Southwest Journal of Pulmonary, Critical Care and Sleep – Imaging

Wednesday, February 11, 2015 at 8:00AM

Figure 1. 23 cm adult Ascaris lumbricodes recovered from patient’s feces.

A 25 year-old man was admitted to the ICU with acute renal failure and acute respiratory failure from fluid overload after attempting to cross the border. The patient was successfully extubated after five days of mechanical ventilation and renal replacement therapy. Following extubation, the patient had a bowel movement and passed a 23cm adult Ascaris lumbricoides. He was treated with a single dose of albendazole 400 mg.

Ascariasis is a very common helminthic infection, particularly in pediatric populations, and affects mostly the gastrointestinal tract. When infective eggs are swallowed by the host, larvae hatch in the GI tract. The larvae invade the GI mucosa and then are brought into the lungs via portal circulation. The larvae can then move up the tracheobronchial tree and then are swallowed into the GI tract where the mature worms form (1).

While our patient had a simple gastrointestinal infection, several pulmonary complications of ascariasis have been reported (2). Adult worms can cause largyngospasm as well as mechanical obstruction of the airway which can result in cardiac arrest (3,4). This migration of worms from the stomach to the trachea may be related to the use of anesthetics and the subsequent relaxation of the lower esophageal sphincter. Ascaris larvae have been implicated in Loeffler’s syndrome, also described as simple pulmonary eosinophilia, characterized by transient pulmonary infiltrates and eosinophilia with a usually benign course.

Candy Wong¹; Aaron Fernandes², Jennifer Huang², and Sachin Chaudhary¹

¹Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine.

² Department of Medicine

University of Arizona

Tucson, AZ

References

1. Centers for Disease Control and Prevention. Parasites – Ascariasis. Biology. Available at: http://www.cdc.gov/parasites/ascariasis/biology.html (accessed 1/13/2015).

2. Li QY, Zhao DH, Qu HY, Zhou CN. Life-threatening complications of ascariasis in trauma patients: a review of the literature. World J Emerg Med. 2014;5(3):165-70. [CrossRef] [PubMed]

3. Maletin M, Veselinović I, Stojiljkovic GB, Vapa D, Budakov B. Death due to an unrecognized ascariasis infestation: two medicolegal autopsy cases. Am J Forensic Med Pathol. 2009;30(3):292-4. [CrossRef] [PubMed]

4. Husain SJ, Zubairi AB, Sultan N, Beg MA, Mehraj V. Recurrent episodes of upper airway blockage associated with Ascaris lumbricoides causing cardiopulmonary arrest in a young patient. BMJ Case Rep. 2009;2009. pii: bcr01.2009.1415. [CrossRef] [PubMed]

Reference as: Wong C, Fernandes A, Huang J, Chaudhary S. Medical image of the week: ascaris lumbridoies. Souhtwest J Pulm Crit Care. 2015;10(2):81-2. doi: http://dx. doi.org/10.13175/swjpcc008-15 PDF

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Ascaris in children | how to treat roundworm in humans | photo of roundworm

What are roundworms? These are roundworms that parasitize in the human body and cause such a disease as ascariasis . These helminths are bisexual, roundworm length can reach up to 25 cm for males and up to 40 cm for females. Unlike many other parasites, the adult roundworm is not attached to the intestines and can move freely inside the body and penetrate into various organ systems, causing damage to them.

Where roundworms live: the life cycle of the parasite

Ascaris roundworms are geohelminths: eggs develop in the soil. Under suitable conditions (sufficient humidity and warmth), the egg becomes infective within 10-16 days. If the ambient temperature is below 12ºС, then roundworm eggs do not develop, but remain viable for 2-3 years. This vitality of the egg is provided by the presence of five shells.

Together with particles of the earth, invasive helminth eggs fall on fruits and vegetables, into the water, where they are usually swallowed by a person. Infection can also occur through inhalation of soil particles (for example, while working in the garden).

