Ascariasis is an infection caused by the roundworm Ascaris lumbricoides. These parasitic worms eventually settle and grow in the small intestine, where they can reach a length of 12 inches or more and drain the body of nutrients. Although ascariasis is common throughout the world, particularly in children living in tropical and subtropical regions with poor sanitation, it is relatively uncommon in the United States. Because most infected people have mild or no obvious symptoms, detecting ascariasis can be difficult; however, recognising the symptoms and receiving appropriate treatment can help prevent a variety of health problems.
Part 1 Recognizing Ascariasis
1. Keep an eye out for respiratory symptoms. Although most people infected with Ascaris lumbricoides worms show no symptoms, those with weakened immune systems frequently do. The first symptoms of ascariasis can be similar to those of mild-to-moderate asthma or pneumonia, such as a persistent cough, shortness of breath, wheezing, and mild chest pain. It is possible to cough up mucus (sputum) and see blood. These early lung symptoms are caused by the worm’s life cycle.
After ingesting fertilised Ascaris eggs, the larvae are absorbed into the blood and travel to the lungs, causing irritation and a type of allergic reaction.
The larvae spend about a week in the lungs before being coughed up the trachea and into the throat, where they are swallowed down the oesophagus into the stomach and pass into the small intestine.
2. Keep an eye out for abdominal pain and nausea. Ascaris larvae exit the lungs and enter the small intestine, where they mature into adult worms over a few weeks and live until they die (many months or years) (many months or a few years). The worms do not always cause symptoms in the intestine, but if there are enough of them, one of the first symptoms is vague abdominal pain and mild nausea.
Worms can clog the intestine or bile duct, causing abdominal pain.
The abdominal pain is difficult to pinpoint and is easily confused with indigestion and bloating, but it is not alleviated by passing gas or taking antacids.
In mild cases, the nausea comes and goes, but it usually does not result in vomiting.
Children who live in filthy conditions and have weakened immune systems are far more likely to become infected and exhibit symptoms.
3. Keep an eye out for bloody diarrhoea. If the body’s immune system is unable to combat the worm infection, more of them will grow, increasing the likelihood of unpleasant symptoms such as severe abdominal pain and diarrhoea. As the diarrhoea worsens and the worms irritate the intestinal wall, blood is frequently seen in the toilet.
If the blood is dark and resembles coffee grounds, it indicates small intestine bleeding. If the blood is bright cherry red, it indicates rectum bleeding from excessive wiping or a burst blood vessel from straining too hard.
In addition to blood in the stool, an Ascaris worm(s) can occasionally be seen in the toilet.
4. Keep an eye out for chronic vomiting and weight loss. In moderate-to-severe cases of Ascariasis, the worms can almost completely block the small intestine, causing severe abdominal pain, nausea, and vomiting. When vomiting becomes regular (daily) and chronic (lasting more than a few weeks), there is a relatively rapid loss of weight.
Even when food is available, it is frequently not consumed due to a loss of appetite and painful digestion.
The face, upper body, and buttocks/thighs show the most weight loss. Due to the mass of worms and the blockage of food and liquids, the abdomen may still protrude.
Worms are frequently found in the vomit of people suffering from severe Ascaris infections.
5. Keep an eye out for signs of malnutrition. Malnutrition becomes more visible as the symptoms of ascariasis progress, particularly in children, and includes severe weight loss, stunted growth (short for age), weakness, fatigue, skin rashes, visual problems, and intellectual/developmental disability. Protein, vitamin A, and vitamin C deficiency are the most common nutritional deficiencies associated with ascariasis.
A lack of protein leads to muscle wasting and weakness, as well as a bloated stomach.
A lack of vitamin A causes vision problems and the potential for blindness, as well as skin problems.
Skin problems, internal bleeding, hair and tooth loss, as well as fatigue and listlessness, are all caused by a lack of vitamin C.
6. Differentiate it from other infections. Ascariasis can look like a variety of other infections and diseases. When Ascaris larvae cause pulmonary symptoms, they can be similar to asthma and upper respiratory viral infections like influenza, the common cold, and pneumonia. When adult worms infect the gastrointestinal tract, they can mimic other parasitic infections, food poisoning, and viral gastroenteritis (stomach flu).
