Ascariasis: Causes, Symptoms, Diagnosis, and Treatment

Parasitic worms classified as "soil-transmitted helminths," such as Ascaris lumbricoides, hookworm, and whipworm, are thought to affect between 807 million and 1.2 billion individuals worldwide (STH). They together bear a significant portion of the global burden of parasitic illness.

Intestinal Ascaris parasites are present. The faeces (poop) of afflicted persons contain Ascaris eggs. Worm eggs are spread on the soil when an infected person urinates outside (for example, next to bushes, in a garden, or a field), or when their faeces are used as fertilizer. The parasite form that develops from the worm eggs can then spread to other people. Consuming the worm eggs results in ascariasis. This can occur when eating produce that hasn't been thoroughly peeled, cleaned, or cooked, or when putting hands or fingers with contaminated soil on them in the mouth.

Ascariasis patients may exhibit no symptoms. If symptoms do develop, they may be minor. Abdominal discomfort or pain are symptoms. Children's growth can be slowed by severe illnesses clogging the intestines.

Pig roundworms can also infect humans (Ascaris suum).

Ascariasis: Causes

Ascariasis does not pass from one person to another directly. An individual must instead come into touch with water contaminated with ascariasis or soil with ascariasis eggs combined with pig or human excrement. In certain underdeveloped nations, human excrement is mixed with the soil in yards, ditches, and fields or utilized as fertilizer because of inadequate hygienic conditions. Infected pig or chicken liver that has not been fried can likewise cause infection in humans.

Small children frequently play in the dirt, and if they put their dirty fingers in their mouths, it might cause an illness. Unwashed produce cultivated in polluted soil has also been shown to spread ascariasis eggs.

A Worm's Life Cycle

The life cycle of a worm has the following four stages −

• Ingestion. Without contact with dirt, the small (microscopic) ascariasis eggs cannot spread the disease. Through hand-to-mouth contact or consuming uncooked fruits or vegetables cultivated in contaminated soil, people might unintentionally ingest (swallow) contaminated soil.

• Migration. The larvae emerge from the eggs in your small intestine, pass through the intestinal wall, and then move via the circulation or lymphatic system to reach the heart and lungs. The larvae enter your airway and go up your throat, where they are coughed up and ingested, after growing for around 10 to 14 days in your lungs.

• Maturation. Once within the intestines again, the parasites develop into either male or female worms. Female worms may grow to a length of more than 15 inches (40 centimeters) and a diameter of just about a quarter inch (6 millimeters). In general, male worms are smaller.

• Reproduction. If there are both male and female worms in the intestines, female worms can create 200,000 eggs every day, and the eggs exit your body in faeces. Before becoming infectious, the fertilized eggs must remain in the soil for at least two to four weeks.

Ascariasis: Symptoms

The majority of ascariasis patients show no symptoms at all. Depending on the area of your body that is impacted, moderate to severe infestations result in different indications or symptoms.

Within the Lungs

The ascariasis larvae hatch in the small intestine after you swallow the tiny (microscopic) ascariasis eggs, and then they move through the bloodstream or lymphatic system to the lungs. You may already be displaying symptoms like asthma or pneumonia, such as −

• Chronic cough

• Respiration difficulty

• Wheezing

The larvae migrate to the throat after spending 10 to 14 days in the lungs when you cough them up and then ingest them.

During Digestion

In the small intestine, the larvae develop into adult worms, which normally reside in the intestines.

The intestinal infection might result: in cases of mild or moderate ascariasis.

• Strange stomach ache

• Nausea and diarrhea

• Bloody stools or diarrhea

The following conditions might occur if you have a lot of worms in your intestine −

• Intense stomach discomfort

• Fatigue and Vomiting

• Loss of weight or undernutrition

• Worms in your faeces or vomit

Ascariasis: Risk Factors

The major risk factors include −

• Age. The majority of ascariasis patients are 10 years old or younger. Because they are more prone to play in the dirt, kids in this age range may be at a higher risk.

• A hot environment. The Southeast of the United States is where ascariasis is most prevalent. However, it happens more frequently in developing nations with warm weather all year round.

• Poor hygiene. In underdeveloped nations where human waste is left to interact with the soil, ascariasis is common.

Ascariasis: Diagnosis

When there is a severe infestation, worms may be discovered in your cough or vomit. Other bodily openings, such as your mouth or nostrils, can serve as exit points for the worms.

Stools Tests

In your gut, mature female ascariasis worms start to lay eggs. After passing through your digestive tract, these eggs finally end up in your faeces.

Your doctor will look for the small (microscopic) eggs and larvae in your faeces to diagnose ascariasis. However, eggs won't show up in stools for at least 40 days following infection.

Blood Tests

You can have your blood examined to see whether there are more eosinophils, a specific type of white blood cell. Your eosinophils can increase due to ascariasis, but so can other medical conditions.

Imaging Exams

X-rays. If you have a worm infestation, an abdominal X-ray may reveal the mass of worms. An X-ray of the chest may occasionally show that there are larvae in the lungs.

Ultrasound. An ultrasound may reveal worms in the liver or pancreas. In this method, internal organ pictures are produced using sound waves.

CT or MRI scans. Your doctor can identify worms that are obstructing ducts in the liver or pancreas by using any of these tests, which produce precise pictures of the interior structures.

Ascariasis: Treatment

Usually, only infections that result in symptoms require treatment. Ascariasis can sometimes go away on its own.

Medications

Ascariasis is often treated first with anti-parasite drugs. The majority are −

• Ivermectin with albendazole

• Mebendazole

The mature worms are killed by these drugs when administered for one to three days. Mild diarrhoea or stomach ache are examples of side effects.

Pyrantel pamoate is safe for use during pregnancy.

Surgery

Surgery may be required to remove worms and fix whatever harm they've done in situations of severe infestation. Surgery may be necessary for issues such as appendicitis, bile duct obstruction, and intestinal blockage or perforation.

Ascariasis: Prevention

• Avoid consuming any soil that may be polluted with human or pig faeces, such as in areas where crops are fertilized with human excrement ("night soil"), wastewater, or pig manure.

• Before handling food, wash your hands with soap and water.

• After handling pigs, cleaning pig pens, or handling pig dung, wash your hands with soap and water.

• Teach kids the value of washing their hands to avoid illness.

• Children should be watched near pigs to prevent them from putting their unclean hands in their mouths.

• Before consuming, wash, peel, or boil any raw fruits or vegetables, especially those that were produced on land that has received manure fertilizer.

Conclusion

Acute abdominal pain is frequently caused by ascariasis, which is linked to poor personal cleanliness and low socioeconomic status. Prompt investigations should be indicated in patients with a strong clinical suspicion of worm blockage to make a certain diagnosis and stop problems from occurring.