Ascariasis – symptoms, treatment

Ascaris is a disease caused by the invasion of the human roundworm (Ascaris lumbricoides). Infection with the largest known intestinal nematode is the most common intestinal parasitosis in the world.

epidemiology glistnicy

Ascariasis is a disease that occurs mainly in developing countries. It is estimated that the global number of people infected is 800 million-1,4 billion. The frequent occurrence of this infestation is favored by poor hygiene, especially neglect of sewage management. Other factors significantly influencing the occurrence of this infection are habit: using human excrements as fertilizer and a humid and warm climate. The highest incidence is observed among children in preschool and early school age in rural areas.

Human roundworm infection occurs via the faecal-oral route. The most common sources of infection are soil containing invasive eggs of this parasite, as well as agricultural crops and food contaminated with it. The human roundworm is a geohelminth, its eggs are not invasive immediately after excretion in the faeces. It takes 2-4 weeks for eggs to mature in the soil and only after this period they become invasive – humans can become infected. Eggs are resistant to environmental factors and can survive in soil, remaining invasive for several months, and under exceptionally favorable conditions in a humid and warm environment – even for several years. Man is the main definitive host of the human roundworm, although some importance is also attached to the pigs which are the definitive host for the porcine roundworm – Ascaris suum. Infection with this parasite can occur in humans and is indistinguishable from infection with human roundworm.

Etiology of ascariasis

The human roundworm (Ascaris lumbricoides) is a nematode measuring 15-40 cm long and up to 5 mm wide. It lives in the lumen of the human intestine for 10-24 months, excretes over 200 thousand. eggs a day.

Roundworm — pathogenesis

After infection in the digestive tract, the larvae are released from the invasive eggs, which pass through the intestinal mucosa into the blood, and then into the liver and lungs. They then travel to the alveoli and then, through the bronchioles and bronchi, to the throat. When expectorated, they are swallowed – the larvae moult in the digestive tract and the parasite transforms into mature forms. The migration period of the larvae is approximately 14 days. During this time, the immune system is stimulated, leading to the formation of eosinophilic granulomas in the liver and inflammatory infiltrates in the lungs. The intestinal phase of invasion lasts 10-24 months, with egg excretion starting 9-11 weeks after infection. Massive invasion (over 60 individuals) may cause intestinal obstruction and may lead to malabsorption syndrome, as a consequence, to malnutrition and delayed psychophysical development in children. In addition, migration of mature roundworms to the appendix, bile ducts and pancreatic ducts can trigger an inflammatory process in these organs.

If you suspect a parasitic disease, you can choose to have a mail-order test for the concentration of eosinophilic protein X, which the body produces in a defense response to the parasite. You will collect a stool sample yourself using the kit provided and send it to the laboratory.

Clinical symptoms of ascariasis

Clinical symptoms of ascariasis should be divided into those related to the migration period and to the parasitization of mature human roundworms in the intestine.

During the migration period of the larvae, the following are observed:

  1. dry cough;
  2. chest discomfort which increases with deep breathing and coughing;
  3. shortness of breath and hemoptysis are less common;
  4. while auscultating the lungs, individual wheezing and fine bubble rales are sometimes observed;
  5. feeling of general breakdown;
  6. low-grade fever or low fever;
  7. additional tests show eosinophilia, elevated levels of total IgE antibodies, and hypergammaglobulinemia.

Chest X-rays often show “airy” infiltrates – parenchymal densities of round or oval shape, from a few millimeters to several centimeters in size (Löeffler infiltrates). These symptoms begin between 9 and 12 days after infection and last from a few days to two weeks.

During the parasitic time of roundworms in the digestive tract, most people do not experience any symptoms. Occasionally, roundworm can be found in the vomit or faeces. In endemic areas in children, symptoms of malnutrition are observed, the most frequently mentioned is the deficiency of protein and vitamins A and C. It is not known whether the deficiencies are caused by ascariasis – the results of the studies conducted so far are inconclusive. Massive invasion may be manifested by abdominal pain, small intestine obstruction or obstruction. It is related to the presence of a roundworm in the lumen of the intestine. Complications of ascariasis, such as cholestasis or extrahepatic cholestasis, sometimes occur as a result of the migration of mature specimens outside the small intestine. The entry of roundworm into the pancreatic duct can cause pancreatitis, and the migration of this parasite into the appendix can also cause inflammation.

