Other effective agents include levamisole, ivermectin, nitazoxanide, and piperazine citrate. Occasionally, as in this patient, the worm is passed via the rectum.īenzimidazoles (mebendazole and albendazole) are the mainstay of treatment for ascariasis. A variety of techniques may be used to detect infection, including microscopy of stool, a complete blood cell count to identify eosinophilia, radiographic imaging (with either plain films and/or contrast studies), and serology. 3Īlthough many patients remain asymptomatic, some may experience a variety of symptoms, especially with a high worm burden these include pulmonary (wheezing and coughing) and hypersensitivity effects, pancreatic and hepatobiliary symptoms, and symptoms from intestinal obstruction. Between 8000 and 10,000 deaths occur annually, mainly in children as a result of intestinal obstruction or perforation secondary to a high parasitic burden. They may invade other parts of the GI tract and in rare instances may migrate to involve the brain and renal system. During this period, the larvae migrate up the respiratory tract and are then swallowed into the GI tract, where they mature, mate, and then deposit eggs in the intestinal tract.Īdult worms may reside in the GI tract for 6 to 24 months, during which time they can cause bowel and biliary tract obstruction, the most common serious complications. It takes approximately 40 days from the development of pulmonary tract symptoms until the eggs may be detected in the stool. Ova and parasite evaluation of stool specimens is not diagnostic at this stage because eggs are not being released. Released larvae penetrate the intestinal wall and migrate via the pulmonary vascular beds and alveoli. Once the eggs are ingested, either in food products, contaminated water sources, or soil contaminated with fecal material, they usually hatch in the small intestine. The worms can range from 15 to 40 cm long and are the largest of the nematodes that affect humans. Infestation is believed to be associated with poor sanitation, local practices (ie, termite mound eating in Kenya), 2 and keeping house pets such as dogs and cats. Children are more frequently infected than adults and have heavier infestations than adults. United States and is frequently found in high-risk groups, such as refugees and immigrants from Asia and South America, as well as international travelers. 1 Ascaris is indigenous to the rural southeast of the About 25% to 33% of the world’s population is infected with this intestinal nematode, including approximately 4 million people in the United States. This patient had a gastrointestinal (GI) infection caused by Ascaris lumbricoides, the most common intestinal roundworm. Rectal examination shows no excoriations or gross bleeding. Abdominal examination reveals normal bowel sounds and no masses, guarding, or rebound. His vital signs are stable, lung are clear, and heart rate and rhythm are regular. He works as an entertainer and recently returned from a several-month tour in Southeast Asia. He does not take any daily medications and has no history of significant medical disorders. He is otherwise healthy and occasionally drinks alcohol. He denies any recent fever, chills, nausea, or vomiting. A 35-year-old man presents to your office with a worm (shown here) that he found in the toilet after a morning bowel movement.
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