Ascariasis

Content
1. Introduction
2. Clinical picture
3. Diagnosis
4. Treatment and prevention

● Ascariasis is caused
by Ascaris lumbricoides
● Largest and most
common intestinal nematode
of human
● Warm and humid
countries in tropics and
subtropics

Life cycle and morphology of Ascaris lumbricoides

● Grow upto 40cm

● Female is larger than male
● The posterior end is curved towards the ventral side with a pointed tail, and they
have copulatory spicules.
Ascaris lumbricoides eggs
Round worm disease

● Only 15% of infected patients are symptomatic.

● Reasons for becoming symptomatic are due to,
○ Larval migration and moulting in the lung
○ Obstruction of bowels and associated viscera in a heavy infection
○ Malnutrition in chronic and heavy infection

Larvae in the lung

Adult worm in the gut

Signs and symptoms due to larval migration

● First moulting takes place in soil in shelled egg whereas, second and third moulting
take place in alveoli of lung.
● The final moulting takes place in intestine

● Protein of parasite's debris is highly allergenic

● A large number of larvae moulting causes, immune reactions in human
○ Persistent cough
○ Fever
○ Shortness of breath
○ Wheezing
○ Hemorrhagic pneumonia
○ Skin reactions like urticaria

Loffler syndrome
● Initially described by loffler
● Loffler syndrome is a transient respiratory illness associated with blood eosinophilia
and radiographic shadowing
● The original description of loffler syndrome listed parasitic infection with Ascaris
lumbricoides as its most common cause.
Obstruction of bowels and other lumina
● Round worm does not attach to the wall of the bowel, and they are continuously
moving against peristalsis.
● When a patient gets a large number of worms in the gut lead to,
○ Intestinal obstruction
○ Migration to atypical sites
○ Bowel wall rupture or piercing, cause faecal peritonitis
○ Bile duct obstruction
○ Entering the trachea - suffocation
● Chronic symptoms
○ Pancreatitis
○ Cholecystitis
○ Appendicitis

● Ascaris takes its nutritional needs from the food and reduces the availability to
humans.
● Strong research evidence is there that the Ascaris lumbricoides infection definitely
retards childhood growth

Diagnosis
● Diagnosing the disease condition due to larvae migration
○ WBC count - eosinophilia
○ Examination of sputum smear for larvae (usually not practicing these days)
○ On stool examination, eggs may be absent in a primary infection

Diagnosing the disease cause by adult worm

Examining stools for the eggs in the most straightforward method
● Heavier than infection
● More eggs in the stool and
● A large number of female compared to male worms - more unfertilized eggs.
Treatment
● Mebendazole 500mg single dose
● 100mg twice daily for 3 days.
(Avoid in the first trimester of pregnancy and below 2 years. Moreover, not
recommended while suffering from fever due to risk of atypical migration.)
● Albendazole 400mg single dose.
● Pyrantel for children below 2 years.

Prevention
● Ascaris is a soil - borne disease and, not faeco-oral transmitting disease.
○ Health education
○ Proper sanitation
○ Personal hygiene
○ Mechanical vector control
○ Proper cooking methods
○ Use boiled water
○ Avoiding use night soil as fertilizer
○ Regular treatments for adult worm