Presentation
Imaging Chest radiograph, if cough is present Abdominal imaging, if abdominal signs or symptoms of obstruction or perforation Differential Diagnosis Ascariasis should be considered in the differential diagnosis when a patient presents with pneumonia, [unboundmedicine.com]
Provide small, frequent meals if intestinal obstruction is not present. Auscultate bowel sounds for changes suggesting evidence or resolution of intestinal obstruction. Obtain stool specimens, as ordered, for laboratory testing. [quizlet.com]
Clinical presentation: The patients may often present with a history of passing worms by mouth or anus. A number of patients, presents with a subacute clinical course. [histopathology-india.net]
Analogously, the penetration of a worm in Meckel’s diverticulum or other congenital or acquired intestinal diverticula may present as an acute diverticulitis. [jpss.eu]
Figure 6 Duodenal ascariasis presenting as biliary colic. [wjgnet.com]
Entire Body System
- Fever
Complications Bronchopneumonia may be seen during the pulmonary migrational stage, producing fever, cough, dyspnea, wheeze, eosinophilia, and pulmonary infiltrates (Löeffler syndrome). [unboundmedicine.com]
During migration and molding through lungs, larvae may causes pneumonia with low grade fever, cough and other allergic symptoms. [onlinebiologynotes.com]
Clinical findings, larval migration elsewhere Conjunctivitis, fever, seizures, rash. Clinical findings with mature worms Abdominal colic, nausea, vomiting, anorexia, anal pruritus, weight loss, diarrhoea, malabsorption. [medical-dictionary.thefreedictionary.com]
The adult worms can be stimulated to migrate by stressful conditions (eg, fever, illness, or anesthesia) and by some antihelmintic drugs. [meddean.luc.edu]
- Asymptomatic
Clinical findings Often asymptomatic. Clinical findings, larval migration to lungs Wheezing, cough, chest pain, dyspnoea, pneumonitis at time of transpulmonary migration. [medical-dictionary.thefreedictionary.com]
Clinical Manifestations: Most infections are asymptomatic, although nonspecific gastrointestinal tract symptoms may occur in some patients. Pulmonary involvement. [meddean.luc.edu]
Cerebrovascular disease in symptomatic and asymptomatic patients with sickle cell anemia: screening with duplex transcranial Doppler US — correlation with MR imaging and MR angiography. Radiology 1993; 189:457-466. [books.google.es]
Intestinal obstruction Pneumonitis Mostly asymptomatic Stomach discomfort or pain Nausea and vomiting Recent travel to an endemic area Restlessness Disturbed sleep Cough Dyspnea Chest pain Assessment-Physical Findings Abdominal tenderness Dehydration [quizlet.com]
- Malnutrition
The infection results in malnutrition and retardation of growth in children. Large number of Ascaris cause abdominal discomforts, colic pains and interfere with the digestion of man. [biologydiscussion.com]
Effects due to adult worms are as follows: Loss of appetite Malnutrition may occur Heavy infection may cause intestinal obstruction Worms may be vomited out or may come out through mouth or nose. [medindia.net]
The implementation of these strategies would go far toward eliminating the morbidity attributable to malnutrition in children in much of the world. [infectionlandscapes.org]
[…] eggs are thin-walled, ellipsoidal; found in the small intestine, particularly the jejunum SECTION II - HEALTH HAZARD PATHOGENICITY: Symptoms correlate with worm load: light loads are asymptomatic; heavier loads cause abdominal symptoms, diarrhea and malnutrition [msdsonline.com]
- Weight Loss
Even if food is available, it's often not eaten due to loss of appetite and painful digestion. Weight loss is most noticeable around the face, upper body and buttocks/thighs. [wikihow.com]
Clinical findings with mature worms Abdominal colic, nausea, vomiting, anorexia, anal pruritus, weight loss, diarrhoea, malabsorption. [medical-dictionary.thefreedictionary.com]
In those that have them, infection may cause: Lungs: Dry cough Fever Wheezing Breathing problems Bowels: Belly cramps Vomiting Diarrhea Weight loss The worms can cause problems in the gallbladder, liver, pancreas, and appendix. [cvshealthresources.com]
