Ascariasis is a human disease caused by the parasitic roundworm Ascaris lumbricoides.

Perhaps
as many as one quarter of the world's people are infected[1], and ascariasis is particularly
prevalent in tropical regions and in areas of poor hygiene. Other species of the genus Ascaris are
parasitic and can cause disease in domestic animals.

Infection occurs through ingestion of food contaminated with feces containing Ascaris eggs. The
larvae hatch, burrow through the intestine, reach the lungs, and finally migrate up the respiratory
tract. From there they are then reswallowed and mature in the intestine, growing up to 30 cm (12
in.) in length and anchoring themselves to the intestinal wall.

Infections are usually asymptomatic, especially if the number of worms is small. They may
however be accompanied by inflammation, fever, and diarrhea, and serious problems may
develop if the worms migrate to other parts of the body.

Ascariasis is an intestinal infection caused by a parasitic roundworm. While it is the most

common human infection caused by worms in the world, ascariasis is not common in the United
States. It occurs in varying prevalence worldwide, with far greater frequency in areas with poor
sanitation or crowded living conditions.

Description
Ascariasis occurs when worm eggs of the parasite Ascaris lumbricoides commonly found in soil
and human feces are ingested. The eggs can be transmitted from contaminated food, drink, or
soil. The roundworms range in size from 5.9 to 9.8 inches for adult males and 9.8 to 13.8 inches
for adult females. The worms can grow to be as thick as a pencil and can live for 1 to 2 years.

Ascariasis is frequently found in developing countries where sanitary conditions are poor or in
areas where human feces are used as fertilizer. When the eggs are swallowed and passed into the
intestine, they hatch into larvae. The larvae then begin to move through the body.

Once they get through the intestinal wall, the larvae travel from the liver to the lungs through the
bloodstream. During this stage, pulmonary symptoms such as coughing (even coughing up
worms) may occur. In the lungs, the larvae climb up through the bronchial tubes to the throat,
where they are swallowed. The larvae then return to the small intestine where they grow, mature,
mate, and lay eggs. The worms reach maturity about 2 months after an egg is ingested from the
soil.

Adult worms live and remain in the small intestine. A female worm can produce up to 240,000
eggs in a day, which are then discharged into the feces and incubate in the soil for weeks.
Children are particularly susceptible to ascariasis because they tend to put things in their mouths,
including dirt, and they often have poorer hygiene habits than adults.

Ascariasis is common in warmer or tropical climates, particularly in developing nations, where it

can affect large segments of the population. Ascariasis is rare in the United States, due to strict
sanitation rules and regulations.
Contagiousness
Ascariasis is not spread directly from one person to another. To become infected, an individual
has to consume the worm's eggs.

Prevention
The most important measure of protection against ascariasis is the safe and sanitary disposal of
human waste, which can transmit eggs. Areas of the world that use human feces as fertilizer must
thoroughly cook all foods or clean them with a proper iodine solution (particularly fruits and
vegetables).

Children who are adopted from developing nations are frequently screened for worms as a
precautionary measure. Kids who live in underdeveloped areas of the world may be prescribed a
preventive deworming medication.

These practices are recommended for all children:

• Try as much as possible to keep kids from putting things in their
mouths.
• Teach kids to wash hands thoroughly and frequently, especially after
using the bathroom and before eating

Signs and Symptoms

Although no symptoms may occur, the greater the number of worms involved in the infestation,
the more severe a child's symptoms are likely to be. Kids are more likely than adults to develop
gastrointestinal symptoms because they have smaller intestines and are at greater risk of
developing intestinal obstruction.

Symptoms seen with mild infestation include:

• worms in stool
• coughing up worms
• loss of appetite
• fever
• wheezing

More severe infestations can result in more serious signs and symptoms, including:
• vomiting
• shortness of breath
• abdominal distention (swelling of the abdomen)
• severe stomach or abdominal pain
• intestinal blockage
• biliary tract blockage (includes the liver and gallbladder

First appearance of eggs in stools is 60–70 days. In larval ascariasis,

symptoms occur 4–16 days after infection. The final symptoms are
gastrointestinal discomfort, colic and vomiting, fever, and observation of live
worms in stools. Some patients may have pulmonary symptoms or
neurological disorders during migration of the larvae. However there are
generally few or no symptoms. A bolus of worms may obstruct the intestine;
migrating larvae may cause pneumonitis and eosinophilia.
Source
The source of transmission is from soil and vegetation on which fecal matter
containing eggs has been deposited. Ingestion of infective eggs from soil
contaminated with human feces or transmission and contaminated
vegetables and water is the primary route of infection. Intimate contact with
pets which have been in contact with contaminated soil may result in
infection, while pets which are infested themselves by a different type of
roundworm can cause infection with that type of worm (Toxocara canis, etc)
as occasionally occurs with groomers.
Transmission also comes through municipal recycling of wastewater into crop fields. This is
quite common in emerging industrial economies, and poses serious risks for not only local crop
sales but also exports of contaminated vegetables. A 1986 outbreak of ascariasis in Italy was
traced to irresponsible wastewater recycling used to grow Balkan vegetable exports[7] .
Transmission from human to human by direct contact is impossible