If there is a parasite in your body, start using Na Parasites regularly – the Panaseus dietary supplement, which supports the functioning of the digestive system and helps to get rid of uninvited guests.

Diagnosis of ascariasis

The detection of typical papillary-shaped eggs in the faeces confirms infection with human roundworm. During the migration period, the presence of the larvae can sometimes be detected in the sputum. Often the diagnosis is made on the basis of the presence of mature parasites in the stool. Eosinophilia, common during larval migration, is rare during intestinal invasion and may not be significantly elevated. Complications of ascariasis can be confirmed by imaging tests: x-ray image abdominal cavity in case of suspected intestinal obstruction and retrograde cholangiopancreatography i ultrasound examination abdominal cavity when suspected bile duct ascariasis or pancreatic ducts.

To assess the presence of parasites in the body, it is worth doing a Dispatch test of the intestinal microflora and intestinal markers, which you can buy at Medonet Market. Specifically, towards the human roundworm, perform a genetic mailing test for the presence of human roundworm.

Differential diagnosis

During the migration phase, ascariasis should be differentiated from pneumonia or bronchitis, sometimes with bronchial asthma. The occurrence of symptoms of choke or obstruction requires differentiation of the causes of this condition, taking into account intestinal tumors, torsion and intussusception.

Ascariasis – treatment

Antiparasitic treatment is effective only in the adult intestinal parasites, but not on the larvae circulating in the lungs.

1. Symptomatic treatment is applied in the migration phase of the larvae – administration of bronchodilators or glucocorticosteroids may be necessary. In cases of sporadic infections, apart from endemic areas, the drug of choice is pyrantel in a single dose of 10 mg / kg bw. Use of this drug in areas with high incidence should be limited due to the possibility of provoking intestinal obstruction.

2. Infections in an endemic zone where there is a high risk of massive invasion, should be treated with mebendazole at a dose of 2 times 100 mg for 3 days or 500 mg once. An alternative is to administer a single dose of 400 mg of albendazole. Even without treatment, the disease disappears after 2 years at the latest, if there are no repeated infections. Conservative management is usually effective in the event of obstruction.

In the case of ascariasis, it is worth using the Wormwood herb, which also has a prophylactic effect. Or you can try Worms, a mixture of herbs with wormwood and tansy.

The prognosis of ascariasis

The prognosis is good, potentially life-threatening complications such as obstruction and appendicitis are rare and manageable well.

Summation

Ascaris is a disease caused by infection with human roundworm. Sources of contamination are soil or food contaminated with soil, and water contaminated with human faeces. Human roundworm infection is common, most common in tropical and subtropical regions. After infection, the eggs hatch from the eggs in the digestive tract, which then pass through the blood to the lungs. Clinical symptoms during the migration period mainly concern the respiratory system. During the parasitic period of roundworms in the intestine, most infections are asymptomatic. The treatment includes pyrantel, mebendazole or albendazole. The prognosis is good.

Literature

1. Crompton D.W.: Ascaris and ascariasis, Adv Parasitol 2001; 48: 285-375.

2. Bethony J., Brooker S., Albonico M. i wsp.: Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm, Lancet 2006; 367: 1521-1532.

3. Massara C.L., Enk M.J.: Treatment options in the management of Ascaris lumbricoides, Expert Opin Pharmacother 2004; 5: 529- 539.

4. Villamizar E., Mendez M., Bonilla E. i wsp.: Ascaris lumbricoides infestation as a cause of intestinal obstruction in children: experience with 87 cases, J Pediatr Surg 1996; 31: 201-204.

Source: J. Cianciara, J. Juszczyk, Infectious and parasitic diseases; Czelej Publishing House

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