Intestinal ascariasis; Nausea Vomiting Colicky abdominal pain Abdominal distention Weight loss and diarrhea Malbasorption of nutrition Growth retardation Heavy worm in children leads to intussusception and total obstruction Complications: Appendicitis [onlinebiologynotes.com]
- Falling
I've seen dreams of salvation fall through trembling hands and wither in solitude. Only perseverance remains On this path I've walked so long. Through anguish we must rise, To carve the world before our eyes. [ascariasis.bandcamp.com]
At hit of Mature eggs in the human intestine larvae are released from egg shells and implemented in the intestinal Vienna, which fall into the portal, and then into the inferior Vena cava and the right heart. [medicalency.com]
[…] number of infected people: avoid contact with soil that may be contaminated with human faeces; wash hands with soap and water before handling food; wash, peel or cook all raw vegetables and fruits; protect food from soil and wash or reheat any food that falls [who.int]
[…] will be better to keep away from contact with soil that may be contaminated with human faeces,wash hands with soap and water before handling food,wash, peel or cook all raw vegetables and fruits,protect food from soil and wash or reheat any food that falls [streetdirectory.com]
Respiratoric
- Pneumonia
Migration by the larvae results in the development of hepatitis and pneumonia. Other less common sequelae include biliary duct obstruction and a severe interstitial pneumonia when atypical larvae, e.g. Ascaris suis, infect cattle. [medical-dictionary.thefreedictionary.com]
Ball of worms Filling defects in the biliary system Differential Diagnosis Biliary colic Intestinal obstruction Community-acquired pneumonia Complications Appendicitis Jaundice (if bile ducts are involved) Pneumonia Bowel perforation Mechanical obstruction [learningradiology.com]
During movement through the lungs the larvae may produce an uncommon form of pneumonia called eosinophilic pneumonia. Once they are back in the intestines, the larvae mature into adult roundworms. [dxline.info]
- Sputum
Sputum culture may reveal larvae. Diagnostic Test Results-Imaging Abdominal X-rays show whirlpool pattern of intraluminal worms. (Intestinal obstruction may be noted.) [quizlet.com]
Diagnosis during the stage of larval migration is difficult, although occasionally larvae may be found in the sputum or gastric contents. [isradiology.org]
Demonstration of larvae: The larvae may be detected in the sputum during the stage of migration to lungs. Blood tests: Antibodies against Ascaris lumbricoides can be detected through blood tests. [medindia.net]
- Aspiration
Laboratory Diagnosis The diagnosis of ascariasis depends on the identification of the adult worms passed through the rectum or from some other body orifice, or by identifying the eggs of A. lumbricoides in the stool, vomitus, sputum, or small bowel aspirate [isradiology.org]
[…] fever, cough, chest pain, hemoptysis, dyspnea, and wheezing due to (1) Loffler's syndrome, (2) the effects of larval tissue migration, (3) airway reactivity or bronchospasm, (4) infectious bacterial complications from parasitic migration and associated aspiration [ncbi.nlm.nih.gov]
But somehow determination prevails, Either driven by aspiration Or a devotion to idle love, Neither of which bare the certainty That my persistence was not forlorn. Only the lingering truth, That even the selfless will be betrayed. [ascariasis.bandcamp.com]
The pus is obtained by duodenoscopy or ERCP from the pus points in the papillary orifice or bile aspiration respectively. [jgid.org]
Gastrointestinal
- Overeating
Over half a dozen anti-parasitic medications are effective against the worm, but prevention efforts are more important, such as using proper toilet facilities and avoiding tainted food. [house.wikia.com]
Author of over 100 publications including peer-reviewed journal articles, books, and book chapters on parasitology and related topics; including the senior editorship of “Toxocara the enigmatic parasite and “The Geohelminths: Ascaris, Trichuris and Hookworm [books.google.de]
Images in Clinical Medicine Myoung Kuk Jang, M.D., and Ki Sung Lee, M.D. 2 Citing Articles A 60-year-old woman presented to the outpatient clinic with vague abdominal discomfort that had developed over the previous several weeks. [nejm.org]
- Nausea
