Ascariasis

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Ascariasis facts

  • Ascariasis is a disease caused by a parasite named Ascaris lumbricoides.
  • Ascaris lumbricoides is a large nematode (roundworm) that infects the human gastrointestinal tract; the adults are visible to the naked eye and can reach over 12 inches in length.
  • Ascariasis is caused by the parasites as they proceed through their life cycle in humans.
  • Risk factors for ascariasis infection include living in and/or visiting tropical and subtropical areas along with poor hygiene and eating or drinking contaminated foods.
  • Signs and symptoms of ascariasis may include the following:
  • Diagnosis is usually done by detecting characteristic Ascaris lumbricoides eggs in feces with a microscope; other tests may also be done (X-rays, ultrasound, for example).
  • Treatment is oral medication for about one to three days in patients who do not have additional complications.
  • Treatment may be done by primary-care doctors; patients who have complications may need specialists such as infectious-disease specialists, lung specialists, and/or surgery specialists.
  • There are many home remedies for ascariasis, but a patient should discuss their use with a doctor before attempting these remedies.
  • Most of the complications of ascariasis occur in the gastrointestinal tract with obstruction of the G.I. tract as a major complication; other organs may also be involved.
  • The prognosis for ascariasis that is diagnosed and treated appropriately is very good. The prognosis worsens if complications develop; ascariasis may also increase fertility in women.
  • It's possible to prevent ascariasis by avoiding contaminated food and water sources and by good hygiene and eating only cooked hot food while traveling.

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Roundworm Symptoms, Transmission & Treatment

Roundworms, also known as nematodes, are a common term for parasites that comprise the phylum Nematoda that contain mainly free-living species and are located everywhere on earth. Roundworms are not ringworm, which is a fungal infection. Researchers estimate there may be as many as 500,000 species, but only about 60 species infect man and animals as parasites. The most commonly identified parasites that use us and some animals as food for survival, multiplication, and spread (transmission to others) are termed ascariasis, trichuriasis, hookworm, enterobiasis, strongyloidiasis, filariasis, and trichinosis. Each nematode has a life cycle that can be complex. Many have only part of their cycle completed in humans and animals.

What is ascariasis?

Ascariasis is a disease caused by the parasite Ascaris lumbricoides, a large nematode (roundworm) that infects humans in the gastrointestinal tract and requires human infection to complete its complex life cycle. Another species, Ascaris suum, that infects pigs may occasionally infect humans.

What is Ascaris lumbricoides? What do Ascaris worms look like?

Ascaris lumbricoides, also known as roundworm or giant roundworm, is a nematode parasite that can infect humans by residing in the gastrointestinal tract or in other areas of the body such as the lungs. The worms have a worldwide distribution but are most common in tropical and subtropical areas where humans have poor sanitation and where human feces are used as soil fertilizer. Many individuals infected show no symptoms, but abdominal discomfort and/or cough are two major symptoms of infection.

The roundworms are the largest nematode parasites that live in the human intestine. Figures 1 and 2 show how large and how numerous these intestinal parasites can be. Figure 3 shows the life cycle of the worms in the human -- from ingestion to penetration of the intestinal lining to migration and maturation in the lungs, migration to the throat and then to small intestine where they mature and produce eggs that are passed with stool, where they await ingestion by other humans.

Figure 1: Ascariasis lumbricoides nematode worms (male on left, female on right); females can reach lengths of over 12 inches (26.4 cm).
Figure 1: Ascariasis lumbricoides nematode worms (male on left, female on right); females can reach lengths of over 12 inches (26.4 cm); SOURCE: CDC
Figure 2: Mass of Ascariasis lumbricoides worms passed rectally by a child in Africa.
Figure 2: Mass of Ascariasis lumbricoides worms passed rectally by a child in Africa; SOURCE: James Gathany/CDC
Figure 3: Life cycle of Ascaris lumbricoides.
Figure 3: Life cycle of Ascaris lumbricoides; SOURCE: CDC

What causes ascariasis?

The cause of ascariasis is the invasion, spread, and eventual maturation of Ascaris lumbricoides in the human host. The symptoms described below are due to the parasite's ability to penetrate the intestinal tract and proceed from there to the lungs where they eventually mature further and penetrate the air sacs of the lungs, migrate to the throat, and are subsequently swallowed to allow maturation in the intestinal tract.

What are the signs and symptoms of an ascariasis infection?

The incubation period is variable because the parasite's life cycle may take four to eight weeks to be completed. The signs and symptoms of the nematode infection by Ascaris lumbricoides may include the following:

  • Abdominal discomfort
  • Abdominal cramping
  • Abdominal swelling (especially in children)
  • Fever
  • Coughing and/or wheezing
  • Nausea
  • Vomiting
  • Passing roundworms and their eggs in the stool

What are the risk factors for developing ascariasis?

