment and Prevention. Indian J Pediatr. 2018 Nov;85(11):1017-1024. [PubMed: 29127616]

13.

Silber SA, Diro E, Workneh N, Mekonnen Z, Levecke B, Steinmann P, Umulisa I, Alemu H, Baeten B, Engelen M, Hu P, Friedman A, Baseman A, Mrus J. Efficacy and Safety of a Single-Dose Mebendazole 500 mg Chewable, Rapidly-Disintegrating Tablet for Ascaris lumbricoides and Trichuris trichiura Infection Treatment in Pediatric Patients: A Double-Blind, Randomized, Placebo-Controlled, Phase 3 Study. Am J Trop Med Hyg. 2017 Dec;97(6):1851-1856. [PMC free article: PMC5805036] [PubMed: 29016336]

14.

Mara D. Water- and wastewater-related disease and infection risks: what is an appropriate value for the maximum tolerable additional burden of disease? J Water Health. 2011 Jun;9(2):217-24. [PubMed: 21942188]

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GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 08;388(10053):1545-1602. [PMC free article: PMC5055577] [PubMed: 27733282]

16.

Olds GR. Deworming the world. Trans Am Clin Climatol Assoc. 2013;124:265-74. [PMC free article: PMC3715900] [PubMed: 23874034]

Disclosure: Daniela de Lima Corvino declares no relevant financial relationships with ineligible companies.

Disclosure: Shawn Horrall declares no relevant financial relationships with ineligible companies.

Ascariasis – symptoms, causes, signs and methods of treatment in adults in the “SM-Clinic”

This disease is treated by Gastroenterologist
, Infectionist

• About the disease
• Species
• Signs and symptoms of ascariasis in humans
• Causes of ascariasis
• Methods for diagnosing ascariasis
• Expert opinion
• Treatment of ascariasis
• Prevention of infection with ascariasis
• Rehabilitation
• Questions and answers
• Doctors

About the disease

Ascariasis is considered one of the most common infestations that is transmitted through the soil. According to experts from the World Health Organization, more than 1 billion people worldwide suffer from this pathology. Especially often the spread of ascariasis is observed in children and adolescents.

The immediate cause of ascariasis is the ingestion of an invasive egg by a human. The egg contains a mature larva. The main route of transmission is contact-household. The larva leaves the shell in the intestinal lumen and enters the venous bed, and then penetrates into the lungs. Through the bronchial tree, it crawls out into the pharynx and is re-swallowed with saliva into the intestines. After 2–3 months in the intestine, it transforms into an adult. Migration of the larva is usually accompanied by coughing and inflammation of the bronchial wall.

Clinical manifestations of helminthiases are often non-specific and may have different masks of infectious and non-infectious diseases. This creates certain diagnostic difficulties and can complicate the course of existing diseases. In some cases, ascariasis can become the main cause of the development of somatic, to a greater extent, allergic pathology, including bronchial obstruction syndrome. Sometimes ascariasis is complicated by obstruction of the digestive system, which may be an indication for urgent surgical intervention.

Diagnosis of the disease is carried out on the basis of microscopic examination of feces, in which helminths can be detected. However, a negative result of the coprogram does not exclude helminthic invasion. Therefore, to establish an accurate diagnosis, a comprehensive laboratory study is carried out, which includes the determination of antibodies to roundworms, a general clinical and biochemical blood test.

Treatment of ascariasis (uncomplicated forms) consists of anthelmintic therapy. In case of intestinal obstruction, emergency surgical intervention is performed.

Species

There are 2 stages during ascariasis:

• Migratory (pulmonary).
• Enteric.

There are 2 forms of ascariasis:

• uncomplicated;
• complicated.

The disease can be acute or chronic.

Signs and symptoms of ascariasis in humans

As a rule, the disease in the migratory stage is asymptomatic, but sometimes malaise, cough and nausea are possible. Helminths are powerful antigens for the human body, so allergic skin reactions often develop (most often like urticaria). In the intestinal stage, when the endoparasite is localized in the intestine, the previous signs of ascariasis (weakness, nausea) intensify and new ones appear – headaches and abdominal pains, salivation, activity and appetite decrease. In addition, obstructive complications may develop in the second stage. For example, a ball of helminths in the intestinal lumen can lead to its obstruction. Internal bleeding is also possible, due to the fact that adult helminths attach to the intestinal mucosa with pointed ends. Ingestion of worms into the respiratory tract can cause suffocation (asphyxia).

Causes of ascariasis

The causative agent of ascariasis is round worms of different sexes. As adults, they live in the small intestine. The female is 15-20 cm longer than the male (the length of the female is about 40 cm). The body of the helminth is elongated, spindle-shaped, at the ends there are constrictions that can drill through the mucosal layer. Females differ from males not only in length, but also in the shape of the end part (in males it is bent to the abdomen, and in females it is straight). At the head end there is a mouth opening surrounded by three lips, on which taste buds are located. There are no fixation organs in the helminth, so they constantly move towards the incoming food. In turn, the pointed ends allow you to rest against the walls of the intestine and thereby prevent the exit to the outside with feces.