Common gastrointestinal complaints associated with helminth infection include abdominal pain, nausea, and diarrhea. [amboss.com]
[…] loss or malnutrition A worm in your vomit or stool When to see a doctor Talk to your doctor if you have persistent abdominal pain, diarrhea or nausea. [mayoclinic.org]
Adult Ascaris may cause vitamin A deficiency, malnutrition, nausea etc. ii. Adult worms are residing inside the lumen of the intestine of man and damaging the inner lining of intestine and cause peritonitis. iii. [biologydiscussion.com]
After spending about a week in the lungs, the larvae eventually get coughed up the trachea and into the throat, where they are swallowed down the esophagus into the stomach and pass into the small intestine. 2 Be aware of abdominal pain and nausea. [wikihow.com]
Intestinal obstruction Pneumonitis Mostly asymptomatic Stomach discomfort or pain Nausea and vomiting Recent travel to an endemic area Restlessness Disturbed sleep Cough Dyspnea Chest pain Assessment-Physical Findings Abdominal tenderness Dehydration [quizlet.com]
- Worms in Stool
Microscopic examination of stool Identification of adult worms in stool or emerging from the nose, mouth, or rectum Diagnosis of ascariasis is by microscopic detection of eggs in stool or observation of adult worms in stool or emerging from the nose or [merckmanuals.com]
Signs Distinctive Ascariasis eggs in stool Roundworm passed in stool Length: 15-30 cm (6 to 12 inches) Color: creamy white VII. Labs Stool Ova and Parasite s Stool microscopy Worm if available IX. [fpnotebook.com]
Pain Obstruction (2 per 1,000) Peritonitis from perforation Biliary colic, hepatitis, or pancreatitis from blockages due to worms History of passage of large worms in the stool or vomitus is suggestive of ascariasis. [unboundmedicine.com]
Diagnosis is by identifying eggs or adult worms in stool, adult worms that migrate from the nose or mouth, or larvae in sputum during the pulmonary migration phase. Treatment is with albendazole, mebendazole, or ivermectin. [msdmanuals.com]
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 [dxline.info]
- Intestinal Perforation
Efem SE. (1987) Ascaris lumbricoides and intestinal perforation. Br J Surg 74(7): 643-4 17. Paraskevaides EC, Ghawass MI. (1988) Ascaris lumbricoides and intestinal perforation. Br. J. Surg. 75 (1): 92 18. [jpss.eu]
However, if complications like bowel blockage or intestinal perforation occur, other doctors such as a surgeon and/or infectious disease specialist may need to be consulted. [medicinenet.com]
Complications including volvulus, ileocecal intussusception, gangrene, and intestinal perforation occasionally result. The overall incidence of obstruction is approximately 1 in 500 children. [web.stanford.edu]
- Abdominal Colic
Clinical findings with mature worms Abdominal colic, nausea, vomiting, anorexia, anal pruritus, weight loss, diarrhoea, malabsorption. [medical-dictionary.thefreedictionary.com]
Liver, Gall & Pancreas
- Jaundice
Worm migration can cause peritonitis, secondary to intestinal wall penetration Common bile duct obstruction resulting in acute obstructive jaundice. Diagnostic Tests: The diagnosis is established by finding characteristic eggs in the feces. [meddean.luc.edu]
Ball of worms Filling defects in the biliary system Differential Diagnosis Biliary colic Intestinal obstruction Community-acquired pneumonia Complications Appendicitis Jaundice (if bile ducts are involved) Pneumonia Bowel perforation Mechanical obstruction [learningradiology.com]
In some cases the adult parasite can invade the biliary or pancreatic ducts and cause obstruction with development of jaundice, cholecystitis, ascending cholangitis, pancreatitis, and hepatic abscesses. [histopathology-india.net]
Obstructive jaundice and acute haemorrhagic pancreatitis have been known to occur when the worm has entered into the biliary passage. At time the parasite penetrates high up in the liver causing one or more abscesses. v. [biologydiscussion.com]
Pancreatitis, cholangitis, jaundice, liver abscesses. Respiratory tract obstruction. Prognosis [ 5 ] Uncomplicated infections respond well to treatment with anthelmintics. [patient.info]
Skin
- Erythema