Although the nematodes are distributed worldwide, the most common areas they inhabit are areas where the climate is warm and moist such as tropical and subtropical regions of the world. The highest risk factors for contracting this infection are poor sanitation and poor hygiene. Ascariasis is transmitted indirectly in most cases by an uninfected individual ingesting contaminated food or water that contain the Ascaris eggs deposited by infected humans in their feces into the environment. Children are commonly infected in these areas; children are more frequently infected than adults.

How do health-care professionals diagnose ascariasis?

Infection is relatively easily diagnosed by examining the stool sample from the patient using a microscope to identify Ascaris lumbricoides eggs. In some instances, stool particles are concentrated to increase the likelihood of finding the nematode eggs. Other tests that suggest infection include blood tests that show eosinophilia (the increased presence of a certain type of white blood cell); abdominal X-rays and/or ultrasound studies may detect a large mass of worms in the intestines.

Figure 4: Microscopic appearance of a fertilized egg from Ascaris lumbricoides.
Figure 4: Microscopic appearance of a fertilized egg from Ascaris lumbricoides; SOURCE: CDC

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What is the treatment for ascariasis?

Fortunately, there is effective treatment available for ascariasis. Medications such as albendazole (Albenza) and mebendazole (Vermox) are drugs of choice for ascariasis. The drugs are usually administered for only about one to three days. Other drugs such as ivermectin (Stromectol), levamisole (Ergamisol), pyrantel pamoate (Pin Rid, Pin X), and piperazine citrate have also been used effectively. Pyrantel pamoate is used to treat pregnant women; other drugs like mebendazole and albendazole may cause teratogenic effects in the fetus.

On Jan. 15, 2016, the U.S. Food and Drug Administration (FDA) approved a new drug application for mebendazole (Emverm) in a new 100 mg chewable tablet.

What type of specialists treat ascariasis?

Once diagnosed, most patients can be treated by their primary-care physician for ascariasis. 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. Other severe complications can involve the lungs and may require a lung specialist (pulmonologist) to be consulted.

Are there home remedies for ascariasis?

There are a number of home remedies for ascariasis. Garlic, wormwood, worms seed, pumpkin seeds, and many other herbs have been used to treat ascariasis. However, infected individuals should check with their doctor before utilizing any of these home remedies as their effectiveness may not be as good or as rapid as the prescription medications described in the treatment section.

What are the complications of ascariasis?

There are a number of complications that may occur with untreated ascariasis. Following is a list of these complications:

  • Bowel obstruction
  • Pancreatitis (inflammation of the pancreas)
  • Cholecystitis (inflammation of the gallbladder)
  • Peritonitis (inflammation of the abdominal cavity lining)
  • Intussusception (an intestinal condition in which part of the intestine is pulled into itself, creating an obstruction)
  • Volvulus (abnormal twisting of the intestine)
  • Peritoneal granulomas (scar tissue lining the abdomen)
  • Hepatic (liver) abscesses
  • Pneumonitis (inflammation of the lungs)

Organs other than the intestinal tract and lungs may be occasionally involved; some patients may have allergic reactions that may become severe. About 11,000 deaths occur each year worldwide due to bowel obstructions caused by ascariasis, with the majority of patients being children.

What is the prognosis of ascariasis?

The prognosis of ascariasis that is diagnosed and treated appropriately is very good. However, the prognosis begins to decline if the patient develops a high number of worms in the body (worm burden). This worm burden can lead to more serious complications such as intestinal obstruction and worsens the prognosis of this disease.

An interesting additional effect of ascariasis may be increased fertility in women who have the infection. Researchers in Bolivia suggest that the worm alters the immune system for its own protection that results also in allowing females to become pregnant easier. The mechanism of this enhanced fertility is unknown, but researchers suggest it could lead to development of fertility-enhancing drugs.

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Is it possible to prevent ascariasis?

Yes, it is possible to prevent ascariasis; before handling or eating any food, wash hands with soap and water and avoid drinking any local water sources when traveling. Use only boiled water or bottled water and avoid raw vegetables and fruits unless you can clean them yourself.

In addition, it is suggested that while traveling, eat only foods that are cooked well and served hot. In addition, people who live in areas where ascariasis infections are common can become reinfected. Consequently, some individuals, especially children, are given prophylactic doses of medication (such as ivermectin) every two or three years in some countries.

REFERENCES:

Dora-Laskey, A. "Ascaris lumbricoides." Medscape.com. Nov. 21, 2014. <http://emedicine.medscape.com/article/788398-overview>.

United States. Centers for Disease Control and Prevention. "Parasites-Ascariasis." Jan. 10, 2013. <http://www.cdc.gov/parasites/ascariasis/>.

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Reviewed on 3/3/2016
References
REFERENCES:

Dora-Laskey, A. "Ascaris lumbricoides." Medscape.com. Nov. 21, 2014. <http://emedicine.medscape.com/article/788398-overview>.

United States. Centers for Disease Control and Prevention. "Parasites-Ascariasis." Jan. 10, 2013. <http://www.cdc.gov/parasites/ascariasis/>.

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