Quick Overview of Ascariasis With Symptoms, Causes and Treatment

When the small intestine gets infected by a roundworm (Ascaris Lumbricoides) a person suffers from the condition called ascariasis. It is one of the most common diseases all around the world. However, it is most common in countries which lack proper sanitation. Ascaris Lumbricoides acts like a parasite and from the intestinal tract of the host, it gets the nutrients. This condition usually spreads when a person defecates openly. Nearly 10 percent of the population of the developing world is suffering from the problem of ascariasis.

This type of infection can occur by eating food products or drinks which are contaminated from ascaris eggs. To prevent this disease it is imperative that the sanitation is improved. If there is an area where more than 20 percent of the population is infected then it is recommended that a patient should be treated at regular intervals.

It is defined as an infectious disease of the small intestine in humans and is caused by a species of roundworm known as Ascaris lumbricoides. These roundworms are parasitic organisms that thrive within the small intestine. This infection is mainly caused by the consumption of food and drinks contaminated with the eggs of Ascaris from faeces.

These parasites hatch within the small intestine and then burrows through the wall of the gut and finally migrates up to the lungs via the blood. After reaching the lungs they rupture the alveoli and move up to the trachea, from where they are coughed up and may be swallowed. These larvae then moves through the stomach for the second time into the intestine, where they become adult worms.

Ascariasis is more common among children than in adults. In most of the cases this infection bears no symptoms initially when the number of worms is less. However, at a later stage with the increase in the number of worms, the symptoms show up and may include fever, breathing problems, abdominal swelling, abdominal pain, diarrhoea, weight loss, malnutrition and learning problems.

Recent researches have shown that about 0.8 to 1.2 billion people throughout the world is seen to suffer from Ascariasis and the affected populations are mostly from sub-Saharan Africa, Latin America, and Asia. Hence, It is one of the most common soil transmitted helminthiasis. In severe cases, this intestinal infestation of roundworms can even lead to death.

In majority of the cases no symptoms are exhibited in people infected with the condition of ascariasis. If the infestations are ranging from moderate to heavy then it can lead to the various symptoms. If a person accidentally or unknowingly ingests the microscopic eggs of ascaris then they hatch in the intestine and migrate through the bloodstream to the lungs. The symptoms are similar to that of pneumonia or asthma. The symptoms which may be exhibited in this case are

• Wheezing
• Persistent cough
• Shortness of breath.

If the infestation of the larvae happens in the small intestine the symptoms which may be exhibited by the person are given below

• Vomiting
• Nausea
• Abdominal pain
• Weight loss
• A worm can be seen in the vomit or stool
• Tiredness.

The infection of ascariasis does not spread from one person to another directly. For this infection to occur a person needs to come into contact with the soil that has human feces mixed in it. The human feces have eggs of ascaris. It can also happen if the person is drinking water contaminated by human feces. In the majority of the developing countries human feces are used as a fertilizer. Small children who play in this type of soil are often infected with this type of infection. The fruits and vegetables which are grown up in the area that has contaminated soil can transmit this disease if used unwashed.

People who live in the area that has proper modern sanitation have a very low chance of developing the infection of ascariasis. Although, it is very important that a person washes his hands properly after using the washroom and the fruits and vegetables are properly washed before being used. The cooking surface and utensils must also be washed properly every time after use. If a person visits any place that has improper sanitation then he/she must take care of the following precautions

• The water should be boiled and filtered before drinking.
• Wash hands with hot water and soap before and after eating the food.
• If the bathing areas are unclean then it must be avoided.
• Children playing outside must be made to wash their hand properly.
• The vegetables grown in unsanitary conditions must be peeled and cooked properly.
• A person must inspect and observe the space for food preparation."

If during vomiting or coughing worms comes out of the mouth, the person must take the worm to the doctor for identification. A doctor may prescribe the following test to confirm the diagnosis

Blood test: A sample of blood is taken to check for the increase in the level of white blood cells. Eosinophils get elevated due to ascariasis.

Stool test: The ascaris worms which are mature lay their eggs in the intestine. The eggs move through the digestive system and can be identified in the blood. In stool test the doctor would be examining the stool for larvae or microscopic eggs. The eggs will only appear in the stool if the person remains infected for more than 40 days.

Other imaging tests may be ordered by the doctor like x-ray of the abdomen to confirm the mass of worms. Ultrasound and MRIs can also be conducted to check for worms which are blocking the ducts of the pancreas or liver.