Diagnosis
The diagnosis is usually incidental when the host passes a worm in the stool or vomit. Stool
samples for ova and parasites will demonstrate Ascaris eggs. Larvae may be found in gastric or
respiratory secretions in pulmonary disease. Blood counts may demonstrate peripheral
eosinophilia. On X-ray, 15-35 cm long filling defects, sometimes with whirled appearance (bolus
of worms).

Symptoms
Patients can remain asymptomatic for very long periods of time. As larval stages travel through
the body, they may cause visceral damage, peritonitis and inflammation, enlargement of the liver
or spleen, toxicity, and pneumonia. A heavy worm infestation may cause nutritional deficiency;
other complications, sometimes fatal, include obstruction of the bowel by a bolus of worms
(observed particularly in children) and obstruction of the bile or pancreatic duct. More than 796
Ascaris lumbricoides worms weighing 550 g [19 ounces] were recovered at autopsy from a 2-
year-old South African girl. The worms had caused torsion and gangrene of the ileum, which
was interpreted as the cause of death.[9]

Ascaris takes most of its nutrients from the partially digested host food in the intestine. There is
limited evidence that it can also pierce the intestinal mucous membrane and feed on blood, but
this is not its usual source of nutrition. [10] As a result, Ascaris infection does not produce the
anemia associated with some other roundworm infections.[citation needed]

In Canada in 1970, a postgraduate student tainted his roommates' food with Ascaris
lumbricoides. Four of the victims became seriously ill; two of these suffered acute respiratory
failure

Treatment
Main article: Ascaricide
Pharmaceutical drugs that are used to kill roundworms are called ascaricides and include:
 • Mebendazole (Vermox) (C16H13N3O2). Causes slow immobilization and death of the
worms by selectively and irreversibly blocking uptake of glucose and other nutrients in
susceptible adult intestine where helminths dwell. Oral dosage is 100 mg 12 hourly for 3
days.
• Piperazine (C4H10N2.C6H10O4). A flaccid paralyzing agent that causes a blocking response
of ascaris muscle to acetylcholine. The narcotizing effect immobilizes the worm, which
prevents migration when treatment is accomplished with weak drugs such as
thiabendazole. If used by itself it causes the worm to be passed out in the feces. Dosage is
75 mg/kg (max 3.5 g) as a single oral dose.
• Pyrantel pamoate (Antiminth, Pin-Rid, Pin-X) (C11H14N2S.C23H16O6) Depolarizes
ganglionic block of nicotinic neuromuscular transmission, resulting in spastic paralysis of
the worm. Spastic (tetanic) paralyzing agents, in particular pyrantel pamoate, may induce
complete intestinal obstruction in a heavy worm load. Dosage is 11 mg/kg not to exceed
1 g as a single dose.
• Albendazole (C12H15N3O2S) A broad-spectrum antihelminthic agent that decreases ATP
production in the worm, causing energy depletion, immobilization, and finally death.
Dosage is 400 mg given as single oral dose (contraindicated during pregnancy and
children under 2 years).
• Thiabendazole. This may cause migration of the worm into the esophagus, so it is usually
combined with piperazine.
• Hexylresorcinol effective in single dose, mentioned in : Holt, Jr Emmett L, McIntosh
Rustin: Holt's Diseases of Infancy and Childhood: A Textbook for the Use of Students
and Practitioners. Appleton and Co, New York,11th edition
• Santonin, more toxic than hexylresorcinol, mentioned in : Holt, Jr Emmett L, McIntosh
Rustin: Holt's Diseases of Infancy and Childhood: A Textbook for the Use of Students
and Practitioners. Appleton and Co, New York,, 11th edition
• Oil of chenopodium, more toxic than hexylresorcinol, mentioned in : Holt, Jr Emmett L,
McIntosh Rustin: Holt's Diseases of Infancy and Childhood: A Textbook for the Use of
Students and Practitioners. Appleton and Co, New York, 11th edition
Also, corticosteroids can treat some of the symptoms, such as inflammation.

Prevention
Prevention includes: use of toilet facilities; safe excreta disposal; protection of food from dirt and
soil; thorough washing of produce; and hand washing.
Food dropped on the floor should never be eaten without washing or cooking, particularly in
endemic areas. Fruits and vegetables should always be washed thoroughly before consumption.

