Definition

Ascariasis is a common worm infection worldwide. Worms need the human intestine to grow from larvae or eggs into adult worms, which can reproduce and reach lengths up to 30 centimeters. Most people have minor infections with no signs or symptoms. On the other hand, a severe infection may result in a wide range of signs, symptoms, and complications. It is more common for child populations in tropical and subtropical regions to be affected, especially in areas with inadequate sanitation and hygiene facilities.

Causes

Ascariasis is not transmitted by person-to-person contact. It is spread through soil contaminated with human feces or water. The use of human feces as fertilizer persists in numerous developing countries. Inadequate sanitation can also contribute to transmission, as human feces may contaminate soil in open areas.

Children are at risk of ascariasis if they engage in the following activities:

• Playing around in dirt
• Barefooting on roundworm egg-contaminated soil
• Touching egg-contaminated surfaces

These objects can cause infections if someone touches them and doesn't wash their hands.

Other potential transmissions include:

• Eat unwashed fruits and vegetables cultivated on polluted soil
• Consume uncooked meat, pork, or freshwater fish

Risk Factor

The following factors may increase the risk of ascariasis:

• Age. Ascariasis affects mostly children under 10. Children in this age group may be at a higher risk since they are more exposed to dirt.

• Warm conditions. Ascariasis is more prevalent in developing nations with year-round warmth.

• Poor sanitation. Ascariasis is common in impoverished nations where human waste is used as fertilizer.

• Places with a high population density

Symptoms

Most people with ascariasis show no signs or symptoms. However, those with moderate to severe infections may experience a variety of signs and symptoms, depending on the body part involved. Examples of symptoms that may arise include:

• Non-specific abdominal pain can even be severe if the number of worms infecting the body is large.
• Nausea or vomiting.
• Diarrhea or bloody stools.
• If the number of worms in the intestine is large, individuals may experience severe abdominal pain, fatigue, persistent vomiting, weight loss, and the presence of worms in vomit or feces.

After ingesting the tiny (microscopic) worm eggs, the eggs can hatch in the small intestine. The larvae can then migrate through the bloodstream or lymphatic system to the lungs. At this stage, infected individuals may exhibit respiratory signs and symptoms, such as:

• Persistent cough
• Shortness of breath
• Wheezing-like breathing sounds

After 6 to 10 days in the lungs, the larvae can ascend to the throat, where they are coughed up and swallowed back into the digestive system. These swallowed larvae can then develop into adult worms in the small intestine, where they remain until death.

Diagnosis

A comprehensive interview (anamnesis) concerning the following is necessary to confirm a diagnosis of ascariasis:

• Patient symptoms
• Progressivity of the disease
• History of the patient's disease-related habits, such as barefooting
• Sanitation of the living environment

The doctor will then examine your digestive organs and anus. Worms can be found in severe infections when coughing, vomiting, or defecating. If needed, the doctor will suggest additional tests, such as:

• Fecal analysis. Female worms in the intestines can hatch eggs that can be detected by microscopic stool examination. However, eggs are not visible in the stool until at least 40 days after infection.
• Blood test. Blood tests can be performed to evaluate for an increase in eosinophil white blood cells. Although ascariasis can cause an increase in eosinophils, other medical conditions can also show similar symptoms.
• Imaging. An X-ray may be performed to detect worm masses in the abdomen. In some cases, worm larvae can even be seen in the lungs on a chest X-ray. An ultrasound may be performed to provide a clearer picture of the presence of worms in the liver or pancreas. Additional tests, such as a CT scan or MRI, may also be performed if necessary to detect worms blocking the liver or pancreatic ducts.

Management

Ascariasis infections can recover spontaneously, but in most cases, ascariasis infections require treatment. The primary therapy for ascariasis involves the use of antiparasitic medicines. Albendazole, ivermectin, and mebendazole are the selected antiparasitic medications for roundworm infections. The drug can be used for one to three days to eradicate developed worms. In some severe cases, surgical intervention may be conducted to remove the mature worms and restore the affected tissues caused by this parasite. Typically, a doctor will advise surgical intervention in cases where there is an obstruction or perforation in an organ, as these conditions can be life-threatening.

Complications

One of the complications that might result from an ascariasis infection is intestinal obstruction.  This complication can occur when several worms block the intestines, producing abdominal discomfort and vomiting. Due to their smaller intestines, children are more susceptible to this condition. Liver or pancreatic duct blockages cause appetite loss and inadequate nutrient absorption. Thus, children may have dietary deficits that may impact their growth. High pressure from the obstruction may destroy organ walls, known as perforation. This is a medical emergency that requires immediate treatment.

Prevention

An effective way to prevent ascariasis is by maintaining high personal hygiene, such as:

• Maintain hand hygiene. Wash your hands with soap and clean water before touching food
• Wash fruits and vegetables before consuming them. Avoid raw vegetables
• Maintain cleanliness while traveling, especially in endemic areas. If you are unsure about the cleanliness of the water in the area, use bottled water
• Eat only warm, cooked food
• Take a shower regularly. This may remove attached roundworm eggs
• Change clothes every day
• Wash contaminated clothes, sheets, and towels with hot water
• Keep the room bright during the day. Worm eggs are susceptible to sunlight
• Cut your nails regularly, as nails are also a source of infection

When to See a Doctor?

If your children have persistent symptoms such as nausea, vomiting, stomach discomfort, swelling, worms in the feces, diarrhea, and weight loss, visit your doctor. Treating worm infections as soon as possible will help prevent growth abnormalities in children.

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