Usually the infection which shows any signs and symptoms require treatment. It will resolve on its own in some of the cases. The first line of treatment for ascariasis is anti-parasite medications. Some of the medications which may be prescribed are as follows

• Mebendazole
• Albendazole
• Ivermectin

These medications are prescribed for a total duration of three days for killing the worms which are adult. Some of the side effects of the medicine may be inclusive of diarrhea or abdominal pain.

If infestation is very heavy then a surgery may be necessary for the removal of the worms so that damage caused by the worms can be minimized. Some of the common complications of the heavy infestation of worms are intestinal obstruction, appendicitis, and bile duct obstruction.

Fortunately, in the recent years, a number of medications are available that can be used effectively for the treatment of Ascariasis. The common medications used to treat this infection are albendazole (Albenza) and mebendazole (Vermox). These drugs are usually prescribed for a course of about one to three days. The other drugs that can be used for this purpose effectively include ivermectin (Stromectol), pyrantel pamoate (Pin Rid, Pin X), piperazine citrate and levamisole (Ergamisol).

Pyrantel pamoate is usually prescribed for pregnant women, whereas other drugs such as mebendazole and albendazole can lead to teratogenic effects in the foetus. However, in severe cases, surgical treatment may be necessary to remove the worms and repair the damages cause by them to the intestine. Patients having intestinal obstruction or perforation, bile duct obstruction, and appendicitis due to Ascariasis may require surgery.

Any person who is diagnosed as having ascaris and having symptoms like fever, breathing problems, abdominal swelling, abdominal pain, diarrhoea, weight loss, mal-nutrition and learning problems are considered as eligible for this treatment. It is seen that on an average, children are affected more by this infection than the adults.

People who are healthy or have been diagnosed as not having the infection of ascaris are not eligible for this treatment.

The medications for treatment of Ascariasis are more or less safe and very few patients are reported as having suffered from the side effects of these medicines. However, the drug pyrantel pamoate is usually prescribed for pregnant women to treat ascaris, whereas other drugs such as mebendazole and albendazole can lead to teratogenic effects in the foetus.

Though rare, some of the side effects of having mebendazole and albendazole are nausea, vomiting, stomach and abdominal pain, headache, dizziness, temporary hair loss, vision changes, yellowing eyes or skin, severe stomach or abdominal pain, dark urine, unusual tiredness, easy bleeding, seizures, confusion, very stiff neck and hepatocellular injuries.

People who are healthy or have been diagnosed as not having the infection of ascaris are not eligible for this treatment.

The problem of Ascariasis is initially asymptomatic, but when the infection grows, various symptoms may come up. A patient, who is subjected to medical treatment for ascaris, is usually seen to recover within a short span of time, i.e. one to three days after he/she takes the prescribed medicines. For patients having serious complications due to this problem and had undergone surgical treatment, recovers within a period of 7 to 10 days.

The treatment of Ascariasis using medications is generally a non-expensive one. The patient is usually prescribed medications for a course of three days and the cost of medication ranges from Rs. 20 to Rs. 30 only in India. However, patients having serious complications like intestinal obstruction or perforation, bile duct obstruction, and appendicitis due to ascaris need surgical treatment for the removal of worms and repair of the damaged parts of the intestine. Such surgical treatment may cost higher. This treatment easily available in all cities and towns in India.

The results of the treatment of ascaris using medications and surgery are permanent, on a condition that the patient maintains personal hygiene and consumes uncontaminated food after recovery, to avoid the chances of reoccurrence of this parasitic infection. It is advisable for every person to maintain personal hygiene and wash hands properly with soap before eating or handling food. Even drinking water should be properly boiled before consumption. Such measures can help to prevent the further occurrence of this intestinal infection.

A person can opt for some of the natural home remedies which can be used for the treatment of ascariasis. Pumpkin seeds, wormwood, garlic and several other herbs can be used for treating ascaris. Before using these natural remedies for the treatment the doctor’s must be taken into consideration. It is possible that these natural remedies may not be as helpful as the medicines for the treatment of ascariasis.

Ascariasis is transmitted usually from the objects which have been contaminated by the eggs in the fecal matter. It is because of the ingestion of these eggs in the form of contaminated vegetables, fruits, and water ascaris occurs. It is the primary cause of the infection. Direct transmission of ascariasis from one human to another is impossible. The transmission can happen due to the municipal recycling of the wastewater in the fields containing crops. Transmission of ascaris from one to another can occur only if hands of the human are dirty and they come in touch with the other human.