The source of human invasion is soil contaminated with roundworm eggs. The method of infection is fecal-oral. Invasion usually occurs when a person does not wash their hands, consumes contaminated plant products, or drinks raw water from open water.

Infection usually occurs if a person does not follow the rules of personal hygiene – dirty hands, the use of unwashed vegetables, berries, fruits and raw water from open sources.

Roundworm is characterized by a complex life cycle, which determines its danger to humans. Thus, the larvae formed in the female genital tract are oxygen-dependent. Therefore, with the faeces of the main host, they enter the environment and enter the soil and groundwater. After the egg enters the human intestine (through dirty hands, unwashed vegetables and fruits, contaminated water), the larva is released from the shell and enters the intestinal lumen. She perforates the intestinal wall, enters the bloodstream and then migrates to the lungs located near the heart, where she receives oxygen that is important for her. After about 2 weeks, the larva enters the larynx and causes a reflex cough that facilitates its re-swallowing. Once again in the small intestine, it is transformed into a sexually mature individual. The whole process of morphogenesis takes about 3 months. After the “growing up” of the helminth, the release of eggs into the intestinal lumen begins. Helminth lives for about 12 months.

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If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

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Methods for diagnosing ascariasis

Based on the clinical symptoms, a qualified physician establishes a preliminary diagnosis of helminthiasis. It is even more confirmed if eosinophilia is detected in the general clinical analysis of the blood. However, normal eosinophil levels do not rule out the presence of helminthiasis.

Subsequent laboratory diagnostics is aimed at identifying the species of the pathogen. The first step is a microscopic examination of feces, in which parasite eggs or especially mature ones can be detected. But it should be borne in mind that the results of this analysis will be negative during the period of migration of ascaris larvae, with a low degree of invasion, and also if only males are present in the patient’s intestines. In this regard, additional methods for diagnosing ascariasis are serological studies aimed at identifying specific immunoglobulins M and G in the patient’s blood serum. For a functional assessment of the state of the digestive tract, a biochemical blood test is performed.

Expert opinion

In most cases, ascariasis is latent, without specific symptoms, and often the diagnosis is made “accidentally” during medical examinations. Considering that potential transmission factors constantly surround a person, it is recommended to undergo a screening examination. This allows you to timely establish the correct diagnosis and prescribe treatment, thereby avoiding the development of dangerous complications. Preventive examination is also recommended at the stage of conception planning, because. if helminthiasis is detected during pregnancy, then the possibilities of antihelminthic treatment are significantly limited.

Martishevskaya Evgenia Anatolyevna

Pediatrician, infectious disease specialist

Treatment of ascariasis

According to clinical guidelines for ascariasis, uncomplicated forms are treated conservatively. With the development of complications, surgery may be the only correct solution.

Conservative treatment

If roundworm eggs or sexually mature helminths are found in the feces, antihelminthic chemotherapy is performed. The standard course of treatment lasts about 3 days. Roundworms are highly sensitive to the right treatment, so the recurrence of the disease is associated only with re-infection. As part of complex therapy, desensitizing drugs and agents that improve digestion can also be prescribed.

Surgical treatment

With the development of acute surgical pathology, surgical treatment of complications of ascariasis is indicated. The operation consists in removing the helminth tangle and restoring the passage through the intestines.

Prevention of infection with ascariasis

Prevention of ascariasis consists in careful observance of sanitary and hygienic rules:

• frequent washing of hands with soap, especially before eating, as well as after harvesting;
• Refusal to consume unwashed crop products;
• food protection against insects (cockroaches, flies, ants and others).

In the villages, as part of the prevention of infection with ascariasis, it is important to stop using human feces as fertilizer for the garden. This poses a potential danger to the public.

Rehabilitation

After surgery, early activation, adherence to a sparing diet, and time limitation of strength training are shown.

Possible complications

• Intestinal obstruction is one of the most common variants of complicated ascariasis, which develops as a result of obturation of the intestinal lumen by helminths. Symptoms of ascariasis in humans with the development of acute intestinal obstruction are characterized by intense abdominal pain, stool and gas retention, flatulence, vomiting with or without nausea. The higher the level of mechanical obstruction, the earlier the gag reflex appears and the more pronounced it is. Abdominal pain is usually spasmodic. On palpation, tumor-like densely elastic conglomerates, which are painful, can be detected.
• Peritonitis. Its development may be due to the fact that adult roundworms are able to enter the abdominal cavity, perforating the intestinal wall.
• Allergic reactions. With toxic sensitization by foreign proteins, which are the decay product of the larvae themselves and their metabolic products, the body is sensitized. This is manifested by all kinds of allergic reactions – from skin rashes to the development of systemic anaphylactoid reactions.
• Ascariasis appendicitis. Cases of inflammation of the vermiform appendix against the background of ascaris invasion are described.

Questions and answers

Diagnosis and treatment of this disease is carried out by an infectious disease specialist.

Ascariasis is not transmitted from person to person, so sick people are not dangerous and do not require isolation.

There is no such vaccine, therefore, in endemic areas, preventive treatment of the population is carried out (it helps to reduce the risks of the spread of invasion).

