Ascariasis

• Causes, incidence, and risk factors

  Ascariasis is caused by consuming food or drink contaminated with roundworm eggs. Ascariasis is the most common intestinal worm infection. It is found in association with poor personal hygiene, poor sanitation, and in places where human feces are used as fertilizer.

  Once consumed, the eggs hatch and release immature roundworms called larvae within the intestine. The larvae then move through the bloodstream to the lungs, exit up through the large airways of the lungs, and are swallowed back into the stomach and intestines.

  During movement through the lungs the larvae may produce an uncommon form of pneumonia called eosinophilic pneumonia. Once they are back in the intestines, the larvae mature into adult roundworms. Adult worms live in the intestine where they lay eggs that are present in feces.

  It is estimated that 1 billion people are infected worldwide. Ascariasis occurs in people of all ages, though children are affected more severely than adults.

• Symptoms

  Most of the time, there are no symptoms. If there are symptoms, they may include:

  • Bloody sputum
  • Cough
  • Low-grade fever
  • Passing worms in stool
  • Shortness of breath
  • Skin rash
  • Stomach pain
  • Vomiting worms
  • Wheezing
  • Worms exiting through the nose or mouth
• Signs and tests

  The infected person may show signs of malnutrition. Tests to diagnose this condition include:

  • Abdominal x-ray
  • Complete blood count
  • Stool ova and parasites exam
• Treatment

  Treatment includes medications that paralyze or kill intestinal parasitic worms, such as albendazole or mebendazole. If there is a blockage of the intestine caused by a large number of worms, endoscopy or, rarely, surgery may be needed.

• Expectations (prognosis)

  Most people recover from symptoms of the infection, even without treatment, although they may continue to carry the worms in their body.

  Complications may be caused by adult worms that move to certain organs or multiply and cause a blockage in the intestine.

• Complications
  • Liver secretion (biliary tract) obstruction
  • Blockage in the intestine
  • Hole (perforation) in the gut
• Calling your health care provider

  Call your health care provider if you have symptoms of ascariasis, particularly if you have traveled to a high-risk area. Also call if symptoms get worse, do not improve with treatment, or if new symptoms occur.

• Prevention

  Improved sanitation and hygiene in developing countries will reduce the risk in those areas. In areas where this disorder is common, routine or preventive (prophylactic) treatment with deworming medications may be advised.

• References
  Kazura JW. Nematode infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 378.

Review Date: 12/3/2008

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.