[…] swallowing and autoinfection → larvae mature into adult, egg-producing worms in the intestine → eggs develop into “ free-living ” infectious larvae and are excreted in feces Incubation period : 1–4 weeks Clinical features Cutaneous phase: swelling, erythema [amboss.com]
Neurologic
- Seizure
Clinical findings, larval migration elsewhere Conjunctivitis, fever, seizures, rash. Clinical findings with mature worms Abdominal colic, nausea, vomiting, anorexia, anal pruritus, weight loss, diarrhoea, malabsorption. [medical-dictionary.thefreedictionary.com]
[…] weight loss, nausea, and vomiting Symptoms caused by cysticerci accumulation in subcutaneous tissue, muscles, brain, spinal cord, and eyes Palpable subcutaneous cysts Myalgia Neurocysticercosis : increased intracranial pressure, neurological deficits, seizures [amboss.com]
Workup
X-Ray
- Pulmonary Infiltrate
Complications Bronchopneumonia may be seen during the pulmonary migrational stage, producing fever, cough, dyspnea, wheeze, eosinophilia, and pulmonary infiltrates (Löeffler syndrome). [unboundmedicine.com]
Larvae in the lungs may cause cough, fever, asthma and pulmonary infiltrates usually 1-2 weeks after infection. Adult worms live in small intestine, where they may cause no symptom. [coursera.org]
Patients with pulmonary conditions caused by larval migration are characterised by wheezing, cough, fever, eosinophilia and pulmonary infiltration. [www2.health.vic.gov.au]
Accompanying pathological symptoms include pulmonary infiltration, eosinophilia (symptoms of the overabundance of eosinophils in the blood such as asthma and allergic reactions), and a diagnostic symptom is, aside from standard microscopy of stools, radiographic [en.wikipedia.org]
Microbiology
- Necator Americanus
Commonly Associated Conditions This infection may be associated with other soil-transmitted helminths: Hookworm ( Necator americanus, Ancylostoma duodenale ) Trichuris trichiura Strongyloides stercoralis Toxocara canis Diagnosis History Gastrointestinal [unboundmedicine.com]
Ancylostoma duodenale and necator americanus measure 10 mm in length; the adult worm is not seen in stool. Strongyloides stercoralis is only 2 mm long, and the worm is not seen in stool. Medically important nematodes. [meddean.luc.edu]
References: [11] [1] [14] [15] [16] [17] [18] Hookworm infections (ancylostomiasis; necatoriasis) Pathogen Human hookworms ( Ancylostoma duodenale and Necator americanus ): nematodes ( roundworms ) Zoonotic hookworms, i .e., cat and dog hookworms ; that [amboss.com]
Cutaneous larva migrans Definition CLM or creeping eruption is an intense pruritic condition caused by prolonged migration of the dog and cat hookworms in man Aetiology 1) Ancylostoma braziliense 2) A. caninum 3) Gnathostoma spinigerum 4) Necator americanus [slideshare.net]
- Fasciola Hepatica
On multiple dot ELISA for 12 parasite antigens, A suum, T canis, Dirofilaria immitis, Anisakis simplex, Gnathostoma doloresi, Strongyloides ratti, Paragonimus westermanii, Paragonimus miyazakii, Fasciola hepatica, Clonorchis sinensis, Spirometra erinacei [jnnp.bmj.com]
Treatment
Ongoing Care Follow-Up Recommendations Treatment is highly effective. Reexamination of stool specimens 2 weeks after therapy can be considered but is not essential. [unboundmedicine.com]
Worms, Vectors and Human Diseases This course provides students an understanding of important human parasitic diseases, including their life cycles, vectors of transmission, distribution and epidemiology, pathophysiology and clinical manifestations, treatment [coursera.org]
[…] including drug, dosage, and frequency of administration possible adverse effects of medications; that albendazole requires a one-time dose; mebendazole 100 mg should be used twice daily for three days or 500 mg should be given as a one-time dose that treatment [quizlet.com]
Treatment consists of anthelmintic agents such as albendazole or praziquantel. For helminth infection prevention, see “ Food and water safety ” in the learning card food poisoning. [amboss.com]
Piperazine citrate, pyrantel pamoate, mebendazole, and albendazole are effective treatments. [medical-dictionary.thefreedictionary.com]
Prognosis
Prognosis Once intestinal infection is detected and treated, the prognosis is excellent. If obstructive or respiratory complications have occurred, the prognosis is less favorable. [unboundmedicine.com]