The swallowed roundworm egg enters the human stomach, and then into the small intestine, where its shell is destroyed and the roundworm larva appears. It pierces the intestinal wall and reaches the circulatory system. Together with the blood flow, roundworms are brought into the bronchi and lungs, where they continue their development. Through the respiratory tract, parasites enter the pharynx and larynx, and, being swallowed again, together with saliva, they again find themselves in the gastrointestinal tract.

Adult roundworms parasitize in the intestines, but since the worm does not have a device for attaching to its walls, helminths can freely move towards food masses, and also affect the gallbladder, liver, and various organ systems.

After fertilization, the female roundworm produces up to 200,000 eggs per day, which are excreted along with feces. The development of the roundworm worm from an egg to a sexually mature individual after entering the host organism takes 72-76 days, while the life expectancy of a helminth is about a year. After death, the body of the parasite is excreted along with the feces.

Structural features

Like many parasites, roundworms have a fairly simple structure, the most developed reproductive system, which explains the large number of eggs produced by the worm. Roundworm respiration is anaerobic, energy is generated by the breakdown of glycogen. The digestive system is well developed: the roundworm has a mouth opening, thanks to which it swallows food that enters the intestines.

The structure of the roundworm allows it to move freely in the gastrointestinal tract and cavities of the human body, while with a slight invasion, the patient may not even be aware of the presence of parasites. There are frequent cases when roundworms in children are found only a year after the invasion: with the natural death of the worm.

Ascaris in children and adults

Unlike other types of worms, roundworms do not change owners throughout their entire life cycle, while both larvae and adults are equally dangerous for humans. Larvae migrating through the bloodstream can be introduced into any organ systems, causing damage to them, but they pose the most serious threat to the respiratory system. Roundworms in the lungs affect the alveoli and disrupt normal gas exchange, cause a choking cough, provoke the development of bronchitis and pneumonia. In the process of life, the larvae release toxins that destroy lung tissue, making the respiratory system vulnerable to other parasites, as well as fungal infections, viruses and bacteria. Larval migration lasts 9-12 days, after which their development continues in the intestine.

The danger of roundworms for humans also lies in the fact that, with significant invasion, the worms are able to block the intestinal lumens, causing its mechanical obstruction. Ascaris in a child and an adult cause severe intoxication, as well as metabolic disorders due to the fact that most of the micronutrients are absorbed by helminths and not absorbed by the body. All this makes ascariasis one of the most dangerous, and at the same time common, helminthiases. The symptoms of ascaris in adults and children are described in detail in the article about ascariasis posted on this site.

How to remove ascaris from the body?

Due to the wide distribution of these parasites and their danger to humans, doctors face the question of timely diagnosis of helminths and their removal. Classical therapy involves deworming with chemicals, but they can not be taken for long courses. As a result, chemicals affect only adult worms, and ascaris larvae, which are no less dangerous to humans, remain viable.

Effective deworming must be comprehensive. Antiparasitic drugs from NPK “Optisalt”, created exclusively from natural ingredients, can be taken in long courses, the duration of which is sufficient to remove not only adult roundworms from the body, but also their larvae, as well as eggs. In addition, the Optisalt complex eliminates the harm caused to the human body by helminthic invasion: it removes the waste products of the worm, improves the functioning of the gastrointestinal tract, replenishes the reserves of trace elements. You can read in detail about how and how to treat roundworms in our article about ascariasis, published on the website.

Ascariasis: treatment, symptoms, diagnosis, classification

Ascariasis is the defeat of the small intestine of the body by helminthic invasions. The causative agent is roundworms – roundworms (hence the name), parasitizing at the expense of human intestinal tissues.

Intestinal nematodosis (another name for the disease) occurs in people of all ages and genders everywhere – regardless of climatic conditions.

Main symptoms of disease

Symptoms of ascariasis depend largely on the extent of damage to the small intestine, as well as the age of the patient and the stage of development of the disease.

The primary phase may pass without clinical manifestations, especially in the period of migration of larvae. A person may experience one or more characteristic symptoms:

• an allergic reaction is manifested by numerous rashes on the limbs or torso. They itch intensely, bringing serious discomfort;
• infectious syndrome is expressed by elevated body temperature, excessive sweating, loss of strength;
• a liver factor can be observed – ascariasis is manifested by an increase in the size of the spleen and liver and causes pain under the ribs on the right side.

