Ascariasis 101

WHAT IS ASCARIASIS?

Ascariasis is an infection of the small intestine by the roundworm Ascaris lumbricoides. Roundworms are parasitic in nature and the infections they cause are common. Ascariasis is the commonest roundworm infection. According to the World Health Organization, about 10 percent of people in developing countries are infected with intestinal worms.

These parasitic worms are very common in the United States as reported by the Centers for Disease Control and Prevention. Ascariasis is most prevalent in places with poor environmental hygiene and sanitation. The mode of transmission is through the consumption of infected food or water. The infection is usually asymptomatic though there can be intestinal or pulmonary problems when the parasites are highly concentrated.

Ascariasis
Photo Credit: NaturalPedia

CAUSES OF AN ASCARIASIS INFECTION

One can get infected with ascariasis after accidental ingestion of the eggs of an A. lumbricoides roundworm. The eggs are found in soil that has been contaminated by the feces of man or by uncooked food that been contaminated by soil housing the eggs of roundworm.

Children are the major sufferers and they get this infection when they place their hands in their mouth after they must have played in contaminated soil. Ascariasis can also be transmitted from one person to another.

SYMPTOMS OF ASCARIASIS

Ascariasis is usually symptomless but when the infestation grows, symptoms may start getting noticed.

When present in the lungs, round worms can cause the following symptoms

  • Coughing or gagging
  • Wheezing or fast breathing
  • Aspiration pneumonia
  • Blood in mucus
  • Chest discomfort
  • Fever

Roundworms in the intestine can also cause the following:

  • Nausea
  • Vomiting
  • Frequent defecation or diarrhea
  • An intestinal obstruction which presents with vomiting and severe pain
  • Appetite loss
  • Presence of worms in stool
  • Abdominal discomfort or pain
  • Weight loss
  • Mal-absorption causing impaired growth in children

Those with a more concentrated level of infestation may have additional symptoms such as excessive tiredness and fever. When the infestation is major, it will make the affected individual very uncomfortable. One can have any or even all of the symptoms listed above especially if you do not get prompt treatment.

LIFE CYCLE OF A ROUND WORM

Upon ingestion, this worm gets to the intestine and reproduces there. It undergoes different stages of growth including:

  • Swallowed eggs are hatched in the intestine
  • The larvae are released into the bloodstream and they are circulated to the lungs
  • When the roundworms mature, they migrate from the lungs to the throat
  • Once they get to the throat, they are either coughed up or swallowed. The ones that are swallowed will find their way back to the intestines
  • At the intestines, they again mate and lay more eggs
  • The cycle continues and some eggs are passed through the feces. Other eggs hatch and are sent back to the lungs via the bloodstream.

RISK FACTORS FOR ASCARIASIS

Roundworms are found worldwide though they are more in tropical and subtropical areas, including Latin America and sub-Saharan Africa. It is also common in areas with poor environmental sanitation.

Risk factors for ascariasis that are environment related include:

  • Absence of modern hygiene and sanitation infrastructure.
  • Making use of human feces for fertilizer
  • Residing in or visiting a tropical or subtropical climate
  • Exposure to an environment with a high possibility of dirt ingestion

You can reduce your exposure to roundworm by doing away with unsafe food and water. Keep your surrounding clean by cleaning cooking surfaces and laundering clothes that have been exposed to some unsanitary conditions.

If you are paying a visit to a remote tropical area, ensure that you do the following:

  • Hand washing with soap and water before and after eating or preparing food
  • Boil or filter drinking water
  • Inspect the facilities used for food preparation
  • Avoid bathing areas that are unclean
  • For areas that lack sanitation infrastructure or those that make use of human feces as fertilizer, always remember to peel or cook unwashed vegetables.

Children between the ages of 3 to 8 are most likely to get infected because they get in contact with the soil when playing.

COMPLICATIONS

Majority of cases of ascariasis are mild in severity and usually do not cause major problems.  Still, a heavy concentration of the ascariasis in the blood stream can be disseminated to other body parts and can lead to harmful complications such as:

  • Intestinal obstruction: this happens when the worms form a mass which occludes the intestines thus causing serious pain and vomiting. Intestinal obstruction is a medical emergency and requires immediate treatment
  • Blocked ducts: this occurs when the worms occlude the small pathways to the liver or pancreas.
  • Nutritional deficiency: this infestation can cause an appetite loss and mal-absorption of nutrients thus putting children at risk of not receiving sufficient nutrients thereby impeding their growth.

Children have a much smaller intestinal size which means that they are more likely to have an intestinal obstruction and also more likely to manifest symptoms of gastrointestinal complications.

DIAGNOSIS OF ASCARIASIS

The diagnosis of ascariasis is made by stool examination for parasites and their eggs. A stool sample is usually requested if there is any suspicion that one has ascariasis.

The following imaging tests are further required when one has ascariasis:

Imaging tests help to show number of worms that have matured and the group of worms found inside the body.

The doctor will also determine the duration of infection so as to evaluate one’s risk of developing complications.

TREATMENT OF ASCARIASIS

The treatment modalities can be medical or surgical depending on the severity and the presence of complications. The drugs commonly used are anti-parasitic drugs such as:

  • Albendazole
  • Ivermectin
  • Mebendazole

For severe cases, additional treatment may be needed. For a bigger infestation, surgery is recommended especially if the roundworms are completely obstructing the intestinal lumen.

LONG TERM OUTLOOK

A mild treatment can cure ascariasis. Symptoms may disappear even before all the worms are cleared.

Ascariasis can still be complicated when the infestations are concentrated enough. See a doctor if you think that you have been infected with roundworms. Ascariasis can be prevented by doing the following:

  • Maintaining good hygiene. Hand-washing with soap and water before and after eating or handling food, also after making use of the bathroom. Children should be taught to also do the same.
  • Drink only at trusted places
  • Only drink water that has been bottled and do away with raw fruits and vegetables except you get to wash and peel them by yourself when you are at a place that lacks modern sanitation.

Leave a Reply