ASCARIASIS

A COMMON ROUND WORM DISEASE

Dr. Matobogolo Boaz Masalu

Specialist Physician
 INTRODUCTION
¨ Ascaris lumbricoides is
the largest nematode
(roundworm) parasitizing
the human intestine.
¨ Ascaris lumbricoides is an
intestinal worm found in
the small intestine of man.
¨ They are more common in
children then in adult.
¨ As many as 500 to 5000
adult worms may inhabit
a single host.
 Epidemiology
¨ World wide distribution, very common in Africa,
especially in the countryside (areas with
inadequate sanitation)
Factors favoring the spread of the transmission:
1. Simple life cycle.
2. Enormous egg production ( 240,000 eggs/ day/
female ).
3. These eggs are highly resistant to ordinary
disinfectants( due to the ascroside). The eggs
may remain viable for several years.
4. Social customs and living habits.
5. Disposal of feces is unsuitable.
 MORPHOLOGY
¨ It is a elongated, cylindrical and
tapering at both ends.
¨ Sexes are separate
¨ The female is longer than male
20 – 35 cm long, 4-6 mm in
diameter.
¨ Male is smaller being 15-30 cm
long, 2-4 mm in diameter.
¨ The posterior end of male is
curved having penial setae near
the end.
Adult worm of A. lumbricoides
 The Mouth Parts
¨ The mouth opens at the anterior end.
¨ It is surrounded by three finely toothed
lips.
¨ The lips are one dorsal and two
ventrolateral.
¨ These lips bear sensory structures called
labial papillae
¨ The dorsal lip has two double sensory
papillae and ventrolateral lip has one
double sensory papilla.
¨ The ventrolateral lip also bear amphidial
gland which is olfactory and
chemoreceptor
The lips of Ascaris lumbricoides

The three lips are seen

at the anterior end. The
margin of each lip is lined
with minute teeth which
are not visible at this
magnification.
 INFECTION TO MAN
¨ It occurs when the man swallows the
infective eggs of Ascaris with contaminated
food or water.
The Egg of Ascaris
¨ Egg: There are three kinds of the eggs. They are fertilized eggs,
unfertilized eggs and decorticated eggs. We usually describe an
egg in 5 aspects: size, color, shape, shell and content.
1. Fertilized eggs: broad oval in shape, brown in color, an average
size 60× 45µm. The shell is thicker and consists of ascaroside,
chitinous layer, fertilizing membrane and mammillated
albuminous coat stained brown by bile. The content is a fertilized
ovum. There is a new-moon(crescent) shaped clear space at the
each end inside the shell.
2. Unfertilized egg: Longer and slender than a fertilized egg. The
chitinous layer and albuminous coat are thinner than those of the
fertilized eggs without ascaroside and fertilizing membrane. The
content is made of many refractable granules various in size.
3. Decorticated eggs: Both fertilized and unfertilized eggs
sometimes may lack their outer albuminous coats and are
colorless.
Fertilized Ascaris Egg

A fertilized Ascaris egg, still

at the unicellular stage, as
they are when passed in
stool. Eggs are this stage
when passed in stool. Eggs
are normally at this stage
when passed in the stool
Unfertilized egg
The chitinous layer and
albuminous coat are thinner
than those of the fertilized
eggs without ascaroside and
fertilizing membrane. The
content is made of many
refractable granules various
in size.
 The Life Cycle
¨ 1. Site of inhabitation: small intestine
2. Infetive stage: embryonated eggs
3. Route of infection: by mouth
4. No intermediate and reservoir hosts
5. Life span of the adult: about 1 year
This worm lives in the lumen of small intestine,
feeding on the intestinal contents, where the fertilized
female lays eggs. An adult female can produce
approximately 240,000 eggs per day, which are passed in
feces. When passed, the eggs are unsegmented and require
outside development of about three weeks until a motile
embryo is formed within the egg.
¨ Adult worms live in the lumen of the small intestine.
A female may produce approximately 200,000 eggs
per day, which are passed with the faeces .
¨ Unfertilized eggs may be ingested but are not
infective. Fertile eggs embryonate and become
infective after 18 days to several weeks.
¨ After infective eggs are swallowed , the larvae
hatch , invade the intestinal mucosa.
¨ Carried via the portal, then systemic circulation to
the lungs. larvae mature further in the lungs (10 to 14
days), penetrate the alveolar walls, ascend the
bronchial tree to the throat, and are swallowed.
¨ Upon reaching the small intestine, they develop into
adult worms. Between 2 and 3 months are required
from ingestion of the infective eggs to oviposition by
the adult female. Adult worms can live 1 to 2 years.
LIFE CYCLE
Rhabditiform larvae