Davydova I.V. Helminthiases registered on the territory of the Russian Federation: epidemiological situation, biology of parasites, pathogenesis, clinic, diagnostics, etiotropic therapy. Consillium Medicum. 2017; 19(8): 32-40.

Parasitoses in children / Arakelyan R.S., Okunskaya E.I., Galimzyanov Kh.M., Bogdanyants M.V., Kimirilova O.G. etc. // Textbook for students. – Astrakhan, 2017. – 46 p.

Safety of food products according to parasitological indicators / S.A. Shemetova, R.S. Arakelyan, N.V. Polyanskaya and others // Bulletin of Avicenna. 2021. V. 23. No. 2. S. 166 – 173.

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Diseases referred to Gastroenterologist

Avitaminosis
Atrophic gastritis
Achalasia
Balantidiasis
Crohn’s disease
Viral hepatitis
Gastritis
gastroptosis
Gastroenteritis
Gastroenterocolitis
Helminthiasis
Liver hemangioma
Hepatitis A
Hepatitis B
Hepatitis D
Hepatitis E
Hepatitis C
Hepatomegaly
hiatal hernia
Diarrhea
diarrhea during pregnancy
Traveler’s diarrhea
Intestinal diverticulosis
Dysbacteriosis
Dyspepsia
Benign neoplasms of the esophagus
Duodenitis
Jaundice
Cholelithiasis
fatty liver disease
Fatty hepatosis
Constipation
Heartburn
intestinal candidiasis
liver cyst
pancreatic cyst
intestinal colic
Colitis
Blood in stool
Flatulence
Mechanical jaundice
food poisoning
pancreatitis
Intestinal pneumatosis
Polyps of the stomach
Gallbladder polyps
Intestinal polyps
Postcholecystectomy syndrome
Reflux esophagitis (GERD)
Gilbert’s syndrome
Spasm of the esophagus
Toxic hepatitis
Helicobacteriosis
Cholangitis
cholestasis
Cholecystitis
Chronic gastritis
Chronic cholecystitis
celiac disease
Cirrhosis of the liver
Enteritis
Enterocolitis
Erosive gastritis
Esophageal ulcer
Peptic ulcer of the stomach and duodenum
Ulcerative colitis

Diseases referred to Infectionist

Anisakidosis
Ankylostomiasis
Balantidiasis
Blastomycosis
Brucellosis
Epstein-Barr virus
Viral infection
Viral hepatitis
Gastroenteritis
Gastroenterocolitis
Hemophilus infection
Genital herpes
Flu
Traveler’s diarrhea
Dysentery
Diphyllobothriasis
Diphtheria
Jaundice
Whooping cough
Rubella

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Licenses

Go to the section of licenses Go to the section of legal information and a person. The average length of an adult female human roundworm is about 30 cm, male – 20 cm. Imagine dozens of adult roundworms wandering through the intestines, not a very exciting sight, is it?

Ascariasis can be easily contracted by eating fruits and vegetables contaminated with mature worm eggs that reach the small intestine after ingestion. In the future, roundworm larvae enter the bloodstream through a perforated intestinal wall.

Blood-borne Ascaris larvae reach the heart and from there to the pulmonary capillaries, where they settle, starting a new cycle of their development. After about 10 days, the larvae, passing through the bronchial tree, end up in the mouth, are swallowed again and are partially eliminated by coughing and sneezing.

Returning back to the small intestine, the larva completes its maturation and becomes an adult in two or three months. Each mature female, after mating with a male, is able to lay up to 20,000 eggs per day, which are excreted in the feces. Eggs in suitable climatic conditions (moist soil, no direct sunlight) can maintain the ability to develop over a long period of time. In the eggs, larvae develop, with which, in the interval from 18 days to several weeks, two mutations occur before reaching the stage of parasitizing in the human body.

Symptoms of ascariasis

A small helminthic infestation rarely indicates the presence of any specific symptoms and is discovered incidentally. Most often, human ascaris causes gastrointestinal disorders:

– abdominal pain;

– nausea;

– vomiting;

– diarrhea alternating with constipation.

It happens that large specimens of worms move along the digestive tract and block the bile ducts. This leads to pain in the right hypochondrium, jaundice, acute cholecystitis, as well as hepatitis, appendicitis and intestinal obstruction. At whatever level the tissue obstruction caused by ascaris persists, it is followed by necrosis followed by perforation of the organ, which is life-threatening complication of ascariasis .

In the early stages, when the larvae are in the respiratory tract, the disease is characterized by a hacking cough, chest pain, and sometimes streaks of bright red blood in the sputum.

Basic diagnostic form Ascariasis is a fecal examination to determine the presence of human roundworm eggs. Endoscopic examination is necessary if there is a suspicion of ascaris in the duodenum and bile ducts. You can donate blood for total antibodies to ascaris. (Today, the price of such a study at laboratory sampling points is “Lakmus” is 140 UAH, fecal analysis for helminth eggs – 80 UAH) Sometimes helminths are found in vomit if the invasion went spontaneously up the gastrointestinal tract.