In most cases, the patient suffers from a wet or dry cough and severe shortness of breath, pain in the chest area. All this can lead to pleurisy.

If ascariasis in children or adults is started, there may be a sharp decrease in appetite, diarrhea, nausea, vomiting, bloating, pain in the intestinal area, convulsions, weight loss.

Main causes of infection

The main cause of ascariasis is infection with helminth eggs, which occurs as a result of their getting into the mouth of a person after his bodily contact with an infected person, as well as with unwashed vegetables, fruits, berries, and household items.

Once inside the human body, the larvae hatch from eggs and penetrate the circulatory system, spreading to the capillaries of the lungs. From there they reach the bronchi, trachea and pharyngeal zone. There they mix with saliva, are swallowed by a person and again enter the small intestine, growing in it to full-fledged adults.

Most affected categories

Most often, ascariasis is diagnosed in children with an insufficient level of hygienic education. Also, agricultural workers, gardeners, cleaners, and specialists working at sewage treatment plants are especially susceptible to the disease.

Preventive measures

Prevention of ascariasis is based on the timely detection of the disease and adequate treatment under the supervision of a physician.

Of particular importance in this process is the observance of all hygiene rules: it is necessary not only to keep your hands and children’s hands clean, but also to instill in them proper hygiene habits.

Regular washing of hands after a walk, going to the toilet, before eating, as well as proper sanitization of food that falls on the table, can largely protect the body from infection with roundworms.

Diagnostic features

Having noted one or more symptoms of this disease in yourself or your child, you should seek help from an infectious disease specialist (in the case of a child, a pediatrician or a pediatric infectious disease specialist).

Diagnosis of ascariasis involves the delivery of a general blood test: an increase in ESR and eosinophils, a slight increase in the number of leukocytes and a decrease in hemoglobin will indicate the presence of an ailment.

In addition, an X-ray of the lungs can be prescribed, on which, in the presence of helminths, foci of infiltration are detected.

The presence of ascaris can also be confirmed by microscopic examination of sputum.

It is important to seek help from a center with a really competent specialist and high-quality equipment, since helminths tend to show themselves far from all analyzes. Only an experienced doctor is able to see their presence in the patient’s body.

Treatment

Drug therapy based on the intake of anthelmintic drugs is prescribed. They are selected depending on the stage at which the disease is currently located. In some cases, a single dose for ascariasis may not be enough, and the drug will need to be taken 3 times with a pause between doses set by the doctor.

In the presence of allergic manifestations, the doctor additionally prescribes antihistamines. If the patient has a disorder of the stool, bloating and pain in the abdomen and other disorders of the intestines, then enzymes and probiotics are also selected for him.

At the end of the main treatment for the next 3 months, the patient is at the dispensary with periodic blood and stool tests.

Treatment of disease at home

Treatment of ascariasis should be carried out under the supervision of a specialist.

Thoughtless taking of drugs can provoke serious toxic poisoning of the body with further use of a dropper and hospitalization.

Answers to common questions

Is it possible to get rid of ascaris with herbs?

Many medicines contain herbal ingredients. Herbs also have a certain effect, but we must not forget about the serious side reactions that their thoughtless use can lead to.

Self-treatment of ascariasis with herbs is categorically not recommended.

Can I get rid of ascaris myself without going to a doctor?

No, this is strictly prohibited, as it is fraught with poisoning of the body and the occurrence of serious complications in the work of internal organs, in particular, the organs of the pulmonary system and intestines.

How is ascariasis transmitted?

The disease can be transmitted by shaking hands, as well as other types of bodily contact.

The most common infection is through contact with poorly washed fruits, vegetables, berries and herbs. You should also remember about hand hygiene after returning from the street and using the toilet.

What foods can cause disease?

Absolutely any, if they are not processed properly.

Why does cough develop in ascariasis?

Cough appears due to the penetration of larvae through the capillary vessels into the region of the lungs and bronchi.

What is the prognosis after treatment of ascariasis?

The prognosis is generally favorable.