Ascariasis is an intestinal infection caused by a parasitic roundworm.
While globally it is the most common human infection caused by worms and it occurs most often in areas with poor sanitation or crowded living conditions. It is an infection caused by Ascaris Lumbricoides, an intestinal roundworm.
Risk factors
presence of pets within the house
consuming vegetables or fruits that have not been
carefully cooked washed or peeled
Poor hygiene and sanitation
Factors favoring the spread of the transmission
simple life cycle
enormous egg production eggs are highly resistant to ordinary disinfectants the eggs may remain viable for several years
living habits disposal of feces is unsuitable
Ascaris lumbricoides
Is the most common intestinal nematode
MORPHOLOGY
ADULT WORM - cylindrical in shape -creamy-white or pinkish in color
-the female averages 20-35 cm in length, the largest 49cm
-the male is smaller, averaging 15-31cm in length and
distinctly more slender than the female
-the typical curled tail with a pair sickle
on the tip of the head there are 3 lips
they have a complete digestive tract
reproductive organs are tubular
male has a single reproductive tubule
The female has two reproductive tubules
the lips are seen at the anterior end The margin of each lip is lined with minute
teeth which are not that visible
Female
Male
A large mass of Ascaris lumbricoides that
was passed from the intestinal tract
Life Cycle
This worm lives in the lumen of small intestine Feeding on the intestinal contents 3 the fertilized female lays eggs
It takes 60-75 days that a larvae hatch in the intestinal tract
An adult female can produce approximately 200 000- 240
000 eggs per day, which are passed in feces
host digestive juices acts on the egg shell
and liberate the larvae (0.2 0.3 mm in length)
Into the small intestine
These larvae penetrate the intestinal mucosa
and enter lymphatics and mesenteric vessels
they are carried by circulation to the liver,
right heart and finally to the lungs where
they penetrate the capillaries into the alveoli
in which they molt twice and stay for 10-14
days
Then they are carried, or migrate, up the
bronchioles, bronchi, and trachea to the
epiglottis
When swallowed, the larvae pass down into
small intestine where they develop into
adults
The time for the ingestion of embryonated
eggs to ovi-position by the females is about
60-75 days the adult worms live for about
one year
The life cycle begins with the production of
mammillated eggs by adult females living in the distal small intestine of an infected human host image. Once deposited in the soil, eggs become infectious within several weeks. Eggs are subsequently transmitted by ingestion, or possibly by inhalation of contaminated dust; larvae do not hatch in soil and do not invade the skin.
Inside their next human host, Ascaris larvae hatch in
the jejunum, penetrate the intestinal wall, and migrate by way of hepatic venules to the right heart and pulmonary circulation. They subsequently break through into alveolar spaces, ascend the trachea, and are swallowed back into the intestine, where they undergo a final molt and develop into adults, which mate and spawn a new generation of eggs.
Occasionally, male-only adult infections occur,
yielding no eggs in stool. Female-only infections produce infertile eggs, which never become infectious. Otherwise, under normal conditions, the time from ingestion of eggs to development of new eggs is 10 to 12 weeks. Adult worms live for approximately 1 year, and are then expelled.
In the early Phase ( 4-16 days after egg ingestion) Respiratory symptoms result from migration of larvae through the lungs Classically, these symptoms occur in the setting of: eosinophilic pneumonia ( Loffler syndrome) Fever Nonproductive cough Dyspnea Wheezing
In the Late Phase ( 6-8 weeks egg ingestion), GIT. Symptoms may occur and related to the mechanical effects of high parasite loads. Passage of worms ( mouth, nares, anus) abdominal pain Nausea, vomiting Pharyngeal globus, tingling throat Dry cough
The patients may presents with complications:
biliary obstruction intestinal obstruction
Appendicitis
pancreatitis
Biliary obstruction
Intestinal obstruction
Induced pancreatitis
Physical examination
Fever
Jaundice (in biliary obstruction)
Cachexia (due to malnutririon)
Pallor ( anemia)
Deminished breath sounds Abdomina pain
Migrating larvae may transmit other organisms
Causing:
Bacterial pneumonia
Airway obstruction
Lacrimal drainage obstruction
Small bowel intussusception Acute interstitial nephritis encephalopathy
Laboratory test
Early infection
CBC may show eosinophilia
Sputum analysis may reveal larvae or charcot -leyden
crystals ( mass of crystalloid composed of eosinophilic proteins Stool examination findings are typically the presence of ascaris eggs Increses in lgE and later lgG
Feces are examined for the ascaris eggs by:
direct fecal film simple and effective
the eggs are easily found using this due to the large no of the female oviposition brine- floatation method recovery of adult worms
Imaging studies
In gal bladder
Endoscopic extraction of an ascaris worm
Ascaris larvae in lung
Larvae
TREATMENT
Mebendazole
MOA
_interferes with cellular microtubule formation in the
worm thus distributing the glucose uptake and the normal digestive functions of the worm to such an extent that an autolysis process occurs Dose: 1 tablet 500mg once a day repeated once after 10 days
Albendazole
MOA - it acts by destruction of cytoplasmic microtubules in the
intestinal and absorptive cells of the worm leading to in inhibition of glucose uptake and other nutrients resulting in the death of the worm Dose : Adult and children >2 yrs old single oral dose of 400mg (1 tab = 200mg) Children < 2 yrs old Single oral dose of 200mg
Flubendazole
Like albendazol
Dose
1 tab 100mg twice daily for 3 consecutive
days
Levamisole
MOA - it acts on nematode nerve ganglia paralyzing the worm
musculature within seconds of contact, unable to maintain their position, the worms are then ejected normal peristaltic moven Dose 5ml 1-2 yrs old 10 ml 5-15 yrs old 15 ml 16- above
PREVENTION
Avoid contact with soil that may be contaminated with
human feces, including with human fecal matter like night soil used to fertilize crops Proper hygiene
Teach children the importance of washing their
hands Wash, peel, or cook all raw vegetables and fruits before eating particularly those grown in soil
Vaccination Deworming
Chemoprophylaxis-refers to the drugs
given to exposed and susceptible hosts to prevent them from developing an infection. Limiting exposure to reservoirs of infection Using protective suits or equipment when exposed to area
Thank you!
Nakamura sign
Clinical features of paragonomiasis cases
recently found in Japan : parasite- specific immunoglobin M and G antibody classes
