ASCARIASIS – SYMPTOMS, CAUSES, AND TREATMENT

WHAT IS ASCARIASIS?

An ascariasis is a form of roundworm infection. These worms are parasites that use your body as the host to mature from larvae or eggs to adult worms. Adult worms, which reproduce, could be more than a foot (30 centimeters) long.

One of the most common worm infections in people worldwide, ascariasis is unusual in the United States. The majority of infected people have mild cases with no symptoms. But heavy infestation could lead to severe symptoms and complications.

Ascariasis happens most often in children in tropical and subtropical regions of the world — particularly in areas with poor sanitation and hygiene.

SYMPTOMS

Most people infected with ascariasis do not have signs or symptoms. Moderate to heavy infestations cause a variety of signs or symptoms, depending on which part of your body is affected.

In the lungs

After you swallow the tiny (microscopic) ascariasis eggs, they hatch into the small intestine and the larvae migrate through the bloodstream or lymphatic system into the lungs. At this stage, you might experience signs and symptoms similar to asthma or pneumonia, including:

• Persistent cough
• Shortness of breath
• Wheezing

After spending ten to fourteen days in the lungs, the larvae travel to the throat, where you cough them up and then swallow them.

In the intestines

The larvae mature into adult worms in the small intestine, and the adult worms generally live in the intestines until they die. In mild or moderate ascariasis, the intestinal infestation could cause:

• Vague abdominal pain
• Nausea and vomiting
• Diarrhea or bloody stools

If you have a large number of worms in the intestine, you may have:

• Severe abdominal pain
• Fatigue
• Vomiting
• Weight loss or malnutrition
• A worm in your vomit or stool

WHEN SHOULD YOU SEE A DOCTOR?

Speak to your doctor if you have persistent abdominal pain, diarrhea, or nausea.

CAUSES

Ascariasis does not spread directly from one person to another. Instead, a person needs to come into contact with soil mixed with human or pig feces that contain ascariasis eggs or infected water. In some developing countries, human feces are used for fertilizer, or poor sanitary facilities enable human waste to mix with soil in yards, ditches, and fields. People could also get it from eating uncooked pig or chicken liver that is infected.

Small children often play in the dirt, and infection could happen if they put their dirty fingers in their mouths. Unwashed fruits or vegetables grown in contaminated soil also could transmit the ascariasis eggs.

Life cycle of a worm

• Ingestion – The tiny (microscopic) ascariasis eggs cannot become infective without coming into contact with soil. People could accidentally ingest (swallow) contaminated soil through hand-to-mouth contact or by eating uncooked fruits or vegetables that have been grown in contaminated soil.
• Migration – Larvae hatch from the eggs in your small intestine and then go through the intestinal wall to travel to the heart and lungs through the bloodstream or lymphatic system. After maturing for about 10 to 14 days in your lungs, the larvae break into your airway and travel up the throat, where they are coughed up and swallowed.
• Maturation – Once they are back in the intestines, the parasites grow into male or female worms. Female worms could be more than 15 inches (40 centimeters) long and a little less than a quarter-inch (6 millimeters) in diameter. Male worms are usually smaller.
• Reproduction – Female worms could produce 200,000 eggs a day if there are both female and male worms in the intestines, and the eggs leave your body in feces. The fertilized eggs must be in the soil for at least 2 to 4 weeks before they become infective.

The whole process — from egg ingestion to egg deposits — takes about 2 or 3 months. Ascariasis worms could live inside your body for a year or two.

RISK FACTORS

• Age – Most people who have ascariasis are ten years old or younger. Children in this age group might be at higher risk because they are more likely to play in the dirt.
• Warm climate – In the United States, ascariasis is more frequent in the Southeast. But it is more frequent in developing countries with warm temperatures year-round.
• Poor sanitation – Ascariasis is widespread in developing countries where human feces are permitted to mix with local soil.

COMPLICATIONS

Mild cases of ascariasis generally do not cause complications. If you have a heavy infestation, potentially dangerous complications might include:

• Slowed growth – Loss of appetite and poor absorption of digested foods put children with ascariasis at risk of not getting enough nutrition, which could slow growth.
• Intestinal blockage and perforation – In heavy ascariasis infestation, a mass of worms could block a portion of your intestine. This could cause severe abdominal cramping and vomiting. The blockage could even make a hole in the intestinal wall or appendix, causing internal bleeding (hemorrhage) or appendicitis.
• Duct blockages – In some cases, worms might block the narrow ducts of your liver or pancreas, causing severe pain.

PREVENTION

The best defense against ascariasis is good sanitation and common sense. Follow these tips to stay away from infection:

• Practice good hygiene – When handling food, always wash your hands with soap and water. Wash fresh fruits and vegetables properly.
• Use care when traveling – Only use bottled water, and avoid raw vegetables unless you could peel and wash them.

DIAGNOSIS

To diagnose ascariasis, your doctor might review your symptoms and order tests.

In heavy infestations, it is possible to find worms after you cough or vomit. The worms could come out of other body openings, like your mouth or nostrils. If this happens to you, take the worm to your doctor so that he or she could identify it and prescribe the proper treatment.

Stool tests

Mature female ascariasis worms in your intestine start laying eggs. These eggs travel through your digestive system and eventually could be found in your stool.

To diagnose ascariasis, your doctor will check your stool for tiny (microscopic) eggs and larvae. But eggs would not appear in stool until at least 40 days after you are infected. And if you are infected with only male worms, you would not have eggs.

Blood tests

Your blood could be tested for the presence of an increased number of a certain type of white blood cell, known as eosinophils. Ascariasis could elevate your eosinophils, but so could other types of health problems.

Imaging tests

• X-rays – If you are infested with worms, the mass of worms might be visible in an X-ray of the abdomen. In some cases, a chest X-ray could reveal the larvae in the lungs.
• Ultrasound – An ultrasound might show worms in the pancreas or liver. This technology uses sound waves to create pictures of internal organs.
• CT scans or MRIs – Both types of tests create detailed pictures of the internal structures, which could help your doctor detect worms that are blocking ducts in the liver or pancreas. CT scans combine X-ray pictures taken from many angles. MRI uses radio waves and a strong magnetic field.

TREATMENT

Generally, only infections that cause symptoms need to be treated. In certain cases, ascariasis will resolve on its own.

Medications

Anti-parasite medications are the first line of treatment for ascariasis. The most common are:

• Albendazole (Albenza)
• Ivermectin (Stromectol)
• Mebendazole

These medications, taken for 1 to 3 days, kill adult worms. Side effects involve mild abdominal pain or diarrhea.

Pregnant women might take pyrantel pamoate.

Surgery

In cases of heavy infestation, surgery might be necessary to remove worms and repair damage they have caused. Intestinal blockage or holes, bile duct blockage, and appendicitis are complications that might require surgery.

If you or anyone you know is suffering from ascariasis, our expert providers at Specialty Care Clinics will take care of your health and help you recover.

Call us on (469) 545-9983 to book an appointment with our specialists.