HELMINTHIASIS

ASCARIASIS
(Roundworm Infection)
  Ascaris is an infection caused by a
parasitic roundworm, Ascaris
Lumbricoides

DEFINITION
 Ascaris Lumbricoides
1. Elongated & cylindrical worms that are
tapered at the oral portion & pointed at the
anal end
2. Creamy & pinkish yellow when fresh
ETIOLOGIC 3. Grow as thick as a pencil & live for 1-2 years
AGENT 4. Female worm can produce up to 240,000
eggs per day, which are discharged into
feces and incubated in the soil for weeks.
5. Large worms ranging from 4-12 inches in
length and in general appearance it is
similar to earth worms.
  Males reach about 15 – 30 cm
 Females reach about 20 – 35 cm

ETIOLOGIC
AGENT
 1. Ascaris Lumbricoides is transmitted
through contaminated fingers put into
MODE OF the mouth.
TRANSMISSION 2. Ingestion of food & drinks
contaminated with embryonated eggs
can transmit ascaris.
  Infection is the result of ingestion of
embryonated eggs containing the larvae.
 After ingestion, Ascaris hatches & release
larvae which penetrates the intestinal wall &
reach the lungs through the bloodstream.
PATHOGENESIS  After 10 days in the pulmonary capillaries &
alveoli, the larvae migrate to the bronchioles,
bronchi, trachea & epiglottis.
 They are then swallowed & returned to the
intestine where they mature & mate.
  After 10 days, The female worm is a
prolific egg producer, releasing as many
as 27 million eggs, which are passed in the
human feces.
 The eggs become mixed with the soil, and
under proper conditions of temperature &
moisture they develop & are eventually
PATHOGENESIS blown away in the dust.
 Thus, the soil becomes the infective
medium to the host, from which the
infection is:
Dust-borne, Food-borne, Hand-borne &
Money-borne
  The vomitus is sometimes bile stained
and may contain worms.
 Steatorrhea & diminished vitamin A
absorption also may occur.

SIGNS &  The adult worms can grown to more

SYMPTOMS than 20 cm in length and hence are
easily seen in stool.
 Worms may also emerge form the nose
or mouth, as a result of coughing or
vomiting.
  Ascaris eggs appear in stool 60 to 70
days after ingestion.
INCUBATION
PERIOD  Pulmonary symptoms may occur 4-6
days after ingestion.
LIFE CYCLE
OF ASCARIS
 Developmental Stage
1. Embryonated ova
 Soil contamination with human excreta

LIFE CYCLE  Contamination of food, water & other objects

OF ASCARIS  Ingested to intestine
 2. Larval Stage
 The larvae penetrate the walls of the
intestine (duodenum).
 The larvae are picked up by lymphatics or
LIFE CYCLE bloodstream.
OF ASCARIS
 They are carried to the liver
 Some larvae may reach the heart
 Sometimes they are carried to the biliary
tract
SYMPTOMATOLOGY:

Nause & Vomiting Poor Appetite Periumbilical Pain

RUQ Pain Wheezing Urticaria

Asthma Increase in the eosinophils
Other symptoms:
1. Malaise
2. Cough
3. Leukocytosis
4. Angioneurotic edema
  They may reach the stomach , esophagus &
then the upper respiratory tract.
 They may still in the capillaries of the
lungs, and they reach the alveoli, where
they grow & molt for 10 days.
 From the alveoli, they migrate to the
LIFE CYCLE bronchioles, bronchi, trachea & epiglottis.
OF ASCARIS
 Ascaris in the larvae stage may be
swallowed or ingested.
 During the pulmonary migration of the
larvae there may be a mild dry cough &
hemoptysis.
SYMPTOMATOLOGY:

Cough Fever Rales

Blood-tinged sputum Nasal pruritus

 3. Adult / Intestinal Stage
 Adult ascaris stays in the small intestine
 At times they become erratic that they go
the stomach to the esophagus, &
LIFE CYCLE sometimes to the common bile duct & the
OF ASCARIS gall bladder
 In the GIT, they copulate. The female lay
eggs about 2-3 months after embryonated
eggs are ingested.
SYMPTOMATOLOGY:

1. Nakamura Sign – colicky, periumbilical pain aggravated by cold stimulation

2. Intestinal Obstsruction

3. Severe abdominal pain associated with vomiting

SYMPTOMATOLOGY:

4. Children with heavy infections suffer from:

a.Malnutrition
b. Dehydration
c. Electrolyte Imbalance

5. The worms may crawl up to the esophagus to the pharynx and be

vomited or crawl from the nose & mouth, or they may find their
way to the lungs, causing a fatal pneumonia.
 1.Stool for ova (Kato-Katz
Technique)
DIAGNOSTIC
TESTS 2.Abdominal X-ray “Dot Sign”
3.Routine blood counts
  The pulmonary symptoms may be
similar to: Asthma, Pneumonia,
Aspergillosis, Strongyloidiasis,
Hookworm & Other parasitic
infections affecting the lungs.
DIFFERENTIAL  The intestinal phase may resemble a
DIAGNOSIS variety of GIT disorders.
 Postprandial dyspepsia caused by
Ascaris may mimic duodenal ulcer,
hiatal hernia or pancreatic or
gallbladder disease.
  Biliary tract obstruction; patient
develops cholestatic jaundice
 Hepatic abscess & cholangitis
 Intestinal Obstruction, perforation,
COMPLICATIONS peritonitis
 Malnutrition due to damage of the
intestinal mucosa, which impairs the
absorption of nutrients.
 1. Albendazole or mebendazole – 15cc as a
single dose
2. Piperazine citrate – 75mg/kg twice daily,
orally
 The action of which causes paralysis of the
TREATMENT neuromuscular junction within the worm.
This in turn inhibits the worm’s activity to
such an extent that is carried away in the
feces
3. Pyrantel Pamoate - 1 mg/kg as a single
dose, orally
 1. Isolation is not needed.
2. Preventive measures in each home &
in the community should be enforced.
3. All the members of the family must
be taught on sanitary practices
NURSING 4. Availability of toilet facilities must be
INTERVENTIONS ensured.
5. Importance of personal hygiene
should be explained.
6. Proper disposal of diapers should be
emphasized to mothers.
  Self-care deficit
 Altered nutrition: Less than body
requirement
COMMON  Altered in bowel elimination
NURSING
 Fear
DIAGNOSIS
 Pain & discomfort
 High risk for infection
 1. Improved sanitation & hygiene
practices
2. Improved nutrition
3. Deworming may be advised
PREVENTION
4. When travelling to areas where
sanitation & hygiene are poor, avoid
water or food that may be
contaminated.