What is the prognosis of ascariasis? The prognosis of ascariasis for appropriately diagnosed and treated ascariasis is very good. However, the prognosis begins to decline if the patient develops a high number of worms in the body (worm burden). [medicinenet.com]
Biliary colic Intestinal obstruction Community-acquired pneumonia Complications Appendicitis Jaundice (if bile ducts are involved) Pneumonia Bowel perforation Mechanical obstruction Treatment Oral Albendazole is the drug of choice Vitamin supplementation Prognosis [learningradiology.com]
Outlook (Prognosis) Most people recover from symptoms of the infection, even without treatment, although they may continue to carry the worms in their body. [dxline.info]
Etiology
This syndrome has been related to the group of disorders characterized by eosinophilia and pulmonary changes which include Löffler's syndrome 2 and tropical eosinophilia. 3 The etiologic basis of this syndrome has not been proved, but it has been assumed [jamanetwork.com]
Etiology Children commonly acquire this infection from playing in dirt contaminated with Ascaris eggs. [unboundmedicine.com]
Etiology: Ascaris lumbricoidesis the largest and, globally, the most widespread of all human intestinal roundworms (Nematode). Life cycle: Human is the definitive host. [meddean.luc.edu]
Etiologic agent, its general characteristics and key tests for identification Historical information to include when and who isolated the microbe and any significance of its name Historically, humans have been living with ascariasis for hundreds, if not [austincc.edu]
Figure 4 Impact of hepatobiliary and pancreatic ascariasis as an etiologic factor in biliary disease, hepatic abscesses, biliary lithiasis and acute pancreatitis. [wjgnet.com]
Epidemiology
Epidemiology Infection occurs after ingesting eggs in contaminated food or, more commonly, is carried to mouth by the hands after contact with contaminated soil. After an early pulmonary phase (larval migration), worms stay in the intestine. [medical-dictionary.thefreedictionary.com]
Her main research interests are in the epidemiology and control of the soil-transmitted helminths including Ascaris and Toxocara. [books.google.de]
[…] course by Duke University Tropical Parasitology: Protozoans, Worms, Vectors and Human Diseases This course provides students an understanding of important human parasitic diseases, including their life cycles, vectors of transmission, distribution and epidemiology [coursera.org]
Pathophysiology
University Tropical Parasitology: Protozoans, Worms, Vectors and Human Diseases This course provides students an understanding of important human parasitic diseases, including their life cycles, vectors of transmission, distribution and epidemiology, pathophysiology [coursera.org]
Pathophysiology Infected patient with Ascariasis secretes eggs in stool Stool contaminates soil with Ascariasis eggs (and eggs may persist for up to 10 years in soil) Ascariasis eggs hatch into worms within 2-4 weeks at which point they are infective [fpnotebook.com]
Pathophysiology Fertilized eggs are ingested from soil contaminated with human feces. Larvae hatch in the small intestine and migrate to cecum and colon. [unboundmedicine.com]
The pathophysiology is unclear and may include competition for nutrients, impairment of absorption, and depression of appetite. [merckmanuals.com]
Pathophysiologic mechanisms include Direct tissue damage The immunologic response of the host to infection with larvae, eggs or adult worms [2] Obstruction of an orifice or the lumen of the gastrointestinal tract by an aggregation of worms Nutritional [web.stanford.edu]
Prevention
~1/6 of the world’s population is infected. 8–15% of infections are symptomatic. 120–220 million cases Mostly moderate and heavy worm loads General Prevention Infection control Sanitary disposal of human excrement, not using human feces as fertilizer [unboundmedicine.com]
Prevention of Ascaris infection depends primarily on the sanitary disposal of human feces and discontinuing their use as fertilizer. [medical-dictionary.thefreedictionary.com]
So for preventing the ascariasis infection, it is necessary to dispose of the fecal matter properly. [healthresource4u.com]
Treating in this way is called preventive treatment (or “preventive chemotherapy”). [cdc.gov]