Egg hatch------3rd stage larva --- hepatic

portal vessels to liver (3-4 days) ------
Hepatic vein ------ Post caval vein -----
Heart --- Lungs (7days-3rd moulting) ---
Larynx --- oesophagus --- Stomach (4th
moulting)
 Symptoms of Ascariasis
¨ No symptoms
¨ Stage 1: worm larvae in the bowels attach to bowel walls
¨ Stage 2: worm larvae migrate into the lungs:
¨ Fever and breathing difficulty
¨ Coughing and pneumonia
¨ Stage 3: worms enter the small intestine and mature into worms
and remain there to feed
¨ Abdominal symptoms
¨ Abdominal discomfort
¨ Intestinal blockage - may be partial or complete
¨ Partial intestinal blockage
¨ Total intestinal blockage
¨ Severe abdominal pain
¨ Vomiting
¨ Restlessness
¨ Disturbed sleep
¨ Worm in stool
¨ Worm in vomit
Pathogenesis
There are two phase in ascariasis:
1. The blood-lung migration phase of the larvae:
During the migration through the lungs, the larvae
may cause a pneumonia. The symptoms of the
pneumonia are low fever, cough, blood-tinged
sputum, asthma. Large numbers of worms may
give rise to allergic symptoms. Eosionophilia is
generally present. These clinical manifestation is
also called Loeffler’s syndrome.
¨ 2. The intestinal phase of the adults. The presence
of a few adult worms in the lumen of the small
intestine usually produces no symptoms, but may give
rise to vague abdominal pains or intermittent colic,
especially in children. A heavy worm burden can
result in malnutrition. More serious manifestations
have been observed. Wandering adults may block the
appendical lumen or the common bile duct and even
perforate the intestinal wall. Thus complications of
ascariasis, such as intestinal obstruction, appendicitis,
biliary ascariasis, perforation of the intestine,
cholecystitis, pancreatitis and peritonitis, etc., may
biliary ascariasis is the
occur, in which
most common complication.
 CLINICAL FEATURES
¨ Abdominal pain, diarrhoea, vomiting
and slight temperature.
¨ It blocks intestine and appendix.
¨ They may enter bile or pancreatic
duct and interfere with digestion.
¨ Injure the intestine and cause
peritonitis.
¨ They produce toxins which irritate
the mucous membrane of the gut, or
prevent digestion of protein by host
by destroying an enzyme trypsin.
¨ In children they cause stunted growth
and makes the mental capacity dull.
¨ Larvae causes inflammation and
haemorrhage in the lungs which
results in pneumonia – may prove
fatal.
 Iii. Diagnosis
¨ The symptoms and signs are for reference only. The
confirmative diagnosis depends on the recovery and
identification of the worm or its egg.
1. Ascaris pneumonitis: examination of sputum for
Ascaris larvae is sometimes successful.
2. Intestinal ascariasis: feces are examined for the ascaris
eggs.
(1) direct fecal film: it is simple and effective. The
eggs are easily found using this way due to a large number
of the female oviposition, approximately 240,000 eggs per
worm per day. So this method is the first choice.
(2) brine-floatation method:
(3) recovery of adult worms: when adults or
adolescents are found in feces or vomit and tissues and
organs from the human infected with ascarids , the
diagnosis may be defined.
 Treatment
¨ Infections with A.lumbricoides are easily
treated with a no. of anthelmintic drugs:
¨ pyrantel pamoate given as a single dose of
10 mg/kg.
¨ levamisole given as a single dose of 2.5
mg/kg.
¨ mebendazole given as a single dose of 500
mg.
¨ albendazole given as a single dose of 400
mg.
 PREVENTION
¨ Keeping good sanitation conditions is the only way to
prevent the infection of Ascaris.
¨ Pollution of soil with human faeces should be avoided.
¨ Vegetable should be thoroughly washed in a mild solution
of Pottasium permanganate and properly cooked before
use.
¨ Finger nails should be regularly cut to avoid the collection
of dirt and eggs below them.
¨ Hands should be properly washed with some antiseptic
soap before touching edibles or eating.
 Prevention and Treatment
(summary)
¨ 1.Treatment to ascariasis:Mebendazole,
Albendazole and Levamizole are
effective.
¨ 2.Sanitary disposal of feces.
¨ 3.Hygienic habits such as cleaning of
hands before meals.
¨ 4.Health education.
 REFERENCES
¨ Medical parasitology by Chatterjee
¨ www.pubmedcentral.nih.gov/
articlerender.fcgi?artid
¨ www.websters-online-dictionary.org/As/
Ascaris.html
¨ emedicine.medscape.com/article