Ascariasis

Causes

Ascariasis is caused by consuming food or drink contaminated with roundworm eggs. Ascariasis is the most common intestinal worm infection. It is found in association with poor personal hygiene, poor sanitation, and in places where human feces are used as fertilizer.
Once consumed, the eggs hatch and release immature roundworms called larvae within the small intestine. Within a few days, the larvae then move through the bloodstream to the lungs, exit up through the large airways of the lungs, and are swallowed back into the stomach and reach the small intestine.
During movement through the lungs the larvae may produce an uncommon form of pneumonia called eosinophilic pneumonia. Once they are back in the small intestine, the larvae mature into adult roundworms. Adult worms live in the small intestine where they lay eggs that are present in feces. They can live 10 – 24 months.
It is estimated that 1 billion people are infected worldwide. Ascariasis occurs in people of all ages, though children are affected more severely than adults.

Symptoms

Most of the time, there are no symptoms. If there are symptoms, they may include:

• Bloody sputum
• Cough
• Low-grade fever
• Passing worms in stool
• Shortness of breath
• Skin rash
• Stomach pain
• Vomiting worms
• Wheezing
• Worms exiting through the nose or mouth

Exams and Tests

The infected person may show signs of malnutrition. Tests to diagnose this condition include:

• Abdominal x-ray
• Complete blood count
• Eosinophil count
• Stool ova and parasites exam

Treatment

Treatment includes medications that paralyze or kill intestinal parasitic worms, such as albendazole or mebendazole. These drugs should not be used for pregnant patients. Pyrantel pamoate is the preferred medication for pregnant patients.
If there is a blockage of the intestine caused by a large number of worms, endoscopy to remove the worms or, rarely, surgery may be needed.

Outlook (Prognosis)

Most people recover from symptoms of the infection, even without treatment, although they may continue to carry the worms in their body.
Complications may be caused by adult worms that move to certain organs such as the bile duct, pancreas, or appendix, or multiply and cause a blockage in the intestine.

Possible Complications

• Liver secretion (biliary tract) obstruction
• Blockage in the intestine
• Hole (perforation) in the gut

When to Contact a Medical Professional

Call your health care provider if you have symptoms of ascariasis, particularly if you have traveled to a high-risk area. Also call if symptoms get worse, do not improve with treatment, or if new symptoms occur.

Prevention

Improved sanitation and hygiene in developing countries will reduce the risk in those areas. In areas where this disorder is common, routine or preventive (prophylactic) treatment with deworming medications may be advised.

References

Kazura JW. Nematode infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 378.
Maguire JH. Intestinal nematodes (roundworms). In: Mandell GL, Bennett JE, Dolan R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Orlando, FL. Saunders Elsevier; 2009:chap 287.