Ascariasis is an intestinal infection caused by a parasitic roundworm.

While globally it is the most common human infection caused by worms and it occurs most often in areas with poor sanitation or crowded living conditions. It is an infection caused by Ascaris Lumbricoides, an intestinal roundworm.

Risk factors
presence of pets within the house

consuming vegetables or fruits that have not been

carefully cooked washed or peeled

Poor hygiene and sanitation

Factors favoring the spread of the transmission

simple life cycle
enormous egg production eggs are highly resistant to ordinary disinfectants the eggs may remain viable for several years

living habits disposal of feces is unsuitable

Ascaris lumbricoides
Is the most common intestinal nematode

MORPHOLOGY
ADULT WORM - cylindrical in shape -creamy-white or pinkish in color

-the female averages 20-35 cm in length, the largest 49cm

-the male is smaller, averaging 15-31cm in length and

distinctly more slender than the female

-the typical curled tail with a pair sickle

 on the tip of the head there are 3 lips

they have a complete digestive tract

reproductive organs are tubular

male has a single reproductive tubule

The female has two reproductive tubules

 the lips are seen at the anterior end The margin of each lip is lined with minute

teeth which are not that visible

Female

Male

 A large mass of Ascaris lumbricoides that

was passed from the intestinal tract

Life Cycle

 This worm lives in the lumen of small intestine Feeding on the intestinal contents 3 the fertilized female lays eggs

It takes 60-75 days that a larvae hatch in the intestinal tract

An adult female can produce approximately 200 000- 240

000 eggs per day, which are passed in feces

 host digestive juices acts on the egg shell

and liberate the larvae (0.2 0.3 mm in length)

Into the small intestine

These larvae penetrate the intestinal mucosa

and enter lymphatics and mesenteric vessels

 they are carried by circulation to the liver,

right heart and finally to the lungs where

they penetrate the capillaries into the alveoli

in which they molt twice and stay for 10-14

days
Then they are carried, or migrate, up the

bronchioles, bronchi, and trachea to the

epiglottis

 When swallowed, the larvae pass down into

small intestine where they develop into

adults
The time for the ingestion of embryonated

eggs to ovi-position by the females is about

60-75 days the adult worms live for about

one year

 The life cycle begins with the production of

mammillated eggs by adult females living in the distal small intestine of an infected human host image. Once deposited in the soil, eggs become infectious within several weeks. Eggs are subsequently transmitted by ingestion, or possibly by inhalation of contaminated dust; larvae do not hatch in soil and do not invade the skin.

 Inside their next human host, Ascaris larvae hatch in

the jejunum, penetrate the intestinal wall, and migrate by way of hepatic venules to the right heart and pulmonary circulation. They subsequently break through into alveolar spaces, ascend the trachea, and are swallowed back into the intestine, where they undergo a final molt and develop into adults, which mate and spawn a new generation of eggs.

 Occasionally, male-only adult infections occur,

yielding no eggs in stool. Female-only infections produce infertile eggs, which never become infectious. Otherwise, under normal conditions, the time from ingestion of eggs to development of new eggs is 10 to 12 weeks. Adult worms live for approximately 1 year, and are then expelled.

In the early Phase ( 4-16 days after egg ingestion) Respiratory symptoms result from migration of larvae through the lungs Classically, these symptoms occur in the setting of: eosinophilic pneumonia ( Loffler syndrome) Fever Nonproductive cough Dyspnea Wheezing

In the Late Phase ( 6-8 weeks egg ingestion), GIT. Symptoms may occur and related to the mechanical effects of high parasite loads. Passage of worms ( mouth, nares, anus) abdominal pain Nausea, vomiting Pharyngeal globus, tingling throat Dry cough

The patients may presents with complications:

biliary obstruction intestinal obstruction

Appendicitis
pancreatitis

Biliary obstruction

Intestinal obstruction

Induced pancreatitis

Physical examination
Fever

Jaundice (in biliary obstruction)

Cachexia (due to malnutririon)

Pallor ( anemia)
Deminished breath sounds Abdomina pain

Migrating larvae may transmit other organisms

Causing:

Bacterial pneumonia
Airway obstruction

Lacrimal drainage obstruction

Small bowel intussusception Acute interstitial nephritis encephalopathy

Laboratory test
Early infection

CBC may show eosinophilia

Sputum analysis may reveal larvae or charcot -leyden

crystals ( mass of crystalloid composed of eosinophilic proteins Stool examination findings are typically the presence of ascaris eggs Increses in lgE and later lgG

Feces are examined for the ascaris eggs by:

direct fecal film simple and effective

the eggs are easily found using this due to the large no of the female oviposition brine- floatation method recovery of adult worms

Imaging studies

 In gal bladder

 Endoscopic extraction of an ascaris worm

 Ascaris larvae in lung

Larvae

TREATMENT

Mebendazole
MOA
_interferes with cellular microtubule formation in the

worm thus distributing the glucose uptake and the normal digestive functions of the worm to such an extent that an autolysis process occurs Dose: 1 tablet 500mg once a day repeated once after 10 days

Albendazole
MOA - it acts by destruction of cytoplasmic microtubules in the

intestinal and absorptive cells of the worm leading to in inhibition of glucose uptake and other nutrients resulting in the death of the worm Dose : Adult and children >2 yrs old single oral dose of 400mg (1 tab = 200mg) Children < 2 yrs old Single oral dose of 200mg

Flubendazole
Like albendazol
Dose

1 tab 100mg twice daily for 3 consecutive

days

Levamisole
MOA - it acts on nematode nerve ganglia paralyzing the worm

musculature within seconds of contact, unable to maintain their position, the worms are then ejected normal peristaltic moven Dose 5ml 1-2 yrs old 10 ml 5-15 yrs old 15 ml 16- above

PREVENTION
Avoid contact with soil that may be contaminated with

human feces, including with human fecal matter like night soil used to fertilize crops Proper hygiene

 Teach children the importance of washing their

hands Wash, peel, or cook all raw vegetables and fruits before eating particularly those grown in soil

 Vaccination Deworming

Chemoprophylaxis-refers to the drugs

given to exposed and susceptible hosts to prevent them from developing an infection. Limiting exposure to reservoirs of infection Using protective suits or equipment when exposed to area

Thank you!

Nakamura sign
Clinical features of paragonomiasis cases

recently found in Japan : parasite- specific immunoglobin M and G antibody classes