There is also some overlap in symptoms with gluten sensitivity, irritable bowel syndrome, and Crohn’s disease.
Only when actual worms are discovered in vomit or diarrhoea is Ascariasis visible to doctors and patients, and easily distinguished from other infections or diseases.
Part 2 Preventing Ascariasis
1. Avoid coming into contact with contaminated soil. Ascaris worms thrive in soil contaminated with human and animal faeces (poop). Fecal matter is intentionally used to fertilise crops in many places around the world, so be cautious when travelling in developing countries, particularly rural farming areas. Children in these areas are frequently infected after putting their hands in their mouths after playing or working in contaminated soil.
Another common source of infection is eating uncooked food (fruits and vegetables) grown in contaminated soil or irrigated with wastewater.
Always thoroughly wash produce at home before eating it, regardless of where you purchased it. Consider cooking all raw vegetables before eating them.
Soaking fresh produce in water laced with iodine, hydrogen peroxide, and/or white vinegar may aid in the killing of parasites, viruses, and bacteria.
2. Maintain good hygiene. Washing yourself and practising good hygiene, in addition to washing your produce, is another way to help prevent Ascaris worm infection. Always wash your hands after using the restroom, as well as before and after handling food. Ascaris worm larvae and eggs are spread through faeces, which can be found in soil, water, or on unwashed hands.
Wash your hands frequently with warm water and soap, especially if you’re travelling and purchasing food in developing Asian and African countries.
Carry a small bottle of alcohol-based hand sanitizer with you when travelling and use it frequently to clean your hands.
If you don’t have soap or sanitizer, try cleaning your hands with fresh citrus juice (from lemons, limes, or grapefruits).
3. Travel to developing countries should be avoided. If you want to reduce your chances of contracting Ascariasis, the best advice is to avoid underdeveloped countries where the infection is most common, such as rural China, Southeast Asia, Sub-Saharan Africa, India, Latin America, the Caribbean, and parts of the Middle East.
If you must travel to these areas for work or family reasons, please follow the sanitary precautions outlined above. Handwash frequently, keep your hands away from your mouth, drink only bottled water, and avoid eating raw vegetables.
Ascariasis is most common in the Southeastern United States, but it is not nearly as common as it is in developing countries with warm temperatures all year.
Part 3 Treating Ascariasis
1. Let’s wait and see. Typically, only Ascaris infections that cause symptoms must be treated, which occurs in a small percentage of cases. In many cases, ascariasis symptoms will flare up for a short period of time (a few weeks), then fade away for long periods of time. In some cases, ascariasis resolves completely on its own due to a stronger immune system’s ability to defeat it.
In many parts of the world where ascariasis is prevalent, a lack of nutritious food and safe drinking water is a greater concern than parasitic infections.
Adults usually fare much better than children when it comes to ascariasis. If a child is failing to thrive and losing weight, it’s time to see a doctor to figure out why.
To make a diagnosis, a doctor will examine a stool sample for Ascaris eggs.
2. Anti-parasitic medication should be taken. Anti-parasitic (or anti-helminthic) drugs are the first-line treatment for ascariasis and the majority of other parasitic worm infections. Albendazole (Albenza), ivermectin (Stromectol), and mebendazole are the most commonly prescribed medications to kill Ascaris worms. Ascaris infections are typically treated with pills for one to three days.
Albendazole has a single effective dose of 400 mg, while mebendazole has a dose of 500 mg.
Albendazole and mebendazole are not recommended during pregnancy; the drug of choice for pregnant women is pyrantel pamoate.
These drugs effectively kill adult worms while causing no side effects. People frequently carry larvae that are not killed by drugs, necessitating a six-month follow-up treatment.
3. Surgery should only be used as a last resort. Surgery may be required to remove the mass of worms and repair the damage they’ve caused in cases of severe Ascaris infections and heavy intestinal infestation. The following are the most common reasons for surgery: intestinal blockage (obstruction) or perforation, bile duct blockage, pancreatitis, and/or an appendicitis flare-up caused by the infection.
Before recommending surgery, your doctor will most likely order x-rays (abdomen and chest), an ultrasound, a CT scan, and/or an MRI to determine the extent of your problem.
An endoscope is a small tube with a cutting device and a camera on the end that is inserted down the throat or up through the anus to reach the worms in the small intestine.
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