Trivia
• Ascariasis may result in allergies to shrimp and dustmites due to the shared antigen,
tropomyosin.
• Ascaris have an aversion to some general anesthetics and may exit the body, sometimes
through the mouth.
Genus and Species Ascaris lumbricoides
Common Name Giant Intestinal Roundworm
 Etiologic Agent of:
Infective stage
Definitive Host
Portal of Entry
Mode of Transmission
Habitat
Pathogenic Stage
Mode of Attachment
Mode of Nutrition
Pathogenesis
Laboratory diagnosis
Treatment
Diagnostic Feature - Adult
Diagnostic Feature - Egg
Ascariasis
Embryonated Egg
Man
Mouth
Ingestion of Embryonated egg through contaminated food or
water
Small Intestine
Adult, Larva
Retention in the mucosal folds using pressure
Feeding of Chyme
Larva – pneumonitis, Loeffler’s Syndrome;
Adult – Obstruction, Liver abscess, Appendicitis. With
Blood-Lung Phase along with Hookworms and
Strongyloides stercoralis.
Concentration methods and Direct Fecal Smear: Kato-Katz
Albendazole, Mebendazole, or Pyrantel pamoate
Female - prominent genital girdle
Coarse mammilated albuminous coating

Ascariasis is infection caused by Ascaris lumbricoides, an intestinal roundworm. The infection

often causes no symptoms but may cause fever, coughing, and wheezing, followed by abdominal
cramps. In severe infections, children may not grow normally, or worms can block the intestine,
resulting in severe pain and vomiting.

• People acquire the infection by swallowing the roundworm eggs, usually in food.
• People may have no symptoms or may have fever, coughing, wheezing, abdominal
cramps, nausea, and vomiting.
• Children with a heavy infection may not grow normally, or worms can block the
intestine, resulting in severe pain and vomiting.
• Doctors usually diagnose the infection by identifying the eggs or worms in a stool
sample.
• People are treated with antiparasitic drugs such as albendazole Some Trade Names
ALBENZA
.
Ascariasis is the most common roundworm infection in people, occurring in over 1.4 billion
people worldwide. The infection is common in areas with poor sanitation and often occurs in
tropical or subtropical areas. In the United States, ascariasis occurs most often in immigrants and
in people who have lived abroad in areas where hygiene is poor, but occasionally it occurs
among people who have not traveled.

Infection begins when a person swallows Ascaris eggs, often in contaminated food. Food is
contaminated through contact with soil that has been contaminated by human stool (feces)
containing the eggs. Ascaris eggs are hardy and can survive in the soil for years.

Once swallowed, Ascaris eggs hatch and release larvae in the intestine. Each larva migrates
through the wall of the small intestine and is carried through the lymphatic vessels and
bloodstream to the lungs. Once inside the lungs, the larva passes into the air sacs (alveoli),
moves up the respiratory tract and into the throat, and is swallowed. The larva matures in the
small intestine, where it remains as an adult worm. This process takes 2 to 3 months. Adult
worms range from 6 to 20 inches in length and from 1/10 to 2/10 inch in diameter. They live 1 to 2
years. Eggs laid by the adult worms are excreted in stool, develop in the soil, and begin the cycle
of infection again when they are ingested.

Symptoms and Diagnosis

Many people who have ascariasis do not develop symptoms. However, the migration of larvae
through the lungs can cause fever, coughing, wheezing, and sometimes blood in phlegm
(sputum). A large number of worms in the intestine can cause abdominal cramps and,
occasionally, a blockage of the intestine, most commonly in children living in areas with poor
sanitation. A blockage can cause nausea, vomiting, abdominal swelling (distention), and
abdominal pain. Sometimes adult worms migrate to the mouth or nose, are vomited up, or passed
in the stool—situations that can be psychologically distressing. Adult worms occasionally block
the opening into the appendix, biliary tract, or pancreatic duct, producing severe abdominal pain.
Infected children may not grow or gain weight normally.

Ascariasis is diagnosed by identifying eggs or adult worms in a stool sample or, rarely, by seeing
adult worms that have migrated to the throat or nose. If computed tomography (CT) or
ultrasonography is done for other reasons, adult worms may be seen. Rarely, the effects of larvae
migrating through the lungs can be seen on a chest x-ray.

Prevention and Treatment

The best strategies for preventing ascariasis include using adequate sanitation and avoiding
uncooked and unwashed foods, particularly in areas where human feces is used as fertilizer.
To treat a person with ascariasis, a doctor prescribes albendazole Some Trade Names
ALBENZA (mebendazole)
VERMOX (pyrantel pamoate)
ANTIMINTH

However, because these drugs may harm the fetus, they should not be taken by pregnant women.
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
feces . Unfertilized eggs may be ingested but are not infective. Fertile
eggs embryonate and become infective after 18 days to several weeks ,
depending on the environmental conditions (optimum: moist, warm, shaded
soil). After infective eggs are swallowed , the larvae hatch , invade the
intestinal mucosa, and are carried via the portal, then systemic circulation to
the lungs . The 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.