Ascariasis:

 Pathophysiology,  Clinical  
Manifesta7ons  and  Treatment  
 Ascariasis:  Pathophysiology  
•  Transmission  occurs  by  inges7on  of  soil  contaminated  
with  feces  containing  Ascaris  eggs  
•  Pathology  can  be  created  by  migra7ng  larvae  and  adult  
worms  
•  Eggs  migrate  to  small  intes7ne  where  they  mature  into  
larvae  and  penetrate  the  intes7nal  mucosa  
•  Larvae  enter  the  bloodstream  and  travel  through  the  
right  heart  to  the  lungs  
 Ascariasis:  Pathophysiology  
•  Larvae  get  caught  in  pulmonary  capillaries,  
and  burrow  into  alveolae  
•  They  then  migrate  up  the  trachea  and  are  
swallowed  into  the  esophagus  and  return  to  
the  small  intes7ne  
•  This  process  takes  10-­‐14  days  
 Ascariasis:  Clinical  Manifesta7ons  
•  Larvae  in  lungs  may  cause  cough,  fever,  asthma  and  
pulmonary  infiltrates  usually  1-­‐2  weeks  aHer  infec7on  
•  Adult  worms  live  in  small  intes7ne,  where  they  may  
cause  no  symptoms,  mild  symptoms  such  as  abdominal  
pain,  or  severe  symptoms  such  as  obstruc7on  or  
volvulus  in  children  with  heavy  worm  burdens  
•  In  more  severe  cases  worms  may  cause  appendici7s,  
genital  tract  invasion,  esophageal  perfora7on  or  
peritoni7s  
 Ascariasis:  Clinical  Manifesta7ons  
•  Female  worms  may  migrate  into  biliary  tract,  
causing  obstruc7on  or  liver  abscess  
•   Circula7ng  larvae  may  rarely  enter  the  
arterial  circula7on  and  cause  localized  
symptoms  in  the  brain,  eye  or  re7na  
 Ascariasis:  Laboratory  Findings  and  
Diagnosis    
•  Peripheral  blood  eosinophilia  may  be  seen  
during  larval  infiltra7on  of  lungs  
•  Diagnosis  made  by  iden7fica7on  of  Ascaris  
eggs  in  stool,  which  may  be  seen  60-­‐70  days  
aHer  infec7on  
 Ascariasis:  Treatment    
•  Single  dose  albendazole  is  the  preferred  
op7on  
•  Mebendazole  may  also  be  used  
 Ascariasis:  Case  History  
•  6  yo  boy  complained  of  RUQ  crampy  abdominal  
pain  
•  On  exam  his  temperature  is  38.8  and  he  is  
tachycardic  
•  Abdomen  distended  and  tympani7c;  bowel  
sounds  very  ac7ve  and  he  has  borborygmus  
•  There  is  diffuse  tenderness  with  rebound  
 Ascariasis:  Case  History  
•  KUB  shows  distended  loops  of  small  bowel  and  no  
colon  air  
•  Diagnosed  with  small  bowel  obstruc7on.    NG  tube  
placed,  NPO,  IV  fluids  and  an7bio7cs  given  
•  He  improved  clinically,  and  passed  stool.    Ascaris  eggs  
were  iden7fied,  and  he  was  given  albendazole  
•  His  symptoms  resolved  aHer  several  days  and  he  was  
discharged